Tests: ECGs, PFTs...

Question 0

Leads showing LATERAL MI

Answer 0

St elevation: I, aVL (also V5, V6)

reciprocal: II, III, aVF

Question 1

Leads showing INFERIOR MI

Answer 1

ST-elevation: II, III, aVF

reciprocal: aVL

Question 2

leads showing SEPTAL MI

Answer 2

ST elevation: V1, V2

Question 3

leads showing ANTERIOR MI

Answer 3

ST elevation: V4, V5

* often w/ V-fib (common complication)

Question 4

leads showing POSTERIOR MI

Answer 4

reciprocal change (ST depression): V1-V4
* "carousel" shaped pattern

Question 5

Normal Jugular Venous Distention measurements

Answer 5

8 cm above sternal angle or less.

R atrium = 5 cm into body from sternal angle

Question 6

location for palpating apical impulse

Answer 6

in 5th interspace, just medial to midclavicular line

= 1st 1/3 of systole

Question 7

Bell of stethoscope used to hear

Answer 7

low pitched sounds

• diastolic murmur
• S3, S4

Question 8

diaphragm of stethoscope used to hear

Answer 8

high pitched sounds

• S1 & S2 (*S1 longer than S2)
• ejection & midsystolic clicks
• aortic regurg. murmur

Question 9

heart sounds (murmur) caused by

Answer 9

vibration of heart valves & heart system during valve closure or blood flow turbulence

Question 10

possible causes of S2 splitting

Answer 10

• Variable splitting, w/ inspiration: physiologic, RBBB, pulmonary stenosis
• Fixed wide splitting: atrial septal defect
• Variable reversed splitting (“paradoxical”): LBBB, LV failure, HTN

Question 11

midsystolic click indicates

Answer 11

systolic mitral valve prolapse,

* later w/ increased LV volume.

Question 12

causes of S3 & S4

Answer 12

S3 = early rapid filling
S4 = vigorous atrial contraction

Question 13

likely causes of Ejection clicks

Answer 13

• bicuspid valve
• pulmonary stenosis
• dilatation of aorta or pulmonary artery

Question 14

cause of opening snap

Answer 14

rheumatic mitral stenosis.

Question 15

innocent flow murmur

Answer 15

twangy, crescendo-decrescendo systolic murmur;

from high flow through normal valves.

Question 16

determining axis of heart on ECG

Answer 16

using limb leads:
lead w/ the most deflection = same axis
OR isoelectric lead = perpendicular to axis
(I = 0, II = +60, aVL = -30, III = 120, aVF = +90)
* >90 = R shift, <-30 = L shift.*

Question 17

P wave > 2.5 in lead II

Answer 17

Right atrial enlargement

Question 18

prolonged P wave on ECG (> 1 mm, negative @ end)

Answer 18

Left atrial enlargement,

P wave changes = in lead I, changes = early and negative

Question 19

typical ABG results for pneumonia

Answer 19

Low V/Q –> hypoxemia due to focal shunt.

* may have increased PaCO2 if severe lung damage.

Question 20

Characteristics of a “quality” sputum sample

Answer 20

> 25 WBCs and < 10 epithelial cells @ x100 magnification

often risk oral or other contamination when obtaining sample

Question 21

obstructive disease PFT

Answer 21

FEV1/FVC < LLN = obstructive disease
(Mild: FEV1 > 70% predicted; Severe: < 50% predicted)
* high RV & often high TLC (bc air trapping)!
= slow emptying (bc decreased elastic recoil)
ie: asthma, COPD, upper airway obstruction

Question 22

PFT for restrictive disease

Answer 22

TLC < 80% predicted w/ symmetrically low RV (not if just poor effort)
(also often low FVC and high FEV1/FVC).
ie: interstitial lung disease, pulmonary fibrosis

Question 23

Variable Extrathoracic Upper airway obstruction

Answer 23

when tracheal P < atmospheric P w/ Inspiration (only, not expiration) –> trachea narrows.
==> reduced INspiratory limb (bottom) on Flow volume loop
ie: laryngeal tumor

Question 24

Obstructive vs. Restrictive Flow Volume Loops

Answer 24

Obstructive: scooped out expiratory limb, otherwise normal shape
Restrictive: small, squished loop (shorter & earlier on horizontal axis)

Question 25

Variable Intrathoracic Upper Airway obstruction

Answer 25

when pleural P > tracheal P => trachea narrows.

==> reduced EXpiratory limb (top) on Flow Volume Loop

Question 26

Fixed Upper Airway obstruction

Answer 26

BOTH INspiratory & EXpiratory limbs reduced on flow volume loop
(could be intrathoracic or extrathoracic)

Question 27

measuring RV (residual volume) of lung

Answer 27

• cannot measure directly bc RV = volume left after maximal expiration!
  ==> RV = FRC - ERV
  (ERV = expiratory reserve volume)

Question 28

Measuring TLC (total lung capacity)

Answer 28

1. body plethysmography

2. Gas dilution
   (neither very accurate)

Question 29

DLCO

Answer 29

measures rate of gas transport from alveoli to hemoglobin

(aka: diffusion into blood)
* Low CO exhaled = high DLCO = normal. (high CO exhaled = bad)
- -> abnormal if decreased alveolar surface area or low hemoglobin

Question 30

Aortic stenosis murmur & ECG

Answer 30

High, late, loud systolic murmur w/ S4.

ECG: strain & LVH

Question 31

Mitral stenosis murmur & ECG

Answer 31

opening snap + soft diastolic murmur,
loud S1 & P2 (from pulm. htn);
ECG: broad biphasic P wave, RVH, +/- atrial fibrillation