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ICM Exam 1 > Week 5 - CV 2, PV, and Lymphatics > Flashcards

Week 5 - CV 2, PV, and Lymphatics Flashcards

1
Q

ROS Question

A

Any swelling, pain, or discoloration in your arms or legs?

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2
Q

Systole is when?

A

Interval between S1 and S2

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3
Q

Diastole is when?

A

S2 and S1

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4
Q

When is S1 heard?

A

Just before the carotid upstroke

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5
Q

When is S2 heard?

A

Following the carotid upstroke

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6
Q

Where is S1 louder than S2?

A

At apex

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7
Q

Where is S2 louder than S1?

A

Base

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8
Q

What sounds are listened to by the diaphragm?

A

High-pitched sounds

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9
Q

What 3 sounds can be heard with the diaphragm?

A
  1. S1 and S2
  2. Aortic and mitral regurgitation
  3. Pericardial friction rubs
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10
Q

What do we listen to with the bell?

A

Low-pitched sounds

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11
Q

What 2 things can we hear from the bell?

A
  1. S3 and S4

2. Murmur of mitral stenosis

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12
Q

How do we apply the bell?

A

Lightly

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13
Q

2 specific times when S1 can be accentuated?

A
  1. High cardiac output

2. Mitral stenosis

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14
Q

2 specific times when S1 can be diminshed?

A
  1. Mitral valve is calcified and relatively immobile

2. L ventricular contractility is markedly reduced

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15
Q

Where do we listen for splitting in S2?

A

2nd or 3rd L interspace

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16
Q

Where do we see pathologic splitting a lot?

A

Atrial septal defect

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17
Q

Where do we see early systolic ejection sounds?

A

Aortic valve disease from congenital stenosis

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18
Q

What do we often see systolic clicks?

A

Mitral valve prolapse

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19
Q

What is “Opening Snap”?

A

Very early diastolic sound usually produced by the opening of a stenotic mitral valve

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20
Q

Where is “Opening Snap” heard best?

A

Just medial to apex

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21
Q

Where will we often detect PHYSIOLOGICAL S3?

A
  1. Children and in young adults to the age of 35 or 40

2. Last trimester of pregnancy

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22
Q

When does S3 occur?

A

Early in diastole during rapid ventricular filling

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23
Q

Is an S3 in adults over 40 pathological? What is it caused by?

A

Yes; high pressures and abrupt deceleration of inflow

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24
Q

What is “Kentucky”?

A

Involved in S3. Gives rise to the term gallop from the cadence of 3 heart sounds, especially rapid heart rates that sound like Kentucky

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25
Q

What is S4 commonly due to?

A

Increased resistance to ventricular filling following atrial contraction

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26
Q

What is “Tennessee”?

A

Left sided S4 heard best at the apex in the L lateral position

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27
Q

What is a “Summation Gallop”?

A

A patient that has both S3 and S4 producing a quadruple rhythm. At rapid rates S3 and S4 may merge into one extra large heart sound called a summation gap

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28
Q

What do we do for a heart murmur?

A
  1. Timing (S or D?)
  2. Where is it loudest
  3. Shape of murmur
  4. Maneuver the patient
  5. Identify associated features (quality of S1/2, presence of extra sounds)
  6. Intensity
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29
Q

2 terms associated with the timing of heart murmurs

A
  1. Pansystolic murmur

2. Midsystolic murmur

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30
Q

Pansystolic Murmur

A

Often occurs with regurgitant flow across AV valves

31
Q

Midsystolic Murmur

A

Arise from blood flow across aortic and pulmonic (semilunar) valves

32
Q

What do we see in early diastolic murmurs?

A

Regurgitant flow across incompetent semilunar valves

33
Q

What do we see in mid diastolic and presystolic murmurs?

A

Turbulent flow across AV valves

34
Q

Continuous Murmur

A

Beings in systole and extends into all or part of diastole

35
Q

2 causes of Continuous Murmur

A
  1. Congenital patent ductus arteriosus

2. Pericardial friction rubs

36
Q

4 descriptions of the shapes of murmurs and what are they associated with?

A
  1. Crescendo (grows louder) - mitral stenosis
  2. Decrescendo (grows softer) - aortic regurgitation
  3. Crescendo-Decrescendo (rises, then falls) - aortic stenosis
  4. Plateau (same intensity) - mitral regurgitation
37
Q

What does the left lateral decubitus position do?

A

Brings left ventricle close to chest wall and accentuates left sided S3 and S4 mitral murmurs, especially mitral stenosis

38
Q

What side of the stethoscope do we use in L lateral decubitus?

A

Bell lightly on the apical impulse

39
Q

How do we accentuate aortic murmurs?

A
  1. Sit up
  2. Lean forward
  3. Exhale completely
  4. Stop breathing in expiration
40
Q

What side of stethoscope do we use for aortic murmurs and where? Why?

A

Diaphragm; L sternal border and at apex because otherwise we might miss soft diastolic murmur of aoritc regurgitation

41
Q

What decreases when a person stands?

A

Venous return to the heart

42
Q

What else declines when a person stands?

A
  1. Arterial BP
  2. Stroke volume
  3. Volume of blood in L ventricle
43
Q

Does squatting cause an increase in venous return?

44
Q

What do the changes in venous return help with?

A
  1. Identify prolapsed mitral valve (sooner and louder with less cardiac volume)
  2. Distinguish hypertrophic cardiomyopathy (sooner/louder with less) from aortic stenosis (decreased intensity with less volume)
45
Q

What is Valsalva Maneuver?

A

Forcible exhalation against closed glottis to increase intrathoracic pressure

46
Q

What do we see in Valsalva Maneuver?

A

Drop of both BP and L ventricular volume during “release” phase and then “overshoot” several seconds later

47
Q

Grade 2 Murmur

A

Quiet but heard immediately with stethoscope

48
Q

Grade 4 Murmur

A

Palpable thrill

49
Q

Grade 5/6 Murmur

A

Extremely loud thrill (no stethoscope needed for 6)

50
Q

What and where do we see mitral regurgitation murmur?

A

Decreased S1; apex

51
Q

Where do we see tricuspid regurgitation?

A

Lower L sternal border

52
Q

Can we have an innocent murmur and pathologic murmur both present?

A

Occasionally

53
Q

Is a physiologic murmur a possible sign of likely cause?

54
Q

Where do we see aortic stenosis?

A

R 2nd interspace

55
Q

What associated findings do we see in Hypertrophic Cardiomyopathy?

A

S3 may be present and S4 often present at apex (unlike mitral regurgitation)

Carotid pulse rises quickly unlike pulse in aortic stenosis

56
Q

Where do we see pulmonic stenosis?

A

2nd and 3rd L interspaces

57
Q

What are associated findings with aortic regurgitation? (diastolic murmur?

A

Pulse pressure increases and arterial pulses are often bounding

58
Q

What is an Austin Flint?

A

Midsystolic flow murmur of mitral diastolic murmur suggesting large regurgitant flow

59
Q

Where do we see PDA?

A

L 2nd interspace (both diastolic and systolic murmur components)

60
Q

5 things with Peripheral Arterial Exam

A
  1. Measure BP in both arms
  2. Palpate for carotid upstroke, aorta, determine maximal diameter
  3. Auscultate for aortic, renal, and femoral bruits
  4. Palpate arteries
  5. Inspect ankles and feet for color, temp, skin integrity
61
Q

What might lymph edema of the arm and hand follow?

A

Axillary node dissection and radiation therapy

62
Q

What scale us used for edema?

A

4 points scale

63
Q

3 things “Diffuse Edema” is associated in?

A
  1. HF
  2. Cirrhosis
  3. Nephrotic syndrome
64
Q

3 causes for “Unilateral Edema”

A
  1. Deep venous thrombosis
  2. Chronic venous insufficiency
  3. Lymphedema
65
Q

When does Gangrene develop? When not?

A

Chronic Arterial insufficiency; venous

66
Q

Neuropathic Ulcer

A

Developes in pressure points of areas with diminished sensation

67
Q

Where do we often see neuropathic ulcers?

A
  1. Diabetic neuropathy
  2. Neurological disorders
  3. Hansen disease
68
Q

Is there pain in neuropathic ulcers?

69
Q

Symptoms of Neuropathic Ulcer

A

Decreased sensation and absent ankle jerks

70
Q

What size inguinal nodes are normal and palpable?

71
Q

ABI formula for R foot

A

R ABI = highest P in R foot / highest P in both arms

72
Q

ABI value of moderate arterial disease

73
Q

ABI value acceptable

74
Q

ABI value for severe arterial disease

ICM Exam 1 (7 decks)

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