Cardiovascular

Question 1

JVD is a sign of what?

Answer 1

increased right atrial pressure

Question 2

How do u position the pt for JVD analysis?

Answer 2

Raise the head of the bed or examining table to 30°
Turn the patient’s head gently to the left
Identify the topmost point of the flickering venous pulsations

Question 3

How do u measure JVD?

Answer 3

Place a centimeter ruler upright on the sternal angle (Angle of Louis)
Place a card or tongue blade horizontally from the top of the JVP to the ruler, making a right angle
Measure the distance above the sternal angle in centimeters, add 5cm (since the Right Atrium is 5cm below sternal angle
A 0 - 8 centimeter elevation is normal

Question 4

Before you palp the carotids, what should u do?

Answer 4

auscultate for bruits

Question 5

What should u hear in the carotids normally?

Answer 5

nothing

Question 6

What will u hear if there is carotid stenosis?

Answer 6

you may hear a Whooshing sound – like the Karotkoff sounds when checking BP

Question 7

How do u position the pt for a chest palpation?

Answer 7

Stand on the right side of the patient
Drop gown, keep sheet over lower extremities
Palpate shape of chest wall, PMI, Heaves

Question 8

How do u find the PMI?

Answer 8

Inspect the left anterior chest for a visible PMI

Using your fingerpads, palpate at the apex for the PMI

Question 9

What are the characteristics of the PMI?

Answer 9

Tapping, or normal
Sustained — suggests LV hypertrophy from hypertension or aortic stenosis, or
Diffuse — suggests a dilated ventricle from congestive heart failure or cardiomyopathy

Question 10

How do u measure the PMI?

Answer 10

Locate the PMI by interspace and distance in centimeters from the midsternal line

Question 11

What things are u palpating for in the chest?

Answer 11

heaves or thrills

Question 12

What is systole?

Answer 12

The right ventricle pumps blood into the pulmonary arteries (pulmonic valve is open)
The left ventricle pumps blood into the aorta(aortic valve is open)

Question 13

What is diastole?

Answer 13

The ventricles relax
Blood flows from the right atrium → right ventricle (tricuspid valve is open)
Blood flows from the left atrium → left ventricle (mitral valve is open)

Question 14

What is the diaphragm of the stethoscope best for?

Answer 14

high-pitched sounds like S1, S2, and also S4 and most murmurs

Question 15

What is the bell of the stethoscope best for?

Answer 15

low-pitched sounds like S3 and rumble of mitral stenosis

Question 16

What is S1 and S2?

Answer 16

S1 closure of AV valves

S2 closure of Semilunar valves

Question 17

What is the splitting of S2?

Answer 17

Right sided pressures are lower than the left
Right sided events occur slightly later than left
Example: the aortic valve closes slightly before the pulmonic valve (A2 before P2)
Inspiration causes (accentuates) a split
With expiration the split may disappear

Question 18

What is an ejection click?

Answer 18

early systole

Sound of diseased aortic valve opening

Question 19

What is an opening snap?

Answer 19

early diastole

Sound of diseased mitral valve snapping open

Question 20

What is S3?

Answer 20

Rapid deceleration of blood
Decreased compliance such as heart failure
May be normal in children and young adults

Question 21

What is S4?

Answer 21

Atrial kick against non-compliant ventricular wall

Question 22

What are the shapes of murmurs?

Answer 22

Crescendo, decrescendo, or both (sometimes called diamond-shaped)

Question 23

Give the grades of murmurs from 1-6

Answer 23

Grade 1 – very faint, possibly not heard in all positions
Grade 2 – Easily heard but faint
Grade 3 – Moderately loud
Grade 4 – Loud with palpable thrill
Grade 5 – Heard with stethoscope partially off chest
Grade 6 – Heard with stethoscope off the chest

Question 24

What do u hear in left lateral decubitis?

Answer 24

Mitral stenosis, S3, S4

Question 25

What do u hear in Sitting, leaning forward, breath out and hold?

Answer 25

Aortic murmur

Question 26

What can u hear in Standing, squatting, valsalva?

Answer 26

MVP, aortic stenosis

Question 27

What do u auscultate in the abdomen?

Answer 27

Aorta
Renal
Iliac
Femoral

Question 28

What do u palpate in the abdomen?

Answer 28

Using a two sided approach to approximate the diameter of the Aorta
2 cm is “normal”
May not be palpable at all in large patients

Question 29

What is the 0-4 scale of edema?

Answer 29

1 – ankle
2 – tibia
3 – femur
4 – sacrum

Question 30

What are varicosities?

Answer 30

Caused by faulty valves in the veins

Can be uncomfortable as well as unsightly

Question 31

What is stasis dermatitis?

Answer 31

Caused by venous insufficiency
Skin is scaly and discolored by hemoglobin from extravasated RBCs
Can lead to ulcers which are very slow to heal

Question 32

What are the characteristics of arterial insufficieny?

Answer 32

Smooth, waxy and pale skin
No hair growth
Can lead to eventual ulceration of the skin
NOT to be confused with depilation in a healthy female

Question 33

What does splinter hemorrhages indicate?

Answer 33

Associated with endocarditis
Caused by tiny clots that damage the capillaries
These are occurring throughout the body but they are only visible under the finger nails.-

Question 34

What are the 6 arterial palpation points for extremities?

Answer 34

Radial
Brachial
Femoral
Popliteal
Dorsalis pedis
Posterior tibialis

Question 35

Describe the allen test

Answer 35

Palm up
Have patient clench fist
Compress both arteries
Have patient open the hand
Observe the palmer pallor
Release the ulnar artery
Finding
Normal – entire hand turns pink in 3-5 seconds
Abnormal – only medial half of hand turns pink
If abnormal repeat and release radial artery

Question 36

What is the homan sign?

Answer 36

Check for Deep Venous Thrombosis (DVT)
With the knee in flexion, the examiner forcefully dorsiflexes the ankle
Calf or popliteal pain occurs in approximately 35% of the patients with DVT
Homan sign is neither sensitive nor specific for DVT