CARDIOVASCULAR

Question 1

Surface markings of the borders of the heart

Answer 1

anticlockwise: 3rd RCC –> 6th RCC –> 5th Left ICS @MCL –> 2nd Left ICS 2.5 cm from sternum –> 3rd RCC

Question 2

Where would you auscultate the heart valves?

Answer 2

Aortic = right 2nd ICS at sternal border
Pulmonary = lefts 2nd ICS at sternal boder 
Tricuspid = left 5th ICS at sternal border
Mitral = left 5th ICS at MCL

Question 3

Anatomical locations of the heart valves

Answer 3

All lie under the sternum 
Aortic = right 3rd ICS 
Pulmonary = left 3rd CC 
Tricuspid = right 4th ICS 
Mitral = left 4th CC

Question 4

examine the carotid pulse

Answer 4

anterior to sternocleidomastoid lateral to larynx - count for 30s and multiply by 2 - report pulse rate (normal 60-100bpm) and rythm (normal or irregular)

Question 5

examine the brachial pulse

Answer 5

mid arm: medial side between biceps and triceps tendons

OR

cubital fossa: medial to biceps tendon

• count for 30s and multiply by 2 - report pulse rate (normal 60-100bpm) and rythm (normal or irregular)

Question 6

examine the radial pulse

Answer 6

radial side of rist 2cm bellow base of thumb

• count for 30s and multiply by 2 - report pulse rate (normal 60-100bpm) and rythm (normal or irregular)

Question 7

examine the ulnar pulse

Answer 7

ulnar side of wrist under lateral border of flexor carpi ulnaris

• count for 30s and multiply by 2 - report pulse rate (normal 60-100bpm) and rythm (normal or irregular)

Question 8

tachycardia vs bradycardia pulse rates

Answer 8

tachy = >100bpm resting 
brady = <60bpm resting

Question 9

palpate the apex beat

Answer 9

at left 5th ICS at MCL - with palm and middle 3 fingers - start palpating from lateral side and move anteriorly

Question 10

causes of absence of apex beat at 5th ICS

Answer 10

"DR. POPE" 
D - dextrocardia 
R - ribs
P - pericardial effusion
O - obesity 
P - pleural effusion 
E - emphysema

Question 11

Routine venepuncture sites

Answer 11

Antebrachial vein (branch off of median cubital vein)
median cubital vein  (connects the cephalic and basilic veins in the cubital fossa) 

• ask patient to repeatedly make fists while you restrict blood flow (use hands as a tourniquet)

Question 12

Boders of the cubital fossa

Answer 12

medial border = brachioradialis
lateral border = pronator teres
superior border = line between epicondyles of humerus

Question 13

contents of cubital fossa

Answer 13

laterally to medially: 
radial nerve
biceps brachii tendon 
median cubital vein
brachial artery 
median nerve

Question 14

surface markings of the aortic arch

Answer 14

beginning of arch = Right 2nd CC
top of arch = midpoint between jug notch and sternal angle
end of arch = Left 2nd CC

Question 15

branches off the aorta

Answer 15

from R to L
brachiocephalic trunk (becomes r common carotid and subclavian arteries)
left common carotid
left subclavian

Question 16

surface markings of ascending and descending aorta

Answer 16

AA = lower border of R 3rd CC to R 2nd CC
DA = L 2nd CC to 2.5cm superior to transpyloric plane

Question 17

surface markings of common carotid arteries and internal jugular veins

Answer 17

right CC = from brachiocephalic trunk to under right SCM muscle (point on anterior border of SCM from sternoclavicular joint to earlobe)

left CC = from aortic arch to under L SCM

Jugular veins - run just lateral to CC

Question 18

what structures does the right coronary artery supply

Answer 18

right atrium
right ventricle
SA node
AV node

Question 19

structures supplied by the left main coronary artery

Answer 19

left ventricle
left atrium
(gives rise to circumflex artery)

Question 20

where does the coronary sinus drain

Answer 20

into the right atrium

Question 21

Position of patient in cardio exam

Answer 21

supine with bed at 45 degrees