Examination of the praecordium Flashcards by Jenna Dymond

3 key stages

inspection
palapation for apex beat
auscultation of the heart

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what should be done prior to the examination of the praecordium

general observation 
hands 
pulses
blood pressure
JVP face and mouth

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what to observe for in general inspection?

pectus excavatum

sternotomy scar

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what is the apex beat

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

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where is the apex beat found?

5th intercostal space midline

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prominent apex beat implies

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

c.left ventricular hypertrophy

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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.pleural effusion/ pnuemothorax/left ventricular enlargement

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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

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

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

a. prominent
b. failed detection
c. displacement

b.failed detection

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

a. prominent
b. failed detection
c. displacement

c.displacement

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

a. prominent
b. failed detection
c. displacement

c.displacement

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

a. prominent
b. failed detection
c. displacement

a.prominent

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which should you do first?

a. palpate apex beat
b. count rib spaces

a.palpate apex beat

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where is the apex beat palpated?

a. right hemithorax
b. left hemithorax

b.left hemithorax

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

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

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what are heaves caused by?

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

c.right ventricular enlargement

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What are thrills caused by ?

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

b. turbulent blood flow - cardiac murmurs

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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

c.closure of mitral and tricuspid

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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

c.closure of aortic and pulmonary valves

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.start of ventricular systole

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

b.end of ventricular systole

what is it essential to do while auscultating?

feel carotid pulse

which of these cannot cause a murmur?

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

b.hypertension

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

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

a.turbulent/increased

what should be noted following a murmur identification?

timing systole (ejection/pan/mid/late) diastole (early/mid) ``` quality radiation intensity location variation with insp ```

murmur heard, increase during inspiration what side is murmur located? a. left b. central c. right

c.right

which side of the diaphragm is used for listening to high pitched sounds? a. bell b. diaphragm

b.diaphragm

when using the diaphragm how should it be held on the skin? a. loosely b. firmly

b.firmly

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. heart sounds 1 and 2/ aortic diastolic murmurs

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

d.murmurs of aortic stenosis

where is the mitral area? a. lower left sternal edge b. 2nd ICS right sternal edge c. 5th ICS MCL

c.5th ICS MCL

where is the tricuspid area? a. lower left sternal edge b. 2nd ICS right sternal edge c. 5th ICS MCL

a.lower left sternal edge

where is the pulmonary area? a. lower left sternal edge b. 2nd ICS left sternal edge c. 5th ICS MCL

b.2nd ICS left sternal edge

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

e.2nd ICS right sternal edge

where should the diaphragm used?

aortic, pulmonary tricuspid, mitral | while simultaneously feeling carotid pulsation

where is the bell used?

tricuspid and mitral area (lower valves)

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

palpate apex beat | listen with bell to apex and into axilla

where is mitral stenosis localised ?

medial to apex beat

where is a murmur of mitral incompetence heard ?

axilla

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

lean forward take deep breath exhale and hold use diaphragm

what does the patient leaning forward and exhaling increase the intensity of? a. murmur of mitral stenosis b. murmur of mitral incompetence

b. murmur of mitral incompetence

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

c.aortic and tricuspid

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

diaphragm

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

diaphragm

what should be listened for at the carotid artery?

bruits/ radiation of murmur of aortic stenosis