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ICM Exam 1 > Week 5 - CV 2, PV, and Lymphatics > Flashcards

Week 5 - CV 2, PV, and Lymphatics Flashcards

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1
Q

ROS Question

A

Any swelling, pain, or discoloration in your arms or legs?

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2
Q

Systole is when?

A

Interval between S1 and S2

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3
Q

Diastole is when?

A

S2 and S1

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4
Q

When is S1 heard?

A

Just before the carotid upstroke

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5
Q

When is S2 heard?

A

Following the carotid upstroke

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6
Q

Where is S1 louder than S2?

A

At apex

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7
Q

Where is S2 louder than S1?

A

Base

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8
Q

What sounds are listened to by the diaphragm?

A

High-pitched sounds

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9
Q

What 3 sounds can be heard with the diaphragm?

A
  1. S1 and S2
  2. Aortic and mitral regurgitation
  3. Pericardial friction rubs
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10
Q

What do we listen to with the bell?

A

Low-pitched sounds

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11
Q

What 2 things can we hear from the bell?

A
  1. S3 and S4

2. Murmur of mitral stenosis

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12
Q

How do we apply the bell?

A

Lightly

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13
Q

2 specific times when S1 can be accentuated?

A
  1. High cardiac output

2. Mitral stenosis

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14
Q

2 specific times when S1 can be diminshed?

A
  1. Mitral valve is calcified and relatively immobile

2. L ventricular contractility is markedly reduced

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15
Q

Where do we listen for splitting in S2?

A

2nd or 3rd L interspace

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16
Q

Where do we see pathologic splitting a lot?

A

Atrial septal defect

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17
Q

Where do we see early systolic ejection sounds?

A

Aortic valve disease from congenital stenosis

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18
Q

What do we often see systolic clicks?

A

Mitral valve prolapse

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19
Q

What is “Opening Snap”?

A

Very early diastolic sound usually produced by the opening of a stenotic mitral valve

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20
Q

Where is “Opening Snap” heard best?

A

Just medial to apex

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21
Q

Where will we often detect PHYSIOLOGICAL S3?

A
  1. Children and in young adults to the age of 35 or 40

2. Last trimester of pregnancy

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22
Q

When does S3 occur?

A

Early in diastole during rapid ventricular filling

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23
Q

Is an S3 in adults over 40 pathological? What is it caused by?

A

Yes; high pressures and abrupt deceleration of inflow

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24
Q

What is “Kentucky”?

A

Involved in S3. Gives rise to the term gallop from the cadence of 3 heart sounds, especially rapid heart rates that sound like Kentucky

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25
What is S4 commonly due to?
Increased resistance to ventricular filling following atrial contraction
26
What is "Tennessee"?
Left sided S4 heard best at the apex in the L lateral position
27
What is a "Summation Gallop"?
A patient that has both S3 and S4 producing a quadruple rhythm. At rapid rates S3 and S4 may merge into one extra large heart sound called a summation gap
28
What do we do for a heart murmur?
1. Timing (S or D?) 2. Where is it loudest 3. Shape of murmur 4. Maneuver the patient 5. Identify associated features (quality of S1/2, presence of extra sounds) 6. Intensity
29
2 terms associated with the timing of heart murmurs
1. Pansystolic murmur | 2. Midsystolic murmur
30
Pansystolic Murmur
Often occurs with regurgitant flow across AV valves
31
Midsystolic Murmur
Arise from blood flow across aortic and pulmonic (semilunar) valves
32
What do we see in early diastolic murmurs?
Regurgitant flow across incompetent semilunar valves
33
What do we see in mid diastolic and presystolic murmurs?
Turbulent flow across AV valves
34
Continuous Murmur
Beings in systole and extends into all or part of diastole
35
2 causes of Continuous Murmur
1. Congenital patent ductus arteriosus | 2. Pericardial friction rubs
36
4 descriptions of the shapes of murmurs and what are they associated with?
1. Crescendo (grows louder) - mitral stenosis 2. Decrescendo (grows softer) - aortic regurgitation 3. Crescendo-Decrescendo (rises, then falls) - aortic stenosis 4. Plateau (same intensity) - mitral regurgitation
37
What does the left lateral decubitus position do?
Brings left ventricle close to chest wall and accentuates left sided S3 and S4 mitral murmurs, especially mitral stenosis
38
What side of the stethoscope do we use in L lateral decubitus?
Bell lightly on the apical impulse
39
How do we accentuate aortic murmurs?
1. Sit up 2. Lean forward 3. Exhale completely 4. Stop breathing in expiration
40
What side of stethoscope do we use for aortic murmurs and where? Why?
Diaphragm; L sternal border and at apex because otherwise we might miss soft diastolic murmur of aoritc regurgitation
41
What decreases when a person stands?
Venous return to the heart
42
What else declines when a person stands?
1. Arterial BP 2. Stroke volume 3. Volume of blood in L ventricle
43
Does squatting cause an increase in venous return?
Yes
44
What do the changes in venous return help with?
1. Identify prolapsed mitral valve (sooner and louder with less cardiac volume) 2. Distinguish hypertrophic cardiomyopathy (sooner/louder with less) from aortic stenosis (decreased intensity with less volume)
45
What is Valsalva Maneuver?
Forcible exhalation against closed glottis to increase intrathoracic pressure
46
What do we see in Valsalva Maneuver?
Drop of both BP and L ventricular volume during "release" phase and then "overshoot" several seconds later
47
Grade 2 Murmur
Quiet but heard immediately with stethoscope
48
Grade 4 Murmur
Palpable thrill
49
Grade 5/6 Murmur
Extremely loud thrill (no stethoscope needed for 6)
50
What and where do we see mitral regurgitation murmur?
Decreased S1; apex
51
Where do we see tricuspid regurgitation?
Lower L sternal border
52
Can we have an innocent murmur and pathologic murmur both present?
Occasionally
53
Is a physiologic murmur a possible sign of likely cause?
Yes
54
Where do we see aortic stenosis?
R 2nd interspace
55
What associated findings do we see in Hypertrophic Cardiomyopathy?
S3 may be present and S4 often present at apex (unlike mitral regurgitation) Carotid pulse rises quickly unlike pulse in aortic stenosis
56
Where do we see pulmonic stenosis?
2nd and 3rd L interspaces
57
What are associated findings with aortic regurgitation? (diastolic murmur?
Pulse pressure increases and arterial pulses are often bounding
58
What is an Austin Flint?
Midsystolic flow murmur of mitral diastolic murmur suggesting large regurgitant flow
59
Where do we see PDA?
L 2nd interspace (both diastolic and systolic murmur components)
60
5 things with Peripheral Arterial Exam
1. Measure BP in both arms 2. Palpate for carotid upstroke, aorta, determine maximal diameter 3. Auscultate for aortic, renal, and femoral bruits 4. Palpate arteries 5. Inspect ankles and feet for color, temp, skin integrity
61
What might lymph edema of the arm and hand follow?
Axillary node dissection and radiation therapy
62
What scale us used for edema?
4 points scale
63
3 things "Diffuse Edema" is associated in?
1. HF 2. Cirrhosis 3. Nephrotic syndrome
64
3 causes for "Unilateral Edema"
1. Deep venous thrombosis 2. Chronic venous insufficiency 3. Lymphedema
65
When does Gangrene develop? When not?
Chronic Arterial insufficiency; venous
66
Neuropathic Ulcer
Developes in pressure points of areas with diminished sensation
67
Where do we often see neuropathic ulcers?
1. Diabetic neuropathy 2. Neurological disorders 3. Hansen disease
68
Is there pain in neuropathic ulcers?
No
69
Symptoms of Neuropathic Ulcer
Decreased sensation and absent ankle jerks
70
What size inguinal nodes are normal and palpable?
1-2cm
71
ABI formula for R foot
R ABI = highest P in R foot / highest P in both arms
72
ABI value of moderate arterial disease
0.5-0.8
73
ABI value acceptable
0.9
74
ABI value for severe arterial disease
<0.5

ICM Exam 1 (7 decks)

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