PCM Normal cardiac/Vascular exam

Question 1

The diaphragm of the stethoscope is used to listen to what kind of sounds?

Answer 1

high pitched

Question 2

High pitched sounds will include

Answer 2

S1, S2, atrial and mitral regurgitation, Friction Rubs

Question 3

Low pitched sounds will include

Answer 3

S3, S4, MS, carotid bruit (a murmur)

Question 4

What sounds will the bell of the stethoscope be used to detect?

Answer 4

S3, S4, MS, carotid bruit (a murmur)

Question 5

Inspection of patient: general appearance

Answer 5

consciousness, cyanosis, flushing, respiratory, patterns anxiety/distress, body habitus, diaphoresis, neck veins (JVD)

Question 6

Inspection of landmarks for precordial exam

Answer 6

sternal notch, and angle, sternal border, mid clavicular line, anterior axillary line, xiphoid process, nipples, scars/signs of trauma

Question 7

Inspection of shape of patient

Answer 7

barrel chested: COPD
Pectus excuvatum (funnel chest) 
Pectus carninatum (pigeon chested)

Question 8

Palpations for the point of maximal impulse

Answer 8

find xiphoid process and move toward midclavicular line
4th-5th intercostal space

“midsternal line to mid clavicular line”

Point of Maximal Impulse
(PMI) or Apical Impulse
 Supine or left lateral decubitus
 Normal: 4th-5th intercostal space at the Mid-clavicular line

Question 9

PMI may not be heard in

Answer 9

healthy patients

Question 10

when do you percuss?

Answer 10

when you do not hear a PMI

Question 11

where do you begin to percuss?

Answer 11

far left, and move medially

Question 12

Auscultation: where

Answer 12

aortic: 2nd intercostal space, right SB
pulmonic: 2nd intercostal space, left SB
tricuspid: 4th intercostal space SB
mitral valve: 5th intercostal space SB

Question 13

S1

Answer 13

closure of tricuspid and mitral valves

Question 14

S2

Answer 14

closure of the aortic and pulmonic valves: may split with inspiration (nml)

Question 15

S3

Answer 15

Dull, low pitch, best heard with bell. Due to high pressures and abrupt deceleration of inflow across the mitral valve at the end of the rapid filing phase. Physiologic in children/young adults, pathologic >40 yo - Kent Tuck Y

Question 16

S4

Answer 16

Dull low pitch, best heard with bell. Atrial gallop from contraction of atria against a stiffened (low compliant) ventricle. Can be normal in trained athletes. “Ten-Nes-See”

Question 17

Describe the PMI

Answer 17

should be small, brisk beat and measure less than 2.5 cm. the impulse should last through the first 2/3 of the systolic period or less. it should not be felt through the second heart sound

Question 18

the four steps of the examination

Answer 18

1. Describes and demonstrates steps to Cardiovascular Exam.

a. Inspection
i. General appearance: Consciousness, Cyanosis/Flushed, Neck Veins, Respiratory patterns, Anxiety, Distress, Body habitus, Perspiration
ii. Chest shape: Barrel chest, Pectus excavatum, Pectus carinatum b. Palpation
i. Locate point of maximum impulse (PMI) c. Percussion
i. Used to estimate cardiac size when PMI not detectable. Start far left on the chest percussing medially from resonance toward cardiac dullness.
d. Auscultation – see below

Question 19

Systolic murmurs fall between

Answer 19

S1 and S2

Question 20

Diastolic murmus fall between

Answer 20

S2 and S 1

Question 21

Grade 1

Answer 21

no sound

Question 22

grade 2

Answer 22

quiet but heard easily with stethoscope

Question 23

grade 3

Answer 23

moderately loud

Question 24

grade 4

Answer 24

loud with palpable thrill

Question 25

grade 5

Answer 25

very loud w/thrill

Question 26

grade 6

Answer 26

heard with stethoscope entirely off the chest

Question 27

R-R-A

Answer 27

rate, rhythm, amplitude

Question 28

ranking peripheral pulses

Answer 28

0-4

0 none 
1 barely palpable 
2 average intensity 
3 strong 
4 bounding