AANP & Murmurs Exam 62 Questions with Answers,100%CORRECT

AANP & Murmurs Exam 62 Questions with Answers What valves are closed during S1/ Systole? - CORRECT ANSWER Mitral Tricuspid & AV close (Ventricular Contraction) S2 ("Dub" sound) is? - CORRECT ANSWER Diastole What valves are closed during S2? - CORRECT ANSWER Aortic Pulmonic Semilunar valves close (Ventricular Dilation) The period b/t S1 & S2 is? - CORRECT ANSWER Systole The period b/t S2 & S1 is? - CORRECT ANSWER Diastole What are murmurs? - CORRECT ANSWER Turbulent blood flow through vessels across a heart valves Where do you hear the Aortic Valve? - CORRECT ANSWER 2nd RIGHT ICS; Right Sternal Border Where do you hear the Pulmonic Valve? - CORRECT ANSWER 2nd Left ICS ; Left Sternal Border Where do you hear the second pulmonic area (Erbs)? - CORRECT ANSWER 3rd Left ICS at Left Sternal Border Where do you hear Tricuspid? - CORRECT ANSWER 4th Left ICS; Lower Left Sternal Border Where do you here Mitral Valve? - CORRECT ANSWER 5th ICS; Left Midclavicular line the "apical" area Toward LEft Axilla IF the rate sounds irregular what do you do? - CORRECT ANSWER Compare the beats per min. over the heart with the radial pulse. Murmurs in conjunction with carotid pulse are? - CORRECT ANSWER Systolic (S1)- should Coincide with the rise of the Carotid pulse (Ask pt to hold breath during EXPIRATION while listening) Systolic Murmurs - MR Peyton Manning AS MVP - CORRECT ANSWER Mitral Regurgitation Physiologic Murmur Aortic Stenosis Mitral Valve Prolapse Stenotic valves dont....??? - CORRECT ANSWER OPEN properly Regurgitant valves dont....??? - CORRECT ANSWER Close properly What does Holosystolic / Pansystolic mean? - CORRECT ANSWER Herd during All of systole (b/t S1-S2) end of S1 to the beginning of S2 Which Murmurs are Holosystolic / Pansystolic ? - CORRECT ANSWER MITRAL REGURGITATION!!!!!!! Tricuspid Regurgitation VSD On examination you find the PMI (point of maximal impulse) is displaced laterally & is diffuse. What do you associate with this finding? - CORRECT ANSWER MITRAL REGURGITATION!!!! Diffuse Amplitude (found by tapping) could be CHF A blowing systolic murmur at the apex, radiating to the axillae on exam is consistent with?? - CORRECT ANSWER Mitral Regurgitation What are symptoms of Mitral Regurgitation? - CORRECT ANSWER CHF Fatigue SOB Bacterial Endocarditis What does it mean to have a Midsystolic Murmur? - CORRECT ANSWER Turbulent blood flow over the Aortic or Pulmonary Valves Is a Physiologic Murmur an example of a Midsystolic Murmur? - CORRECT ANSWER YEP What are example of physiological conditions that can increase the blood flow across the semilunar valves? - CORRECT ANSWER Pregnancy Fever Anemia What are possible causes of S3? - CORRECT ANSWER Physiologic Murmurs Pregnancy Fever Anemia Normal finding in children When can you hear a physiologic murmur the best? - CORRECT ANSWER during Inspiration phys-I-ologic; I-nspiration What does an Early Systolic Murmur mean? - CORRECT ANSWER Aortic Stenosis What is the significance of a Harsh Systolic Crescendo-Decrescendo murmur which First rises in intensity then falls, that also radiates to the carotid arteries? - CORRECT ANSWER Aortic Stenosis What location is Aortic Stenosis herd the loudest? - CORRECT ANSWER - 2nd RICS at Left Sternal Edge - Right Upper Sternal Border and Carotids - at the Apex What position can help better distinguish Aortic Stenosis? - CORRECT ANSWER Squatting What is the significance of finding an audible S4 over the Mitral Area with the bell of the stethoscope? - CORRECT ANSWER Aortic Stenosis - The apex impulse is forceful but as LV dilates, apex become diffuse and lateral What is the leading (1st) cause of Aortic Stenosis? - CORRECT ANSWER Age 15-65 Congenital (Bicuspid valve) What is the 2nd cause of Aortic Stenosis? - CORRECT ANSWER Rheumatic Fever With Aortic Stenosis, what other valve may be involved fi the cause was Rheumatic Fever? - CORRECT ANSWER Mitral Valve - With Mitral regurg = reeallllly severe! What are other causes of Aortic Stenosis? - CORRECT ANSWER Calcified Valves A small and slow carotid upstoke (Parvus Et Tardus) found on examination could be a finding of what? - CORRECT ANSWER Aortic Stenosis A patient with Aortic Stenosis has a narrow pulse pressure. What does a narrow pulse pressure mean? - CORRECT ANSWER The numeric difference between your systolic and diastolic blood pressure is called your pulse pressure (systolic - diastolic = pp) Represents the force that the heart generates each time it contracts. A Narrow Pulse Pressure is less than 25 mmHg (A Wide Pulse pressure is 30; 30-40) What are Symptoms & Complications of Aortic Stenosis - CORRECT ANSWER A - Angina ( in 2/3ds of pts, basically half of them have CAD) S- Syncope (Exertional, often preceeded by dizziness) C- Congestive Heat Failure ( Dyspnea - going down hill) * Once sx appear, mortality rate is 50% at 3 yrs The most common type of heart murmur is ? - CORRECT ANSWER Mitral Valve Prolapse A late Systolic Murmur with midsystoliclick herd at the Apex of the Left sternal Border is a finding of what? - CORRECT ANSWER Mitral Valve Prolapse MVP is accentuated in which position? - CORRECT ANSWER Standing!!!!! What are common etiologies of MVP? - CORRECT ANSWER Mitral valve Leaflets; common in women 14-30 (Too much starbucks haha) Symptoms of MVP are? - CORRECT ANSWER Palpitations (PAC's PVC's c exercise), PSVT, Chest pain Dyspnea, Dizziness, Numbness Diastolic murmurs are best herd when? - CORRECT ANSWER During Expiration Diastolic Murmurs - ARMS - CORRECT ANSWER Aortic Regurgitation Mitral Stenosis What is the significance of an early decresendo diastolic murmur that grows softer? - CORRECT ANSWER Aortic Regurgitation A soft, high pitched diastolic murmurs that radiates towards the Apex on exam is consistent with what valvular disorder? - CORRECT ANSWER Aortic Regurgitation Where is Aortic Regurgitation herd the loudest? - CORRECT ANSWER Aortic Listening Point 4th ICS of Left Sternal Border A prolonged asymptomic period even with exercise, then, decreased exercise tolerance & presents with symptoms of heart failure is common with what valvular disease? - CORRECT ANSWER Aortic Regurgitation Physical Exam finding specific with Aortic Regurgitation include what? (Clue: Both Start with "W") - CORRECT ANSWER 1. wide pulse pressure 2. wide and quick arterial pulses (Water- Hammer Pulse) With Aortic Regurgitation ECG will show what? - CORRECT ANSWER LVH; (Wide .9 QRS ect) What Diagnostic test is needed for LVH & Aortic Regurgitation? - CORRECT ANSWER Radiograph (will show dilated left ventricle with enlargement) Rheumatic Heat Disease, Congenital deformity, Aortic Root Abnormalities, & Syphilis are causes of??? - CORRECT ANSWER Aortic Regurgitation What is the significance of a Mid-Diastolic cresendo murmur that grows louder with an opening Snap (Loud S1)? - CORRECT ANSWER Mitral Stenosis What are symptoms of Mitral Stenosis? - CORRECT ANSWER Dyspnea Hemoptysis (from increased pulmonary pressure) Right ventricular hypertrophy Stage 1 of Mitral Stenosis is? - CORRECT ANSWER Aysmptomatic 20 yrs, then gradual reduction in exercise tolerance 3-5 years Stage 2 of Mitral Stenosis? - CORRECT ANSWER Onset of Pulmonary Congestion Stage 3 of Mitral Stenosis? - CORRECT ANSWER Dev of pul HTN Stage 4 f Mitral Stenosis? - CORRECT ANSWER Severe state of low CO --then you die (Average age of death is 48) Which is a common ECG finding of Mitral Stenosis? - CORRECT ANSWER A FIb Radiograph findings common with Mitral Stenosis are? - CORRECT ANSWER Enlarged Left Atrium A fib is an ECG finding of which following Valve disorders? - CORRECT ANSWER Mitral Stenosis Mitral Regurgitation