General Diagnosis 4 Flashcards
S1 heart sounds
closure of AV (mitral and tricuspid) valves
S2 heart sounds
closure of semilunar (pulmonary and aortic) valves
S3 heart soudns
ventricular gallop
normal in children, young adults, and athletes
>40 years earliest sign of CHF
S4 heart sounds
atrial gallop
similar to S3 and is related to stiffness of ventricular myocardium to rapid filling
aortic valve location
right sternal border at 2nd intercostal space
best auscultated with patient seated, leaning forward, and exhaling
pulmonic valve location
left sternal border at 2nd intercostal space
erb’s point location
left sternal border at 3rd intercostal space
tricuspid valve location
left sternal border at 4th or 5th intercostal space
mitral valve location
mid-clavicular line at 5th intercostal space
best auscultated in left lateral decubitus position
stenosis
valve has trouble opening and blood swirls through a narrow opening
murmur has a low pitch and is best heard with bell of stethoscope
regurgitation
valve is insufficient and blood seeps or squirts back into the chamber
this murmur has a high pitch and is best heard with diaphragm of stethoscope
ARMS&PRTS
occurs in diastole
patent ductus arteriosus
failure of shunt to close between the aorta and left pulmonary artery
creates a continuous/machinery like murmur that can be heart in both phases of heart cycle
tetrology of fallot
dextraposition/overriding of aorta, right ventricular hypertrophy, interventricular septal defect and pulmonic stenosis
creates a loud ejection murmur during systole and severe cyanosis
coarctation of aorta
constriction of descenting aorta
causes higher blood pressure in upper extremity by 20mmHg when compared to lower extremity
subclavian steal syndrome
proximal stenosis of subclavian artery
seen in younger females who faint while exercising
left sided heart failure
MC cause of left sided heart failure is HTN (35-55yo)
early signs of left sided heart failure
pulmonary edema, shorteness of breath, orthopnea
fluid collects at costophrenic angles
right sided heart failure
MC cause is left sided heart failure
increased heart rate, S3 gallop, decreased BP
MC cause of mitral stenosis
rheumatic fever
cor pulmonale
when right side fails by itself
baks up to SVC and down IVC
right sided heart failure leads to?
edema and fluid in extremities, jugular vein distention (SVC), liver/spleen enlargement, +hepatojugular reflex, ascites, caput medusa, pitting edema, stasis dermatits
aortic dissection
an interruption of infima allowing blood into the vessel wall with immeidate “tearing” pain
acute surgical emergency
associateed with HTN, arteriosclerosis (descending aorta) and marfan’s (ascending aorta)
marfan’s syndrome
inherited CT disorder with ventricular weakinging and enlargement
presents with tall, long fingers/limbs, lens subluxation, cardiovascular and lung problems
angina pectoris-coronary vasospasm
comes on with exertion
printzmetal angina comes on with rest (atypical)
relieved by vasodilators under tongue
MI
acute heart failure
comes on with rest
caused by atherosclerosis
CK-MB is elevated, increased LDH, increased SGOT
aneurysm
abnormal widening that involves all 3 layers
defect in elastic-media tissues
p wave
normal atrial depolarization
qrs complex
depolarization of ventricles
repolarization of atria hidden here
t wave
repolarization of ventricles
u wave
repolarization of papillary muscles
increased PR interval
prolonged AV nodal delay
primary heart block
two P waves before QRS
weinkbochs-block of bundle of HIS
seondary heart block
ST segment enlarged or inverted
MI (acute heart failure)
no QRS pattern
complete heart block
ventricular contraction
no P wave
atrial fibrillation
echocardiaogram/doppler
used to evaluate heart valves
increased bowel sounds
early intestinal obstruction
absent bowel sounds
late intestinal obstruction
adynamic (paralytic) ileus
hematamesis
vomiting blood
hemoptysis
coughing up lood
hematochesia
blood instool
tests non specific for liver
increased alkaline phosphatase
SGOT/AST
aspartate transaminase
LDH
tests classic for liver
GGT
SPGT/ALT
tests for liver and kidneys
BUN
jaundice
ywllowing of the skin, sclera, mucous membranes
can occur with liver disorder
what is the most common cause of liver cirrhosis
alcoholism
cirrhosis causes?
HTN
ascites
esophageal varices
mallory weiss syndrome
coughing
tearing esophageal blood vessels
hematamesis
with palmar rash due to bile salts
wernicke-korsakoff syndrome
thiamin deficiency from alcoholism that leads to dementia
beri beri
thiamin deficinecy without alcoholism
s/s of hepatitis
liver may be tender and enlarged but the adge ramins soft and smooth
hepatitis a
from food through fecal/oral rout, self lmiting, not a carrier
hepatits b
dirty needles and sexual contact, carrier for life, most common to become liver cancer
hepatitis c
blood transfusions, illegal drug use
liver cancer
most common site for metastatic disease
liver is enlarged, with a hard and irregular border
alpha fetoprotein
a tumor marker spwcific for hepatocellular carcinoma
how do we definitively diagnose liver cancer?
biopsy
