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STUDY QUESTIONS PHYS.. DX.2 TEST 2
1 DIFFERENTIATE BETWEEN THE CARDIOVASCULAR CAUSES OF CHEST PAIN.
ACHY - MUSCULOSKELETAL
PRICKLY - HERPES
TEARING - AORTIC ANEURYSM
CLENCHED FIST OVER STERNUM (LEVINE’S SIGN) - ANGINA
PAIN OVER STERNUM - ESOPHAGITIS
KNIFE LIKE - PULMONARY EMBOLISM
PNEUMOTHORAX - SHARP, TEARING PAIN ,IN SHOULDER, ASSOC W/ CHEST WALL CHANGES
IN DIAMETER
2 WHAT ARE THE FEATURES OF CLUBBING? (OR HOW DO WE RECOGNIZE CLUBBING IN A
PATIENT)
SEEN WITH AN INCREASE IN THE NAIL BED ANGLE OF 180 OR MORE
NAIL FEELS LIKE IT IS FLOATING WHEN PALPATED
ASSOC. W/ CHRONIC HYPOXIA & LUNG CANCER
3 WHAT ARE THE DIFFERENT KINDS OF CYANOSIS & HOW ARE THEY DISTINGUISHED?
A - CENTRAL CYANOSIS
DECREASED O2 TO LUNGS
INCREASED DE OXY HEMOGLOBIN IN LUNGS
WARMING INCREASES IT
CHRONIC LUNG DISEASE (ASOSC. WITH)
LIPS
MUCOSA
NAILS
B -PERIPHERAL CYANOSIS
INCREASED O2 IN TISSUES DUE TO EXPOSURE
WARMING WILL REMOVE IT
EFFECTS - FINGERS, TOES, NOSE
4 WHAT FEATURES SHOULD BE NOTICED WHEN EXAMINING THE PULSE?
RATE
RHYTHM
CONTOUR
5 HOW LONG IS THE PULSE COUNT IF THE RHYTHM IS REGULAR?
REG. PULSE IS 60-90 BEATS PER MINUTE (BPM)
6 HOW LONG IS THE PULSE COUNT IF THE RHYTHM IS IRREGULAR?
2
< 60 BPM = BRADYCARDIA
 100 BPM = TACHYCARDIA
7 WHAT ARE THE DIFFERENT TYPE OF PULSE PATTERNS ? LIST AN EXAMPLE OF A
DISEASE FOR EACH OF THESE RYTHMS.
A - SMALL / WEAK (DECREASED STROKE VOLUME)
HYPO-VOLEMIA
AORTIC STENOSIS (SEVERE)
B - LARGE / BOUNDING (INCREASED STROKE VOLUME)
ANEMIA
HYPERTHYROIDISM
AGING
ATHERSCLEROSIS
C - BISIFERENS PULSE AORTIC REGURGITATION
AORTIC STENOSIS
D -PULSUS ALTERANS -LEFT VENTRICULAR FAILURE
E - BIGEMINAL PULSE - PREMATURE BEAT
F - PARADOXICAL PULSE -( PALPABLE DECREASE IN AMPLITUDE ON INSP.)
CARDIAC TOMPANADE
8 - HOW WOULD YOU RECOGNIZE A REGULARLY IRREGULAR RHYTHM?
REGULAR / IRREGULAR RHYTHM - WILL DISPLAY AN IRREGULAR BEAT WHICH IS
PREDICTABLE AND THE SAME AT EACH BEAT.
9 - HOW WOULD YOU RECOGNIZE A IRREGULARLY IRREGULAR RHYTHM?
IRREGULAR / IRREGULAR WILL SHOW
TOTAL RANDOMNESS
SPACING AND NO PREDICTABILITY
EG. ATRIAL FIBRILLATION
10 - HOW WOULD YOU EXAMINE FOR A CONDITION OF THE VESSEL WALL?
VESSEL WALLS ARE EXAMINED VIA PALPATION, APPRECIATE:
DISPENSABILITY
FIRMNESS
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EG. ATHEROSCLEROTIC ARTERIES - FEEL HARD
11 - HOW DO WE DISTINGUISH BETWEEN THE JUGULAR VENOUS PULSE AND THE
CAROTID PULSE? (WHAT FEATURES SHOULD BE NOTICED?)
A - JUGULAR VEIN PULSE
RARELY PALPABLE
SOFT, RAPID
PULSATION’S ELIMINATED BY LIGHT TOUCH
DECREASES WHEN PT. RISES
DROPS WITH INSPIRATION
B - CAROTID ARTERY PULSE
PALPABLE
VIGOROUS, SINGLE THRUST
PULSATION NOT THWARTED BY PRESSURE
UNCHANGED BY POSITION
NOT EFFECTED BY INSPIRATION
12 -HOW IS THE JUGULAR VENOUS PULSE MEASURED?
JUGULAR VENOUS PULSE IS MEASURED WITH A VERTICAL FLUID COLUMN AT THE STERNAL
ANGLE
JUGULAR VEIN SHOULD RISE 3-4 CM. ABOVE THE STERNAL ANGLE
13 - WHAT IS THE SIGNIFICANCE OF THE JVP?
JVP - REFLECTS THE PRESSURE IN THE RIGHT ATRIUM
14 - LIST THE DIFFERENT LEVELS OF HYPERTENSION? HOW IS THE SYSTOLIC BP
MEASURED FOR A CHILD?
HTN FIGURES IN MMHG
SEVERE ……………….>115
MODERATE……………105 - 114
MILD…………………….90-104
HIGH NORMAL………..85-89
NORMAL………………<85
FLUSH TECHNIQUE - MAYBE USED TO EVALUATE THE SYSTOLIC PRESSURE OF CHILDREN.
(SIMILAR TO CAPILLARY REFILL PROCEDURE)
15 - WHEN CAN A DIAGNOSIS OF HYPERTENSION BE MADE?
WHEN 3 CONSECUTIVE HIGH READINGS ON 3 CONSECUTIVE VISITS HAVE OCCURRED (TOTAL
OF 9 READINGS)
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16 - DEFINE POSTURAL HYPO-TENSION. WHAT IS ITS ETIOLOGY?
DEFINED AS A 20 MMHG DECREASE IN BP
DUE TO RISING
17 - HOW DOES THE BP IN THE LEGS COMPARE TO THE ARMS?
BLOOD PRESSURE IN THE ARMS IS 10 -15 MMHG HIGHER IN THE LEGS THAN
IN THE ARMS
18 - WHAT FEATURES ARE WE EVALUATING FOR DURING INSPECTION OF THE CHEST?
EVALUATE THE PMI
ANY ABNORMAL BULGING
ABNORMAL PULSATIONS
LUMPS
LESIONS AND VASCULAR SPIDERS MAY INDICATE - PORTAL HTN
ALL SHOULD BE TAKEN INTO ACCOUNT
19 - WHERE IS THE APICAL (MPI) IMPULSE LOCATED
PMI IS LOCATED AT THE 5TH ICS IN THE MID CLAVICULAR LINE.
WHAT DISORDERS MAY CAUSE LATERAL DISPLACEMENT OF THE APICAL IMPULSE?
LATERAL DISPLACEMENT OF THE APICAL IMPULSE MAY BE SEEN IN::
LEFT SIDED HYPERTROPHY
VOLUME OVER LOAD
AND WILL BE FOUND AT THE PMI
LIST REASONS FOR PALPABLE THRILL IN OTHER AUSCULATORY AREAS.
LEFT HEART FAILURE (LHF)
CONGESTIVE HEART FAILURE (CHF)
MYOCARDIAL INFARCTION (MI)
22 - WHAT IS CARDIAC PERCUSSION USED FOR?
IT IS USED TO DETECT:
FLUID DETECTION
HYPERTROPHY DETECTION (AND)
BORDERS OF THE HEART (FINDING THEM)
23 -WHAT ARE THE FIVE AUSCULATORY AREAS?
RIGHT 2ND ICS = AORTIC
LFT 2ND ICS = PULMONIC
5
LFT 345 ICS = ERBS
LEFT LOWER STERNAL BORDER = TRICUSPID
5TH ICS AT MID. CLAVICULAR LINE = MITRAL VALVE
24 - HOW IS S1 BEST DETERMINED AND AT WHICH LOCATION IS IT BEST APPRECIATED?
S2?
S1 = MITRAL CLOSURE (DURING LEFT VENT. CONTRACTION / SYSTOLE)
LEFT 5TH ICS IN MID CLAVICULAR LINE = BEST PLACE TO HEAR.
S2 = CAUSED BY CLOSURE OF THE AORTIC & PULMONIC VALVES.
25 -WHAT PRODUCES THE S1 AND S2 HEART SOUNDS? WHAT CAN AFFECT THE
INTENSITY OF EACH?
S1 LOUDER THAN S2 AT APEX OF HEART.
S1 SOFTER THAN S2 AT THE BASE OF THE HEART
ACCENTUATED S1
DIMINISHED S1
TACHYARDIA
HIGH OUT PUT
MITRAL STENOSIS
1 ST DEGREE HEART BLOCK
MITRAL REGURGITATION
CHRONIC HEART FAILURE
VARYING S1
HEART BLOCK
ATRIAL FIBRILLATION
SPLIT S1
TRICUSPID VALVE MAY NORMALLY BE HEARD
MAY BE HEARD DURING RIGHT BUNDLE BRANCH BLOCK
S2 VARIANTS
WIDE SPLITTING =
EARLY CLOSURE OF AORTIC VALVE
DELAYED PULMONIC VALVE CLOSURE
RIGHT BUNDLE BRANCH BLOCK
MITRAL REGURGITATION
STENOSIS
FIXED SPLITTING =
ATRIAL SEPTAL DEFECT (AND)
RIGHT VENTRICULAR FAILURE
EARLY COSURE OF AORTIC VALVE
INSPIRATION (DOESN’T VARY WITH)
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*26 - WHAT IS MEANT BY SPLITTING OF A HEART SOUND AND THE SIGNIFICANCE OF
CHANGE WITH RESPIRATION?
S1 SHOULD NEVER SPLIT
S2 WILL OFTEN SPLIT UPON INSPIRATION
27 - WHERE IN THE CARDIAC CYCLE IS S3 HEART SOUND HEARD AND WHAT ITS’
SIGNIFICANCE?
S3 IS DUE TO THE OPENING OF THE MITRAL VALVE
IS ACTUALLY THE SOUND OF RAPID PASSIVE VENTRICULAR FILLING
THEREFORE IS OCCURRING DURING DIASTOLE
28 WHERE IN THE CARDIAC CYCLE IS S4 HEART SOUND HEARS AND WHAT ITS’
SIGNIFICANCE?
S4 HEARD OCCASIONALLY
DUE TO THE ATRIA PUSHING BLOOD INTO THE RT. VENT. AT THE END OF SYSTOLE
THIS SOUND JUST PRECEDES S1
29 - WHERE IN THE CARDIAC CYCLE IS AN EJECTION CLICK HEARD AND WHAT’S ITS’
SIGNIFICANCE?
EJECTION CLICK - ASSOC. W/ AORTIC OPENING
2ND RIGHT ICS (BEST PLACE TO HERE)
CAN INDICATE CARDIO-VASCULAR DISEASE
30 - WHERE IN THE CARDIAC CYCLE IS AN OPENING SNAP HEARD AND WHAT’S ITS
SIGNIFICANCE?
OPENING SNAP- ASSOC. W/ MITRAL V. (WHEN STENOSED)
MITRAL VALVE OPENS AS LEFT VENTRICLE COLLAPSES
OCCURS IN VERY EARLY DIASTOLE
31 - WHAT CAUSES A HEART MURMUR TO OCCUR? WHAT ARE THE CHARACTERISTICS?
CAUSED BY TURBULENT BLOOD FLOW,
STENOTIC OR FAILED VALVE MAY CAUSE
NOT PATHOLOGICAL
HEART MURMURS - DISTINGUISHED BY THEIR LONGER SOUNDS
32 -DEFINE THE 6 INTENSITY GRADINGS OF A MURMUR
1 - LOWEST
2 - AUDIBLE
3 -MEDIUM
4 -MEDIUM W/ THRILL
5 - LOUDEST W/ STETESCPOE, THRILL
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6 -LOUDEST W/ OUT STETHESCOPE, THRILL
33 - LIST THE CAUSES OF A SYSTOLIC MURMUR? DIASTOLIC MURMUR?
SYSTOLIC MURMUR DUE TO:
TURBULENT BLOOD FLOW (AND)
LEFT VENTRICULAR EJECTION
CAN BE DUE TO STRUCTURAL CARDIO-VASCULAR ABNORMALITIES (OR)
SECONDARY TO PHYSIOLOGIC ALTERATION IN THE BODY
DIASTOLIC MURMUR
ALMOST ALWAYS INDICATES HEART DISEASE.
FOUND IN MID TO LATE DIASTOLE
34 - WHAT FEATURES DISTINGUISH BETWEEN AN ORGANIC (PATHOLOGICAL) AND
BENIGN (FUNCTIONAL OR INNOCENT) MURMUR?
ORGANIC MURMURS (GRADES 3-6)
LOUD
ALL ARE PATHOLOGICAL (DIASTOLIC)
THRILL = PATHOLOGY
RADIATION OF SOUNDS
INCREASED DURATION = HOLOSTOLIC
INNOCENT / FUNCTIONAL MURMUR - GRADE 2 OR LESS
PECTUS EXCAVATUM
AORTIC VALVULAR SCLEROSIS OFTEN ACCOMPANIES THESE IN THE OLD
NO THRILLS
PULLMONIC / MITRAL AREA
STILL’S MURMUR PRESENT IN 50% OF CHILDREN (GONE BY PUBERTY)
PHYSIOLOGIC MURMUR
TURBULENCE DUE TO TEMPORARY FLOW INCREASE
RIGHT SIDED MURMUR INCREASES ON EXPIRATION
LEFT SIDED MURMUR NOT EFFECTED BY RESPIRATION
ANEMIA, PREGNANCY, FEVER HYPERTHYROIDISM
35 -WHAT SOUNDS ARE HEARD DURING SYSTOLE, DIASTOLE AND BOTH COMPONENTS?
SYSTOLIC SOUNDS
AORTIC EJECTION - STENOTIC OR DILATED AORTA
PULMONIC EJECTION -
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PULMONARY STENOSIS,
HTN,
INCREASED S1
DIASTOLIC SOUNDS
OPENING SNAP - MITRAL VALVE STENOSIS
PHYSIOLOGIC S3 - LATER THAN OPENING SNAP (ADULTS 30-40)
S3 PATHOLOGIC IF > 40 YRS. = CARDIAC DISEASE
CHF- REGURGITATION-MYOCARDIAL FAILURE(?CHECK THIS )
S4- NORMAL IN ATHLETE & ELDERLY
DELAYED AV CONDUCTION
INCREASED RESISTANCE TO VENTRICULAR FILLING
PERIPHERAL VASCULAR (PV) EXAMINATION
36 -WHICH PERIPHERAL ARTERIES ARE EXAMINED? WHAT CHARACTERISTICS ARE
NOTED?
DISTAL PULSES
BRACHIAL
RADIAL
FEMORAL
POPLITEAL
POST. TIBIAL
DORSALIS PEDIS
COMPARE : RATE , RHYTHM, AMPLITUDE BILAT.
37 - WHICH DISORDERS MAY LEAD TO ASYMMETRICAL, WIDENED OR DIMINISHED
PULSES?
WIDENED OR EXAGGERATED- DUE TO ANEURYSM
DIMINISHED OR ABSENT-PROXIMAL OR PARTIAL OR COMPLETE BLOCKAGE
(CAN LEAD TO)
INTERMITTENT CLAUDICATION
POSTURAL COLOR CHANGES
TROPHIC CHANGES IN THE SKIN
38 - WHAT FEATURES ARE NOTED DURING INSPECTION OF THE EXTREMITIES?
LOWER EXTREMITY - COMMON SITE FOR VASCULAR LESION
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NOTE:
SIZE
SYMMETRY
SWELLING
VENOUS PATTERN
SKIN COLOR
NAIL BEDS ETC.
39 -WHAT ARE SOME OF THE RISK FACTORS ASSOCIATED WITH PV DISEASE.
BP CHANGES
CAPILLARY REFILL TIME
VARICOSE VEINS
THROMBOSIS
EDEMA
PAIN
VISIBLE PULSES
COLOR CHANGE
SKIN CHANGE
TEMPERATURE
ULCERS
GANGRENE
40 - WHAT ARE SOME OF THE SIGNS OF PV DISEASE?
HAIR LOSS
EDEMA
TEMPERATURE DROP
COLOR
LESIONS OR ULCERS
PIGMENTATION
ECZEMAYOUS DERMATITIS
VARICOSITY’S
41 - HOW DO WE DIFFERENTIATE BETWEEN INTERMITTENT AND NEUROGENIC
CLAUDICATION?
42 WHAT ARE THE FINDINGS OF A CHRONIC ARTERIAL INSUFFICIENCY? WHAT TEST
MAY BE UTILIZED AND HOW ARE THEY INTERPRETED?
INTERMITTENT CLAUDICATION
DECREASED / ABSENT PULSE
PALE COLOR
COOL TEMPERATURE
LITTLE EDEMA
RUBOR
LOSS OF HAIR
SKIN (SHINY, ATROPHIC, THIN)
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ULCERS & GANGRENE OF TOES
ALLEN’S TEST, BP
43 - WHAT ARE THE FINDINGS OF CHRONIC VENOUS INSUFFICIENCY? WHAT TEST MAY
BE UTILIZED. AND HOW ARE THE FINDINGS INTERPRETED ?
LITTLE PAIN
NORMAL PULSE, TEMP., & COLOR
EDEMA, BROWN SKIN COLOR, CHANGE
ULCERS ON ANKLES
TRENDELENBERG, MANUAL COMPRESSION
44 - WHAT ARE THE FINDINGS OF THE SUPERFICIAL THROMBOPHLEBITIS? DEEP
THROMBBOPHLEBITIS?
SUPERFICIAL THROMBOPHLEBITIS
CLOT FORMATION OF SUPERFICIAL VEIN
PAIN LOCALIZED IN AREA ALONG COURSE OF VEIN
DEEP THROMBOPHLEBITIS CLOT IN DEEP VEIN
PRESENTS AS PAIN IN CALF
4 5 -WHAT IS THE SIGNIFICANCE OF EDEMA, PITTING EDEMA AND LYMPHADEMA?
EDEMACAUSES SWELLING WHICH MAY OBSCURE VEINS, TENDONS AND BONY PROMINENCES
CAUSED BY:
TRAUMA (&)
CHRONIC VENOUS INSUFFICIENCY
PITTING EDEMA
SKIN INDENTS AND IS GRADE ON A 1-8 SCALE
ACCORDING TO HOW DEEP THE LESION IS
ORTHOSTATIC AND CHRONIC VENOUS INSUFFICIENCY DISPLAY PITTING
LYMPHEDEMA
DUE TO LYMPHATIC OBSTRUCTION
SOFT EARLY THEN BECOMES HARD & NON-PITTING
SKIN BECOMES THICK, EDEMA OF FOOT & TOES
OFTEN BILATERAL
LIPODEMA & LYMPHEDEMA ARE NON-PITTING