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52 Cards in this Set
- Front
- Back
when you take the carotid pulse and feel a delay or diminished upstroke what might indicate what kind of stenosis
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aortic stenosis
why? |
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which vein is important to view to look for venous pressure
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internal jugular vein - even though it is deep to sternomastoid muscle - you can see pulsations in the lower part of the sternocleidomastoid triangle
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how do pulsations differ in the internal jugular from the carotid?
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the carotid is only a single pulse but you see double pulsations (a wave during atrial contraction and v wave during the ventricular contraction) when viewing the internal jugular
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how many cm above the right atrium is the angle of Louis (sternal angle)
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5 cm
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if internal jugular pulsations are 4 cms above the angle of Louis then the central venous pressure is about
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9cm
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normal CVP rules out what
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R sided congestive heart failure (CHF)
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normal range for CVP is
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5-8cm
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The four auscultatotry areas which correspon with volve abnormalities are (describe where they are)
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1. aortic area (right intercostal space,upper right sternal border (2nd RICS, URSB)
2. Pulmonic area: 2nd LICS, ULSB 3. Tricuspid area (right ventricular area): 4th and 5th L ICS, LLSB 4. Mitral area (also called apex): 5th ICS, L Mid-clavicular line (MCL) |
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where is the apical impulse (PMI)
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th left ICS, MCL (pt supine)
note: displaced laterally in LV eccentric hypertrophy note2: the impulse is larger than 2 cm in LV concentric hypertrophy |
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how might the apical impulse differ in LV concentric hypertrophy
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it may be displaced laterally and be sustained
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vibrations or thrills over the aortic area would suggest
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aortic stenosis
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prominant impulse over the pulmonic area would indicate
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pulmonary hypertension
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a prominant impulse over the tricuspic area would suggest
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right ventricular hypertrophy
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the bell is good for what kind of sounds
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low frequency (like gallop sounds)
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where is S1 loud
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loud at apex and softer at aortic and pulmonic areas
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where will S2 be loud
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over the aortic and pulmonic areas as it is produced by the closure of these valves (A2 preceding P2)
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a normal P2 heart sound is heard only at the pulmonic area. a loud P2 heard away from the pulmonic area suggests
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pulmonary hypertension
P2 also may be heard later during inspiration |
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what are gallops
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left ventricular filling sounds heard during diastole
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how are gallops best heard
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at the apex w/ pt rolled up on the left side (left lateral dcubitus position)
listen with bell in quiet room - hard to hear |
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how do you listen for S3
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it is the rapid filling of ventricle in early diastoli just after S2
you hear itmedial to the apex, listening with the bell supine first. if it is not heard ask the pt to roll over into the left lateral decubitus position. |
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S4 represents
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atrial kick during late diastolic ventricular filling just before S1
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an S4 sound is caused by
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decreased ventricular compliance (LVH, myocardial ischemia, or infarction)
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heard during mid systole in pts with mitral valve prolapse
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midsytolic click: abnormal ballooning of mitral valve into the left atrium. high pitched and clicking in quality.
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a midsystolic click is best heard where?
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between the apex and the lower sternal border with the diaphragm of your stethoscope
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the opening of a stenotic mitral valve is best heard where
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between apex and left lower sternal border and is high pitched and clicking in quality
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the intensity of a murmur depends on
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velocity and volume of blood flow - not severeity of valvular disease
graded on a 1 to 6 scale - based on loudness |
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if a thrill (superficial vibration felt of the skin overlying an area of turbulence) is felt then the murmur is at least a grade
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4
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the typical pattern of an ejection murmur is
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crescendo-decrescendo (diamond shaped)
heard in something like aortic stenosis |
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the typical pattern of a murmer with mitral regurgitation is
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holosystolic
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a typical pattern of aortic regurgitation
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a diastolic mumur that is hard to hear
decreascendo |
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where does a aortic stenosis murmur radiate to
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neck
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where does a mitral regurgitation radiate to
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axilla
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what are 5 associated signs with aortic stenosis
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1. decreased A2
2. slow rising and delayed pulse 3. ejection click 4. S4 5. narrow pulse pressure |
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how do you calculate pulse pressure
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systolic minus diastolic pressure but it can be calculated by stroke volume / compliance
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three associated signs w/ mitral regurgitation
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decreased S1
Laterally displaced diffuse PMI S3 |
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a loud S1 is the hallmark of
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mitral stenosis
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orthostatic blood pressure changes are dfined as
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a blood pressure fall of 20mmHg or more from supine to standing, which should be accompanied by at least a 10 point rise in pulse.
equilibration may take longer in elderly and diabetic patiens |
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what is a paradoxical pulse
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a greater than 10mm decrease in systolic pressure noted during inspiration.
exaggeration of normal variation (pulse becomes weaker as one inhales and stronger as one exhales) |
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Kussmaul sign
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increase in jugular venous pressure height with inspiration
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how do you calculate pulse rate
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count for 15 seconds and multiply by 4
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normal pulse rate in adults is
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60 to 100 beats per minute
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normal respiratory rate in adults is
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8 to 16 breaths per minute
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what is there to assessing tactile fremitus
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when pt speaks 99 and you palpate back. you will feel vibration. fremitus is increased when the transmission of sound is increased liek through consolidated lung of lobar pneumonia, COPD, flui, fibrosis, etc..
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when fluid or solid tissue replace air-containing lung or pleural space - you will go from dull to
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resonance
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what is the normal excursion for the diaphragm (movement of diaphragm during breathing)
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5-6 cm -
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what does a vescicular breath sound mean
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inspiration is loader than expiration. normal. heard around periphery
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what does a broncho-vescicular breath sound sound like
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Inspiration = E
normal audible in two places: 1st and 2nd ICS anteriorly and between the scapulae |
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a bronchial breath sounds means
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E>I
locations ove the manubrium if at all. |
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what does trachial breath sound mean
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I=E, very loud intensity, high pitch, harsh, heard over the extrathoracic portion of the trachea
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crackles / rales results from
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sudden opening of small airways, intermittent, non-musical, brief, short, explosive
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the two criteria to diagnose clubbing
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1. interphalangeal depth ratio exceeding one (divide the depth of the digit at the base of nail compared with the same depth at DIP)
2. hyponychial angle |
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80 % of cases of clubbing are seen in pts with
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lung disorders.
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