Comprehensive Review for PD Full Exam 3 in Medicine

PMI is normally found in the _________

Left 5th ICS at MCL

The PMI is approx. ______cm

1-2.5 cm

Heart sound of the abrupt deceleration of inflow across the mitral valve

S3

Heart sound of the increased left ventricular stiffness which decreases compliance

S4

2nd ICS RSB

Aortic area

2nd ICS LSB

Pulmonic area

3rd ICS LSB

Erb's point

4th ICS LSB

Tricuspid area

5th ICS left MCL

Mitral area

Patient position for a cardiac exam

Supine with head elevated 30-45 degrees

You should auscultate over the mitral valve with the ______ of the stethoscope

Bell

Aortic murmurs are head with the _______ of the stethoscope

Diaphragm

Palpate the RV in the __________

Left lower sternal border/subxiphoid area

Leaning forward and full exhalation accentuates __________ murmurs

Aortic

What position accentuates S3, S4, and mitral murmurs?

Left lateral recumbent

The _____ is used to listen for low-pitched sounds

Bell

The _____ is used to listen for high-pitched sounds

Diaphragm

Bell or Diaphragm: Mid-diastolic murmur of mitral stenosis

Bell

Bell or Diaphragm: S3 in HF

Bell

Bell or Diaphragm: Ejection clicks

Diaphragm

Bell or Diaphragm: Mid-systolic clicks

Diaphragm

Bell or Diaphragm: Early diastolic murmur of aortic regurgitation

Diaphragm

Rash associated with acute rheumatic fever, wavy margins and truncal distribution

Erythema marginatum

Erythema marginatum is associated with ________

Acute rheumatic fever

Subcutaneous nodules over the bony prominences of the elbow in a patient with chronic rheumatic heart disease from previous rheumatic fever

Aschoff bodies

Aschoff bodies can also be seen with __________

Rheumatic fever, Gout, syphilis, RA

Small, painless nodules caused by minute, septic emboli

Janeway lesions

Janeway lesions are associated with _______

Bacterial endocarditis

Painful erythematous nodular lesions resulting from infective endocarditis

Osler nodes

Osler nodes are associated with __________

Infective endocarditis

Splinter hemorrhages are associated with ________

Acute bacterial endocarditis

Funnel chest

Pectus excavatum

Bird chest

Pectus carinatum

Pectus excavatum is seen in 20% of cases of _______

MVP

The JVP reflects pressure in the ________

Right atrium (central venous pressure)

The JVP is best assessed from pulsations in the __________

Right internal jugular vein

What JVP wave:
Positive wave due to the contraction of the right atrium

A wave

What JVP wave:
A positive deflection due to bulging of the tricuspid valve toward the atria at the onset of ventricular contraction

C wave

What JVP wave:
Negative deflection due to atrial relaxation

X wave

What JVP wave:
Positive deflection due to filling of the right atrium against the closed tricuspid valve during ventricular contraction

V wave

What JVP wave:
Negative deflection due to emptying of the right atrium upon ventricular

Y wave

An absent A wave may indicate ____

Afib

An increased V wave may indicate _______

Tricuspid regurgitation, ASD, constrictive pericarditis

An increased A wave may indicate _______

Tricuspid stenosis, AV blocks, SVT, junctional tachy, pulmonic stenosis

What JVP wave: atrial contraction

A wave

What JVP wave: Ventricle contraction

C wave

What JVP wave: Atrial relaxation

X wave

What JVP wave: Atrial filling passively

V wave

What JVP wave: Blood from atrium to ventricle

Y wave

The JVP must be measured with the bed raised to ______

60 degrees

Abnormal JVP is ______ cm above the sternal angle

> 3 cm

Abnormal JVP is ______ cm above the right atrium

> 8 cm

Normal hepatojugular/abdominojugular reflex

≤ 3cm increase in the meniscus

Abnormal hepatojugular/abdominojugular reflex

≥ 4cm increase in the meniscus

The patient should be laying ________ to measure the hepatojugular/abdominojugular reflex

Supine at 20-40 degrees

Diffuse or widened PMI would indicate LV dilation seen in _________

Chronic volume overload

Sustained PMI would indicated pressure overload seen in _______

Aortic stenosis or HTN

What are other causes for PMI displacement?

Pregnancy, chronic lung disease, deformities of the thorax

Normal PMI diameter

≤ 2.5 cm

Normal PMI amplitude

Brisk and tapping

Normal PMI duration

≤ 2/3 of systole

A PMI with a diameter > 3cm indicates _______

LVH

Hypertrophy of PMI may palpate _____ gallop

S4

Dilation of PMI may palpate _____ gallop

S3

PMI amplitude is decreased in ________

Dilated cardiomyopathy

PMI amplitude is increased in ________

Exercise, hyperthyroidism, HTN, severe anemia

PMI duration is sustained in ______

LVH

If you cannot identify the PMI in the supine position, place the patient in the _______

Left lateral decubitus position and ask patient to exhale and hold

Palpate the chest for thrills with the ________

Metacarpal heads

Superficial vibratory sensations felt on the skin overlying a loud murmur

Thrill

When should you percuss the chest in a cardio exam?

If unable to feel the apical impulse

Where should you percuss when attempting to identify the apical impulse?

3rd, 4th, and 5th ICS starting from the left anterior axillary line moving towards the sternum

Diaphragm or bell: S1

Diaphragm

Diaphragm or bell: S2

Diaphragm

Diaphragm or bell: AR

Diaphragm

Diaphragm or bell: MR

Diaphragm

Diaphragm or bell: VSD

Diaphragm

Diaphragm or bell: Pericardial friction rub

Diaphragm

Diaphragm or bell: S3

Bell

Diaphragm or bell: S4

Bell

Diaphragm or bell: MS

Bell

S1 loudest at ______

Apex

S2 loudest at ______

Base

Systolic murmurs can be ______

Benign

Diastolic murmurs are ______

Pathologic

S1 is _______ than S2 at the base

Softer

S1 is _______ than S2 at the apex

Louder

Splitting of S1 occurs with _____

RBBB and Pulmonary HTN

Physiologic splitting of S2 is accentuated by ______

Inspiration

Physiologic splitting of S2 is loudest at the ______

Base 2nd ICS

If S2 is heard at the apex, or if P2 ≥ A2, suspect ______

Pulmonary HTN

Causes for paradoxical splitting of S2

LBBB, AS

Cause for fixed splitting of S2

ASD

Causes for wide splitting of S2

PS, RBBB, MR, VSD, PDA

Low, Medium or High Frequency: MR

High

Low, Medium or High Frequency: TR

High

Low, Medium or High Frequency: AR

High

Low, Medium or High Frequency: VSD

High

Low, Medium or High Frequency: MS

Low

Low, Medium or High Frequency: TS

Low