X_Cardiology_Hour12 Exam1 Dcom Oms2

Front 1

chronic low cardiac output often manifests as ___

Back 1

fatigue

Front 2

Inadequate oxygenation may manifest as ___ and ___ of the fingers / toes as a result of what:

Back 2

central cyanosis
clubbing

right to left or extracardiac shunting

Front 3

Heart failure may manifest as ___ in the distal extremities, cool skin, and increased sweating as a result of ___

Back 3

cyanosis
vasoconstriction

Front 4

___ classically manifests as petechiae, Osler's nodes, and Janeway lesions

Back 4

infective endocarditis

Front 5

what is this an image of:
this is pathognomonic of what:

Back 5

janeway lesion
infective endocarditis

Front 6

what is the description of a janeway lesions: (x4)

Back 6

Non-tender
small (a few millimeters)
erythematous or hemorrhagic
macular or nodular lesions

Front 7

where do janeway lesions occur:

Back 7

palms or soles of feet

Front 8

what are janeway lesions:

what are they caused by:

Back 8

dermal microabscess with necrosis and inflammatory infiltrate

caused by the deposition of circulating immune complexes in small blood vessels

Front 9

what is this an image of:
what are they caused by:

Back 9

Osler's nodes
immune complex deposition

Front 10

what are Osler's nodes:

Back 10

painful, red, raised lesions on the hands (finger pulps) and feet

Front 11

Osler's nodes are indicative of what: (x5)

Back 11

subacute infective endocarditis
systemic lupus erythematosus
marantic endocarditis
disseminated gonococcal infection
infected arterial catheter

Front 12

orthostatic hypotension + tachycardia are likely due to

Back 12

hypovolemia

Front 13

resting tachycardia can be what (x2)

Back 13

hypovolemia or heart failure

Front 14

for tachypnea consider what:

Back 14

pulmonary venous congestion

Front 15

what permits visualization of the small vessels:

Back 15

examination of the retina

Front 16

for optic disk edema, blurred margins, cupping with sharp contours you should consider what: (x2)

Back 16

malignant hypertension
OR
thrombosis of central retinal vein

Front 17

what is papilledma: (x2)

Back 17

swelling of the optic disk due to (↑)intracranial pressure

almost always bilateral

Front 18

what is the differential diagnosis for papilledema: (x8)

Back 18

1. brain tumor or abscess
2. cerebral trauma or hemorrhage
3. meningitis
4. arachnoidal adhesions
5. cavernous or dural sinus thrombosis
6. encephalitis
7. idiopathic intracranial hypertension
8. pseudotumor cerebri - elevated CSF pressure and no mass lesion

Front 19

neovascularization of the retina is common in patients with ___:

this is called ___:

Back 19

diabetes mellitus

diabetic retinopathy

Front 20

retinal ischemia leads to release of ___ stimulating ___ on retina, optic nerve, or iris

Back 20

a vasoproliferative factor
neovascularization

Front 21

what does this image depict:

Back 21

scattered hemorrhages and yellow exudates

Front 22

when examining the retina, what findings are evident of hypertensive retinopathy: (x5)

Back 22

1. Embolic plaques
2. “nicking”
3. scattered flame-shaped hemorrhages
4. very constricted arterioles
5. cotton-wool spots

Front 23

what is the diagnosis:
what do you call the white spots in this image:

Back 23

hypertensive retinopathy
cotton wool spots

Front 24

what is the arrow pointing to:

Back 24

shedding emboli

Front 25

a pulsatile abdominal mass is indicative of ___

Back 25

abdominal aortic aneurysm

Front 26

enlarged liver may be indicative of what: (x2)

Back 26

heart failure
pericarditis

Front 27

systolic hepatic pulsations are indicative of ___

Back 27

tricuspid regurgitation

Front 28

a palpable spleen may be late signs of ___ or can be due to ___

Back 28

severe heart failure
infective endocarditis

Front 29

ascites may occur with ___ and generally responds well to diuretic therapy

consider ___ if ascites is out of proportion to peripheral edema

Back 29

heart failure alone

constrictive pericarditis

Front 30

what is ascites:

Back 30

excess fluid in the space between the tissues lining the abdomen and abdominal organs

Front 31

a continuous murmur heard over the abdomen think ___:

Back 31

arteriovenous fistula

Front 32

systolic bruit heard over the kidney think ___:

Back 32

renal artery stenosis

Front 33

what may lead to identification of occlusive arterial lesions:

Back 33

palpation of peripheral pulses in both upper and lower extremities

Front 34

ischemic tissue damage of the toes presents late in what disease process:

Back 34

peripheral atherosclerosis

Front 35

___ may produce claudication of the buttock or lower extremities precedes physical exam findings for

Back 35

peripheral atherosclerosis

Front 36

what is claudication of the buttock:

Back 36

pain or discomfort in a group of muscles, usually in the legs, hips, or buttocks and is worsened by exercise and relieved with rest

Front 37

bilateral edema in the lower extremity may be a sign of ___ or may be secondary to ___ or ___

Back 37

right sided heart failure
varicose veins
thrombophlebitis

Front 38

unilateral lower extremity edema may be caused by: (x3)

Back 38

saphenous vein harvest
DVT
thrombophebitis

Front 39

what is the ankle-brachial index (ABI):

Back 39

ratio of the systolic blood pressure at the ankle divided by the higher of the two arm systolic blood pressures

Front 40

ABI indicates what:

what is an abnormal ABI:

Back 40

severity of lower-extremity arterial occlusive disease

ABI<0.9

Front 41

ABI ___ is consistent with critical ischemia and tissue loss

Back 41

<0.3

Front 42

pressure is ___ distal to stenotic lesions

Back 42

reduced

Front 43

___ is a small weak pulse commonly due to what: (x3)

Back 43

pulsus parvus

(↓)left ventricular stroke volume
narrow pulse pressure
(↑)peripheral vascular resistance

Front 44

when you see a Hypokinetic pulse think ___ (x3)

Back 44

left ventricular failure
restrictive pericardial disease
mitral stenosis.

Front 45

what is a hypokinetic pulse:

Back 45

pulse with low volume and amplitude

Front 46

what is pulsus tardus:

what is it indicative of:(x2)

Back 46

delayed systolic peak

(1) Obstruction of left ventricular ejection
**(2) Aortic stenosis

Front 47

what kind of pulse is a hyperkinetic pulse:

what is it indicative of: (x8)

Back 47

bounding pulse

1. (↑)stroke volume
2. complete heart block
3. anxiety
4. anemia
5. exercise
6. fever
7. patent ductus arteriosus
8. peripheral arteriovenous fistula

Front 48

what is depicted in this image:

Back 48

delayed systolic peak

Front 49

bisferiens pulse is one that has what:

it is indicative of what: (x2)

Back 49

two systolic peaks

aortic regurgitation
hypertrophic cardiomyopathy

Front 50

dicrotic pulse is one that has what:

it is indicative of what: (x2)

Back 50

one palpable wave one in systole and another palpable wave in diastole

very low stroke volume
dilated cardiomyopathy

Front 51

what does the image depict:

Back 51

pulsus bisferiens

Front 52

identify the labeled figure:

Back 52

(see figure)

Front 53

identify the type of pulse:

Back 53

normal

Front 54

identify the type of pulse:

Back 54

pulsus tardus

Front 55

identify the type of pulse:

Back 55

Pulsus bisferiens

Front 56

what is the cardiovascular condition associated with this pulse:

Back 56

hypertrophic obstructive cardiomyopathy

Front 57

identify the type of pulse:

Back 57

dicrotic pulse - has accentuated diastolic dicrotic wave that follows the dicrotic notch

Front 58

what is Pulsus alternans:

Back 58

regular rhythm but regular alteration of the pressure pulse amplitude

Front 59

what is occurring in Pulsus alternans:

Pulsus alternans and loud S3 are associated with what:

Back 59

alternating left ventricular contractile force (strong beat/weak beat)

severe left-sided heart failure

Front 60

what pulse is associated with loud S3

Back 60

Pulsus alternans

Front 61

what is pulsus bigeminus characterized by:

how does it differ from pulsus alternans:

Back 61

regular rhythm and regular alteration of pressure pulse amplitude

Premature ventricular contraction (PVC) follows each regular beat

Front 62

what is pulsus paradoxus characterized by: (x2)

Back 62

(1) accentuated inspiratory decrease in systolic arterial pressure beyond the normal/physiologic decrease of <=10 mmHg.
(2) peripheral pulse may completely disappear during inspiration

Front 63

pulsus paradoxus can be indicative of what: (x3)

Back 63

pericardial tamponade
airway obstruction
superior vena cava obstruction

Front 64

Radial and femoral arterial pulses should be what:

femoral pulse that is weakened and delayed during simultaneous palpation suggests what:

Back 64

virtually coincident

coarctation of the aorta

Front 65

what is coarctation of the aorta:

Back 65

narrowing of the aorta between the upper-body artery branches and the branches to the lower body

Front 66

what is the technique for inspection of waveform and estimation of the central venous pressure: (x2)

Back 66

use right internal jugular vein
(2) pulsation is greatest when the trunk is inclined by less than 30° (patients with elevated venous pressure may require elevation of 90°)

Front 67

what does the jugular venous pulse reflect:

what does it consist of:

Back 67

phasic pressure changes in the right

2 or 3 positive waves and 2 negative troughs

Front 68

what is the dominant wave in the JVP:

what is it produced by:

Back 68

the "a" wave

venous distention due to right atrial contraction

Front 69

Right atrium contracting against increased resistance will cause ___ in the "a" wave

Back 69

increase

Front 70

what is the increasing resistance the causes an increase in the "a" wave: (x3)

Back 70

tricuspid stenosis
pulmonary hypertension
pulmonic stenosis

Front 71

atrial fibrillation will cause ___ "a" waves:

Back 71

absent

Front 72

slide 32

Back 72

slide 32