Cardiovascular system

Question 1

where is the base of the heart

Answer 1

right ventricle meets pulmonary artery superiorly

Question 2

where is the point of maximal impulse (PMI) ?

Answer 2

apex of the heart

Question 3

trace the flow of blood through the heart

Answer 3

superior VC > right atrium > tricuspid valve > right ventricle > pulmonary valve > pulmonary artery> lungs> pulmonary veins > left atrium > mitral valve > Left ventricle > aortic valve > aorta

Question 4

what are the positions of the valves during sytole?

Answer 4

aortic valve = open

mitral valve = closed

Question 5

what are the positions of the valves during diastole?

Answer 5

aortic valve = closed

mitral valve = open

Question 6

what produces heart sound S1?

Answer 6

closing of mitral valve (listen with diaphragm)

Question 7

what produces heart sound S2?

Answer 7

closing of aorta valve (listen with diaphragm)

Question 8

what does heart sound S3 represent?

Answer 8

S3 gallop  (listen with bell)
rapid deceleration of column of blood against ventricular wall

Question 9

what does heart sound S4

Answer 9

usually happens just before S1 (listen with bell)

marks atrial contraction

Question 10

what causes splitting of S2?

Answer 10

occurs with inspiration

aortic valve and pulmonic valve closure

Question 11

What causes the “harsh” sounding heart murmur?

Answer 11

a stenotic valve
abnormally narrow valvular oriface
(i.e. aortic stenosis)

Question 12

Where is the mital valve heard best?

Answer 12

cardiac apex (5th intercostal space)

Question 13

where is the tricuspid valve heard best?

Answer 13

LLSB (lower left substernal border)

Question 14

where is the pulmonic valve heard best?

Answer 14

Left 2nd & 3 rd intercostal space (close to sternum)

Question 15

where is the aortic valve heard best?

Answer 15

Right 2nd intercostal space

Question 16

Which node has a delay in conduction?

Answer 16

AV node

Question 17

the p wave is associated with what?

Answer 17

atrial depolarization

Question 18

the QRS complex is associated with what?

Answer 18

ventricular depolarization
heart sound S1 (R wave)
left ventricular end diastolic volume

Question 19

the T wave is associated with what

Answer 19

ventricular repolarization
end of T wave (S2 sound)
left ventricular end systolic volume

Question 20

what is the Q wave?

Answer 20

1st downward deflection

septal depolarization

Question 21

what is the R wave?

Answer 21

ventricular depolarization

Question 22

define cardiac output

Answer 22

volume of blood ejected each ventricle in 1 min

Question 23

define stroke volume

Answer 23

volume of blood ejected with each heartbeat

Question 24

define preload

Answer 24

the load that stretches the cardiac muscle before contraction.
volume of blood in the RV at end of diastole

Question 25

the following increase preload

Answer 25

1. inspiration 2. increase volume 3. CHF

Question 26

the following decrease preload

Answer 26

1. exhalation 2. decreased LV output 3. pooling of blood (cap. bed/venous system)

Question 27

define myocardial contractility

Answer 27

refers to the ability of the cardiac muscle, when given a load, to shorten

Question 28

what increase myocardial contractility

Answer 28

stimulation from sympathetic nervous system

Question 29

What decreases myocardial contractility

Answer 29

impaired blood flow (O2 delivery) to myocardium

Question 30

what is afterload?

Answer 30

degree of vascular resistance (tone in walls of artial system) to ventricular contraction

Question 31

what is arterial pulse?

Answer 31

pressure wave felt on exam by the contraction of the LV ejecting a volume of blood into the aorta then into arterial system

Question 32

what is true of jugular venous pressure?

Answer 32

1. height in venous column of blood in the internal jugular vein 2. reflects R. atrial pressure 3. clinical indicator right hear dynamics 4. measured on right side, more direct path to right atrium

Question 33

how is JVP (jugular venous pressure) measured?

Answer 33

1) make patient comfortable. Raise head slightly (pillow) to relax the sternomastoid ms. 2) Raise head of bead (HOB) of exam table to 30 degrees and turn patients head away from side inspected. 3) Examine both sides of neck. Identify external jugular vein (EJ) then find the internal jugular pulsations. 4) Raise or lower the HOB until oscillations of IJV are seen in the lower half of the neck. 5) Focus on the right internal jugular vein. Look for pulsations in the suprasternal notch. 6) Identify the highest point of pulsation in the right IJV. Extend card horizontally and ruler vertically from sternal angle and form a right angle. Distance on ruler in cm=JVP

Question 34

what is paroxysmal nocturnal dyspnea?

Answer 34

suddent dyspnea or orthopnea that awakens pt. feel like they need to open a window to get air

Question 35

what are some indicationos of obstructive sleep apnea?

Answer 35

snoring sleepy during day complete obstruction of airway more than 10 seconds while sleeping

Question 36

what are non modifiable risk factors for cardiac disease?

Answer 36

age gender heredity

Question 37

how far do you inflate the cuff for B/P?

Answer 37

30 mmHg

Question 38

what is a thrill

Answer 38

palpable humming virbration

Question 39

what is a bruit

Answer 39

murmur like sound in vasculature, use diaphragm of stethoscope

Question 40

True or false. Brachial arteries reflect aortic pulsations more accurately

Answer 40

False. carotid artery. brachial when carotid occluded

Question 41

PMI is how big in diameter? and last how long?

Answer 41

a. 2.5 cm | b. first 2/3 of systole

Question 42

Which part of stethoscope do you use to hear high pitch sound? low pitch?

Answer 42

High - diaphragm | low - bell

Question 43

what is true of S1

Answer 43

is first heart sound hear mostly the mitral valve; Heard best near heart’s apex over the mitral area with diaphragm

Question 44

What is true of S2

Answer 44

second heart sound Long diastolic intervals separates one pair from another Heard best near heart’s base, over pulmonic area

Question 45

what is true of S3

Answer 45

Heard best with bell over mitral area | May be seen in anemia, fever, pregnancy, thyrotoxicosis

Question 46

What is true of S4q

Answer 46

Heard best with the bell near heart’s apex, over the mitral area non-compliant left ventricle

Question 47

What are the murmur grades?

Answer 47

I – very faint II – quiet but heard immediately III – moderately loud IV – loud with a palpable thrill V – very loud, thrill, heard with stethoscope partly off the chest VI – very loud, thrill, heard with stethoscope entirely off the chest

Question 48

Mid-systolic ejection murmur, heard best over aortic area, crescendo/decrescendo, radiates to neck

Answer 48

aortic stenosis

Question 49

Mid-systolic click, heard best over mitral area

Answer 49

mitral valve prolapse

Question 50

valve is unable to contain blood within the ventricle during systole, S1 may be decreased heard best over apex, radiates to left axilla

Answer 50

mitral regurg - pansystolic (holosystolic)

Question 51

valve fails to close completely during systole, heard best over lower left sternal border

Answer 51

tricuspic regurg - pansystolic

Question 52

what is true of aortic regurg

Answer 52

Leaflets of aortic valve fail to close – volume overload in LV Heard best in aortic area with patient sitting and leaning forward May be caused by rheumatic heart disease, congenital bicuspid valves, Marfan’s syndrome, aortic dissection, syphilis

Question 53

what is true of mitral stenosis

Answer 53

Leaflets of valve have become thick, stiff, and distorted because of rheumatic fever Heard best at apex and using bell Mainly rheumatic in origin

Question 54

What are the murmur intensisty grades

Answer 54

I – very faint II – quiet but heard immediately III – moderately loud IV – loud with a palpable thrill V – very loud, thrill, heard with stethoscope partly off the chest VI – very loud, thrill, heard with stethoscope entirely off the chest