(L3) Cardiovascular Exam (Johnston)

Question 1

Barrel chestedness is associated with what disease?

Answer 1

COPD

Question 2

Which jugular vein is a better estimate of central venous pressure and right atrial pressure?

Answer 2

The internal jugular vein is better than the external jugular vein

Question 3

What occurs during the A wave, X descent, V wave, and Y descent?

Answer 3

A wave: Atrium contracting while the tricuspid valve is open

X descent: Atrium relaxing and then filling (tricuspid closed)

V wave: The atria tense while full, but the tricuspid is closed

Y descent: Atrium emptying while the tricuspid is open

AXVY

Question 4

What four heart diseases were presented as having patterns of familial clustering?

Answer 4

Hypertrophic Cardiomyopathy

Marfan’s Syndrome

Prolonged QT Syndrome

CAD

Question 5

What causes the S4 heart sound?

When could it be considered normal?

Answer 5

Blood ejected from the atria striking a low compliance (stiffened) ventricle

– Can be normal in trained athletes –

Question 6

Where is the point of maximum impulse (apex beat) found?

Answer 6

Upright: fifth intercostal space on the left, 1 cm medial to the mid-clavicular line

Supine at 45°: 4th-5th intercostal space at the midclavicular line

Question 7

What six things in the lecture were presented to cause increased jugular venous pressure / jugular venous distention?

Answer 7

Superior vena cava obstruction

severe heart failure

constrictive pericarditis

cardiac tapenade

right ventricular infarction

restrictive cardiomyopathy

(anything that puts back pressure on the heart)

Question 8

What is the “five finger method” of heart evaluation?

Answer 8

History, Physical, ECG, Imaging, Lab

Question 9

What causes the S3 heart sound?

Answer 9

Deceleration of inflow at the end of the rapid filling phase of the ventricle.

Question 10

What is the grading system for murmurs?

Answer 10

I – barely audible

II – soft but easily heard

III – loud without a thrill

IV – loud with a thrill

V – loud with minimal contact between stethoscope and chest

VI – loud, can be heard without a stethoscope

Question 11

How do we measure jugular venous pressure?

Answer 11

Measure the top of the pulse of the internal jugular (or external, if you must) vein, to the sternal angle (angle of Louis) – and add 5 cm to account for the distance to the center of the right atrium.

Question 12

In what order must you execute the steps of a complete cardiovascular exam?

Answer 12

Inspection

Palpation

Percussion

Auscultation