Nov16 M1,2-Cardiac Physical Exam

Question 1

important cause of overestimation of BP (high BP)

Answer 1

loose BP cuff

Question 2

exam components (6)

Answer 2

• inspection
• BP, HR, RR
• JVP and carotid pulse
• heart palpation
• heart auscul
• edema

Question 3

inspection steps

Answer 3

distress (access muscles of resp), skin, nails, ears, eyes, mouth, chest

Question 4

skin exam

Answer 4

peripheral or central cyanosis, temp, xanthomas, Osler nodes, Janeway lesions,

Question 5

xanthomas and meanings

Answer 5

tendinous: FH
tuberous: primary biliary cirrhosis
eruptive: hyperTG

Question 6

Osler nodes and Janeway lesions meaning

Answer 6

infective endocarditis

Question 7

nails exam

Answer 7

splinter hemorrhages: shows valve problem

Question 8

ears exam

Answer 8

oblique earlobe crease: coronary disease

Question 9

eyes exam

Answer 9

xanthelasma (plaque on eyelids) and arcus senilis (dyslipidemias)

Question 10

mouth exam

Answer 10

palatal petechiae: endocarditis

Question 11

chest exam

Answer 11

pectus excavatum: Marfan’s and mitral valve prolapse

pectus carinatum: MArfan’s

Question 12

BP measurement prep

Answer 12

no smoking or coffee before, at rest, arm free, supported at heart level

Question 13

correct BP cuff choice

Answer 13

width of bladder (empty part of cuff) 40% upper arm circumf

length of bladder 80% arm circumf

Question 14

important position rule in BP

Answer 14

brachial artery at lvl of heart

Question 15

enemy in BP measurement

Answer 15

auscultatory gap

Question 16

htn def

Answer 16

over 130-80 on 24hrs. OR over 135-80 during day. OR over 180-110. Otherwise, take P over 24 hrs

Question 17

rule in BP and htn

Answer 17

measure twice. + 2nd office visit if htn.

Question 18

how to get HR + other thing to check

Answer 18

radial pulse during 30s. 60s if fast or slow

+ assess rhythm

Question 19

causes of orthostatic hypotension

Answer 19

drugs (antihtn), blood loss, prolonged bed rest, ANS disease

Question 20

JVP technique (4 steps)

Answer 20

position the patient
distinguish internal jugular vs carotid pulsation
estimate height of JVP
evaluate waveforms

Question 21

JVP vs carotid

Answer 21

JVP is biphasic not monophasic
JVP’s more vigorous thrust goes inward
can shut JVP if push on jugular above clavicle

Question 22

waveforms and what correspond to

Answer 22

a wave: before S1 (atrial contraction)
x descent: when systole
v wave: almost with S2
y descent: early diastole

Question 23

a wave problems and significance

Answer 23

prominent = reduced RV compliance
cannon = vent rhythm or tricuspid block
absent = a fib maybe

Question 24

x descent importance

Answer 24

created by RV suction on RA. IS MOST VIGOROUS MVMT OF JVP

Question 25

v wave normally and problems

Answer 25

should be smaller than a wave. if bigger: tricuspid regurg.

Question 26

Kussmaul sign def

Answer 26

rise in height of JVP and failure to decrease JVP with inspiration

Question 27

Kussmaul sign meaning

Answer 27

constrictive pericarditis, restrictive CMP, PE, RV infarction, advanced systolic HF

Question 28

carotid pulse technique

Answer 28

press till max amplitude and then slowly decrease P until sense arterial P and contour

Question 29

amplitude variations in carotid pulse

Answer 29

low am: aortic stenosis | high amp: aortic regurg

Question 30

apical impulse normal vs prob

Answer 30

brisk and tapping. can be sustained in htn or aortic stenosis

Question 31

auscultation: where + what portion of steth for what

Answer 31

4 areas. bell for S3, S4 and mitral stenosis