History and Physical

Question 1

Common symptoms cardiac in origin

Answer 1

1) dyspnea with exertion
2) irregular heart beat
3) faintness/dizziness
4) swell in feet/hands
5) wake from sleep SOB
6) difficulty sleep when lie flat
7) leg pain with activity
8) stroke
9) chest pain/pressure
10) Passing out
11) cyanosis

Question 2

True symptom of coronary artery disease

Answer 2

angina pectoris

Question 3

what causes angina pectoris

Answer 3

supply demand mismatch in the coronary arteries –> hypoxia in the myocardium –> pain

Question 4

Levine’s sign

Answer 4

pt points directly to sternum for pain

Question 5

Associated symptoms with chest pain

Answer 5

1) N/V
2) diaphoresis
3) lightheadedness/syncope
4) palpitations

Question 6

Murmurs

Answer 6

a

Question 7

SYNCOPE

Answer 7

transient loss of consciousness from cerebral hypoperfusion

Question 8

define orthostatic hypotension

Answer 8

exercising without hydration

pressure changes when you stand up

Question 9

Approach of physical exam

Answer 9

1) exam from pt’s right side
2) develop pattern
3) Ask questions at each step

Question 10

Estimating jugular venous pressure

Answer 10

1) examine from right side with head turned slightly left

Question 11

Blood pressure

systolic blood pressure =

Answer 11

systolic blood pressure = first Korotkoff sound

diastolic blood pressure = loss Korotkoff osund

Question 12

define orthostatic hypotension

Answer 12

1) patient lie down 5 min, check BP and pulse
2) repeat

20 mm Hg DROP in systolic BP WITH STANDING

Question 13

Palpating carotid arteries

Answer 13

1) use 1-2 fingers btwn larynx and anterior bridge of sternocleidomastoid @ level of cricoid

Question 14

palpating brachial pulse

Answer 14

1) right brachial artery pulse palpate in ANTECUBITAL FOSSA

pt can be stand, sit, or supine

Question 15

point of maximal impulse

Answer 15

1) hand under nipple

feel where LV is beating and hitting hand

can feel sluggish with LBBB
can feel widened with dilated cardiomyopathy

Question 16

coarctation of aorta

Answer 16

1) if BP high in arm and lower in legs above malleolus

ex: Turner’s

Question 17

if BP different in two arms what could this be

Answer 17

(1) aortic dissection

(2) stenosis

Question 18

palpating right ventricle in epigastrium

Answer 18

if RV is dysfunctional feel hand slide up due to RV heave

Question 19

if patient pulse irregular

if patient pulse separated by pause

Answer 19

atrial fibrillation

PAC or PVC

Question 20

palpating dorsalis pedis artery and tibial pulses

Answer 20

important

Question 21

where is pain most commonly assoc with myocardial infarction

Answer 21

pain in chest radiating to left arm

Question 22

less likely locations of pain with MI

Answer 22

1) right side
2) jaw
3) epigstrium
4) back

Question 23

Angina vs. non angina

location

Answer 23

angina = retrosternal, diffuse

Not angina = left inframammmary, localized

Question 24

angina vs non angina

radiation

Answer 24

angina = left arm, jaw back

non angina = right arm

Question 25

angina vs non-angina description

Answer 25

angina = “aching” dull, pressing, squeezing, vise-like non angina = sharp, shooting, cutting

Question 26

angina vs non angina intensity

Answer 26

angina = mild to severe non angina = excruciating

Question 27

angina vs non angina duration

Answer 27

angina = minutes non angina = sec, hour, day

Question 28

angina vs non angina precip by

Answer 28

angina = effort, emotion, eating, cold non angina = respiration, posture, motion

Question 29

angina vs non angina relieved by

Answer 29

angina = rest, nitro non angina = nonspecific