valvular disease

Question 1

passive leg raise increases ____

Answer 1

preload

Question 2

squatting increases ____

Answer 2

preload (because when you squat, vasoconstrict and shunt blood back to heart)

Question 3

decrease preload- which manuevers

Answer 3

valsalva (straining) inspiration (increase the preload on RV)
standing (moving blood down from the legs)

Question 4

expiration effect on preload

Answer 4

decrease the RV preload

Question 5

right sided murmur what intensifies

Answer 5

inspiration

Question 6

expiration increases intensity of

Answer 6

left sided murmur

Question 7

What increases afterload (manuever)

Answer 7

increased hand grip
squatting

because it increases SVR

Question 8

diastolic murmurs are almost always

Answer 8

abnormal

Question 9

classic triad of aortic stenosis

Answer 9

SAD: syncope, angina, dyspnea

Question 10

pulsus parvus et tardus- what does it mean

Answer 10

seen in aortic stenosis. weak and late pulse. longer, because it takes a long time to get the high pressure out of the aorta.

Question 11

A2P2- seen in

Answer 11

aortic stenosis

Question 12

harsh crescendo decresendo systolic ejection murmur- radiates to carotids: which murmur

Answer 12

aortic stenosis

Question 13

location of aortic stenosis

Answer 13

R 2ND ICS

Question 14

Cause of aortic stenosis (3)

Answer 14

dystrophic calcification (normal levels of calcium) but high deposition of calcium on aortic valve esp in elderly patients

bicuspid aortic valve- fusion of aortic leaflets in young patients

rhuematic fever

Question 15

aortic regurgitation

Answer 15

regurg blood back into the left ventricle
can be acute or chronic

Question 16

difference between dystrophic calcification and metastatic calcification

Answer 16

dystrophic calcification: normocalcemia, damaged tissue

metastatic calcification: hypercalcemia, normal tissue

Question 17

What are the causes of aortic regurgitation?

Answer 17

aortic valve sclerosis,
bicuspid aortic valve
aortic diltation (aneursym, connective tissue diesase, tertiary sypllis)
poorly controlled HTN ( aortic dissection and thoracic aortic aneurysm)

Question 18

water hammer pulse- meaning?

Answer 18

increased systolic pressure
lower diastolic pressure
increased pulse pressure

Question 19

murmur of aortic regurg

Answer 19

early decrescendo diastolic murmur

Question 20

increase murmur intensity for aortic regurg

Answer 20

increase preload, increase afterload, and expiration

Question 21

presentation of aortic regurg

Answer 21

exertional dyspnea
pulmonary edema
head bobbing

Question 22

is the most common cause of mitral stenosis

Answer 22

rheumatic fever

Question 23

systolic heart failure is associated with which type of hypertrophy due to ___ overload

Answer 23

eecentric- volume overload

Question 24

diastolic heart failure is associated with ___ hypertrophy due to _____ overload

Answer 24

concentric hypertrophy due to pressure overload

Question 25

diastolic rumbling murmur opening snap. which kind of murmur

Answer 25

mitral stenosis

Question 26

4 signs of atrial dilatation

Answer 26

pulmonary edema, hoarseness, dysphagia, atrial fibrillation

Question 27

mitral stenosis where to auscultate

Answer 27

L 5th ICS midclavicular line (apex)

Question 28

time between S2 and opening snap

Answer 28

less time- worse severity of mitral stenosis

Question 29

MCC of mitral stenosis

Answer 29

rheumatic heart disease manifestation after acute rehumatic fever (group A step- pyogenes)

Question 30

acute rhuematic fever presentation

Answer 30

migratory arthritis pancarditis syndeam chorea subcutraneous nodules erythema marginatum JONES

Question 31

holosytolic blowing murmur- which murmur

Answer 31

mitral regurg

Question 32

relationship between mitral regurg and PCWP/LVEDV

Answer 32

increased PCWP, LVEDV

Question 33

cause of mitral regurg

Answer 33

posterior papillary muscle mitral valve prolapse infective endocarditis

Question 34

mitral valve prolapse

Answer 34

myoxomatous generation of mitral valve, increased tension on chordae tendinae and papillary muscles

Question 35

causes of mitral valve prolappse

Answer 35

marfan papillary rupture infective endocarditis rheumatic heart disease

Question 36

decrease the preload, increases the murmur of which one?

Answer 36

mitral valve prolapse

Question 37

infective endocarditis- what bug

Answer 37

staph aureus

Question 38

tricuspid reurg

Answer 38

regurg blood into the RA

Question 39

carcinoid syndrome associated with which murmur

Answer 39

tricuspid regurg 5-HIAA goes to lungs (metabolized)