Cardiovascular

Question 1

Demonstrate the surface marking of the borders of the heart

Answer 1

Upper border
• 3rd right CC, 1cm from sternal border
• To 2nd left ICS, 2.5cm from sternal border

• Left border - to 5th ICS at MCL
• Lower border - to 6th right CC, 1cm from sternal border
• Right border - back up to 3rd right CC

Question 2

Demonstrate where you would auscultate for the valves using a stethoscope

Answer 2

• Aortic - right 2nd ICS at sternal border
• Pulmonary - left 2nd ICS at sternal border
• Tricuspid - left 5th ICS at sternal border
• Mitral - left 5th ICS at MCL (location of apex beat)

(you’re listening downstream of the valves)

Question 3

How do you take and describe the pulse?

Answer 3

• Index and middle finger
• 30s x2 (explain to examiner than 1min would be ideal)
• Note whether pulse is has a normal (sinus) rhythm or is irregular

Question 4

Demonstrate the surface marking of the apex beat of the heart and demonstrate palpation

Answer 4

• Ask patient to lie at 45º angle
• Count down to 5th ICS from sternal angle
• Start more laterally then move medially towards MCL (to eliminate possibility of lateral deviated apex beat)
• Palpate by having palm of hand on patient and using middle 3 fingers
• Middle finger at ICS, and other 2 fingers on ribs above and below

Question 5

Give a physiological and pathological cause of apex beat absence

Answer 5

• Physiological - dextrocardia

* Pathological - pericardial effusion

Question 6

Demonstrate the sites of routine venepuncture

Answer 6

• Show borders of cubital fossa: brachioradialis (lateral), pronator teres (medial), line between epicondyles (superior)
• Locate biceps brachii tendon
• Median cubital vein is medial to the tendon

(anastomosis of cephalic and basilic veins)

Question 7

Describe and demonstrate the surface marking of the arch of the aorta

Answer 7

ascending aorta =>
• Beginning of arch - right 2nd CC
• Upper border reaches bottom part of manubrium
• End of arch - left 2nd CC
=> thoracic aorta

Question 8

Describe and demonstrate the surface markings of the internal jugular vein + common carotid artery

Answer 8

Right common carotid
• from brachiocephalic trunk
• ask patient to turn head left
• draw line from right sternoclavicular joint to earlobe
• along anterior border of SCM

Left common carotid
• from aortic arch
• ask patient to turn head right
• draw line from sternal angle to left earlobe
• along anterior border of SCM

Jugular veins
• draw lines from from respective sternoclavicular joints to earlobes
• run lateral to carotid arteries

Question 9

Describe the location of the heart valves

Answer 9

All behind the sternum
• Pulmonary - 3rd CC
• Aortic - 3rd ICS
• Mitral - 4th CC
• Tricuspid - 4th ICS

Question 10

Describe the placement of the ECG leads

Answer 10

• V1 - 4th ICS, right border of sternum
• V2 - 4th ICS, left border of sternum
• V4 - 5th ICS, MCL
• V5 - Same level as V4, anterior axillary line
• V6 - Same level as V4/5, MAL

• V3 - between V2 and V4

Arm (between shoulder and elbow) and leg leads