Cardiovascular Exam

Question 1

What is the point of maximal impulse (PMI)?

Answer 1

Estimates the apex/left border of the heart
Usually near 4-5th ICS at mid-clavicular line
*may not be felt in healthy people

Question 2

Where should you start your percussion in looking for the heart?

Answer 2

Far left in resonance

Move medially to find cardiac “dullness”

Question 3

What is the S3 sound?

Answer 3

Abrupt deceleration of inflow across mitral valve at end of rapid filling
Physiologic in children, pathologic in adults >40

Question 4

What is the S4 sound?

Answer 4

Atrial gallop from forceful contraction of atria against stiffened ventricle
Normal in trained athletes

Question 5

Where is the carotid pulse located?

Answer 5

Medial to SCM

Question 6

What are the 6 peripheral pulses?

Answer 6

Radial
Brachial
Femoral
Popliteal
Dorsalis pedis
Posterior tibial

Question 7

What is the pulse grading system?

Answer 7

0 = absent
\+1 = diminished, barely palpable
\+2 = average intensity, normal
\+3 = strong, full, increased
\+4 = bounding

Question 8

How to you test for capillary refill?

Answer 8

Press on nail for several seconds, then not time it takes for color to return
Normal = 2 seconds or less

Question 9

Where are the 3 places to check for edema and how long should you press there?

Answer 9

Dorsum of foot
Anterior tibia
Behind medial malleolus
*5 seconds

Question 10

What is the grading system for edema?

Answer 10

0 = absent
\+1 = slight pitting (2mm), rapidly disappears
\+2 = slight indentation (4mm), 10-15 seconds
\+3 = deeper indentation (6mm), ~1 minute
\+4 = very deep indentation (8mm), 2-3 minutes