Practical 1

Question 0

What is physiologically happening during S2 heart sound?

Answer 0

Closure of the aortic and pulmonic valves

Semilunar valves

Question 1

What is physiologically happening during S1 heart sound?

Answer 1

Closing of the mitral and tricuspid valves

Atrioventricular valves

Question 2

Where is S1 heart sound heard best?

Answer 2

Mitral area (5th intercostal space inline with mid clavicular line)
Aka apex of the heart

Question 3

Where is S2 heart sound best heard?

Answer 3

Aortic area (right 2nd ICS)
Aka base of the heart

Question 4

Where would listen to hear the aortic valve?

Answer 4

Right 2nd ICS

Question 5

Where would you listen to hear the pulmonic valve?

Answer 5

Left 2nd ICS

Question 6

Where would you listen to hear the mitral valve?

Answer 6

5th ICS inline with mid clavicular line

Question 7

Where would you listen to hear tricuspid valve?

Answer 7

3rd or 4th ICS left or right of sternum

Question 8

Where should you stand while performing heart ascultations?

Answer 8

Right Side of patient

Question 9

What is happening between S1 and S2 heart sounds?

Answer 9

Systole (ventricular contraction)

Question 10

ABI=?

Answer 10

Highest ankle SBP/highest arm BP

Question 11

Where should you palpate for the radial artery pulse

Answer 11

Proximal and medial to radial styloid process

With forearm pronated

Question 12

Where should you palpate for the carotid artery pulse?

Answer 12

Anterior to SCM

Question 13

What would happen if you put too much pressure while palpating the carotid artery?

Answer 13

You will stimulate a vasovagal response

Question 14

Where should you palpate to feel the brachial artery pulse?

Answer 14

Find the biceps tendon then move medially.

Should palpate slightly superior to cubital fossa

Question 15

What is a normal capillary refill time?

Answer 15

Less than or equal to 2 seconds

Question 16

What happens to the BP reading if the arm is above the level of the heart?

Answer 16

Reading will be too low

Question 17

What happens to the BP reading if the arm is below the level of the heart?

Answer 17

Reading will be too high

Question 18

What is the first Koratkoff sound represent?

Answer 18

Systolic BP

Question 19

How do you test for orthostatic hypotension?

Answer 19

Take pts BP in supine
Have pt sit on edge of bed for 2 minutes at rest
Retake  BP
Have pt stand for 2 minutes
Retake BP

Question 20

What is a normal ABI

Answer 20

1-1.29

Question 21

What is borderline ABI

Answer 21

.91-.99

Question 22

What is mild PAD ABI

Answer 22

.8-.9

Question 23

What is moderate PAD ABI

Answer 23

.5-.79

Question 24

What is severe PAD ABI

Answer 24

<0.5

Question 25

What is it called when foot become beet red after rubor of dependency test?

Answer 25

Reactive hyperemia

Question 26

What is a normal response to the rubor dependency test?

Answer 26

Quick blushing of foot less than or equal to 15 secs

Question 27

What is an abnormal response to the rubor of dependency test?

Answer 27

Greater than 20-30 seconds for foot to pick up or foot becomes beet red Pts with PaD will have this response

Question 28

What is a S3 heart sound indicative of?

Answer 28

CHF | Hallmark sign for heart failure and such as identifies a poor cardiac pump

Question 29

What is an S4 heart sound?

Answer 29

An exaggerated atrial contraction and subsequent turbulence | Heard as a low frequency sound in early diastole

Question 30

How do you measure the ankle for edema?

Answer 30

Figure 8 1. Midway b/t ant tib tendon and lateral malleolus 2. Draw tape medially across instep distal to navicular tuberosity 3. Pull tape across arch of foot proximal to base of 5th MT 4. Pull across ant tib tendon then around ankle joint distal to malleoli

Question 30

What is a S4 heart sound indicative of?

Answer 30

Chronic hypertension

Question 31

What is a loud S2 indicative of?

Answer 31

Pulmonary hypertension

Question 32

Determine risk of DVT using Wells clinical prediction rule

Answer 32

``` Active cancer (treatment within 6 months, or palliation) (Points: 1 ) Paralysis, paresis, or immobilization of lower extremity (Points: 1 ) Bedridden for more than 3 days because of surgery (within 4 weeks) (Points: 1 ) Localized tenderness along distribution of deep veins (Points: 1 ) Entire leg swollen (Points: 1 ) Unilateral calf swelling of greater than 3 cm (below tibial tuberosity) (Points: 2 ) Unilateral pitting edema (Points: 1 ) Collateral superficial veins (Points: 1 ) Alternative diagnosis as likely as or more likely than DVT (Points: -2 ) ```

Question 33

Based on the results of Wells clinical prediction rule how would you rate the probability of DVT

Answer 33

> 3 points; high risk—Refer to MD immediately 1-2 points; moderate risk—Clarify PT w/ MD < 1 point; low risk—PT is ok!

Question 34

Define blood-oxygen saturation

Answer 34

The amount of oxygen bound to hemoglobin in the blood, expressed as a percentage

Question 35

Values for evaluating results of ABI

Answer 35

* 1-1.29 * .91-.99 * .8-0.9 * .5-0.79 * <0.5 Normal Borderline (equivocal)Mild Moderate Severe PAD

Question 36

Using the back of your hand compare the temperature of the lower leg/foot from side to side. What might this tell you about circulation?

Answer 36

A decrease in superficial skin temperature may indicate poor arterial perfusion. An increase in superficial skin temperature may indicate infection or active disease processes.

Question 37

What must you do if a pt needs to stop during 6MWT

Answer 37

Do not stop the timer. Record when they stopped, amount of rest break, HR, BP and RPE.