Physical Exam Flashcards

1
Q

5 ways to differentiate from MS and Austin Flint murmur

A

-MS has opening snap
-MS can worsen with amyl nitrate (with reflex tachycardia)
-MS does not have S3
-Soft S1 (if severe, loud if mild) ; Soft A2 if valvular AR
-Associated early diastolic decrescendo murmur of AR

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

5 ways to differentiate PS from AS?

A

-PS located at left upper sternal border
-PS has widened S2
-PS associated with right sided S4
-PS murmur increased on inspiration
-Post Valsalva causes an immediate return in loudness of the PS murmur but a delay in the return of AS murmur

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

3 ways to tell difference between A2-P2 and S2-OS

A

-OS: Associated MS murmur
-OS: Widened ‘split’ on standing
-OS: 2nd component widens with inspiration where as OS interval will become wider with expiration
-OS: 2nd component of split S2 is as loud at the apex as at the LSB
-Inspiration will make PS louder and OS softer
-OS heard loudly in the Apex/LLSB whereas P2 heard loudest in the LUSB
-OS associated with a loud S1 (MS)

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

3 ways to tell the difference between s3 versus OS?

A

-Shorter time interval from S2-OS
-OS is higher pitched (better heard with diaphragm)
-OS is associated with sharp loud S1
-Upon standing, OS will lengthen from S2 whereas S3 distance doesn’t change

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

Review changes in Mitral Stenosis with increasing severity

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

Review PR without Pulm HTN vs. Graeme Steele murmur

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

Describe the 4 phases of Valsalava?

A

-Onset: Increased BP and increased intrathoracic pressure
-Sustained: Decreased venous return and blood pressure
-Release: Brief decreased blood pressure
-Overshoot: Increased venous return, blood pressure and reflex bradycardia and decreased SVR

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

Describe the physical exam for an ASD? (5)

A

-Systolic murmur from increased flow across the pulmonic valve

-Wide split and Fixed S2

-Holosystolic murmur from TR

-RV enlargement -> RV heave

-Signs of RV failure (Wide split S2, Right sided S3, Elevated JVP, Kussmaul’s, Palpatile Liver, Ascits, Edema)

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

What do you expect on physical for restrictive VSD? (4)

What happens as VSD becomes more significant? (2)

A

-Restrictive: Holosystolic murmur in left parasternal murmur (3rd/4th left intercostal spaces) with spokewheel radiation and palpable thrill

-As VSD worsens: Progressive LA/LV dilation, pulmonary hypertension -> Eisenmengers, loss of murmur

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

Name 4 physical exam findings on PDA?

A

-Continuous machine like murmur heard in left 2-3rd intercostal space

-LV dilation

-Progressive pulmonary hypertension

-Wide pulse pressure, other signs of increased cardiac output

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

Name 3 physical exam findings of supravalvular aortic stenosis

A

-Crescendo-decrescendo murmur heard radiating to carotids

-Loud A2

-Blood pressure in right arm > left arm

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

Name 4 physical exam findings of Aortic coarctation

A

-Crescendo-decrescendo murmur heard at scapula. (If collaterals: continuous murmur)

-Upper extremity hypertension (>20mmhg)

-Radial-femoral delay

-Signs of LVH/S4

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

Name 4 findings of TOF post repair

A

-Singular S2

-PR murmur

-RV heave +/- signs of RV failure

-Systolic murmur (RVOT re-obstruction OR residual VSD)

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

Name 4 fundoscopy findings in hypertension

A

-AV knicking
-Cotton wool spots
-Papilledema
-Exudates and heomorrhages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What part of hand to palpate apex? Thrill?

A

-Apex: Finger tips

-Thrill: Palm at level of MCP

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

3 causes of variable intensity S1?

A

-AV dissociation
-Tamponade
-AFib

17
Q

3 causes of split S1?

A

-RBBB
-ASD
-Ebsteins

18
Q

5 causes of Paradoxical splitting of S2?

A

-Aortic Stenosis
-Aortic Regurgitation
-LVOT-O/HoCM
-Paced Rhythm
-LBBB

19
Q

4 causes of wide splitting of RBBB?

A

-RBBB
-Mitral Regurgitation
-VSD
-Pulmonary Stenosis/RVOT Obstruction

20
Q

3 causes of increased intensity of A2?

A

-Hypertension
-Aortic Coarctation
-Ascending Aortic Aneurysm

21
Q

2 causes of decreased intensity of A2?

A

-Aortic Regurgitation
-Aortic Stenosis

22
Q

What are 3 ways to tell if P2 is loud?

A

-Its louder than A2 in left upper sternal border
-Heard at apex
-Palpable

23
Q

2 causes of Loud P2?

A

-Pulmonary Hypertension
-Supravalvular RVOT obstruction

24
Q

What are 4 causes of systolic ejection click?

A

-BAV
-Pulmonary stenosis
-PA dilation
-Aortic dilation

25
Q

How to tell difference between AS and PS?

A

-PS murmur decreases on inspiration

26
Q

How to differentiate right sided extra heart sounds to the left?

A

-Right: Left parasternal (not apical), and increases with inspiration

27
Q

What are 3 causes of early diastolic murmur?

A

-Aortic regurgitation
-Graham Steel
-PR without PHtn

28
Q

What are 4 causes mid-diastolic murmur?

A

-MS
-TS
-Austin flint murmur
-Myxoma

29
Q

Name 9 causes of continuous murmur?

A

-PDA
-Lutembacher’s syndrome
-Aortopulmonary window
-Ruptured sinus of valsalva aneurysm
-Coronary AV fistula
-Pulmonary AV fistula
-Mammary murmur of pregnancy
-Cervical venous hum
-Bronchial collateral murmur

30
Q

How to define A wave (in JVP) temporally?

A
  • With S4
  • Before S1 (V is after and before S2)

-Prior to Carotid pulse (V is after)

31
Q

What are two ways to define sustained Apex?

A

-All throughout systole

-During all of carotid pulse or after

32
Q

List 5 causes of late opening snap other than mild MS

A

-Bradycardia
-Impaired Relaxation of LV
-Severe AR
-Low atrial pressure
-High Aortic pressure

33
Q

Is narrow or wide S2-OS interval more specific for MS?

A

-Narrow (no mimickers where was there are mimickers for wide)

34
Q

What S2-OS interval indicates severe MS?

A

< 50 msec

35
Q

What are three ways to make an S4 softer or disappear altogether?

A

-Firm pressure with the diaphragm
-Listening to the patient supine (decreased venous return)
-Listening at sites away from the apex