Physical Examination

Question 1

What should be examined first?

Answer 1

Vital signs:

Body Temperature (orally, axillary, rectal, ear, skin)

Pulse Rate (PR)

Blood pressure (BP)

Respiratory Rate (RR)

Question 2

After Vital signs what should you check for signs of Cyanosis ?

Answer 2

Lips and nails for color (Cyanosis)

Question 3

Explain steps in Lung examination

Answer 3

• Percuss then auscultate posterior lungs in a*
• ladder pattern*

Question 4

Listening to the lungs

you have to make sure to do what?

Answer 4

• Listen to the lungs, making sure to*
• listen to the Right Middle Lobe under the axilla*

Question 5

After lung examination,

what should be examined next?

What position should the patient be in?

Answer 5

1. Examine the Vessels in the Neck and in the Heart
2. Patient is in Supine positon

Question 6

Neck examination:

Explain steps/what to look for and how?

Answer 6

Examine the Neck first:

Height of venous pressure and sternal angle

1. Assess the jugular venous pressure (JVP)
2. Find the highest point of oscillation in the (IJV) and measure the vertical distance from the sternal angle.
3. Palpate the Normal Upstroke (Normal=brisk, smooth, rapid and follows S1 almost immediately)

Note: Large Bunding upstrokes (pulses) indicate Aortic insufficiency

4. Listen for Bruit: Whooshing, murmul-like sound of vascular origin= Suggests atherosclerotic narrowing

Note: The jugular venous pressure (JVP) reflects pressure in the right atrium (central venous pressure); the venous pressure is estimated to be the vertical distance between the top of the blood column (highest point of oscillation) and the right atrium.

Question 7

Heart Examination:

Define: PMI

Define: 6 listening areas

Answer 7

• The point of maximal impulse (PMI)*
• is the location at which the cardiac impulse can be best palpated on the chest wall.*
• Frequently, this is at the fifth intercostal space at the midclavicular line.*
• how to check for “Tapping impulse Point of the Heart”*

Note: listen to S1 and S2 in each of the 6 listening areas

1. Aortic area (Right 2nd interspace)
2. Pulmonic area (Left 2nd interspace)
3. (Left 3rd interspace)

4-5 Tricuspid area (Left 4th and 5th interspaces)

6. Mitral area (apex)

Note: Use the diaphragm at the RUSB adn LLSB

Use the Bell at the apex

(The bell transmits low frequency sounds, while the diaphragm transmits higher frequency sounds)

Question 8

How to examine the Abdomen

Answer 8

Listen to the abdomen

Palpate the abdomen

Question 9

• The following findings may be heard in the cardiac auscultation of this patinet*
• with recent onset of chest pain..*

Q. How can S4 be identified?

Answer 9

S4 is a low pitched diastolic sound reflecting changes in ventricular compliance, best heard with the bell with the patient in a left lateral decubitus position.

It may be present during ischemia or in teh setting of hypertension.

Question 10

• heart sounds in the MITRAL area or APEX*
• are wooshy and rapid:*
• Indicative of what condition?*

Answer 10

Mitral regurgitation is a holosystolic murmur reflecting mitral valve dilatation, best heard at the apex that may rediate to the axilla and lower left sternal border.

It may occur with transient ischemia.

Question 11

Holosystolic Murmur

Define:

Answer 11

Holosystolic Murmur

A holosystolicmurmur begins at the first heart sound (S1) and continue to the second heart sound (S2), as illustrated in the phonocardiogram.

Typically high-pitched, these murmurs are usually caused by ventricular septal defect, mitral regurgitation or tricuspid regurgitation

Question 12

transient ischemic attack (TIA)

define:

Answer 12

transient ischemic attack (TIA),

commonly known as a mini-stroke, is a brief episode of neurological dysfunction caused by loss of blood flow in the brain, spinal cord, or retina, without tissue death .

TIAs have the same underlying mechanism as ischemic strokes.

brief episode of cerebral ischemia that is usually characterized by temporary blurring of vision, slurring of speech, numbness, paralysis, or syncope (fainting) and is often predictive of a serious stroke

Question 13

Assess congestinve heart failure (CHF) in Patients with extensive MI that compromises cardiac output due to decreased stroke volume or heart rate (CO=SV x HR)

Q: which findings on the cardiac exam have the best evidence for congestive heart failure?

Answer 13

Rales

Elevated JVP

S3

consistently predict heart failure

Question 14

Rales

Define:

Answer 14

rales

Abnormal rattling sounds accompanying the breath sounds and heard through a STETHOSCOPE duringexamination of the chest.

They are caused by air passing through fluid or mucus in the small air tubes (bronchioles)

Compare RHONCHI.

Question 15

Elevated (JVP)

Define and what does it mean?

Answer 15

Jugular venous pressure (JVP)

provides an indirect measure of central venous pressure.

This is possible because the internal jugular vein (IJV) connects to the right atrium without any intervening valves, resulting in a continuous column of blood.

The presence of this continuous column of blood means that changes in right atrial pressure are reflected in the IJV (e.g. raised right atrial pressure results in distension of the IJV).

Question 16

S3

used in prediction of HF

Define:

Why do we palpate the ankles?

Answer 16

S 3 is a dull, low-pitched sound best heard with the bell placed over the cardiac apex with the patient lying in the left lateral decubitus position.

THIRD HEART SOUND (S3 – Ventricular Gallop)

Produced by rapid filling (& expansion) of ventricles. It occurs just after S2 in diastole when the AV valves open. It may be a normal finding in young patients & pregnancy, but almost always pathological after 40 years. The most common cause of pathological S3 is a congestive cardiac failure.

2. Looking for EDEMA