Bates

Question 1

What makes up the physiologic splitting of S2?

Answer 1

A2 = aortic valve closure
P2 = pulmonic valve closure

Question 2

Which sound do you hear first in splitting of S2?

Answer 2

A2

Question 3

When are you more likely to hear a split S2?

Answer 3

During inspiration when the right heart filling time is increased

Question 4

During the splitting of S2, which sound is louder?

Answer 4

A2

Question 5

Where should you listen to hear splitting of S2?

Answer 5

2nd and 3rd left left interspace close to the sternum

Question 6

What causes S3?

Answer 6

A pathologic change in ventricular compliance; An abrupt deceleration of inflow across the mitral valve (dilated heart from too much volume)

Question 7

What causes S4?

Answer 7

Increased left ventricular and diastolic stiffness that decreases compliance

Question 8

What causes the “opening snap” of mitral valve stenosis?

Answer 8

The mitral valve leaflet motion is restricted, so when it opens you can hear it

Question 9

S4 marks ____ contraction and comes right before S1

Answer 9

Atrial

Question 10

Where would you hear a mitral regurgitation murmur?

Answer 10

At the apex

Question 11

Where does a mitral regurgitation murmur radiant toe?

Answer 11

The left axilla

Question 12

Does a mitral regurgitation murmur become louder with inspiration?

Answer 12

No!

Question 13

Where do you listen to hear a tricuspid regurgitation murmur?

Answer 13

Lower left sternal border

Question 14

Where does a tricuspid regurgitation murmur radiate to?

Answer 14

Right of the sternum, to the xiphoid area, and to the midclavicular line, but NOT into the axilla

Question 15

Does the intensity of tricuspid regurgitation increase with inspiration?

Answer 15

Yes

Question 16

Where will you hear a ventricular septal defect?

Answer 16

3rd, 4th, and 5th left ICS

Question 17

Where will you hear an innocent/physiologic murmur?

Answer 17

2nd to 4th ICS between the left sternal border and the apex

Question 18

Will an innocent/physiologic murmur radiate?

Answer 18

A little

Question 19

What will cause an innocent murmur to disappear or decrease?

Answer 19

Sitting

Question 20

Where would you hear aortic stenosis

Answer 20

Right 2nd ICS

Question 21

Where does aortic stenosis radiate to?

Answer 21

Often to BOTH carotids, down the left sternal border and to the apex

Question 22

What will help you to hear an aortic stenosis murmur better?

Answer 22

Have the patient sit and lean forward!

Question 23

Where will you hear a pathologic murmur of hypertrophic cardiomyopathy?

Answer 23

3rd and 4th ICS

Question 24

Where does a hypertrophic cardiomyopathy murmur radiate?

Answer 24

Down the left sternal border to the apex, possibly to the base, but NOT to the neck

Question 25

What causes the pathologic murmur of hypertrophic cardiomyopathy to decrease?

Answer 25

Squatting!!***

Question 26

What causes the pathologic murmur of hypertrophic cardiomyopathy to increase?

Answer 26

Straining down from Valsalva and standing

Question 27

Where will you hear a pulmonic stenosis murmur?

Answer 27

2nd and 3rd left interspaces

Question 28

Where will a pulmonic stenosis murmur radiate?

Answer 28

Toward the left shoulder and neck (if loud)

Question 29

So if you haven't noticed pulmonic stenosis and aortic stenosis sound VERY similar, so how do you tell the difference?

Answer 29

The areas where you listen Pulmonic = Left 2nd and 3rd ICS Aortic = Right 2nd ICS The radiation Pulmonic = left shoulder and neck Aortic = Carotids and down left sternal border Splitting of S2 Pulmonic will have a decreased P2 sound if split Aortic will have a decreased A2 sound if split And you are going to hear an aortic stenosis murmur better when the patient is SITTING FORWARD!

Question 30

Where are you going to hear an aortic regurgitation murmur?

Answer 30

2nd and 4th ICS

Question 31

Where is an aortic regurgitation murmur going to radiate?

Answer 31

To the apex and maybe right sternal border

Question 32

What is the pitch of an aortic regurgitation murmur?

Answer 32

High ... USE THE DIAPHRAGM

Question 33

Blowing decrescendo; may be mistaken for breath sounds

Answer 33

Aortic regurgitation

Question 34

How should the patient be positioned if you are listening for an aortic regurgitation murmur? What do you listen with?

Answer 34

Sitting and leaning forward with a breath held after exhalation Listen with the diaphragm!

Question 35

Where is the location of mitral stenosis usually limited to?

Answer 35

The apex

Question 36

How should the patient be positioned to listen to a mitral stenosis murmur? What should you listen with?

Answer 36

Lateral decubitus - heard better w/ exhalation Listen with the BELL!

Question 37

If your patient reports having chest pain, what could be going on?

Answer 37

Angina Myocardial infarction Aortic dissection Pulmonary embolus

Question 38

An "irregularly irregular" heart palpitation could be?

Answer 38

Afib

Question 39

If your patient says their heart beat "skips and flops" it could be?

Answer 39

Premature contractions

Question 40

If your patient says their heart beat is regular and then speeds up and then slows down again, it could be?

Answer 40

PSVT

Question 41

If your patients heart rate is regular and rapid, it could be?

Answer 41

Sinus tachycardia

Question 42

When does "sudden" dyspnea occur?

Answer 42

Pulmonary embolus Spontaneous pneumothorax Anxiety

Question 43

When does exertional dyspnea occur?

Answer 43

Heart failure and other cardiac and pulmonary problems

Question 44

What disorders might your patient have if they are complaining of orthopnea, or dyspnea that occurs when they are lying down and gets better when they sit up?

Answer 44

LVH | Mitral stenosis

Question 45

What is the type of dyspnea that will wake a patient up from sleeping 1-2 hours after going to bed, and what is it associated with?

Answer 45

Paroxysmal nocturnal dyspnea LVH Mitral stenosis

Question 46

What is dependent edema, edema in the lowest body parts, typically caused by?

Answer 46

Heart failure

Question 47

Ascites is usually caused by?

Answer 47

Liver failure

Question 48

Pain or cramping in the legs during exertion that is relieved by rest within 10 minutes is called? what is it associated with?

Answer 48

Intermittent claudication Atherosclerotic peripheral artery disease

Question 49

What could cause abdominal, flank, or back pain?

Answer 49

An expanding hematoma from an abdominal aortic aneurysm

Question 50

Coldness, numbness, or pallor in the legs with loss of hair over the anterior tibial surfaces could be?

Answer 50

Decreased ARTERIAL perfusion Could get dry or brown-black ulcers from gangrene

Question 51

What could be two causes of swelling in the calves, legs, or feet?

Answer 51

Pitting edema | Chronic venous insufficiency

Question 52

How do you tell the difference between pitting edema and chronic venous insufficiency?

Answer 52

Chronic venous insufficiency will have "brawny changes" and skin thickening, especially near the ankle Ulceration is common with chronic venous insufficiency; will have a brownish pigmentation

Question 53

When the rhythm of the pulse remains regular, but the force of the arterial pulse alternates because of strong and weak ventricular contractions; alternately loud and soft Korotkoff sounds

Answer 53

Pulsus alterans

Question 54

What does pulsus alterans usually indicate?

Answer 54

Severe left sided heart failure

Question 55

An abnormally large drop in systolic pressure during inspiration. Should normally be 3-4mmHg, but when it is greater than a 10mmHg drop it is??

Answer 55

Paradoxical pulse

Question 56

Paradoxical pulse should make you consider??

Answer 56

Pericardial tamponade | Constrictive pericarditis

Question 57

Humming vibrations when you palpate the carotid artery

Answer 57

Thrills

Question 58

A murmur like sound arising from turbulent arterial blood flow

Answer 58

Bruits

Question 59

If your patient has a thrill on palpation or a bruit on auscultation, what does this mean?

Answer 59

They could likely have atherosclerotic narrowing of the carotid artery, but could also be from external carotid artery disease or aortic stenosis

Question 60

Where will you hear a venous hum?

Answer 60

Above the medial third of the clavicles especially on the right

Question 61

Where will a venous hum radiate to?

Answer 61

1st and 2nd ICS

Question 62

What will help you hear a venous hum?

Answer 62

Auscultating with the BELL

Question 63

Where is a pericardial friction rub best heard?

Answer 63

3rd ICS to the left of the sternum

Question 64

What may increase the intensity of a pericardial friction rub?

Answer 64

When the patient leans forward, exhales, and holds their breath

Question 65

What does a pericardial friction rub sound like? is it high or low pitched?

Answer 65

Scratchy, scraping sound that is high pitched

Question 66

Pericardial friction rub is associated with??

Answer 66

Pericarditis!

Question 67

Where will you hear patent ductus arteriosus best?

Answer 67

2nd left ICS

Question 68

Produced from a congenital abnormality in which an open channel persists between the aorta and pulmonary artery

Answer 68

Patent ductus arteriosus

Question 69

Benign sound produced by turbulence of blood in the jugular veins, common in children

Answer 69

Venous hum

Question 70

What is the starting point for assessing JVP?

Answer 70

Head of bed at 30 degrees

Question 71

What is an above normal JVP?

Answer 71

Greater than 3-4cm above the sternal angle OR 8-9cm above the right atrium

Question 72

An above normal JVP is 98% specific for??

Answer 72

Increased left ventricular end diastolic pressure and low left ventricular ejection fraction

Question 73

An above normal JVP increases a persons risk for?

Answer 73

Death from heart failure

Question 74

What else is an elevated JVP associated with?

Answer 74

``` Acute and chronic right and left sided heart failure Tricuspid stenosis Chronic pulmonary HTN Cardiac tamponade Pericarditis ```