cardio exam

Question 1

At what angle should the patient’s head be positioned for the cardio exam?

Answer 1

45 degrees

Question 2

Before you do anything else in the cardio exam, what three things should you do?

Answer 2

Wash your hands

Tell the patient who you are and obtain consent

Examine the praecordium and general appearance

Question 3

Why is the head positioned upwards for the cardio exam?

Answer 3

To allow the JVP (jugular venous pressure) to be assessed

Question 4

What is the first step of the cardio exam proper?

Answer 4

Examination of the hands

Question 5

How are the hands correctly examined in the cardio exam?

Answer 5

First looking at the nails (clubbing) and finger ends

Then looking at palmar creases etc

Question 6

What is examined after the hands in the cardio exam?

Answer 6

The radial pulse

Question 7

What should be noted about the radial pulse in the cardio exam?

Answer 7

Rate of pulse

Rhythm

Presence or absence of delay of the femoral pulse compared with the radial pulse

Question 8

Is the volume and character of the pulse best felt at the radial artery or the brachial artery?

Answer 8

Brachial

Question 9

What should be measured after the radial pulse in the cardio exam?

Answer 9

Blood pressure

Question 10

Where is the best place for the bladder of the blood pressure cuff to be placed?

Answer 10

The antecubital fossa on the medial arm

Question 11

Is it important if the bladder of the blood pressure cuff is not at the level of the heart?

Answer 11

Yes – will add to or subtract from the blood pressure reading if it isn’t on the level of the heart

Question 12

If the bladder of the blood pressure cuff is lower than the heart, would you expect that to add to the actual blood pressure or subtract from it?

Answer 12

Add to it

Reading will be higher if the cuff is lower

Question 13

What is the name of the sounds that you can hear in your stethoscope while listening during blood pressure measurement?

Answer 13

Korotkoff sounds

Question 14

How many korotkoff sounds are there?

Answer 14

5

Question 15

What is the austultatory gap?

Answer 15

When the korotkoff sounds disappear just under the systolic pressure and reappear before the diastolic pressure

Question 16

After the blood pressure and radial pulse are assessed, what is the next step in the cardio exam?

Answer 16

Examination of the face

Question 17

How do you examine the face in the cardio exam?

Answer 17

Look at the sclera (jaundice)

Into the mouth at the palate (Marfan if it’s high), teeth (IE), ask the patient to stick the tongue out and look at lips for central cyanosis

Question 18

After the face, what is examined in the cardio exam?

Answer 18

The neck

Question 19

How is the neck examined in the cardio exam?

Answer 19

Palpate the carotid arteries

JVP height should be assessed

Question 20

What is examined after the neck in the cardio exam?

Answer 20

The praecordium

Question 21

Must the praecordium be inspected before commencing with its examination in the cardio exam?

Answer 21

Yes – looking for things such as scars, pectus excavitatum (Marfans; also, deformity of the chest can change the places where you expect to find heart sounds), pace-maker

Also look for the apex beat but if you can’t see it then you will palpate for it

Question 22

How is the praecordium palpated in the cardio examination?

Answer 22

Apex beat at 5th intercostal, 1cm medial to midclavicular line

Parasternal impulse at the left of the sternum with the finger lifted slightly off the chest (right ventricular enlargement if present)

Thrills can be felt with the palm of the hand starting left sternum, moving laterally across the base of the heart (superior). Apical thrills felt with patient rolled on to left side, basal thrills felt best with patient sitting up leaning forward in full expiration

Question 23

Should the chest be listened to (auscultation) or tapped (percussed) first?

Answer 23

Percussion and then auscultation

Question 24

How should the praecordium be percussed?

Answer 24

Midclavicular line moving inferiorly to find base of heart, then anterior axillary line towards sternum in 5th intercostal space to find the left border

Question 25

How should the praecordium be auscultated during the cardio exam?

Answer 25

Bell of stethoscope first below nipple, then diaphragm (mitral)

Next, 5th intercostal space parasternally with diaphragm (tricuspid)

Then, 2nd intercostal space parasternally on the left (pulmonary artery)

Then, 2nd intercostal space parasternally on the right (aorta)

Question 26

After examination of the praecordium in the cardio exam, what is the next step?

Answer 26

Auscultation of the lung fields

Look for pitting oedema of the sacrum

Question 27

After examination of the back in the cardio exam, what is the next step?

Answer 27

The abdomen

Looking at the size of the liver (RHF)

Looking at the size of the spleen (IE)

Question 28

After examination of the abdomen in the cardio exam, what is the next step?

Answer 28

Examination of the lower limbs

Question 29

What signs are you looking for in the lower limbs in the cardio exam?

Answer 29

Pitting oedema

Scars

Ulcers

Varicose veins

Question 30

What are some tests you should do on the lower limbs in the cardio exam?

Answer 30

Palpate for temperature and popliteal, posterior tibial and dorsalis pedis pulses