Clinical Skills 2

Question 1

LaPlace Equation

Answer 1

T = (P x r)/2h (h is thickness)

Question 2

Chronic Ventricular Adaptation to Increased Afterload

Answer 2

Tries to fix wall stress, so decreases radius and increases thickness via concentric hypertrophy (grows inwards), delaying heart failure but preventing ideal filling

Question 3

Precordial Impulse in Concentric Hypertrophy/Increased Afterload

Answer 3

Normal location, but enlarged and sustained

Question 4

S4

Answer 4

Turbulence when blood comes into stiff ventricle from increased afterload (usually). Low pitch sound just before S1

Question 5

Hypertension Effect on A2 and P2

Answer 5

Normal HTN makes A2/S2 way louder. Pulmonary HTN makes P2 louder and drown out A2, and might also come before A2 bc valve slams shut

Question 6

Ventricular Adaptation to Increased Preload

Answer 6

Try to decrease pressure by increasing r and compensating by increasing h outward (eccentric hypertrophy)

Question 7

Abdominojugular Test

Answer 7

Great to test R heart failure, especially when CVP normal. Compress abdomen, increasing venous return to R heart, and see if it causes distension of jugulars (backup, not normal)

Question 8

Sign of Increased LV Preload/Dilatation

Answer 8

Inferolateral displacement and enlargement of PMI

Question 9

S3

Answer 9

Rapid deceleration of blood into ventricle, usually from excess volume/preload or non-compliant ventricle. Low pitched just after S2 (way after carotid)

Question 10

Ejection Sound (manifestation and 2 causes)

Answer 10

High freq sound just after S1 that is very loud and heard everywhere
Doming of Stenotic Valve - either A or P, domes then pops open
Dilated Great Vessel - blood turbulence right outside of valve

Question 11

3 Extra Sounds Heard Around S1 (and how to distinguish)

Answer 11

Ejection Sound - just after, high freq heard everywhere
S4 - before carotid
TM only at tricuspid area

Question 12

Systolic Click

Answer 12

1 or 2 clicks in mid systole, usually from mitral valve prolapse so they leak but are snapped back by chordae tendinae to try to prevent leakage. Not murmurs bc aren’t sustained

Question 13

Opening Snap (OS)

Answer 13

High pitch sound just after S2 from mitral stenosis popping open valve, usually a product of rheumatic heart disease

Question 14

3 Sounds Heard Around S2 (and how to distinguish)

Answer 14

S3 - low pitch
OS - high pitch
Splitting on inspiration near pulmonary area