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FOM 3 wks 1-6 > CMR wk 1 > Flashcards

CMR wk 1 Flashcards

1
Q

basic CV exam components

A

cardiac auscultation + palpation:

-chest inspection
-heart + carotid a. auscultation
-palpation (chest wall pain, PMI, pulses [carotid, b/l UE, b/l LE])

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2
Q

advanced CV exam (vascular system) components

A

inspection (extremities)
-clubbing
-cyanosis

palpation
-capillary refill
-edema
-JVP

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3
Q

which heart sounds are diaphragm used for? how much pressure is applied?

A

valvular heart sounds (A, P, T, M), firm pressure

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4
Q

which heart sounds are bell used for? how much pressure is applied?

A

non-valvular heart sounds, light pressure

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5
Q

what you look for during visual inspection of chest

A

-pectus excavatum/carinatum
-symmetry of chest
-skin lesions/rashes
-bruising
-tattoos

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6
Q

what do you listen to at the 2nd right intercostal space?

A

aortic valve

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7
Q

what do you listen to at the 2nd left intercostal space?

A

pulmonic valve

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8
Q

what do you listen to at the 4th left intercostal space?

A

tricuspid valve

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9
Q

what do you listen to at the 5th left intercostal space?

A

mitral (bicuspid) valve

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10
Q

valve behavior during systole

A

aortic + pulmonic valves open

mitral + tricuspid valves close

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11
Q

what creates the 1st heart sound (S1)?

A

mitral + tricuspid valves closing

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12
Q

what are the ventricles doing during systole?

A

contracting

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13
Q

what are the ventricles doing during diastole?

A

relaxing

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14
Q

valve behavior during diastole

A

aortic + pulmonic valves close

mitral + tricuspid valves open

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15
Q

what creates the 2nd heart sound (S2)? and what is the main valve you are hearing?

A

aortic + pulmonic valves closing

mainly hearing aortic valve

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16
Q

where is S1 loudest? why?

A

apex

bc of contraction of left ventricle

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17
Q

where is S2 loudest?

A

base

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18
Q

is timing of systole longer or shorter than diastole?

A

systole is shorter

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19
Q

what are S3 and S4 heart sounds called?

A

gallops (extra heart sounds)

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20
Q

where are S3 and S4 heard best?

A

apex

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21
Q

are S3 and S4 high or low-pitched?

A

low-pitched

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22
Q

what part of stethoscope do you use to listen to S3 and S4? why?

A

bell, they’re low-pitched

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23
Q

is S3 normal or pathologic

A

can be both

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24
Q

is S4 normal or pathologic

A

always pathologic

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25
what are you hearing with S3
too much blood sloshing into left ventricle
26
what are you hearing with S4
blood hitting stiff left ventricle wall (hypertrophic) while filling ventricle
27
when does S3 occur
early diastole, right after S2 lub_de-bub
28
when does S4 occur
late diastole, just before S1 be-lub_dub
29
pathologic causes of S4
-restrictive cardiomyopathy -uncontrolled HTN
30
in what pt population is S3 usually normal
young children, some adults
31
pathologic causes of S3
-volume overload (too much fluid in heart) -CHF
32
what you hear during gallops vs murmurs
gallops = fluid sloshing into ventricle / hitting ventricle wall murmurs = turbulent flow
33
why do murmurs occur?
valves too tight / not closing fully / hole in the wall
34
what does laminar flow mean
smooth flow
35
what does turbulent flow mean
rough flow
36
what is stenosis
stiffness / narrowing of the valve, FORWARD flow
37
what is regurgitation / insufficiency
valve unable to close fully, BACKWARD flow
38
types of systolic murmurs
early mid late holosystolic
39
types of diastolic murmurs
early late
40
what is a continuous murmur
throughout both systole and diastole
41
how many numbers on a murmur grading scale
1-6
42
1/6 murmur
quiet, heard if listening hard
43
2/6 murmur
quiet, heard immediately
44
3/6 murmur
loud, no thrill
45
4/6 murmur
loud, palpable thrill
46
5/6 murmur
very loud, palpable thrill, may hear it with stethoscope partially off chest
47
6/6 murmur
very loud, palpable thrill, may hear it with stethoscope entirely off chest
48
does bell listen for low-pitched or high-pitched heart sounds?
low-pitched
49
does diaphragm listen for low-pitched or high-pitched heart sounds?
high-pitched
50
are murmurs high-pitched or low-pitched
high-pitched, EXCEPT diastolic murmurs (mitral stenosis, aortic regurg) are low-pitched
51
PMI stands for
point of maximal impulse
52
what do you feel at PMI
apex of the heart- where it's closest to the anterior chest wall, feeling it contract at 1 beat per cycle
53
where is PMI located
5th left intercostal space, mid-clavicular line, 2-3 cm in diameter
54
pt positions to best feel PMI
-supine -sitting slightly leaning forward -left lateral recumbent
55
hand positioning to feel PMI
open right hand with MCPs of 2-5 fingers, then localize with finger pads
56
what are you concerned for if PMI is laterally displaced
cardiomegaly is one concern
57
grading of pulses
+0,1,2,3 / 3
58
normal pulse for age newborn - 2 years
100-180 bpm
59
normal pulse for age 2-10 years
60-140 bpm
60
normal pulse for age 10 - adult
60-99 bpm
61
documentation of cardiac exam for SOAP note
RRR. No murmurs, rubs, gallops. PMI is non-displaced. Carotid, radial, dorsalis pedis pulses equal 2+ b/l. No carotid bruit. Capillary refill <2 seconds at fingertips b/l. No cyanosis, clubbing, LE edema b/l. JVP is 6 cm from right atrium.
62
do you use diaphragm or bell to listen to S1 and S2?
diaphragm, bc they are high-pitched
63
what is "physiologic splitting" of S2
slightly delayed closing of pulmonic valve, heard best during inspiration
64
where do you best hear a split S2? why?
2nd left intercostal space, pulmonic valve located here
65
which type of heart murmur is always considered pathologic?
diastolic
66
the 2 most common systolic murmurs related to heart valves
-aortic stenosis -mitral regurgitation
67
normal aortic valve function vs aortic stenosis
normal aortic valve = opens as left ventricle closes to expel blood into peripheral circulation stenotic aortic valve = restricts blood flow and causes murmur
68
what happens during mitral regurgitation
left ventricle contracts to expel blood to peripheral circulation across aortic valve -> but mitral valve cannot close -> blood moves backwards across mitral valve causing murmur
69
most common diastolic murmur related to heart valves
mitral stenosis
70
what disease most commonly causes mitral stenosis
rheumatic heart disease

FOM 3 wks 1-6 (27 decks)

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