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Physical Diagnosis > Cardiac Exam > Flashcards

Cardiac Exam Flashcards

1
Q

Inspection

What are you looking for?

A
  • 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
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2
Q

Orientation of external jugular vein

A

Superficial and lateral

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3
Q

Soft, rarely palpable

IJV or Carotid artery?

A

Internal jugular vein

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4
Q

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

IJV or Carotid artery?

A

Internal jugular vein

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5
Q

Palpable, single vigorous motion per heartbeat

IJV or Carotid artery?

A

Carotid artery

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6
Q

Pulsations NOT eliminated with light pressure

IJV or Carotid artery?

A

Carotid artery

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7
Q

Pulsations ELIMINATED by light pressure

IJV or Carotid artery?

A

Internal jugular vein

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8
Q

Height of pulsations change with patient position

IJV or Carotid artery?

A

Internal jugular vein

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9
Q

Height of pulsation unchanged by position

IJV or Carotid artery?

A

Carotid artery

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10
Q

Height of pulsation usually falls with inspiration

IJV or Carotid artery?

A

internal jugular vein

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11
Q

Height of pulsations not affected by inspiration

IJV or Carotid artery?

A

Carotid artery

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12
Q

S1

Closing of which valves?

A

Atrioventricular valves

mostly mitral valve

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13
Q

S2

Closing of which valves?

A

Closing of semilunar valves

mostly aortic valve

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14
Q

Splitting of heart sound in S2

A

Aortic and pulmonic component

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15
Q

Extra sounds in systole

What are we auscultating for?

A

Ejection sounds and systolic clicks

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16
Q

Extra sounds in diastole

What are we auscultating for?

A

S3 and S4

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17
Q

Systolic and diastolic murmurs

duration of sound?

A

Sounds of longer duration

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18
Q

Diaphragm of Stethoscope

Type of sound? Examples?

A

-Hear HIGH pitched sounds

Examples:

  • S1
  • S2
  • murmurs of aortic regurgitation
  • murmurs of mitral regurgitation
  • pericardial friction rubs
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19
Q

Bell of Stethoscope

Type of sound? Examples?

A

-hear LOW pitched sound

Examples:

  • S3
  • S4
  • murmurs of mitral stenosis
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20
Q

Aortic area to auscultate

A

RIGHT 2nd interspace

21
Q

Pulmonic area to auscultate

A

LEFT 2nd interspace

22
Q

Tricuspid area to auscultate

A

Left sternal border in 2nd-5th interspace

23
Q

Mitral area to auscultate

A

At apex, midclavicular 5th interspace

24
Q

Which position will help accentuate S3, S4?

A

Left lateral decubitus

25
Q

Which position will help accentuate mitral murmurs?

A

Left lateral decubitus

26
Q

Which position will help accentuate mitral stenosis?

A

Left lateral decubitus

27
Q

Which position will help accentuate aortic murmur?

A

Patient lean forward, exhale and stop breathing on expiration

28
Q

Which position will help accentuate aortic regurgitation?

A

Patient lean forward, exhale and stop breathing on expiration

29
Q

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

A

Bell of stethoscope

30
Q

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

A

Diaphragm of stethoscope

31
Q

You are auscultating patient’s Carotid artery.

Presence of bruit is indicative of what?

A

Narrowing of Carotid artery

32
Q

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

A
  • ischemic heart disease

- stroke

33
Q

Precordium

A

The portion of the body over the heart and lower chest

34
Q

Thrills

A

Vibratory pulsations associated with murmurs

35
Q

Heaves or lifts

A

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

36
Q

You are palpating aortic area in the right 2nd interspace.

Palpable S2 is indicative of what?

A

Systemic hypertension

37
Q

You are palpating aortic area at the right 2nd interspace.

Pulsation in this area is indicative of what?

A

Dilated or aneurysmal aorta

38
Q

IJV waveforms

What is “a”?

A

Atrial contraction

39
Q

IJV waveforms

What is “c”?

A

Tricuspid valve closure

40
Q

IJV waveforms

What is “x”?

A

Atrial diastole

41
Q

IJV waveforms

What is “v”?

A

Passive atrial filling

Ventricular contraction

42
Q

IJV waveforms

What is “y”?

A

Atrial emptying

43
Q

Which IVJ wave precedes S1?

A

“a” wave

“a”= atrial contraction

44
Q

What is the normal JVP measurement above sternal angle?

A

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

45
Q

What is JVP?

A

Distance measured in centimeters above the sternal angle

46
Q

What information does JVP provide?

A

-rapid estimate of “Central Venous Pressure”

—useful in assessing volume status (especially CHF)

47
Q

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

A

Right, because it has the ability to reflect what’s going on in the:

  • Right Atrium,
  • Right ventricular pressure and volume
48
Q

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

A

Carotid artery

49
Q

What is normal JVP measurement above right atrium?

A

Lower than 8cm above right atrium

Physical Diagnosis (3 decks)

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