CV exam

Question 1

stills murmur

Answer 1

benign, midsystolic, louder supine

Question 2

split S1

Answer 2

normal if heard LSB

if RSB then prob RBBB

Question 3

split S2

Answer 3

normal- gets wider w/inhalation and dcreases w/exhalation

abnormal if fixed, RBBB or PS

Question 4

S3

Answer 4

early diastolic
best at apex 
normal up to age 30
noncompliant ventricle
LV path (mitral regurg or dilated cardiomyopathy)

Question 5

S4

Answer 5

late diastole just after atrial contraction
best at apex in left lat decubitus
caused by virbration from atrial kick
low pitched, quiet, bell

Question 6

S4 etiology

Answer 6

thickening and stiffening of ventricular walls 
HTN
AS
PS
hypertrophic cardiomyopathy

Question 7

gallop rhythm

Answer 7

all 4 sounds technically

Question 8

ejection cilck

Answer 8

sound occurring at moment of maximal pressure w/sudden tensing of valve root

Question 9

aortic ejection click

Answer 9

early systolic at onset of LV ejection aortic root stretches
dilated aneurysm of aorta
COA
HTN
AS/AR

Question 10

Aortic stenosis

Answer 10

systolic crescendo-decresceno
medium pitched
typically hard
transmits sound to carotid aa

Question 11

pathology of AS

Answer 11

rheumatic disease
congenital bicuspid valve
calcification

Question 12

symptoms of AS

Answer 12

dyspnea on exertion
angina
syncope
S4

Question 13

AR

Answer 13

austin flint murmur
early diastolic high pitched blowing decrescendo
dilates LV -> S3

Question 14

AR pathology

Answer 14

rheumatic disease
congenital bicuspid valve
endocarditis

Question 15

pulmonary ejection click

Answer 15

sudden root tensing

very early systole

Question 16

pulmonary ejection click pathology

Answer 16

PHTN
aneurysm dilating root
PS/PR

Question 17

PS

Answer 17

systolic crescendo-decrescendo murmur

most asymptomatic and do not progress

Question 18

severe PS symptoms

Answer 18

exertional dyspnea 
chest pain
syncope
dilated RV
S4

Question 19

PS etiology

Answer 19

congenital
carcinoid tumor
PHTN

Question 20

PR

Answer 20

graham steel murmur

softer diastolic decrescendo

Question 21

PR path

Answer 21

PHTN
MS
LV failure
obstructive sleep apnea
emphysema

Question 22

tricuspid stenosis

Answer 22

diastolic low pitched rumble, bell
opening snap
accentuated by inspiration
increases CVP

Question 23

tricuspid pathology

Answer 23

RD
congenital HD
carcinoid tumor

Question 24

TR

Answer 24

early pansystolic
diaphragm
will not radiate to left axilla
inspirational accentuation

Question 25

TR path

Answer 25

ebstein congenital anomaly

Question 26

mitral valve opening snap

Answer 26

stenotic mitral leaflets are tethered at orifice, but still mobile

Question 27

MS

Answer 27

diastolic can be w/opening snap can cause PHTN, elevated JVP, RV hypertrophy

Question 28

MS path

Answer 28

almost always from RD

Question 29

MP

Answer 29

mid to late systolic click at apex that may or may not be followed by a murmur high pitched short murmur

Question 30

MR

Answer 30

holosystolic loud high pitched can radiate to left axilla

Question 31

MR etiology

Answer 31

endocarditis RD post MI pap mm rupture

Question 32

squatting

Answer 32

increases preload decreases MP and hypertrophic cardiomyopathy murmur increases AD

Question 33

standing

Answer 33

decreases preload increases MP and hypertrophic cardiomyopathy murmur decreases AS

Question 34

IHSS

Answer 34

idiopathic hypertrophic subaortic stenosis | symptoms same as AS- exertional dypsnea, angina, syncope

Question 35

IHSS murmur

Answer 35

systolic ejection murmur along left sternal border and apex, often accentuated PMI

Question 36

PDA

Answer 36

murmur through systole and diastole best at pulmonic may have thrill

Question 37

constrictive pericarditis

Answer 37

pericardial knock

Question 38

inflamed pericarditis

Answer 38

rub more in systole leaning forward accentuates

Question 39

4 main risk factors of vascular disease

Answer 39

smoking DM HTN hyperlipidemia

Question 40

mitral valve prolapse

Answer 40

often present w/complaint of symptom of palpitations young women at risk for arrhythmia if there is also dilated LA

Question 41

carotid bruit

Answer 41

can be atherosclerosis, primary stenosis at carotid or a radiating aortic stenosis at risk for stroke