Module 2: Evaluating the Neck

Question 1

what are you mainly looking for when inspecting the neck?

Answer 1

-JVD (jugular venous distension)
-JVP (jugular venous pulsations)
-skin abnormalities
*sometimes carotid pulse/upstroke
(better determined w/ palpation)

Question 2

what type of abnormalities do you look for when inspecting the neck?

Answer 2

trauma
skin abnormalities: lacs, rash, moles, lesions
muscular atrophy/hypertrophy
masses

Question 3

when palpating for the carotid artery, what are you looking for?

Answer 3

carotid pulse
-only palpate unilaterally
»> both at same time you can cause pt to pass out

Question 4

when auscultating the carotid pulse, what are you looking for and what does it sound like?

Answer 4

carotid bruit

- turbulent blood flow through the vessel

Question 5

at what position is JVD best evaluated and what can it indicate?

Answer 5

lying at 30 degrees recumbence

-right sided heart failure (veins empty in vena cava and go to R atrium)

Question 6

how do you measure the sternal angle for JVD & what is a normal measurement in healthy patients?

Answer 6

< 4cm

• pt lying down at 45 degrees
• use one ruler on top of sternum vertically & another ruler horizontally to determine the distance from sternum to jugular vein

Question 7

what is considered a normal carotid pulse upstroke?

Answer 7

brisk upstroke of carotid pulse

Question 8

what does delayed upstroke of the carotid pulse suggest?

Answer 8

aortic stenosis

• prevents pulse from getting there
• does not correlate with S1

Question 9

what does bounding upstroke of the carotid pulse suggest?

Answer 9

aortic insufficiency

-increased amount of volume

Question 10

what does decreased/faint upstroke of the carotid pulse suggest?

Answer 10

decreased stroke volume

• local atherosclerotic issues bruit/buildup
• severe anemia

Question 11

what does weak/thready upstroke of the carotid pulse suggest?

Answer 11

cardiogenic shock

Question 12

why is the bell better in auscultation of the carotid pulse?

Answer 12

higher frequency -> better tones & contact w/ skin

Question 13

what are some conditions associated with turbulent blood flow through carotid?

Answer 13

◦ Atherosclerotic issues
◦ Tortuous artery
◦ Hyper-vascularity with hyperthyroidism
◦ External compression from thoracic outlet syndrome

Question 14

if you can detect a carotid bruit after turning the pt 90 degrees, what does this indicate? what should you do?

Answer 14

tortuous artery: abnormal twisting of arteries
-send pt for carotid doppler 
-pt may be at risk for:
aneurysm formation
dissection 
ischemic events

Question 15

True or False:

Bruits do not correlate with clinically significant underlying disease.

Answer 15

True

• bruits can be congenital/normal
• loudness/intensity doesn’t correlate to a problem

Question 16

why are carotid dopplers problematic when trying to detect \ asymptomatic carotid disease?

Answer 16

Low sensitivity and specificity

-false positives occur if pt does not have any carotid pulse abnormalities

Question 17

when is the use of carotid dopplers indicated?

Answer 17

high risk populations

• older age
• artherosclerotic disease

*can cause 10% of ischemic strokes

Question 18

how do you measure for JVP?

Answer 18

– Raise the head of the bed or examining table to 30 - 45°
– Turn the patient’s head to the left (as blood comes out of a valve, it goes to right jug vein first, preferred place to look)
– Place a centimeter ruler upright on the sternal angle, perpendicular to the floor.
– Identify the topmost point of the flickering venous pulsations
– Place a card or tongue blade horizontally from the top of the JVP to the ruler, making a right angle
– Measure the distance above the sternal angle in centimeters: a 3- to 4-centimeter elevation is normal (anything above is abnormal)

Question 19

what do jugular veins reflect & if an elevation is present, what can it indicate?

Answer 19

right atrial pressure

-right ventricular failure/right heart failure

Question 20

what can decreased JVP indicate?

Answer 20

◦ Hypovolemic state

◦ Sepsis

Question 21

if the JVP is elevated > 3cm above the sternal angle, what associated conditions can this indicate?

Answer 21

◦ Heart failure
◦ Tricuspid stenosis
◦ Chronic pulmonary hypertension
◦ Superior vena cava obstruction
◦ Cardiac tamponade
◦ Constrictive pericarditis