cardiovascular exam

Question 1

where are the 4 places used on the cardiovascular exam

Answer 1

atrial
pulmonary
tricuspid
mitral

always pay tra…velers money

Question 2

where can you examine the aortic valve from

Answer 2

the upper right sternal border of the right intercostal space

Question 3

where can you examine the pulmonary valve

Answer 3

upper left sternal border at the level of the 2nd left intercostal space

Question 4

where can you examine the tricuspid valve

Answer 4

lower left sternal angle of the left 4th intercostal space

Question 5

where can you examine the mitral valve

Answer 5

over the apex beat point - 5th left intercostal space along the mid-clavicular line

Question 6

where do you find the carotid pulse

Answer 6

in the neck, medial to the sternocleidomastoid muscle

Question 7

where do you find the brachial pulse

Answer 7

2cm above the elbow joint - medially, beside/ underneath biceps tendon

Question 8

where do you find the radial pulse

Answer 8

proximal to the wrist joint, on the radial side

Question 9

where do you find the femoral pulse

Answer 9

half way between the hip and mid way in the crease in the leg and push in (and a bit up)

Question 10

where do you find the popliteal pulse

Answer 10

behind knee join, halve them bend knee, once in position ask to take their legs weight

Question 11

where do you find the posterior tibial pulse

Answer 11

inside of the leg, behind the ankle joint

Question 12

where do you find the dorsalis pedis pulse

Answer 12

on the bone 3cm (ish) up between the big and 2nd toe

Question 13

how is rate calculated

Answer 13

15 seconds multiply

Question 14

how can be rhythm described

Answer 14

regular, regularly-irregular, irregularly-irregular

Question 15

what can the volume of the radial pulse be described as

Answer 15

normal, bounding, full, thread, low volume

Question 16

what are you looking for on the hands and arms of a patient in the cardiovascular exam

Answer 16

tar staining 
warm and sweaty hands 
peripheral cyanosis 
clubbing 
splinter haemorrhages 
capillary refill 
fine tremor
iv tract marks

Question 17

what should you be looking for when examining the head in the cardiovascular exam

Answer 17

malar flush

anaemia - lower eyelids

look for sings of xanthelasmata

corneal arcus

look for central syanosis

iron deficiency - angular sotmatits

Question 18

what should you look for on the lower leg examination of the cardiovascular exam

Answer 18

pitting odema

atrial disease

varicose veind

Question 19

what should you be looking for when examining the head in the cardiovascular exam

Answer 19

malar flush

anaemia - lower eyelids

look for sings of xanthelasmata

corneal arcus

look for central cyanosis

iron deficiency - angular stomatitis

Question 20

what is xanthelasmata

Answer 20

sharply demarcated yellowish deposit of cholesterol underneath the skin - linked to atherosclerosis

Question 21

what is corneal arcus

Answer 21

where white arcs appear on the cornea (coloured part of eye) makes the bored look fuzzy

Question 22

what is angular stomatitis

Answer 22

erythema and maceration (redness and broken skin) of the skin adjacent to the angle of the mouth.

Question 23

what should you look for on the lower leg examination of the cardiovascular exam

Answer 23

pitting oedema

atrial disease

varicose veins

Question 24

how do you examine for pitting oedema

Answer 24

inside of the leg - couple of inches above the ankle

firm pressure with thumb - for 15 seconds

should leave indentation

Question 25

what are you looking for to suggest atrial disease

Answer 25

cold, smooth, hairless skin with increased capillary refill time in the toe, and arterial leg ulcers

Question 26

how do you examine for varicose veins in the legs

Answer 26

ask the patient to stand and look on both the front and back of legs

Question 27

what is the normal range for JVP

Answer 27

under 4cm

Question 28

what does JVP stand for

Answer 28

jugular venous pulse

Question 29

how is JVP measured

Answer 29

vertical height of the flickering column from the sternal angle

Question 30

what must be done when looking for the JVP

Answer 30

the patient must be at 45 degrees when palpated you should not feel a pulse (making sure its not the carotid) relaxes their head and leans it to their left

Question 31

where is the JVP located

Answer 31

it lies between the sternal and clavicular heads of the sternocleidomastoid muscle

Question 32

what is the best way to see the JVP

Answer 32

from a lateral angle - even from a bit behind the patient

Question 33

what are you doing in the inspection of the precordium (front of chest) in the cardiovascular exam)

Answer 33

inspectiong palpating and ascultating

Question 34

what are you looking for on inspection of the precordium

Answer 34

any chest deformities - kyphoscoliosis or pectus excavatum any scars any pace maker - left infra-clavicular area visible pulsation

Question 35

what are you examining on palpation

Answer 35

trackeal position cardiac pacemaker apex beat heaves thrills

Question 36

what are you examining on palpation

Answer 36

tracheal position cardiac pacemaker apex beat heaves thrills

Question 37

what is the apex beat

Answer 37

the most lateral and inferior palpable pulsation

Question 38

what are heaves

Answer 38

when the hand is easily lifted with the chest

Question 39

what are thrills

Answer 39

a palpable buzz - usually a systolic murmur

Question 40

how do you examine for heaves

Answer 40

press flat hand firmly on to the left side of the sternum

Question 41

how do you examine for thrills

Answer 41

place hand on apex beat and both sides of the sternum

Question 42

what are the 3 parts to auscultation during the cardiovascular exam

Answer 42

listen to all 4 valve areas (diaphragm and bell0 listen for left side systolic murmurs listen for left side diastolic murmurs

Question 43

what is the S1 sounds

Answer 43

mitral and tricuspid valve closure (onset of systole)

Question 44

what are the S2 sounds

Answer 44

aortic and pulmonary valve closes (onset of diastole)

Question 45

when are 3rd heart sounds heard

Answer 45

heard in diastole

Question 46

when are 4th heart sounds heard

Answer 46

less common and occurs just before S1

Question 47

when should you listen for murmurs

Answer 47

listen between S1 and S2 (systolic) listen between S2 and S1 (diastolic)

Question 48

what are the 4 valve areas

Answer 48

atrial pulmonary tricuspid mitral

Question 49

what should you do when auscultating the 4 valve areas

Answer 49

palpate the carotid pulse - pulses at the same time as S1

Question 50

what to things are you listening for when looking for left side systolic murmurs

Answer 50

aortic stenosis mitral regurgitation

Question 51

how do you examine for aortic stenosis

Answer 51

DIAPHRAGM listen over aortic valve again, then over both carotid arteries for murmur and high pitched injection (systolic between S1 and S2)

Question 52

how do you examine for mitral regurgitation

Answer 52

DIAPHRGM listen again over the apex beat and then the left axilla for pansystolic murmur

Question 53

when/ how do you auscultate for bruits

Answer 53

when preforming the pheriferal pulsese asculcultate with diaphragm over femoral and carotid

Question 54

what are bruits

Answer 54

the wooshing sound that is made whn blood rushes past a obstruction

Question 55

how do you measure radial femoral delay

Answer 55

take both the femoral and radial pulse and feel for delay - there shouldn't be one

Question 56

how do you check for a collapsing pulse

Answer 56

find radial pulse ask patient if they have any pain in their arm or shoulder raise arm above head while taking pulse

Question 57

what is a pansystolic murmur

Answer 57

a murmur that last through both systole and diastole

Question 58

what are the two things examined when listening for left side diastolic murmurs

Answer 58

mitral stenosis aortic regurgitation

Question 59

how do you examine for mitral stenosis

Answer 59

USING THE BELL place stethoscope on apex beat - get patient to roll onto left side and listen while the patient is holding their breath on expiration

Question 60

what would mitral stenosis sound like

Answer 60

a low pitched ''rumbling'' mid-diastolic murmur

Question 61

how would you examine for atrial regurgitation

Answer 61

USING THE DIAPHRAGM ask the patient to sit up, and listen to the lower left sternal edge while the patient holds their breath on expiration