Exam 2: Cardiovascular And Periph Vascular

Question 1

The diaphragm of the stethoscope is better for:

Answer 1

Higher pitched sounds. Murmurs of aortic and mitral regurgitation. Pericardial friction rubs.

Question 2

The bell of the stethoscope is more sensitive to:

Answer 2

Low pitched sounds. S3 and S4. Murmur of mitral stenosis.

Question 3

Splitting of S2 is usually heard on ____ (Inspiration or expiration) in the ______ area.

Answer 3

Inspiration Pulmonic

Question 4

S2 is louder than S1 in what areas?

Answer 4

Aortic and pulmonic areas

Question 5

S2 diminishes, S1 gets louder in what areas?

Answer 5

Through third interspace. Into tricuspid area. Into mitral area.

Question 6

Attributes of murmurs

Answer 6

TIMING SHAPE LOCATION OF MAXIMAL INTENSITY (Determined by site of origin, explore where murmur is loudest- position relative to sternum, Apex, midsternal, midclavicular, axillary lines) RADIATION (transmission from the point of maximal intensity, reflects site of origin, intensity of murmur, and direction of blood flow) INTENSITY (Graded on a six point scale, expressed as a ratio. Numerator=intensity, denominator =6) PITCH QUALITY (Harsh, blowing, musical, rumbling)

Question 7

Rubor

Answer 7

Dusky redness May appear gradually Suggests poor arterial circulation

Question 8

Ventricular gallop S3

Answer 8

A ventricular gallop is the third heart sound, S3. This low frequency vibration occurs after S1 and S2 and seem to result from the change in blood flow in diastole when rapid filling ends and slow filling starts. When listening for S3, the heart sounds resemble the pronunciation of the word Kentucky, with the Y representing S3. S3 has been described as testing the Costco Tori skills of the examiner because of its low frequency and intensity as well as interference of the normal sounds in the chest from the lungs and abdomen. It is best heard with the bell of the stethoscope. Sometimes it is normally heard in those under the age of 40 and trained athletes.

Question 9

Atrial gallop S4

Answer 9

And atrial Gallup is the fourth heart sound, Asfoor. It is a low frequency sound that occurs in late diastolic filling due to atrial contraction. This causes vibrations in the ventricular walls and happens just before S1, making it difficult to hear. If loud, it can indicate pathology, and it resembles the pronunciation of the word Tennessee, where the 10 is S4. When it is clearly heard it can indicate an increased resistance to ventricular filling. Sometimes S4 can occur normally in people older than 40, especially after exercise.

Question 10

Pericardial friction rub

Answer 10

Is a sound generated from inflammation of the pericardial sac as it rubs against the linings surrounding the heart, and not really a heart sound. Pericarditis is an inflammatory disease of the pericardium, which causes the membranes to become sticky, producing friction when the heart beats or when the patient breathe. This friction produces the sound known as a pericardial friction rub. It is a scratching, grading, high frequency sound that is heard in both systole and diastole. It seems to be heard with the diaphragm of the stethoscope at the left lower sternal border.

Question 11

Innocent (or functional) murmurs

Answer 11

Are non-cardiac murmur’s related to pregnancy, hyperthyroidism, exercise, and anemia. It is most often heard and children. This type of murmur is normally heard with systole in the pulmonic precordial area.

Question 12

Pathological murmurs

Answer 12

Are due to congenital or valvular defects. Specific valvular defects can be identified by their timing during (S, systolic, S, diastolic) and the auscultation region where they are heard.

Question 13

The presence of a thrill changes the grading of the murmur? True or False

Answer 13

True

Question 14

What position would you put the patient into for palpating or auscultating the PMI?

Answer 14

Left lateral decubitis position

Question 15

Where would you palpate and auscultate the PMI?

Answer 15

5th intercostal space, midclavicular line or 7-9 from midsternal line

Question 16

What is the normal diameter of the PMI?

Answer 16

1-2.5 cms

Question 17

Rare congenital transposition of heart, heart situated in the right chest cavity and generates right sided apical pulse

Answer 17

Dextrocardia

Question 18

JVP measured at 3cm above sternal angle, or >8cm above the right atrium is normal. True or False

Answer 18

False

Question 19

Where could you put the HOB for hypovolemic patients to see point of oscillation best?

Answer 19

You can put the HOB sometimes as low as 0.

Question 20

In volume overload, where would might the HOB go, to best assess the point of oscillation?

Answer 20

HOB 60 degrees or even 90 degrees.

Question 21

What maneuver would you perform to assess for mitral stenosis?

Answer 21

Left lateral decubitis position, listen lightly with the bell on the apical pulse.

Question 22

What maneuver would you perform to assess aortic regurgitation?

Answer 22

Have patient sit up and lean forward, breathe deeply and exhale completely, and have patient briefly stop breathing.

Question 23

How would you identify systole and diastole?

Answer 23

Auscultate the chest and palpate the right carotid artery in the lower 3rd of the neck with your left index and middle fingers.

Question 24

What position can the patient be in to auscultate mitral valve prolapse?

Answer 24

Squatting, supine, standing and seated.

Question 25

You auscultate loud and soft kortkoff sounds or sudden doubling of the HR as the cuff pressure declines.

Answer 25

Pulsus Alternans

Question 26

What does pulsus alternans indicate?

Answer 26

left ventricular dysfunction

Question 27

Greater than normal drop in systolic BP during inspiration

Answer 27

Paradoxical Pulse

Question 28

What murmur is often not heard until adulthood and is heard at the 2nd interspace, and radiates to the carotids, is harsh and has a midsystolic crescendo decrescendo and is heard best with the patient sitting and leaning forward?

Answer 28

Aortic Stenosis

Question 29

Which part of the stethoscope is aortic stenosis best detected with?

Answer 29

The diaphragm