Mosbys

Question 1

What is the force exerted against the wall of the artery when ventricles contract?

Answer 1

systolic pressure

Question 2

The result of cardiac output, blood volume and compliance of the atrial tree is dependent upon (blank)

Answer 2

systolic presure

Question 3

What is the secondary upstroke in the descending part of the pulse that corresponds to the transient increase in pressure upon closure of the aortic valve.

Answer 3

dicrotic notch

Question 4

What is the force exerted against the wall of the artery when the heart is in filling or relaxed state and is primarily the function of peripheral vascular resistance

Answer 4

diastolic pressure

Question 5

What is the difference between systolic and diastolic pressure?

Answer 5

pulse pressure

Question 6

What is the stroke volume?

Answer 6

volume of blood ejected

Question 7

What are these:
o Volume of blood ejected – Stroke volume
o Distensibility of the aorta and other large arteries
o Viscosity of the blood
o Peripheral arteriolar resistance

Answer 7

Contributors of arterial pulse and pressure

Question 8

What are the three types of pressure that gives you an arterial pulse?

Answer 8

systolic, diastolic, pulse

Question 9

(blank) reflect the activity of the right side of the heart

Answer 9

jugular veins

Question 10

What is the order of venous pulsation?

Answer 10

A-> c -> x -> v ->y -> a

Question 11

What are the three peaks of venous pulsation?

Answer 11

A,C,V

Question 12

What are the 2 descending slopes of venous pulsation?

Answer 12

X and Y

Question 13

What is happening during the A peak of venous pulsation?
C?
V?

Answer 13

 A
• Brief backflow of blood into the vena cava during right atrial contraction
 C
• Vigorous backward push from the tricuspid valve when it closes during ventricular systole
 V
• Increasing volume and concomitant increase in the right atrium
o Late in ventricular systole

Question 14

What is happening during the descending slope X and Y?

Answer 14

 x
• Passive atrial filling
 Y
• Open tricuspid valve and rapid refilling of the ventricles

Question 15

Infants and children, cutting the umbilical cord requires (blank)

Answer 15

respiration

Question 16

What happens when you cut the umbilical cord of the child lung and vascular wise?

Answer 16

 Expansion of the lungs and air to the aveoli
 Pulmonary vascular resistance drops
 Systemic vascular resistance increases
 Once the pulmonary vascular resistance is lower than systemic vascular resistance, blood flows into the pulmonic arteries instead of across the interatrial foramen ovale
 foramen ovale Closes by shifting pressures of the right and left heart
 i.e. closes at birth
 Blood flows freely to the lungs but not peripherally.
 The ductus areteriosus closes within 12-14 hours of life

Question 17

What happens to systemic vascular resistance in infants right after umbilical cord is cut?
pulmonary vascular resistance?
Why?

Answer 17

increases
decresases
blood flows into the pulmonic arteries instead of across the interatrial foramen ovale

Question 18

How does the foramen ovale close?

Answer 18

Closes by shifting pressures of the right and left heart

Question 19

Who does this describe:
o System vascular resistance decreases
o Peripheral vasodilation occurs
 Can lead to palmar erythema & spider telangiectasias
o Systolic BP decreases slighty
 Greater decrease in diastolic pressure
o Lowest levels seen in the second trimester
o Venous compression of the vena cava and impaired venous return lead to hypotension
o Blood in lower extremities pool in lower limbs
 Unless in lateral recumbent position
 Due to the enlarged uterus pressing on inferior vena cava and pelvic veins
 May cause and increase in dependent edema, varicosities of the legs and vulva and hemorrhoids

Answer 19

pregnant women

Question 20

WHo does system vascular resistance decrease in?

Answer 20

pregnant women

Question 21

Peripheral vasodilation occurs where?

Answer 21

in pregnant women

Question 22

Systolic BP decreases slightly in ( greater decrease in disastolic pressure)

Answer 22

pregnant women

Question 23

When are lowest level of BP seen in pregnant women?

Answer 23

second trimester

Question 24

What happens to the blood in lower extremities of pregnant women?

Answer 24

blood in lower extremities pool in lower limbs

Question 25

Why does blood in lower extremities pool in lower limbs of pregnant women? (unless in recumbent position)

Answer 25

due to enlarged uterus pressing on inferior vena cava and pelvic veins

Question 26

What cal pooling of blood in lower limbs cause?

Answer 26

May cause and increase in dependent edema, varicosities of the legs and vulva and hemorrhoids

Question 27

Who does this happen in: o Calcification damages o Superficial vessels become more tortuous and prominent o Arterial walls lose elasticity and vasomotor tone o Increased peripheral vascular resistance  Elevated BP

Answer 27

older adults

Question 28

In old people, what loses elasticity and vasomotor tone? Do old people get increased or decreased vascular resistance? In old people, which vessels become tortuous and prominent?

Answer 28

arterial walls increased (i.e. elevated BP) superficial vessels

Question 29

During the HPI watch should you look for?

Answer 29

``` leg pain and cramps? swollen ankles? other symptoms? On a plane or at high elevation? Do any medications help? ```

Question 30

During PMH and FH what should you ask about?

Answer 30

 Any past cardiac problems?  Any rheumatic fever?  Any hypertension, hyperlipidemia, diabetes, stroke, arrhythmia etc.?

Question 31

During SH what should you ask about?

Answer 31

 Any stress at work?  Any tobacco, alcohol, or illegal drugs? If so, how often?  Diet and exercise? Stay away from McDonald’s! • Mosby’s says olive oil and red wine (in moderation) = healthy heart

Question 32

What should you specifically look for in infants and children?

Answer 32

 Look for hemophilia, renal disease, and leg pain when exercising

Question 33

What should you look for in pregnant women?

Answer 33

 Look for increases in BP, abnormal bruising or edema, varicosities, pain  Can have preeclampsia -> more common with advanced maternal age (>40), first pregnancy, and previous Hypertension or diabetes

Question 34

What is preeclampsia?

Answer 34

Hypertension during pregnancy along with protein in urine

Question 35

In old people, what should you look for?

Answer 35

```  Look for leg edema and when it occurs  Ask if the symptoms hinder daily activity  What medications make it better?  Varicose veins! • More common in: o Women  particularly in pregnancy o Irish and German descent o Sedentary lifestyles o Old age ```

Question 36

During the peripheral exam of the arteries, What are you going to palpate? Which one should you NOT palpate bilaterally at the same time?

Answer 36

• Carotid, brachial, radial, femoral, popliteal, dorsalis pedis, and posterior tibial Carotid, you might mess up blood flow to the brain

Question 37

When determining heart rate, how long do you do it for?

Answer 37

15 seconds and times it by four

Question 38

What is it called if heartbeat is irregular but in a repeated pattern? In this, when is HR higher, lower, Normal?

Answer 38

sinus arrhythmia on inspiration, on expiration on expiration in little kids : )

Question 39

What is indicitative of a heart rate that is irregular but not in a repeated pattern?

Answer 39

CHF

Question 40

• Want to compare arteries on each side to look for differences in (blank)

Answer 40

pulse contour, amplitude, and symmetry

Question 41

When you are checking pulse contour, what are you checking?

Answer 41

for normal pulse

Question 42

What kind of pulse is Strong, then weak and it repeats -> left ventricle failure

Answer 42

alternating pulse

Question 43

What kind of pulse has 2 main peaks of pulsation at carotids-> aortic stenosis

Answer 43

pulsus bisferiens

Question 44

What kind of pulse has a Normal pulse and then premature contraction ->dysrhythmia

Answer 44

bigeminal pulse

Question 45

What kind of pulse has a Strong pulse (3+) -> exercise, anxiety, fever, hyperthyroidism

Answer 45

Large, bounding pulse

Question 46

What kind of pulse has ↓ upon inspiration, ↑ upon expiration ->premature contraction, obstruction in trachea or bronchi, asthma, pericarditis

Answer 46

paradoxic pulse

Question 47

What kid of pulse has High amplitude that is short in duration-> patent ductus arteriosus or aortic regurgitation

Answer 47

Water-hammer (Corrigan) Pulse

Question 48

When looking at arterial amplitude, what is the scale?

Answer 48

``` 1-4  4 Bounding, aneurysmal  3 Full, Increased  2 Expected  1 Diminished, barely palpable  0 Absent, not palpable ```

Question 49

When looking at arterial symmetry, what could lack of symmetry show?

Answer 49

could be an obstruction in circulation | (coarctation of the aorta, atheroscletotic peripheral vascular disease, vasculitis)

Question 50

What is coarctation of the aorta?

Answer 50

o Aortic arch is narrow in location that ductus arteriosus inserts (Congenital)

Question 51

What is vasculitis

Answer 51

inflammation of a blood vessel or blood vessels.

Question 52

What does the allen test do?

Answer 52

determines sufficiency of ulnar artery

Question 53

How does the allen test work?

Answer 53

o Kind of random but used when puncturing the radial artery (for blood gas sampling or catheter insertion)

Question 54

How should the allen test be performed?

Answer 54

1) Compress radial and ulnar artery with palm facing up 2) Have patient close and open fist 5 times 3) release pressure on ONLY ulnar artery 4) if color is regained in less than 5 seconds, your good, if not you have ulnar artery insufficiency THEN DONT PUNCTURE radial artery b/c your arm will then be diminished of a blood supply

Question 55

You should auscultate or listen over the artery for what?

Answer 55

bruits

Question 56

what are bruits?

Answer 56

pretty much a murmur sound over an artery  use BELL

Question 57

How do you listen for bruits?

Answer 57

Have patient hold breath so respiratory sounds don’t interfere! It is hard enough to hear as it is : (

Question 58

What is the most common bruit?

Answer 58

carotid bruit

Question 59

What sounds just like a carotid bruit?

Answer 59

venous hum

Question 60

When do you hear venous hum?

Answer 60

anemia and pregnancy

Question 61

Where can you hear carotid bruit?

Answer 61

subclavian, abdominal aorta, iliac, femoral

Question 62

When will you hear a carotid bruit?

Answer 62

* Most common cause is aortic stenosis | * Can also occur if there is atherosclerosis in the carotid artery obviously

Question 63

 If you suspect peripheral artery disease/occlusion from this physical exam, how can you be sure?!

Answer 63

look for the P's

Question 64

What are the p's in Peripheral artery disease/occluision?

Answer 64

1) Pallor  should be localized, can see cyanosis o 2) Pain  in area distal to stenosis o 3) Pulselessness o 4) Parasthesias (only with major arteries) o 5) Paralysis (RARE)

Question 65

How can you see how severe the peripheral artery disease/occlusion is?

Answer 65

o Have patient elevate extremity above heart level so it loses color  then bring back down and see how long it takes to regain color  2 minutes = SEVERE! ALSO can do same thing with capillary refill time test with squeezing finger tips, greater than 2 seconds bad. (not diagnosis)

Question 66

if color doesnt regain for 2 minutes in peripheral artery disease test, what does this indicate?

Answer 66

SEVERE

Question 67

If a patient has peripheral artery disease/occlusion and has pain in calf which artery is affected? thigh? glutes?

Answer 67

Superficial femoral Common femoral or external iliac Common iliac or distal aorta

Question 68

How should you measure blood pressure?

Answer 68

``` in both arms no clothing Patient must be SITTING USE BELL correct size cuff ```

Question 69

When measuring blood pressure where should you put cuff?

Answer 69

2-3 cm superior to crease in arm

Question 70

While palpating radial pulse, increase pressure to 20-30mmHg above the values at which the radial pulse disappears, then what do you do?

Answer 70

slowly release pressure and wait until you hear pulse=systolic

Question 71

When reading BP, once the pulse disappears is the (blank) pressure/

Answer 71

diastolic

Question 72

The sounds you hear while reading BP are called (blank) sounds

Answer 72

Korotkoff sounds

Question 73

How many phases are there in the korotkoff sounds?

Answer 73

5 phases

Question 74

•(blank) can be wider in old patients = sounds quiet so be careful b/c you might have inaccurate systole reading

Answer 74

Auscultatory gap

Question 75

• In general ->taller and bigger = (blank) BP than shorter and leaner!

Answer 75

higher

Question 76

```  Normal vs. Pre-HTn vs. HTn • Normal? • Pre-HTn? 120-139 or 80-89 • HTn o Stage 1 ? o Stage 2 ? ```

Answer 76

120/ 120-139 or 80-89 140-159 or 90-99 >160 or >100

Question 77

In pulse pressure, the difference between systolic and diastolic BP is bad if what?

Answer 77

too narrow or too wide

Question 78

 If diastolic value is above 90 and you expect coarctation of the aorta OR aortic stenosis, measure BP in (blank)

Answer 78

legs at popliteal artery

Question 79

BP at legs at popliteal artery is (blank) than in arms. | If it isnt, could be coarctation of the aorta or aortic stenosis

Answer 79

higher

Question 80

What is Orthostatic/postural hypotension?

Answer 80

greater than 15 mmHg drop in systolic BP upon standing (along with drop in diastolic BP). Increase in heart rate

Question 81

When should you think about testing for Orthostatic/postural hypotension

Answer 81

o Is on anti-HTn medication o Has less blood volume o Has syncope (fainting/lightheadedness)

Question 82

When might you see Orthostatic/postural hypotension

Answer 82

• Can be seen with mild blood loss (as with a blood donation), drugs, ANS disorder, laying down too long, GI bleeding

Question 83

What kind of pulse is this: Difference in systolic BP upon expiration and inspiration should be 5 mmHg

Answer 83

paradoxical pulse

Question 84

WHen do you get an exaggerated paradoxical pulse? When does this happen?

Answer 84

1) Difference in systolic BP upon expiration and inspiration greater than 10 mmHg 2) cardiac tamponade, pericarditis, or COPD

Question 85

What are some disruptions to a blood pressure test?

Answer 85

cardiac dysrhythmias aortic regurgiation venous congestion valve replacement