Cardiology

Question 1

Jugular notch

Answer 1

T2/3

Question 2

Sternal angle and manubriosternal joint

Answer 2

T4/5

Question 3

Xiphersternal joint

Answer 3

T8/9

Question 4

Heart surface projection

Answer 4

Third costal cartilage 1 cm from sternal border

Sixth costal cartilage 1 cm from sternal border

Fifth intercostal space to apex beat at midclavicular

Second intercostal space or costal cartilage 2.5 cm away from sternal border

Question 5

Heave

Answer 5

Hypertrophy of left ventricle

Question 6

Thrill

Answer 6

Hyperkinetic and more sustained apex beat - palpable murmur

Volume overload

Heart failure and mitral and aortic regurgitation.

Question 7

Apex beat on other side

Answer 7

Dextrocardia

Question 8

Apex beat may not be palpable

Answer 8

Patients with thick chest wall, emphysema, pericardial effusion and shock.

Question 9

Location of valves

Answer 9

Pulmonary valve at the level of the 3rd costal cartilage.

Aortic valve at the level of the 3rd intercostal space.

Mitral valve at the level of the 4th costal cartilage.

Tricuspid valve at the level of the 4th intercostal space.

Placing the stethoscope superficial to the blood filled space downstream of a given valve may allow the sound of that valve to be distinguished clearly from the sounds of other valves.

Question 10

Arterial pulse assessments

Answer 10

Pulse rate – usually assessed by palpating right radial pulse and expressed in beats per minute.

Rhythm - usually assessed by palpating right radial pulse. The rhythm can be regular or irregular. Irregular rhythm is usually due to cardiac problems such as atrial fibrillation or ectopic beats.

Character and volume- usually assessed by palpating the right carotid artery pulse which is closest to the heart than the radial pulse.

Symmetry – of radial, brachial, femoral, popliteal, and pedal pulses can be assessed by comparing pulses on both sides.

Radio-femoral delays between major arteries might observed and are abnormal.

Question 11

Venepuncture

Answer 11

Cubital fossa where the veins are usually prominent and easily accessible.

Median cubital vein which often connects the cephalic and basilic veins.

Question 12

Compression of heart from fluid accumulation in pericardial sac

Answer 12

Cardiac tamponade

Treat with pericardiocentesis (left fifth ICS near sternal border perpendicular to chest wall or left subxiphisternal toward left shoulder or left nipple in men advancing posteriorly and superiorly)

Question 13

Abnormal heart sounds

Answer 13

AS, AR, MS, MR

Ejection sys, early dia, mid dia, pansys

Carotid artery, aortic valve leaning forward, apex beat lying on left side, apex beat lying on left side

Question 13

Common cause of irregularly irregular rhythm

Answer 13

Atrial fibrillation

Question 14

Lateral or inferior shift in apex beat

Answer 14

Cardiomegaly

Question 15

Causes of left ventricular hypertrophy

Answer 15

Hypertension, AS

Question 16

Cause of right ventricular hypertrophy

Answer 16

Pulmonary hypertension