Ab Thorax Week 7

What can cause a heart murmur?

Regurgitation or stenosis

What grade is a faint, barely audible murmur with no thrust or thrill?

1/6

What grade is a faint, but audible murmur with no thrust or thrill?

2/6

What grade is a moderately loud murmur with no thrust or thrill?

3/6

What grade is a loud murmur with a thrust or thrill?

4/6

What grade is a murmur loud enough to be heard with a tilted stethoscope?

5/6

What grade is a murmur loud enough to be heard with the stethoscope off the chest?

6/6

What type of stenosis and regurgitation can cause diastolic murmurs?

Aortic regurgitation

Mitral stenosis

Pulmonic regurgitation

Tricuspid stenosis

What type of stenosis and regurgitation can cause systolic murmurs?

Mitral regurgitation

Tricuspid regurgitation

Aortic stenosis

Pulmonic stenosis

T or F: a physiological murmur would most likely be heard during diastole

False (systole)

When is physiological splitting of S2 heard?

Inhalation

Where do you auscultate for an S2 physiological split?

Pulmonic

When does wide splitting persist?

Through inhale and exhale

Delayed closure of which valve can cause wide splitting?

pulmonic valve

(right bundle branch block or pulmonic stenos)

Early closure of which valve can cause wide splitting?

aortic

(mitral regurgitation)

What other heart sound split can a right bundle branch block cause?

S1

What is the term for wide splitting that does not vary with respiration?

Fixed splitting

What condition can cause fixed splitting?

Atrial septal defect

Right ventricular failure

What is the term for splitting that appears on expiration and disappears on inspiration?

Paradoxical splitting

What is the most common cause of paradoxical splitting?

Left bundle branch block

What is a high-pitched sound with a. sharp, clicking quality that occurs shortly after S1 sounds?

Early systolic ejection sounds

T or F: Early systolic ejection sounds are a benign finding

False (they are pathological)

What is the high-pitched sound heard during systole that often occurs in patients with a mitral valve prolapse?

Systolic click

Where do you best hear systolic click?

Mitral valve

What effect does squatting have on systolic click?

moves it later in systole

What is an opening snap associated with?

Mitral stenosis

When is an opening snap heard in the cardiac cycle?

Right after S2 (beginning of diastole)

Is the opening snap heard better with diaphragm or bell?

Diaphragm

What part of the stethoscope are murmurs heard better with?

Bell

Which maneuver enhances a pleural friction rub?

Aortic maneuvers

Where is the pericardial friction rub head best?

Erb's point

What is a continuous murmur heard loudest in diastole, sometimes heard above the clavicles with radiation to the 1st and 2nd interspaces of upright seated children?

Venous hum

How can you obliterate a venous hum?

Press on the jugular vein

What accentuates a physiological split of S2 and the murmurs of tricuspid stenosis?

Inhalation

What creates a to-and-fro heart sound?

Patent ductus arteriosus

What do you inspect for in the peripheral vascular system?

Colour (pallor, rubor, cyanosis)

Trophic skin changes (shiny, thin, hair loss, edema)

Stasis dermatitis

What is the term for a rash-like patchy red colour caused by poor venous return?

Stasis dermatitis

Which peripheral arteries do you palpate?

Temporal

Carotid

Brachial

Radial

Ulnar

Abdominal Aorta

Femoral

Popliteal

Posterior tibial

Dorsalis pedis

What is the term for inflamed clots in leg veins?

Thrombophlebitis

What are the signs of arterial occlusion?

Decreased/absent pulse

Pallor

Cold skin

What are the signs of venous occlusion?

Normal pulse

No pallor

Normal temperature

Pitting edema

Stasis dermatitis

What characteristics of peripheral arteries do you assess during palpation?

Rate

Rhythm

Amplitude

Contour (only at the radial)

What are the breathing instructions for auscultating carotid arteries?

Inhale and hold breath

What are the characteristics of thrombophlebitis?

Palpable cords

Redness

heat

AP tenderness

Homan's sign

Edema

What type of pulse is associated with heart failure, hypovolemic shock, and severe aortic stenosis?

Small and weak

What type of pulse is associated with hyperthyroidism, fever, anemia, and decreased compliance of the aortic walls?

Large and bounding

What alternates in pulsus alternans?

amplitude

What stays constant in pulsus alternans?

Rhythm

What is the term for a pulse that decreases in amplitude on inhale?

Paradoxical pulse

What can cause paradoxical pulse?

COPD

How are pulsus alternans and paradoxical pulse detected?

sphygmomanometry

What is the term for a small pulse followed by a larger pulse in the same heart beat?

Bisferiens pulse

What can cause bisferan's pulse?

Aortic regurgitation