CVS PhExam

Question 1

Jane way lesion - non tender red macular
osler nodes - painful red raised
splinter hemorrhages - red brown lines in nail bed

Answer 1

all signs seen in infective endocarditis

Question 2

pressure applied to nail bed until it turns white

prolonged: dehydration, shock, PVS, hypothermia

Answer 2

capillary refill

Question 3

JVP best assessed where

Answer 3

right internal jugular vein

Question 4

atrium contracting tricuspid valve open

Answer 4

A wave on JVP

Question 5

atrium relaxing then filling, tricuspid closed

Answer 5

x descent on JVP

Question 6

atrium tense, full; tricuspid closed

Answer 6

v wave on JVP

Question 7

atrium emptying, tricuspid open

Answer 7

y wave on JVP

Question 8

resistance to RA emptying at or beyond TV
open tricuspid
causes - pulmonary HTN, tricuspid stenosis

Answer 8

elevated a wave

Question 9

occurs when RA contracts against a closed TV during AV dissociation
cause - PAC; ventricular beats, complete AV block, ventricular tachycardia
closed tricuspid valve

Answer 9

cannon a wave

Question 10

no atrial contraction

cause A fib

Answer 10

absent a wave

Question 11

increased atrial filling during systole

cause - tricuspid regurgitation (lancisi sign)

Answer 11

elevated v wave

Question 12

normal JVP

Answer 12

3-4 cm above sternal angle

8-9 cm from right atrium

Question 13

increased JVP

Answer 13

1) RHF
2) pericardial dz
3) tricuspid stenosis
4) chronic pulmonary HTN
5) SVC obstruction

Question 14

decreased JVP

Answer 14

hypovolemia

Question 15

with px breathing normally, place right hand on RUQ of abdomen and press firmly upward under costal margin for 10-15 sec
+ sign: JVP rises and persists as long as abdominal pressure continues
RHF

Answer 15

hepatojugular reflex

Question 16

+ sign: failure of the jugular venous column to collapse during inspiration
constrictive pericarditis

Answer 16

kussmaul sign

Question 17

correlates well with pulse pressure

Answer 17

amplitude

Question 18

speed of upstroke - brisk or high pitched, murmur like sound
smooth, rounded, midsystolic - contour

Answer 18

contour

Question 19

high pitched, murmur like sound

Answer 19

bruit or thrill

Question 20

small thready pulse amplitude

Answer 20

cardiogenic shock

Question 21

bounding amplitude

Answer 21

AR

Question 22

delayed upstroke contour

Answer 22

AS

Question 23

pulsus alternans contour

Answer 23

beat to beat variability

Question 24

bigeminal pulse contour

Answer 24

normal heart alternating with PVC

Question 25

biferiens pulse contour

Answer 25

double systolic peak

Question 26

carotid sinus tortuous carotid artery hypervascularity of hyperthyroidism external compression from TOS

Answer 26

examples of bruits and thrills

Question 27

``` rarely palpable soft, biphasic, undulating quality eliminated on light pressure height of pulsations changes on inspiration usually falls ```

Answer 27

JVP

Question 28

``` palpable brisk, single pulse does not disappear on light tough no change with position change no effect on inspirations ```

Answer 28

carotid pulse

Question 29

point of maximal impulses

Answer 29

5th ICS, LMCL | single outward pulse

Question 30

double pulse (2 peaks)

Answer 30

hypertrophic cardiomyopathy

Question 31

fast impulse with large amplitude, terminates quickly increase volume work MR and AR, exercise, hyper metabolic state

Answer 31

forceful and hyper dynamic amplitude

Question 32

impulse is sustained throughout systole increase pressure work AS, LVH, systemic HTN

Answer 32

forceful and sustained amplitude

Question 33

anemia hyperthyroidism high cardiac output

Answer 33

hyper metabolic state

Question 34

``` closure of mitral and tricuspid mitral closes first transition from diastole to systole listen with diaphragm loudest at apex identify just before the carotid upstroke ```

Answer 34

S1 sound

Question 35

short PR interval mild mitral stenosis hyperdynamic states

Answer 35

loud S1

Question 36

``` Long PR interval severe mitral stenosis LBBB COPD obesity pericardial effusion ```

Answer 36

soft S1

Question 37

AV dissociation atrial fibrillation large pericardial effusion severe LV dysfunction

Answer 37

variable S1

Question 38

``` closure of AV and PV AV closes first identify just after upstroke listen to it with diaphragm during expiration single during inspiration split loudest at base - 2 ICS ```

Answer 38

S2 sound

Question 39

presence if splitting during expiration, wider during inspiration RBBB, pulmonic stenosis, MR

Answer 39

wide split

Question 40

splitting at both expiratory and inspiratory phases but dies not lengthen with inspiration ASD, RV failure, pulmonary HTN

Answer 40

fixed splitting

Question 41

reverse of normal physiology; splitting of S2 during expiration, singular during inspiration pulmonary before aortic LBBB, AS

Answer 41

paradoxical split

Question 42

single S2

Answer 42

severe AS or AR

Question 43

listen with the bell ventricular gallop rhythm (Kentucky) apex, left lateral decubitus position early diastole: rapid ventricular filling physiological: child, pregnant, athletes pathological: abrupt deceleration (LVF, volume overload, decreased myocardial contraction)

Answer 43

S3

Question 44

``` listen with bell atrial gallop (Tennessee) apex, left lateral decubitus position late diastole pathologic: stiff and non complaint ventricle ```

Answer 44

S4

Question 45

heard at right 2 ICS at early systole causes: dilated aorta, AS

Answer 45

aortic ejection sound

Question 46

heard left 2 ICS and 3 ICS at early systole cause: dilated pulmonary artery, pulmonic stenosis, pulmonary HTN

Answer 46

pulmonic ejection sound

Question 47

heard at apex at mid systole cause: ballooning of part of MV into the atrium

Answer 47

MVP click

Question 48

vibration felt through chest wall

Answer 48

thrills

Question 49

murmur intensities

Answer 49

grade 1 - barely audible grade 2 - soft but easily heard grade 3 - loud grade 4 - loud + palpable thrill grade 5 - loud with minimal contact between stethoscope and chest + thrill grade 6 - loud with no contact between stethoscope and chest + thrill

Question 50

heard at erbs point - left 3 ICS

Answer 50

AR

Question 51

``` scratchy, scraping sound left 3 ICS seen in pericarditis px leans forward, exhales and holds breath triphasic in 50% of px ```

Answer 51

pericardial friction rub

Question 52

systemic HTN | dilated aortic root

Answer 52

loud A2

Question 53

calcified aortic stenosis

Answer 53

soft or absent A2

Question 54

pulmonary HTN | ASD

Answer 54

loud P2

Question 55

pulmonic stenosis COPD aging

Answer 55

soft or absent P2