EXAM -2 CV/Peripheral Ass

Question 1

**A heave or lift =

Answer 1

sustained forceful thrusting of ventricle in systole secondary to **↑ **WORKLOAD

Question 2

Left Vent. Heave seen where?

Answer 2

@ Apex

Question 3

Right Vent. Heave seen where?

Answer 3

@ Sternal Border

Question 4

Precordium palpate - If displaced down & to left =

Answer 4

Left Vent. Dilation = volume overload

Question 5

PRECORDIUm palpate If ↑ force & duration but No change in location =

Answer 5

Left Vent. Hypertrophy = pressure overload

Question 6

Thrill (palpable vibration), if present =

often accompanied by______

Answer 6

turbulent flow

• Often accompanied by murmur

Question 7

Percuss -

Answer 7

to detect heart enlargement

Question 8

Normal

Answer 8

Left border cardiac dullness @ 5 interspace mid-clavicular line

Question 9

Dullness slopes up medially toward

Answer 9

sternum to **2nd interspace L. sternal border

Question 10

• Right border matches

Answer 10

R. sternal border

Question 11

Precordium Enlargement indicates_____ or _______

4 conditions

Answer 11

↑ Vent. volume or wall thickness

• HTN, CAD, HF, Cardiomyopathy

Question 12

S3 = ____gallop 2 conditions

Answer 12

ventricular gallop• HF & Volume Overload

Question 13

S4 =________ 1 condition

Answer 13

atrial gallop

Ex: CAD

Question 14

Negative intra-thoracic pressure =

Answer 14

↑ venous return to Right heart

Question 15

• A2 closes first,

Answer 15

then P2 – happens on inspiration
increase venous return to right heart
More to the RIGHT, Less to the LEFT (LL)

Question 16

• MoRe to_____, Less to the______

Answer 16

theRight; Left

Question 17

Neck Vessels

Answer 17

Reflect efficiency of cardiac function

Question 18

**Carotids

Answer 18

• Btw. Trachea & sternomastoid m.

* Pressure wave coincides w/ systole

Question 19

**Jugular veins

Answer 19

Reflects Right side Heart activity
•*** Filling Pressure
• **Volume Changes

Question 20

Carotid Normal pulse =
• Diminished =______
• Increased = ______states such as

Answer 20

2+ bilaterally
↓ SV
hyperkinetic such as • (exercise, anxiety, fever, etc.)

Question 21

Auscultate carotid artery for ____

Answer 21

Bruits

Question 22

3 listening positions: (BAM)

Answer 22

• 1 – angle of jaw
• 2 – mid-cervical area
• 3 – base of neck

Question 23

Avoid compressing may lead to

Answer 23

false bruits

Question 24

• Up to 2/3 =______bruit, 2/3+ =

* Total occlusion =

Answer 24

loud ; diminished sound

no sound

Question 25

Internal Jugular Vein Valve where?

Answer 25

• Only valve btwn. Vena Cava & Brain

Question 26

JVD indicates ______

Answer 26

Right Sided HF • Vol. & Pressure increase • Jugular veins become distended = JVD

Question 27

Think of Jugular Veins as a

Answer 27

CVP manometer Allows “reading” of CVP • Reference point @ Sternal Angle • Compare w/ highest point of venous pulsation

Question 28

What is a normal JVP?

Answer 28

Normal = 2cm or less above Sternal angle

Question 29

Hepatojugular Reflux Test Perform if 2 reasons

Answer 29

* venous pressure elevated | * Suspect CHF

Question 30

Hepatojugular Reflux Techniques

Answer 30

* Pt. Supine * Your R. hand @ RUQ over Liver * Push w/ firm sustained pressure 30 sec. * Watch jugular veins

Question 31

***Normal heart hepatojugular Reflux vs CHF

Answer 31

* ***With Normal Heart – veins rise few sec.s, then recede | * *** With CHF – veins stay elevated as long as you push

Question 32

Clubbing use | Normal clubbing angle is

Answer 32

Profile sign • Clubbing - use profile sign • Normal nailbed angle = 160 degrees

Question 33

Nailbed greater than 180

Answer 33

• 180+ = cyanotic heart ds, cor pulmonale, subacute BE

Question 34

Normal Capillary fill time is

Answer 34

Normal: 1-2 sec.

Question 35

• 3+ Capillary refill associated with

Answer 35

vasoconstriction or ↓ C.O. | • (hypovolemia, HF, Shock)

Question 36

Grade Force w/ 4 point scale 4+______ 3+_______ Both indicates ____

Answer 36

bounding Increased HYPERKINETIC STATES

Question 37

Grade Force w/ 4 point scale 1+_______ 0______ Both indicates

Answer 37

weak absent "Thready" Shock or PAD

Question 38

Allen Test determines what ?

Answer 38

Determines patency of Radial & Ulnar Arteries

Question 39

)))Allen test techniques

Answer 39

``` Compress radial artery with thumb • Ask pt. close fist several times • Continue to compress & ask pt. to open hand • Palm should turn pink ***IMMEDIATELY • If not, ulnar artery occluded • Repeat w/ Ulnar artery ```

Question 40

Modified Allen Test – tests what________ • Occlude_________ • Normal color return =

Answer 40

collateral circulation BOTH arteries 3 – 5 sec.

Question 41

Leg Inspect • Measure calf size – s/b equal bilaterally • Diffuse bilateral edema =________

Answer 41

systemic illness

Question 42

Leg Unilateral swelling =

Answer 42

acute local problem

Question 43

• Asymmetry of calves

Answer 43

* **1cm or more refer for poss. DVT * ***• (+) Homans’ sign (~35%) - ->Flex knee; anteriorly compress gastroc. M., if pain = (+)

Question 44

Lymphedema 1-3cm =

Answer 44

mild

Question 45

Lymphedema 3-5cm

Answer 45

moderate

Question 46

Lymphedema:5+cm =

Answer 46

severe

Question 47

Leg • Brown discoloration

Answer 47

Hemosiderin = venous insufficiency/stasis

Question 48

Venous stasis ulcers

Answer 48

* Above medial malleolus | * Shallow, poorly defined edges

Question 49

Arterial ulcers

Answer 49

* @ or below lateral malleolus, foot/toes * Deeper, well defined edge * “punched out” appearance

Question 50

Palpate & Inspect Legs • Use_________ • Assess temperature changes/differences • Note ___________ • If you suspect arterial deficit, raise legs ~12”, ask pt. to flex feet_______ • Then have pt. sit up, legs over side of bed • Normal color return =

Answer 50

back of hand iff gradual or abrupt • Skin color now reflects only arterial blood contribution < 10 sec.

Question 51

Arterial deficit seen with

Answer 51

Unilateral cool leg or foot w/ abrupt temp. drop as you move down

Question 52

what does Dependent rubor indicates =

Answer 52

severe arterial insufficiency

Question 53

Palpate popliteal

Answer 53

``` Popliteal • Difficult to feel • Use both hands Press deep into popliteal fossa • Often felt just lateral to medial tendon ```

Question 54

Palpate DP (location)

Answer 54

DP (dorsalis pedis) | • Dorsum, btwn. 1st & 2nd Metatarsal

Question 55

Palpate PT (posterior tibial)

Answer 55

• Posterior to medial malleolus

Question 56

Also palpate leg and check for __________

Answer 56

Check for pre-tibial edema

Question 57

Bilateral dependent pitting edema indicates (2)

Answer 57

HF or Cirrhosis

Question 58

Manual Compression Test – tests valve competence | What does competent valve prevent?

Answer 58

* Pt. standing * Compress vericose vein distally * With other hand 20cm higher, compress vein moving down the leg * Competent valves prevent wave transmission

Question 59

___________= normal valves

Answer 59

• No wave felt

Question 60

During manual compression test if Wave felt =

Answer 60

incompetent valves

Question 61

What does the vascular doppler check for?

Answer 61

• Tests for diminished peripheral flow

Question 62

ABI is used for

Answer 62

Ankle-Brachial Index • Non-invasive test to determine extent of PVD • Measures pressures @ arm and ankle

Question 63

In ABI, which pressure is normally higher?

Answer 63

Normal ankle pressure slightly higher

Question 64

Normal ABI usually =

Answer 64

1.0 to 1.2

Question 65

ABI that indicates PVD

Answer 65

0.9

Question 66

ABI that indicates Mild PVD

Answer 66

0.7-0.9

Question 67

ABI that indicates moderate PVD

Answer 67

0.7 – 0.4

Question 68

ABI that indicates SEVERE PVD

Answer 68

• 0.4 – 0.3

Question 69

PVD ABI ______ indicate extreme ischemia impending _________

Answer 69

< 0.3 ; limb loss