CV Exam

Question 1

Aortic Stenosis is best heard where?

Answer 1

Suprasternal notch

Question 2

Aortic Insufficiency is best heard where?

Answer 2

Left 2nd ICS @ SB

Question 3

Mitral valve regurgitation is best heard where?

Answer 3

At the Apex of the heart (5th ICS, left, 1.0 cm, medial to mid coronal line)

Question 4

What are thrills?

Answer 4

They are turbulent blood flow causing murmurs

Question 5

Where is the PMI (Point of maximal impulse) palpated?

Answer 5

Left 4th-5th ICS at mid clavicular line

Question 6

The level of JVP (Jugular Venous Pressure) gives and indication of what?

Answer 6

Right Atrial Pressure

Internal jugular is bettter than external jugular

Question 7

What is Kussmal’s Sign

Answer 7

when the neck veins stay up (superficial) during inspiration

Question 8

To measure the JVP; how is this done?

Answer 8

Measure from top level of Jugular venous pulse to sternal angle and then add 5

Question 9

How does Triscupid valve regurgitation typically present on a Jugular venous pressure wave?

Answer 9

Prominent V wave

Question 10

An obstruction betweeen the RA and RV presents as what in a jugular venous pressure wave?

Answer 10

Prominent A wave

Question 11

What is the C wave due to?

Answer 11

It is due to bowing back of the AV valve against the atria, during isovolumetric ventricular contraction

Question 12

What is the X wave in the jugular venous pressure graph indicative of?

Answer 12

Passive atrial filling and atrial relaxation (blood flowing from the Vena cava into the RA)

Question 13

What condition(s) does a steep X wave indicate?

Answer 13

Cardiac Tamponade & Constrictive Pericarditis (Fluid around thee HRT, impedes venous return)

Question 14

What does the V wave indicated in a jugular venous pressure wave graph?

Answer 14

Atrial filling (increase in atrial volume)

Question 15

What does a prominent V wave indicate?

Answer 15

Tricuspid valve regurgitation and pulmonary HTN

Question 16

What does the Y slope indicated on a jugular venous pressure slope graph?

Answer 16

Open TV and rapid RV filling in RV diastole

Question 17

What is HJR?

Also, what does a positive finding of this test indicate?

Answer 17

HJR: Hepatojugular Reflex (w/ application of pressure over the liver, the neck veins can distend)

2) Pericarditis or RV failure

Question 18

When is the S1 and S2 sound split and when is it unified?

Answer 18

Split: Inspiration (More time for RV to deliver blood flow to the lung)

Unified: Expiraiton

Question 19

What does a pulse of 4/4; described as

Answer 19

Bounding

Question 20

Where is edema most palpable?

Answer 20

Ant. Tibia, Medial Malleolus, dorsum of the foot

Question 21

What is the subcostal view useful for during a V scan?

Answer 21

Visualizing four chambers & looking for pericardial fluid

Probe is angled superior to the heart

Question 22

What is a parasternal axis useful for when using a V scan?

Answer 22

It can asses left ventricular and atrial funciton.

useful for evaluating for LV hypertrophyy and systolic function

Tech: Left 3rd and 4th ribs

Question 23

When are systolic murmurs best heard?

Answer 23

Between S1 and S2

Question 24

When are diastolic murmurs heard?

Answer 24

Between S2 and S1

Question 25

What is the rule regarding HR and temperature?

Answer 25

1* F above normal = 10 bpm

Question 26

LVH (left ventricular hypertrophy) will result in what, regarding PMI?

Answer 26

Lateral displacement; downward to the 6th and 7th ICS

Question 27

RVH will result in what regarding PMI?

Answer 27

Sustained systolic lift at lower left sternal area

Question 28

What is a midsysotlic murmur?

Answer 28

Begins after S1 and stops just prior to S2

Question 29

What is a holosystolic murmur?

Answer 29

Begins at S1 and Stops at S2

Question 30

What is a late systolic murmur?

Answer 30

Usually starts with S1 and stops at S2, without a gap between murmur and heart sounds