Cardio 2

Question 1

What bony structure does the aorta pass beneath?

Answer 1

manubrium

Question 2

What is considered normal JVP height?

Answer 2

<5cm

Question 3

what is normal BP?

Answer 3

<120/80

Question 4

what is pre-HTN?

Answer 4

120-139/80-89

Question 5

What is stage 1 HTN?

Answer 5

140-159/90-99

Question 6

What is stage 2 HTN?

Answer 6

>160/>100

Question 7

What happens to pulse and BP as we age?

Answer 7

pulse decreases, BP increases

Question 8

what are heaves/lifts?

Answer 8

very strong beats that can be visualized with inspection

Question 9

what eye changes are associated with hepatic congestion?

Answer 9

scleral icterus, scleral jaundice

Question 10

what disease states are edema of the eyes associated with?

Answer 10

HF, low protein states, nephrotic syndrome

Question 11

What respiratory condition does not cause clubbing?

Answer 11

COPD

Question 12

what grade murmur presents with thrill?

Answer 12

at least 4/6

Question 13

What part of the hand is used to palpate a thrill?

Answer 13

palmar aspect of MCP joints

Question 14

When should the carotid be palpated on PE?

Answer 14

during initial auscultation to match up systole

Question 15

What is auscultated with the patient in left lateral decubitus position?

Answer 15

the apex with the bell

Question 16

where are mitral murmurs heard best?

Answer 16

left lateral decubitus position

Question 17

When can S2 splitting best be heard?

Answer 17

patient sitting and leaning forward during full exhalation - listen of aortic and pulmonic areas with diaphragm

Question 18

what can cause a murmur?

Answer 18

increased flow over a normal valve, partially obstructed flow (stenosis), regurgitation, flow into a dilated chamber, shunting

Question 19

grade 1/6 murmur

Answer 19

very faint, barely audible

Question 20

grade 2/6 murmur

Answer 20

clearly audible but quiet

Question 21

grade 3/6 murmur

Answer 21

moderately loud

Question 22

grade 4/6 murmur

Answer 22

loud-palpable thrill

Question 23

grade 5/6 murmur

Answer 23

very loud, may be heard with the stethescope partially off the chest

Question 24

grade 6/6 murmur

Answer 24

may be heard without a stethescope

Question 25

what does a pericardial friction rub sound like?

Answer 25

triphasic - 2 atrial and 1 ventricular

Question 26

what causes mechanical clicks?

Answer 26

prosthetic valves (prosthetic aortic valve heard in S2

Question 27

what are the 3 layers of an artery

Answer 27

intima, media (SM), adventitia

Question 28

What is an atheroma?

Answer 28

begins in the intima as a lipid filled foam cell that turns into fatty streaks which weaken the media and are covered with a fibrous smooth muscle and collagen matrix - rupture = thrombosis

Question 29

true or false: veins are distensable and contain twice as much blood

Answer 29

TRUE

Question 30

Why don't veins develop atheromas?

Answer 30

they don?t have an endothelial intima

Question 31

what is a variscosity of the testes called?

Answer 31

variocele

Question 32

what allows veins to respond to physiologic changes?

Answer 32

elastic tissue and smooth muscles

Question 33

Which veins carry most of LE blood?

Answer 33

deep veins (90%)

Question 34

what are the superficial leg veins?

Answer 34

greater and small saphenous

Question 35

which vein is used for bypass grafting?

Answer 35

greater saphenous

Question 36

What type of pressure mediates interactions between arterioles, venules and lymph?

Answer 36

hydrostatic

Question 37

if there is a cool limb what does it mean?

Answer 37

arterial insufficiency

Question 38

What bony prominences are palpated over to check for peripheral edema?

Answer 38

medial malleolus, lateral malleolus, pre-tibial, dorsum of foot

Question 39

Grade 1+ pitting edema

Answer 39

slight, disappears rapidly (2mm)

Question 40

grade 2+ pitting edema

Answer 40

deeper than 1+, disappears in 10-15 seconds (4mm)

Question 41

grade 3+ pitting edema

Answer 41

noticeably deep, \>1minute, extremely swollen (6mm)

Question 42

grade 4+ pitting edema

Answer 42

deep pit, lasts 2-5 minutes, gross swelling (8mm)

Question 43

where can pitting be observed?

Answer 43

dependent areas: feet, lower back, anisarka = pitting all over

Question 44

where is one of the first places to pit in CHF?

Answer 44

penis/scrotum

Question 45

does lymphedema pit?

Answer 45

no

Question 46

what causes lymphedema?

Answer 46

lymphatic dysfunction of disturbance in hydrostatic or osmotic pressures

Question 47

what disease is characterized by severe lymphedema?

Answer 47

elephantitis

Question 48

what position is the patient in to check for varicose veins?

Answer 48

standing - use compression to map the vein

Question 49

when are carotid upstrokes present?

Answer 49

aortic stenosis

Question 50

where is the internal jugular vein located?

Answer 50

between the 2 heads of the SCM

Question 51

what angle should the bed be in during JVP testing?

Answer 51

30 degrees, distension decreases as head and torso are elevated

Question 52

define bruit

Answer 52

audible vibrations caused by partial obstruction of flow

Question 53

why does the pt hold their breath when auscultating bruits?

Answer 53

to reduce tracheal sounds

Question 54

what end of the stethescope should you use to auscultate bruits?

Answer 54

the bell

Question 55

What are the most common sites for arterial auscultation?

Answer 55

temporals, carotids, renal arteries, abdominal aorta, iliacs, femorals

Question 56

what can a bruit indicate?

Answer 56

stenosis, aneurysm

Question 57

what are the restroperitoneal organs?

Answer 57

ureters, kidneys, aorta, duodenum, pancreas (best heard on the back)

Question 58

normal adult heart rate

Answer 58

70-100

Question 59

what types of rhythm could be present?

Answer 59

regular, regularly irregular, irregularly irregular

Question 60

no more than 3 PVCs in a row and ... in a minute

Answer 60

6

Question 61

grade 4+ pulse

Answer 61

bounding, increased (aortic stenosis and regurgitation)

Question 62

grade 3+ pulse

Answer 62

full, increased

Question 63

grade 2+ pulse

Answer 63

expected

Question 64

grade 1+ pulse

Answer 64

diminished (HOTN, syncope)

Question 65

grade 0 pulse

Answer 65

absent, not palpable - check with doppler

Question 66

what pulses are gathered on PE?

Answer 66

carotid, brachial, radial, femoral, popliteal, dorsalis pedis, posterior tibial

Question 67

what should be done before palpation of the carotid?

Answer 67

auscultate for bruits

Question 68

if dorsalis pedis pulse is present what other pulse should be present?

Answer 68

posterior tibial - due to collateral circulation

Question 69

6 P's of acute arterial occlusion

Answer 69

pain, pallor, pulselessness, paresthesias, paralysis, poikilothermia

Question 70

what is compartment syndrome?

Answer 70

increased pressure in a compartment

Question 71

causes of acute arterial occlusion

Answer 71

snake bites, afib, IE, pelvic fracture, aneurysm, arterial dissections, fat embolism, trauma

Question 72

what arteries does acute mesenteric ischmia affect?

Answer 72

superior/inferior mesenterics

Question 73

what pressure is diagnostic of compartment syndrome?

Answer 73

\>15mmHg

Question 74

skin changes in chronic arterial insufficiency?

Answer 74

prolonged capillary refill, loss of hair, thinning of skin, shiny skin, dependent rubor, painful ulcers

Question 75

PVD warning signs

Answer 75

claudication, fatigue, erectile dysfunction, poorly healing LE wounds, rest pain in foot or LE

Question 76

describe the appearance of a chronic arterial ulcer

Answer 76

painful, punched out, smaller, diminished pulses, distal coldness

Question 77

describe the appearance of a diabetic ulcer

Answer 77

punched out over malleoli and plantar feet - painless

Question 78

what can cause stasis ulcers

Answer 78

poor circulation common with CVD - dermatitic first, wide and undulating adges with clean base

Question 79

signs of DVT

Answer 79

warmth, erythema, posterior calf tenderness, Homan's sign, swelling (measure circumference)

Question 80

how to r/o DVT?

Answer 80

2 negative US

Question 81

what is the normal diameter of an infrarenal aorta?

Answer 81

\>3cm

Question 82

what diameter is it necessary to intervene with a AAA

Answer 82

\>5.5cm

Question 83

risk factors for AAA?

Answer 83

\>65, smoking, CVD, PVD, HTN, hyperlipidemia

Question 84

who should be screened for AAA?

Answer 84

smokers \>65 with US

Question 85

when should pts be referred with AAA?

Answer 85

\>4cm, palpable, enlargements

Question 86

description of AA on XR?

Answer 86

ballooning with calcifications