Physical exam

Question 1

What are the 8 big steps of CV physical examination?

Answer 1

1. Inspection
2. Blood Pressure
3. Heart Rate
4. Respiratory rate
5. Orthostatic Hypotension
6. JVP assessment
7. Carotid Pulse
8. Palpation and auscultation of the heart

Question 2

What are the things that we inspect?

Answer 2

• Is the patient in acute distress?
• Is the patient using accessory muscles for respiration?
• INSPECTION OF THE SKIN:
  1. Cyanosis (central or peripheral)
  2. Temperature
  3. Xanthomata (tendinous, tuberous or eruptive)
  4. Osler’s note or Janeway lesions
• Inspection of the nails
• Inspection of favies (earlobe creases)
• Xanthelasma (yellow plates on eyelids)
• Arcus Senilis
• Palatal petchiae
• Chest configuration
• Extremities (congenital syndromes)

Question 3

How do we take the BP?

Answer 3

PALPATION

1. Palpate the brachial artery
2. Lower border 2.5 above antecubital crease
3. Inflate until radial pulse dissapears and add 30 mm Hg

STETHOSCOPE (bell)

4. Deflate, FIRST SOUND IS SYSTOLIC BP
5. Continue deflating, when SOUND STOPS IS DIASTOLIC BP

Take more than once and wait a few minutes (3 times)

Question 4

How do we assess JVP?

Answer 4

Reflects the right heart pressure
1- Positioning the patient - Inclination 30*
- Leaning on the side evaluated
- Head on the other side
- Tangetinal lighting
2- Distinguishing internal jugular with carotid pulsations
3- Estimation of the height of the JVP from atria (5 cm + X)
4- Evaluation of the various waveforms

Question 5

Where do you stand when we evaluate the patient?

Answer 5

To his RIGHT

Question 6

What distance between the sternum and the right atria?

Answer 6

5 cm