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PCMIII Ex2 > Exam2 > Flashcards

Exam2 Flashcards

1
Q

Pressure, squeezing, sharp, burning

Radiates to back or jaw, shoulders, arms upper abdomen

A

Acute Coronary Syndrome

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2
Q

Patients with ACS the frequency of atypical presentations is increased in these groups:

A
  1. Older patients >75
  2. Women
  3. Diabetes mellitus
  4. Impaired renal function
  5. Dementia
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3
Q

Atypical symptoms of acute coronary syndrome

A

Epigastric apin
Indigestion
Stabbing or pleuritic pain
Increasing dyspnea in the absence of chest pain

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4
Q

Modifiable Risk factors for Cardiovascular disease

Nonmodifiable Risk factors

A

Nonmodifiable

  1. Age
  2. Family history
  3. Gender

Modifiable

  1. HTN
  2. Obesity
  3. High density lipoproteins/ Dyslipidemia
  4. Diabetes
  5. Smoking
  6. Sedentary lifestyle
  7. Obesity
  8. Stress
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5
Q

Negative risk factor for cardiovacular disease

A

HDL >/= 60 mg/dl

Protective

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6
Q

Nonspecific EKG Findings
May have inverted T wave
Normal Cardiac enzymes

A

Unstable angina

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7
Q

Normal or May have ST depression
T wave inversion
Elevated Cardiac enzymes

A

NSTEMI

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8
Q

ST segment elevation
LBBB
Elevated cardiac enzymes

A

STEMI

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9
Q

Immediate treatment of ACS

A

MONA-B

Morphine: 2 mg IV q4hr
O2: regardless of saturation
Nitroglycerine (NTG): 0.3 mg sublingual 5 min x3 for chest pain
Aspirin (ASA): 325 PO coated chewable
Beta blocker: if not contraindicated
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10
Q

Labs for ACS (6)

A
  1. CBC, CMP
  2. Cardiac markers
    - Troponin I or T immediately repeat Q6h x3
  3. CXR
  4. EKG: Immediately upon presentaion Q8h x3
  5. Lipid panel: fasting
  6. Urine drug screen
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11
Q

What to do if uncontrollable chest pain, new left bundle branch block or STEMI

A

STAT cath lab

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12
Q

NTG and phosphodiesterase inhibitors (Sildenafil- Viagra)

A

Absolue contraindication
-secondary to hypotensive effects secondary to systemic vasodilation

Can result in severe hypotension or even death

Use of phosphodiesterase inhibitors within 24 hr of presentation is a contraindication to use NTG

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13
Q

Chapman reflex of myocardium

A

2nd ICS along sternal border

Intertranserve spaces between T2-3

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14
Q

Chapman reflex of Bronchus

A

2nd ICS along sternal border

Lateral to T2 spinous process

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15
Q

When take immediately to Cath lab

A

Uncontrollable chest pain
New Left bundle branch block
STEMI

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16
Q

Chapman reflex of upper lung

A

3rd ICS along sternal border

Intretransverse space between T2-3 and intertransverse space between T3-T4

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17
Q

Chapman reflex of lower lung

A

4th ICS along sternal border

Intertransverse space between T4-T5

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18
Q

Chapman reflex 2nd ICS along sternal border

A

Myocardium

Bronchus

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19
Q

Chapman reflex 3rd ICS along sternal border

A

Upper lung

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20
Q

Chapman reflex 4th ICS along sternal border

A

Lower lung

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21
Q

Chapman reflex Intertranserve spaces between T2-3

A

Myocardium

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22
Q

Chapman reflex Intertranserve spaces between T2-3 and T3-4

A

upper Lung

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23
Q

Chapman reflex Lateral to T2 spinous process

A

Bronchus

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24
Q

Chapman reflex Intertranserve spaces between T4-5

A

Lower lung

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25
Q

Chest high pitched sounds (5)

A 
Use diaphragm
S1
S2
AR
MR
Friction Rubs
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26
Q

Chest low pitched sounds

A 
Use bell
S3
S4
MS
Carotid bruit
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27
Q

Steps to CV Exam (4)

A
  1. Inspection
  2. Palpation
  3. Percussion
  4. Auscultation
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28
Q

PMI Location

A

near the 4th -5th ICS in the Mid-clavicular line

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29
Q

PMI

  • size
  • timing
A

small brisk beat, measured less than 2.5 cm

Impulse should last through the first 2/3 of the systolic period (or less)

It should not be felt through the second heart sound

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30
Q

R 2nd ICS at SB

A

Aortic valve

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31
Q

L 2nd ICS at SB

A

Pulmonic valve

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32
Q

L 4th ICS at SB

A

Tricuspid valve

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33
Q

L 5th ICS at mid-clavicular line

A

Mitral valve

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34
Q

S1 sound

A

Closure of the Tricuspid and mitral valves

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35
Q

S2 sound

A

Closure of the aortic and pulmonic valves

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36
Q

S3 sound

A

Dull low pitch
best heard w/ bell

Due to high pressures and abrupt deceleration of inflow across the mitral valve at end of the rapid filling phase

Pathologic > 40

Kent-Tuck-Y

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37
Q

Pulmonic valve

A

L 2nd ICS at SB

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38
Q

S4 sound

A

Dull low pitch
best heard w/ bell

Atrial gallop from forceful contraction of atria against a stiffened (low compliant) ventricle

Can be normal in trained athletes

Ten-Nes-See

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39
Q

Systolic murmurs

A

Between S1 and S2

Aortic Stenosis
Pulmonic Stenosis
Mitral Regurgitation
Tricuspid Regurgitation

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40
Q

Tricuspid valve

A

L 4th ICS at SB

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41
Q

Diastolic murmurs

A 
Falls between S2 and S1
Aortic regurgitation
Pulmonic regurgitation
Mitral stenosis
Tricuspid Stenosis
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42
Q 
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
A

Grade 1: Very faint

Grade 2: Quiet but heard easily w/ stethoscope

Grade 3: Moderately loud no thrill

Grade 4: Loud w/ palpable thrill

Grade 5: Very load w/ thrill, may be heard partially off chest

Grade 6: heard with stethoscope entirely off chest

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43
Q

Aortic Valve

A

R 2nd ICS at SB

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44
Q

Moderately loud no thrill

A

Grade 3

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45
Q

Loud w/ palpable thrill

A

Grade 4

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46
Q

Grade 4+ on pulse

A

Bounding

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47
Q

Mitral valve

A

L 5th ICS at midclavicular line

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48
Q

Grade +1 edema

A

Slight pitting 2 mm

disappears rapidly

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49
Q

Grade +2 edema

A 
Slight indentation (4 mm)
10-15 sec
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50
Q

Grade +3 edema

A 
Deeper indentation (6mm)
may be >1 min
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51
Q

Grade +4 edema

A

Very marked indentation (8mm)

2-5 minutes

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52
Q

Fatigue, dyspnea, hemoptysis

A

Nontuberculosis Mycobacterial infection NTM

M. Kansaii

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53
Q

NTM dx:

A

sputum culture (Cx) and molecular diagnostic

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54
Q

Pneumonia
Nodules
Cavitation

A

Fungal infection

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55
Q

Fungal dx:

A

Sputum culture

Regional exposure

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56
Q

Fever cough, chest pain, hemoptysis, dyspnea

A

Lung cancer

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57
Q

Lung cancer dx

A

Histopathology

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58
Q

Hilar lymphadenopathy

A

Sarcoidosis

Can have cavitary lesions

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59
Q

Sarcoidosis dx

A

Histopathology- noncaseating granulomas

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60
Q

Septic emboli dx

A

blood culture

echocardiogram

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61
Q

Fever, cough, sputum production

A

Lung abscess

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62
Q

Lung abscess dx

A

CXR: air fluid levels in cavitary lesion

Other pulmonary infiltrates

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63
Q

What to do when positive TST test w/ history of BCG vaccination

A

IFN-gamma release assay

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64
Q

> 5 mm induration

A

HIV
Close contact
Fibrotic changes consistent w/ TB
Immunosuppression

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65
Q

> 10 mm induration

A

Silicosis, DM, Chronic renal failure, malignancies, malnourished, IV drug abuse

Children <4

Foreign

Healthcare employee

Homeless/ jail

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66
Q

> 15 mm induration

A

Healthy

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67
Q

Sputum culture for tuberculosis is a ___ diagnosis

A

Microbiological diagnosis

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68
Q

What is the gold standard for TB diagnosis

A

Culture

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69
Q

Inital screening stain for TB

A

Rhodamine-auramine stain

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70
Q

Confirmatory AFB stain for TB

A

Ziehl-neelsen and/or Kinyun stain

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71
Q

Interferon gamma release assay (IGRA) indicates

A

There has been a cellular response to tuberculosis

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72
Q

Nucleic acid amplification test (NAAT)

A

utilized in conjunction with a smear that is positive for AFB while cultures are pending

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73
Q

NAAT-TB

A

detects tuberculosis genetic material

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74
Q

NAAT-R

A

detects INH and rifamprin resistance

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75
Q

Red orange body fluids

A

Rifampin

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76
Q

Steven johnson syndrome

A

Rifampin

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77
Q

Peripheral neuropathy

A

Isoniazid (INH)

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78
Q

Gout hyperuricemia

A

Pyrazinamide

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79
Q

Optic neuritis, color blindness

A

Ethambutol

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80
Q

Next step after patietn diagnosed w/ TB report

A

report to state or local public health (24 hrs)

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81
Q

TB control hierarchy (3)

A
  1. Administrative controls
    - management measures to decrease risk of exposure
    - minimize the number of areas with exposure may occur
  2. Environmental controls (negative pressure room)
    - Prevent spread and reduce concetnration of infectious droplet
    - control source by local exhaust ventilation (hoods)
    - control air flow
    - respiratory protective equipment
  3. Respiratory cotnrols
    - use of personal protective equipment
    - training health care workers
    - educate patietns on respiratory hygiene and cough etiquette
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82
Q

Types O2 delivery (5)

A
  1. Room air= FiO2 21%
  2. Nasal cannula (NC)= 1-6 liters, 24-44%
  3. Simple face mask= 6-10 liters, 40-70%
  4. Venturi mask= 3-15 liters, 24-50%
  5. Non-rebreather (NRB)- 15 liters, bag reservoic 80-100%
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83
Q

Tension pneumothorax location needle decompression

A

2nd ICS just superior to 3rd rib margin at the midclavicular line

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84
Q

Chest tube insertion location

A

4th ICS at mid or anterior axillary line in the 4th intercostal space just superior to the margin of the 5th rib

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85
Q

Increased tactile fremitus

A

pneumonia

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86
Q

Decreased/ absent fremitus

A

COPD
Pleural effusions
Fibrosis
Pneumothorax

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87
Q

Dullness replaces resonance

A

Lobar pneumonia
Pleural effusion
Hemothorax

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88
Q

Hyperresonance

A

COPD
Emphysema
Asthma

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89
Q

Unilateral hyperresonance

A

Pneumothorax

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90
Q

Breath sound over most lungs

A

Vesicular

Soft and low pitched

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91
Q

bronchovesicular breath sounds

A

Intermediate in intensity and pitch
equally inspiration and expiration

Heard best 1st and 2nd ICS anterior and between scapulae

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92
Q

Bronchial breath sounds

A

Loud and high pitched
Expiratory sounds heard longer than inspiratory
Heard best over manubrium

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93
Q

Tracheal breath sounds

A

Very loud and high pitched
Heard equally in inspiration and expiration
Heard best over trachea of neck

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94
Q

Wheeze that is entirely or predominantly inspiratory in nature

A

Stridor
Medical emergency
Partial obstruction of larynx

95
Q

Weber/rinne test

A

lateralizes to one ear
(conduction loss in that ear or sensorineural loss in opposite)

Bone conduction>AC then conductive loss to that ear

96
Q

Most accurate place for skin tenting

A

Forehead

97
Q

Acute phase reactants that go down w/ infection/inflammation

A

Albumin

Transferrin

98
Q

Positive acute phase reactants

A 
ESR
CRP
Ferritin
WBC
haptoglobin
Ceruloplasmin
99
Q

Diagnostic criteria for AKI

KDIGO

A

Increase serum creatinine > 0.3 mg/dL within 48 hrs or >50% within 7 ways
or urine output of <0.5 in > 6 hrs

100
Q

Hyperkalemia

A

serum k > 7.0 meq/L

101
Q

Tall peaked T waves

Loss of Pwaves

A

Hyperkalemia

102
Q

Tx hyperkalemia

A

Give calcium gluconate

Give Insuin & glucose

103
Q

SIRS

A

2 or more

1) Temp > 38 C (100.4F) or <36
2) HR > 90
3) Resp rate >20 or PaCO2 <32
4) WBC >12,000

104
Q

Most common UTI

A

E coli

105
Q

Honeymoon cystitis

A

Staph saprophyticus

106
Q

Viscero-somatic reflex kidneys

A

T10-11

107
Q

Dialysis therapy

A

Fluid overload
Hyperkalemia
Metabolic acidosis

108
Q

BUN:Cr ratio in upper GIB

A

30:1

109
Q

Division Upper GIB vs lower GIB

A

Ligament of Trietz

110
Q

Abruptly stopping a beta blocker can lead to

A

Rebound sinus tachycardia

111
Q

Fast of KCL in peripheral IV

A

10mEq/ hr

112
Q

When to transfuse

A

Young patients w/ comorbidities: Hemoglbin <7 g/dL

Olderpatients w/ comorbid require >9 g/dL

113
Q

Colorectal cancer screening

A

regular starting at 45 –> 75

no longer at 85

first degree relative diagnosed before 60
- every 5 years beginning at 40 or 10 years before age of relative

Famililal adenomatous polyposos
- genetic testing, annual screening by sigmoidoscopy starting at age 10-12 yrs

Hereditary nonpolyposis colorectal cancer
-genetic testing or colonscopy every 1-2 yrs being at 20-25 or 10 years younger than age of diangosis in family

114
Q

ASCA positive

A

Crohns

115
Q

Crohns descriptors

A 
Skip lesions
String sign
Non-caseating granuloma
Abscesses
Fissures
Cobble stoning
Creeping fat
116
Q

UC descriptors

A

Continous lesions
Bloody diarrhea
Toxic megacolon
Ulcerated pseudopolyps

117
Q

pANCA positive

A

UC

118
Q

Check what before immunomodulatory or biologic medication

A

TPMT (Thiopurine methyltransferase) enzyme activity- metabolizes azathiopurine
PPD skin test for TB
Viral hepatitis serology

119
Q

AAA size

A

> /= 3 cm

120
Q

Cecum

A

lateral proximal 1/5th of right thigh

anteriorly on tensor fascia lata

121
Q

Ascending colon

A

R lateral middle 3/5th of thigh, anterior distribution of IT band

122
Q

Transverse colon

A

Proximal to knee, anterolateral aspect of thigh bilaterally

123
Q

Sigmoid colon

A

Lateral proximal 1/5th of left thigh anteror on tensor fascia lata

124
Q

Descending colon

A

L lateral middle 3/5th of thigh, anterior distribution of IT band

125
Q

Rectum

A

Medial aspect of proximal thigh over lesser trochanters bilaterally

Posterior: sacrum, at lower end of SI articulation bilaterally

126
Q

Colon posteriorly

A

Transverse process L2 to TP of L4 extending laterally to iliac crest

127
Q

Adrenals chapman

A

2-2.5 above and lateral umbilicus

Intratransverse space T11-T12

128
Q

Kidney chapman

A

1 above 1 lateral umbilicus

intertransverse spaces between T12-L1

129
Q

Ureter chapman

A

1 above 1 lateral umbilicus

Intertransverse spaces between L1-L2

130
Q

Bladder chapman

A

Periumbilical/ umbilical

Superior edge of L2 TP

131
Q

Urethra chapamn

A

Inner edge of pubic ramus near symphysis

Superior edge of L2 TP

132
Q

Viscerosomtics

A 
Heart: T1-5
Lungs: T2-7
Esophagus: T2-T8
Stomach: T5-T9
Liver T6-T9
Gallbladder T6-9
SI: T9-T11
Colon: T10-L2
Pancreas: T5-T11
Appendix T12
Kidney: T10-L1
Ureter: upper T10-L1; Lower L1-L2
Bladder T11-L2
133
Q

Murphy sign

A

palpate deeply under right costal margin during inspiration & observe for pain &/or sudden stop in inspiratory effort

Acute cholecystitis or cholelithiasis

134
Q

Courvoiser sign

A

enlarged non-tender gallbladder secondary to pancreatic disease or cancer

135
Q

Iliopsoas muscle test

A

flex hips against resistance

Increased abdominal pain

Irritation of psoas m from inflammation of appendix

136
Q

Obturator muscle test

A

Flex patietns right thigh at hip, with knee bent, rotate leg internally at hip

Right hypogastric pain is positive

Irritation of obturator from inflammed appendix

137
Q

Heel strike

A

Appendicitis or peritonitis

138
Q

Rovsing sign

A

RLQ pain during left sided pressure

Apenditicits

139
Q

McBurney

A

Rebound tenderness or pain 1/3 of the distance form ASIS to umbilicus

Apendicitis

140
Q

Appendicitis test

A 
McBurney
Rovsing
Heel strike
Obturator
Psoas
141
Q

Meningitis birth-2 months

A

Group B strep
E coli
Listeria monocytogens

142
Q

Meningitis 2 months-12 years

A

S. penumoniae (G + diplococci)
N. meningitides (Gram - diplococci)
H. influenza (gram - coccobacilli)

143
Q

Meningitis adolescents

A

N. meningitidis

144
Q

Meningitis >60

A

S. pneumoniae

Listeria monocytogenes

145
Q

CSF

  • Bacteria
  • Viral
  • Fungal
A

Bacterial

  • Pressure >300
  • WBC >1000
  • Glucose <40

Viral

  • pressure <300
  • WBC <1000
  • Glucose >40

Fungal
- pressure 300
- WBC <500
Glucose < 40

146
Q

Kernig sign

A

flex patient leg at both hip and knee, the straighten extend knee

147
Q

Brudzinski sign

A

as flex neck, hip and knees react

148
Q

Meningitis tx

A

Vancomycina nd ceftriaxone

+ampicillin if >50

149
Q

Bells palsy

A

upper and lower face
loss of taste
hyperacusis
CN7 lesion

150
Q

CNXII lesion

A

Tongue licks its wounds

151
Q

Top shoulder

A

C4

152
Q

Radial aspect forearm

A

C6

153
Q

Little pinkie

A

C8

154
Q

Nipple

A

T4

155
Q

Tip xiphoid

A

T7

156
Q

Umbilicus

A

T10

157
Q

Patella

A

L4

158
Q

Great toe

A

L5

159
Q

Little toe

A

S1

160
Q

Continous murmurs (4)

A

PDA- machinery

  • patent ductus arterosis
  • connection between aorta and pulmonary a.

AV fistula

ASD w/ high LA pressure

Coarctation
-narrowing or stricture in aortic arch distal to left subclavian artery

161
Q

Mitral regurgitation (MR) due to (chronic)

A

MVP
-myxomatous degeneration (most common)

MAC (mitral annular calcification

162
Q

Mitral regurgitaiton (MR) acute causes

A

Rupture of chordal tendineae
Rupture of papillary muscle
Ischemic papillary muscle dysfunction
Infective endocarditis (IE); valve perforation

163
Q

Systolic murmur
Blowing
Prominent at apex
Radiates into left axilla

-may have

A

Mitral regurgitation

  • Decreased S1 or normal
  • Systolic click
164
Q

Severity of MR relates to

A

Loudness of murmur

165
Q

RHF/LHF murmur

A

MR

166
Q 
Pulmonary edema
Hemoptysis
Arterial emboli 
Afib
Murmur
A

Mitral stenosis

167
Q

Ortner syndrome

- murmur

A

hoarseness= compression of left recurrent laryngeal nerve

Mitral stenosis

168
Q

Malar flush

-murmur

A

Ruddy cheeks, blue facies

Mitral stenosis

169
Q

Diastolic murmur
RUmbling
Low pitched heard at apex
Increased S1

A

Mitral stenosis

170
Q

Rheumatic heart

A

Aortic stenosis

171
Q

Angina
Syncope
Heart failure
-Murmur

A

Aortic stenosis

172
Q

Narrow pulse pressure
Decreased SV and systolic pressure
Delayed pulses

A

Aortic stenosis

173
Q

Systolic murmur, harsh 2nd ICS RSB

Radiates into supra sternal notch/ carotids

A

Aortic stenosis

174
Q

Gallavardin phenomen

A

Aortic stenosis

Murmur radiates to apex like MR

175
Q

Aortic dissection
Syphilis
Ankylosing psondylitis
- Murmur

A

Aortic regurgitation

176
Q

Wide pulse pressure
Whole lots of signs
-De musset, corrigan, quincke, traube

A

Aortic regurgitation

177
Q

Diastolic murmur
Decrescendo
3rd ICS, LSD

A

Aortic regurgitation

178
Q

Murmur assoc w/ pulmonary HTN

Inferior MI/ RV infarction

A

Tricuspid regurgitation

179
Q

Prominent V wave in JVP

A

Tricuspid regurgitation

180
Q

Blowing systolic murmur LSB
Increase w/ inspiration (carvallos sign)
3-4th ICS

A

Tricuspid regurgitiation

181
Q

Prominant A wave in JVP, ascites, hepatomegaly

A

Tricuspid stenosis

182
Q

Diastolic murmur LSB 4th CIS, increase w/ inspiration and decrease with expiration and valsalva

A

Tricupsid stenosis

183
Q

Diastolic blowing murmur 2nd LSB, 2nd ICS

A

Pulmonic regurgitation

184
Q

Graham steell

A

Pulmonic regurgitation

185
Q

Systolic murmur, 2nd-3rd CIS, LSB/ radiates toward left shoulder and incrases on inspiration

A

Pulmonary stenosis

186
Q

Murmur associated with TOF or TGA

A

Pulmonary stenosis

187
Q

D-dimer is for

A

Pulmonary embolism

Non-specific, pulmonary complaints

188
Q

When you think patient had stroke what do you get

A

Duplex

189
Q

What to get if patient has paresthesia, numbness, weakness, loss of sensation, history of nerve complaints

A

Nerve conduction study

190
Q

Most common use of doppler

A

Fetal heart sounds

191
Q

Doppler US vs Duplex

A

Doppler records sound waves reflecting off moving objects such as blood, measures their speed and other aspects of how they flow

Duplex is doppler US plus traditional US

192
Q

Head CT: After you confirm thrombus what additional test to confirm how the incident occured?

A

Transthoracic echocardiogram with bubble study

193
Q

When to use transesophageal echocardiogram

A

Great for endocarditis

Views of posterior structures of heart

194
Q

Choice to use w/ HF

A

Transthoracic echocardiogram with EF measurement

195
Q

Bubble study

A

real time assessment of intracardiac blood flow

R–>L shunts in atrium or ventricle, PFO, arteriovenous shunt in pulmonary vaculature

196
Q

Pericarditis + car accident=

A

Tampanode

197
Q

When to immediately transfer to Cath lab

A

evidence of MI on EKG

198
Q

FAST Exam

A

Focused assessment with Sonography in Trauma
Tamponade

To detect hemoperitoneum & pericardial effusion

199
Q

6 What to use when suspect tamponade

A

FAST exam

200
Q

Assess for DVT

A

Compression US of femoral v.

201
Q

Electrical alternates on EKG

A

Tamponade

Heart is swinging back and forth in fluid wave

202
Q

Beck’s triad

A

++JVP
Muffled heart sounds
– BP

Cardiac tamponade

203
Q

Initial test of choice to evaluate cardiac anatomy and function

A

Transthoracic echocardiogram

204
Q

Transthoracic echocardiogram used for

A

Evaluate

  • Pericardium
  • ventricles/artia/septa
  • cardiac valves
  • ejection fraction
205
Q

Think dissection what exam

A

Abdominal aortic angiography

206
Q

If bruits in carotids exam

A

B/L carotid artery US

207
Q

Abdominal aortic aneurysm size

A

> 3 cm

Palpable at 5 cm

208
Q

AAA at 5 cm requires

If AAA >4 cm then

A

CTA of the abdominal aorta
Computed tomography angiography

Refer to vascular specialist

209
Q

Patient in A fib

A

Transesophageal echo

210
Q

At birth 3 things that happen

A
  1. Foarmen ovale closes
  2. ductus arteriosus closes (forms ligamentum arteriosus)
  3. Ductus venosus closes (forms ligamentum teres)
211
Q

Patients with a history of sudden death in young people

A

Idiopathic hypertrophic subaortic stenosis (IHSS)

212
Q

Full cardiac exam on infants if

A
  1. Feeding intolerance
  2. Failure to thrive
  3. Respiratory symptoms
  4. Cyanosis
213
Q

Full cardiac exam on older children if

A
  1. Chest pain (not relasted to musculoskeletal)
  2. Syncope
  3. Exercise intolerance
  4. Hx of sudden death
214
Q

Six things to look for with Mumurs

A
  1. Grade
  2. Timing
  3. Location of highest intensity
  4. Character
  5. Changes with position
  6. Radiation
215
Q

Thrill

A

Grade 4 murmur

216
Q

Thrill caused by

A

Blood flowing from high pressure to lower pressure

217
Q

Splitting of heart sounds

A

Split S1 is normal
Split S2 w/ inspiration normal

Fixed split S2 is indicative of an atrial septal defect (ASD)

218
Q

Fixed split S2 is indicative of

A

atrial septal defect (ASD)

Get overfilling of right side of heart, there for closure of pulmonic valve is delayed a little bit behind the aortic valve, doesnt go away w/ inspiration

219
Q

If S1 or S2 obscured tehn

4 causes

A

Holosytolic murmur

  1. VSD
  2. AV valve regurgitation murmur
  3. Patient ductus arteriosis
  4. severe pulmonary valve stenosis
220
Q

VSD causes a ___ murmur

A

Holysystolic murmur

221
Q

Diastolic murmur (4)

A

LIsten w/ bell

Usually lower pitched

“Rumbling” character

Never normal on its own

222
Q

Only sound in diastole taht doesnt warrant a referral to cardiology

A

Venous hum

223
Q

Venous hum caused by

A

caused by flow of venous blood from the head and neck into thorax

224
Q

Venous hum should disappear (3)

A
  1. When pressure is place on the jugular vein
  2. Child heads is turned
  3. Child is lying supine
225
Q

What murmur decreases in intensity when child stands

A

A Still’s murmur

226
Q

Only pathologic murmur that changes significantly with standing

A

Hypertrophic cardiomyopathy
Idiopathic hypertrophic subaortic stenosis (IHSS)

Murmur increases in intensity when stands up

227
Q

Harsh crescendo descrescendo systolic murmur heard best at apex and left sternal border

A

IHSS

228
Q

Key features to innocent murmers

-7 S

A 
Sensitive (changes w/ position)
Short duration (not holysystolic)
Single (no clicks or gallops)
Small 
Soft
Sweet (not harsh sounding)
Systolic
229
Q

Referral to a cardiology (12)

A
  1. Grade 4 murmur
  2. Diastolic murmur
  3. INcrease in intensity when patient stands
  4. Murmur symptomatic
  5. Heart sounds obscured
  6. Femoral pulses weak
  7. Clicks
  8. Hyperactive precordium
  9. Hx of sudden death
  10. Abnormal or extra heart sounds
  11. Conditions predisposing patietn to congenital heart lesions
  12. Get “that feeling”
230
Q

Still’s murmur

A

Innocent murmur

Best heard at APEX of heart & L sterna border, w/ bell

231
Q

5 cyanotic congenital defects

A

1) Big trunk: truncus arteriosus
2) Interchanged vessels: Transposition of great vessels
3) Tricuspid atresia
4) Tetralogy of fallot
5) Total anomalous pulmonary venous return

232
Q

Lesions assoc with critical congenital heart disease (CCHD)

A

Ductal dependent lesions

233
Q

Before baby goes home

A

O2 sat test done on upper extremity and lower extremity

PCMIII Ex2 (10 decks)

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