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37 Cards in this Set
- Front
- Back
- 3rd side (hint)
Most common cause of split S1?
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Right Bundle Branch Block
Less Common: ASD Tricuspid Stenosis |
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Generally, what maneuvers increase preload to right and left heart, respectively, making murmurs worse on those sides?
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L heart - expiration
R heart - Muller maneuver -> patient attempt to inspire while mouth and nares are held closed |
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What heart functions are represented by:
-a wave -c wave -v wave |
a = (a)trial contraction
c = RV (c)ontraction v = filling against closed (v)alve |
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Describe the grading of murmurs.
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1 = barely audible by expert
2 = quiet but audible 3 = not loud but easily heard 4 = loud w/ THRILL 5 = heard w/ tilted diaphragm 6 = heard w/ diaphragm off chest |
Scale of 1 ot 6
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Where do you find:
-Roth spots -Osler nodes -Janeway lesions |
Roth -> (r)etinal hemorrhages
Osler nodes -> finger/toe pads Janeway -> palms and soles |
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Si/Sx of rheumatic fever?
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J oint
O-itis N odes E rythema Marginatum S yndenham's chorea |
JONES
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Aschoff bodies are the pathognomonic histological finding of what condition?
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Rheumatic fever -> granulomas throughout body, especially myocardium surrounding blood vessels.
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Which of the following is potentially normal: S3 or S4?
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S3, in young folks or pregnant women in their third trimester
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What conceptually causes S3?
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Volume overload of either ventricle.
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What are some specific causes of S3? (3)
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CHF
Mitral regurge Tricuspid regurge |
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What is the conceptual cause of S4?
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Stiff left ventricle
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What is a potential (and controversial) specific cause of S4?
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Cardiac hypertrophy from exercise -> must be distinguished from hypertrophic cardiomyopathy, which is dangerous for athletes
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What are some pathological causes of S4? (4)
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HTN
MI Aortic Stenosis Hypertrophic Cariomyopathy |
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What causes pulsus bisfiriens? (3)
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Aortic regurge w/ stenosis
Pure aortic regurge HOCM |
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A patient w/ aortic regurge has fingernails w/ pulsatile color changes when pressure is applied to them. Eponym?
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Quincke pulse
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A patient w/ aortic regurge has head that bobs with heartbeat. Eponym?
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de Musset sign
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Distinguish:
-pulsus bisfiriens -pulsus alternans -pulsus bigeminus |
Pulsus bisfiriens = double wave pulse (AI, HOCM)
Pulsus alternans = regularly alternating amplitude (decompensation, tamponade) Pulsus bigeminus = irregularly alternating amplitude (PVCs) |
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What condition is associated with "pulsus parvus et tardus"?
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Aortic stenosis
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What is a pericardial knock? What condition is it associated with?
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An early-to-mid diastolic sound, associated with constrictive pericarditis.
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What is the Kussmaul sign?
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Inspiratory distension of neck veins.
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What conditions are the Kussmaul sign associated with? (4)
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Superior vena cava syndrome
RV infarct Constrictive pericarditis Tricuspid Stenosis |
Right heart diastolic dysfuction
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What is the tracheal tug sign? What condition is it assoicated with?
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The ability to palpate the aortic pulse by grasping the trachea, ass'd with AORTIC DISSECTION.
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What two murmurs are increased with standing or the Valsalva maneuver?
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HOCM
MVP |
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What maneuver increases mitral regurge?
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Hand grip
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Patient has leukocytosis, pleural effusion, pericarditis, and fever 3 days to 6 weeks after an MI. Dx? Rx?
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Dx: Dressler syndrome, aka post-MI syndrome.
Rx: ASPIRIN! |
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Where are S3 and S4 best heard?
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S3 = APICAL low-pitched sound
S4 = APICAL low-pitched sound NOT THE BASE OF THE HEART! |
S3 represents passive
ventricular filling. S4 represents active ventricular filling. |
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Squatting (or passive leg raising) increase which murmurs? (3)
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1) VSD, VSD, VSD
2) Aortic regurge 3) Mitral regurge |
These maneuvers increase ventricular filling, so they exacerbate the same murmurs that amyl nitrite improves.
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Causes of wide splitting of S2? (3)
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1) Mitral regurge -> Pulm HTN
2) Pulmonic stenosis 3) Right bundle branch block* * - RBBB also cause split S1 |
Pulmonic is slowest to close. These three conditions make the pulmonic valve close even slower.
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What murmurs do amyl nitrite improve?
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1) VSD, VSD, VSD
2) Aortic regurge 3) Mitral regurge |
These maneuvers decrease ventricular filling, so they improve the same murmurs that squatting exacerbates.
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Causes of fixed splitting of S2? (1)
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ASD
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Classic cause...
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Cause of paradoxical splitting of S2?
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Left bundle branch block
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Paradoxical splitting represents a fixed delay in left venticular contraction.
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Normal pattern of split S2?
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Normal: inspiratory split
Paradoxical: Expiratory split |
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Cause of paradoxical splitting of S2?
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Left bundle branch block
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Paradoxical splitting represents a fixed delay in left venticular contraction.
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Normal pattern of split S2?
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Normal: inspiratory split
Paradoxical: Expiratory split |
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ASD effects on S1 and S2
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1) Split S1
2) Fixed splitting of S2 |
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ASD murmur
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Systolic
Crescendo-decrescendo 2nd left IC space |
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Causes of VSD? (2)
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1) MI
2) congenital |
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