Cardiovascular

Question 1

right ventricle

Answer 1

-occupies most of the anterior cardiac surface and is easily accessible to palpation

Question 2

s1

Answer 2

• usually louder than s2 at apex

- diminished in first-degree heart block

Question 3

s2

Answer 3

• usually louder than s1 at base

- diminished in aortic stenosis

Question 4

carotid artery

Answer 4

• palpation during auscultation is invaluable aide in timing of sound or murmur
• carotid upstroke always occurs in systole immediately after s1, sounds or murmurs coinciding with upstroke are systolic
• sounds or murmurs occurring after completion of upstroke are diastolic

Question 5

apical impulse

Answer 5

• Represents brief early pulsation of left ventricle as it moves anteriorly during contraction and touches chest wall
• left ventricular area

Question 6

s2

Answer 6

• inspiratory splitting caused by closure of aortic, then pulmonic valves
• 2 componets A2 and P2 caused by closure of aortic and pulmonic valves
• during inspiration, the closure of the aortic valve and closure of pulmonic valve separate slightlym and this may be heard as 2 audible components, instead of a single sound

Question 7

murmur at cardic apex

Answer 7

mitral valve- sounds are usually heard best at and aroudn cardiac apex

Question 8

orthopnea

Answer 8

dyspnes that occurs when patient is lying down and improves when patient sits up. if positive may indicate CHF

Question 9

Normal BP

Answer 9

<120/80

Question 10

Prehypertension

Answer 10

120-139/80-89

Question 11

Stage 1 htn

Answer 11

140-159/90-99

Question 12

Stage 2 htn

Answer 12

> 160/100

Question 13

diabetes or kidney disease

Answer 13

< 130/80

Question 14

carotid vs jugular pulse

Answer 14

Carotid is palpable; jugular venous is rarely palpable. Carotid upstroke normally brisk, but may be delayed and decreased in aortic stenosis or bounding as in aortic insufficiency

Question 15

Elevated jugular venous pressure

Answer 15

• JVP reflects pressure in right atrium
• causes include
• -constrictive pericarditis
• -right-side heart failure
• -tricuspid stenosis
• -superior vena cava syndrome

Question 16

cause for increase in amplitude of apical impulse

Answer 16

• hyperthyroidism
• severe anemia
• pressure overload of left ventricle (i.e., aortic stenosis)
• volume overload of left ventricle (mitral regurgitation)

Question 17

When positioning patient in left lateral decubitus position which valvular defects are best heard

Answer 17

• mitral
• left lateral decubitus position bring left ventricle closer to chest wall thereby mitral valve murmurs to be heard better

Question 18

best position for aortic regurgitation murmur

Answer 18

• upright but leaning forward

- brings aortic valve and left ventricular outflow tract closer to chest wall

Question 19

second degree a-v block can result in

Answer 19

pulse < 60

Question 20

PMI location

Answer 20

in left 5th intercostal space, 7 to 9 cm lateral to sternum

Question 21

what occurs at start of diastole

Answer 21

closure of aortic valve

-at beginning of diastole the valves which allow blood to exit the heart close

Question 22

s1 sound

Answer 22

closure of aortic valve

Question 23

s2 sound

Answer 23

closure of mitral valve

Question 24

what is true of s2 sound

Answer 24

caused by rapid deceleration of blood against ventricular wall

Question 25

splitting of s2 sound

Answer 25

best heard over pulmonic area with bell of stethoscope

Question 26

JVP measurement

Answer 26

• vertical height of blood column plus 5 cm

- important to assess patient’s fluid status

Question 27

JVP - systolic phenomenon

Answer 27

“X” descent

Question 28

incresed CV risk for each increment of 20 systolic and 10 diastolic

Answer 28

100%

-doubles risk

Question 29

metabolic syndrome

Answer 29

• waist > 40 inches male
• waist > 35 female
• BP > 130/85
• triglycerides >=150
• fasting glucose >- 110
• HDL < 40 men
• HDL < 50 women

Question 30

maximum heart rate (for exercise)

Answer 30

220-age

Question 31

when measuring JVP

Answer 31

-measure the highest visible pressure, usually at end of expiration

Question 32

bounding carotid pulse

Answer 32

found with aortic insufficiency
-may also be seen with conditions that increase cardiac output, including stimulant use, anxiety, hyperthyroidism, fever, etc

Question 33

patient in left lateral decubitus position, auscultated with bell might hear

Answer 33

• mitral stenosis murmur
• opening snap of mitral valve
• s3 and s4 gallops

-might be missed in other positions

Question 34

To determine if murmur is systolic or diastolic

Answer 34

-palpate carotid pulse

Question 35

what correlated with sustained, high amplitude PMI

Answer 35

hypertension - SUSTAINED

Question 36

what helps with listening for s2 splitting

Answer 36

use vell with light pressure over 2nd intercostal space

Question 37

a grade 4 intensity murmur

Answer 37

is associated with a “thrill”

• cannot be grade 4 unless thrill is present
• the thrill is a “buzzing” feeling over the area where the murmur is loudest

Question 38

what produces murmur of equal intensity throughout systole

Answer 38

mitral insufficiency

Question 39

pattern or strong pulse then weak pulse

Answer 39

likely severe left heart failure

Question 40

mitral valve prolapse

Answer 40

• chest pain intermittent and located to left of sternum
• short high-pitched sound in systole (midsystolic click)
• followed by murmur which increases in intensity until s2
• heard best over apex
• when squat noise moves later in systole along with murmur