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Med 1- Physical Diagnosis > Chapter 9- Cardiovascular System > Flashcards

Chapter 9- Cardiovascular System Flashcards

1
Q

Occupies the most of the anterior cardiac surface

A

Right Ventricle

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2
Q

Lies below the junction of the sternum and the xiphoid process

A

Inferior border of RV

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3
Q

structure at the level of the sternal angle or base of the heart

A

Pulmonary artery

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4
Q

Forms the lateral left margin of the heart

A

Left ventricle

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5
Q

Inferior tip of left ventricle is the

A

Cardiac apex

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6
Q

produces the apical impulse

A

Cardiac apex

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7
Q

Palpation of the precordium will give you the

A

Point of maximal impulse

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8
Q

Location of the PMI

A

Left border of the heart
5th intercostal space
Medial to the left midclavicular line
7-9 cm lateral to the midsternal line

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9
Q

PMI is on the right

A

Situs inversus

Dextrocardia

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10
Q

In supine patients, diameter of PMI is

A

1 to 2.5 cm

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11
Q

PMI is greater than 2.5 cm

A

Left ventricular hypertrophy from hypertension or aortic stenosis

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12
Q

Most prominent palpable PMI in person with COPD

A

Xiphoid or epigastric area due to right ventricular hypertrophy

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13
Q

If PMI is palpable >10 cm lateral to midsternal line, person has

A

LVH

Ventricular dilatation from myocardial infarction or congestive heart failure

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14
Q

Reflects right atrial pressure, which in turn equals central venous pressure and right ventricular end-diastolic pressure

A

Jugular venous Pressure

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15
Q

The JVP is best estimated at

A

right internal jugular vein (most direct channel to the superior vena cava and right atrium)

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16
Q

Jugular veins and pulsations are difficult to see in?

A

Children under 12 years old

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17
Q

pressure where the dominant movement is inward coinciding x descent

A

JVP

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18
Q

Pulse where the dominant movement is outward

A

Carotid pulse

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19
Q

Fluctuations of the JVP yields clues about

A 
Volume status
Right and Ventricular Function
Patency of tricuspid and pulmonary valves
Pressures in the pericardium
Arrhythmias
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20
Q

In order to estimate the level of JVP, one must learn to find

A

Highest point of oscillation in the internal jugular vein OR

Point above which the external jugular vein collapsed

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21
Q

sternal angle is _____ cm above the right midatrium

A

5 cm

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22
Q

JVP measured is ELEVATED AND ABNORMAL WHEN?

A

When JVP is measured above >3cm above the sternal angle of > 8 cm above right atrium

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23
Q

The usual starting position for the head of the bed or examining table when assessing JVP is

A

30 degrees

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24
Q

In hypovolemic patient, JVP will be? Position of the head to see the point of oscillation best?

A

Low (0 degrees)

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25
Q

In hypervolemic patients, JVP will be? Position of the head to see the point of oscillation best?

A

High JVP

Elevate patient’s head @ 60-90 degrees

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26
Q

Interpretation of the measured JVP

A

JVP at >3 cm above sternal angle or >8cm in total distance above the right atrium is ELEVATED

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27
Q

An elevated JVP is highly correlated with?

A 
Acute and Chronic Heart Failure
Tricuspid stenosis
Chronic pulmonary hypertension 
Superior Vena Cava Obstruction
Cardiac Tamponade
Constrictive  Pericarditis
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28
Q

An elevated JVP is >95% specific for

A

Increased left ventricular and diastolic pressure

Low left ventricular EF

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29
Q

JVP appear elevated on expiration but veins collapse on inspiration

A

Obstructive lung disease

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30
Q

Pressure in the carotid sinus may cause

A

Reflex bradycardia

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31
Q

Carotid pulse in cardiogenic shock

A

Small, thready, weak

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32
Q

Carotid pulse in aortic regurgitation

A

Bounding

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33
Q

The carotid pulse is delayed in?

A

Aortic stenosis

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34
Q

Thrills in aortic stenosis are transmitted to the carotid arteries from the?

A

Suprasternal notch or 2nd right intercostal space

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35
Q

Bruits are caused by

A 
Atherosclerotic luminal stenosis
Turtuous carotid artery
External carotid arterial Disease 
Aortic stenosis 
Hypervascularity of hyperthyroidism 
External compression from thoracic outlet syndrome
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36
Q

Low-pitched extra sounds such an S3, opening snap indicates

A

Diastolic rumble of mitral stenosis

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37
Q

Soft-decrescendo higher-pitched diastolic murmur indicates

A

Aortic regurgitation

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38
Q

rare congenital transposition of the heart is situated in the right chest cavity and generates a right-sided apical impulse

A

Dextrocardia

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39
Q

The heart, lung, stomach and spleen are on the right, and the liver and gallbladder are on the left

A

Full situs inversus

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40
Q

Most useful characteristic of the apical impulse for identifying hypertrophy of the left ventricle

A

Duration

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41
Q

Shift the apical impulse upward and to the left

A

Pregnancy or High left diaphragm

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42
Q

Lateral displacement toward the the axillary line from ventricular dilatation is seen in?

A 
Heart failure 
Cardiomyopathy 
Ischemic heart disease 
Thoracic deformities 
Mediastinal shifts
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43
Q

The apex beat is palpable in 25%-40% of adults in the _____ position

A

Supine position

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44
Q

The apex beat is palpable in 50%-70% of adults in ____ position

A

Left lateral decubitus position (especially those who are thin)

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45
Q

In the left lateral decubitus position, a diffuse PMI with a diameter of >3 cm signals?

A

Left ventricular enlargement

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46
Q

A hyperkinetic high-amplitude impulse may occur in?

A

Hyperthyroidism
Severe anemia
Pressure overload from left ventricle from hypertension or aortic stenosis
Volume overload of the left ventricle from aortic regurgitation

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47
Q

A sustained high amplitude impulse increases the likelihood from

A

LVH from pressure overload in hypertension

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48
Q

If sustained high-amplitude impulse is displaced laterally, it considers

A

volume overload

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49
Q

Valves open during systole

A

Aortic and pulmonic valve

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50
Q

Valves open during diastole

A

mitral and tricuspid valves

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51
Q

Atypical descriptors of chest pain is common in

A

women and elderly

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52
Q

Acute aortic dissection description

A

Tearing, ripping or radiating

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53
Q

Shortness of breath is produced by

A

Dyspnea
Orthopenia
PND

54
Q

Anasarca determinant is edema

A

Above the knee

55
Q

Albumin is filtered out from the glomerulus

A

Nephrotic Syndrome

56
Q

Most common cause of fainting

A

Neurocardiogenic

57
Q

Cardiologist commonly used in assessment

A

10 year cardiovascular risk

58
Q

Diabetes risk assessment is done

A

Every 3 years

59
Q

Lifestyle modification normal daily sodium intake:

A

Less than 6 grams

60
Q

Blood pressure elevated at values in mmHg:

A

120/80-129/89

61
Q

Hypertension causing left ventricular hypertrophy is due to:

A

Due to high pressure in aorta

62
Q

Normal PMI

A

<2.5 cm in diameter

63
Q

Abnormal diameter of PMI is attributable to:

A

Aortic Stenosis

Hypertension

64
Q

Hypovolemic patients are best positioned at, when taking JVP

A

30 degrees

65
Q

Difference between carotid pulse and internal jugular pulsation

A

b. IJV is biphasic, carotid is single pulse c.IJV affected by inspiration, carotid is not
d. IJV change by position, carotid is not

66
Q

Positioning for carotid pulse palpation

A

Supine head elevated

67
Q

Palpate at level of cricoid not thyroid cartilage, why?

A

To prevent vasovagal stimulation

68
Q

Pulsus alternans is indicative of:

A

Left ventricular dysfunction

69
Q

Paradoxical pulse is indicative of:

A

Cardiac tamponade

70
Q

Instruction to clearly heard bruit in carotid artery

A

Position with head leaning forward

71
Q

Positioning for aortic regurgitation suspicion:

A

Orthopneic position

72
Q

Carotid upstroke coincide with what heart sounds?

73
Q

OS extra sound is indicative of:

A

Mitral stenosis

74
Q

Splitting of heart sound

A

S2
Aortic then Pulmonic
Inspiration

75
Q

Diaphragm of the stethoscope is used in the following

A

S1 and S2 high pitch sound

b. Murmurs AR and MR
c. Peicardial friction rub

76
Q

Bell is used in the following

A

Low pitch
Murmur of MS
Apply lightly

77
Q

50-year-old male, chronic uncontrolled hypertension. BP 160/100 mmHg, HR 80 bpm. PE reveals PMI 3cm at 6th left intercostal space at anterior axillary line.

A

Left ventricular hypertrophy

78
Q

cause leftward deviation of PMI.

79
Q

In recent studies, what heart sound may arise from rapid deceleration of the column of blood against the ventricular wall?

80
Q

What does S2 mean?

A

c. The nadir of the closing of the aortic valve

81
Q

Loud systolic blowing murmur heard at the right parasternal intercostal space radiating to the cardiac apex and left carotid areas.

A

Mitral regurgitation

82
Q

Recurrent palpitations and easy fatigability. History of tonsillo-pharyngeal infection. Soft diastolic murmur located in cardiac apex.

A

Mitral stenosis

83
Q

JVP is indicative of

A

Right atrial pressure

84
Q

Classic exertional chest pain, pressure, or discomfort in the chest, shoulder, back, neck or arm is seen in 18% of patients with:

85
Q

Defines moderate alcohol consumption:

A

< 2 drinks in male
<1 drink in females

2 drinks= 1 oz ethanol
= 24 oz beer
= 10 oz wine
= 2-3 oz whiskey

86
Q

Physical finding for carotid pulsation and not jugular pulsation.

A

Single outward movement

87
Q

Which of the following is often preceded by systolic click?

A

Mitral valve prolapse

88
Q

Best heard with patient leaning forward.

A

Aortic Regurgitation

89
Q

Increase in systole 10mmhg, during inspiration

A

Paradoxical pulse

90
Q

Lower extremities PAD risk factors,

A

A. >/= 65yo
C. Leg symp with exertion
D. Nonhealing wounds

91
Q

Female patient, BMI = 30, BP cuff placed at ankle. Where do you position the stethoscope?

A

Dorsum of the foot

92
Q

Male, 63, rushed to ER due to stabbing chest pain which radiates to the back (PS 9/10). After doing ECG what is the next best thing to do?

93
Q

Intermittent claudication.

A

Chronic arterial insufficiency

94
Q

Tissue ischemia.

A

A. Chronic Arterial Insufficiency

95
Q

Edema present, often marked.

A

Chronic Venous Insufficiency

96
Q

Stasis dermatitis present.

A

Chronic Venous Insufficiency

97
Q

Gangrene

A

Chronic Arterial Insufficiency

98
Q

Define AAA

A

Infrarenal artery < 3cm

99
Q

Strongest risk factor for AAA

A

Old age
Male
Smoking

100
Q

Patient’s brachial pulse (brisk). How do you interpret this physical

101
Q

COPD patient. Where is the probable location of the PMI?

A

Xiphoid/Epigastric Area

102
Q

Valve at the Right 2nd interspace to the apex

A

Aortic Valve

103
Q

Left 2nd and 3rd interspaces close to the sternum

A

Pulmonic Valve

104
Q

At or near the lower left sternal border:

A

Tricuspid Valve

105
Q

At or around the cardiac apex

A

Mitral Valve

106
Q

Follows the AHA criteria

A. Exercise moderate intensity: >=100mins/week
B. BMI: 30kg/m2
C. Fasting blood sugar: <100mg/dl
D. Triglyceride: <250mg/dl

107
Q

A patient with Chronic Obstructive Pulmonary Disease who is non-compliant on his maintenance medications came in for his annual check-up. As the medical intern on duty, you were tasked by the Resident Physician to do a thorough physical examination on his cardiovascular system. What is an expected finding for this patient? A. The point of maximal impulse is located on the apex.

A

The point of maximal impulse may be in xiphoid or epigastric area

108
Q

Condition where S1 is diminished.

A

First Degree Heart Block

109
Q 
Female. BMI: 31. Waist circumference: 105cm. Other criteria for metabolic syndrome:  
A. Triglyceride <150 mg/dL 
B. HDL 30 mg/dL 
C. FBS < 100 mg/dL 
D. Blood pressure 120/80mmHg
110
Q

Eggs bacon and sausage:

A

a.High in cholesterol and saturated fat

111
Q

Decresendo murmur that can be heard at 4th ICS near the sternum that radiates to the apex.

A

Aortic Regurgitation

112
Q

Grade 5/6 murmur. a.Very loud with thrill.

A

b.Very loud with thrill, may be heard when the stethoscope is partly off the chest.

113
Q

Pansystolic murmur radiates to axilla.

A

Mitral regurgitation, anterior leaflet involvement

114
Q

Diagnosis of mitral valve prolapse. What do you say to keep your friend calm?

A

More common in females than males

115
Q

Diffuse PMI, murmur radiating to axilla.

A

HF with mitral regurgitation

116
Q

As you were examining a patient with combined aortic stenosis and aortic regurgitation, you noticed an increasing arterial pulse with double systolic peak. Identify this abnormal arterial pulse.

A

C. Bisfierens pulse

117
Q

Pulmonary hypertension

A

P2 is equal or louder than A2

118
Q

18 y.o female 3rd year student, BP=110/70 HR = 116, rushed to the ER for palpitations.

A. hyperthyroidism
B. anxiety
C. atrial fibrillation
D. angina pectoris

119
Q

True of physiologic S3:

a. common in 1st trimester in pregnancy
b. appreciated in children and adults 45-50
c. heard best in 2nd left IS on inspiration
d. listen with bell, very light light pressure

120
Q 
Which is true?  
A. A wave atrial relaxation  
B. X wave atrial contraction  
C. V wave ventricular systole  
D. Y wave ventricular contraction
121
Q

True of cardiac events

a. During systole aortic valve is open b.During systole mitral valve is open
c. During diastole pulmonic valve is open
d. During diastole mitral valve is close

122
Q

Best describes ECG

a. 6 leads frontal plane
b. 5 limb leads
c. Measure pulse pressure
d. Determines hypertension

123
Q 
JNC8 indication >18 with CKD and Diabetes  
A. S>/=120 D 90  
B. S>/=130 D 90  
C. S>/=140 D 90  
D. S>/=150 D 90
124
Q

What is the goal for a woman with central obesity

A

a.<35 inches

125
Q

Goal of activity according to AHA

A

a.150 mins/week

126
Q

Liters before occurrence of edema

127
Q

Most common extra sound

A

Systolic click of mitral valve prolapse

128
Q

Expiratory filling suggests

A

Valvular abnormality

129
Q

Persistent filling results from

A

Delayed closure of pulmonic valve and early closure of aortic valve

130
Q

Diastolic murmurs usually represents

A

Valvular Heart Disease

131
Q

The pulse pressure is approximately

A

30-40 mmHg

132
Q

Increased arterial pulse with double systolic peak

A

Bisferiens pulse

Med 1- Physical Diagnosis (1 decks)

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