Heart

Question 1

6 procedures in the physical exam of the heart

Answer 1

heart rate/pulse
BP
chest inspection
heart percussion
heart palpation
heart auscultation

Question 2

7 complaints leading to a heart exam

Answer 2

• chest pain
• symptoms extending fromt he left jaw/arm
• “strange” sensation in chest/palpation
• shortness of breath, orthopnea, dyspnea
• VBI symptoms
• swelling of extremities or abdomen
• unexplained mid-back pain

Question 3

VBI

Answer 3

vertebral-basilar insufficiency

Question 4

abdominal obesity defining level

• men: >___cm (__in)
• female: >____cm (___in)

Answer 4

102; 40

88; 35

Question 5

BMI: ___ you are the more its inaccurate

Answer 5

shorter

Question 6

carotid pulse

• inspect __ to SCM
• palpate for ___, ___ or ___
• avoid ___ ___

Answer 6

medial
amplitude, contour, thrills
carotid sinus

Question 7

___: humming vibrations like a purring cat

Answer 7

thrills

Question 8

____: hear this if an artery is 50% or more occluded

Answer 8

bruit

Question 9

right ventricle occupies most of ___ cardiac surface; ___ and to the ___ of the sternum

Answer 9

anterior
behind
left

Question 10

cardiac ____ is at the 2nd intercostal spaces parasternally left and right, where the right ventricle meets the pulmonary artery

Answer 10

base

Question 11

left ventricle is located behind the right ___and extends ____ to the left, forming the left lateral border of the heart

Answer 11

ventricle

inferiorly

Question 12

apex located….

Answer 12

5/6 intercostal space on the left at the midclavicular line

Question 13

right ____ comprises the right lateral border

Answer 13

atrium

Question 14

left ___ lays ont he posterior aspect of the heart

Answer 14

atrium

Question 15

point of maximal impulse (PMI) aka ___ __

Answer 15

apical impulse

Question 16

PMI produced by the ___ ___

Answer 16

cardiac apex

Question 17

PMI normally __-__cm lateral to sternum at ___ ICS at the ___ line

Answer 17

7-9
5th
midclavicular

Question 18

PMI is usually __-___ cm wide

Answer 18

1-2.5

Question 19

____ heart: diameter increases, location displaces laterally

Answer 19

hypertrophic

Question 20

right ventricular hypertrophy may create a dominant impulse at ___/___ area

Answer 20

xyphoid/epigastric

Question 21

2 atrioventricular valves

Answer 21

mitral on the left

tricuspid on the right

Question 22

2 semilunar valves

Answer 22

aortic (R)

pulmonic (L)

Question 23

positive findings for heart palpation

Answer 23

heaves
thrills
lifts

Question 24

indications for heart palpation

Answer 24

valvular stenosis
regurgitation
CHF

Question 25

rumbling murmur during palpation indications

Answer 25

aortic stenosis ventricular septal defect mitral stenosis

Question 26

S1 and S2 heard at ectopic and epigastric areas indicitive of...

Answer 26

cardiomegaly | thin/frail human bc of descending aorta

Question 27

auscultation - patient is ____ or at ___ degrees - patient ___ or ___ __ when needed

Answer 27

supine; 30 | seated; side-lying

Question 28

diaphragm of steth is for ___ pitched sounds

Answer 28

high

Question 29

bell of steth is for ___ pitched sound

Answer 29

low

Question 30

S1 and S2 are ___ pitched sounds

Answer 30

high

Question 31

S3 and S4 are __ pitched sounds

Answer 31

low

Question 32

if you have hypertrophic/ cardiomegaly, have to have patient do ____ ____ to elicit a murmur

Answer 32

valsalva's manuever

Question 33

___ ___ ___: brings left ventricle close to the chest; may accentuate S3, S4 and mitral murmurs

Answer 33

left lateral decubitus

Question 34

patient seated and leaned forward, accentuates ___ murmurs

Answer 34

aortic

Question 35

5 auscultatory points

Answer 35

``` aortic pulmonic Erb's tricuspid mitral ```

Question 36

2 parts to cardiac cycle

Answer 36

systole | diastole

Question 37

___ - ventricular contraction

Answer 37

systole

Question 38

___ - ventricular relaxation

Answer 38

diastole

Question 39

___: pressure rises from 5-120mmHg

Answer 39

systole

Question 40

systole : following ejection into aorta, pressure ___

Answer 40

falls

Question 41

diastole: pressure declines and blood flows from ___ to ___

Answer 41

atrium | ventricle

Question 42

systole - aortic valve ___ - mitral valve ___ - pulmonic valve ___ - tricuspid valve ____

Answer 42

open closed open closed

Question 43

diastole - aortic valve ___ - mitral valve ___ - pulmonic valve ___ - tricuspid valve ____

Answer 43

closed open closed open

Question 44

S1 composed of 2 valves

Answer 44

mitral | tricuspid

Question 45

S2 composed of 2 valves

Answer 45

aortic | pulmonary

Question 46

split S2...

Answer 46

aortic and pulmonic are not synchronized

Question 47

__: mitral valve prolapse

Answer 47

clicks

Question 48

___ attributed to turbulent blood flow

Answer 48

murmurs

Question 49

murmurs may be ___ or indicative of ___ heart disease

Answer 49

innovent | valvular

Question 50

mitral valve located at the cadiac ___

Answer 50

ape

Question 51

tricuspid valve located at lower ___ sternal border

Answer 51

left

Question 52

pulmnic valve located at __/__ ICS at the ___ parasternal border

Answer 52

2/3 | left

Question 53

aortic valve located at __/__ ICS at the ___ parasternal border

Answer 53

2/3 | right

Question 54

___ ____: muscle is stretched and thin; doesnt pump as well

Answer 54

dilated cardiomyopathy

Question 55

____ murmur usually involves the aortic and pulmonic valves (semilunar)

Answer 55

midsystole

Question 56

____ murmurs typically represent regurgitant AV valves

Answer 56

pansystolic

Question 57

___ ____ murmurs indicate mitral valve prolapse

Answer 57

late systolic

Question 58

disastolic murmurs are always ___

Answer 58

abnormal

Question 59

___ ___ murmur suggest regurgitant semilunar vales

Answer 59

early diastolic

Question 60

____ murmur suggests turbulant flow across AV valves

Answer 60

middiastolic

Question 61

___ ____/___-___ murmur has systolic and diastolic compnents, consider pericadial friction rub or venous hum

Answer 61

late diastolic/pre-systolic

Question 62

S1 (lub) marks the beginning of ___ and loudest at the ___

Answer 62

systole | apex

Question 63

S2 (dub) marks the end of ___ and loudest at the ___

Answer 63

systole | base

Question 64

ejection clicks are most common early ___ sound

Answer 64

systolic

Question 65

ejection clicks results from abrupt halting of ___ valves

Answer 65

semilunar

Question 66

____ ejection click: loud high frequency sound, associated with murmur due to sam etiology; does not vary with respiration

Answer 66

aortic

Question 67

aortic ejection click best hear at the ___ valve with the ___ of the steth

Answer 67

aortic | diaphragm

Question 68

potential causes of aortic ejection click

Answer 68

aortic stenosis bicuspid aortic valves dilated aortic root

Question 69

___ ejection click: early systolic ejection sound with associated murmur; diminishes with inspiration

Answer 69

pulmonic

Question 70

location of pulmonic ejection click

Answer 70

2/3 ICS at edge of sternum

Question 71

potential causes of pulmonic ejection clicks

Answer 71

pulmonic stenosis pulmonary hypertension dilated pulmonary trunk

Question 72

___ ___: high frequency early diastolic sound associated with mitral stenosis

Answer 72

opening snap

Question 73

___ ___: sound occurs due to abrupt deceleration of mitral leaflets; associate murmur; diminishes with inspiration

Answer 73

opening snap

Question 74

opening snap located between cardiac ___ and ___ lower sternal border

Answer 74

apex | left

Question 75

cadence of opening snap

Answer 75

S1 S2 opening snap murmur of mitral stenosis

Question 76

S3 heart sound is ___ frequency sound in early ____

Answer 76

low | diastole

Question 77

causes of S3 heart sound

Answer 77

increased atrial pressure - congestive heart failure | dilated cardiomyopathy

Question 78

S3 heart sound may be normal in patients less than ___

Answer 78

40

Question 79

S4 heart sound is a ___ frequency sound in ___ portion of diastole

Answer 79

low | presystolic

Question 80

causes of S4 heart sound

Answer 80

stiffened left ventricle

Question 81

chest pain due to 4 things

Answer 81

coronary heart disease angina pectoris myocardial infarction dissecting aortic aneurysm

Question 82

stable angina | - pain on ___

Answer 82

exertion

Question 83

unstable angina | - pain during ____

Answer 83

everything

Question 84

myocardial infarction | - death of ___ ____

Answer 84

cardiac muscle

Question 85

___: unpleasant awareness of ones own heartbeat

Answer 85

palpitations

Question 86

___: irregular beat, rapid acceleration or deceleration, increased force of contraction, anxiety

Answer 86

palpitations

Question 87

___: uncomfortable awareness of breathing that is inappropriate for level of exertion

Answer 87

dyspnea

Question 88

___ - dyspnea when lying down which improves when seated

Answer 88

orthopnea

Question 89

___ ____ ___: episodes of sudden dyspnea/orthopnea that awaken patient

Answer 89

paroxysmal nocturnal dyspnea

Question 90

pericarditis can be due to ___ ___

Answer 90

syphilitic aortitis