Cardiac

Question 1

Diaphragm

Answer 1

High pitched sounds: S1, S2
Murmurs: AR, MR
Pericardial friction rub

Question 2

Bell:

• Sounds
• Murmurs
• Location

Answer 2

Low pitched sounds: S3, S4
Murmur: MS
Apex, medially along sternal border

Question 3

Measuring JVD

Answer 3

Position @ 30, 45, or 60 degrees 
Pillow under neck
Penlight, 2 rulers
Measure top of point where you see IJ
Normal < 3-4cm

Question 4

Assessing carotids

Answer 4

Position @ 30 degrees
Auscultation using diaphragm and possibly bell
Make sure pt is holding breath

Question 5

Systolic impulse of RV

Answer 5

LSB, ICS 3,4,5 and/or epigastric

Question 6

Palpate: diastolic movements of S3, S4

Answer 6

ICS 4,5

Question 7

Systolic murmur- timing

Answer 7

Between S1 and S2

Commonly benign

Question 8

Diastolic murmur- timing

Answer 8

Between S2 and S1

Commonly pathological

Question 9

Positioning for murmurs

Answer 9

L side- can hear MV and mitral murmurs better

Lean forward- can hear AV and aortic murmurs better

Question 10

Grading murmurs

Answer 10

Grade 1: faint
Grade 4: lowest grade with palpable thrill
Grade 6: highest grade; can hear with stethoscope off chest wall

Question 11

AS murmur

Answer 11

Crescendo-decrescendo systolic murmur

Question 12

MR murmur

Answer 12

Holosystolic murmur
Harsh
Medium pitched
Best heard @ apex

Question 13

AR murmur

Answer 13

Decrescendo diastolic murmur
Soft, blowing
Best heard @ LLSB

Question 14

CV PE: 8 steps

Answer 14

1. JVD: HOB @ 30 degrees
2. Carotid: inspect, palpate, auscultation with bell
3. Precordium and PMI: inspect and palpate
4. Auscultation with diaphragm- APTM
5. Auscultation with bell- apex, LSB: S1, S2, physiologic splitting
6. L side: with bell @ apex for S3=MS
7. Sit, lean fwd, exhale: with diaphragm for murmurs
8. Palpate pulses: brachial, radial, popliteal, DP, PT

Question 15

S3

Answer 15

Dull, low pitch, apex in LL decub; use bell
Physiological: kids, YAs, 3rd trimester
Pathological: high LV pressure, abrupt development of inflow across MV at the end of diastole d/t decreased contractility, HF, AR, MR, L-R shunt

Question 16

S4

Answer 16

Dull, low pitch, LLSB, use bell at apex
Physiological: athletes, older pts
Patho: vent hypertrophy/fibrosis —> stiffness, increased resistance, decreased compliance; HTN, AS, ICM, HCM (right sided S4 with pHTN, PS)
Never heard in AF