Go on. Explore!

lvl 0 • 0 xp

lvl 1

Home Market Decks Interests

Competency

memorize.ai (lvl 286)

Section 1

Preview this deck

Heard well in LLD

Front

1 / 24

Competition Prep

0.0

0 reviews

5			0
4			0
3			0
2			0
1			0

Active users

All-time users

Favorites

Last updated

6 years ago

Date created

Mar 1, 2020

Cards (24)

Section 1

(24 cards)

Heard well in LLD

Front

mitral stenosis, S3, S4

Back

6 grades of intensity

Front

Grade 1: barely audible with greatest difficulty Grade 2: Faint but heard immediately upon listening Grade 3: Easily heard, no thrills Grade 4: Palpable thrills Grade 5: Loud enough to be heard with stethoscope set on edge Grade 6: So loud it can be heard with stethoscope off the chest

Back

Assess for S2 split

Front

During inspiration, pulmonic valve closes later than aortic valve Have patient exhale (resolves physiologic split)

Back

Verbalize murmurs

Front

Timing (systolic, diastolic) Duration (early, middle, late or pan) Shape - crescendo/decrescendo (aortic stenosis) or decrescendo (aortic regurg) Location - valvular area Radiation - neck (aortic stenosis) or axilla (mitral regurg) Intensity (6 grades) Pitch (L, M, H) Quality (musical, rumbling, harsh)

Back

S4=

Front

atrial kick against decreased compliance

Back

Ejection click in early systole =

Front

diseased aortic valve or pulmonic valve

Back

Hepatojugular reflex

Front

Normal exam will show distention of JVD and then resolution within 10-20sec due to increased forced volume back to heart. Continued visualization of JVD can indicate HF or tricuspid regurgitation

Back

Crescendo or decrescendo murmur common in

Front

aortic stenosis

Back

Radiation to the neck can indicate

Front

aortic stenosis

Back

Squatting

Front

increases venous return, increases after load decreases murmur in HCM and MVP, increases AS

Back

Auscultation

Front

Note rate and rhythm Auscultate all 4 areas with diaphragm and bell assess for splitting of S2 in pulmonic area

Back

S3=

Front

rapid deceleration of blood

Back

Standing

Front

decreased venous return- increases murmur in HCM and MVP, and decreases in AS

Back

Opening snap in early diastole =

Front

mitral stenosis or tricuspid stenosis

Back

Radiation to axilla can indicate

Front

mitral regurg

Back

Extremities

Front

Edema (1-3) Varicosities Stasis dermatits pigmentation and ulceration (valvular incompetency) Nail beds (splinter hemorrhages with endocarditis) Compare pulses bilaterally (brachial, radial, femoral, popliteal, dorsalis pedis, post tibialis) Assess for capillary refill (<3 secs) Assess for signs of phlebitis, venous tenderness, cords, warmth

Back

When are aortic murmurs best heard?

Front

sitting and leaning forward

Back

Verbalize extra sounds

Front

Ejection click in early systole = diseased aortic valve or pulmonic valve Opening snap in early diastole = mitral stenosis or tricuspid stenosis S3 = rapid deceleration of blood S4 = atrial kick against decreased compliance

Back

Verbalize S1 and S2!

Front

S1 is the closing of AV valves (marks onset of systole) S2- closure of semilunar valves (aortic and pulmonic)

Back

Chest

Front

Inspect all 4 areas with lighting Visualize PMI and observable lifts Palpate all areas with finger tip pads and palmar surface for lifts Palpate all 4 areas Palpate apical pulse using pad of fingers while lying flat and lateral decubitus

Back

Neck

Front

inspect for JVD measure JVP hepatojugular reflex auscultate for carotid bruits (upper and lower) palpate carotids

Back

Decrescendo murmur common in

Front

aortic regurg

Back

Special positions - verbalize

Front

Left lateral decubitus (mitral stenosis, S3, S4) Sitting, leaning forward (aortic murmurs) Standing (decreased venous return- increases murmur in HCM and MVP, and decreases in AS) Squatting (increases venous return, increases after load) decreases HCM/MVP, increases AS

Back

Pulses to check

Front

brachial, radial, femoral, popliteal, dorsalis pedis, post tibialis

Back