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Physical Diagnosis > Midterm Practical: Heart exam > Flashcards

Midterm Practical: Heart exam Flashcards

1
Q

Patient/Table Position

A

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

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2
Q

Blood Pressure Cuff Application

A

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

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3
Q

Palpating for the Target Systolic Pressure

A

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

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4
Q

Taking Blood Pressure

A

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

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5
Q

Upper Extremity Pulses (Name, Location, Time)

A

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

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6
Q

Inspecting the Upper Extremities

A

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

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7
Q

Cause of Decreased Turgur

A

Dehydration

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8
Q

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

A

Hold for 5 seconds
Normal Refill: approximately 2 Seconds

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9
Q

Lower Extremity Pulses (Name, Location, Time)

A

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

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10
Q

Lower Extremity Inspection

A

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

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11
Q

Cause and Location of checking Pitting Edema

A

DVT
Shin, Dorsum of foot & posterior to medial malleolus

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12
Q

Capillary Refill (hold time) (normal refill time)

A

Hold for 5 seconds
Normal Refill: approximately 2 seconds

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13
Q

Observe Jugular Venous Pulsation (JVP)

A

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”

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14
Q

Normal Height of JVP

A

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

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15
Q

Cause of JVP

A

Right Sided Heart Failure

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16
Q

Observe Precordium for Visible Pulsations

A

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

17
Q

Normal Location of Apical Pulse

A

Left 5th Intercostal @ Mid-Clavicular Line

18
Q

Apical pulse Represents what?

A

Left Lateral Border of the Heart

19
Q

Attempt to visualize any other visible pulsations

A

Using tangenital Lighting

20
Q

Pathology in an Abnormal Visible Pulsation

A

Enlarged Ventricles

21
Q

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

A

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

22
Q

Palpate Apical Pulse/PMI

A

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

23
Q

Lateral PMI ->

A

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

24
Q

Palpate for Heave and Lifts

A

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

25
Q

Pathology resulting in a Lift or Heave

A

Enlarged ventricles

26
Q

Palpate for Thrills

A

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

27
Q

Pathology that could cause a Thrill

A

Valvular Stenosis

28
Q

Percussion

A

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

29
Q

Explain Auscultation To Patient

A

Patient breathes normally
All Patients Sheild Breasts

30
Q

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

A

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

31
Q

Auscultate 6 Listening Spots (with Diaphragm)

A

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

32
Q

Auscultate 6 Listening Spots (with Bell)

A

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

33
Q

Palpate Carotid Artery during Auscultation of 6 Spots

A

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

34
Q

Name 2 Abnormal Heart Sounds & Their Causes

A

Rub: Pericarditis
Murmur: Stenosis or Regurgitation

35
Q

Exam Sequence of the Heart Exam

A

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

Physical Diagnosis (7 decks)

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