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NYCPM Physical Assessment > The Heart > Flashcards

The Heart Flashcards

1
Q

The apical impulse, known as the point of maximum impulse, is normally found in the

A

5th intercostal space

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2
Q

Location of aortic sound

A

Second intercostal space, right sternal border

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3
Q

Location of pulmonic sound

A

Second intercostal space, left sternal border

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4
Q

Location of tricuspid sound

A

Left lower sternal border

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5
Q

Location of mitral sound

A

Cardiac apex (5th intercostal space, mid-clavicular line).

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6
Q

The area at which pulmonic sounds or aortic sounds are best heard is

A

Erb’s point (third left intercostal space).

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7
Q

The first heart sound (S1) is produced by the

A

Closure of the AV (tricuspid and mitral) valves.

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8
Q

The second heard sound (S2) is produced by the

A

Closure of the semilunar valves.

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9
Q

An “opening snap” refers to the sound made when

A

A narrow AV valve opens.

It occurs during diastole

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10
Q

An “ejection click” sound is produced by

A

A stenotic semilunar valve opening.

It occurs during systole

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11
Q

The sequence of opening and closing of the four valves is as follows:

A

Mitral valve closes
Tricuspid valve closes
Pulmonic valve opens
Aortic valve opens

Aortic valve closes
Pulmonic valve closes
Tricuspid valve opens
Mitral valve opens

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12
Q

The mitral component of S1 occurs as a result of the

A

Closure of the mitral valve when the left ventricular pressure rises to more than the left atrial pressure; it is written as M1

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13
Q

The tricuspid component of S1 occurs as a result of

A

Closure of the tricuspid valve when right ventricular pressure rises to more than right atrial pressure.

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14
Q

Isovolumetric contraction is

A

The time between the closure of the AV valves and the opening of the semilunar valves.

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15
Q

Ejection is

A

The time between the opening and the closing of the semilunar valves.

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16
Q

The incisura is the point at which

A

Ejection is completed and the aortic and left ventricular curve separate.

It is simultaneous with the aortic component, or closure of the aortic valve.

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17
Q

The time between the closure of the semilunar valves and the opening of the AV valves is called

A

Isovolumic contraction

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18
Q

At the end of diastole __ and the additional 20% of ventricular filling occur.

A

Atrial contraction

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19
Q

Mnemonics for remembering the cadence and characteristics of the third and fourth sounds are:

A

SLOSH-ing-in (S1, S2, S3)

A-STIFF-wall (s4, S1, S2)

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20
Q

Splitting of the first heart sound may be heard in the

A

Tricuspid area

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21
Q

Physiological splitting occurs as a result of:

A

Inspiration.

Intrathoracic pressure lowers, causing more blood to be drawn from the superior and inferior vena cavae into the right chambers of the heart.

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22
Q

Sinus arrhythmia occurs as a result of

A

An increase in heart rate with inspiration; it is a reflex tachycardia.

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23
Q

The anacrotic notch is a

A

Noth in the arterial pulsation toward the end of the rapid ejection period.

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24
Q

The positive wave that follows the dicrotic notch is called the

A

Dicrotic wave

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25
Q

In the arterial pulse, the percussion wave occurs

A

Earlier than the dicrotic notch and is associated with the rate of flow in the artery.

It occurs during peak velocity of flow.

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26
Q

The tidal wave is the

A

Second wave in the arterial pulse and is occurs during peak systolic pressure.

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27
Q

Blood pressure depends on

A

The volume of blood ejected

The velocity of blood

Distensibility of the arterial wall

Viscosity of the blood

Pressure within the vessel after the last ejection

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28
Q

The jugular venous pulse provides direct information about the pressures in the _ side of the heart because the jugular system is in direct continuity with the __.

A

Right side of the heart

Is in direct continuity with the right atrium.

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29
Q

If ther is no stenoic lesion at the pulmonic or mitral valves, the right ventricle will

A

Directly monitor the pressures in the left atrium and left ventricle.

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30
Q

The most common cause of right sided heart failure is

A

Left sided heart failure.

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31
Q

The “a” wave of the jugular venous pulse is produce by

A

Right atrial contraction.

It occurs 90 msec after the P wave.

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32
Q

The “x” descent is caused by

A

Atrial relaxation

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33
Q

In the jugular venous curve, the drop in right atrial pressure is terminated by the

A

“C” wave.

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34
Q

The “c” wave involves

A

Closing of the tricuspid valve secondary to right ventricular contraction.

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35
Q

The “x prime” descent involves

A

An increase in the size of the atrium, causing a fall in its pressure.

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36
Q

An increase in right atrial filling pressure causes the shape of the

A

“V” wave.

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37
Q

A drop in right atrial pressure produces the

A

“Y” descent.

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38
Q

Angina pectoris the true symptom of

A

Cardiac heart disease

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39
Q

Angina is commonly the consequence of

A

Hypoxia of the myocardium resulting from imbalance of coronary supply and myocardial demand.

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40
Q

Characteristics of angina

A

Retrosternal, diffuse pain

Felt on the left arm and jaw

Is described as aching, dull, pressing, squeezing, viselike

Is mild to sever and last minutes.

It is precipitaed by effort, emotion, eating and cold

It is relieved by rest and nitroglycerin.

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41
Q

Characteristics that are not indicative of angina:

A

Left inframmary localized pain or pain in the right arm

Sharp, shooting, cutting and excruciating pain

Lasts seconds, hours or days

Is due to respiration, posture and motion, and is relieved by nonspecific methods.

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42
Q

Extrasystoles are commonly caused by

A

Bradyarrhythmias

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43
Q

Atrial premature beats are most commonly caused by

A

Heart block

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44
Q

Nodal premature beats are most commonly caused by

A

Heart block

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45
Q

Ventricular premature beats are msot commonly caused by

A

Drugs

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46
Q

Tachyarrhythmias are most commonly caused by

A

Bronchodilators

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47
Q

Paroxysmal supraventricular tachycardia is most commonly caused by

A

Digitalis

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48
Q

Atrial flutter is msot commonly cuased by

A

Antidepressants

49
Q

Atrial fibrillation is most commonly caused by:

A

Smoking

50
Q

Multifocal atrial tachycardia is most commonly caused by

A

Caffeine

51
Q

Ventricular tachycardia is msot commonly caused by

A

Thyrotoxicosis

52
Q

Cardiac causes of dyspnea include

A

Left ventricular failure

Mitral sentosis

53
Q

Pulmonary causes of dyspnea are:

A

Obstructive lung disease

Asthma

Restrictive lung disease

Pulmonary embolism

Pulmonary hypertension

54
Q

A common emotional cause of dyspnea is

A

Anxiety

55
Q

A common high-altitude exposure cause of dyspnea is

A

Decreased oxygen pressure

56
Q

A common anemia cause of dyspnea is

A

Decreased oxygen carrying capacity.

57
Q

Cardiac causes of syncope include

A

Decreased cerebral perfusion secondary to cardiac rhythm disturbance

Left ventricular output obstruction

58
Q

Metabolic causes of syncope

A

Hypoglycemia

Hyperventilation

Hypoxia

59
Q

Psychiatric causes of syncope

A

Hysteria

60
Q

Neurologic causes of syncope include

A

Epilepsy

Cerebrovascular disease

61
Q

Orthostatic hypotension causes syncope by the following mechanisms:

A

Volume depletion

Antdepressant medications

Antihypertensive medications

62
Q

Vasovagal response causes syncope by

A

Vasodepression

63
Q

Micturition causes syncope due to

A

A visceral reflex (vasodepressor)

64
Q

Coughing can cause syncope due to

A

Chronic lung disease

65
Q

The carotid sinus can cause syncope by

A

A vasodepressor response to carotid sinus sensitivity.

66
Q

Mitral stenosis is an important cause of

A

Hemoptysis

67
Q

Differential cyanosis, a type of cyanosis found only in the lower extremities, is related to a

A

Right-to-left shunt through a patent ductus arteriosus.

68
Q

Prehypertension includes a blood pressure of

A

120-139/80-89

69
Q

Stage 1 hypertension is defined as a blood pressure reading of:

A

140 - 159/90-99

70
Q

Stage 2 hypertension is defined as a blood pressure reading of

A

160/100

71
Q

How to rule out orthostatic hypertension

A

After the patient has been recumbent for at least 5 minutes, measure the baseline blood pressure and pulse. Then have the patient stand, and repeat the measurements immediately.

72
Q

How to rule out supravalvular aortic stenosis

A

If hypertension is detected in the right arm, place the cuff on the left arm and determine the auscultatory pressure. In a healthy patient, there should not be a difference in blood pressures.

73
Q

How to rule out coarctation of the aorta

A

Measure blood pressure in the lower extremity, then the upper extremity. In a healthy patient, a leg systolic blood pressure should be higher than in the arm.

74
Q

How to rule out cardiac tamponade.

A

Paradoxical pulse

Have the patient breathe as normally as possible. Inflate the blood pressure cuff until no sounds are heard. Deflate the cuff until sounds are heard in expiration only. Continue to deflate the cuff until sounds are heard during inspiration. If the difference in these pressures exceeds 10 mm Hg, a marked pulsus paradoxus is present and cardiac tamponade may be the cause.

75
Q

To palpate the carotid artery

A

Place your index and third fingers on the patient’s thyroid cartilage and slip them laterally between the trachea and the sternocleidomastoid muscle.

76
Q

An anacrotic notch is indicative of

A

Aortic stenosis

77
Q

A waterhammer (Corrigan’s notch - looks like a smooth hump) and the bisiferiens hump (double humps) are indicative of

A

Aortic regurgiation

78
Q

Alternans (alternating low and high peaks) are indicative of

A

Congestive heart failure

79
Q

Paradoxical (two high peaks, two low peaks, then two high peaks, etc) are indicative of

A

Tamponade

Constructive pericarditis

Chronic obstructive lung disease

80
Q

Features of the jugular pulse

A

Not palpable

Soft, undulating

Inspiration and sitting up decrease the height of wave forms
Valsalva maneuver increase the height of wave forms

81
Q

Features of the carotid pulse

A

Palpable, vigorous sound with multiple waveforms.

Inspiration, sitting up and the valsalva maneuver have no effect on the pulse.

82
Q

Percussion of the heart is performed at the

A

3rd, 4th and 5th intercostal spaces from the left anterior axillary line.

83
Q

Palpating for localized motion involves

A

Having the patient lie down so that all four main cardiac areas can be palpated.

The presence of a systolic impulse in the second intercostal space to the left of the sternum is suspect for pulmonary hypertension.

84
Q

Palpating for generalized motion involves

A

Palpating for any large area of sustained outward motion (called a heave or lift).

A parasternal rock is indicative of a large right ventricle.

85
Q

Thrills are

A

Superficial vibratory sensations felt on the skin overlying an area of turbulence.

The presence of a thrill indicates a loud murmur.

86
Q

The supine position is used for auscultating

A

All areas

87
Q

The left lateral decubitus position is used, listening with the BELL, to auscultate the

A

Mitral area

88
Q

The upright position is used for listening to __ and the upright, leaning forward position is used for _

A

Upright only - all areas

Upright, leaning forward - listening with the diaphragm at the base positions.

89
Q

In the supine position, auscultate and evaluate the

A

S1, S2 and systolic murmurs in all areas

90
Q

At the left lateral decubitus, auscultate and evaluate the

A

Diastolic events at apex with the bell of the stethoscope

91
Q

In the upright position, auscultate/evaluate the

A

S1, S2

Systolic murmurs in all areas

Diastolic murmurs in all areas

92
Q

In the upright, leaning forward position, auscultate/evaluate the

A

Diastolic events at the base with a diaphragm of a stethoscope.

93
Q

The intensity of murmurs is graded from I to VI, based on increasing loudness. Sounds I - III are:

A

I: not heard by inexperienced listeners
II: audible to inexperienced listeners
III: medium intensity without a thrill

94
Q

The intensity of murmurs is graded I to VI, based on increasing loudness. Murmurs IV - VI are heard as:

A

IV: medium intensity with a thrill
V: loudest murmur that is audible when the stethoscope is placed on the chest; associated with a thrill.
VI: loudest intensity; audible when stethoscope is removed from chest; is associated with a thrill.

95
Q

The factors that are responsible for the intensity of S1 are:

A

The rate of rise of ventricular pressure

The condition of the valve

The position of the valve

The distance of the heart from the chest wall

96
Q

The conditions that change the intensity of S2 are

A

Changes in systolic pressure

Condition of the valve

Calcification or fibrosis of the semilunar valves can affect the heart sounds.

97
Q

Midystolic clicks are not

A

Ejection clicks.

98
Q

Ejection murmurs appear diamond shaped and are described as:

A

Crescendo-decrescendo.

They begin slightly after S1 and end before S2.

99
Q

High pitched murmurs heard during S3 are indicative of volume overload. These murmurs are also known as

A

Regurgitation

Incompetence

Insufficiency

100
Q

Diastolic murmurs begin after S2 with the opening of the

A

AV valve.

Mitral stenosis and tricuspid stenosis are examples of this type of murmur.

101
Q

Sounds heard during the early systolic phase of the cardiac cycle are

A

Ejection clicks

Aortic prosthetic valve opening sounds

102
Q

Sounds heard during the midsystolic to late systolic are

A

Midsystolic click

Rub

103
Q

Sounds heard during the early diastolic cardiac cycle are

A

Opening snap

S3

Mitral prosthetic valve opening sound

Tumor plop

104
Q

Sounds heard during the mid-diastolic cardiac cycle are

A

S3

Summation gallop

105
Q

Sounds heard during the late diastolic cardiac cycle are

A

S4

Pacemaker sound

106
Q

The sounds of aortic stenosis are

A

Medium pitched and harsh.

107
Q

Associated signs with aortic stenosis are

A

Decreased A2

Ejection click

S4

Narrow pulse pressure

Slow rising delayed pulse

108
Q

The sounds associated with mitral regurgitation are

A

High, blowing with a holosystolic shape.

109
Q

Associated signs of mitral regurgitation are

A

Decreased S1

S3

Laterally displaced diffuse PMI

110
Q

Sounds associated with mitral stenosis are:

A

Low, rumbling, decrescendo.

111
Q

Signs associated with mitral stenosis are

A

Increased S1

Opening snap RV rock

Presystolic accentuation

112
Q

Sounds associated with aortic regurgitation are

A

High, blowing, decrescendo

113
Q

Signs associated with aortic regurgiation are

A

S2

Laterally displaced PMI

Wide pulse pressure

Bounding pulses

Austin flint murmur

Systolic ejection murmur

114
Q

Features of pulmonic stenosis murmur

A

Located in the pulmonic area and radiates to the neck.

It is diamond shaped, has a medium pitch and is of harsh quality.

115
Q

Features of tricuspid regurgitation

A

Located in the tricuspid area and radiates to the right of the sternum.

It is holosystolic and has a high, blowing noise.

116
Q

Features of ventricular septal defect

A

They are located in the tricuspid area and radiate to the right of the sternum.

They are holosystolic, high and harsh sounding.

117
Q

Features of venous hum murmur

A

Above the clavicle and radiates to the right neck.

It is a continuous, high, roaring and humming sound.

118
Q

Features of an innocent murmur

A

It is widespread and has minimal radiation.

It is diamond shaped, and has a medium, twanging and vibratory quality sound.

NYCPM Physical Assessment (2 decks)

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