Cardiac Exam Competency

Question 1

Where is the listening post for the aortic valve?

Answer 1

Right 2nd ICS at sternal border (Right upper sternal border)

Question 2

Where is the listening post for the pulmonary valve?

Answer 2

Left 2nd ICS at sternal border (left upper sternal border)

Question 3

Where is the listening post for the tricuspid valve?

Answer 3

Left 4th ICS at sternal border (left lower sternal border)

Question 4

Where is the listening post for the mitral valve?

Answer 4

Left 5th ICS at mid-clavicular line (at heart apex)

Question 5

What are the 6 peripheral pulses?

Answer 5

RadialBrachialFemoralPoplitealDorsalis edisPosterior tibial

Question 6

What can a slow capillary refill be indicative of?

Answer 6

Arterial occlusionHypovolemic shockHypothermia

Question 7

What is a normal capillary refill time?

Answer 7

2 seconds or less

Question 8

How is pitting edema graded?

Answer 8

0 = absent1 = barely detectable nonpitting (2mm)2 = slight indentation (4mm); 10-15 sec3 = Deeper indentation (6mm); can be >1min4 = very marked indentation (8mm); 2-5 min

Question 9

How do you examine for pitting edema/in what 3 places do you assess?

Answer 9

By pressing firmly for 5 seconds over the dorsum of the foot, behind the medial malleolus, or over anterior tibia

Question 10

What do you assess for at the carotid pulse?

Answer 10

Thrills and bruit -> can use stethoscope bell

Question 11

How are heart murmurs graded?

Answer 11

1 = very faint2 = quiet, but heard easily with stethoscope3 = moderately loud, no thrill4 = loud with palpable thrill5 = very loud with stethoscope partially off chest6 = heard without stethoscope

Question 12

During which heart sounds is a systolic murmur heard?

Answer 12

Between S1 and S2

Question 13

During what heart sounds is a diastolic murmur heard?

Answer 13

Between S2 and S1

Question 14

What high pitched sounds are listening for with the diaphragm of your stethoscope?

Answer 14

S1S2ARMRFriction rub

Question 15

What low pitched sounds are you listening for with the bell of your stethoscope?

Answer 15

S3S4MSCarotid bruit

Question 16

What are the landmarks used for inspecton during a normal cardiac exam?

Answer 16

Sternal notch and angleSternal borderMid clavicular lineAnterior axillary lineXiphoid processNipples

Question 17

What is the point of maximal impulse (PMI) used to estimate?

Answer 17

The location of the apex/left border

Question 18

What are characteristics of a normal point of maximal impulse (PMI)?

Answer 18

• Should be small, brisk beat and measure less than 2.5cm- Should last through the first 2/3 of the systolic period (or less) - SHouldnt be felt through the second heart sound

Question 19

What is the proper way to percuss when performing a normal cardiac exam?

Answer 19

Start left where “resonant” (lung) and move medially to find cardiac “dulness”- Use percussion to estimate cardiac size when PMI not detectable

Question 20

What should S3 and S4 dound like?

Answer 20

Dull and low pitched -> heard best with bell of stethoscope

Question 21

What are systolic murmurs indicative of?

Answer 21

Aortic stenosisPulmonary stenosisMitral regurgitationTricuspid regurgitation

Question 22

What are diastolic murmurs indicative of?

Answer 22

Aortic regurgitation Pulmonic regurgitation MItral stenosisTricuspid stenosis

Question 23

Where is the carotid pulse felt?

Answer 23

Medial to the SCM

Question 24

How are peripheral pulses graded?

Answer 24

4 = bounding 3 = strong, full, increased2 = normal, average intensity1 = diminished, barely palpable0 = absent

Question 25

What is Erb’s point and where is it heard?

Answer 25

the point at which S1 and S2 are heard equally; heard at L 3rd ICS at SB

Question 26

Pressure on the carotid baroreceptors when taking a carotid pulse may cause what?

Answer 26

A hypotensive reflex and possible fainting

Question 27

What 3 things in particular can capillary refill test for?

Answer 27

Tests for digital perfusion so it can test for arterial occlusion, hypovolemic shock and hypothermia