Midterm Practical: Heart exam

Question 1

Patient/Table Position

Answer 1

Supine
Table Elevated 30 degrees
Gown Open Anteriorly
Dr. Stands on Pt’s Right Side

Question 2

Blood Pressure Cuff Application

Answer 2

Arm supported @ Heart level
Artery marker over brachial artery
2.5cm Superior to Cubital Fossa
Snug w/ room for 2 fingers

Question 3

Palpating for the Target Systolic Pressure

Answer 3

Find Radial pulse
Pump cuff until pulse is lost
Add 30 to estimate systolic

Question 4

Taking Blood Pressure

Answer 4

Stethoscope on brachial artery (medial to bicep tendon)
Deflate cuff @ 3mmHg per second
Report within +/-5 mmHg

Question 5

Upper Extremity Pulses (Name, Location, Time)

Answer 5

[Brachial]
Medial to Bicep Tendon
Palpate for 3-5 Seconds
[Radial]
Anterior Distal Radius
Palpate for 3-5 Seconds

Question 6

Inspecting the Upper Extremities

Answer 6

1) Color, Temperature (use back of hand), Edema
2) Digital Clubbing (bulbous swelling of nail base)
3) Skin Turgur (decreased stays elevated for several seconds
4) Capillary Refill

Question 7

Cause of Decreased Turgur

Answer 7

Dehydration

Question 8

Capillary refill (time to hold) (normal refill time)

Answer 8

Hold for 5 seconds
Normal Refill: approximately 2 Seconds

Question 9

Lower Extremity Pulses (Name, Location, Time)

Answer 9

[Posterior Tibial]
Posterior to the Medial Malleolus
Palpate for 3-5 seconds
[Dorsalis Pedis]
Dorsum of Foot
Palpate for 3-5 seconds

Question 10

Lower Extremity Inspection

Answer 10

1) Color, Temperature (use back of hand), Absence of Hair
2) Pitting Edema: “if pit remains after I release, this is pitting edema”
3) Capillary refill

Question 11

Cause and Location of checking Pitting Edema

Answer 11

DVT
Shin, Dorsum of foot & posterior to medial malleolus

Question 12

Capillary Refill (hold time) (normal refill time)

Answer 12

Hold for 5 seconds
Normal Refill: approximately 2 seconds

Question 13

Observe Jugular Venous Pulsation (JVP)

Answer 13

Use Tangenital Lighting
“Right internal jugular vein used to locate JVP”
“Internal Jugular vein located lateral and deep to sternal insertion of SCM”
JVP indicative of “venous pressure”

Question 14

Normal Height of JVP

Answer 14

From Sternal Angle of Louis: less than or equal to 3cm

Question 15

Cause of JVP

Answer 15

Right Sided Heart Failure

Question 16

Observe Precordium for Visible Pulsations

Answer 16

Visualize apical pulse using tangenital lighting
State normal location of apical pulse
State what the apical pulse represents

Question 17

Normal Location of Apical Pulse

Answer 17

Left 5th Intercostal @ Mid-Clavicular Line

Question 18

Apical pulse Represents what?

Answer 18

Left Lateral Border of the Heart

Question 19

Attempt to visualize any other visible pulsations

Answer 19

Using tangenital Lighting

Question 20

Pathology in an Abnormal Visible Pulsation

Answer 20

Enlarged Ventricles

Question 21

Palpate Carotid Artery (Fingers, Time, Normal Heart Rate)

Answer 21

Use 2 fingers @ Cricoid Cartilage Level
(Medial to SCM)
Hold Palpations for 3-5 seconds
Normal HR: 60-100 bpm

Question 22

Palpate Apical Pulse/PMI

Answer 22

Shield Breats
Start with pads of hands over the Mitral Area
Isolate Pulse with a single finger

Question 23

Lateral PMI ->

Answer 23

“PMI that is lateral to the mid Clavicular line may represent cardiomegaly”

Question 24

Palpate for Heave and Lifts

Answer 24

Shield breats
Place Finger Pads flat against chest in Intercostal Spaces
“Heaves & Lifts are sustained pulses that rhythmically lift my fingers”

Question 25

Pathology resulting in a Lift or Heave

Answer 25

Enlarged ventricles

Question 26

Palpate for Thrills

Answer 26

Shield Breasts Place ball of hand firmly on chest “Thrill is a buzzing sensation caused by Underlying Turbulent Blood Flow”

Question 27

Pathology that could cause a Thrill

Answer 27

Valvular Stenosis

Question 28

Percussion

Answer 28

State “percussion is used to estimate size of heart if PMI cant be located during observation or Palpation”

Question 29

Explain Auscultation To Patient

Answer 29

Patient breathes normally All Patients Sheild Breasts

Question 30

State Location of all 6 Listening Spots & What Valve is heard best at them

Answer 30

2nd Right ICS: Aortic 2nd Left ICS: Pulmonic 3rd Left ICS: Aortic & Pulmonic [Erb’s Point] 4th and 5th Left ICS: Tricuspid 5th Left ICS @ Mid-Clavicular line: Mitral

Question 31

Auscultate 6 Listening Spots (with Diaphragm)

Answer 31

3-5 seconds each with diaphragm Say “diaphragm used for high-pitched” sounds Name a high-pitched heart sound: S1

Question 32

Auscultate 6 Listening Spots (with Bell)

Answer 32

3-5 seconds each Say “Bell is used for low-pitched sounds” Name a low-pitched heart sound: S3

Question 33

Palpate Carotid Artery during Auscultation of 6 Spots

Answer 33

With BOTH Bell and Diaphragm Say “carotid upstroke facilitates identification of systole and diastole (S1 & S2)” Say “S1 falls just before Carotid upstroke and S2 follows the Carotid Upstroke

Question 34

Name 2 Abnormal Heart Sounds & Their Causes

Answer 34

Rub: Pericarditis Murmur: Stenosis or Regurgitation

Question 35

Exam Sequence of the Heart Exam

Answer 35

Upper Extremity Lower Extremity Chest Inspection Palpation Percussion??? Auscultation