Patient Assessment Test 1 Set 2

Front 1

Systolic Murmurs (4)

Back 1

1)aortic stenosis
2)pulmonary stenosis
3)mitral regurgitation
4)tricuspid regurgitation

Front 2

Diastolic Murmurs (4)

Back 2

1)mitral stenosis
2)tricuspid stenosis
3)aortic regurgitation
4)pulmonic regurgitation

Front 3

Aortic Stenosis (6)

Back 3

1)mid systolic
2)med-pitch (like sea-gull cooing)
3)best heart @ 2nd right ICS to 3rd left ICS
4)associated w/ LVH
5)pulsus bisferiens (plateau pulse)
6)transmitted into R carotid

Front 4

Pulmonary Stenosis (3)

Back 4

1)best heard at 2nd left ICS
2)med pitch
3)transmitted into L carotid

Front 5

Mitral reguritation (4)

Back 5

1)high pitch
2)5th ICS by MCL
3)associated w/ LVH
4)radiates to auxilla (left armpit)

Front 6

Tricuspid Regurgitation (4)

Back 6

1)high pitch
2)4th ICS
3)associated w/ RVH
4)accentuated w/ inspiration (b/c this loads R side of the heart)

Front 7

Mitral Stenosis (4)

Back 7

1)low pitch/rumbling
2)5th L ICS
3)heard under a dime (sharply localized)
4)associated w/ RVH*********

Front 8

Why is mitral stenosis associated w/ RVH?

Back 8

b/c RV pumps to LA->LV; and LA contraction contributes only 10% to LV, RV contributes 90% to LV

Front 9

Tricuspid stenosis (3)

Back 9

1)low pitch/rumbling
2)4th L ICS
3)accentuated w/ inspiration

Front 10

Aortic Regurgitation (5)

Back 10

1)high pitch/blowing
2)2nd R ICS
3)best w/ pt leaning forward
4)associated w/ LVH
5)sharp pulse wave

Front 11

Plateua pulse =....

Back 11

aortic stenosis

Front 12

Pulmonic Regurgitation (4)

Back 12

1)high pitch
2)2nd/3rd L ICS
3)associated w/ RVH*****
4)due to pulmonary HTN

Front 13

Why is pulmonic regurgitation associated w/ RVH?

Back 13

b/c you have a leak back and have to pump it out again

Front 14

REST OF MURMURS ARE CATEGORIZED AS OTHER

Back 14

N/A

Front 15

HTN aortic stenosis (5)

Back 15

1)like aortic stenosis but NOT as loud (also in systole)
2)turbulence b/c of HTN
3)med-low pitch
4)on R 2nd ICS
5)GIVE MEDS FOR HTN AND MURMUR DISAPPEARS

Front 16

Innocent Murmur (5)

Back 16

1)med pitch
2)systolic
3)best @ L sternal border
4)change in velocity/viscosity (so may disappear is these change)****
5)most common murmur

Front 17

Mitral valve prolapse (4)

Back 17

1)mid systolic CLICK
2)may hear split S2
3)most common in women
4)malfxning mitral valve lets backflow of blood into LA causing enlargement

Front 18

Idiopathic Hypertrophic Subaortic Stenosis (6)

Back 18

1)Apex and L sternal border
2)more severe w/ time
3)intensified or present w/ exercise****
4)positional (gone when laying down, there when sitting up)****
5)systolic
6)sudden death in healthy ppl

Front 19

IHSS?

Back 19

subaortic stenosis; obstructing ridge below aortic valve

Front 20

Ventricular septal defect (5)

Back 20

1)loud, course, high-pitch
2)L sternal border in 3rd/4th ICS
3)lower chest
4)congenital
5)heard in systole and diastole (b/c its a hole in the heart)

Front 21

Atrial Septal Defect (4)

Back 21

1)high pitch/loud/harsh
2)best heard in pulmonic area (upper chest)
3)congenital (hole in heart)
4)heard in systole and diastole

Front 22

Patent Ductus Arteriosis (3)

Back 22

1)machine like systolic/diastolic murmur
2)connexn b/w pulmonary artery and aorta
3)see SOB during puberty

Front 23

Friction Rub (4)

Back 23

1)associated w/ pericarditis
2)heard L of sternum in 3rd/4th ICS
3)triphasic sound
4)scrathy, grating

Front 24

Can you live w/ a nonfxnal atrium?

Back 24

yes, its called atrial fibrillation

Front 25

Purpose in squatting in cardio exam (2)

Back 25

1)Incr venous return and incr afterload
2)incr most aortic regurgitation murmurs

Front 26

Purpose in standing from squatting in cardio exam (2)

Back 26

1)reduces venous return (decr RV filling/decr preload)
2)may decr aortic stenosis***

Front 27

Valsalva purpose in cardio exam (2)

Back 27

1)most murmurs decr b/c decr in preload
2)2/3rds of hypertrophic cardiomyopathy INCR

Front 28

Handgrip purpose in cardio exam (3)

Back 28

1)do NOT use in angina, MI
2)decr murmurs from hypertrophic cardiomyopathy
3)incr afterload

Front 29

Respiration purpose in cardio exam***** (2)

Back 29

1)deep inspiration incr R side murmurs
2)expiration decr right side murmurs

Front 30

Amyl nitrite purpose in cardio exam (4)

Back 30

1)decr systemic vascular resistance (decr afterload)
2)DECR aortic insufficiency and mitral regurgitation
3)INCR aortic stenosis and hypertrophic cardiomyopathy murmurs
4)IS A VASODILATOR

Front 31

CHD consists of...(2)

Back 31

1)coronary artery disease
2)ischemic heart disease

Front 32

non-STEMI MI (3)

Back 32

1)non-Q wave infarction (subendocardial)
2)ST depression
3)T wave inversions w/o Q waves
4)partial thickness MI

Front 33

STEMI MI (4)

Back 33

1)wave infarction (transmural)
2)Q waves w/ hyperacute T waves
3)ST elevations followed by T wave inversions
4)full thickness MI

Front 34

Classic angina (3)

Back 34

1)non-infarctional subendocardial ischemia
2)transient ST depression
3)give nitro to reverse

Front 35

Prinzmetal's variant angina (3)

Back 35

1)non-infarctional transmural ischemia
2)transient ST elevations
3)incr T wave postivity

Front 36

When do these occur?
a)stable angina
b)unstable angina
c)printzmetals angina (2)

Back 36

a)w/ exercise
b)progressive, less exercise, can lead to MI
c)at rest due to arterial spasm near plaque OR spasm w/o plaque

Front 37

Difference b/w stable and unstable plaque

Back 37

1)stable has thick cap and smaller fatty core (primary cause of artherosclerosis)
2)thin cap w/ large fatty core (more likely to rupture = MI/CVA)

Front 38

Ischemic heart pain characteristics**** (2)

Back 38

1)chest pain that is CRUSHING, pressure (not stabbing)
2)radiates into left arm/jaw

Front 39

MI due to... (3)

Back 39

1)ischemia/necrosis
2)coronary artery occlusion due to plaque rupture
3)can be from spasm

Front 40

MI symtoms similar to.... (2)

Back 40

1)angina, but do NOT go away
2)after 3 nitro's go to ER

Front 41

MI signs (4)

Back 41

1)rapid weak pulse
2)EKG changes
3)arrythmias
4)enzymes (myoglobin, troponin, CPK)

Front 42

Chest pain is an MI until...

Back 42

PROVEN OTHERWISE

Front 43

MI algorithm

Back 43

MONA
1)morphine
2)oxygen
3)nitro
4)ASA

(not in any real order and ASA can be 81mg or not)

Front 44

Chest Pain differential (caused by cardiac) (3)

Back 44

1)CAD
2)endocarditits
3)pericarditis

Front 45

Chest Pain differential (caused by pulmonary) (3)

Back 45

1)PE
2)pneumonia
3)pleuritis

Front 46

Chest Pain differential (caused by Musculoskeletal) (3)

Back 46

1)costocondritis
2)arthritis
3)spasm

Front 47

Chest Pain differential (caused by Neural) (1)

Back 47

1)herpes zoster

Front 48

Chest Pain differential (caused by GI) (5)

Back 48

1)ulcer
2)reflux
3)hernia
4)pancreatitis
5)cholecystitis

Front 49

Chest Pain differential (caused by Psychological) (2)

Back 49

1)anxiety
2)depression

Front 50

DIDN'T PUT IN DYSPNEA OR SYNCOPE DIFFERENTIAL'S

Back 50

N/A

Front 51

Palpatations Differential
a)arrhythmias (3)
b)other (3)

Back 51

a)PAC, PJC, PVC***
b)anxiety, caffeine, tobacco

Front 52

Caffeine limit should be...

Back 52

250mg/day

Front 53

Secondary HTN causes (3)

Back 53

1)cushings
2)aldosteronism
3)pheochromocytoma

Front 54

HTN risk factors (one's I don't know) (9)

Back 54

1)alcohol
2)stress
3)old age
4)hormone levels
5)kidneys
6)family history
7)black
8)pregnanat
9)birth control

Front 55

Hyperlipidemia signs (has no symptoms) (4)

Back 55

1)xanthomas
2)arcus senilis
3)fundiscopic changes
4)HTN

Front 56

Hyperlipidemia risk factors (3)

Back 56

1)same as HTN pretty much
2)can be drug induced
3)male

Front 57

Metabolic syndrome (6)

Back 57

1)ab obesity
2)atherogenic dyslipidemia (low HDL and high LDL)
3)high BP
4)insulin resistance/glc intolerance
5)prothrombotic state
6)proinflammatory state

Front 58

Endocarditis
a)cause (1)
b)signs (3)

Back 58

a1)IV drug use

b1)fever/CHF symptoms
b2)janeway lesion
b3)osler nodes

Front 59

Cor Pulmonale
a)what is it
b)what causes it

Back 59

a)large RV due to pulmonary dysfxn
b)COPD/fibrosis from smoking

Front 60

Physical Exam of heart (checks for)
a)inspection
b)palpation
c)percussion
d)auscultation

Back 60

a)pulsation
b)murmur
c)heart size
d)use bell and diaphragm

Front 61

Def of...
a)Arteries
b)Arerioles
c)Venules
d)Veins

Back 61

a)vessels that take blood FROM heart TO body
b)part of artery that ends in capillaries
c)connect capillaries w/ larger systemic veins
d)blood FROM tissues back TO the heart for reoxygenation

Front 62

Pallor is usually caused by...

Back 62

occlusion of artery

Front 63

Hair pattern inspection on arms/legs looks for...

Back 63

lack of hair on toes/legs can be caused by inadquate blood flow

Front 64

Components of Peripheral vascular exam (5)

Back 64

1)inspect (look)
2)palpate (feel)
3)auscultate (listen w/ steth)
4)special tests
5)looks for disease caused by poor circulatory system

Front 65

Capillary refill? (INSPECTION OF ARMS/LEGS) (3 and look for what 2 results)

Back 65

1)push nail bed for few seconds on a toe/fingernail
2)release pressure
3)observe time elapsed before nail regains full color

1)should occur in less than 2seconds
2)longer than 2seconds implies circulatory system compromise

Front 66

Pulpation of pulses where? (8)

Back 66

1)external maxillary
2)brachial
3)posterial libial
4)dorsalis pedis
5)ulnar
6)radial
7)carotid
8)superficial temporal

Front 67

Amplitude of pulse is described on scale of 0 to 4 (and what is normal)

Back 67

4)bounding
3)full, increased
2)expected
1)diminished, barely palpable
0)absent, not palpable

Normal pulse is 2+

Front 68

Which pulses to compare? and why?

Back 68

upper and lower extremity; b/c pulses should be symmetric if they aren't consider impaired circulation where weaker pulse is

Front 69

Arterial pulses should be examined w/...

Back 69

distal pads of 2nd/3rd fingers; thumb may be used to "fix" brachial/femoral pulses

Front 70

Palpation of carotid arteries (3)

Back 70

1)closest to cardiac source so useful in evaluating heart activity
2)NEVER palpate both sides simultaneously
3)carotid massage can slow pulse or reduce blood flow to brain

Front 71

Location of
a)Brachial pulse
b)Ulnar pulse
c)Radial artery pulse

Back 71

a)medial to biceps tendon (elbow)
b)medial/ventral side of wrist
c)lateral/ventral side of wrist

Front 72

How to get Radial artery pulse and use (4)

Back 72

1)use gentle pressure
2)determine HR/rhythm, amplitude, symmetry and occlusion

Front 73

Allen's Test? (3)

Back 73

1)compress ulnar AND radial artery until blood flow is shut off from hand
2)release one @ a time to see if good blood flow from each
3)DO BEFORE ARTERIAL STICK TO CHECK FOR BLOWN ARTERY

Front 74

Palpation of Aortic artery
a)location
b)can be felt...

Back 74

a)left of midline of abdomen b/w xiphoid and umbilicus
b)pulsation can be palpated deeply (felt w/o deep palpation in slim pts)

Front 75

Location of femoral arteries (for PALPATION OF PULSE)

Back 75

midway b/w anterior superior iliac spine and pubic tubercle

Front 76

Popliteal arteries (FOR PALPATION OF PULSE)
a)location
b)easier to find if...
c)how pt should be seated

Back 76

a)back of knee in popliteal fossa
b)place both thumbs on patella, then palpate deeply w/ fingers
c)pt lie on abdomen w/ knees flexed

Front 77

Dorsalis Pedis PULSES
a)location
b)how best to locate

Back 77

a)dorsum(top) of each foot just lateral to extensor hallucis longus
b)pt raise their big toe; raised tendon is the extensor hallucis longus

Front 78

Posterior Tibial PULSES location

Back 78

in groove b/w the medial malleolus (inner ankle) and achilles tendon

Front 79

Pedal Bloodflow (2)

Back 79

1)foot is where capillary bed joins the arterial and venous systems
2)time it takes the capillary bed to fill after it is occluded by pressure gives indication of health of vascular system

Front 80

Pedal Bloodflow Test (3procudure and results 2)

Back 80

1)push nail bed for few seconds
2)release pressure
3)observe time elapsed b4 nail regains full color

1)should occur in less than 3sec
2)longer than 3 implies circulatory system compromise

Front 81

Palpation of temperature in arms/legs (2)

Back 81

1)should feel warm, indicating good blood flow
2)cold=poor blood flow or Raynaud's

Front 82

Edema of arms/legs manifests as...

Back 82

change in usual contour of leg

Front 83

Edema of arms/legs
a)evidenced by...
b)usual causes (2)

Back 83

a)depression that does NOT rapidly refill
b)MOST COMMON IS right heart failure BUT can be caused by incr fluid/Na

Front 84

Lymph System Components (6)

Back 84

1)tonsils
2)lymph nodes
3)adenoids
4)thymus
5)spleen
6)intestine lymphoid tissue

Front 85

Lymph System Purpose (3)

Back 85

1)supply all tissues w/ antibodies
2)absorb fat
3)etc

Front 86

Ausculatation of PULSE is...and how heard

Back 86

1)listening to arterial sounds
2)w/ bell side of steth

Front 87

Bruit? (AUSCULTATION) (4)

Back 87

1)"swishing" sound
2)blood moving thru NARROWED artery
3)indicative of blockage of artery
4)complete obstruction eliminates bruit

Front 88

For Bruit listen to: (AUSCULTATION) (6)

Back 88

1)temporal
2)carotid
3)aortic
4)renal
5)Iliac
6)femoral

Front 89

Bruits of Carotid Artery
a)how best heard (2)
b)a bruit here may include...(2)

Back 89

a1)best hard @ anterior margin of SCM muscle
a2)auscultate w/ diaphragm, then w/ bell

b1)localized carotid bruit
b2)transmitted murmurs from heart

Front 90

Causes of Carotid Bruit? (4)

Back 90

1)valvular aortic stenosis
2)ruptured chordae tendinae of mitral valve
3)severe aortic regurgitation
4)vigorous LV ejection

Front 91

Allen's Test
a)tests for...
b)reperfusion should occur within...
c)if it does not occur in that time frame....

Back 91

a)ulnar patency prior to drawing arterial blood gases
b)8 seconds
c)radial catheterization should not be performed

Front 92

Limb Circumference test
a)tests for...
b)how to do...

Back 92

a)embolism/thrombosis of lower limbs (venous or arterial)
b)measure circumference of calves bilaterally (in cm); no more than 1cm discrepancy

Front 93

Limb Circumference ARTERIAL BLOCKAGE
a)symptoms (5)

Back 93

1)sudden excruciating pain in extremity
2)followed by numb/weakness
3)becomes pallid/pulseless
4)turns blue 1-2hrs later
5)ultimately becomes colder

Front 94

Limb Circumference VENOUS BLOCKAGE symptoms (2)

Back 94

1)decr blood return from lower extremities = enlargement of leg
2)calf size discrepency is 2cm or greater

Front 95

Aortic Aneurysm? (4)

Back 95

1)swelling/dilation of wall of abdominal artery
2)caused by weakness in arterial wall
3)usually result of congenital defect, degenerative disease or infexn
4)BACK PAIN IS MOST COMMON COMPLAINT

Front 96

Superficial PHLEBITIS
a)what is it
b)how detected
c)associated w/... (5)

Back 96

1)inflammation of superficial vein
2)palpated as a linear cord or localized "clot"
3)associated w/ inflammation, tenderness, pain, erythema, warmth to skin

Front 97

Superficial THROMBOSIS (WHAT IS IT?)

Back 97

thrombosed superficial vein (clot in vein)

Front 98

Deep Phlebitis (THROMBOPHLEBITIS)
a)what is it?
b)cause
c)symptoms (3)

Back 98

a)inflammation of deep vein
b)clot in vein beginning in valve cusps of deep calf veins
c1)can be none
c2)swelling
c3)pain/tenderness

Front 99

Deep Vein Thrombophlebitis
a)symptoms if in LOWER LEG

Back 99

3 main veins drain lower legs, so may have NO swelling, cyanosis or dilated superficial veins

Front 100

Deep Vein Thrombophlebitis (in THIGH)
a)palpating it
b)symptoms if in THIGH (2)

Back 100

a)deep, hard cord in femoral triangle, groin, medial thigh or popliteal spaces
b1)soreness/pain on standing/walking
b2)pain relieved by rest w/ leg elevated

Front 101

Homan's Sign
a)tests for...
b)how done

Back 101

a)DVT in lower extremities
b1)pt flex knee and then forcefully push foot up @ ankle
b2)produces pain in 35% of pts w/ DVT

Front 102

Raynaud Phenomenon
a)cause
b)precipitated by...
c)population in which it occurs
d)can cause...

Back 102

a)idiopathic, intermittent spasm and constriction of arterioles in digits
b)cold/emotional upset
c)young women
d)TISSUE NECROSIS

Front 103

Peripheral Venous Disease (3 and #1 cause)

Back 103

1)seen on inner ankles
2)untreated can lead to ulcers
3)history of DVT is usual b/c DVT leads to incompetent valves
4)#1 cause is DM

Front 104

Peripheral Artery Disease
a)cause
b)signs and symptoms (4)

Back 104

a)occulsion of arterial blood supply by atherosclerotic plaques
b)3P's (pain, pallor, pulselessness) and loss of hair

Front 105

PAD ACUTE OCCLUSION results in...

Back 105

sudden onset of 6P's (polar, pallor, pulselessness, parethesis, paralysis, pain)

Front 106

PAD chronic occlusion results in...

Back 106

intermittent claudication (pain on exertion @ SAME TIME during exertion (like 15min into bike ride));and immediate relief by rest

Front 107

Varicose veins (3)

Back 107

1)enlarged superficial veins
2)seen in lower extermities and esophagus
3)caused by incompetent venous valves

Front 108

Varicose veins worsened by... (3)

Back 108

1)pregnancy
2)obesity
3)occupations requiring prolonged standing (so walk every 10-15min)