Cardiovascular Exam

Question 1

Physical examination consists of which four basic components

1. Inspection
2. ___
3. ___
4. ___

Answer 1

Inspection
Palpation
Percussion
Auscultation

Question 2

when inspecting the hands, what signs may indicate cardiovascular disease?

Answer 2

clubbing
peripheral cyanosis
capillary refill

Question 3

janeway lesions are small, non-tender erythematous or hemorrhagic lesions located on

Answer 3

the palms or soles of feet

Question 4

Osler’s nodes are tender, raised, red lesions on

Answer 4

hands or feet

Question 5

Palmar crease pallor can be indicative of

Answer 5

anemia caused by malabsorption or blood loss

Question 6

the most accurate pressure for estimating right atrial pressure, volume status and cardiac function

Answer 6

jugular venous pressure

Question 7

central venous pressure is equal to

Answer 7

right ventricle end diastolic pressure?

Question 8

things that can increase right side diastolic pressure include

Answer 8

LH disease
Lung disease
Primary and secondary pulmonary HTN
Pulmonic stenosis

Question 9

external reference point for measuring CVP

Answer 9

sternal angle of louis

Question 10

positioning for jugular venous pressure involves using
the _____ jugular vein (preferrably internal)
placing the patient in a _____ position at 30-45 degree angle, and located the vein between the sternocleidomastoid

Answer 10

right jugular vein

supine position

Question 11

JVP is measured by the vertical distance from the highest point of the column during expiration
use sternal angle of louis as reference point (5cm about RA)
normal JVP is:
Abnormal is :

Answer 11

normal 3-4cm
abnormal >3-4 cm above sternal angle of louis
corresponding to 8-9 cmH2O

Question 12

rating the pulse of a peripheral artery

Answer 12

0 = absent
1 = barely palpable
2 = average 
3 = strong
4 = bounding

Question 13

capillary refill time is normally less than

Answer 13

2 seconds

Question 14

rating edema (on a four point scale)

Answer 14

0 = absent
1 = barely detectable, non pitting (2mm) 
2 = slight indentation (4mm) 10-15 sec
3 = deeper indentation (6mm) >1min 
4+ = very marked indentation (8mm) 2-5 min

Question 15

a 4+ pulse in the carotids can be indicative of

Answer 15

cardiac tamponade, trauma, desperate badness

Question 16

PMI is generally located

Answer 16

4-5th intercostal space at mid-clavicular line

Question 17

increased PMI can denote what

Answer 17

LV enlargement

Question 18

grading system for murmors

Answer 18

1 = barely audible 
2 = soft but easily heard 
3 = loud without thrill
4 = loud with thrill 
5 = loud with minimal contact between chest and steth - thrill
6 = loud, heard without steth ,thrill/heave

Question 19

S2 coincides with what valve closure

Answer 19

aortic and pulmonic

Question 20

splitting of s2 occurs when ____ closes before _____

Answer 20

aortic closes before pulmonic

Question 21

an s3 sound can be heard under what condition

Answer 21

after s2, large amount of blood striking a very compliant left ventricle - often associated with ischemic cardiomyopathy, HF

Question 22

S3 sounds can be associated with

Answer 22

ischemic cardiomyopathy, HF

Question 23

abdominojugular test can be used to test for:
involves placing patient at 45-90 degrees and applying pressure to abdomen - moninter CVP for rise of >4cm for more than 10 sec

Answer 23

triscupsid disease, left heart disease (elevated left atrial pressure)

Question 24

Kussmaul’s sign can indicate:

paradoxic elevation of CVP during inspiration

Answer 24

constrictive pericarditis