Cardiovascular Exam

Question 1

What are the main steps in a cardio exam?

Answer 1

Prepare the patient
Hand hygiene
General inspection
Hands
Radial pulse
BP
Head and neck
JVP
Carotid pulse
Chest inspection
Chest palpation
Chest auscultation
Lower limbs
Conclude and close assessment

Question 2

How do you prepare the patient?

Answer 2

Introduction and consent
Explanantion
Exposure: undress to underwear; provide gown
Position: examine from the right; bed at 45 degrees

Question 3

What is included in the general inspection

Answer 3

Environment

Patient

Question 4

What do you inspect in the hands?

Answer 4

Fingers and nails
Palmar creases
Capillary refill
Nicotine stains

Question 5

What qualities are you measuring when taking the radial pulse?

Answer 5

Rate

Rhythm

Question 6

What do you inspect at the head and neck?

Answer 6

Conjunctivae

Lips, tongue, and palate

Question 7

How do you measure JVP?

Answer 7

Sternocleidomastoid muscle relaxed, view pulse in line with neck
Locate sternal angle
Measure vertical distance using fingers from sternal angle to upper level of pulsation

Question 8

On which side do you take the carotid pulse?

Answer 8

Both

Question 9

Where do you palpate the chest?

Answer 9

Locate and palpate apex beat

Demonstrate position relative to mid-clavicular line and 5th intercostal space

Question 10

What do you auscultate in the chest?

Answer 10

Listen with bell to
- Apex beat
- Lower left sternal edge
- Upper left sternal edge
- Upper right sternal edge
Listen with diaphragm to
- Apex beat
- Lower left sternal edge
- Upper left sternal edge
- Upper right sternal edge
Listen to lung bases

Question 11

What do you assess in the lower limbs?

Answer 11

Assess for pitting oedema in both feet
- Palpate behind medial malleolus
- Press thumb down hard for 3 sec
- Run fingers over area
Pulses in both feet
- Dorsalis pedis
- Posterior tibial

Question 12

What is clubbing?

Answer 12

Deposition under nails

General sign

Question 13

What are you looking for in the palmar creases?

Answer 13

Pale lesions = anaemia

Question 14

What are you examining the conjunctivae for?

Answer 14

Pallor = anaemia

Question 15

What are you examining the lips, tongue, and palate for?

Answer 15

Cyanosis

Question 16

Why might the JVP be elevated?

Answer 16

Raised pressure in the right side of the heart

Question 17

What might it mean if the apex beat has shifted laterally?

Answer 17

Left ventricular hypertrophy

Question 18

Why do you listen to the lung bases?

Answer 18

Crackles of heart failure

Question 19

What is the normal height for JVP?

Answer 19

Less than 2-3 cm

Question 20

Where is the superior heart border?

Answer 20

Line between 2nd L and 3rd R costal cartilages, 2 cm from sternal edge

Question 21

Where is the right heart border?

Answer 21

Line between 3rd and 6th R costal cartilages, 2 cm from sternal edge

Question 22

Where is the left heart border?

Answer 22

Line between 2nd L costal cartilage, 2 cm from sternal edge, and 5th L intercostal space, in mid-clavicular line

Question 23

Where is the inferior heart border?

Answer 23

Line between 5th L intercostal space, in mid-clavicular line, and 6th R costal cartilage, 2 cm from sternal edge

Question 24

Where are the heart valves located?

Answer 24

Oblique line behind sternum
6th R to 2nd L costal cartilage
Superior to inferior
- Pulmonary
- Aortic
- Mitral
- Tricuspid

Question 25

What valve do you auscultate at the apex?

Answer 25

Mitral

Question 26

What valve do you auscultate in the 5th intercostal space to the left of the sternum?

Answer 26

Tricuspid

Question 27

What valve do you auscultate in the 2nd intercostal space to the left of the sternum?

Answer 27

Pulmonary

Question 28

What valve do you auscultate in the 2nd intercostal space to the right of the sternum?

Answer 28

Aortic