Cardiac And Pulmonary Exam

Front 1

when you take the carotid pulse and feel a delay or diminished upstroke what might indicate what kind of stenosis

Back 1

aortic stenosis
why?

Front 2

which vein is important to view to look for venous pressure

Back 2

internal jugular vein - even though it is deep to sternomastoid muscle - you can see pulsations in the lower part of the sternocleidomastoid triangle

Front 3

how do pulsations differ in the internal jugular from the carotid?

Back 3

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

Front 4

how many cm above the right atrium is the angle of Louis (sternal angle)

Back 4

5 cm

Front 5

if internal jugular pulsations are 4 cms above the angle of Louis then the central venous pressure is about

Back 5

9cm

Front 6

normal CVP rules out what

Back 6

R sided congestive heart failure (CHF)

Front 7

normal range for CVP is

Back 7

5-8cm

Front 8

The four auscultatotry areas which correspon with volve abnormalities are (describe where they are)

Back 8

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)

Front 9

where is the apical impulse (PMI)

Back 9

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

Front 10

how might the apical impulse differ in LV concentric hypertrophy

Back 10

it may be displaced laterally and be sustained

Front 11

vibrations or thrills over the aortic area would suggest

Back 11

aortic stenosis

Front 12

prominant impulse over the pulmonic area would indicate

Back 12

pulmonary hypertension

Front 13

a prominant impulse over the tricuspic area would suggest

Back 13

right ventricular hypertrophy

Front 14

the bell is good for what kind of sounds

Back 14

low frequency (like gallop sounds)

Front 15

where is S1 loud

Back 15

loud at apex and softer at aortic and pulmonic areas

Front 16

where will S2 be loud

Back 16

over the aortic and pulmonic areas as it is produced by the closure of these valves (A2 preceding P2)

Front 17

a normal P2 heart sound is heard only at the pulmonic area. a loud P2 heard away from the pulmonic area suggests

Back 17

pulmonary hypertension

P2 also may be heard later during inspiration

Front 18

what are gallops

Back 18

left ventricular filling sounds heard during diastole

Front 19

how are gallops best heard

Back 19

at the apex w/ pt rolled up on the left side (left lateral dcubitus position)

listen with bell in quiet room - hard to hear

Front 20

how do you listen for S3

Back 20

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.

Front 21

S4 represents

Back 21

atrial kick during late diastolic ventricular filling just before S1

Front 22

an S4 sound is caused by

Back 22

decreased ventricular compliance (LVH, myocardial ischemia, or infarction)

Front 23

heard during mid systole in pts with mitral valve prolapse

Back 23

midsytolic click: abnormal ballooning of mitral valve into the left atrium. high pitched and clicking in quality.

Front 24

a midsystolic click is best heard where?

Back 24

between the apex and the lower sternal border with the diaphragm of your stethoscope

Front 25

the opening of a stenotic mitral valve is best heard where

Back 25

between apex and left lower sternal border and is high pitched and clicking in quality

Front 26

the intensity of a murmur depends on

Back 26

velocity and volume of blood flow - not severeity of valvular disease

graded on a 1 to 6 scale - based on loudness

Front 27

if a thrill (superficial vibration felt of the skin overlying an area of turbulence) is felt then the murmur is at least a grade

Back 27

4

Front 28

the typical pattern of an ejection murmur is

Back 28

crescendo-decrescendo (diamond shaped)

heard in something like aortic stenosis

Front 29

the typical pattern of a murmer with mitral regurgitation is

Back 29

holosystolic

Front 30

a typical pattern of aortic regurgitation

Back 30

a diastolic mumur that is hard to hear

decreascendo

Front 31

where does a aortic stenosis murmur radiate to

Back 31

neck

Front 32

where does a mitral regurgitation radiate to

Back 32

axilla

Front 33

what are 5 associated signs with aortic stenosis

Back 33

1. decreased A2
2. slow rising and delayed pulse
3. ejection click
4. S4
5. narrow pulse pressure

Front 34

how do you calculate pulse pressure

Back 34

systolic minus diastolic pressure but it can be calculated by stroke volume / compliance

Front 35

three associated signs w/ mitral regurgitation

Back 35

decreased S1
Laterally displaced diffuse PMI
S3

Front 36

a loud S1 is the hallmark of

Back 36

mitral stenosis

Front 37

orthostatic blood pressure changes are dfined as

Back 37

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

Front 38

what is a paradoxical pulse

Back 38

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)

Front 39

Kussmaul sign

Back 39

increase in jugular venous pressure height with inspiration

Front 40

how do you calculate pulse rate

Back 40

count for 15 seconds and multiply by 4

Front 41

normal pulse rate in adults is

Back 41

60 to 100 beats per minute

Front 42

normal respiratory rate in adults is

Back 42

8 to 16 breaths per minute

Front 43

what is there to assessing tactile fremitus

Back 43

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..

Front 44

when fluid or solid tissue replace air-containing lung or pleural space - you will go from dull to

Back 44

resonance

Front 45

what is the normal excursion for the diaphragm (movement of diaphragm during breathing)

Back 45

5-6 cm -

Front 46

what does a vescicular breath sound mean

Back 46

inspiration is loader than expiration. normal. heard around periphery

Front 47

what does a broncho-vescicular breath sound sound like

Back 47

Inspiration = E
normal
audible in two places: 1st and 2nd ICS anteriorly and between the scapulae

Front 48

a bronchial breath sounds means

Back 48

E>I
locations ove the manubrium if at all.

Front 49

what does trachial breath sound mean

Back 49

I=E, very loud intensity, high pitch, harsh, heard over the extrathoracic portion of the trachea

Front 50

crackles / rales results from

Back 50

sudden opening of small airways, intermittent, non-musical, brief, short, explosive

Front 51

the two criteria to diagnose clubbing

Back 51

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

Front 52

80 % of cases of clubbing are seen in pts with

Back 52

lung disorders.