Trans - Pediatric Cardiac PE

Question 1

Harrison’s groove

Answer 1

rib deformity and sign of chronic heart failure with diaphragm enlargement

Question 2

palpating for heaves - movement on which part of the hand indicates LV heave? RV heave?

Answer 2

[1] RV heave - palm/sternum

[2] LV heave - fingers

Question 3

cause of thrills

Answer 3

turbulence of underlying murmurs

Question 4

thrills can first be felt at what grade of murmurs

Answer 4

4/6

Question 5

the stethoscope diaphragm is useful for picking up which sounds?

Answer 5

high pitched sounds - S1, S2, murmurs of aortic and mitral regurgitation, pericardial friction rubs

Question 6

the stethocscope bell is useful for picking up which sounds?

Answer 6

low pitched sounds - S3, S4, murmur of mitral stenosis

Question 7

how is ascultation of the pediatric patient done? why?

Answer 7

C manner (infraclavicular –> parasternal –> apex –> axilla), because most pediatric heart conditions are congenital

Question 8

where is the normal splitting of S1 detected?

Answer 8

lower left sternal border

Question 9

physiological splitting of S2 occurs when?

Answer 9

during inspiration

Question 10

why does the physiological splitting of S2 occur?

Answer 10

During inspiration, the increase in negative intrathoracic pressure causes increased central venous return. Because this increased volume passes through the pulmonary trunk, causing the pulmonic valve to close a bit later than normal.

Question 11

components of S2

Answer 11

A2, P2

Question 12

which is louder? A2 or P2?

Answer 12

A2

Question 13

[T/F] S3 or S4 in an athlete is an abnormal finding

Answer 13

F

Question 14

how are murmurs differentiated from normal heart sounds?

Answer 14

murmurs have a longer duration

Question 15

things to evaluate in auscultation [6]

Answer 15

[1] rate
[2] rhythm
[3] quality of heart sound
[4] S1/S2
[5] extra heart sounds
[6] murmur

Question 16

where is S1 louder?

Answer 16

apex

Question 17

where is S2 louder?

Answer 17

base

Question 18

midsystolic murmur - description

Answer 18

begins after S1, stops before S2; gaps between murmur and heart sound

Question 19

midsystolic murmur - lesions

Answer 19

deals with blood flow across semilunar valves

Question 20

holosystolic murmur - description

Answer 20

starts with S1 and stops at S2

Question 21

holosystolic murmur - lesions

Answer 21

often due to regurgitant flow across AV valves

Question 22

late systolic murmur - description

Answer 22

in mid- late- systole persisting up to S2

Question 23

late systolic murmur - lesions

Answer 23

mitral valve prolapse (may or may not be preceeded by systolic click)

Question 24

early diastolic murmur - description

Answer 24

starts right after S2 without gap, fades into silence before next S1

Question 25

early diastolic murmur - lesions

Answer 25

often accompany regurgitant flow across incompetent semilunar valves

Question 26

middiastolic murmur - description

Answer 26

begins quickly after S2

Question 27

middiastolic murmur - lesion

Answer 27

turbulent flow across AV valves

Question 28

S3 rumbles - description

Answer 28

middiastolic murmur associated with S3, associated with torrential inflow

Question 29

Austin Flint murmur - description

Answer 29

begin in middiastole, may be confined to middiastole or continue through presystole

Question 30

S3 rumbles - lesion

Answer 30

AV regurgitation, ASD

Question 31

Austin Flint murmur - lesion

Answer 31

aortic regurgitation

Question 32

pericardial friction rub - causes

Answer 32

inflammation of pericardial sac

Question 33

pericardial friction rub - components [3]

Answer 33

[1] atrial systole [2] ventricular systole [3] ventricular diastole

Question 34

patent ductus arteriosus

Answer 34

open channel persists between aorta and pulmonary artery

Question 35

patent ductus arteriosus - type of murmur

Answer 35

continuous murmur with silent interval late in diastole and loudest in late systole

Question 36

[T/F] friction rubs are a type of heart murmur

Answer 36

F, not caused by flow

Question 37

crescendo-decrescendo murmur - lesions

Answer 37

present in obstructive lesions

Question 38

crescendo-decrescendo murmur - why?

Answer 38

crescendo - ventricles try to pump blood through obstruction | decrescendo - blood passes through, pressure is released

Question 39

aortic regurgitation - type of murmur

Answer 39

diastolic

Question 40

aortic stenosis - type of murmur

Answer 40

systolic

Question 41

pulmonic regurgitation - type of murmur

Answer 41

diastolic

Question 42

pulmonic stenosis - type of murmur

Answer 42

systolic

Question 43

mitral stenosis - type of murmur

Answer 43

diastolic

Question 44

mitral regurgitation - type of mumur

Answer 44

systolic

Question 45

tricuspid regurgitation - type of murmur

Answer 45

systolic

Question 46

tricuspid stenosis - type of murmur

Answer 46

diastolic

Question 47

ventricular septal defect - type of murmur

Answer 47

uniform holosystolic murmur (due to pressure gradient present in systole)

Question 48

patent ductus arteriosus - type of murmur

Answer 48

continuous murmur (due to pressure difference in both systole and diastole)

Question 49

atrial septal defect - ascultatory findings [3]

Answer 49

[1] diastolic rumble in tricuspid (stenosis) [2] pulmonic murmur (due to increased blood flow from right ventricle to pulmonic valve) [3] widely fixed split S2 (due to increased blood flow through pulmonic valve)

Question 50

atrial myxoma

Answer 50

mass in atrium causing mitral inflow obstruction

Question 51

atrial myxoma - type of murmur

Answer 51

crescendo-decrescendo murmur in diastole