CVS PVS

Question 1

When inspecting, palpating and some of the auscultation of the precordium, what position should the patient be in?

Answer 1

Supine with 30 degree elevation at the head.

Question 2

Area over the heart and lower chest

Answer 2

Precordium

Question 3

PMI

Answer 3

Point of Maximal Impulse

Question 4

Where is the PMI?

Answer 4

4th and 5th intercostal space near the midclavicular line.

Question 5

When palpating the precordium, what would you methodologically be doing?

Answer 5

Use fingerpads first followed by the ball of the hand.

Question 6

Important areas to palpate

Answer 6

1. Aortic (2nd intercostal space on R)
2. Pulmonic (2nd intercostal space on L)
3. 3rd, 4th, 5th intercostal spaces along the left sternal border (Tricuspid Valve area)
4. Mitral Valve/Apical Area (More towards midclavicular on L)

Question 7

When palpating the extremities, you notice lymphadenopathy near the elbow. Tell me the name of these lymph nodes and where they are in relation to the general “elbow.” And what might this indicate?

Answer 7

Epitrochlear Lymph Nodes;
Located superior to the medial epicondyle.
Skin infection, Lymphoma, other skin malignancy

Question 8

What vessels drain into the epitrochlear lymph nodes?

Answer 8

Ulnar, Forearm, Hand

Question 9

Lymph nodes near those V-cuts cuz I’m so swole/built. (Near the groin)

Answer 9

Inguinal Lymph Nodes

Question 10

How do you auscultate the carotid arteries?

Answer 10

Have patient hold breath and auscultate over each carotid artery in the neck using the diaphragm of your steth.

Question 11

When palpating peripheral pulses, what is important to note about the carotid pulse?

Answer 11

YOU NEVER PALPATE BOTH AT THE SAME TIME

Question 12

What are the 7 peripheral pulses to palpate for?

Answer 12

1. Carotid
2. Radial
3. Brachial
4. Femoral
5. Popliteal
6. Dorsalis pedis
7. Posterior Tibial

Question 13

When auscultating the precordium, what is important to know about your steth?

Answer 13

USE DIAPHRAGM, SHEESH!

Question 14

Exceptions to the diaphragm usage in auscultating…of course there are exceptions…“Hhhii”

Answer 14

Use Bell for:

1. Tricuspid Area
2. Mitral Area

(Only after auscultating with Diaphragm, though)

Question 15

This is the sound heard when the mitral and tricuspid valves close. What stage of the Cardiac Cycle are we in?

Answer 15

S1
Systole
“Lub”

Question 16

It occurs just after atrial contraction and immediately before the systolic S1 and is caused by the atria contracting forcefully in an effort to overcome an abnormally stiff or hypertrophic ventricle.

Answer 16

S4 (Very Rare)

Question 17

It occurs at the beginning of diastole after S2 and is lower in pitch than S1 or S2 as it is not of valvular origin. The third heart sound is benign in youth, some trained athletes, and sometimes in pregnancy but if it re-emerges later in life it may signal cardiac problems (Heart Failure. Beta Blocker anyone?).

Answer 17

S3

Question 18

This is the sound heard when the aortic and pulmonic valves are closed. What stage of the Cardiac Cycle are we in?

Answer 18

S2
Diastole
“Dub”

Question 19

Vibratory sensation cause by the heart felt on the body surface.

Answer 19

Thrill

Question 20

After completing the first part of auscultation (with patient in a certain position), what do you do?

Answer 20

Ask patient to sit up and auscultate again while patient holds his breath.

Question 21

Assessing the patency of the ulnar and radial blood supply. What is the name of this test?

Answer 21

Allen Test

Question 22

Suspected Right Heart Failure would cause us to look for??

Answer 22

Jugular Venous Pressure

Question 23

How to perform the Allen Test?

Answer 23

1. Have the patient make a fist
2. Compress both the ulnar and radial arteries with your thumbs and fingers
3. Ask the patient to open the hand (note that the palm is pale)
4. Release the pressure that you are holding over the ulnar artery.
   If the ulnar artery is patent, the palm flushes within 3-5 minutes.

***You may also assess the patency of the radial artery by releasing the pressure on the radial artery rather than the ulnar artery.

Question 24

Measurement of Jugular Vein greater than ______ cm above the sternal angle is considered elevated JVP.

Answer 24

3-4 cm

Question 25

How to measure JVP?

Answer 25

1. Identify the right internal jugular vein
2. Identify the highest point of pulsation in the right IJ vein.
3. Extend a long rectangular object or card horizontally from this point to a centimeter ruler held vertically from the sternal angle making a 90° angle.

The distance measured in cm above the sternal angle is the JVP. A measurement greater than 3-4cm above the sternal angle is considered elevated.

Question 26

Anterior chest pain is often described

Answer 26

Ripping or Tearing

Question 27

Factors that contribute to Arterial Pressure

Answer 27

1. SV
2. PR
3. Blood volume
4. Aorta/Large artery distensibility

Question 28

Which chamber of the heart takes up the majority of the space of the anterior cardiac surface?

Answer 28

Right Ventricle

Question 29

Any clinical symptom caused by myocardial ischemia

Answer 29

Acute Coronary Syndrome

Question 30

Where is dependent edema located?

Answer 30

Lower extremities

Question 31

Risk Assessment for CAD begins at what age?

Answer 31

20 years old

Question 32

During systole, the aortic and pulmonic valves are _______ and the mitral and tricuspid valves are _______.

Answer 32

Open; Closed (S1 Sound!)

Question 33

During diastole, the aortic and pulmonic valves are _______ and the mitral and tricuspid valves are _______.

Answer 33

Closed; Open (S2 Sound!)

Question 34

How do you subjectively check for orthopnea?

Answer 34

How many pillows does the patient sleep with?

Question 35

If the PMI is more than ______ deviated laterally to the midsternal line, it’s a sign of hypertrophy.

Answer 35

10 cm

Question 36

T/F

JVP can be associated with pulmonary hypertension.

Answer 36

TRUE, or Right Heart Failure (Same thing kinda)

Question 37

Diameter of PMI in supine patients

Answer 37

1-2.5 cm