CV PE Exam

Question 1

Bruits

Answer 1

Noise produced by turbulent flow of blood

Question 2

Thrills

Answer 2

Palpable turbulent blood flow

palpable murmur

Question 3

Heaves and Lifts

Answer 3

Sustained impulses usually produced by an enlarged heart

Question 4

Korotkoff Sounds

Answer 4

Sounds heard during blood pressure maneuver

Question 5

Systolic

Answer 5

Maximum arterial pressure during contraction of left ventricle

Question 6

Diastolic

Answer 6

Minimum arterial pressure during relaxation

Question 7

Heart sounds are made from?

Answer 7

“snap” of valve closure

Question 8

S1

Answer 8

• Closing of Mitral and Tricuspid valves
• “Lub”
• Beginning of Systole

Question 9

S2

Answer 9

• Closure of Aortic and Pulmonic valves
• “Dub”
• Beginning Diastole

Question 10

S3

Answer 10

• Occurs just after S2 as Mitral valve opens
• Considered normal in young athletic teenagers
• In elderly generally diagnostic of CHF
• “Kentucky”

Question 11

S4

Answer 11

• Occurs just before S1
• “Tennessee”
• Almost always considered PATHOLOGICAL
• Diastolic heart failure
• Active ischemia

Question 12

Pulsus paradoxus

Answer 12

• An exaggerated fall in systolic BP and rate on inspiration (>10 mm Hg on sphygmomanometry)
• Found with Cardiac tamponade, acute asthma, COPD, Pericarditis

Question 13

Bounding Pulses

Answer 13

• Large volume
• Anemia
• Hepatic failure
• Respiratory failure (high CO2)

Question 14

Stethoscope Diaphragm: (Firm pressure)

Answer 14

• Best for higher pitched sounds like breath sounds and normal heart sounds
• S1 and S2
• Mitral regurgitation

Question 15

Stethoscope Bell: (Light pressure)

Answer 15

• Best for detecting lower pitched sounds like some heart murmurs and bowel sounds.
• S3 and S4
• Mitral stenosis

Question 16

Regurgitation

Answer 16

Incompetent valve leaflets, floppy valves, blood going both ways

Question 17

Stenosis

Answer 17

Incompetent sclerotic valves, scar tissue, hard valves, takes more pressure for the valves to open

Question 18

Cachexia

Answer 18

General physical wasting with loss of weight and muscle mass due to a disease.

Question 19

Beck’s Triad

Answer 19

• Distended neck veins
• Decreased or muffled heart sounds
• Decreased blood pressure or hypotension

Question 20

Causes from Becks Triad

Answer 20

• Cardiac Tamponade

- Pericarditis

Question 21

Corneal Arcus: aka “Arcus senilis”

Answer 21

White, grey, or blue opaque ring / opacity in theperipheral cornealmargin.
Common at birth but then fades.
Quite common in the elderly

Question 22

Corneal arcus typically associated with

Answer 22

• hyperlipidemia which puts patient at risk for:
• Peripheral artery dz
• Stroke
• Aortic aneurysm
  Does not decrease vision or harm the eye.

Question 23

Clubbing

Answer 23

Bulbous swelling of the terminal phalanges of the fingers and toes, giving them a “club-like” appearance.

Question 24

Cause of clubbing

Answer 24

• Most etiologies unknown
• Common with Pulmonary and Cardiac disorders with some GI and Endocrine disorders
• —> Lung CA, Cystic Fibrosis, Congenital Heart Defects, Celiac Disease, Graves Dz, Liver Dz., etc…

Question 25

Peripheral Cyanosis

Answer 25

• Cutaneous Vasoconstriction due to low CO
• Cold (hypothermia)
• Obstruction (DVT), Peripheral Vascular Dz
• LVF and Shock
  (Decreased Cardiac Output)

Question 26

Central Cyanosis

Answer 26

• Arterial Blood Desaturation / Abnormal Hb
  -Polycythemia
• Altitude
• Lung Disease
• Methemoglobinemia
  (Blue skin people of Appalachian heritage.)
• Sulfhemoglobinemia
  (H2S (rotten eggs smell) producing intestinal bacteria.)
• Shunt
  (R – L shunts (Impaired Pulmonary functions))

Question 27

Splinter Hemorrhages

Answer 27

Tiny blood clots running vertical under nail beds.

Question 28

Causes od spliter hemorrhage

Answer 28

• Sub-acute bacterial endocarditis (SBE)
• Trichinosis
• Systemic lupus erythematosus (SLE)
• Rheumatoid arthritis
• Trauma

Question 29

Homan’s Sign: aka “dorsiflexion sign test”

Answer 29

Procedure to test for Deep Vein Thrombosis (DVT)

Question 30

Useful tools to help determine DVT

Answer 30

• D-dimer
• Ultrasound
• Multidetector helical CT

Question 31

Janeway Lesions

Answer 31

• septic emboli which deposit bacteria, forming micro-abscesses.
• found on hands, feet, tips of finger and toes
• PAINLESS AND NON-TENDER
• Generally associated with:
  Sub-acute Bacterial Endocarditis (SBE)

Question 32

Osler Nodes

Answer 32

• Red-purple, slightly raised lumps, frequently observed with a pale center.
• TENDER
• Can occur at any time during the course of endocarditis (usually subacute)
• Other causes: Lupus (SLE), Disseminated GONOCCOCAL infection, Distal to infected arterial catheter

Question 33

Claudication

Answer 33

• Pain caused by insufficient blood flow, usually during exercise.

Question 34

Prinzmetal angina “prints metal”

Answer 34

• Syndrome typically consisting of angina (cardiac chest pain) at rest that occurs in cycles.
  Exposure to cold weather (shoveling snow)

Question 35

Orthostatic Hypotension

Answer 35

• Drop in systolic pressure of 20mm of Hg
• Drop in diastolic pressure of 10 mm Hg
• Pulse increase by 20 beats /minute

Question 36

Causes of orthostatic hypotension

Answer 36

• Arrhythmias, vascular dz.
• Hypotension / Dehydration / Blood loss
• Endocrine and Neurological dz.
• Age
• Medications
• Prolonged bed rest

Question 37

Aortic valve

Answer 37

2nd-3rd right intercostal space

Question 38

Pulmonic valve

Answer 38

2nd-3rd left intercostal space

Question 39

Tricuspid valve

Answer 39

Left sternal boarder (between 3rd and 5th intercostal space)

Question 40

Mitral valve

Answer 40

Apex