Cca: Cardio

Front 1

Aortic stenosis murmur - location

Back 1

RUSB

Front 2

Aortic stenosis murmur - radiation

Back 2

Carotids

Front 3

Aortic stenosis murmur - shape (diamond, pansystolic)

Back 3

diamond

Front 4

Aortic stenosis murmur - systolic/diastolic, clicks, snaps, heart sounds

Back 4

systolic, ejection click, loud S2

Front 5

Aortic stenosis - associated physical exam findings

Back 5

Pulsus parvus et tardus, syncope, dyspnea, angina

Front 6

Aortic stenosis - etiologies

Back 6

Age-related calcification, bicuspid aortic valve

Front 7

Aortic regurgitation murmur - location

Back 7

2nd-4th LICS

Front 8

Aortic regurgitation murmur - radiation

Back 8

Apex

Front 9

Aortic regurgitation murmur - shape (diamond, pansystolic)

Back 9

Decrescendo

Front 10

Aortic regurgitation murmur - systolic/diastolic, clicks, snaps

Back 10

diastolic

Front 11

Aortic regurgitation - pitch

Back 11

High pitched, blowing

Front 12

Aortic regurgitation - etiologies

Back 12

Aortic root dilation, bicuspid aortic valve, endocarditis, rheumatic fever

Front 13

Aortic regurgitation - manuvers

Back 13

Exhaled (left heart murmur), leaning forward

Front 14

Aortic regurgitation - associated exam signs

Back 14

Waterhammer pulse, wide pulse pressure (systolic - diastolic), head bobbing

Front 15

Austin flint murmur - what, when, why, where?

Back 15

low pitched mid-Diastolic murmur at the apex in severe AR, due to rapid regurgitant flow into the LV causing rumbling of the mitral valve

Front 16

mitral regurgitation murmur - location

Back 16

Apex

Front 17

mitral regurgitation murmur - radiation

Back 17

Left axilla

Front 18

mitral regurgitation murmur - shape (diamond, pansystolic)

Back 18

Holosystolic

Front 19

mitral regurgitation murmur - systolic/diastolic, clicks, snaps

Back 19

Systolic

Front 20

mitral regurgitation - pitch

Back 20

High pitched, blowing

Front 21

mitral regurgitation - etiologies

Back 21

Ischemic heart disease, MVP, LV dilation

Front 22

mitral regurgitation - presentation

Back 22

LV failure - dyspnea, fatigue, orthopnea, palpitations

Front 23

mitral stenosis murmur - location

Back 23

apex

Front 24

mitral stenosis murmur - radiation

Back 24

none

Front 25

mitral stenosis murmur - shape (diamond, pansystolic)

Back 25

mid-diastolic

Front 26

mitral stenosis murmur - systolic/diastolic, clicks, snaps, other heart sounds

Back 26

opening snap due to abrupt halt in leaflet motion, loud S1

Front 27

mitral stenosis - pitch

Back 27

low pitched, rumbling

Front 28

mitral stenosis - etiologies

Back 28

Rheumatic fever

Front 29

mitral stenosis - manuvers

Back 29

LLD + listen with bell

Front 30

mitral stenosis - presentation

Back 30

LV failure - dyspnea, fatigue, orthopnea, palpitations

Front 31

VSD murmur - location

Back 31

Left sternal border

Front 32

VSD murmur - systolic/diastolic, clicks, snaps

Back 32

Holosystolic, harsh sounding murmur

Front 33

PDA murmur - systolic/diastolic

Back 33

continuous, loudest at S2 (end of systole)

Front 34

PDA murmur - pitch

Back 34

Machine-like

Front 35

PDA murmur - etiology

Back 35

Congenital rubella, prematurity

Front 36

PDA murmur - location

Back 36

Left infraclavicular

Front 37

HOCM murmur - location

Back 37

Left sternal edge, 3rd/4th intercostal space

Front 38

HOCM murmur - systolic/diastolic

Back 38

systolic

Front 39

MVP murmur - location

Back 39

apex

Front 40

MVP murmur - systolic/diastolic, clicks, snaps

Back 40

Mid-systolic click followed by late systolic crescendo murmur

Front 41

MVP murmur - etiology

Back 41

myxomatous degeneration, rheumatic fever, chordae rupture

Front 42

What is MVP?

Back 42

valve balloons back into the atrium, and sometimes regurgitates blood (murmur)

Front 43

What grade is a murmur heard with stethoscope entirely off chest?

Back 43

6

Front 44

What grade is a murmur with a palpable thrill but can't be heard with stethoscope off chest?

Back 44

4

Front 45

What grade is a murmur that is quiet but easily recognizable when stethoscope placed on chest?

Back 45

2

Front 46

What grade murmur is loud but with no thrill?

Back 46

3

Front 47

What murmur radiates to the carotids?

Back 47

AS

Front 48

What murmurs increase intensity with decreased LV volume?

Back 48

HOCM, MVP

Front 49

What murmur radiates to axilla?

Back 49

MR

Front 50

Which valvular defects are associated with loud heart sounds?

Back 50

Stenotic valves with valve closure (M1 in mitral stenosis, A2 in aortic stenosis)

Front 51

What holosystolic murmurs are heard loudest at the tricuspid area?

Back 51

VSD, Tricuspid regurg, maybe distinguish by respiratory phase?

Front 52

What murmur is late systolic preceeded by a midsystolic click?

Back 52

MVP

Front 53

What murmur is diamond shaped preceeded by an ejection click?

Back 53

AS

Front 54

What murmur is due to congenital rubella or prematurity?

Back 54

PDA

Front 55

What murmurs are "blowing"/high pitched

Back 55

Regurgitation murmurs

Front 56

Physical findings in hypertension

Back 56

"Cardiac: reduced exercise, easy fatigue, chest discomfort, palpitations, hyperdynamic apical impulse, left ventricular hypertrophy, ECG changes)
Renal: nocturia, proteinuria, hematuria
Brain: dysarthria, sensory/motor defect (aneurysm)
Ophthalmologic: small vessel constriction of both arterioles and venules, AV nicking, exudates/hemorrhages, papilledema"

Front 57

What murmur is early decrescendo diastolic?

Back 57

AR

Front 58

What murmur is rumbling diastolic in mid/late diastole?

Back 58

MS

Front 59

What murmur is more likely significant - systolic or diastolic?

Back 59

Diastolic

Front 60

What heart sound is mitral/tricuspid?

Back 60

S1

Front 61

What valves close on S2?

Back 61

Aortic, pulmonic

Front 62

What causes physiologic splitting?

Back 62

Inspiration -> increased venous return -> P2 stays open longer

Front 63

What causes fixed splitting?

Back 63

ASD, VSD, shunt allows both valves to close simultaneously

Front 64

What causes reversed splitting?

Back 64

AS, HOCM, LBBB - cause aortic valve to stay open longer

Front 65

What causes wide splitting?

Back 65

LBBB, RBBB - but still varies with inspiration/expiration

Front 66

Causes of S3 sound?

Back 66

Rapid ventricular filling (MR, TR - due to high volume in valves), CHF (due to high volume?)

Front 67

Causes of S4 heart sound?

Back 67

Sound of atrial contraction on stiff ventricle - HTN, AS, coronary artery disease

Front 68

How are S3/S4 best heard?

Back 68

With bell - low pitch

Front 69

A wave of JVP - peak/valley, and what is it?

Back 69

Strong peak in atrial pressure during atrial contraction

Front 70

C wave of JVP - peak/valley, what is it?

Back 70

Very slight peak in atrial pressure as a result of RV contraction, not normally seen

Front 71

X wave of JVP - peak/vally, what is it?

Back 71

Valley, due to atrial relaxation

Front 72

V wave of JVP - peak/valley, what is it?

Back 72

Peak - due to increased pressure from venous filling

Front 73

y wave of JVP - peak/valley, what is it?

Back 73

Valley - due to decreased pressure from tricuspid valve opening

Front 74

Order of peaks/valleys in JVP?

Back 74

ACXVY, (peak, peak, valley, peak, valley)

Front 75

When is cyanosis evident?

Back 75

Deoxyhemoglobin > 5 mg/dl

Front 76

What underlying condition would cause a patient to not become cyanotic even in chronic bronchitis?

Back 76

Anemia

Front 77

What heart failure causes paroxysmal nocturnal dyspnea?

Back 77

Left heart failure -> pulmonary edema

Front 78

Physical exam findings in cardiomegaly?

Back 78

"PMI lateral to midclavicular line
Increased PMI diameter and amplitude
Increased PMI duration
Prolonged right ventricular heave"

Front 79

How long should a patient be sitting before taking BP?

Back 79

5 minutes

Front 80

Where should the bp cuff bladder be centered?

Back 80

2.5 cm above antecubital crease

Front 81

Will a large blood pressure cuff cause high or low reading in a small person?

Back 81

Low reading, bladder applies too much pressure so you get a low reading

Front 82

How fast should you deflate the BP cuff, and what is considered the systolic pressure?

Back 82

2-3 mm Hg / second, until you hear 2 consecutive beats (Systolic pressure)

Front 83

Radial artery location

Back 83

Lateral flexor surface of forearm

Front 84

Femoral pulse location

Back 84

below inguinal ligament, halfway between ASIS and symphisis pubis

Front 85

Popliteal artery location

Back 85

Knee somewhat flexed, palpate in the midline behind the knee

Front 86

Dorsalis pedis location

Back 86

lateral to extensor tendon of big toe

Front 87

Posterior tibial pulse location

Back 87

behind and below the medial malleolus of the ankle

Front 88

Risk factors of CV disease

Back 88

"Genetics (african americans, FHx)
Gender - men
Age
Cigarette
HTN
Hyperlipidemia
Inactivity
Obesity
Stress
Cocaine/alcohol
Diabetes"

Front 89

Signs and symptoms of arterial peripheral vascular disease

Back 89

"exercise induced pain in limb
coldness / numbness in feet
Digital ischemia (Raynaud's)
Reduced pulses
Femoral bruit
Delayed venous filling time
Pallor"

Front 90

Signs and symptoms o venous peripheral vascular disease

Back 90

"Swelling of feet/legs (edema)
Prominent veins
Hyperpigmentation, edema, cyanosis
Ulcers on the lower legs near ankles"