CV Exam Lab

Question 1

Order for normal CV Exam

Answer 1

inspection
palpation of PMI & anterior chest
percuss (for cardiac border)
auscultate

Question 2

What is most important when listening w/ stethoscope?

Answer 2

always listen on bare skin

Question 3

What does a barrel chest indicate?

Answer 3

COPD

Question 4

What is pectus carinatum?

Answer 4

pigeon chest

Question 5

What is pectus excavatum?

Answer 5

funnel chest

Question 6

Landmarks for chest inspection

Answer 6

sternal notch & angle
sternal border
mid-clavicular line
anterior axillarly line
xiphoid process
nipples

Question 7

Where do you palpate for PMI?

Answer 7

used to estimate location of apex/left border

near 4th-5th intercostal space in mid-clavicular line

palpate for thrill

Question 8

Where do you auscultate in CV exam?

Answer 8

aortic valve-R 2nd ICS @ SB
pulmonic valve-L 2nd ICS @ SB
tricuspid valve-L 4th ICS @ SB
bicuspid valve-L 5th ICS @ mid-clavicular line

Question 9

How do you listen for carotid bruits?

Answer 9

using BELL of diaphragm AFTER palpating pulse

ask pt to inhale & hold breath while listening

Question 10

S1 heart sound

Answer 10

closure of tricuspid & bicuspid valves

Question 11

S2 heart sound

Answer 11

closure of aortic & pulmonic valves (may split w/ inspiration which is normal)

Question 12

S3 heart sound

Answer 12

dull, low pitch that best heard w/ bell (during rapid filling of ventricles)

normal in children but pathologic if <40

“Kent-tuck-y”

Question 13

S4 heart sound

Answer 13

dull, low pitch, heard w/ bell (atrial gallop from forceful contraction of atria v stiff ventricle)

“Ten-nes-see”

Question 14

What are systolic murmurs?

Answer 14

fall between S1 & S2 heart sounds

aortic stenosis
pulmonic stenosis
mitral regurgitation
tricuspid regurgitation

Question 15

What are diastolic murmus?

Answer 15

fall between S2 & S1 heart sounds

aortic regurgitation
pulmonic regurgitation
mitral stenosis
tricuspid stenosis

Question 16

Grading scale for murmurs

Answer 16

Grade 1-very faint
Grade 2-quiet but can be heard w/ stethoscope
Grade 3-moderately loud, NO thrill
Grade 4-loud w/ palpable thrill
Grade 5-very loud w/ thrill
Grade 6-heard w/ stethoscope that is off chest

Question 17

Where do you palpate & assess the carotid pulse?

Answer 17

medial to SCM

do NOT assess both carotid pulses @ same time

use bell of stethoscope for bruits (audible) & palpate for thrills

Question 18

Normal peripheral pulse

Answer 18

+2/4 average intensity, expected normal

Question 19

Normal capillary refill

Answer 19

refill time should be 2 seconds or less

Question 20

Where do you examine for pitting edema?

Answer 20

dorsum of foot
anterior tibia (mid-shin)
posterior medial malleolus

+0/4 is normal
+2/4 is slight indent that stays for 10-15 sec

Question 21

Why would JVP be measured?

Answer 21

suspected heart failure

measure vertical distance above sternal angle where horizontal object crosses ruler & add 5cm to distance for JVP

Question 22

Allen test

Answer 22

evaluates functioning of radial & ulnar arteries

indicates lack of dual blood supply to hand (negative indication for radial catheterization)