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PD Block 2 Flashcards

1
Q

a. pericardium

A

double-walled fibrous sac that holds the heart; contains heart, roots of the great vessels, and pericardial fluid; protects, lubricates, and fixes heart in place

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2
Q

b. right and left ventricles

A

ventricles receive blood from the atria and then strongly pump it out during systole

thick-walled, muscular, provides the “oomph” of the heart, most of the heart’s mass

RV receives blood from RA, pumps to lungs via pulmonary artery
LV receives blood from LA, pumps to aorta/body
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3
Q

d. aortic valve

A

semilunar valve
between LV and ascending aorta
forced open in systole
one-way valve: prevents blood from flowing backward from the aorta into the LV
Trileaflet (comprised of three leaves that come together when the valve is closed)

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4
Q

c. right and left atria

A

atria receive blood from the circulation (body and lungs) and drain into ventricles
relatively thin-walled, reservoirs
RA receives deoxygenated blood from the body/vena cavae
LA receives oxygenated blood from the pulmonary circulation via pulmonary veins

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5
Q

e. pulmonic valve (AKA pulmonary valve)

A

semilunar valve between RV and pulmonary artery forced open in systole

one-way valve:

Trileaflet

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6
Q

f. the great vessels

A

collectively, the large vessels that route blood to and from the heart:

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7
Q

j. tricuspid valve

A

AKA right atrioventricular valve
between RA and RV
open in diastole
one-way valve: prevents blood from flowing backward from the RV into the RA
Trileaflet (comprised of three leaves that come together when the valve is closed)

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8
Q

k. mitral valve

A

AKA left atrioventricular valve, AKA bicuspid valve
between LA and LV
open in diastole
one-way valve: prevents blood from flowing backward from the LV into the LA
Bileaflet (comprised of two leaves that come together when the valve is closed)

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9
Q

A. Preload:

A

the initial stretching of the cardiac myocytes prior to contraction

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10
Q

B. Afterload:

A

can be thought of as the “load” that the heart must eject blood against, closely related to aortic pressure

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11
Q

C. Systole:

A

The part of the cardiac cycle during which the heart contracts, particularly the ventricles, resulting in a forceful flow of blood into both the systemic and pulmonary circulations. (M)

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12
Q

D. Diastole:

A

That time between two contractions of the heart when the muscles relax, allowing the chambers to fill with blood; diastole of the atria precedes that of the ventricles; diastole alternates, usually in a regular rhythm, with systole. (M)

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13
Q

S1:

A

produced by the closure of the mitral and tricuspid valves (CE)

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14
Q

S2:

A

produced by the closure of the aortic and pulmonic valves (CE)

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15
Q

S3 (S3 Gallop):

A

The first stage of diastole is a period of rapid ventricular filling. At the end of this stage of rapid filling, an S3 may be heard if the volume of blood that has been transferred is abnormally large, as in mitral regurgitation. The S3 gallop is thought to be the sound the ventricle makes when it is forced to dilate beyond its normal range due to volume overload in the atria (ex: heart failure). Conditions of high cardiac output (ex: thyrotoxicosis, severe anemia) can also cause an S3 gallop. (HS)

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16
Q

S4 (S4 gallop):

A

The late stage of diastole is marked by atrial contraction. If the ventricle is stiff and non-compliant (ex: left ventricular hypertrophy secondary to longstanding severe hypertension, MI, or cardiomyopathies) then the pressure wave gradient generated as the atria contract generates an S4 sound. Ex of right sided S4: pulmonary hypertension, pulmonary stenosis (HS)

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17
Q

Superior Vena Cava

A

routes deoxygenated blood from the head/neck/upper extremities (upper body) into the RA

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18
Q

Inferior Vena Cava

A

routes deoxygenated blood from the abdomen/pelvis/lower extremities (lower body) into the RA

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19
Q

Pulmonary Artery

A

routes deoxygenated blood from the RV to the lungs

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20
Q

Aorta

A

routes blood from the LV to the body; ascending – arch – descending – thoracic – abdominal

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21
Q

Pulmonary Veins

A

routes oxygenated blood from the lungs to the LA

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22
Q

a. physiologic splitting

A

The pressure of the right side of the heart and left side of the heart are not the same. The right atrium, right ventricle, and pulmonary artery have a lower pressure than the left side of the heart. This results in sounds occurring at different times. For example, the aortic valve found on the left side will close before the pulmonic valve on the right side. This creates a split in S2 which can be broken down as sounds A2 and P2.

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23
Q

b. pathologic

fixed splitting-

A

A splitting of sounds A2 (aortic component of 2nd heart sound) and P2 (pulmonic component of 2nd heart sound) that is wide and there is no variation between respirations. This could be heard in atrial septal defect and right ventricular failure.

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24
Q

pathologic splitting

ii. paradoxic splitting-

A

During respiration there is a delay in the closure of the aortic valve (A2) creating an inconsistent movement of A2 and P2. The sounds are separate during expiration and sound closer together during inspiration. This could be heard with a left bundle branch block.

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25
Q

electrical cycle in heart

A

SA node - contraction of atria, filling of ventricles (diastole)
AV node — purkinje fibers — contraction of ventricles (systole)

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26
Q

SA Node

A

natural pace maker

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27
Q

auscultation position: aortic area

A

R 2 ICS

aortic valve and S2

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28
Q

auscultation position: pulmonic area

A

L 2 ICS

pulmonic valve

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29
Q

auscultation position: Erb’s point

A

L 3 ICS

pulmonary artery - best for S2

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30
Q

auscultation position: Tricuspid (apex)

A

L 4/5 ICS

Tricuspid

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31
Q

auscultation position: Mitral

A

Lateral L 5/6 ICS

S1

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32
Q

Cardiac Exam Inspection acute

A

GA: signs of acute cardiac distress:
Cyanosis, diaphoresis, pallor, cool temp, difficulty breathing, anxiety, Levine’s sign (clutching fist over chest)

Apical impulse: beating of LV during systole at 4th or 5th LICS at midclavicular line. Not normally seen while supine. May need light.

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33
Q

Cardiac Exam Inspection chronic

A

GA: signs of chronic heart conditions:
Clubbing fingernails, xanthelasma (yellow waxy deposits on extremities & around eyes, d/t increase cholesterol)
Obesity or coarction (underdeveloped lower extremities)

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34
Q

Cardiac Exam Palpation

A

Patient elevated 30 degrees
Use carotid pulse to detect timing of systole

Palpate for PMI (apical impulse)
If elsewhere than apex = abnormality

Provides estimation of size of heart
Assess location, diameter (should be one ICS or 1 cm), amplitude (should be gentle), duration

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35
Q

palpable cardiac abnormalities

A

lift, heave, thrill

For thrills, palpate over areas corresponding to valves

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36
Q

Cardiac Exam: auscultation

A

Listen to all areas with pt. upright, supine & left lateral recumbent

Upright leaning forward best to hear S2 & aortic murmurs
LL recumbent best to hear S1, mitral murmurs, & low-pitched diastole filling sounds
Listen to all areas with bell and diaphragm

Skin contact!

Listening for: Normal & abnormal heart sounds, rate & rhythm

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37
Q

5 Locations of cardiac exam

A

Aortic, Pulmonic, Erb’s, Tri, Mitral

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38
Q

S1 heart sound

A

S1:
Produced by closure of mitral and tricuspid valves
Indicates beginning of systole

Loudest over the apex of the heart; best heard with diaphragm of stethoscope

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39
Q

S2 heart sound

A

S2:
Produced by the closure of aortic and pulmonic valves
Indicates beginning of diastole

Loudest at left and right intercostal spaces (left for pulmonic valve, right for aortic valve); best heard with diaphragm of stethoscope

Can sometimes hear physiologic splitting of S2 on deep inspiration

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40
Q

chest pain sx

A

levine’s sign, fist on chest, uncomfortable look

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41
Q

fatigue sx

A

can’t maintain normal activities
can’t keep up with contemporaries
sleeping more
unusual or persistent

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42
Q

dyspnea sx

A

aggravated by exertion
difficult breathing
looking uncomfortable

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43
Q

diaphoresis

A

excessive sweating

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44
Q

syncope sx

A

associated with palpitations
change in posture
happen with looking up or turning head
unusual exertion

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45
Q

cyanosis sx

A

found in periphery first
blue/pallor color
decreased OX, decrease bloodflow

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46
Q

cough sx

A

onset/duration?
dry/wet
increased when laying down

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47
Q

orthopnea sx

A

SOB while laying flat
LV failure
fixed by sitting up

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48
Q

Claudication sx

A

pain during exercise from decreased blood flow

mostly in legs, can be arms

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49
Q

paroxysmal nocturnal dyspnea sx

A

SOB at night
coughing
awakens pt from sleep

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50
Q

xanthelasma sx

A

waxy yellow deposits on skin
around eye/extensor surfaces
increased cholesterol in blood

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51
Q

other organ systems evaluated with CV complaint

A 
EKG
diaphragm
lungs
PVS
musculoskeletal complaints - shoulder pain/jaw pain/xyphoidynia
GI distrubances - heartburn, uclers
anxiety
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52
Q

hypotension

A

low BP

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53
Q

postural/ orthostatic hypotension

A

abnormal decrease in BP from sitting to standing

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54
Q

hypertension

A

> 140/90

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55
Q

normotension

A

<120/80

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56
Q

heart murmur intensity grade 1

A

Grade 1: faint, intermittent

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57
Q

heart murmur intensity grade 2

A

Grade 2: quiet but easy to hear

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58
Q

heart murmur intensity grade 3

A

Grade 3: moderately loud, no palpable thrill

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59
Q

heart murmur intensity grade 4

A

Grade 4: loud, palpable thrill

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60
Q

heart murmur intensity grade 5

A

Grade 5: loud, palpable thrill; can hear with stethoscope barely touching chest

61
Q

heart murmur intensity grade 6

A

Grade 6: very loud, palpable thrill; can hear with stethoscope off chest

62
Q

seven dimensions of a heart murmur

A 
timing/duration
pitch
intensity (grading scale)
pattern
location
radiation
respiratory phase variations
63
Q

b. pitch: (murmur)

A

high, medium, or low? Bell or diaphragm?

64
Q

a. timing and duration (murmur)

A

between S1 and S2, or S2 and S1? Short or prolonged?

65
Q

MURMUR d. pattern: crescendo

A

: increased blood velocity; decresendo: decreased blood velocity; square/plateau: constant intensity

66
Q

e. location MURMUR

A

: where is it auscultated best?

67
Q

MURMUR f. radiation:

A

do you hear it only over the specific valve or elsewhere? sound generally transmitted in direction of blood flow

68
Q

g. respiratory phase variations: MURMUR

A

impacted by inspiration/expiration? variation of intensity, quality, timing? if venous return issue, increase with insp, decrease with

69
Q

external cues to peripheral health

A 
Hair pattern on extremities
  Skin color:
o   Cyanosis at extremities, lips and nose
o   Rubor
o   Pallor
o   mottling
Capillary refill time <2seconds
 Temperature of skin
Pulse strength and regularity
Dependent edema
70
Q

List the sequence of blood flow through the systemic circulatory system.

A

LV - aorta - brain/lower body/liver/mesentery - through cap beds - exchange of OX - leaves brain/liver/lower body/mesentery – SVC/IVC – RA — RV —- Lungs — reOX – LA — LV

71
Q

arterial pulse

A

pressure wave through system from ventricular contraction

72
Q

arterial BP

A

force exerted by blood against wall of artery as ventricles contract and relax

73
Q

Variable in arterial pulse

A

blood volume
distensibility of aorta
viscosity of blood
peripheral arterial resistance

74
Q

characteristics of jugular venous pressure (JVP)

A

Jugular veins reflect activity/competency of the right side of the heart
Visibility of jugular venous pulsations/fluttering indicates right atrial pressure

75
Q

normal range for JVP

A

The vertical distance from the sternal angle to the straight edge is the JVP value
Normal range is < 3 cm

76
Q

Normal range for CVP

A

CVP (central venous pressure) can be approximated:
5cm + JVP = CVP
Normal CVP is 7 cm, upper limit is 9 cm

77
Q

carotid -

A

just below angle of jaw

78
Q

abdominal aorta -

A

left lateral and superior to umbilicus
Ausculate before palpating!
Only pulse where both hands needed to apply deep pressure

Pulsations should be less than 2.5 cm apart

79
Q

femoral -

A

crease of groin

80
Q

brachial -

A

medial antecubital fossa of elbow

81
Q

radial -

A

thumb side of wrist where it creases

82
Q

ulnar

A
  • pinky side of wrist where it creases
83
Q

dorsalis pedis

A
  • top of foot, between metatarsals 1 and 2
84
Q

popliteal

A
  • directly behind (flexed) knee
    most difficult pulse to find of people
    If non-palpable, ensure dosalis pedis and posterior tibialis are symmetrical with good amplitude
85
Q

posterior tibialis

A
  • posterior to medial malleolus of ankle
86
Q

Amplitude’s for Pulses 0-4

A 
0=no palpable pulse  
1=diminished
2=normal / expected  
3=full / increased
4=bounding
87
Q

a. pulsus alternans

- PE findings:

A

Pulse has constant rate and rhythm but amplitude (force) alternates between a smaller amplitude and larger amplitude

88
Q

a. pulsus alternans - Clinical significance:

A

Can be due to left ventricular dysfunction/failure

89
Q

b. pulsus bigeminus - Clinical significance:

A

Can be due to heart disease, digitalis toxicity, or a temporary benign finding.

90
Q

b. pulsus bigeminus

- PE findings:

A

Normal pulse beat followed by a premature beat (due to premature ventricular contraction) and a pause. Premature beat’s amplitude (force) is less than the amplitude of the normal beat.

91
Q

c. pulsus bisferiens

- PE findings:

A

Pulse has two peaks during systole-the first is the “normal” pulse that occurs during ventricular contraction, but the second is an early diastole due to a backflow of blood; best noticed with palpation of carotid artery

92
Q

-c. pulsus bisferiens Clinical significance:

A

Can be due to severe aortic regurgitation or aortic stenosis (narrowing) coupled with aortic insufficiency.

93
Q

d. pulsus paradoxus

- PE findings:

A

Atypical decrease in systolic arterial blood pressure (>10 mm Hg) and amplitude (force) during inspiration (breathing in). Normally there is a slight decrease in BP with inspiration, but it’s less than 10 mm Hg. May be detected with palpation, but much easier to detect by taking pt’s BP.

94
Q

d. pulsus paradoxus - Clinical significance:

A

Can be due to emphysema, asthma, premature heart contraction, tracheobronchal obstruction, or pericardial effusion (fluid around the heart).

95
Q

e. pulse deficit

- PE findings:

A

difference between the rates in pulse when auscultating the heart’s apex (assessing the pulse using stethoscope over apex of heart) versus palpating a peripheral artery (e.g. taking someone’s radial pulse)

96
Q

e. pulse deficit - Clinical significance:

A

Occurs when ventricular contraction doesn’t eject a sufficient amount of blood to produce a pulse wave in the arteries. Often associated with premature beats, pulsus bigeminus, and atrial fibrillation.

97
Q

a. venous insufficiency (chronic)

Assess:

A

IPPA of lower extremities, Trendelenberg retrograde filling test, Hx of phlebitis, leg injury

98
Q

a. venous insufficiency (chronic) Findings:

A

Brawny ankle edema and induration, stasis pigmentations, varicosities, ankle ulcerations, pitting edema, cyanosis/erythema

99
Q

b. venous obstruction

Assess:

A

IPPA of lower extremities, pain and swelling in ankle, Homan’s sign; calf measurement

100
Q

b. venous obstruction Findings:

A

DVT –> PE, unilateral pitting edema, acute superficial thrombophlebitis

101
Q

c. arterial insufficiency (chronic)

Assess:

A

IPPA of lower extremities; postural color changes

102
Q

c. arterial insufficiency (chronic) Findings:

A

Cool, pale (upon elevation), thin, shiny atrophic skin around ankle/lower leg. Loss of hair over foot and toes; thickened toenails; gangrene; pain that goes away upon resting

103
Q

d. arterial obstruction

Assess:

A

IPPA of upper and lower extremities; Allen test;

104
Q

d. arterial obstruction Findings:

A

Pain, numbness, tingling, weakness, pallor –> Acute Arterial Occlusion;

105
Q

e. varicosities

Assess:

A

Inspection of lower limbs, palpate for increased venous pressure.

106
Q

e. varicosities Findings:

A

Dilated, tortuous, visibly blue/purple veins. Sometimes painful. Indicative of chronic venous insufficiency.

107
Q

f. dependent edema / pitting and nonpitting

Assess:

A

Firmly over bony prominence comparing like areas and recording topographic areas. Please refer to lecture slides for picture.

108
Q

f. dependent edema / pitting and nonpitting Findings:

A

Bilateral indicates systemic. Unilateral indicates local. “4+ pitting edema from _______ to _______.” CHF —> Edema go higher and higher on Lower Ext.

109
Q

g. claudication

Assess:

A

Hx of pain caused by too little blood flow during exercise. Generally affects the blood vessels in the legs, but claudication can affect the arms, too.

110
Q

g. claudication

Findings:

A

Sx of peripheral vascular disease

111
Q

h. capillary refill

Assess:

A

Pinch fingernails or toenails and observe for capillary refill < 2 seconds.

112
Q

h. capillary refill Findings:

A

Greater than 2 seconds indicative of arterial inefficiency

113
Q

bruits and where to look

A

turbulent bloodflow through vessels - may be an obstruction/stenosis/restriction

using diaphragm listen for bruits over
carotids
femoral
iliac
renal
aortic
114
Q

a. paraphimosis:

A

foreskin becomes trapped behind the glans penis

115
Q

o. cryptorchidism:

A

undescended testicle

116
Q

n. femoral hernia:

A

bulging of intestines through the femoral ring

117
Q

m. direct inguinal hernia:

A

doesn’t go through internal inguinal ring; through external right; hernia bulges anteriorly, pushes against side of finger

118
Q

l. indirect inguinal hérnia:

A

through internal ring; most common type of hernia, pts often young males; pain on straining; touches fingertip on exam

119
Q

k. epispadias:

A

urethral deformity; can open on top, side, or be open along length of penis

120
Q

j. testicular tumor:

A

câncer that develops in the testicles

121
Q

b. hypospadias:

A

urethral opening is on underside of the penis

122
Q

i. epididymitis:

A

inflammation of infection of the epididymis; generally caused by chlamydia, gonorrhea, or E. Coli

123
Q

h. varicocele:

A

enlargement of the veins within the scrotum

124
Q

g. spermatocele:

A

benign, sperm-filled cyst at the head of the epiddidymis

125
Q

f. hydrocele:

A

collection of fluid in the scrotum

126
Q

e. peyronie disease:

A

connective tissue disorder; chronic inflammation and scar tissue formation in the túnica albugínea

127
Q

d. condyloma:

A

presence of warts caused by HPV

128
Q

c. chancre:

A

painless ulceration formed during primary stage of syphilis

129
Q

techniques used to minimize patient anxiety associated with a genital examination

A 
chaperone
answers all questions before examination 
positions they will be in 
equipment
instruction
130
Q

Male genital self exam (GSE)

Step 1:

A

Patient should hold penis in hand
Inspect head of penis for lesions or masses (if not circumcised, pull back foreskin)
Palpate head of penis feeling for bumps, sores, warts or blisters.

131
Q

Step 2: Male genital self exam (GSE)

A

Inspect urethral meatus, squeeze to see if there is any

discharge.

132
Q

Step 3: Male genital self exam (GSE)

A

Patient should examine entire shaft.
Evaluate for any lesions, sores or masses.
Use a mirror to visualize the underside.

133
Q

Step 4: Male genital self exam (GSE)

A

Patient should then examine the base of the penis by moving pubic hair out of the way.

134
Q

Step 5: Male genital self exam (GSE)

A

Scrotum evaluation

Patient should hold each testicle gently while inspecting and palpating using lighter then firmer pressure.

135
Q

sequence and examination techniques for male GU Adult

Inspection

A 
lesions, chancres, 
pubic hair patterns, 
note circumcised or uncircumcised, 
position, 
meatus position/stenosis, 
phimosis and paraphimosis
136
Q

sequence and examination techniques for male GU Adult Palpation:

A

tenderness/nodularities/lesions -
palpate top to bottom
side to side
strip the urethra looking for any abnormal discharge or blood at urethral meatus.
Open meatus to inspect for discharge, lesions.

137
Q

Scrotum:

Inspection

A

extreme asymmetry - skin (rashes/redness), separate hair to look at skin,

138
Q

Scrotum:

Palpation

A

P: cremasteric reflex - tongue blade stroked on inside of thigh - testicle on that side should rise voluntarily - tests T12-L1-L2 nerves

139
Q

Testis:

A

isolate one testicle at a time -
can ask pt to hold penis out of the way,
roll testicle around in fingers - smooth - not overly tender - note contours during palpation -

140
Q

Hernia:

A

follow spermatacord up to pelvis, toothpick feeling is the vas defrens, find the external inguinal ring - place tip of finger here and have pt cough/bear down. ,

141
Q

indirect hernia

A

If bulge felt on tip of finger =

142
Q

direct hernia

A

if bulge felt on side of finger =

143
Q

Adolescent: GU male

A

allay anxiety, protect privacy, inspect/palpate - Tanner stage

144
Q

Child GU Male

A

lesions, malformations, discharge, masses, hernias

145
Q

Infant GU Male

A

Mostly looking for congenital abnormalities, urethral placement, retractability of foreskin, descent of testicles (1-2 months) masses (transilluminate)

146
Q

male erection

A

two corpora cavernosa become engorged with blood via arterial dilation and decreased venous flow
autonomic nervous system
local synthesis of nitric oxide

147
Q

male ejaculation

A

emission of secretions from vas defrens, epididimides, prostate and seminal vesicles

148
Q

male orgasm

A

constriction of vessels supplying blood to corpora cavernosa and gradual subsiding of sexual arousal

JG (6 decks)

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