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Board exam review > Cardiovascular examination > Flashcards

Cardiovascular examination Flashcards

1
Q

What should you do if abnormal sounds are suspected during lung auscultation

A

Compare intensity, pitch, quality of sounds bilaterally. ID sounds as vesicular, broncovesicular bronchial or absent

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2
Q

What are normal sounds heard in the trachea

A
  • loud tubular

- tracheal and bronchail sounds

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3
Q

What type of breath sounds should be heard in the distal Airways

A
  • Vesicular breath sounds: high pitched breezy sounds.
  • Bronchial sounds heard over distal airways are abnormal and indicate consolidation or compression of lung tissue that facilitate transmission of sound
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4
Q

What breath sounds are considered abnormal?

A 
Adventitious breath sounds. 
Crackle (formally rails).
Plural friction rub 
Rhonchi
Strider
Wheeze 
Decreased or diminished sound
 Absent breath sound
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5
Q

Adventitious breath sounds.

A

Abnormal breath sounds heard with inspiration and/or expiration can be continuous or discontinuous

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6
Q

Crackle (formally rails).

A

Abnormal continuous high-pitched popping sound

  • Heard in inspiration.
  • Associated with restrictive or obstructive respiratory disorders
  • Represent moving of secretions during inspiration (wet crackles).
  • Sudden opening of closed Airways (dry crackles)
  • If occurring in later half of inspiration indicates atelectasis, fibrosis, pulmonary edema, or plural effusion.
  • heard at the bases of the lungs
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7
Q

Plural friction rub

A
  • Dry crackling heard an inspiration and expiration.

- Happens when inflamed visceral and parietal pleura rub together

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8
Q

Rhonchi

A

Continuous low pitch sounds similar to snoring or gurgling.
- CONTINOUS unlike crakcles that are discontinuous
Occur in inspiration and expiration
-Happens when air passes through obstructed airway of inflammatory secretions, liquid, bronchial spasm or neoplasms

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9
Q

Strider

A

High pitched wheeze

  • indicating upper airway obstruction
  • Occurs during inspiration or expiration
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10
Q

Wheeze

A
  • Continuous whistling with a variety of pithces.
  • Heard in inspiration and or expiration but variable from minute to minute and area to area.
  • Comes from turbulent airflow and vibrations of airway walls.
  • due to narrowing caused by: bronchospasm, edema, collapse, secretions, neoplasm or foreign body
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11
Q

Is the duration of inspiration longer or shorter in the trachea? Distal airways?

A

Trachea- Inspiration is shorter expiration is longer. slight pause in btwn
Distal airways:Inspiratory phase is longer expiratory phase is shorter. No pause

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12
Q

Bronchial breath sounds

A

Abnormal breath breath sounds heard in locations where vesicular sounds are normally present.
May indicate pneumonia

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13
Q

what do decreased or diminished breath sounds indicate

A

Congestion
emphysema
hypo ventilation

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14
Q

what do absent breath sounds indicate

A

Long collapse or pneumothorax

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15
Q

What is broncophony

A

Increased vocal residence with greater clarity and loudness spoken words.
99

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16
Q

what is egophony

A

Spoken long :E” sound changes to long nasal sounding “A” sound

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17
Q

Is whispered pectoriloquy

A

recognition of whispered words 123

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18
Q

What is the anatomic location for electrode limb leads for the right atrium

A

right arm Infraclavicular fossa medial to the right deltoid muscle

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19
Q

What is the anatomic location for electrode limb leads for the Left atrium

A

left arm Infraclavicular fossa medial to the left deltoid muscle

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20
Q

What is the anatomic location for electrode limb leads for the right ventricle

A

Left side of the abdomen below the rib cage left leg

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21
Q

What is the anatomic location for electrode limb leads for the left ventricle

A

Right side of the abdomen below the rib cage right leg

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22
Q

What is the anatomical location of the chest electrodes for precordial leads V1 and V2

A

Fourth intercostal space at the right (v1) or left (v2)sternal border

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23
Q

What is the anatomical location of the chest electrodes for precordial leads V3

A

The way between the one and the V2 and V4

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24
Q

What is the anatomical location of the chest electrodes for precordial leads V4

A

5th intercostal space at mid left midclavicular line

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25
Q

What is the anatomical location of the chest electrodes for precordial leads V5 V6

A

v5 Left anterior axillary line at V4 level.

v6 Left mid axillary line at V4 and V5 levels

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26
Q

P wave

A

Atrial depolarization

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27
Q

PR interval

A

Time for atrial depolarization and conduction from SA node to AV node.
0.1 - .20 seconds

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28
Q

QRS complex

A

Interventricular depolarization and atrial repolarization. 0.06 - 0.10 seconds

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29
Q

QT interval

A

Time for ventricular depolarization and repolarization. 0.20- 0.40 seconds

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30
Q

ST segment

A

Isoelectric period Following QRS when ventricles are depolarized

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31
Q

T wave

A

ventricular repoloarization

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32
Q

What is normal sinus rhythm

A

Atrial depolarization begins at SA node and spreads normally throughout conduction system. Heart rate is between 60 and 100 BPM

33
Q

Sinus bradycardia/ tachycardia

A

Less than 60 BPM

over 100 bpm

34
Q

Sinus arrhythmia

A

Sinus rhythm but with quickening and slowing of impulse formation in the SA node resulting in beat to beat variation

35
Q

Sinus arrest

A

Sinus rhythm with intermittent failure of SA node impulse or AV node conduction that results in complete absence of P or QRS waves

36
Q

What are premature atrial contractions PAC and what is the clinical significance

A

Ectopic focus in atrium initiates impulse before SA node.
P-wave is premature with abnormal configuration.
Very common generally benign
May progress to atrial flutter tachycardia or fibrillation.
Can happen from caffeine, stress, smoking, alcohol in any heart dx

37
Q

What is Atrial flutter and what is the clinical significance

A

Atrial rate of 250 to 350 BPM
-Sawtooth sheet P waves (flutter waves).
Occurs with valvular disease ishemic disease cardiomyopathy, hypertension, acute myocardial infarction, chronic obstructive lung disease and pulmonary emboli
S/S: Palpitations, lightheadedness, angina due to rapid rate

38
Q

What is Atrial fibrillation and what is the clinical significance

A

In an arrhythmia where atria are depolarized between 350 to 600 times a minute.
Irregular in dilation of ECG baseline without discrete P waves
And healthy hearts and patience with CAD, HTN and valvular disease
S/S: Palpitations, fatigue, dyspnea, lightheadedness, syncope and chest pain

39
Q

What is mobitz 1 and mobitz 2 heart block and what is the clinical significance

A

Mobitz 1 wenkebach:Progressive prolongation of PR interval until one and pulse is not conducted generally benign

Mobitz 2 : more serious. non conduction of 1 or more impulses after normal PR intervals. May progress to 3rd degree. MAy decrease CO if HR is slow

40
Q

What is 3rd degree heart block and what is the clinical significance

A

all impulses are blocked at AV node and none are transmitted to ventricles
atrial rate> ventricle rate
can be caused by digitalis, acute MI, degenerative change to condiction system, heart Sx

41
Q

What is Premature ventricular contraction PVC and what is the clinical significance

A

-Premature depolarization of the ventricles due to ectopic focus.
P-wave is absent and QRS is wide and aberrant shape.
Bigeminy- normal sinus followed by QVC.
Trigeminy -PVC occurs after 2 normal sinus impulses

42
Q

Which atrioventricular block: one, two, three is the most serious

A

Third-degree atrioventricular block equals complete heart block. MEDICAL EMERGENCY
First-degree atrioventricular block may have no symptoms or change in cardiac function

43
Q

What is ventricular tachycardia V-tach and what is the clinical significance

A

3 or more PVCs with ventricular rate >150 bpm
- P waves are absent and QRS is wide
-SeaTac longer than 30 seconds is life-threatening. –Patients are unable to maintain adequate BP and become hypotensive.
-May progress to ventricular fibrillation causing cardiac arrest.
Common causes: MI cardiomyopathy valvular disease

44
Q

What is ventricular fibrillation V-fib and what is the clinical significance

A

-Ventricles do not be in coordinated fashion but fibrillate/quiver asynchronously and in effectively. No cardiac output, patient is unconscious.
-Requires immediate defibrillation.
- Afterwords medications to support circulation and intravenous anti-arrhythmic agents.
Cocaine

45
Q

What is ventricular asystole and what is the clinical significance

A

Ventrical standstill with no rhythm.
ECG is a straight line.
Requires immediate CPR and medications to stimulate cardiac activity.

46
Q

What are signs of myocardial ischemia and infarct

A

ST segment depression
ST segment elevation
Q wave
T-wave inversion

47
Q

What is a absolute indication for terminating an exercise test ?

A

drop in SBP >10 mmhg form baseline depite increase in workload + evidence of ishemia

  • moderate angina (3 on scale of 4)
  • nervous system symptoms(ataxia, dizzy)
  • poor profusion; cynosis pallor
  • sustained, uncontrolled or at rest ventricular tachycardia
  • 1 mm ST elevation without diagnostic Q waves
48
Q

What is a relative indication for terminating an exercise test ?

A
  • Drop in SBP >10 mm from baseline despite increase in workload without evidence for ischemia
  • > 2mm ST segment depression
  • PVCs Supraventricular tachycardia , heart block, bradycardia
  • fatigue, SOB, wheeze, leg cramp, claudication
  • development of bundle branch block or intraventricular delay
  • increasing chest pain
  • hypertensive response; >250SBP and or 115DBP
49
Q

what does a negative stress test indicate? a positive test?

A

Negative stress test. Low probability of coronary artery disease.

Positive test indicates high probability of coronary artery disease

50
Q

What is the primary energy use during aerobic exercise

A

ATP

used by long term E system with O2 consumtion

51
Q

How can you calculate the lower and upper maximum heart rate?

A

HRmax x 55%.

HR max X 90%

52
Q

Can you calculate heart rate max.

A

Graded exercise test or estimated by 220 minus age

53
Q

How do you calculate heart rate reserve

A

Lower {(HR max-HR rest)x 40%}+ HR rest

Upper {(HR max-HR rest)x 85%}+ HR rest

54
Q

How long should aerobic activity be performed (duration)

A

20-60 mins

- min of 10 min bouts accumulatedd thorughout day

55
Q

How long should low intensity and high intensity activity be performed for

A

low intenity >30mins

high intenisty >20 mins

56
Q

what aerobic exercise duration is recommended for adults Who are not training for athletic competition

A

Moderate intensity activity for longer duration. Potential hazards and adherence problems associated with high intensity activity

57
Q

How frequently should aerobic exercise be performed

A

3-5 days/week

58
Q

What are the long-term expected outcomes from aerobic exercise .(chrinic adaptations)

A
  • VO2 Max increase at max exercise.
  • Decreased heart rate at submaximal exercise. No change at max exercise.
  • Increased blood lactate at max exercise decrease at submaximal
  • Increase in mitochondrial number and size, capillary density, oxidative enzymes. Increase oxidative capacity of muscle
  • Increased maximal voluntary ventilation.
  • Increased plasma volume.
  • Increased skeletal muscle but blood flow.
  • lower BMI
  • Improved body heat transfer
  • reduced anxeity
59
Q

What are the Normal cardio respiratory response to acute aerobic exercise

A

Increased O2 consumption due to increased CO, increased BF, oxygen utilization and exercising skeletal muscle.
Linear increase in SBP with increasing workload. 8 to 12 MMHG per MET
-Change or moderate decrease in DBP.
Increased respiratory rate and tidal value

60
Q

where Is the designated auscultatory area for the aortic area when listening to the heart

A

2nd intercostal space at right sternal border

61
Q

where Is the designated auscultatory area for the pulmonic area when listening to the heart

A

2nd intercostal space at left sternal border

62
Q

where Is the designated auscultatory area for the mitral area when listening to the heart

A

5th intercostal space medial to the left mid clavicular line

63
Q

where Is the designated auscultatory area for the tricupsid area when listening to the heart

A

4th intercostal space at left sternal border

64
Q

S1

A

lub
First heart sound. Mitral and tricuspid valve close at beginning of ventricular systole.

High frequency sound low pitch and longer duration than S2

65
Q

S2

A

dub
2nd heart sound.
Aortic and pulmonary valves close at beginning of ventricular diastole.
High frequency sound with higher pitch and shorter duration then S1

66
Q

S3

A
  • Third heart sound.
  • Vibration of the distended ventricle walls due to passive flow of blood from atria during rapid filling phase of diastole.
  • Normal in kids; Physiologic third heart sound.
  • Abnormal and adults may be associated with heart failure -called ventricular Gallup
67
Q

S4

A
  • Pathological sound vibration of ventricular wall filling in atrial contraction.
  • May be associated with HTN, stenosis or myocardial infarction
  • called atria Gallup
68
Q

What is the normal red blood cell count for males and females

A

Male 4.3 - 5.6

Female 4.0 - 5.2

69
Q

How many leukocytes is the norm

A

3.54-9.06

70
Q

Which is available in greater differential blood count neutrophils, lymphocytes, monocytes, eosinophils, basophils

A 
neutrophils, 40%- 70%
lymphocytes,20%- 50%
 monocytes, 4-8%
eosinophils, 0–6%
basophils 0- 2%
71
Q

What is the platelet count in the blood

A

150,000 to 450,000
Thrombocytopenia is a condition characterized by abnormally low levels of platelets
- serrious bleeding can occur at a5,000-20,000
greater than 50k pts are allowed to perform resistive exercise

72
Q

What is the expected partial thromboplastin time PTT

A

-Examines clotting factors of all intrinsic pathways except platelets.
-Partial thromboplastin time is more sensitive than prothrombin time detecting minor deficiencies
26.3–39.4 seconds = PPT
11-13.5 =PT
.8-1..1= INR
If clotting time takes too long (high) the blood is taking too long to make a clot. This could be 2\2 liver disease, vitamin K deficiency, or a coagulation factor deficiency (e.g., factor VII deficiency)
- Warfarin coumadin is a blood thinner that will lower PT
- A patient taking warfarin should have INR of 2-3 bc clotting will take longer

73
Q

What is the normal hemoglobin count for males and females

A

Males 13.3 - 16.2.

Females 12.0 - 15.8

74
Q

What is the desirable and high count for total serum cholesterol

A

Desirable 200.

High 240

75
Q

What is the desirable and high count for LDL

A

Desirable 100

High 160-189

76
Q

What is the low and high count for HDL

A

Low 40

High 60

77
Q

What is the desirable and high count for Trilycerides

A

Desirable 150

High 200-499

78
Q

What does low hematocrit indicate? High hematocrit ?

A

Low: anemia, blood loss, vitamin/mineral deficiency,
High: polycythemia vera or dehydration

79
Q 
Precautions to all forms of exercise include the following lab values:
hematocrit 
hemoglobin 
platelet count
white blood cell count
A

Lab Values:
hematocrit of <27%, (normally in the mid-high 30-40s)

hemoglobin of 8 g/dL or less, (Normally 12/13 + 3 gm/dl for gals and guys)

platelet count of <50,000 mm3, (Normally 165-415 10^3 according to SC )

White cell count of <500 mm3. (Normally 3.5-9.0 10^3)

Patients with a low platelet count should not exercise due to the possibility for excessive bleeding and poor tissue healing.

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