History/Physical Exam Flashcards
In which species is cough not suggestive of cardiovascular disease?
Cat
What are two client complaints suggestive of heart failure specific to cats?
Acute blindness and sudden loss of function of backlimbs with pain
(T/F) With a bad enough murmur, the chest can be felt vibrating also known as thrill.
True
What can occur to the abdomen that may be suggestive of cardiovascular disease?
Abdominal distension
(T/F) Your general inspection of an animal should be up close and personal.
F, distance
Why is demeanor important to assess in your general inspection?
Impacts how vitals and patient stability will be interpreted
(T/F) Heart rate should be taken from the pulse.
F, from auscultation
What is the normal heart rate for a dog and what is it typically in a clinic setting?
Normal 60-160 bpm, clinic - 80-130 bpm
What is the normal heart rate for a cat and what is it typically in a clinic setting?
Normal 140-220 bpm, clinic - average 200
Although we are given preset ranges of normal heart rate, what should you base normal or abnormal instead of just the reference ranges of ‘normal’?
Demeanor of the patient
When should the respiratory rate be taken?
During general inspection, from afar
Respiratory rate should not be taken in a patient that is actively __________.
Panting
What is the typical respiratory rate in clinic versus at home?
Clinic - <48 bpm, home - <36 bpm
What is orthopnea?
Open mouth breathing
What is stridor?
High pitched wheeze
What is stertor?
Snoring
What is the term for ‘air hunger’, that indicates an interpretation of a patient to be in distress due to lack of oxygenation, and is an emergency situation?
Dyspnea
When a patient has a productive cough (a cough in which they swallow afterward), is this typical of cardiovascular disease?
No, respiratory disease
A honking cough is typically indicative of what?
Airway collapse
What color and texture of discharge with coughing indicate heart disease (and other diseases) and is an emergency situation?
Pink, foamy liquid
Crackles on respiratory auscultation localize the issue to what location?
Bronchoalveolar
Loud crackles throughout inspiration is indicative of what?
Bronchitis
When would you hear crackles on respiratory auscultation with pneumonia and congestive heart failure? (
End inspiratory crackles
Wheezing on respiratory auscultation localizes the issue to what location?
Airway
Focal reduced sounds on respiratory auscultation are more typical of what pathology?
Mass
Diffuse reduced sounds on respiratory auscultation are more typical of what pathology?
Pleural fluid
What is a wider pulse pressure usually due to?
Reduced end diastolic pressure
What will a reduced systolic pressure do to pulse pressure?
Lower it
What three things is pulse pressure dependent on?
Stroke volume, vascular resistance, and heart rate
Listed below are diseases that can cause bounding pulses, give the species they are pertinent to.
- Patent ductus arteriosus
- Aortic insufficiency
- Hyperthyroidism
- High sympathetic tone and anemia are not species specific
- Patent ductus arteriosus (Dogs)
- Aortic insufficiency (Horse)
- Hyperthyroidism (Cats)
- High sympathetic tone and anemia are not species specific
What changes in preload, contractility, and afterload would cause a weak pulse/smaller pulse pressure?
Reduced preload, reduced contractility, increased afterload
An absent arterial pulse is indicative of what?
Thromboembolism
Besides arrhythmias, what can cause a variable pulse?
Pulsus paradoxus/pericardial effusion
If you are listening to a patient and feeling the pulse concurrently but for an occasional beat of the heart, do not feel a coinciding pulse, what does this indicate?
Premature beats
Why do premature beats not have a corresponding pulse?
Decreased preload → decrease stroke volume → decreased cardiac output = decrease pulse pressure → no pulse!
What does the presence of a jugular pulse indicate?
Elevated right heart pressure
Diffusely blue mucous membranes indicate what two potential causes of deoxygenated blood?
Cardiac or respiratory
Focal blue mucous membranes can be potentially caused by what?
Thromboembolism
What is the normal capillary refill time?
<2-3 seconds
Where should you feel the heartbeat on precordial palpation of the heart?
5th ICS on the left side
What does a more easily felt right precordial palpated heartbeat (easier to feel that the left side) indicate?
Right heart enlargement or cardiac displacement
Sinus arrhythmias are normal in dogs but not in what species?
Cats
What is the period between S1 to S2 heart sounds?
Systole
What is indicated by S1 splitting?
Asynchronous AV valve closure
How can you tell the difference between a physiologic S2 splitting and a pathologic S2 splitting?
Respiration, if it varies with respiration → physiologic, if it is fixed, pathologic, specifically atrial septal defect
What would you hear on cardiac auscultation of a patient with degenerative valve disease?
Clicks-systolic sound → ‘lub’-click-’dub’
(T/F) If you can hear S3 or S4 in a dog/cat, it indicates cardiovascular disease.
True
What are gallops in terms of abnormal heart sounds?
Extra diastolic sound, a sound in S3 and S4, abnormal for small animals only
In general, what do murmurs result from?
Turbulent blood flow
Increased ___________ (velocity/viscosity/diameter) explains almost all murmurs.
Velocity
What would cause increased viscosity that can cause turbulent blood flow and consequent murmurs?
Anemia
Pathologic murmurs are typically related to abnormal AV valve _________ (closure/opening) and abnormal semilunar valve __________ (closure/opening), this means most murmurs are ____________ (diastolic/systolic).
Closure, opening, systolic
If you can hear a murmur in 3 of the heart auscultation locations, what would you grade the murmur?
Grade 3
What would you grade a murmur that is loud on auscultation and has a palpable thrill?
Grade 5
What grades and timing are constant for innocent or non pathologic murmurs?
Soft grade → 2 or less, and always systolic
