Cardiovascular Physical Exam

Question 1

Common Heart Attack symptoms

Answer 1

Chest or left arm pain or discomfort usually with exertion but can occur at rest (angina)
Shortness of breath (dyspnea) at rest OR more easily brought on with usual activities OR or exercise limiting OR accompanied with increased sputum production
Clamminess and profuse sweating

Question 2

Common A-Fib symptoms

Answer 2

Fainting (syncope) or near fainting (pre-syncope)
Palpitations

Question 3

Common heart failure symptoms

Answer 3

• Difficulty laying flat (because of increased shortness of breath; orthopnea)
• Nighttime dyspnea causing the patient to get up (paroxysmal nocturnal dyspnea or PND)
• Lower-extremity or sacral edema

Question 4

Common peripheral artery disease symptoms

Answer 4

Pain in the legs brought on with predictable walking distances eased with 5-10 minutes of rest and (claudication)

Question 5

5 stethoscope points

Answer 5

Aortic - right 2nd IS
Pulmonic - Left 2nd IS
Erb’s point - Left 3rd IS
Tricuspid - Lower left sternal border, 4th IS
Mitral - Left 5th IS, medial to midclavicular line

Question 6

Long, low - pitched. Loudest at apex

Answer 6

S1

Question 7

Short, high-pitched. Loudest at base

Answer 7

S2

Question 8

Aortic Valve Stenosis

Answer 8

Narrowing of aortic valve

Question 9

Aortic Valve regurgitation

Answer 9

Blood flow back into L ventricle

Question 10

Mitral valve stenosis

Answer 10

Narrowing of Mitral valve

Question 11

Mitral valve regurgitation

Answer 11

blood flows back into the left atrium

Question 12

Systolic murmurs occur when?

Answer 12

After the 1st “lub”

Question 13

When do diastolic murmors occur

Answer 13

After 2nd “lub”

Question 14

Two types of Gallops that can be heard

Answer 14

S3 - Ventricular gallop (systolic CHF, hypertension, HOCM) “SLOSH-ing-in”
S4 - Atrial gallop (diastolic CHF) “a-STIFF-wall”

Question 15

What causes a radiation of murmors?

Answer 15

To the carotid arteries, can be accompanied by parvus et tardus (aortic stenosis). Parvus (weak/small/diminished). Tardus (tardy).

To the axilla or left sternal edge (mitral regurgitation)

Question 16

What causes the accentuation of a murmor?

Answer 16

To the carotid arteries, can be accompanied by parvus et tardus (aortic stenosis)
To the axilla or left sternal edge (aortic regurgitation)

Question 17

Pertinant positive findings for hands and fingers

Answer 17

Nail clubbing. (infective endocarditis, cyanotic heart, etc.)
Janeway lesions. Non-tender nodes (bacterial endocarditis)
Osler Nodes. Tender red nodules (bacterial endocarditis)
Sweaty/clammy hands (can be ACS)
Cool to touch (can be poor cardiac output)
Tar stains (smoking)
Poor capillary refill, >2 seconds (hypovolemic)
Poor Color “dusky” (cyanosis, hypoxia)
Radial pulse (arrhythmia, tachycardia, delay)

Question 18

Pertinent positive body findings on exam

Answer 18

Scars - of the neck, chest, arms and legs
Neck - Carotid endarterectomy
Chest - sternotomy, pacemaker, chest tubes, etc.
Arms/Legs - vein and artery graft harvest sites

Question 19

Pertinent positive pulse findings on exam

Answer 19

Slow/late carotid pulse/tardus (carotid stenosis)
weak/small carotid pulse/parvus (carotid stenosis)
Carotid Bruit (carotid stenosis)
Collapsing pulse/Water Hammer (aortic regurgitation)
Narrow pulse pressure (BP reading - aortic stenosis)
Wide pulse pressure (BP reading - aortic regurgitation)
Bounding abdominal midline (aortic aneurysm)

Question 20

Pertinent eye findings on exam

Answer 20

Corneal Arcus
Xanthelasmas/Xanthomas
Hypercholesterolemia

Question 21

Pertinent chest wall findings on exam

Answer 21

Chest wall deformities

Pectus Excavatum
Pectus Carinatum
Chest wall scars (see above)
Visible pulsations at apex (ventricular hypertrophy)