Physical Examination - Cardiovascular

Question 1

Clinical Skills

What are the major steps of the cardiovascular exam?

Answer 1

1. Observation
2. Palpation
3. Auscultation

(*no percussion*)

Question 2

Clinical Skills

What are the major points of the observation/inspection portion of the cardiovascular exam?

Answer 2

1. Jugular venous pulsations/pressure

2. Point of maximal impulse

(*NOTE: both are often not visible*)

Question 3

Clinical Skills

Describe the assessment of jugular venous pressure in the cardiovascular exam.

1. Position table at ___°.

2. Look for visible pulse in jugular vein (normally, pulse should not be visible). If pulse is visible, approximate the distance of the pulse point to the _______ angle, add ___ cm to this to get your JVP.

Answer 3

1. Position table at 30°.

2. Look for visible pulse in jugular vein (normally, pulse should not be visible). If pulse is visible, approximate the distance of the pulse point to the sternal angle, add 5 cm to this to get your JVP.

Question 4

Clinical Skills

Describe the assessment of point of maximal impulse in the cardiovascular exam.

1. Position table at ___°.

2. PMI normally should be at ___th intercostal space at the __________ line, about the size of a quarter. PMIs are commonly not visible, so confirm its location by palpation.

3. Move patient to _____________ position, using the whole hand to feel for PMI.

Answer 4

1. Position table at 30°.

2. PMI normally should be at 5th intercostal space at the mid-clavicular line, about the size of a quarter. PMIs are commonly not visible, so confirm its location by palpation.

3. Move patient to left lateral decubitus position, using the whole hand to feel for PMI.

Question 5

Clinical Skills

What are the major points assessed for during the palpation portion of the cardiovascular exam?

Answer 5

1. PMI

2. Lifts/heaves

3. Edema (at ankles/feet)

4. Abdominojugular reflex (only if right ventricular failure is expected)

Question 6

Clinical Skills

What is a cardiovascular heave/lift?

Answer 6

Being able to feel the ventricular contraction through the chest wall

(indicates right ventricular hypertrophy)

Question 7

Clinical Skills

What is a cardiovascular thrill?

Answer 7

A palpable murmur

Question 8

Clinical Skills

The PMI is palpable in ____% of patients in the left lateral decubitus position.

Answer 8

Clinical Skills

The PMI is palpable in 50% of patients in the left lateral decubitus position (25-40% in the supine position).

Question 9

Clinical Skills

During the palpation portion of the cardiovascular exam, where should one check for heaves/lifts?

Answer 9

With the whole hand at the left sternal border

Question 10

Clinical Skills

The PMI should normally not be larger than what?

Answer 10

A quarter

Question 11

Clinical Skills

True/False.

The more abnormal the heart, the more the PMI is visible.

Answer 11

True.

Question 12

Clinical Skills

When should hepatojugular reflex be assessed?

(How?)

Answer 12

If right ventricular failure is suspected.

(Patient at 30°;

place the heel of the hand under the right costal margin;

press firmly for 30-60 seconds;

ventricular failure leads to a rise in JVP exceeding 3-4 cm)

Question 13

Clinical Skills

A PMI that is diffuse or displaced laterally is indicative of what?

Answer 13

Ventricular enlargement

Question 14

Clinical Skills

What are the six points of the auscultation portion of the cardiovascular exam?

Answer 14

1. Right carotid artery (BELL)

2. Aortic space (DIAPHRAGM)

3. Pulmonic space (DIAPHRAGM)

4. Erb’s point (DIAPHRAGM)

5. Tricuspid area (DIAPHRAGM)

6. Mitral area (DIAPHRAGM)

Question 15

Clinical Skills

Which two peripheral vascular pulses should always be assessed in the cardiovascular exam (Tier I)?

Answer 15

1. Radial
2. Dorsalis pedis

(compare both sides)

Question 16

Clinical Skills

Which peripheral vascular pulses can be assessed in the cardiovascular exam in addition to the radial and dorsalis pedis?

Answer 16

Carotid,

brachial,

femoral,

popliteal,

posterior tibial

Question 17

Clinical Skills

In assessing murmur intensity, what would consitute a 1?

Answer 17

A murmur faintly heard with a stethoscope

Question 18

Clinical Skills

In assessing murmur intensity, what would consitute a 4?

Answer 18

A palpable thrill

Question 19

Clinical Skills

In assessing murmur intensity, what would consitute a 6?

Answer 19

A murmur heard with the stethoscope off the chest

Question 20

Clinical Skills

How can you determine which beat is the S1 during a cardiovascular exam?

Answer 20

The S1 occurs simultaneously with the carotid pulse

Question 21

Clinical Skills

Which Tier 1 auscultation point(s) of the cardiovascular exam is(are) done with the bell?

Answer 21

The carotid arteries

Question 22

Clinical Skills

The stethoscope bell is useful for hearing ______ frequencies.

The stethoscope diaphragm is useful for hearing ______ frequencies.

Answer 22

Clinical Skills

The stethoscope bell is useful for hearing lower frequencies.

The stethoscope diaphragm is useful for hearing higher frequencies.