cardiovascular

Question 1

What can cause a S4 heart sound?

Answer 1

L ventricular hypertrophy-stiff ventricle

• almost always abnormal

Question 2

When can you hear and S4 heart sound and what will you be hearing?

Answer 2

• heard before S1

- hear the atrial contraction

Question 3

When is a split S1 sound best heart?

Answer 3

At the cardiac apex

Question 4

When will you hear a split S2 sound?

Answer 4

When pt is inspiring and the R hear filling is increased

Question 5

What are murmurs caused by?

Answer 5

Turbulent blood flow

Question 6

What are some characteristics of heart murmurs?

Answer 6

Timing (systole/diastole)
Location
Provoking maneuvers
Character (crescendo/decrescendo/holosystolic)
Grading (scale of 1-6)
 1 (faint)
3 moderately loud
6 (heard without stethoscope)
Pitch (high, medium, low)
Extra sounds? S3, S4, Opening Snap?

Question 7

What is the PMI?

Answer 7

point of maximal impulse

- normally at teh L heart border, 5th intercostal space in the midclavicular line (not always palpable)

Question 8

What causes the S1 sound?

Answer 8

mitral and triscupid valves close

Question 9

What causes S2 heart sound?

Answer 9

aortic and pulmonic valves close

Question 10

What causes S3 heart sound?

Answer 10

abrupt deceleration of inflow across the mitral valve

Question 11

What causes S4 heart sound?

Answer 11

increased LV end diastolic stiffness and decreased compliance

Question 12

When is an “opening snap” heard?

Answer 12

if there is restricted movement form mitral stenosis

Question 13

When is the S3 heart sound heard?

Answer 13

just after S2, is normal in children/young adults

Question 14

Where is the aortic valve located?

Answer 14

from R 2nd interspace to the apex

Question 15

Where is the pulmonic valve located?

Answer 15

L 2nd and 3rd interspace near the sternum

Question 16

Where is the tricuspid valve located?

Answer 16

at/near lower L sternal border

Question 17

Where is the mitral valve located?

Answer 17

at and around the cardiac apex

Question 18

When can systolic murmurs be heard?

Answer 18

in healthy pt’s, not pathologic.

will decrease w/ smaller ventricular volume

Question 19

What causes a patent ductus arteriosus continuous murmer?

Answer 19

left to right shunt from aorta to pulmonary artery

Question 20

What is the P in an EKG?

Answer 20

atrial depolarization

Question 21

What is the QRS complex represent in an EKG?

Answer 21

ventricular depolarization

Question 22

What does the T represent in an EKG?

Answer 22

ventricular repolarization

Question 23

What is usually suspected when you find a new arrhythmia (until proven otherwise)?

Answer 23

acute coronary syndrome

Question 24

What is the preload?

Answer 24

load that stretches the cardiac muscle before contraction

Question 25

What is contractility?

Answer 25

ability of the heart muscle to shorten

Question 26

What can increase the preload?

Answer 26

Increased with inspiration and increased blood flow from exercise and increase blood from dilated heart

Question 27

What can increase contractility?

Answer 27

Increased with sympathetic input, decreased with decreased blood/oxygen to myocardium

Question 28

What should you be concerned about with chest pain?

Answer 28

• angina pectoris
• MI
• acute aortic dissection

Question 29

What are sx of angina pectoris?

Answer 29

chest pressure, shoulder discomfort, tooth/jaw pain (18% with acute MI)

Question 30

What are sx of MI?

Answer 30

Classically exertional angina, BUT women often with upper back/neck/jaw pain, SOB, PND, nausea, vomiting, fatigue

Question 31

What are sx of acute aortic dissection?

Answer 31

anterior chest pain tearing/ripping/radiating to the back

Question 32

What are you concerned about if pt’s c/o “skips” or “flip flops”?

Answer 32

premature contration

Question 33

What should you be concerned about if pt has Rapid sudden regular beating with sudden onset/offset?

Answer 33

paroxysmal supraventricular tachycarida

Question 34

What is dyspnea?

Answer 34

uncomfortable awareness of breathing inappropriate for level of exertion

Question 35

What should you be concerned about with sudden dyspnea?

Answer 35

Pulmonary embolus, spontaneous pneumothorax, anxiety

Question 36

What is orthopnea?

Answer 36

dyspnea that occurs when supine and improves when sitting up, “3-pillow orthopnea”

Question 37

What is paroxysmal nocturnal dyspnea (PND)?

Answer 37

sudden, wakes the patient from their sleep

Question 38

What do you use to palpate sternal lift?

Answer 38

heel of the hand rested on the L of the sternum

Question 39

What do you use to measure/palpate thrill?

Answer 39

ball of the hand (like throat of a purring cat)

Question 40

What is the dominant movement of JVP (jugular venous pulsation)?

Answer 40

inward and non-palpable

Question 41

where will you be able to percuss a dilated failing heart?

Answer 41

displaced to the L (percuss to where you hear dullness)

Question 42

Which sounds will you hear best with the diaphragm?

Answer 42

S1, S2, mitral and aortic regurgitation

Pericardial friction rubs

Question 43

Which sounds will you hear best with the bell?

Answer 43

S3, S4, mitral stenosis

Question 44

Where would you hear an innocent murmur and physiologic murmur?

Answer 44

L 2nd and 4th interspace at L sternal border (decreases or disappears on sitting)

Question 45

Where would you hear an aortic stenosis murmur?

Answer 45

Right 2nd and third interspaces, radiates to the carotids

Question 46

Where would you hear pulmonic stenosis murmur?

Answer 46

L nd and 3rd interspace, radiates to L shoulder and neck

Question 47

Where would you hear a hypertrophic cardiomyopathy (thick septum)?

Answer 47

L 3rd and 4th interspaces (decreases w/ squatting, increases with standing and valvava)