Cardiovascular Exam

Question 1

diaphragm of stethoscope

Answer 1

high pitched sounds

Question 2

bell of stethoscope

Answer 2

low pitched sounds

Question 3

steps to cardiovascular exam

Answer 3

inspect palpate percussion auscultation

Question 4

PMI

Answer 4

Used to estimate location of apex/left
border. Can assess either supine or left lateral decubitus position. Usually
palpated near the 4th-5th intercostal space in the Mid-clavicular line. May need to have patient lift her breast. PMI may not be readily felt in healthy heart/patient.
Impulse should be a small, brisk beat and measure less than 2.5 cm. The impulse should last through the first 2/3 of the systolic period (or less). It should not be
felt through the second heart sound.

Question 5

systole

Answer 5

ventricular contractions and ejection

Question 6

diastole

Answer 6

ventricular relaxation and filling

Question 7

aortic valve

Answer 7

R 2nd ICS at SB

Question 8

pulmonic valve

Answer 8

L 2nd ICS at SB

Question 9

tricuspid valve

Answer 9

L 4th the ICS at SB

Question 10

mitral valve

Answer 10

L 5th ICS at midclavicular line

Question 11

S1

Answer 11

closure of tricuspid and mitral valves

Question 12

S2

Answer 12

closure of the aortic and pulmonic valve - may split w/ normal inspiration

Question 13

S3

Answer 13

dull, low pitch, best heard w/ bell Due to high pressures and abrupt deceleration of inflow across the mitral valve at the end of the rapid filling phase. Physiologic in children. Pathologic in ppl older than 40. Kent-Tuck-Y

Question 14

S4

Answer 14

Dull, low pitch, best heard with bell. Atrial gallop from forceful contraction of
atria against a stiffened (low compliant) ventricle. Can be normal in trained
athletes. – Ten-Nes-See

Question 15

systolic murmur

Answer 15

b/w S1 and S2

Question 16

diastolic murmurs

Answer 16

b/w S2 and S1

Question 17

Grade 1

Answer 17

very faint

Question 18

Grade 2

Answer 18

quiet but heard easily w/ stethoscope

Question 19

Grade 3

Answer 19

Moderately loud

Question 20

Grade 4

Answer 20

Loud w/ palpable thrill

Question 21

Grade 5

Answer 21

Very loud w/ thrill - may be heard w stethoscope partly off chest

Question 22

Grade 6

Answer 22

Heard w/ stethoscope entirely off the chest

Question 23

Grading scale for peripheral pulses

Answer 23

4+ Bounding
3+ Strong, full, increased
2+ Average intensity, expected, normal
1+ Diminished, barely palpable
0 Absent, not palpable

Question 24

grading scale for edema

Answer 24

0 Absent
1+ Barely detectable, slight pitting (2mm); disappears rapidly
2+ Slight indentation (4mm); 10-15 seconds
3+ Deeper indentation (6mm); may be >1 minute
4+ Very marked indentation (8mm); 2-5 minutes