Olol Pe Exam 2

Front 1

Exertional CP with radiation down the neck and down the left arm.

Back 1

Angina Pectoris

Front 2

Sharp pain radiating into the back or into the neck

Back 2

Aortic Dissection

Front 3

Symp or Signs of irregular heart action warrant a _____.

Back 3

EKG

Front 4

_______, which is an irregularly irregular heart beat, can be reliably dx'd at bedside.

Back 4

A-fib

Front 5

Pt's with transient skips and flipflops may have _____

Back 5

Possible Premature Contractions

Front 6

Rapid regular beating of sudden onset and offset is ______

Back 6

Possible Proxismal SVT

Front 7

A rapid regular rate of less than 120 bpm especially starting and stopping more gradually.

Back 7

Possible Sinus Tach

Front 8

Orthopnea suggests ____ or _____ and may also accompany ______ lung dz.

Back 8

LV Heart Failure
MS
Obstructive

Front 9

PND suggests ______ or _______ and may be mimicked by __________ attacks.

Back 9

LV Heart Failure
MS
Nocturnal Asthma

Front 10

_______ edema appears in the lowest body parts (feet and lower legs when sitting/sacrum when bedridden)

Back 10

Dependent edema

Front 11

Causes of dependent edema include ______, ________, or ______.

Back 11

Cardiac (CHF)
Nutritional (Hypoalbuminemia)
Positional

Front 12

Edema occurs in _____ and _____ disease.

Back 12

Renal
Liver

Front 13

In nephrotic syndrome you'll see _____ and _______.

Back 13

periorbital puffiness
tight rings on fingers

Front 14

An enlarged waistline can be from _____ and _____.

Back 14

Ascites
Liver Failure

Front 15

Increased JVP suggests ______ sided CHF or less commonly, ______, _______, _______.

Back 15

Right
Constricted Pericarditis
TS
SVC Obstruction

Front 16

In pts w/ Obstructive Lung Dz, JVP may appear elevated on ______ only and the veins collapse on _____.

Back 16

Expiration
Inspiration

Front 17

Unilateral distension of the External Jugular is usually caused by ____ or _____.

Back 17

Local Kinking
Obstruction
*Occasionally bilat distension may have a local cause.

Front 18

Prominent a waves indicate increased resistance to _______ contraction, as in ___ stenosis or the ______ compliance of the hypertrophied ______.

Back 18

Right Atrial
Tricuspid
decreased
RV

Front 19

In A-fib, the __ waves disappear.

Back 19

a

Front 20

Larger __ waves characterize TR.

Back 20

v

Front 21

A unilateral pulsatile bulge of the carotid could be due to ________________.

Back 21

A tortuous and kinked carotid

Front 22

Decreased carotid pulsations maybe caused by a ______ or ___________.

Back 22

Decreased SV
Atherosclerotic narrowing/ occlusion

Front 23

Pressure on the ________ may cause a reflex drop in pulse rate or BP

Back 23

carotid

Front 24

You'll see a small, thready, or weak pulse in _______ shock.

Back 24

Cardiogenic

Front 25

You'll see a bounding pulse in ______ insufficiency.

Back 25

Aortic

Front 26

Delayed Carotid upstroke in ______ stenosis.

Back 26

Aortic

Front 27

A carotid bruit in a middle age or older person suggests but doesn't prove _________. An ______ murmur may radiate to the carotid and sound like a bruit.

Back 27

Arterial narrowing
Aortic

Front 28

The heart sound ___ is decreased in 1st degree heart block.

Back 28

S1

Front 29

The heart sound __ is decreased in AS.

Back 29

S2

Front 30

Thrills may accompany loud, harsh, rumbling murmurs as in ______, ________, _______, and less commonly _____.

Back 30

AS
PDA
VSD
MS

Front 31

When the heart is situated in the R side it is called ______.

Back 31

Dextrocardia (usually associated w/ congenital dz)
*Apical impulse will be on the R

Front 32

If the heart, liver, and stomach are all on the opp side it is called ____.

Back 32

Situs Inversus

Front 33

The apical impulse may be displaced ________ by pregnancy or high left diaphragm.

Back 33

Upward and to the left

Front 34

Lateral displacement from cardiac enlargement in _____, _____, ________.

Back 34

CHF
Cardiomyopathy
Ischemic Heart Dz

Front 35

Apical pulse diameter > _____ in the left lateral decubitus position indicates ___ enlargement.

Back 35

3cm
LV

Front 36

Increased amplitude of the apical impulse may reflect_____, _____, ______, ______.

Back 36

Hyperthyroidism
Severe Anemia
P overload of the LV (AS)
V overload of the LV (MR)

Front 37

A sustained high-amplitude apical impulse that is normally loacted suggests _______.

Back 37

LV hypertrophy from P overload, as in HTN.
*If the impulse is displaced laterally consider V overload.

Front 38

A sustained low-amplitude apical impulse may result from

Back 38

Dilated Cardiomyopathy

Front 39

A bried mid-diastolic apical impulse indicates ____ and an apical impulse just b/f the systolic apical beat itself indicated an _____.

Back 39

S3
S4

Front 40

A marked increase in amplitude of the RV impulse with normal duration occurs in chronic _________.

Back 40

Volume overload of the RV (as in ASD)

Front 41

A RV impulse of increased amplitude and duration occurs w/ ________

Back 41

Pressure overload of the RV (as in Pulmonic Stenosis or Pulm HTN)

Front 42

In OPD, a _______ lung may prevent palpation of an enlarged RV in the left parasternal area.

Back 42

Hyperinflated
*Impulse is easily felt in the epigastrum

Front 43

A prominent pulsation in the left 2nd interspace accompanies dilation or increased flow in the _____.

Back 43

Pulmonary Artery

Front 44

A palpable S2 in the L 2nd interspace suggests increased pressure in the ______.

Back 44

Pulmonary Artery (Pulm HTN)

Front 45

A palpable S2 in the R 2nd interspace suggests _________.

Back 45

Systemic HTN
*a pulsation here suggests a dilated or aneurysmal aorta

Front 46

A markedly dilated failing heart may have a hypokinetic (low-amplitude) _____ pulse, that is displaced far to the left.

Back 46

Apical
*a large pericardial effusion may make the apical impulse undetectable

Front 47

What heart sound can be heard in the 2nd and 3rd L interspaces?

Back 47

Pulmonic sounds

Front 48

The 2nd right interspace is the ____ area

Back 48

Aortic

Front 49

The lower lest sternal border is the _____ heart area

Back 49

Tricuspid

Front 50

The apex is the ___ area.

Back 50

Mitral

Front 51

The diaphragm of the stethoscope is better for hearing ____ sounds of S1, S2, murmurs of AR/MR, and pericardial friction rubs.

Back 51

High pitched

Front 52

The bell of the stethoscope is more sensitive to low-pitched sounds of _____ and ____, and the murmur of ____.

Back 52

S3
S4
MS

Front 53

The left lateral decubitus position brings out a left-sided ___ and ___ and ____ murmurs.

Back 53

S3
S4
MS

Front 54

Having the pt sit up, lean forward and exhale maximally and hold it accentuates ___ murmurs.

Back 54

Aortic
*Esp AR b/c is a soft murmur.

Front 55

What are the 2 components of a split S2 and when in the respiratory cycle to you hear them?

Back 55

A2>P2
In normal pts, hear on inspiration.

Front 56

How do murmurs differ from heart sounds?

Back 56

Longer duration.

Front 57

When either ___ or ____ are absent, as in dz of the respective _____, S2 is persistently single.

Back 57

A2
P2
Valves

Front 58

______ splitting suggests an abnormality.

Back 58

Expiratory

Front 59

What condition is the most common cause of a systolic click.

Back 59

MVP

Front 60

Systolic murmurs fall b/w ____ and ___ and diastolic murmurs fall b/w ____ and ____.

Back 60

S1 and S2
S2 and S1

Front 61

Murmurs that coincide w/ the carotid upstroke are _____

Back 61

Systolic

Front 62

Diastolic murmurs usually indicate ______ heart dz, systolic murmurs may indicated ____ heart dz, but can also occur when _____ are normal.

Back 62

valvular
valvular
valves

Front 63

Midsystolic murmurs are most often related to blood flow across the _____ or _____ valves.

Back 63

Aortic (AS: crescendo-decrescendo)
Pulmonic

Front 64

Pansystolic murmurs often occur w/ _____ or _____ regurg.

Back 64

Mitral (plateau murmur)
Tricuspid

Front 65

A late systolic murmur is the murmur of _____ and is often preceded by a systlic click.

Back 65

MVP

Front 66

Early diastolic murmurs typically accompany ____ and ____.

Back 66

AR (decrescendo)
PR

Front 67

Middiastolic and presystolic murmurs reflect turbulent flow across the ______ valves.

Back 67

Mitral(crescendo)
Tricuspid

Front 68

The murmur of _____ is a continous murmur that starts in systole and continues w/o pause through S2 into diastole.

Back 68

PDA

Front 69

Murmur best heard in the 2nd right interspace usually originates at or near the ______ valve.

Back 69

aortic

Front 70

A loud murmur of ____ often radiates into the neck.

Back 70

AS

Front 71

______ lungs may diminish the intensity of a murmur.

Back 71

Emphysematous

Front 72

Murmurs with identical turbulence sound louder in ____ people than in ______ and _____ people.

Back 72

Thin
Very muscular
Obese

Front 73

Murmurs in the right side of the heart tend to change more w/ _______ than murmurs on the left side.

Back 73

Respiration

Front 74

Having a pt squat or do the valsalva manuever allows you to identify murmurs of ______ and to distinguish _____ from ______.

Back 74

MVP
Hypertrophic Cardiomyopathy
AS

Front 75

Pulsus alternans almost always indicates severe ________ and is best felt by applying light pressure on the _____ or _____ arteries.

Back 75

L sided heart failure
Radial
Femoral
*regular rhythm w/ alternating strong and weak pulse.

Front 76

Alternating loud and soft Korotkoff sounds or a sudden doubling of the apparent HR as the cuff P declines indicates _______.

Back 76

Pulsus Alternans

Front 77

This is a greater than normal drop in systolic pressure during inspiration.

Back 77

Paradoxical Pulse

Front 78

Paradoxical Pulse suggests _____, _______, and most commonly ______.

Back 78

Pericardial Tamponade
Constrictive Pericarditis
Obstructive Airway Dz