Examination of the praecordium Flashcards
3 key stages
inspection
palapation for apex beat
auscultation of the heart
what should be done prior to the examination of the praecordium
general observation hands pulses blood pressure JVP face and mouth
what to observe for in general inspection?
pectus excavatum
sternotomy scar
what is the apex beat
furthest beat laterally and inferiorly at which cardiac impulse can be palpated due to action of left ventricle
where is the apex beat found?
5th intercostal space midline
prominent apex beat implies
a. pleural effusion
b. oneumothorax
c. left ventricular hypertrophy
c.left ventricular hypertrophy
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
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
patient with pericardial effusion
how would this affect palpation of the apex beat?
a. prominent
b. failed detection
c. displacement
b.failed detection
patient with pneumothorax
how would this affect palpation of the apex beat?
a. prominent
b. failed detection
c. displacement
c.displacement
patient with left ventricular enlargement
how would this affect palpation of the apex beat?
a. prominent
b. failed detection
c. displacement
c.displacement
patient with left ventricular hypertrophy
how would this affect palpation of the apex beat?
a. prominent
b. failed detection
c. displacement
a.prominent
which should you do first?
a. palpate apex beat
b. count rib spaces
a.palpate apex beat
where is the apex beat palpated?
a. right hemithorax
b. left hemithorax
b.left hemithorax
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
what are heaves caused by?
a. pleural effusion
b. left ventricular enlargement
c. right ventricular enlargement
c.right ventricular enlargement
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
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
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
