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Clinical skills > Examination of the praecordium > Flashcards

Examination of the praecordium Flashcards

1
Q

3 key stages

A

inspection
palapation for apex beat
auscultation of the heart

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2
Q

what should be done prior to the examination of the praecordium

A 
general observation 
hands 
pulses
blood pressure
JVP face and mouth
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3
Q

what to observe for in general inspection?

A

pectus excavatum

sternotomy scar

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4
Q

what is the apex beat

A

furthest beat laterally and inferiorly at which cardiac impulse can be palpated due to action of left ventricle

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5
Q

where is the apex beat found?

A

5th intercostal space midline

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6
Q

prominent apex beat implies

a. pleural effusion
b. oneumothorax
c. left ventricular hypertrophy

A

c.left ventricular hypertrophy

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7
Q

displacement of apex beat implies

a. pleural effusion/ pneumothorax/left ventricular enlargement
c. left ventricular hypertrophy
d. obesity/hyperinflation of the chest/plural effusion/ pericardial effusion

A

a.pleural effusion/ pnuemothorax/left ventricular enlargement

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8
Q

failed detection of the apex beat implies

a. pleural effusion/ pneumothorax/left ventricular enlargement
c. left ventricular hypertrophy
d. obesity/hyperinflation of the chest/plural effusion/ pericardial effusion

A

obesity/hyperinflation of the chest/ pleural effusion/pericardial effusion

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9
Q

patient with pericardial effusion
how would this affect palpation of the apex beat?

a. prominent
b. failed detection
c. displacement

A

b.failed detection

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10
Q

patient with pneumothorax
how would this affect palpation of the apex beat?

a. prominent
b. failed detection
c. displacement

A

c.displacement

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11
Q

patient with left ventricular enlargement
how would this affect palpation of the apex beat?

a. prominent
b. failed detection
c. displacement

A

c.displacement

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12
Q

patient with left ventricular hypertrophy
how would this affect palpation of the apex beat?

a. prominent
b. failed detection
c. displacement

A

a.prominent

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13
Q

which should you do first?

a. palpate apex beat
b. count rib spaces

A

a.palpate apex beat

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14
Q

where is the apex beat palpated?

a. right hemithorax
b. left hemithorax

A

b.left hemithorax

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15
Q

to check if the apex beat is in the right place?

A

identify manubriosternal joint
rib attached 2nd rib
2nd ICS below
count down to 5th

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16
Q

what are heaves caused by?

a. pleural effusion
b. left ventricular enlargement
c. right ventricular enlargement

A

c.right ventricular enlargement

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17
Q

What are thrills caused by ?

a. left ventricular enlargement
b. turbulent blood flow - cardiac murmurs
c. right ventricular enlargement

A

b. turbulent blood flow - cardiac murmurs

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18
Q

what causes the first heart sound?

a. closure of tricuspid
b. closure of mitral
c. closure of mitral and tricuspid
d. opening of mitral and tricuspid

A

c.closure of mitral and tricuspid

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19
Q

what causes the second heart sound?

a. closure of tricuspid
b. closure of aotic
c. closure of aortic and pulmonary valves
d. opening of mitral and tricuspid

A

c.closure of aortic and pulmonary valves

20
Q

first heart sounds coincides with?

a. start of ventriular systole
b. end of ventricular sytole
c. start of atrial systole
d. end of atrial systole

A

a.start of ventricular systole

21
Q

second heart sounds coincides with?

a. start of ventriular systole
b. end of ventricular sytole
c. start of atrial systole
d. end of atrial systole

A

b.end of ventricular systole

22
Q

what is it essential to do while auscultating?

A

feel carotid pulse

23
Q

which of these cannot cause a murmur?

a. pregnancy
b. hypertension
c. severe anaemia
d. significant pyrexia

A

b.hypertension

24
Q

what does the prescense of a murmur indicate in terms of blood flow?

a. turbulent/increased
b. decreased
b. turbulent/decreased
d. turbulent

A

a.turbulent/increased

25
Q

what should be noted following a murmur identification?

A

timing
systole (ejection/pan/mid/late)
diastole (early/mid)

quality
radiation
intensity
location 
variation with insp
26
Q

murmur heard, increase during inspiration
what side is murmur located?

a. left
b. central
c. right

A

c.right

27
Q

which side of the diaphragm is used for listening to high pitched sounds?

a. bell
b. diaphragm

A

b.diaphragm

28
Q

when using the diaphragm how should it be held on the skin?

a. loosely
b. firmly

A

b.firmly

29
Q

what is sounds are listened to with the diaphragm?

a. heart sounds 1 and 2 /aortic diastolic murmurs
b. heart sound and aortic diastolic murmurs
c. heart sound 2 and aortic diastolic murmurs
d. murmur of aortic stenosis

A

a. heart sounds 1 and 2/ aortic diastolic murmurs

30
Q

what is sounds are listened to with the bell ?

a. heart sounds 1 and 2 /aortic diastolic murmurs
b. heart sound and aortic diastolic murmurs
c. heart sound 2 and aortic diastolic murmurs
d. murmur of aortic stenosis

A

d.murmurs of aortic stenosis

31
Q

where is the mitral area?

a. lower left sternal edge
b. 2nd ICS right sternal edge
c. 5th ICS MCL

A

c.5th ICS MCL

32
Q

where is the tricuspid area?

a. lower left sternal edge
b. 2nd ICS right sternal edge
c. 5th ICS MCL

A

a.lower left sternal edge

33
Q

where is the pulmonary area?

a. lower left sternal edge
b. 2nd ICS left sternal edge
c. 5th ICS MCL

A

b.2nd ICS left sternal edge

34
Q

where is the aortic area?

a. lower left sternal edge
b. 2nd ICS left sternal edge
c. 5th ICS MCL
d. 2nd ICS
e. 2nd ICS right sternal edge

A

e.2nd ICS right sternal edge

35
Q

where should the diaphragm used?

A

aortic, pulmonary tricuspid, mitral

while simultaneously feeling carotid pulsation

36
Q

where is the bell used?

A

tricuspid and mitral area (lower valves)

37
Q

after the patient rolls to the left lateral position what should be done next?

A

palpate apex beat

listen with bell to apex and into axilla

38
Q

where is mitral stenosis localised ?

A

medial to apex beat

39
Q

where is a murmur of mitral incompetence heard ?

A

axilla

40
Q

after listening with the bell to apex and into axilla what should the patient be asked to do

A

lean forward take deep breath exhale and hold use diaphragm

41
Q

what does the patient leaning forward and exhaling increase the intensity of?

a. murmur of mitral stenosis
b. murmur of mitral incompetence

A

b. murmur of mitral incompetence

42
Q

when the patient is leaning forward the bell is used to auscultate which areas?

a. mitral and tricuspid
b. aortic and pulmonary
c. aortic and tricuspid

A

c.aortic and tricuspid

43
Q

when the patient is leaning forwards which side of the stethoscope should be used?

A

diaphragm

44
Q

what side of the stethoscope should be used to listen to the carotid artery?

A

diaphragm

45
Q

what should be listened for at the carotid artery?

A

bruits/ radiation of murmur of aortic stenosis

Clinical skills (12 decks)

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