Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PCM 3 exam 1- MARIYA > CV Exam Lab OSCE > Flashcards

CV Exam Lab OSCE Flashcards

1
Q

General inspection of CV:

A

look for distress, bleeding, diaphoresis, pale, tachypneic, wheezing, LOC

peripheral (lips+fingers) or central (mucosa) cyanosis

peripheral edema

clubbing, tobacco stains

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What should you inspect on the precordium (thorax in front of heart)?

A 
shape of chest (pectus excavatum/carinatum, kyphosis, scoliosis)
scars
sternal heaves
pulsations
PMI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

General palpation in CV:

A

Carotid A.: note thrills and pulse (amplitude, contour, rate, rhythm)

areas of tenderness or pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What should you palpate on the precordium?

A

aortic, pulmonic, tricuspid area, mitral area

PMI for location, diameter, amplitude, duration (2/3 systole)

epigastrium(subxyphoid)- note any pulsations

note any heaves or thrills

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the pulse grading scale?

A 
0- absent, not palpable
1- diminished, barely palpable
2-expected
3-full, increased
4- bounding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Special pulses: normal carotid feeling? abnormal?

A

Feels like sharp knock;

abnormal is a weak nudge then slight pulsation or push

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Special pulses: pulsus alternans feeling?

A

Alternating strong and weak pulses palpable at radial or femoral arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Special pulses: Water-hammer pulse feeling?

A

Due to large SV and backflow of blood from the aorta into LV

-palpate radial pulses while pt lies on exam table, applying pressure until pulse is obscured; raise arm straight over pts head perpendicular to table and palpate pulse for sudden rise and collapse of radial pulse that feels “jumpy”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a water-hammer pulse feeling indicative of?

A

aortic regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What can Paradoxical pulse be used to assess for?

A

pericarditis or tamponade (varied pulse strength and amplitude as pt breathes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does a positive Kussmaul’s sign indicate?

A

impaired venous return to the heart (when increase in JVP or no change on inspiration)

Explanation: normal JVP shows decline in inspiration but the a wave amplitude increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

in the left lateral decubitas position, a diffuse PMI with a diameter of >3 cm signals what? What does it mean if there is a diameter >4

A

> 3: left ventricular englargement

> 4: makes left ventricular overload almost 5x more likely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is important to auscultate in CV exam?

A

Carotid arteries and precordium

carotid arteries for bruits

all areas previously palpated using diaphragm and bell

Note S1 + S2

murmurs

presence of S3, S4

pericardial rubs

compare to carotid pulse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Where are the points you should auscultate?

A

A- 2nd right IC space
P- 2nd left IC space
T-lower left sternal border (3-5th ICS)
M- 5th ICS, mid sternal line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe the sound of an Aortic Stenosis murmur:

A

harsh quality

right 2nd/3rd ICS

delayed pulses (pulsus tardus et parvus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the sound of a mitral regurg murmur:

A

blowing quality, holosystolic

prominent at apex, radiates to LEFT axilla

loudness correlates w/ degree of valve insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe the sound of a pulmonary stenosis murmur:

A

harsh, loud, ejection click

left 2nd/3rd ICS

radiates to left shoulder

increases with inspiration

18
Q

Describe the sound of a tricuspid insufficiency murmur:

A

blowing quality, increases with inspiration

holosystolic

lower LEFT sternal border

19
Q

What murmurs have blowing qualities to them?

A

mitral regurg, tricuspid insufficiency, aortic regurg, and pulmonary insufficiency

20
Q

Describe the sound of an aortic regurg murmur:

A

blowing, decrescendo murmur

left 2nd ICS to 4th ICS

ausc. with diaphragm

21
Q

Describe the sound of a mitral stenosis murmur:

A

rumbling, low pitched

best heard at apex

auscultate w/ bell

22
Q

Describe the sound of a pulmonary insufficiency murmur:

A

blowing quality

23
Q

Describe the sound of a tricuspid stenosis murmur:

A

increases in intensity w/ inspo, decreases in intensity with expo and valsalva

24
Q

Which murmurs are systolic?

A

aortic stenosis
mitral regurg
pulmonary stenosis
tricuspid insufficiency

25
Q

Which murmurs are diastolic?

A

aortic regurg
mitral stenosis
pulmonary insufficiency
tricuspid stenosis

26
Q

Pneumonic for heart murmurs in diastole (lol might help):

A

ARMS + P(a)RTS

Aortic
Regurge
Mitral
Stenosis

Pulmonary
Regurge
Tricuspid
Stenosis

den all the others r systolic, flipped

remember: regurg= insufficiency

27
Q

Not LO/but useful- what is left lateral decubitus and it allows increased chance of:

A

pt on left side w/ left arm above head, palpate PMI, auscultate for systolic murmurs

increase chance of hearing mitral stenosis and extra heart sounds

28
Q

not LO/but useful-sitting and leaning fwd allows an increased chance of hearing:

A

aortic regurgitation

29
Q

not LO/but useful-straining/valsalva allows an increased chance of hearing:

A

mitral regurg

30
Q

not LO/but useful- what does valsalva differentiate?

A

bw aortic and mitral prolapse or hypertrophic cardiomyopathy

31
Q

not LO/but could be useful- Abdominojugular reflex

A

also hepatojugular reflex; adjunct to measuring JVP

pt relaxes and breathes normally, apply firm pressure of 20-35 mmHg w/ palm of hand to mid-abdomen for 15-30 seconds; observe JVPwaveform before, during, and after compression

test = + = sustained increase in JVP >4 cm within 3-5 sec after pressure removed

32
Q

not LO/but useful- does Valsalva increase or decrease murmur duration in HCM/MVP?

A

increase

33
Q

not LO/but useful- what does Sitting and squatting do in a CV pt?

A

used to differentiate aortic stenosis and MVP, and hypertrophic cardiomyopathy

have pt stand–> squat (squatting increases venous return, PVR, SV, and blood pressure, while standing= opposite)

Auscultate during squatting and standing phases

Squat–> MVP and HCM delay in click, DECREASE in murmur intensity

34
Q

How do you perform JVP estimation?

A
  1. Make the patient comfortable. Raise the head slightly on a pillow to relax the SCM muscles.
  2. Raise head of the bed to about 30°. Turn pt’s head slightly away from the side you are inspecting.
  3. Use tangential lighting and examine both sides of the neck. Identify the external jugular vein on each side, then find the internal jugular venous pulsations.
  4. If necessary, raise or lower the head of the bed until can see the oscillation point or meniscus of the internal jugular venous pulsations in the lower half of the neck.
  5. Focus on the R INTERNAL JUGULAR VEIN. Look for pulsations in the suprasternal notch, between the attachments of the SCM muscle on the sternum and clavicle, or just posterior to the SCM. Distinguish the pulsations of the internal jugular vein from those of the carotid artery.
  6. Identify HIGHEST POINT OF PULSATION in the right jugular vein. Extend a long rectangular object or card horizontally from this point and a centimeter ruler vertically from the sternal angle, making an exact right angle. Measure the vertical distance in centimeters above the sternal angle where the horizontal object crosses the ruler and add to this distance 5 cm, the distance from the sternal angle to the center of the right atrium. The SUM is the JVP.
35
Q

If you had a hypovolemic or septic pt, how would you modify measuring JVP?

A

they may have to lie flat before u see the neck veins

36
Q

If you had a hypervolemic pt (vol overload), how would you modify measuring JVP?

A

you may need to elevate pt’s head to 60 or even 90 degrees to locate the oscillation point

37
Q

What is an elevated JVP highly correlated with?

A

both acute and chronic HF

also seen in tricuspid stenosis, chronic pulm HTN, SVC obstruction, cardiac tamponade, and constrictive pericarditis

38
Q

In patients with obstructive lung dz, JVP can appear:

A

elevated on expiration

veins collapse on inspo

DOES NOT INDICATE HF

39
Q

An elevated JVP is 95% specific for an ___.

A

INCREASED LV end diastolic pressure and
LOW LV EF

not a clear predictor of hospitalization and death from HF tho

40
Q

the last LO in this DSA is to review EKGs (simple ones)

A

cool

PCM 3 exam 1- MARIYA (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions