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Year 2 PCM III > CV and PV Pitcher > Flashcards

CV and PV Pitcher Flashcards

1
Q

What do you note on characterization of peripheral pulses

A

how they feel and if you can feel them

how symmetric they are

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2
Q

What is a thrill and what does it feel like

A

valve problem, feels like a virbation

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3
Q

what position accentuates sounds best

A

supine, 30 degrees

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4
Q

leaning forward accentuates what pathology

A

aortic murmurs and pericarditis

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5
Q

left lateral decubitus accentuates what pathology

A

mitral murmurs

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6
Q

what causes a bruit

A

tubulance in artery outside heart itself

use bell

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7
Q

what is grading for murmurs

A

1 very faint
2 quiet, easily heard in quiet rrom
3 moderately loud
4 loud palpable thrill
5 very loud thrill and with stethoscope barely off chest
6 very loud, thrill, stethoscope off the chest

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8
Q

What can cause a split S1

A

normal variant or abnormal from RBBB or PVC

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9
Q

if S1 and S2 are both split what could it be

A

RBBB and PVC

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10
Q

what is a wide or fixed S2 and what could cause it

A

no respiratory variation

delayed pulmonic closure from stenosis or RBBB

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11
Q

What can cause S3

A

occurs at transition of rapid to slow ventricular filling
LV myocardial damage, CHF, MI (dilated CM)
sudden limitation of normal ventricular relaxation during filling stage in diastole

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12
Q

What are ways of early detection of dilated myocardium

A

BNP, pro-BNP doppler echo

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13
Q

Where is S4 best heard

A

apex in L lateral decubitus

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14
Q

what is going on in heart that causes S4

A

vibration of LV from atriak kick

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15
Q

What can cause S4 pathologically

A

thickening of ventircular walls from a higher work load, and some stiffening
HTN, aortic valve stenosis, pulmonic valve stenosis, hypertrophic CM

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16
Q

What is an ejection click

A

sound occurring at moment of maximal P with sudden tensing of a valve root

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17
Q

when do you hear an aortic ejection click

A

early systolic

at onset of L ventricular ejection, aortic root suddenly stretched

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18
Q

what can cause an aortic ejection click

A

dilated aneurysm of aortic root, coarctation of aorta, HTN
aortic valve stenosis and aortic regurg
(anything that over works root of aortic valve)

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19
Q

what is character of aortic stenosis murmur

A

systolic crescendo-decrescendo pattern, medium pitch, harsh

transmits sound to carotid aa

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20
Q

What are Sx of aortic stenosis

A

dyspnea on exertion, angina, syncope

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21
Q

What pathologies can lead to aortic stenosis

A

rheumatic disease, congenital bicuspid valve, calcification of valve

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22
Q

What is an Austin Flint murmur

A

early diasolit high pitch blowing decresendo murmur from high pressure back flow through narrow orifice. aortic regurg

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23
Q

what pathologies are behind aortic regurg

A

rheumatic disease, congenital bicuspid valve, endocarditis (strep, Staph, haemophilus)

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24
Q

what is a pulmonic ejection click

A

sudden root tensioning, very early systole

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25
Q

what can cause pulmonic ejection click

A

pulmonary HTN, aneurysm dilating the root

pulmonary valve stenosis or regurg can alter stress on the root of the valve

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26
Q

What is sound of pulmonic stenosis

A

systolic crescendo decrescendo murmur

most asymptomatic

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27
Q

what are Sx of pulmonic stenosis

A

exertional dyspnea, chest pain, syncope

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28
Q

What extra heart sound is heard with pulmonic stenosis

A

S4

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29
Q

What is a graham steell murmur

A

pulmonary regurg

soft diastolic decrescendo

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30
Q

what can cause pulmonary regurg

A

pulmonary HTN: mitral stenosis, LV failure, obstructive sleep apnea, emphysema, idiopathic pulmonary HTN

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31
Q

what is sound of tricuspid stenosis

A

diastolid low pitch rumble best hera with bell
openeing snap over tricuspid area
accentuated by inspiration

32
Q

What can cause tricuspid stenosis

A

rheumatic valvular disease, congenital heart disease, carcinoid tumor
impeding R ventricular filling increases central venous P

33
Q

What is sound of tricuspid regurg

A

early holosytolic at LSB
diaphragm
high pitch blowing
accentuated with inspiration

34
Q

what can cause tircuspid regurg

A

ebstein congenital anomaly, thin valve predisposing to failure

35
Q

What is sound of mitral valve stenosis

A

opening snap in diastole

36
Q

what valve in heart is most often affected by Rheumatic heart disease

A

mitral

37
Q

What is sound of mitral valve prolapse

A

click and murmur

louder with valsalva and standing

38
Q

What is mitral valve prolapse assoc with

A

anxiety or panic attacks

dyspnea, non-anginal chest pain, palpitations, syncope

39
Q

What is sound of mitral valve regurg

A

holosystolic (pansystolic) murmur

loud high pitch, best at apex, can radiate to left axilla

40
Q

What are Sx of HOCM

A

exercise induced dyspnea, angina, syncope

41
Q

Where is a systolic ejection murmur heard best in HOCM

A

LSB and apex

42
Q

what is lab test fo choice for HOCM

A

restin echo

43
Q

What type of murmur do you hear with PDA

A

pansystolic and most of diastole
may have thrill
often machine like in quality and can radiate to back

44
Q

majority innocent murmurs are from what

A

benign pulmonary branch stenosis

45
Q

bruit in thyroid, what do you suspect

A

graves, increased blood flow

46
Q

What can cause pericarditis

A

infectino of pericardium, MI, metastasis to pericardium, post cardiac surgery
assoc with recent respiratory viral infection

47
Q

What is best test to Dx pericarditis

A

echo

48
Q

What is sound from constrictive pericarditis

A

pericardial knock, heard widely over precordium

49
Q

What are the 3 phases of pericardial rub

A

atrial systole, ventricular systole, ventricular diastole

triphasic

50
Q

Wha tis TTE and TEE

A

transthoracic endoscopy

transesophageal endoscopy

51
Q

what are risk factors for murmurs

A

smoking, HLD, HTN

52
Q

What medications are used for murmurs

A

Bblockers
ACEI
ARB
peripheral vasodialtors

53
Q

what are surgeries for murmurs

A

valve replacement or repair,
stent
endarterectomy

54
Q

What are Sx of intermittent claudication

A

pain, tension and weakness of a limb when walking which intesifies with continued walking, resolving only when activity stops

55
Q

What are risk facotrs for intermitten claudication

A

aortic stenosis
anemia
polycythemia
atherosclerosis

56
Q

What do you find on PE with intermitten claudication

A

poor pedal pulses, ulcerations, palor, cool, shiny and hairless skin, bruit may be heard

57
Q

How do we Dx intermittent claudication

A

History and PE
segmental BP
ABI <0.9
contrast agiography

58
Q

What is tx for intermittent claudication

A

meticulous foot care, smoking cessation
lower lipids, walk
cilostazole (pletal), phentoxifylline
revascularization procedures

59
Q

the lower the ABI index gets tells you what about severity of PAD

A

lower = worse PAD

60
Q

What are risk factors for carotid artery stenosis

A

older male
HTN, DM
smoking, HLD, heart disease

61
Q

What do you use to Dx carotid a stenosis

A

bruit, dopper ultrasound

MRA and angiogrpahy if dopler and ultrasound are +

62
Q

Tx for carotid a stenosis

A 
endarterectomy if >69% occluded
elective endarterectomy >50% stenosis
stents
risk factor management
aspirin prophylaxis
63
Q

What is a pseudoaneurysm

A

dilation or hematoma that may or may not involve layers of vessel wall which is contained and does not dissect

64
Q

When do aneurysms become painful

A

expanding or leaky

65
Q

What type valve defect can aortic ascending aneurysm cause

A

aoritc regurg

66
Q

Where are 75% AAA located

A

distal to renal aa

67
Q

What is Dx tool for AAA

A

if bruit with bell then US or CT angiography

Contrast CT if not emergent

68
Q

What is Tx for aneurysm

A

elective graft

betablockers to reduce shear stress unless hypotensive already

69
Q

What is raynaud phenomenon assoc with

A

scleroderma, lupus, peripheral neuritis, polyarteritis

70
Q

What other problems is raynaud disease assoc with

A

none

71
Q

What is Tx raynaud

A 
avoid or stop smoking
avoid cold temperatures
aboid Bblockers
manage stressors
CCB
72
Q

What are large vessel vasculitis

A

takayasu aortitis: aorta and major branches “pulseless disease”

73
Q

what are the medium vessel vasculitis

A

polyarteritis nodosa

wegeners granulomatosis

74
Q

what are the small vessel vasculitis

A

HSP: palpable purpura abdomen and legs, children more than adults
assoc with IC

75
Q

Sx polyarteris nodosa

A

fatigue, weakness, fever, wt loss, HA, abdominal pain

elevated WBC neutrophils

76
Q

how do you confirm Dx polyarteritis nodosa

A

biopsy

77
Q

Tx for polyarteritis nodosa

A

steroids and immune modulating agents

Year 2 PCM III (5 decks)

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