Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

4th year passmedicine by topic > Murmurs > Flashcards

Murmurs Flashcards

1
Q

Area for auscultating the Aortic

A

Aortic: 2nd I.C.S right sternal border

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Area for auscultating the Pulmonary

A

Pulmonary: 2nd I.C.S left sternal border

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Area for auscultating the Tricuspid

A

Tricuspid: 5th I.C.S left sternal border

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Area for auscultating the Mitral

A

Mitral: 5th I.C.S mid clavicular line (apex area)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

The first heart sound (S1) is caused by

A

closure of mitral and tricuspid valves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

soft first heart sound is caused by

A

soft if long PR or mitral regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

loud first heart sound is caused by

A

loud in mitral stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

The second heart sound (S2) is caused by

A

closure of aortic and pulmonary valves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

second heart sound (S2) soft in

A

soft in aortic stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

second heart sound (S2) splitting due to

A

splitting during inspiration is normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

S3 (third heart sound) is always pathological

A

false

considered normal if < 30 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

S3 (third heart sound) may persist in who?

A

(may persist in women up to 50 years old)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

S3 caused by

A

caused by diastolic filling of the ventricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

S3 is heard in which conditions?

A 
heard in left ventricular failure (e.g. dilated cardiomyopathy)
constrictive pericarditis (called a pericardial knock) mitral regurgitation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is pericardial knock?

A

S3 sound in constrictive pericarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

S4 is always normal

A

false

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

S4 is caused by ventricular contraction against a stiff ventricle

A

false

caused by atrial contraction against a stiff ventricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

S4 coincides with which part of the ECG

A

p waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

S4 is heard in which conditions?

A

aortic stenosis, hypertension & HOCM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

(in HOCM a double apical impulse may be felt as a result of

A

palpable S4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Aortic stenosis Clinical features of symptomatic disease?

A

chest pain
dyspnoea
syncope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What type of murmur do you get in aortic stenosis?

A

delayed ejection systolic murmur

classically radiates to the carotids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

aortic stenosis radiating to a carotids is decreased following the Valsalva manoeuvre

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Pulse in aortic stenosis

A

narrow pulse pressure & slow rising pulse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Which heart sounds are soft/absent in aortic stenosis

A

soft/absent S2, S4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Aortic stenosis complications

A

left ventricular hypertrophy or failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Causes of aortic stenosis

A

degenerative calcification (most common cause in older patients > 65 years)
bicuspid aortic valve (most common cause in younger patients < 65 years)
William’s syndrome (supravalvular aortic stenosis)
post-rheumatic disease
subvalvular: HOCM

28
Q

Management of aortic stenosis if asymptomatic

A

if asymptomatic then observe the patient is general rule

29
Q

Management of aortic stenosis if symptomatic

A

if symptomatic then valve replacement

30
Q

Management of aortic stenosis and asymptomatic - when is surgery considered?

A

valvular gradient > 40 mmHg and with features such as left ventricular systolic dysfunction then consider surgery

31
Q

Why is angiogram important prior to surgery in aortic stenosis?

A

Cardiovascular disease may coexist.

For this reason an angiogram is often done prior to surgery so that the procedures can be combined
balloon valvuloplasty (limited to patients with critical aortic stenosis who are not fit for valve replacement)
32
Q

What murmur do you get in Aortic regurgitation

A

early diastolic murmur:

33
Q

Aortic regurgitation intesnity of murmur increased by

A

intensity of the murmur is increased by the handgrip manoeuvre

34
Q

Aortic regurgitation pulses?

A

collapsing pulse & wide pulse pressure

35
Q

Quincke’s sign

A

(nailbed pulsation) in aortic regurgitation

36
Q

De Musset’s sign

A

(head bobbing) in aortic regurgitation

37
Q

Causes of aortic regurgitation (due to valve disease)

A

rheumatic fever
infective endocarditis
connective tissue diseases e.g. RA/SLE
bicuspid aortic valve

38
Q

Causes of aortic regurgitation (due to aortic root disease)

A 
aortic dissection
spondylarthropathies (e.g. ankylosing spondylitis)
hypertension
syphilis
Marfan's, Ehler-Danlos syndrome
39
Q

Atrial flutter is a features of mitral stenosis

A

false

atrial fibrillation

40
Q

Mitral stenosis murmur

A

mid-late diastolic murmur (best heard in expiration)

loud S1, opening snap

41
Q

mitral stenosis can cause malar flush

A

true

42
Q

mitral stenosis pulse

A

low volume pulse

43
Q

causes of mitral stenosis?

A

rheumatic fever, rheumatic fever and rheumatic fever. Rarer causes that may be seen in the exam include mucopolysaccharidoses, carcinoid and endocardial fibroelastosis

44
Q

Features of severe MS?

A

length of murmur increases

opening snap becomes closer to S2

45
Q

CXR & MS?

A

left atrial enlargement may be seen

46
Q

Echo & MS?

A

the normal cross sectional area of the mitral valve is 4-6 sq cm.
A ‘tight’ mitral stenosis implies a cross sectional area of < 1 sq cm

47
Q

What is Mitral regurgitation

A 
mitral regurgitation (MR) occurs when blood leaks back through the mitral valve on systole
mitral valve is located between the left atrium and ventricle, and regurgitation leads to a less efficient heart as less blood is pumped through the body with each contraction.
48
Q

second most common valve disease after aortic stenosis.

A

mitral regurgitation

49
Q

MR is common in otherwise healthy patients to a trivial degree and does not need treatment.

A

true

50
Q

Risk factors for MR?

A 
Female sex
Lower body mass
Age
Renal dysfunction
Prior myocardial infarction
Prior mitral stenosis or valve prolapse
Collagen disorders e.g. Marfan's Syndrome and Ehlers-Danlos syndrome
51
Q

Causes of MR?

A

Post MI
Infective endocarditis
Rheumatic fever
Congenital

52
Q

Most patients with MR are asymptomatic

A

True
Most patients with MR are asymptomatic, and patients suffering from mild to moderate MR may stay largely asymptomatic indefinitely.

53
Q

MR Symptoms tend to be due to

A

failure of the left ventricle, arrhythmias or pulmonary hypertension.
This may present as fatigue, shortness of breath and oedema.

54
Q

MR ECG

A

ECG may show a broad P wave, indicative of atrial enlargement

55
Q

MR CXR

A

Cardiomegaly may be seen on chest x-ray, with an enlarged left atrium and ventricle

56
Q

MR Echo

A

Echocardiography is crucial to diagnosis and to assess severity

57
Q

MR acute mx

A

Medical management in acute cases involves nitrates, diuretics, positive inotropes and an intra-aortic balloon pump to increase cardiac output

severe- surgery

58
Q

MR mx dditional drugs for heart failure

A

If patients are in heart failure, ACE inhibitors may be considered along with beta-blockers and spironolactone

59
Q

A systolic murmur heard best in the 5th intercostal space is most consistent with?

A

mitral regurgitation

60
Q

ascending aortic dissection may cause

A

aortic regurgitation

61
Q

Tricuspid regurgitation murmur is systolic/diastolic

A

systolic

62
Q

Tricuspid regurgitation murmir is pan systolic

A

true

63
Q

Which valve disease presents with left parasternal heave

A

tricuspid regurgitation

64
Q

Tricuspid regurgitation presents with which liver symmptom?

A

pulsatile hepatomegaly

65
Q

Tricuspid regurgitation causes?

A 
right ventricular infarction
pulmonary hypertension e.g. COPD
rheumatic heart disease
infective endocarditis (especially intravenous drug users)
Ebstein's anomaly
carcinoid syndrome
66
Q

A 75-year-old man presents with difficulty breathing at night, occasional palpitations and tight chest pain. On examination, he has a collapsing pulse and a laterally shifted apex beat. You also notice his head bobs in time with his pulse.

This is ?

A

Aortic regurgitation

4th year passmedicine by topic (96 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions