Lecture 1b: Clinical Evaluation of CV System & PE

Question 1

diaphragm side of stethoscope listens to:*

Answer 1

high frequency sounds

Question 2

bell side of stethoscope listens to:*

Answer 2

low frequency sounds

Question 3

differential cyanosis

Answer 3

the bluish coloration of the lower but not the upper extremity and the head. This is seen in patients with a patent ductus arteriosus (web)

Question 4

normal jugular veins on PE should:*

Answer 4

not extend past thoracic inlet, should bounce back after being depressed

Question 5

Hepatojugular reflex*

Answer 5

gentle pressure applied to cranial abd to increase venous return. If jugular pulsations seen, means there is a right-sided heart disease (such as diastolic dysfunction or volume overload)

Question 6

When you are feeling a pulse, you are feeling the difference between:

Answer 6

systole and diastole

Question 7

Thrill*

Answer 7

vibration caused by a murmur. The jet of a murmur “hits your hand”

Question 8

PMI*

Answer 8

point of maximal intensity. Usually located over the LV apex. Web: the point on the chest wall at which the maximal cardiac impulse is seen and/or palpated

Question 9

murmur is what kind of blood flow?*

Answer 9

turbulent

Question 10

Regions of cardiac auscultation*

Answer 10

• left apex
• left base
• left, cranial
• R apex
• R base
• Sternum

Question 11

left apex murmur assoc. with:*

Answer 11

mitral insufficiency, mitral stenosis Usually located at PMI

Question 12

left base murmur assoc. with:*

Answer 12

(listen to aorta and pulmonary a.)
pulmonic stenosis
pulmonic insufficiency
aortic stenosis
aortic insufficiency

Question 13

left cranial murmur assoc. with:*

Answer 13

PDA, arteriopulmonary window

Question 14

right side murmur assoc. with:*

Answer 14

(listen to tricuspid valve)
tricuspid insufficiency –> heard best at R apex
ventricular septal defect –> heard best at R heart base

Question 15

auscultate sternum for:*

Answer 15

murmur, especially in cats because they have a lazy aorta

Question 16

What to listen for on L side of horse*

Answer 16

Heart base, apex, cranial region for pulmonic valve, aortic valve, mitral valve, PDA.

Question 17

S1 in horse*

Answer 17

apex beat (listen over apex)
AV valve closure
start of systole
longer sound than S2

Question 18

S2 in horse*

Answer 18

semilunar valve closure
listen over P and A valve area
represents end of systole

Question 19

What to listen for on R side of horse*

Answer 19

same as right side. Also listen to tricuspid valve

Question 20

S1 corresponds to:*

Answer 20

AV valves (mitral and tricuspid) closing

Question 21

S2 corresponds to:*

Answer 21

semilunar (aortic and pulmonary) valves closing

Question 22

S3 gallop often due to:*

Answer 22

diastolic volume overloading as in dilated cardiomyopathy, PDA, mitral insufficiency, and septal defects

Question 23

S4 gallop often due to:*

Answer 23

increased ventricular concentric hypertrophy and stiffness

Question 24

mid-systolic clicks often due to:*

Answer 24

sudden tensing of chordae tendina

Question 25

possible cause of split heart sounds*

Answer 25

heart worms

Question 26

atrial fibrillation sounds like*

Answer 26

some beats soft, others loud. Sounds like shoes in washing machine

Question 27

sinus arrhythmia sounds like*

Answer 27

uneven beats

Question 28

3rd degree AV block sounds like*

Answer 28

fast pulse then stop

Question 29

sinus arrest sounds like*

Answer 29

long period of no beats

Question 30

Murmurs are classified based on:*

Answer 30

• timing (i.e. is it systolic, diastolic?)
• locaiton
• intensity
• pitch
• shape

Question 31

systolic murmur*

Answer 31

murmur that you hear between S1 and S2

Question 32

diastolic murmur*

Answer 32

murmur heard after S2

Question 33

continuous murmur*

Answer 33

murmur heard throughout S1 and S2

Question 34

Heart mumur intensity:1*

Answer 34

only auscultable in a quiet room with calm dog

Question 35

Intensity 2*

Answer 35

soft murmur

Question 36

Intensity 3*

Answer 36

prominent, readily heard upon auscultation

Question 37

Intensity 4*

Answer 37

loud murmur that isn’t palpable

Question 38

Intensity 5*

Answer 38

loud murmur that is palpable (thrill)

Question 39

Intensity 6*

Answer 39

murmur auscultable with the stethoscope off the chest

Question 40

Does intensity of murmur = severity?*

Answer 40

Not always. Intensity can vary depending on the “direction” of the murmur, or if a defect creates a small or large hole

Question 41

High frequency pitch of murmur assoc. with:*

Answer 41

degenerative valve dz in EARLY stages

Question 42

Low frequency pitch of murmur assoc. with:*

Answer 42

degen. valve dz in LATER stages

Question 43

Diamond shaped ejection murmur assoc. with:*

Answer 43

Subvalvular aortic stenosis (SAS)
Pulmonary Stenosis (PS)
Ventricular Septal Defect (VSD)

Question 44

Plateau Shaped Murmur assoc. with:*

Answer 44

Mitral/Tricuspid Insufficiency

Question 45

Diastolic Decrescendo Murmur assoc. with:*

Answer 45

Aortic/Pulmonary Insufficiency. Begins at the end of systole

Question 46

Pre-systolic murmur assoc. with:*

Answer 46

mitral stenosis. Diastolic, low-intensity murmur