Cardiac Exam

Question 1

Inspection

What are you looking for?

Answer 1

• Skin, nails, conjunctiva
• Internal Jugular Vein
• Carotid Artery
• Chest Wall: deformities, body habitus, scars
• Precordium: check point of maximal impulse which normally is the apical impulse, abnormal pulsation, and/or bulging

Question 2

Orientation of external jugular vein

Answer 2

Superficial and lateral

Question 3

Soft, rarely palpable

IJV or Carotid artery?

Answer 3

Internal jugular vein

Question 4

Soft, undulating, 2 elevations and 2 troughs per heart beat

IJV or Carotid artery?

Answer 4

Internal jugular vein

Question 5

Palpable, single vigorous motion per heartbeat

IJV or Carotid artery?

Answer 5

Carotid artery

Question 6

Pulsations NOT eliminated with light pressure

IJV or Carotid artery?

Answer 6

Carotid artery

Question 7

Pulsations ELIMINATED by light pressure

IJV or Carotid artery?

Answer 7

Internal jugular vein

Question 8

Height of pulsations change with patient position

IJV or Carotid artery?

Answer 8

Internal jugular vein

Question 9

Height of pulsation unchanged by position

IJV or Carotid artery?

Answer 9

Carotid artery

Question 10

Height of pulsation usually falls with inspiration

IJV or Carotid artery?

Answer 10

internal jugular vein

Question 11

Height of pulsations not affected by inspiration

IJV or Carotid artery?

Answer 11

Carotid artery

Question 12

S1

Closing of which valves?

Answer 12

Atrioventricular valves

mostly mitral valve

Question 13

S2

Closing of which valves?

Answer 13

Closing of semilunar valves

mostly aortic valve

Question 14

Splitting of heart sound in S2

Answer 14

Aortic and pulmonic component

Question 15

Extra sounds in systole

What are we auscultating for?

Answer 15

Ejection sounds and systolic clicks

Question 16

Extra sounds in diastole

What are we auscultating for?

Answer 16

S3 and S4

Question 17

Systolic and diastolic murmurs

duration of sound?

Answer 17

Sounds of longer duration

Question 18

Diaphragm of Stethoscope

Type of sound? Examples?

Answer 18

-Hear HIGH pitched sounds

Examples:

• S1
• S2
• murmurs of aortic regurgitation
• murmurs of mitral regurgitation
• pericardial friction rubs

Question 19

Bell of Stethoscope

Type of sound? Examples?

Answer 19

-hear LOW pitched sound

Examples:

• S3
• S4
• murmurs of mitral stenosis

Question 20

Aortic area to auscultate

Answer 20

RIGHT 2nd interspace

Question 21

Pulmonic area to auscultate

Answer 21

LEFT 2nd interspace

Question 22

Tricuspid area to auscultate

Answer 22

Left sternal border in 2nd-5th interspace

Question 23

Mitral area to auscultate

Answer 23

At apex, midclavicular 5th interspace

Question 24

Which position will help accentuate S3, S4?

Answer 24

Left lateral decubitus

Question 25

Which position will help accentuate mitral murmurs?

Answer 25

Left lateral decubitus

Question 26

Which position will help accentuate mitral stenosis?

Answer 26

Left lateral decubitus

Question 27

Which position will help accentuate aortic murmur?

Answer 27

Patient lean forward, exhale and stop breathing on expiration

Question 28

Which position will help accentuate aortic regurgitation?

Answer 28

Patient lean forward, exhale and stop breathing on expiration

Question 29

Which side of stethoscope will help you accentuate sounds while patient is in left lateral decubitus?

Answer 29

Bell of stethoscope

Question 30

Which side of stethoscope will accentuate sounds while patient is leaning forward?

Answer 30

Diaphragm of stethoscope

Question 31

You are auscultating patient’s Carotid artery. | Presence of bruit is indicative of what?

Answer 31

Narrowing of Carotid artery

Question 32

You that prevalence of patients with Asymptomatic bruits increases with age. What 2 associated conditions increases risk by 3-folds as you age?

Answer 32

- ischemic heart disease | - stroke

Question 33

Precordium

Answer 33

The portion of the body over the heart and lower chest

Question 34

Thrills

Answer 34

Vibratory pulsations associated with murmurs

Question 35

Heaves or lifts

Answer 35

Movement of the thorax and ribs as a result of forceful ventricular contraction or hyper dynamic muscle

Question 36

You are palpating aortic area in the right 2nd interspace. Palpable S2 is indicative of what?

Answer 36

Systemic hypertension

Question 37

You are palpating aortic area at the right 2nd interspace. Pulsation in this area is indicative of what?

Answer 37

Dilated or aneurysmal aorta

Question 38

IJV waveforms What is “a”?

Answer 38

Atrial contraction

Question 39

IJV waveforms What is “c”?

Answer 39

Tricuspid valve closure

Question 40

IJV waveforms What is “x”?

Answer 40

Atrial diastole

Question 41

IJV waveforms What is “v”?

Answer 41

Passive atrial filling | Ventricular contraction

Question 42

IJV waveforms What is “y”?

Answer 42

Atrial emptying

Question 43

Which IVJ wave precedes S1?

Answer 43

“a” wave | “a”= atrial contraction

Question 44

What is the normal JVP measurement above sternal angle?

Answer 44

Less than 3cm** —4cm above the sternal angle

Question 45

What is JVP?

Answer 45

Distance measured in centimeters above the sternal angle

Question 46

What information does JVP provide?

Answer 46

-rapid estimate of “Central Venous Pressure” | —useful in assessing volume status (especially CHF)

Question 47

Which side should you inspect the JVP? Left or right? Why?

Answer 47

Right, because it has the ability to reflect what’s going on in the: - Right Atrium, - Right ventricular pressure and volume

Question 48

If you palpate just medial to the SCM at the lower 3rd of the neck, what are you palpating?

Answer 48

Carotid artery

Question 49

What is normal JVP measurement above right atrium?

Answer 49

Lower than 8cm above right atrium