Cardiovascular exam

Question 1

Components of the vascular exam are?

Answer 1

• size and symmetry of distal extremities
• color and texture of nail beds
• edema/erythema
• varicose veins/homans sign
• ulcers/brawny discoloration
• clubbing of nails
• cyanosis

Question 2

What is clubbing?

Answer 2

widened, flattened and scooped

Question 3

What is brawny?

Answer 3

chronic edema, get hemoglobin deposition into skin, heme that stays there discolors skin

Question 4

Where do you feel for the posterior tibial pulse?

Answer 4

medial side by malleolus

Question 5

What does a pulse scale of 3 which equals bounding possibly indicate?

Answer 5

1. high blood pressure
2. Aortic insufficiency or regurgitation of aortic valve
3. aneurysm

Question 6

Why would regurgitation of aortic valve cause bounding pulse?

Answer 6

blood goes up and rushes back in, so have a high difference between systolic and diastolic

Question 7

What are you checking with the jugular vein? (generally speaking)

Answer 7

distention, pressure

Question 8

When auscultating carotid pulse, what should you have patient do?

Answer 8

hold their breath

Question 9

What is the jugular vein the best estimate of?

Answer 9

right arterial pressure AND right sided function

Question 10

Internal and External jugular veins
Which is more readily visible?
More reliable?

Answer 10

visible: external
reliable: internal

Question 11

What are thrills?

Answer 11

palpable vibrations that represent a palpable murmur

Question 12

What are heaves/lifts?

Answer 12

visible movement of pericardium due to movement of the heart

Question 13

Feeling PMI can be best done when pt is laying on ?

Answer 13

left side

Question 14

When is systole heard?

Answer 14

time between S1 and S2 (working time of the heart, when ventricles contract to move blood into lungs and body across pulmonic and aortic valves)

Question 15

As systole is complete, the —- valves close and create S1? crea

Answer 15

AV valves close

Question 16

When will you hear systolic murmur?

Answer 16

with first heart sound, S1

Question 17

What sound do the AV valves closing make?

Answer 17

lubb

S1

Question 18

What is the sound of S2?

Answer 18

dubb

pulmonic and aortic valves closing

Question 19

Where is S2 hear the loudest?

Answer 19

aortic area

Question 20

What is also happening when the pulmonic and aortic valves are closing, and you are hearing S2?

Answer 20

AV valves are opening

Question 21

What is S2?

Answer 21

actually two sounds that merge during expiration!!!

Question 22

What sound is louder, s1 or s2?

Answer 22

s2

Question 23

What is the resting phase of the heart, when the ventricles are refilling with blood from the vena cavas and pulmonary veins?

Answer 23

dyastole

Question 24

What is the time between S2 and S1?

Answer 24

diastole

Question 25

What is the time between S1 and S2?

Answer 25

systole

Question 26

As diastole is completed, the semilunar valves close and create?

Answer 26

s2

Question 27

What contracts at the end of diastole?

Answer 27

atria

Question 28

What closes first, the aortic or the pulmonic?

Answer 28

the aortic **can here a split as the pulmonic valve closes, heard best over pulmonic area

Question 29

What is S3?

Answer 29

a gallop --quiet, early sound during DIASTOLE that reflects the passive filling stage of the ventricles (second stage is the muscular injection from the atria)

Question 30

How do you intensify the S3 sound?

Answer 30

have pt raise leg or squeeze hand which increases venous return

Question 31

When is the S3 sound common?

Answer 31

young children and young athletic adults due to rapid refiling of ventricle -CHF, mitral/tricuspid incompetence

Question 32

S4, what can it be confused with because it occurs so late in diastole?

Answer 32

split s1

Question 33

what is S4 best hear with?

Answer 33

the bell

Question 34

What cough is associated with being worse in the morning, or only in the am?

Answer 34

chronic bronchitis

Question 35

What causes a non-productive cough?

Answer 35

viral, interstitial lung disease, tumor, asthma, post nasal drip

Question 36

What cough is worse in recumbent position?

Answer 36

sinusitis, CHF, reflux

Question 37

What cough is barking?

Answer 37

croupe, laryngeal

Question 38

What cough is nocturnal?

Answer 38

asthma, chf

Question 39

What cough is productive?

Answer 39

infections, bronchiectasis

Question 40

What cough is bloody?

Answer 40

tumor, CHF

Question 41

What produces rust sputum?

Answer 41

pneumococcal pneumonia

Question 42

What produces yellow, green sputum?

Answer 42

pneumonia, bronchiectasis, bronchitis

Question 43

What produces anchovy paste sputum?

Answer 43

amebiasis

Question 44

What produces blood streaked sputum?

Answer 44

epistaxis, bronchitis secondary to sever cough, tumor

Question 45

What produces frothy and or pink sputum?

Answer 45

CHF, PE

Question 46

What produces bloody sputum? NOT BLOODY STREAKED

Answer 46

Tumor, malignancy, bronchiectasis, PE

Question 47

What produces foul smelling sputum?

Answer 47

bronchiectasis, anaerobes, lung abscess

Question 48

difference b/w PND and orthopena?

Answer 48

orthopnea cannot lie down while PND can sleep and then wake up orthopnea is further advanced CHF

Question 49

What is platypnea?

Answer 49

SOB sitting up and better breathing lying down

Question 50

What is kussmaul?

Answer 50

pattern of breathing that is deep and rapid = metabolic acidosis

Question 51

What is cheyne-stokes?

Answer 51

crescendo/decrescendo interspersed with apnea = brain damage, drugs induced respiratory compromise

Question 52

What is biot?

Answer 52

irregular patter of breathing = increased intracranial pressure, brain damage, poison

Question 53

What is ataxic?

Answer 53

irregular breathing, more extreme than biots (usually see in neurology and not common)