Multiple Choice Questions

position of AV valve -- delayed conduction from atria to ventricles. Mitral valve drifts shut b4 ventricular contraction closes itChange in valve structure-- extreme calcification, which limits mobility.More forceful atrial contraction into noncompliant ventricle; delays or diminishes ventricular contraction
  • What conditions decrease the intensity of S1
  • Which conditions increase the intensity of S2
  • What conditions increase the intensity of S1
  • Which conditions decrease the intensity of S2
Splitting of the S2 can happen during inspiration. It is heard when the aortic valve closes earlier than the pulmonic valve. Instead of it sounding like "dub" it sounds like "T-Dub". You can hear it only in the pulmonic valve area.
  • Explain the mechanism producing normal first and second heart sounds
  • Explain the physiologic mechanism for normal splitting of S2. In what location on the heart would you expect to hear a split S2?
  • Explain the position of the valves during each phase of the cardiac cycle
  • Define the fourth heart sound. When in the cardiac cycle does it occur? Describe its intensity, quality, location in which it is heard, and method of auscultation
A pulse deficit signals a weak contraction of the ventricle; it occurs with atrial fibrillation, premature beats, and heart failure.
  • Define bruit, and discuss what it indicates
  • Define venous pressure and jugular venous pulse
  • Define heave or lift, and discuss what it indicates
  • Define pulse deficit, and discuss what it indicates
Pattern- crescendo(louder)decrescendo(taper off) crescendo-decrescendo( depends on blood flow/pressureQuality- musical,blowing, harsh, rumblingLocation- pmi (best) or valve area, intercostal space on the neck, back or axillaRadiation- heard in the direction of blood flowPosture- may dissapear or enhance with postionGrading of the murmur-- 1-difficult to hear( quiet room needed)2- audible but faint3.- easy to hear mod loud4- loud-thrill palp on chest5- very loud with part of stethscope lifted off chest6- loudest with stethscope off chest
  • List the areas of questioning to address during the health history for the cardiovascular system
  • Discuss the characteristics of an innocent or functional murmur
  • Explain the position of the valves during each phase of the cardiac cycle
  • List the characteristics to explore when you hear a murmur, including the grading scale of murmurs
ObeseThick chest wallLarge breast tissue
  • Which abnormal variations may affect the location of apical impulse
  • Which normal variations may affect the location of the apical impulse
  • Which conditions increase the intensity of S2
  • Define apical impulse and describe its normal location, size, and duration
S2- "Dup"- is the loudest at the base.
  • Describe the effect of respiration on the heart sounds
  • Describe the characteristics of the first heart sound and its intensity at the apex of the heart and at the base
  • Define the fourth heart sound. When in the cardiac cycle does it occur? Describe its intensity, quality, location in which it is heard, and method of auscultation
  • Describe the characteristics of the second heart sound and its intensity at the apex of the heart and at the base of the heart
higher closing pressure (ex systemic hypertension, rining or booming)Exercise and excitement increase pressure in aorta (ex mitral stenosis or heart failure)Pulmonary hypertension (ex aortic or pulmonic stenosis)Semilunar valves calcified but still mobile P488
  • Which conditions increase the intensity of S2
  • What conditions decrease the intensity of S1
  • Which conditions decrease the intensity of S2
  • What conditions increase the intensity of S1
Right SideDuring inspiration blood is pushed into vena cava increasing venous return to R side of heartwhich increases RV stroke volume. = Prolong RV systole and delay pulmonic valve closureLeft sideMore blood is in the lungs during inspiration which decreased LV stroke volume. = Shortens LV systole and allows the aortic valve to close a bit earlier. When aorotic valve closesearlier than pulmonic valve*More to the Right heart, Less to the left - Can cause a split in s2 - only heard in pulmonic valve area= you can hear the mitral and tricuspid components separately = this is a split S2
  • Discuss the characteristics of an innocent or functional murmur
  • Describe the effect of respiration on the heart sounds
  • Differentiate a physiological S3 from a pathological S3.
  • Define pulse deficit, and discuss what it indicates
Cardiac enlargementL Ventricle dilation (volume overload) displaces impulse down and to the left and I ncreases size more than one space. Barrell chest
  • Which normal variations may affect the location of the apical impulse
  • List the areas of questioning to address during the health history for the cardiovascular system
  • Which conditions decrease the intensity of S2
  • Which abnormal variations may affect the location of apical impulse
First heart sound (S1) occurs with closure of the AV valves and this signals the beginning of systole. The mitral component of the first sound slightly precedes the tricuspid component, but you usually hear these two components fused as one sound. You can hear S1 over all the precordium but usually loudest at the apex.Second heart sound (S2) occurs with closure of the semilunar valves and signals the end of systole. The aortic component of the second sound (A2) slightly precedes the pulmonic component. Although it is heard over all the precordium, S2 is loudest at the base.
  • Explain the position of the valves during each phase of the cardiac cycle
  • Explain the physiologic mechanism for normal splitting of S2. In what location on the heart would you expect to hear a split S2?
  • Describe the effect of respiration on the heart sounds
  • Explain the mechanism producing normal first and second heart sounds
apical impulse: point of maximal impulse; pulsation created as the left ventricle rotates against the chest wall during systolelocation: normally at the fifth left intercostal space in the midclavicular lineduration: systole (short. normally first 1/2 of systole)Size: normally 1 x 2 cm
  • Define venous pressure and jugular venous pulse
  • Define heave or lift, and discuss what it indicates
  • Define apical impulse and describe its normal location, size, and duration
  • Define the fourth heart sound. When in the cardiac cycle does it occur? Describe its intensity, quality, location in which it is heard, and method of auscultation
Afterload is the opposing pressure the ventricle must generate to open aortic valve against the higher aortic pressure. It is the resistance against which the ventricle must pump its blood. Once the ventricle is filled with blood, the ventricular end diastolic pressure is 5 - 10 mm Hg, whereas that in the aorta is 70 - 80 mm Hg. To overcome this difference, the ventricular muscle tenses. After the aortic valve opens, rapid ejections occur.
  • Define heave or lift, and discuss what it indicates
  • Define afterload
  • Define preload
  • Define apical impulse and describe its normal location, size, and duration
Low pitched sound that occurs in early diastole. You will hear this sound at the apex in the left lateral position. Use the bell of the stethoscope. Normal in children and young adults. It is abnormal when it persists in a person. Usually abnormal in adults over the age of 40 and can be an early sign of heart disease or congested heart failure.
  • Define apical impulse and describe its normal location, size, and duration
  • Define heave or lift, and discuss what it indicates
  • Define the fourth heart sound. When in the cardiac cycle does it occur? Describe its intensity, quality, location in which it is heard, and method of auscultation
  • Define the third heart sound. When in the cardiac cycle does it occur? Describe its intensity, quality, location in which it is heard, and the method of auscultation. When is an S3 sound normal? When is an S3 sound abnormal?
Preload is the venous return that builds during diastole. It is the length to which the ventricular muscle is stretched at the end of diastole just before contraction. When the volume of blood returned to the ventricles is increased (as when exercise stimulates skeletal muscles to contract and force more blood back to the heart), the muscle bundles are stretched beyond their normal resting state to accommodate it. The force for this switch is the preload.
  • Define afterload
  • Define preload
  • Define apical impulse and describe its normal location, size, and duration
  • Define the fourth heart sound. When in the cardiac cycle does it occur? Describe its intensity, quality, location in which it is heard, and method of auscultation
Venous pressure - the pressure exerted on the walls of the veins by the circulating bloodJugular Venous Pulse - The pulse in the right internal jugular vein at the root of the neck; pressure of right atrium
  • Define venous pressure and jugular venous pulse
  • Define bruit, and discuss what it indicates
  • Define heave or lift, and discuss what it indicates
  • Differentiate between the carotid artery pulsation and the jugular vein pulsation
a fall in systemic blood pressure causes a decrease in valve strength (ex shock)Semilunar valves thickened and calcified, decreased mobility (ex. aortic or pulmonic stenosis)
  • What conditions decrease the intensity of S1
  • Which conditions decrease the intensity of S2
  • What conditions increase the intensity of S1
  • Which conditions increase the intensity of S2
Diastole- AV valves (i.e. tricuspid and mitral) are openSystole- AV valves shut producing SAortic valves open to eject blood rapidly. then some back flow from psi equalizing b/t aorta and ventricles causes aortic valve to shutDiastole again- all 4 valves closed, mitral valve opens and diastolic filling begins again
  • Discuss the characteristics of an innocent or functional murmur
  • Define apical impulse and describe its normal location, size, and duration
  • Explain the position of the valves during each phase of the cardiac cycle
  • Define the fourth heart sound. When in the cardiac cycle does it occur? Describe its intensity, quality, location in which it is heard, and method of auscultation
S1- "LUB"- Loudest at the apex and softer at the base.
  • Describe the effect of respiration on the heart sounds
  • Describe the characteristics of the first heart sound and its intensity at the apex of the heart and at the base
  • Define the third heart sound. When in the cardiac cycle does it occur? Describe its intensity, quality, location in which it is heard, and the method of auscultation. When is an S3 sound normal? When is an S3 sound abnormal?
  • Describe the characteristics of the second heart sound and its intensity at the apex of the heart and at the base of the heart
A heave or lift is a sustained forceful thrusting of the ventricle during systole. It occurs with ventricular hypertrophy as a result of increased workload. A right ventricular heave is seen at the sternal border; a left ventricular heave is seen at the apex.
  • Define heave or lift, and discuss what it indicates
  • Define venous pressure and jugular venous pulse
  • Define bruit, and discuss what it indicates
  • Define pulse deficit, and discuss what it indicates
The S4 is a ventricular filling sound. It occurs when the atria contract late in diastole. It is heard immediately before SThis is a very soft sound, of very low pitch. You need a good bell, and you must listen for it. It is heard best at the apex, with the person in left lateral position.
  • Define the fourth heart sound. When in the cardiac cycle does it occur? Describe its intensity, quality, location in which it is heard, and method of auscultation
  • Define the third heart sound. When in the cardiac cycle does it occur? Describe its intensity, quality, location in which it is heard, and the method of auscultation. When is an S3 sound normal? When is an S3 sound abnormal?
  • Define apical impulse and describe its normal location, size, and duration
  • Define heave or lift, and discuss what it indicates
• S1 is the start if systole and thus serves as the reference point for the timing of all other cardiac sounds; usually you can identify S1 instantly because you hear a pair of sounds close together (lub-dup), and S1 is the first of the pair• S1 is louder than S2¬ at the apex; S2 is louder than S1 at the base• S1 coincides with the carotid artery pulse. Feel the carotid gently as you auscultate at the apex; the sound you hear as you feel is pulse is S1• S1 coincides with the R wave (the upstroke of the QRS) complex) if the person is on an ECG monitor
  • What conditions decrease the intensity of S1
  • Differentiate a physiological S3 from a pathological S3.
  • State four guidelines to distinguish S1 from S2
  • Describe the effect of respiration on the heart sounds
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Multiple Choice Questions
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