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52 Cards in this Set

  • Front
  • Back
when you take the carotid pulse and feel a delay or diminished upstroke what might indicate what kind of stenosis
aortic stenosis
why?
which vein is important to view to look for venous pressure
internal jugular vein - even though it is deep to sternomastoid muscle - you can see pulsations in the lower part of the sternocleidomastoid triangle
how do pulsations differ in the internal jugular from the carotid?
the carotid is only a single pulse but you see double pulsations (a wave during atrial contraction and v wave during the ventricular contraction) when viewing the internal jugular
how many cm above the right atrium is the angle of Louis (sternal angle)
5 cm
if internal jugular pulsations are 4 cms above the angle of Louis then the central venous pressure is about
9cm
normal CVP rules out what
R sided congestive heart failure (CHF)
normal range for CVP is
5-8cm
The four auscultatotry areas which correspon with volve abnormalities are (describe where they are)
1. aortic area (right intercostal space,upper right sternal border (2nd RICS, URSB)
2. Pulmonic area: 2nd LICS, ULSB
3. Tricuspid area (right ventricular area): 4th and 5th L ICS, LLSB
4. Mitral area (also called apex): 5th ICS, L Mid-clavicular line (MCL)
where is the apical impulse (PMI)
th left ICS, MCL (pt supine)

note: displaced laterally in LV eccentric hypertrophy
note2: the impulse is larger than 2 cm in LV concentric hypertrophy
how might the apical impulse differ in LV concentric hypertrophy
it may be displaced laterally and be sustained
vibrations or thrills over the aortic area would suggest
aortic stenosis
prominant impulse over the pulmonic area would indicate
pulmonary hypertension
a prominant impulse over the tricuspic area would suggest
right ventricular hypertrophy
the bell is good for what kind of sounds
low frequency (like gallop sounds)
where is S1 loud
loud at apex and softer at aortic and pulmonic areas
where will S2 be loud
over the aortic and pulmonic areas as it is produced by the closure of these valves (A2 preceding P2)
a normal P2 heart sound is heard only at the pulmonic area. a loud P2 heard away from the pulmonic area suggests
pulmonary hypertension

P2 also may be heard later during inspiration
what are gallops
left ventricular filling sounds heard during diastole
how are gallops best heard
at the apex w/ pt rolled up on the left side (left lateral dcubitus position)

listen with bell in quiet room - hard to hear
how do you listen for S3
it is the rapid filling of ventricle in early diastoli just after S2

you hear itmedial to the apex, listening with the bell supine first. if it is not heard ask the pt to roll over into the left lateral decubitus position.
S4 represents
atrial kick during late diastolic ventricular filling just before S1
an S4 sound is caused by
decreased ventricular compliance (LVH, myocardial ischemia, or infarction)
heard during mid systole in pts with mitral valve prolapse
midsytolic click: abnormal ballooning of mitral valve into the left atrium. high pitched and clicking in quality.
a midsystolic click is best heard where?
between the apex and the lower sternal border with the diaphragm of your stethoscope
the opening of a stenotic mitral valve is best heard where
between apex and left lower sternal border and is high pitched and clicking in quality
the intensity of a murmur depends on
velocity and volume of blood flow - not severeity of valvular disease

graded on a 1 to 6 scale - based on loudness
if a thrill (superficial vibration felt of the skin overlying an area of turbulence) is felt then the murmur is at least a grade
4
the typical pattern of an ejection murmur is
crescendo-decrescendo (diamond shaped)

heard in something like aortic stenosis
the typical pattern of a murmer with mitral regurgitation is
holosystolic
a typical pattern of aortic regurgitation
a diastolic mumur that is hard to hear

decreascendo
where does a aortic stenosis murmur radiate to
neck
where does a mitral regurgitation radiate to
axilla
what are 5 associated signs with aortic stenosis
1. decreased A2
2. slow rising and delayed pulse
3. ejection click
4. S4
5. narrow pulse pressure
how do you calculate pulse pressure
systolic minus diastolic pressure but it can be calculated by stroke volume / compliance
three associated signs w/ mitral regurgitation
decreased S1
Laterally displaced diffuse PMI
S3
a loud S1 is the hallmark of
mitral stenosis
orthostatic blood pressure changes are dfined as
a blood pressure fall of 20mmHg or more from supine to standing, which should be accompanied by at least a 10 point rise in pulse.
equilibration may take longer in elderly and diabetic patiens
what is a paradoxical pulse
a greater than 10mm decrease in systolic pressure noted during inspiration.

exaggeration of normal variation (pulse becomes weaker as one inhales and stronger as one exhales)
Kussmaul sign
increase in jugular venous pressure height with inspiration
how do you calculate pulse rate
count for 15 seconds and multiply by 4
normal pulse rate in adults is
60 to 100 beats per minute
normal respiratory rate in adults is
8 to 16 breaths per minute
what is there to assessing tactile fremitus
when pt speaks 99 and you palpate back. you will feel vibration. fremitus is increased when the transmission of sound is increased liek through consolidated lung of lobar pneumonia, COPD, flui, fibrosis, etc..
when fluid or solid tissue replace air-containing lung or pleural space - you will go from dull to
resonance
what is the normal excursion for the diaphragm (movement of diaphragm during breathing)
5-6 cm -
what does a vescicular breath sound mean
inspiration is loader than expiration. normal. heard around periphery
what does a broncho-vescicular breath sound sound like
Inspiration = E
normal
audible in two places: 1st and 2nd ICS anteriorly and between the scapulae
a bronchial breath sounds means
E>I
locations ove the manubrium if at all.
what does trachial breath sound mean
I=E, very loud intensity, high pitch, harsh, heard over the extrathoracic portion of the trachea
crackles / rales results from
sudden opening of small airways, intermittent, non-musical, brief, short, explosive
the two criteria to diagnose clubbing
1. interphalangeal depth ratio exceeding one (divide the depth of the digit at the base of nail compared with the same depth at DIP)
2. hyponychial angle
80 % of cases of clubbing are seen in pts with
lung disorders.