Final Flashcards
What is the normal location and diameter of PMI? What happens to PMI in LV
5th interspace 7 to 9 centimeters lateral to the mid-sternal line. It is approximately the size of a quarter, 1 to 2.5 centimeters in diameter.
In Left Ventricular Hypertrophy (LVH), the PMI is displaced laterally and found greater than 10 cm lateral to the mid-sternal line
What are the locations on the chest wall where you hear the murmurs originating each of the mitral valve, tricuspid valve, pulmonic valve, and aortic valv
Mitral Valve Murmur: at or around the cardiac apexTricuspid
Valve Murmur: at or near the lower left sternal border
Pulmonic Valve Murmur: 2nd and 3rd interspaces close to the sternum, but occasionally higher or lower
Aortic Valve Murmur: anywhere from the right 2nd interspace to the apex
What is the importance of JVP? From which vein is it best estimated
Jugular Venous Pressure (JVP) reflects right atrial pressure and is best estimated from the right external jugular vein
What are the causes of weak pulse
Weak Pulse: decreased stroke volume (heart failure, hypovolemia, severe aortic stenosis) and increased peripheral resistance (cold exposure, severe congestive heart failure)
Causes of bounding pulsw
Bounding Pulse: increased stroke volume, decreased peripheral resistance or both (fever, anemia, hyperthyroidism, aortic regurgitation, arteriovenous fistulas, patent ductus arteriosus), increased stroke volume due to slowed heart rate (bradycardia, complete heart block), and decreased compliance of aortic walls (aging, atherosclerosis, aortic insufficiency
pulsus alternans
pulse alternates in amplitude from beat to beat even though the rhythm is basically regular. Indicates left ventricular failure
Paradoxical Pulse:
a palpable decrease in pulse amplitude on quiet inspiration. Found in pericardial tamponade, constrictive pericarditis, and obstructive lung disease
Paroxysmal nocturnal dyspnea
episodes of sudden dyspnea and orthopnea that awaken the patient from sleep, usually 1 or 2 hours after going to bed, prompting the patient to sit up, stand up, or go to a window for air. The episode usually subsides but may recur at about the same time on subsequent nights. Causes include left ventricular heart failure or mitral stenosis
What are the AHA guidelines for screening of BP, BMI, waist circumference, fasting lipoprotein profile and fasting glucose in adults for prevention of cardiovascular diseases and stroke
Blood pressure, BMI, waist circumference and pulse should be screened at each routine visit (at least every two years).Fasting lipoprotein profile and fasting glucose should be screened at least every five years (or every 2 years if risk factors for hyperlipidemia or diabetes are present).
What are the steps in assessing JVP? What is normal JVP? What are the causes of increased NP
Make the patient comfortable. Raise the head slightly on a pillow to relax the sternocleidomastoid muscles.
▪Raise the head of the bed or examining table to 30°.
▪Turn the patient’s head gently to the left Identify the topmost point of the flickering venous pulsations using tangential lighting if necessary.
▪Place a centimeter ruler upright on the sternal angle. Place a card or tongue blade horizontally from the top of the JVP to the ruler, making a right angle.
▪Measure the distance above the sternal angle in centimeters: a 3-to 4-centimeter elevation is normal
Increased pressure suggests right-sided congestive heart failure or, less commonly, constrictive pericarditis, tricuspid stenosis, or superior vena cava obstruction
How will you distinguish between internal jugular and carotid pulsation
carotid is:
palpable
only has one phase
pulse unchanged by position
What is the cause of delayed carotid upstrok
Aortic stenosis
Define bruit.
murmur-like sound of vascular rather than cardiac origin
what is the cause of carotid bruit
aortic valve murmur
what is the significance of asymptomatic carotid bruit
3X increased risk for ischemic heart disease and stroke
Define thrill
A thrill is a humming vibrations, or thrills, that feel like the throat of a purring cat and may be caused by aortic stenosis, patent ductus arteriosus, ventricular septal defect, and mitral stenosis.
What are the sounds you hear better with the diaphragm
high-pitched sounds like S1, S2, and also S4 and most murmurs
best sound to hear with bell?
low-pitched sounds like S3 and the rumble of mitral stenosis.
How will you determine whether a murmur is systolic or diastolic
Systolic murmurs fall between S1 and S2. Diastolic murmurs fall between S2 and S1
Which way does a murmur of aortic stenosis radiate
A loud murmur of aortic stenosis often radiates into the neck (in the direction of arterial flow), especially on the right side
which grades has a palpable thrill?
grade 4 and up
Where is the location of epitrochlear lymph node
Epitrochlear lymph nodes are located on the medial surface of the arm approximately 3 cm above the elbow.
What are the 2 groups of superficial inguinal lymph nodess
horizontal group lies in a chain high in the anterior thigh below the inguinal ligament. The vertical group clusters near the upper part of the saphenous vein.
Define intermittent claudication
Intermittent claudication is pain or cramping in the legs during exertion that is relieved by rest within 10 minutes
Cause of intermittent claudication
Chronic arterial occlusion, usually from atherosclerosis, c
How to distinguish between intermittent claudication and spinal stenosis pain
reduced pain by leaning forward and stretching the spinal cord in the narrowed vertebral canal is spinal stenosis
Ischemia of which artery can cause abdominal pain after meals and associated food fear?
Celiac or superior or inferior mesenteric arteries.
causes of asymmetric BP in the two arms
Coarctation of the aorta and dissecting aortic aneurysm
Normal pulse
2 + / brisk
common cause of a decreased or absent pedal puls
Occlusive disease in the lower popliteal artery or its branches, often seen in diabetes mellitus
signs of superficial thrombophlebitis?
Local swelling, redness, warmth, and a subcutaneous cord suggest
signs of chronic venous insufficiency in the leg?
Brownish discoloration or ulcers just above the malleolus
causes of thickened brawny skin?
lymphedema and advanced venous insufficiency.
What are the causes of absent or diminished wrist pulses?
Buerger’s disease (thromboangiitis obliterans).
What is the purpose of Allen test?
patency of the ulnar and radial arteries.
Define Raynaud’s disease.
episodic spasm of the small arteries and arterioles with no vascular occlusion.
What are the features of chronic venous insufficiency ulcers,
medial and sometimes the lateral malleolus.
small, painful granulation tissue and fibrin;
features of arterial insufficiency ulcers,
toes, feet, or possibly areas of trauma (shins).
shows no callus
Pain often is severe
Gangrene may be associated
features of Neuropathic Ulcers
pressure points of areas with diminished sensation;
skin is calloused.
no pain,
no gangrene.
pitting edema,
Edema is soft, bilateral, with pitting on pressure, on the anterior tibiae and feet. (no skin thickening)
Lymph-edema
nonpitting.
biliary tree pain is usually referred to?
to the right shoulder or right posterior chest.
duodenal or pancreatic is usually referred to?
the back.
causes of doubling over with cramping, colicky pain,
renal stone.
Sudden knifelike epigastric pain
gallstone pancreatitis.
characteristics of pain in appendicitis
RLQ or migrates from periumbilical region,
Diverticulitis pain
LLQ with a palpable mass.
Colon cancer
change in bowel habits with mass lesion.
causes of regurgitation of gastric contents?
GERD, esophageal stricture, and esophageal cancer.
the causes of hematemesis?
esophageal or gastric varices, gastritis, or peptic ulcer disease.
causes of early satiety?
gastric cancer, and hepatitis.
location of esophageal dysphagia?
below the sternoclavicular notch.
Define acholic stool.
Acholic stools are gray or light colored due to obstructed bile excretion.
the cause of jaundice with itching?
Jaundice with itching is due to obstructive jaundice.
features of acute pyelonephritis?
Kidney pain, fever, and chills
location of flank pain?
at or below the posterior costal margin near the costovertebral angle.
character of ureteral pain?
severe and colicky and radiates from the costovertebral angle around the trunk to the groin.
What are the causes of pink, purple striae on abdomen?
Cushing’s syndrome.
What are the causes of Dilated veins on the abdomen
hepatic cirrhosis or inf. vena cava obstruction.
What are the causes of Bulging flanks
ascites.
What are the causes of Suprapubic bulge on the abdomen
distended bladder, pregnant uterus, or hernia.
Rovsing’s sign
rebound tenderness in the left lower quadrant.
Referred rebound tenderness
RLQ pain on quick withdrawal.
Psoas sign
pain when the patient flexes his thigh against the examiner’s hand.
Obturator sign
pain when you flex the patient’s thigh and rotate the leg internally
How Murphy’s sign is elicited?
hook fingers under the costal margin
Ask the patient to take a deep breath.
Abdominal wall mass vs. intraabdominal mass:
A mass in the abdominal wall remains palpable when abdominal muscles are tightened
Acute Pancreatitis Location:
Epigastric pain that may radiate to the back or abdomen.
Acute Pancreatitis A/A Factors:
Food aggravates, not relieved by food or antacids.
Acute Cholecystitis Location:
RUQ or upper abdominal pain that may radiate to right
scapular area.
causes of post-menopausal bleeding?
endometrial cancer,
hormone replacement therapy,
uterine and cervical polyps.
cervical cancer screening guidelines?
First Screen: 3 years after first intercourse or at age 21 (whichever is first)
21-29: every 2 years
30-65: every 2 to 3 years
over 65: can stop having cervical cancer if no history
most common STD in the USA?
Chlamydia trachomatis
modes of transmission of HIV in women?
infected partner with high HIV-1 load;
cervical ectopy;
sex during menstruation;
and male partner without circumcision.
red flags warranting HIV testing for women?
recurrent vulvocandidiasis,
concurrent STDs,
abnormal Pap smears,
and HPV infections.
What sign suggests pelvic inflammatory disease on cervical exam?
Pain on movement of the cervix together with adnexal tenderness during a cervical exam suggests PID.
features of Syphilitic Chancre:
firm, painless ulcer
features of Secondary Syphilis:
slightly raised,
round or oval,
flat-topped papules covered by a gray exudate (contagious)
features of Carcinoma of the Vulva:
ulcerated or raised red vulvar lesion in an elderly woman
