Cardiac Exam

Question 1

Jugular Vein Distension

Answer 1

Sign of R sided heart failure

Bed elevated to 45 degrees (seated or recumbent position)

Veins distend above levels of clavicles = jugular vein distension is present

Question 2

Pitting Edema Scale

Answer 2

Skin rebound time

1+ = barely perceptible depression/pit

2+ = w/in 15 sec

3+ = w/in 15-30 sec

4+ = greater than 30 sec

Question 3

S1 heart sound

Answer 3

“lub”

= Closing of the tricuspid & mitral valves (onset of ventricular diastole)

Auscultate at the 4th and 5th IC space

Question 4

S2 heart sound

Answer 4

“dub”

= Closing of the Aortic and Pulmonic valves (start of ventricular diastole)

Auscultate at 2nd IC space @ sternal border
- R (aortic)
- L (pulmonic)

Question 5

S3 heart sound =

Answer 5

“lub dub dub” (abnormal)

= Possible CHF of ventricular dysfunction (early diastole)

*Heard w/ healthy kids = physiologic 3rd heart sound

Auscultate w/ BELL at apex of heart (5th IC space)

“Kentucky”

Question 6

S4 heart sound

Answer 6

“la lub dub” (abnormal)

= INC resistance to ventricular filling (LATE diastole before S1)

Auscultate at the Apex of the heart w/ the BELL

*Hypertensive cardiac disease, CAD/pulmonary disease, MI, CABG

“Tennessee”

Question 7

Evaluate the Mediastinum for Tracheal shift:

Answer 7

Palpate the trachea - pointer and ring on either side of where SCM heads attach and middle follows trachea down to see if it shifts

Question 8

What does a tracheal shift indicate?

Answer 8

Indicates collapsed lung, disproportionate intrathoracic pressures/lung volumes

Contents shift to:

• Affected side when intrathoracic pressure on that side is DEC (lobectomy, atectasis)
• Unaffected side when INC pressure present (pleural effusion, tumor)

Question 9

Assess chest wall motion/evaluate for symmetry and posture:

Answer 9

Assess segmentally - upper, middle, and lower lobes while patient quietly breaths

Eval for symmtry, posture, and timing of movement

Question 10

Upper lobes

Answer 10

palm of hands = ANT chest wall from 4th rib up

Fingers = stretched over traps

thumbs = over middle of chest

Question 11

Middle lobe / L Lingula =

Answer 11

Fingers LAT over POST axillary folds
Palms over chest wall (under breast tissue)

Question 12

Lower chest wall =

Answer 12

POST back:

Wrap fingers along anterior axillary folds, thumbs around base of scapulae

Question 13

Fremitus

Answer 13

*Pt says “99” , looking for symmtery side to side (nomal/INC/DEC), check upper/middle/lower regions

• Vibration that is produced by the voice or by the presence of secretions in the airways
• Transmitted to the chest wall and palpated by the hand

Normal= uniform vibration throughout the entire chest

Question 14

INC fremitus =

Answer 14

Presence of secretions

Question 15

DEC fremitus =

Answer 15

Presence of AIR

Question 16

Assess diaphragm involvement

Answer 16

Palpate ANT chest wall
thumbs = over costal margins/xyphoid process

Ask patient to breathe in - thumbs should move 2-3 inches apart

Question 17

Evaluate Mediate Percussion

Answer 17

Used to assess diaphragmatic excursion - Performed to evaluate any abnormal findings, especially changes in lung density

Start at T7-12 Use middle finger of non-dom hand and place over posterior back, use dominant hand to ext wrist and hit middle finger of non-dominant hand and note sound (normal/dull/tympanic)

Do this once after asking pt to inhale and hold till you hit a dull sound and mark, and again breathing normally and mark again

Question 18

When performing mediate percussion for diaphragmatic excursion, what direction and how far should diaphragm move?

Answer 18

Diaphragm should move up w/ exhalation (rest) 3-5 cm

(Inhalation diaphragm contracts/moves down)

Question 19

Normal mediate percussion sound =

Answer 19

Resonate (normal lung tissue)

Question 20

Dull mediate percussion sound =

Answer 20

Over the liver or solid organ, more dense tissue, sounds like a “thud” (practice on bare thigh)

May indicate consolidation or a tumor

Question 21

Tympanic mediate percussion sound =

Answer 21

Loud, long and hollow

Can be heard over an empty stomach or hyperinflated chest (emphyzema)