36 Questions
What is the most common symptom associated with cardiovascular disease?
Chest pain
During a cardiovascular examination, what is the purpose of estimating the level of jugular venous pressure?
To determine the patient's fluid status
What is the purpose of the Allen test?
To look at the arterial supply to the hand
What is the recommended age range for one-time screening for abdominal aortic aneurysm by ultrasound?
Men between ages 65-75
What is the purpose of calculating the 10-year and lifetime global cardiovascular disease risk?
To identify high-risk patients for lifestyle modifications
What is the recommended age for screening for dyslipidemia in men?
35
What is the purpose of palpating the carotid pulse during a cardiovascular examination?
To identify fruits or bruits
What is the recommended approach for screening for peripheral vascular disease?
Screen patients >64 years old, those with diabetes, or those who smoke
What is the most likely cause of a palpable impulse in the xiphoid area in a patient with a history of smoking?
Pulmonary hypertension
During a breast examination, what is the purpose of inspecting the breasts in 4 views?
To assess skin appearance, size, symmetry, contour, and nipple characteristics
What is a common symptom experienced by patients with aortic stenosis?
All of the above
What is the likely diagnosis for a 70-year-old patient presenting with progressive shortness of breath, jugular venous distension, and a blowing holosystolic murmur?
Tricuspid regurgitation
Why is it important to inspect the axillae during a breast examination?
To palpate the axillary nodes
What is a risk factor for developing breast cancer?
Family history of breast cancer
What is the purpose of palpating the breasts during a breast examination?
To assess for any lumps or masses
What is the likely cause of a systolic blood pressure in the left ventricle that is higher than in the aorta?
Aortic stenosis
What is a symptom of breast discomfort or pain?
All of the above
What is an important aspect of breast examination in men?
Inspecting the nipple and areola
What is a characteristic of breast tissue after menopause?
It becomes less dense due to a decrease in lobules
What is the most likely cause of the patient's symptoms in heart failure?
Removal of intravascular volume with diuresis
What is the effect of estrogen in hormone replacement therapy (HRT) on breast density after menopause?
It increases breast density
What is the relationship between breast density and mammography?
Dense breasts decrease the sensitivity and specificity of mammograms
What is the origin of the patient's pain likely secondary to?
Neurogenic claudication
Which artery is being assessed when a strong pulse is felt located on the dorsum of the foot, just lateral to the extensor tendon of the big toe?
Dorsalis pedis
What is a characteristic of mammography in menopausal and postmenopausal women?
It is more accurate due to decreased breast density
What is true about MRI as a screening modality for breast cancer in the general population?
Sensitivity of screening for breast cancer increases with breast MRI at the expense of specificity
What is the main factor contributing to breast density?
A combination of genetic and hormonal factors
What is the primary symptom of a patient with neurogenic claudication?
Recurring pain after ambulating
What is a recommended approach to breast cancer screening based on the relationship between breast density and mammography?
Limited screening of women in their 40s due to high rates of false positives
What is the effect of menopause on breast tissue?
It leads to a decrease in glandular tissue
What is the location of the posterior tibial artery?
Behind the medial malleolus of the ankle
What is the most likely diagnosis for a patient with a holosystolic murmur heard within the left third to fifth interspaces?
Ventricular septal defect
What is the relationship between breast cancer incidence and age?
Breast cancer incidence starts to rise markedly in menopausal and postmenopausal women
What is the primary benefit of diuresis in a patient with heart failure?
Removal of intravascular volume
What is the characteristic of abdominal aortic aneurysms?
Pain that is bilateral
What is the purpose of assessing pulses in the foot of a diabetic patient?
To diagnose peripheral arterial disease
Study Notes
Cardiovascular System
- Chest pain symptoms: exertional pain/pressure or discomfort in the chest, anterior chest pain, ripping, radiating to the back (acute aortic dissection)
- Shortness of breath (dyspnea), orthopnea (dyspnea when supine)
- Palpitations, swelling, syncopal episodes
- Cardiovascular examination:
- Note general appearance and blood pressure (BP) and heart rate (HR)
- Estimate jugular venous pressure
- Auscultate carotids, palpate carotid pulse
- Inspect anterior chest wall
- Palpate precordium, palpate and locate point of maximal impulse (PMI)
- Palpate for systolic impulse of other arteries on chest wall
- Auscultate S1 and S2, distinguish murmurs or pathological sounds
- Cardiac auscultation sites:
- Mitral area (apex of heart)
- Tricuspid area (right sternal border)
- Pulmonic area (left 2nd to 3rd intercostal space)
- Aortic area (right 2nd to 3rd intercostal space)
Cardiovascular Health Promotion
- Screening for cardiovascular risk factors:
- Step 1: Screen for global risk factors
- Step 2: Calculate 10-year and lifetime global CVD risk
- Step 3: Address individual risk factors (hypertension, diabetes, dyslipidemias, metabolic syndrome, smoking, family history, obesity)
- Lifestyle modifications
Peripheral Vascular System
- Symptoms:
- Pain and swelling of legs and arms
- Raynaud's phenomena, deep vein thrombosis (DVT), venous and arterial ulcers
- Cramping in legs on exertion with relief with rest
- Signs:
- Cold, numbness, pallor, or discoloration in legs, hair loss
- Abdominal, flank, or back pain (sign of expanding abdominal aortic aneurysm)
- Peripheral vascular system assessment:
- Arms: inspect, palpate upper extremities (radial, brachial pulse, epitrochlear lymph nodes)
- Abdomen: palpate inguinal lymph nodes, palpate abdomen, auscultate abdomen (aortic, renal, femoral bruits)
- Legs: inspect, palpate lower extremities (femoral, popliteal, dorsalis pedis, posterior tibial pulses)
- Screening for peripheral vascular disease:
- Age >64
- Age >49 with history of diabetes or smoking
- Leg symptoms with exertion
- Non-healing wounds
- Screening for abdominal aortic aneurysm:
- One-time screening by ultrasound in men between ages 65-75 who have smoked
Breast Examination
- Breast lump or mass: careful evaluation and usually need definitive diagnostic measures
- Breast discomfort or pain: different medications can lead to this (SSRI, Spironolactone), can be cyclic in nature
- Nipple discharge
- Health history and concerning symptoms
- Breast examination:
- Women: inspect in 4 views, palpate breasts, inspect axillae, palpate axillary nodes
- Men: inspect nipple and areola, palpate areola and breast tissue
Heart Sound Interpretation
- Heart murmurs:
- Mitral regurgitation
- Aortic stenosis
- Pulmonic stenosis
- Heart sounds:
- S1 (mitral and tricuspid valves)
- S2 (aortic and pulmonic valves)
Polling Questions
- Polling Question #1: Answer - d. Pulmonary hypertension
- Polling Question #2: Answer - c. Aortic stenosis
- Polling Question #3: Answer - a. Removal of intravascular volume with diuresis
- Polling Question #4: Answer - d. Neurogenic claudication
- Polling Question #5: Answer - c. Dorsalis pedis
- Polling Question #6: Answer - c. This patient is not an ideal candidate for screening via breast MRI based on current evidence.
- Polling Question #7: Answer - c. Glandular tissue of the breast atrophies with menopause, primarily due to decrease in the number of lobules.
Identify symptoms related to cardiovascular health, including chest pain, shortness of breath, and palpitations. Understand the importance of health history and physical examination in diagnosing cardiovascular conditions.
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