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RUSVM SAM 1 > CV Physical Exam > Flashcards

CV Physical Exam Flashcards

1
Q

What does the acronym RAM stand for when performing an observational CV exam?

A

Respiration

  • rate/effort, posture, mouth breathing (mm)

Ambulation and Abd distention

  • thromboembolism, hypotension, ascites

Mentation

  • depression, anxiety, thromboembolism, systemic hypertension, hypotension
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2
Q

T/F: A patient with pink mm and CRT of < 2s does not have heart disease.

A

FALSE

*Although these are normal parameters, mm exams have poor sensitivity in heart disease patients.

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3
Q

What pathology of the eyes can be caused by systemic hypertension?

A

Hyphema

Retinal hemorrhage/detatchment/edema

Vision loss

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4
Q

A patient presents laterally recumbant with jugular vein pulsation along the entire vein. What is causing this finding?

A

The entire vein is at the level of the heart in recumbant patients. This can be seen in normal patients and does not indicate a pathological process.

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5
Q

A patient presents with pulsation of the entire jugular vein while standing with head erect. What 2 disease processes can cause this?

A

Severe tricuspid valve regurgitation

Pericardial disease

*It is normal to see jugular pulsation in standing patients in the lower 1/3 of the vein only.

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6
Q

A patient presents with jugular vein distension, which you know indicates elevated systemic venous pressure. What 3 diseases should you consider in this patient?

A

Right heart disease

Pericardial disease

Obstruction of the cranial vena cava

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7
Q

What is the first method for locating the apex beat during a CV exam?

A

Palpation

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8
Q

On what side of the chest and at what location is the apex beat strongest?

A

Left side at the mitral valve region (5th intercostal space)

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9
Q

A dog with cardiomegaly presents for CV exam. When auscultating the apex beat, what changes do you expect?

A

It may be exaggerated

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10
Q

When performing a thoracic auscultation, where should you begin to hear the loudest heart sounds and determine the heart rate?

A

Apex beat.

(mitral valve)

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11
Q

While auscultating the chest of a 9 year old dog, you find that the femoral pulses aren’t synchronous with the heart beats. What does this indicate?

A

Arrhythmia

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12
Q

Where can you auscultate the Aortic and Pulmonary valves?

A

A: Left side, 4th intercostal space (near the axilla)

P: Left side, 3rd intercostal space (in the axilla)

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13
Q

Where should you auscultate the Tricuspid valve?

A

Right side, 4th intercostal space

*Palpate first to find apex beat

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14
Q

The heart sound S1 is lower and duller, and occurs at…..

A

The onset of ventricular systole

*isovolumetric contraction, increased pressure, and closure of the AV valves

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15
Q

The heart sound S2 is higher pitched and more crisp, and occurs at…

A

The end of ventricular systole

*Aortic and Pulmonary vales close after ventricular contraction

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16
Q

A sound generated by turbulent flow within the cardiac chambers and/or great vessels:

A

Murmur

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17
Q

A 9 year old Cavalier King Charles presents for lethargy and anorexia. The patient is about 5% dehydrated. You see in the history that the patient has a pre-existing heart murmur, but when you listen to the chest you don’t hear one. Why is this?

A

Since the patient is dehydrated, blood viscosity is increased. An increase in viscosity will decrease turbulence in the vessels and you may not hear the murmur.

*As viscosity increases, Reynold’s number decreases

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18
Q

You hear a heart murmur in a 6 year old dog with chronic anemia. Should you send this dog for cardiology referral?

A

Not necessarily. Chronically anemic patients will have increased blood volume, which decreases blood viscosity and can create turbulence in the vessels.

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19
Q

You are auscultating a patient’s chest and think you hear a very faint murmur after several seconds of listening in a certain spot. You can’t seem to find the murmur in any other part of the chest. What grade murmur does this patient have?

A

Grade I

*Very faint, takes several seconds to hear, doesn’t radiate

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20
Q

You auscultate a patient’s chest and hear a faint murmur after a few seconds. You can’t hear the murmur in any other part of the chest. What grade murmur is this?

A

Grade II

*Faint, takes a few seconds to hear, usually doesn’t radiate

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21
Q

You are auscultating a patient’s left chest and immediately hear a murmur. While moving your stethoscope along the chest you continue to hear the murmur on that same side. The murmur is absent upon auscultation of the right side of the chest. What grade murmur is this?

A

Grade III

*Readily heard, radiates on the same side of the chest as the PMI (point of maximal intensity)

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22
Q

You are auscultating a patient’s chest and hear a loud murmur on the left side. You move along to the right side of the chest and can still hear the murmur. What grade murmur is this?

A

Grade IV

*Loud, radiates to opposite side of PMI (bilateral)

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23
Q

You are auscultating the chest of a dog who has a palpable thrill on the left side. You are able to hear the murmur on both sides when your stethoscope is pressed against the chest. What grade murmur is this?

A

Grade V

*Palpable thrill

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24
Q

You are about to auscultate the chest of a dog who has a palpable thrill on the right side. Before you even get your stethoscope pressed against the dog’s chest, you can hear the murmur. What grade is it?

A

Grade VI

*Palpable thrill, audible with stethoscope lifted off chest

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25
Q

What are the three factors for describing a murmur?

A

Grade

Location

Timing

26
Q

In medium and large breed dogs, it is possible to state the location of a murmur by valve. In cats and small dogs it is acceptable to state the location of a murmur by ______.

A

Region (apical vs basilar vs parasternal/sternal border)

27
Q

If you hear a murmur after S1 and before S2 heart sounds, what is the timing?

A

Systolic

(most common)

28
Q

If you hear a murmur after S2 and before S1 heart sounds, what is the timing?

A

Diastolic

29
Q

What is the timing of a murmur that peaks at systole, but is audible at all times in the cardiac cycle?

A

Continuous

30
Q

What is another term for a murmur that is heard during systole and diastole?

A

To-and-Fro murmur

31
Q

On auscultation of a 6 month old Doberman puppy’s chest, there is a murmur present throughout the entire cardiac cycle, which peaks during systole. What is the underlying pathology?

A

Patent Ductus Arteriosus

*PMI is usually at the left base

32
Q

If you hear a murmur on the left side during systole, with a basilar PMI, what are the differentials?

A

Pulmonic Stenosis

Subaortic or Aortic Stenosis

33
Q

If you hear a murmur on the left side during systole, with an apical PMI, what is the pathology?

A

Mitral Regurgitation

34
Q

If you hear a murmur on the right side during systole, and the PMI is located parasternally, what is the pathology?

A

Ventricular Septal Defect

35
Q

If you hear a murmur on the right side during systole, with an apical PMI, what is the pathology?

A

Tricuspid Regurgitation

36
Q

If you hear a murmur on the left side during diastole, with a basilar PMI, what are the differentials?

A

Aortic or Pulmonic regurgitation

37
Q

If you hear a murmur on the left side during diastole, with an apical PMI, what is the pathology?

A

Mitral valve stenosis

38
Q

If you hear a murmur on the right side during diastole, what is the pathology?

A

Tricuspid valve stenosis

39
Q

A diastolic heart sound is heard just after S2. What is the likely underlying disease?

A

Dilated Cardiomyopathy

*An additional heart sound right after S2 would be S3. This occurs during passive ventricular filling. Diastolic heart sounds are also called “gallops”.

40
Q

A patient’s medical history states that a gallop was auscultated on the previous exam. The heart sound was classified as S4. When was this additional sound heard during the cardiac cycle and what is the likely underlying disease?

A

S4 sounds are heard just before S1.

S4 sounds are associated with hypertrophic cardiomyopathy and occur during active ventricular filling/atrial contraction.

41
Q

In some cases, S3 and S4 sounds are both present and may merge when the heart rate is increased. What is this called?

A

Summation gallop

42
Q

Since S3 and S4 are lower frequency sounds, they will become more clear using what part of the stethoscope?

A

Bell

43
Q

In what species can gallops be heard in normal patients?

A

Cats

44
Q

High frequency sounds that occur between S1 and S2. Best hear with the diaphragm of the stethoscope.

A

Systolic clicks

45
Q

You are listening to a patient’s chest with the diaphragm of your stethoscope and hear a high frequency sound between S1 and S2. What do you assume is causing this abnormality?

A

Prolapse of an AV valve

*The sound indicated was a systolic click

46
Q

While listening to the heart of a Great Dane, you note that S1 is split into two sounds. What is causing this abnormality and is it clinically significant in this patient?

A

Split S1 is caused by asynchronous closure of the AV valves.

This can be a normal finding in large breed dogs.

47
Q

What are the underlying causes of a split S1?

A

Bundle branch block

Ventricular ectopic beats

Mitral/Tricuspid stenosis

48
Q

While ausculting the chest of a 7 year old Labrador, you note a split S2. What could be causing asynchronous closure of the semilunar valves in this patient?

A

Pulmonary hypertension

Bundle branch block

Ventricular ectopic beats

Left-to-Right intracardiac shunt

Pulmonic/Aortic/Mitral stenosis

49
Q

Abnormal impulse formation and/or conduction can result in what?

A

Arrhythmias

50
Q

S4 is often heard in patients with what arrhythmia?

A

3rd Degree AV Block

51
Q

In thin patients, or during hyperdynamic states (fever, anemia, hyperthyroidism), you can expect heart sounds to be (increased/decreased) in intensity?

A

Increased

52
Q

In obsese patients or patients with pericardial or pleural effusion, intrathoracic masses, poor ventricular contractility, you can expect the heart sounds to be (increased/decreased) in intensity?

A

decreased

53
Q

How many lung fields should be assessed in medium and large breed dogs? Cats and small dogs?

A

Med/Lg dogs: 3-4 dorsally and 2-3 ventrally

Cats/Sm dogs: 2-3 dorsally, 2 ventrally

54
Q

As pulmonary edema worsens, bronchioles can become compressed. What abnormal lung sounds would you expect to hear in this case?

A

Crackles and wheezes.

Inspiratory crackles at first, then as edema progresses, crackles and wheezes may be heard on both inspiration and expiration.

55
Q

Muffled or absent lung sounds in a canine patient can indicate what disease of the heart? What about in feline patients

A

Canine: Right sided CHF

In cats, can be right or left-sided CHF

*Muffled or absent lung sounds indicate pleural effusion, which can be caused by CHF

56
Q

In what species is the heart positioned more ventrally, and the presence of intermittent gallops and murmurs considered normal?

A

Cats

*Heart is super controlled by SNS. This can cause intermittent gallops and murmurs, especially in a clinical setting. Listen for murmurs parasternally, since the heart is located more ventrally.

57
Q

Certain arrhythmias can result in “pulse deficits”. What does this mean?

A

Femoral pulse is not synchronous with heart rhythm

58
Q

A cat presents to the ER for sudden inability to walk. The cat is hypothermic on rectal temp, and the paw pads on the pelvic limbs are cyanotic. Femoral pulses are not evident on exam. What is causing ataxia in this cat?

A

Saddle Thrombus

59
Q

A 10 year old dog presents for sick visit. The ribs and pelvic bones are visible. Examination of the abdomen shows distension and fluid wave. Rads indicate hepatomegaly. Failure of what side of the heart is responsible for these signs?

A

Right

60
Q

A dog presents for labored breathing. Since the patient is dyspneic, you do an abbreviated CV exam. How long should you listen to the chest and assess vital signs in this case?

A

15-30s for cardiopulm auscultation

15-30s for vital signs

61
Q

What is the most important thing to remember while examining a dyspneic patient?

A

Reduce stress!

62
Q
A

RUSVM SAM 1 (10 decks)

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