Cardio Exam

Question 1

Which sounds do you use the diaphragm for?

Answer 1

high pitched sounds

S1, S2, AR, MR, Friction Rub

Question 2

Which sounds do you use the bell for?

Answer 2

low pitched sounds

S3, S4, MS, carotid

Question 3

Steps to CV exam

Answer 3

1) inspection
2) palpation
3) percussion
4) auscultation

Question 4

Palpation of PMI

Answer 4

impulse should be small, brisk beat and measure less than 2.5 cm
should last through the first 2/3 of the systolic period or less, should not be felt through the second heart sound

Question 5

S1

Answer 5

closure of tricuspid and mitral

Question 6

S2

Answer 6

closure of aortic and pulmonary

may split with inspiration (normal)

Question 7

S3 Ken-Tuck-Y

Answer 7

dull, low pitch, best heard with bell

due to high pressures and abrupt deceleration of inflow across the mitral valve at the end of the rapid filling phase

Question 8

S4 Ten-Nes-See

Answer 8

dull, low pitch, best heard with bell

atrial gallop from forceful contraction of atria against a stiffened ventricle

Question 9

Systolic Murmurs

Answer 9

• between S1 and S2
• Aortic Stenosis
• Pulmonic Stenosis
• Mitral Regurgitation
• Tricuspid Regurgitation

Question 10

Diastolic Murmurs

Answer 10

• between S2 and S1
• Aortic Regurgitation
• Pulmonic Regurgitation
• Mitral Stenosis
• Tricuspid Stenosis

Question 11

Heart Murmur Grading

Answer 11

1- very faint
2- quiet, but heard easily with stethoscope
3- moderately loud, no thrill
4- loud with palpable thrill
5- very loud with thrill
6- heard with stethoscope entirely off chest

Question 12

Pulse Grading

Answer 12

4- bounding
3- string, full, increased
2- average
1- diminished, barely palpable
0- absent, not palpable

Question 13

Cap Refill

Answer 13

• test of digital perfusion
• apply pressure to fingernail for several seconds
• release
• note time it takes for color to return
• normal refill is 2 seconds of less

Question 14

Edema Locations

Answer 14

1) dorsum of the foot
2) anterior tibia
3) posterior medial malleolus

Question 15

Grading for Edema

Answer 15

Absent
1- barely detectable, slight pitting (2mm); disappears rapidly
2- slight indentation (4mm); 10-15 seconds
3- deeper indentation (6mm); may be >1 minute
4- very marked indentation (8mm); 2-5 minutes

Question 16

JVP

Answer 16

• raise head of bed or examining table 30 degrees
• turn patients head away from side inspecting
• identify right internal jugular pulsation
• identify the highest point of pulsation in the right internal jugular vein
• measure the vertical distance in cm above the sternal angle where the horizontal object crosses the ruler and add to this distance 5 cm

Question 17

Allen Test

Answer 17

• evaluates functioning of radial and ulnar arteries
• occlude both arteries while patient makes a fist
• have patient open and close fist; palm should be pale
• release pressure on ulnar artery and observe for color to return to hand within 5-10 seconds
• repeat with radial ulnar