CV physical exam

Question 1

s1 ?

Answer 1

MV closing and Ao opening

Question 2

classic carotid pulse of AI

Answer 2

bisferense pulse

Question 3

AS classical carotid pulse

Answer 3

parvus et tarded

Question 4

pulsus paradoxis

Answer 4

decrease in SBP by 10mmHG with inspeiration tamponade

Question 5

NAme the assocaiated pathology

1. biferense pulse
2. pulsus paradoxis
3. pulus parvis et tardis

Answer 5

1. AI
2. pulsus paradoxis
3. AS

Question 6

constricution think of what on the RA tracing

tamponade

Restriction

Answer 6

W sign (rapid x and y)

Still a large x descent but absent Y desent

No x but prominent Y

Question 7

cannon a waves 3x’s

Answer 7

atrial flutter, chb, vt

Question 8

fixed persistent split mc cause

Answer 8

RBBB, phtn, asd

Question 9

paradoxical splitting causes (3) (splitting with expiration

Answer 9

LBBB, AS, HCM

Question 10

fixed split

Answer 10

asd

Question 11

systolic ejection clicks mc type

Non ejection click

Answer 11

ejection click from bicuspid AV/PV (in PS softer with inspiration bc valve opened more easily).
Timeing coincident with cartid upstoke

2. MVP - mid ot late, timing after carotid upstroke

Question 12

ejection click softer with inspiration

Answer 12

PS

Question 13

How tell if systolic click is AS/PS or MVP

Answer 13

carotid upstroke will be delayed with MVP and decreased learlier with sitting to standing bc shorter IV conctracktion time. . (non ejection

Question 14

MVP systolic click with standing from squat

Answer 14

softer and earlier, bc decreased preload so decreased isovolemci contraction time

Question 15

acute MR murmur is

Answer 15

sublte

Question 16

anterior MR hear?

Answer 16

axilla / back

Question 17

posterior MR hear

Answer 17

LSB

Question 18

3 holosytolic murmurs

Answer 18

MR/TR and VSD

Question 19

AS mild/moderate

severe AS

Answer 19

creshendo decreshenod clear s2

only creshondo, softer single s2 (delayed), should be paradoxical with insperiation but the p2 is often obscured.

Question 20

why with severe AS single s2 (ie no splitting

Answer 20

its paradoxically split but p2 is not audible through the sound of the murmur

Question 21

extra heart sound of severe AS

Answer 21

s4

Question 22

most important hint on boards for severe AS

Answer 22

single s2

Question 23

HCM

1. carotid pulse
2. what manuvers in general increase hcm

What concomitant murmur with HCM?

Answer 23

2. bifid or triple apical pulse
3. those that decrease LV volume ie valsva (decresa venous return and preload, squat to stand

MR due to sam

Question 24

Hand grip and hocm

Answer 24

decrease murmur (increases for MR)

Question 25

MR and hand grip murmur

Answer 25

MR increases

Question 26

AI diastolic rumble way to distinguish from MS

Answer 26

MS will hae and opening snap , AI will have a wide pulse pressure

Question 27

OS timing

Answer 27

> 80 ms timing is sevee

Question 28

pad dynamic exam manuver

Answer 28

Elevation pallor and dependent rubor

Question 29

blue skin

Answer 29

amiodarone

Question 30

blue sclera

Answer 30

Osteogenis imperfecta

Question 31

TIA def

Answer 31

< 24 hrs (usually < 15 min) no evidence of an acute stroke no MRI finding

Question 32

X linked recessive disease

Answer 32

Fabrays

Question 33

fabrays defect

Answer 33

alpha galactosidase

Question 34

stroke is now defined by

Answer 34

MRI imaging new abn

Question 35

1. time window for fibrinolytic rx

2. mechanical thrombectomy

Answer 35

4. 5 hrs

2. recommened to have mechanical thrombectomy for acute large vessel occlusion (5 studies)

Question 36

cryptogenic stroke and PFO

Answer 36

data showing to close pfo esp in young patients.

Question 37

NEw staging classification for VHD

Answer 37

A. at trisk
B. progressive
C. Severe Asx
D. Sx severe (c1 compensated C2 decompenstated)