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Flashcards in IM LE 3 - New Feed Deck (35):
1

23. Mitral apex location

- 5th left midclavicular line

2

24. Tricuspid location

- 3rd-4th ICS Left Parasternal

3

4. False about arterial pulse

Anemia?

Bates - 343:
Blood pressure levels uctuate strikingly throughout any 24-hour period, varying with physical activity, emotional state, pain, noise, environmen- tal temperature, use of coffee, tobacco, and other drugs, and even time of day.

4

1. All are true regarding bp measurement except:




◗ Width of the inflatable bladder of the cuff should be about 40% of upper
arm circumference (about 12–14 cm in the average adult).

◗ Length of the in atable bladder should be about 80% of upper arm circum- ference (almost long enough to encircle the arm).

Now place the bell of a stethoscope lightly over the brachial artery, taking care to make an air seal with its full rim. Because the sounds to be heard, the Korotkoff sounds, are relatively low in pitch, they are generally better heard with the bell.

5

X. Changes in these for factors will result to?

◗ Left ventricular stroke volume
◗ Distensibility of the aorta and the large arteries
◗ Peripheral vascular resistance, particularly at the arteriolar level
◗ Volume of blood in the arterial system

[Changes in any of these four factors alter systolic pressure, diastolic pressure, or both.]

Bates - 343

6

29. In a patient with a normal CVP whom you suspect to have elevated right ventricular pressure, what maneuver will you do to detect this abnormality?

- Abdominojugular Reflux Test

7

11. Bisferens pulse

A. Severe Heart Failure
B. Premature Ventricular Contraction
C. Hypertrophic Obstructive Cardiomyopathy
D. Cardiac Tamponade

- Hypertrophic Obstructive Cardiomyopathy

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Bisferious means striking twice. Classically, it is detected when aortic insufficiency exists in association with aortic stenosis,[1] but may also be found in isolated but severe aortic insufficiency, and hypertrophic obstructive cardiomyopathy. - wiki

8

42. Pulsus tardus

A. Mitral stenosis
B. Tricuspid stenosis
C. Aortic stenosis
D. Pulmonic stenosis

C. Aortic stenosis

Harrisons - 1444

9

5. Assessment of the carotid pulse except:

Can be block by palpation

Bates - 367:
To assess amplitude and contour, the patient should be lying down with the head of the bed elevated to about 30 degrees. When feeling for the carotid artery, first inspect the neck for carotid pulsations. These may be visible just medial to the sternomastoid muscles. Then place your index and middle fingers (or left thumb) on the right carotid artery in the lower third of the neck, press posteriorly, and feel for pulsations.

10

44. A hypokinetic pulse may be found in:

A. Hypovolemia
B. LV Failure
C. Restrictive pericardial disease
D. All of the above

D. All of the above

11

17. Pansystolic Murmur

- Mitral Regurgitation

12

xxx

xxx

13

14. Pulsus Paradoxus

A. Severe Heart Failure
B. Premature Ventricular Contraction
C. Hypertrophic Obstructive Cardiomyopathy
D. Cardiac Tamponade

D. Cardiac Tamponade

Harrisons - 1573

14

48. Man eating steak then suddenly collapse, patient is cyanotic.

- Abdominal thrust (?)

15

47. Not characteristic of systole.

A. Contraction
B. Mitral open
C. Mitral close
D. Venous Pressure > Arterial Pressure

B. Mitral open

16

26. Aortic valve location

- 2nd ICS right parasternal

17

13. Pulsus bigeminus


A. Severe Heart Failure
B. Premature Ventricular Contraction
C. Hypertrophic Obstructive Cardiomyopathy
D. Cardiac Tamponade

- Premature Ventricular Contractions

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Harrison 1492

PVCs that occur at a bigeminal frequency may not gener- ate sufficient cardiac output for a radial pulse and hence may register at rates half that of the heart rate (Fig. 277-1A). Very frequent PVCs can depress ventricular function (see below).

18

46. Conditions characterized by hyperkinetic or bounding pulse, except

A. Anemia
B. PDA
C. AV fistula
D. NOTA

D. NOTA

19

45. Hyperkinetic or bounding pulse may be found in all of the ff except

A. Increased left ventricular stroke volume
B. Wide pulse pressure
C. Decreased peripheral vascular resistance
D. NOTA

D. NOTA

20

41. Which factor(s) affect the intensity of the 1st heart sound (S1)?

A. Position of the mitral leaflet at the onset of ventricular systole
B. Rise of rate of ventricular pressure
C. Presence or absence of structural diseases of mitral valve
D. All of the above

D. All of the above

21

7. (+) Hepatorenal reflex
(Abdomino jugular reflux? - From video)

A. Severe Heart Failure
B. Cardiac Tamponade
C. Hemopericardium
D. AOTA

D. AOTA

Harrison's 1444

22

3. The ff will manifest with a widened pulse

A. PDA
B. Aortic regurgitation
C. Thyrotoxicosis
D. AOTA

D. AOTA


945 - Measure blood pressure using recommended techniques (see pp. 119–124), checking for increased systolic blood pressure (SBP) and widened pulse pressure (PP), de ned as SBP minus diastolic blood pressure (DBP). With aging, SBP and peripheral vascular resistance increase, whereas DBP decreases

23

20. S2 -

Closure of aortic and pulmonary valves

24

9. Chronic Arterial Insufficiency

- Decreased or absent pulse

25

25. Pulmonic location

- 2nd ICS Left parasternal

26

22. S4 -

Not usually heard in adults

27

8. Chronic Venous Insufficiency

- Pale skin

28

49. Chest compression

- 2-2.4 inches

29

32. Factors which may influence the intensity of the first heart sound

A. Rate of rise of IV pressure
B. Presence or absence of structural disease of the mitral valve
C. Amount of tissue, air, and fluid between the heart and the stethoscope
D. AOTA

D. AOTA

30

12. Pulse Alterans

A. Severe Heart Failure
B. Premature Ventricular Contraction
C. Hypertrophic Obstructive Cardiomyopathy
D. Cardiac Tamponade

B. Premature Ventricular Contraction (?)

---
Harrisonsons 1446-

Pulsus alternans, in contrast, is defined by beat-to-beat variability of pulse amplitude. It is present only when every other phase I Korotkoff sound is audible as the cuff pressure is lowered slowly, typically in a patient with a regular heart rhythm and independent of the respiratory cycle. Pulsus alternans is seen in patients with severe left ventricular systolic dysfunction and is thought to be due to cyclic changes in intra- cellular calcium and action potential duration. When pulsus alternans is associated with electrocardiographic T-wave alternans, the risk for an arrhythmic event appears to be increased.

31

21. S3 -

In children and young adults

32

18. Cresendo - Decresendo

Aortic stenosis

33

19. S1 -

Atrioventricular closure

34

2. Factors that affect arterial pressure

A. Peripheral venous resistance
B. Distensibility of aorta and arteries
C. LV Stroke Volume
D. AOTA

D. AOTA


Bates - 343
◗ Left ventricular stroke volume
◗ Distensibility of the aorta and the large arteries
◗ Peripheral vascular resistance, particularly at the arteriolar level
◗ Volume of blood in the arterial system

35

Dicrotic pulse

A. Severe Heart Failure
B. Premature Ventricular Contraction
C. Hypertrophic Obstructive Cardiomyopathy
D. Cardiac Tamponade

Cardiac tamponade