Question 1
According to the lesson, heart failure can be assessed using the Framingham criteria. Which of the
following findings are major criteria suggestive of heart failure? (Select all that apply)
Correct!
Orthopnea
Correct!
S3 gallop
Correct!
Neck-vein distention
For establishing a diagnosis of CHF using the modified Framingham Criteria, 2 major criteria or 1 major
and 2 minor criteria must be present. Major criteria are: Paroxysmal nocturnal dyspnea or orthopnea ;
Neck-vein distention; Rales; Cardiomegaly; Acute pulmonary edema; S3 gallop; Increased venous
pressure >16 cm of water; and Hepatojugular reflux.
Question 2
According to the lesson, low-pitched sounds of S3 and S4 and the murmur of mitral stenosis are best
heard using what?
Correct!
The bell of the stethoscope
Listen throughout the precordium with the diaphragm, pressing it firmly against the chest. The bell is
more sensitive to the low-pitched sounds of S3 and S4 and the murmur of mitral stenosis. Apply the bell
lightly, with just enough pressure to produce an air seal with its full rim. Use the bell at the apex, then
move medially along the lower sternal border. Resting the heel of your hand on the chest like a fulcrum
may help you to maintain light pressure.
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