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H&P > H&P Final Exam: Cardio > Flashcards

H&P Final Exam: Cardio Flashcards

1
Q

What are palpitations commonly described as?

A

Skipping, fluttering, pounding, stopping, flip-flopping, and racing.

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2
Q

What is edema?

A

Accumulation of fluid in the extravascular interstitial space.

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3
Q

How do I know if edema is due to CHF?

A

It is consistent in when it occurs.

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4
Q

How much weight gain can one get from edema?

A

up to 10% (5L of fluid can be absorbed by the interstitial space)

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5
Q

Why does edema occur in pregnancy?

A

Mothers have to increase their blood volume to compensate for the fetus.

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6
Q

Where are the 5 listening posts in terms of intercostal spaces?

A

Aortic = R 2nd intercostal parasternal
Pulmonic = L 2nd intercostal parasternal
Left sternal = L 3-5th intercostal parasternal
Tricuspid = L 5th intercostal space parasternal
Mitral = L 5th intercostal space (anterior axillary)

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7
Q

What do pulsations indicate?

A

Increased blood volume and/or pressure.

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8
Q

What are heaves?

A

Forceful cardiac contractions causing slight to vigorous movement of sternum and ribs and can rhythmically lift your fingers.

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9
Q

What are thrills and what do they indicate?

A

Buzzing or vibration sensation of loud cardiac murmurs. Occurs in turbulent blood flow.

Note:
Similar to a cat purring.

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10
Q

How does the apex shift if someone has LVH?

A

The apex will shift left.

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11
Q

What does the base of the heart refer to?

A

Superior aspect of the heart at the R and L 2nd intercostals near the sternum.

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12
Q

What is another name for PMI?

A

Apical impulse

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13
Q

Where is the PMI/apical pulse palpated?

A

5th ICS, 7-9 cm lateral to midsternal or just medial of the L midclavicular.

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14
Q

When can a PMI not be palpable?

A

Healthy and/or obese people.

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15
Q

How large is a PMI? What makes it larger?

A

<2.5cm (quarter sized)

Left Lateral Decubitus enlarges it.

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16
Q

What is the amplitude of a PMI?

A

Small, brisk, tapping.

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17
Q

What is indicated by strong suprasternal/epigastric pulsations?

A

Increased R ventricular pressure
Ex: Chronic lung disease

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18
Q

What is pulse pressure?

A

SBP - DBP, so its normally around 40 mm Hg.

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19
Q

What is a dicrotic notch?

A

A second notch found in between the SBP and DBP that occurs due to transient increases in aortic pressure as the aortic valve closes.

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20
Q

What is JVP used to diagnose?

A

Right sided heart pressures and cardiac function.
It acts as a barometer to determine the filling pressures of the chambers.

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21
Q

What are two common causes of elevated JVP?

A

Pulmonary HTN

Long-standing Systolic HF

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22
Q

What does JVP parallel in the body?

A

R atrium pressure/central venous pressure.

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23
Q

What is elevated JVP commonly correlated with?

A

Acute and chronic HF.

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24
Q

Describe a jugular waveform.

A

Multiple peaks,

Note:
See slide 20 for a visual.

R atrium contraction is the highest peak.

R ventricle contraction and R atrium filling are similar heights.

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25
Q

What is Kussmaul’s sign?

A

Elevated JVP during inspiration, suggestive of constrictive pericarditis.

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26
Q

What is the acronym POLICE for?

A

Differentiating between carotid and internal jugular pulsations.

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27
Q

What does POLICE stand for?

A

Palpation
Occlusion
Location
Inspiration
Contour
Erect/Position

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28
Q

What is the POLICE for a jugular vein?

A

Palpation: rare
Occlusion: eliminated by light pressure
Location: superficial and lateral in neck, between SCM heads.
Inspiration: height falls during inspiration.
Contour: Double impulse, 3 peaks, 2 troughs.
Erect/Position: Height drops as patient becomes more upright.

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29
Q

What is the POLICE for a carotid?

A

Palpation: palpable
Occlusion: not eliminated by pressure
Location: Deep and medial in neck
Inspiration: no effect
Contour: single thrust
Erect/position: no effect

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30
Q

If I have decreased blood volume, what happens to my JVP?

A

JVP will fall.
Jugular veins will collapse.

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31
Q

If I have increased blood volume, what happens to my JVP?

A

JVP will increase
JVD will occur

Note:
Can occur due to impeded flow into R side of heart or impeded diastolic filling.

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32
Q

What is normal JVP?

A

<3cm below the sternal angle

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33
Q

What is the angle made when measuring JVP?

A

Angle of Louis

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34
Q

If I anticipate my patient is in hypovolemia, what should I do to the head of the bed?

A

Lower the head of the bed, because JVP will be lower.

35
Q

If I anticipate my patient is in hypervolemia, what should I do to the heard of the bed?

A

Raise the head of the bed, because JVP will be higher.

36
Q

What sound is a carotid bruit?

A

Turbulent arterial blood flow.
Sounds like a murmur.

37
Q

If my patient has a weird carotid, what pulse do I assess instead?

A

Brachial

38
Q

Where is S1 heard the loudest?

A

At the apex.

39
Q

What are the characteristics of S1?

A

Closure of AV valves.

Lub sound

Corresponds with pulse

40
Q

What listening post is best to hear S1 splits?

A

Left sternal border

41
Q

What does it mean if S1 is split?

A

MV closure is significantly preceding TV closure.

42
Q

Where is S2 heard the loudest?

A

Base of the heart

43
Q

What listening post is best to hear S2?

A

2nd and 3rd ICS.

44
Q

What are the characteristics of S2?

A

Closure of semilunar valves.

Physiologically split because AV closure precedes PV valve closure normally.

45
Q

When is S2 splitting abnormal?

A

Upon expiration.

Inspiration is normal.

46
Q

What is S3?

A

Kentucky/ventricular gallop.

It represents an increased volume of blood hitting a compliant ventricle.

47
Q

When does S3 occur?

A

At the beginning of diastole after S2.

48
Q

When is S3 normal?

A

Children
Trained athletes
Pregnancy (sometimes)

49
Q

What is S4?

A

Tennessee/atrial gallop

Produced by the sound of blood being forced into a stiff/non-compliant/hypertrophic ventricle.

50
Q

When does S4 occur?

A

Occurs just after atrial contraction at the end of diastole, prior to S1.

51
Q

When is S4 normal?

A

Never!

52
Q

What is a quadruple gallop?

A

presence of S3 S4.

Hello-goodybye

53
Q

What is a summation gallop?

A

Presence of S3 S4 in tachycardia causes them to merge.

54
Q

When is the diaphragm used for heart sounds? Bell?

A

Diaphragm is for S1 and S2. (high-pitch) (S1 and S2 are valves closing, so I imagine a snap, and snaps are high-pitch)

Bell is for S3 and S4. (low-pitch) (They have to do with blood hitting something, which is like a dull splash)

Note:
D = ding which is high pitch.
B = boom which is low pitch.

55
Q

What do clicks means?

A

Damaged valves.

56
Q

What are the common clicks?

A

Mid-systolic click in MVP

Ejection click in AV and PV stenosis after S1.

57
Q

When is an opening snap heard?

A

MV stenosis. It is heard after the A2 component of S2.

AKA heard as part of AV valve opening.

58
Q

When is a pericardial friction rub heard?

A

Loudest in systole, but can be heard at the beginning and end of diastole too.

59
Q

What is a pericardial friction?

A

A scratching, creaking, high-pitched sound coming from rubbing of inflamed pericardium.

Changes with position and time.

60
Q

What are the two valve categories that cause murmurs?

A

Stenotic valves

Insufficiency/regurgitation of valves

61
Q

What are the two timings for murmurs?

A

Systolic = just after S1, coincides with carotid upstroke.

Diastolic = just after S2, post carotid upstroke.

62
Q

What are the murmur shapes?

A

Crescendo = grows louder
Decrescendo = grows softer
Crescendo-Decrescendo = Slowly increases then slowly decreases.
Plateau = same intensity throughout.

63
Q

How do we grade heart murmur intensity?

A

Grade 1-6.

1 = very faint

6 = very loud, might not even need stethoscope to hear.

64
Q

At what grade do heart murmurs start having thrill?

A

4

65
Q

What is left-lateral decubitus used for in terms of heart murmurs?

A

Brings out left-sided S3, S4, and mitral murmurs. (esp mitral stenosis!!!)

66
Q

What is a hunched forward position used for in terms of heart murmurs?

A

Aortic murmurs (esp aortic regurg)

67
Q

What happens to MVP when a patient squats?

A

shortens

68
Q

What happens to venous return in a standing patient?

A

It decreases.

69
Q

How do I differentiate hypertrophic cardiomyopathy (HCM) from aortic stenosis? (AS)

A

HCM increases in intensity when you go from squatting to standing.

Note:
Standing decreases venous return, so Starling’s law must use increased ventricular contraction to compensate is the logic I think of to remember this

70
Q

What is the valsalva maneuver?

A

Forcible exhalation against a closed glottis after full inspiration, causing increased intrathoracic pressure.

71
Q

What happens to my HR in valsalva?

A

Decreases as aortic pressure increases, then bounces back.

72
Q

When is a valsalva maneuver used?

A

Differentiate MVP and HCM from AS.

Mitral valve prolapse
Hypertrophic cardiomyopathy
Aortic stenosis

73
Q

What is PVD?

A

Peripheral venous disease

74
Q

What are the risk factors for PVD?

A

DM
HTN
HLD
FMHx
Smoking
> 55 yo
Males

75
Q

What does red indicate for PVD?

A

Superficial thrombophlebitis

76
Q

What does brown indicate for PVD?

A

Venous insufficiency

77
Q

What is anasarca?

A

Extreme generalized edema characterized by widespread swelling of skin due to effusion of fluid into extravascular space.

Note:
Looks like a super puffy face :(

78
Q

What is pitting edema?

A

Edema that leaves a pit when u press it. Does not rebound fast. Means it is just fluid.

79
Q

What is claudication?

A

Pain or cramping in the legs during exertion that is relieved by rest within 10 mins.

80
Q

How do I grade peripheral pulses?

A

0-3.

3 is bounding
2 is brisk and normal.
1 is diminished
0 is absent, unable to palpate.

81
Q

What is the purpose of the Allen test?

A

Checking for any arterial insufficiency or lack of collateral circulation in the wrist/hand.

82
Q

What happens with untreated PVD?

A

Venous stasis dermatitis or varicose veins

Venous stasis ulcers

DVTs

83
Q

What is Homan’s sign?

A

Calf pain upon dorsiflexion of foot.

84
Q

Is Homan’s sign indicative of DVT?

A

Eh.

It has low sensitivity and low specificity.

H&P (10 decks)

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