Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PA > Cardiovascular and Peripheral Cardiovascular > Flashcards

Cardiovascular and Peripheral Cardiovascular Flashcards

1
Q

A patient you are seeing complains of severe pain in her right foot. Based on examination findings, you suspect arterial insufficiency. Which of the clinical findings below would suggest arterial insufficiency as the cause of her problem?

A. Brisk posterior tibial and dorsalis pedis pulses
B. Pallor of the foot upon elevation
C. Pitting edema of the lower leg
D. Warmth of the right foot

A

B.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

A patient you are seeing complains of a sore on his lower leg that does not seem to get better. Based on examination findings, you suspect venous insufficiency. Which of the clinical findings below would suggest venous insufficiency as the cause of his problem?

A. Leg discomfort is exacerbated by dependency
B. Hyperpigmentation is present around the lower calf area
C. Ulceration is present on the medial side of the ankle
D. Affected leg feels warm to the touch
E. All the above

A

E.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

the venous system has a much lower systemic pressure than

A

the arterial system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the main purpose of the valves?

A

to keep blood from flowing backwards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

3 determinants of venous blood pressure

A
  1. left ventricular contraction
  2. blood volume
  3. the capacity of the right heart to eject blood in to the pulmonary arterial system
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

venous pressure ___ when left ventricular output or blood volume is ___

A

falls ; reduced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

venous pressure ___ when the right heart ___

A

rises ; fails

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Jugular Venous Pressure

A

a reflection of the pressure in the right atrium or central venous pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Normal CVP is

A

0-8 mm Hg or 3-8 cm of H20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pressure in the jugular veins reflects

A

right atrial pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

JVP is best estimated from the

A

internal jugular vein on the right side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

A JVP more than ____ is considered elevated or abnormal

A

8-9 cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Begin to look for the jugular venous pulsations in the

A

suprasternal notch of the neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Remember if you measure the external jugular vein, you measure at

A

the point the vein appears to collapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the difference between preload and after load?

A

preload: the amount of blood that’s coming to the right side of the heart, stretching the muscle as it dilates
afterload: the amount of pressure that the ventricle needs to get to to open the aortic valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what happens in left-sided heart failure?

A

pulmonary edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what happens in right-sided heart failure?

A

if they’re overloaded with fluid, it shows up in their legs - will have edema and increased internal jugular pressure/fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

why do S1 sounds get split?

A

during inspiration, when blood goes to the lungs to pick up oxygen, we inspire - it remains sequestered there for a little bit, which means we have a little less blood in the left side of the heart and more in the right side

what happens is that the aortic valve, since it has less blood, closes so the pulmonic closes after it, instead of closing together

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When would you hear a split S2?

A

at the apex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

mid-systolic click

A

when mitral valve closes and then it regurgitates blood and pushes the flap backwards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

S3 and S4 are

A

ventricular filling sounds that ALWAYS happen during DIASTOLE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

rumbling sound S3

A

normal in kids but usually go away when child sits up - in adults its the first sign of congestive heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

when would you hear the sound for Aortic Stenosis (murmur)

A

at the apex of the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

when would you hear the sound for Mitral Regurgitation? (murmur)

A

at the base of the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What happens in S1?

A

the beginning of systole, which is when the ventricles contract and push blood to the pulmonary artery and through the aorta

P+ A valves contract and OPEN

so that the blood doesn’t go back into the atria, the mitral and tricuspid valves CLOSE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What happens in S2?

A

diastole of the ventricle

aortic and pulmonic CLOSE (make the noise), tricuspid and mitral OPEN to let blood come down from the atria to the ventricles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

orthopnea

A

dyspnea at night

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

DOE

A

dyspnea on exertion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Dyspnea

A

shortness of breath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Paroxysmal nocturnal dyspnea (PND)

A

sleep for a couple hours, then get up in the middle of the night and open the window to get a deeper breath

for people in failure, when they lie down, it increases the volume of intrathoracic blood - it makes them feel breathless (fine when they sit up)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

3 main signs of pulmonary edema

A

left-sided heart failure
pink, frothy sputum
fear of impending doom because of the dyspnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what are heart palpitations?

A

when the patient is aware of their heart rate and beating, whether it’s fluttering, skipping a beat, or bounding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

syncope (definition, causes)

A

passing out - the kind of fainting we associate with heart

may be caused by emotional stress, pain, pooling of blood in the legs due to sudden changes in body position, overheating, dehydration, heavy sweating or exhaustion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

when does edema get worse

A

in the evening because it’s more dependent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

nocturia

A

fluid resorption and secretion during evening hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

anasarca

A

means they have edema everywhere (sacral, arms, legs, face) - everything shows they’re having leakage of fluid into the interstitial spaces

can happen with kidney failure but also liver and heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

central cyanosis

A

skin turning blue or ashen all over – caused by decreased pulmonary venous saturation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

peripheral cyanosis

A

only certain areas, usually around the mouth (perioral cyanosis), etc.

decreased cardiac output or reduce rate of blood flow through capillaries and increased local extraction of oxygen

can be caused by congestive heart failure, shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Hemoptysis

A

coughing up of blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what is the most common cardiac reason for Hemoptysis?

A

mitral valve stenosis (due to increased pulmonary venous congestion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

When taking blood pressure in both arms, there should be no more than ____ difference on either side

A

5-10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

SBP (systolic blood pressure)

A

Pressure generated by left ventricle (LV) during systole, when the LV ejects blood into the aorta and the arterial tree

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

DBP (diastolic blood pressure)

A

Pressure generated by blood remaining in arterial tree during diastole, when the ventricles are relaxed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Orthostatic hypotension often seen in what 3 kinds of patients?

A

Parkinson’s

patients who are receiving hypertensive meds

patients who complain of lightheadedness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is Orthostatic hypotension?

A

changing from supine to standing, systolic decreases no more than 15 mm Hg- heart rate increases up to 10 beats/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is orthostatic hypotension caused by?

A

vascular volume loss from hemorrhage, diarrhea, vomiting, dehydration or excessive diuresis

Redistribution of blood volume because of antihypertensives (affect preload, affect afterload), antidepressant, alcohol or nitrates

Prolonged bed rest, simple vasovagal fainting

autonomic nervous system dysfunction in diabetic neuropathy, adrenal insufficiency or Parkinson’s disease

47
Q

3 kinds of upstroke when palpating the carotid arteries

A

Brisk – normal

diminished – feels small and weak (decreased stroke volume - might be hypervolemic)

Bounding – feels full and strong (did they just exercise or run to the office? otherwise is hyperkinetic states - hyperthyroidism)

48
Q

ventricular hypertrophy

A

seeing the chest wall lift with systole

49
Q

right ventricular lift would be seen at the

A

sternal border

50
Q

left ventricular lift would be seen at

A

the apex (heart placement is the exact opposite of the lungs)

51
Q

where is the point of maximal impulse?

A

in the 5th intercostal space in the midclavicular line in adults

52
Q

Hepatojugular reflux

A

the distension of the neck veins precipitated by the maneuver of firm pressure over the liver

53
Q

What are some causes of hepatojugular reflux

A

tricuspid regurgitation
heart failure due to other non-valvular causes, and other conditions including constrictive pericarditis, cardia tamponade, and inferior vena cava obstruction

54
Q

Where is Herb’s point?

A

at the 3rd intercostal space at the sternal border

55
Q

Tricuspid valve location

A

5th intercostal space, by sternal border

56
Q

Aortic valve location

A

2nd intercostal space, right sternal border

57
Q

pulmonic valve location

A

2nd intercostal space, left sternal border

58
Q

mitral valve location

A

5th intercostal space, by the apex at the midclavicular line

59
Q

The diaphragm is best for detecting what kinds of sounds?

A

high-pitched sounds like S1, S2, and also S4 and most murmurs

60
Q

The bell is best for detecting what kinds of sounds?

A

low-pitched sounds like S3 and the rumble of mitral stenosis

61
Q

What is S1, which valves open and close during S1, and where is it heard the loudest?

A

The start of systole (when the heart contracts)

aortic and pulmonic are opening, Tricuspid and mitral close

heard loudest at the apex of the heart

62
Q

What is S2, which valves open and close during S2, and where is it heard the loudest?

A

S2 is diastole

Aortic and pulmonic are closing (makes the sound), and the tricuspid and mitral are opening (silent)

heard loudest at the base

63
Q

True or false: At the 3rd intercostal space, S1 and S2 have the same intensity of sound?

A

True

64
Q

When can a split S2 only happen?

A

during inspiration

65
Q

S3: ventricular gallop

A

kind of sounds like the word “kentucky” (tap-tap-tap, tap-tap-tap) or distant thunder

usually means that someone is in congestive heart failure - it’s one of the first signs - it occurs both lying down and sitting up in this case (pathological)

can happen normally, to children or with a large cardiac output in pregnancy

66
Q

S4: atrial gallop

A

kind of sounds like the word “tennessee” (luuub-dub-dub)

can occur in athletes, but mostly pathological, and it normally means very low compliance in the ventricles either from CHF, aortic stenosis

you’ll hear these mostly in the left ventricle because it’s the higher

67
Q

early systolic ejection click

A

happens in systole

if aortic and pulmonic valves are not quiet, they make a systolic click

68
Q

remember that when valves are open they should be

A

quiet

69
Q

opening snap (extra sound during diastole)

A

normally opening of AV valves is silent (tricuspid and mitral)
In stenosis - opens with noise
Sharp and high pitched
Diaphragm 3 or 4 ICS at sternal border

70
Q

murmur grading is on a scale of

A

1-6

71
Q

grade 1 murmur

A

barely audible and only heard in a quiet space - not going to happen in ICU

72
Q

grade 2 murmur

A

clearly audible but faint

73
Q

grade 3 murmur

A

moderately loud and very easy to hear

74
Q

grade 4 murmur

A

loud and associated with a thrill on the chest so you can actually feel the valve

75
Q

grade 5 murmur

A

very loud, feel a thrill, don’t even have to have stethoscope fully on the chest

76
Q

grade 6 murmur

A

you can sometimes hear without a stethoscope at all

77
Q

what is a stenosed valve?

A

very tight valve, which occurs when the valve is opening

or a valve that’s regurgitating, when the valve is closing

78
Q

which are worse, diastolic or systolic murmurs?

A

diastolic

79
Q

Midsystolic Ejection Murmurs

A

Aortic Stenosis

Pulmonic Stenosis

80
Q

Pansystolic Regurgitant Murmurs

A

Mitral Regurgitation

Tricuspid Regurgitation

81
Q

Diastolic Rumbles of AV Valves

A

Mitral Stenosis

Tricuspid Stenosis

82
Q

Early Diastolic Murmurs

A

Aortic Regurgitation

Pulmonic Regurgitation

83
Q

Pericardial Rub

A

inflammation of the lining around the heart

84
Q

Note that the smaller the baby, the higher the

A

heart rate and respiratory rate,

and inversely, the lower the blood pressure

85
Q

Acrocyanosis

A

where the baby is slightly cyanotic in their extremities/lips (this is normal)

86
Q

PMI in babies is at the

A

4th ICS

87
Q

Murmurs occur in ___ % of children

A

30-50%

88
Q

Murmurs most often occur in childhood around ___ years of age

A

3-4

89
Q

If a murmur is heard in the first 24 hours of life, there’s a ____ risk of it being a congenital heart disease

A

1:12

90
Q

the right lymphatic duct only drains

A

a very small portion of the body

91
Q

with venous diseases, we see the veins ___ to the surface

A

closer

92
Q

Peripheral arterial disease (PAD)

A

seen often in smokers – heart attack-like pain

93
Q

What should you ask patients with Intermittent claudication?

A

“Have you ever had any pain or cramping in the legs when walking or with exercise?” “Does the pain get better with rest?”

94
Q

Arterial spasm occurs in

A

fingers and toes

95
Q

Venous peripheral vascular disease

A

Swelling of feet and legs - interstitial fluid building up

Ask about ulcers on lower legs, often near ankles

96
Q

Hodgkins

A

generalized lymph swelling (in all of the palpable lymph nodes)

97
Q

Grading Amplitude of pulses

A

3+ Bounding
2+ Brisk, expected (normal)
1+ Diminished, weaker than expected
0 Absent, unable to palpate

98
Q

When feeling for the pulsations on the sides of the aorta, they shouldn’t be more than

A

5 cm

99
Q

unilateral leg coldness could be a sign of

A

inadequate arterial circulation

100
Q

Inguinal lymph nodes and femoral arteries are near

A

the genitals

101
Q

varicose veins are best looked at when the patient is

A

standing

102
Q

Deep venous thrombosis (DVT)

A

blood clot in the leg - leg will swell

103
Q

Lymphedema

A

anything that might cause lymph edema in the heart will show in the leg
never going to pit, though

104
Q

Orthostatic edema

A

edema from standing, lack of movement

105
Q

Allen Test

A

occluding both ulnar and radial arteries - when you let go, the blood should return normally in both

106
Q

Homan’s sign for venous insufficiency

A

if it feels warm, it’s red, and you can feel inflammation of the vein behind the knee, and the patient feels pain in the calf when they flex the foot

107
Q

in varicosity, the veins have become so distended that

A

the valves can’t meet when they close

108
Q

how do the intraluminal valves ensure unidirectional flow

A

Each valve opens toward the heart and closes tightly when filled to prevent back flow of blood

109
Q

The 3 functions of the lymphatic system are:

A

to conserve fluid and proteins that leak out of the capillaries

to form a major part of the immune system

to absorb lipids from the intestinal tract

110
Q

What are the 5 great vessels of the heart?

A 
Superior Vena Cava
Inferior Vena Cava
Aorta
Pulmonary arteries 
Pulmonary veins
111
Q

Layers of the heart, superficial to deep

A 
Fibrous pericardium
Parietal pericardium
Pericardial cavity
Epicardium
Myocardium
Endocardium
112
Q

In which may gangrene develop: chronic arterial insufficiency or chronic venous insufficiency?

A

Arterial

113
Q

Main symptoms of chronic arterial insufficiency: pain, pulses, color, temperature, edema

A

Intermittent claudication progressing to pain at rest

Decreased or absent pulses

Pale color especially on elevation

Cool temperature

Absent or mild edema

114
Q

Main characteristics of chronic venous insufficiency (pain, pulses, color, temperature, edema)

A

None to aching pain on dependency

Normal pulses

Normal or cyanosis skin

Normal temp

Edema present, often marked

PA (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions