Cardiac Exam PD Final (missing some stuff)

What is the scale of cardiac intensity in murmur?

1-6

Apical impulse is usually how many cm?

2.5 or size of quarter

Where is the pulmonary area of cardiac palpation for thrill?

2nd ICS to left sternal border

How many degrees do we set the patient head in JVP?

30

How many pulsating waves does JVP have?

4

Mitral or apical area is where?

5th ICS at left of midclavicular line

What angle do I place the ruler in JVP sternal notch?

90 degrees

What is a normal JVP?

< or = 3 cm

Which of the following are true when examining the carotid arteries of the neck? Pick all that apply a. auscultate first then palpate b. use the diaphragm c. palpate the carotids with thumb and middle fingers d. palpate sweeping out from sternal notch or in from sternomastoid muscle e. note amplitude graded 1-3 f. normal amplitude is 2+

A. Auscultate then palpate and F. Normal amplitutde 2+ EXPLAIN b. you use the bells for bruits c. palpate caritod with INDEX and middle fingers sweeping from TRACHEA or in from sternomastoid muscle e. amplitude graded 1-4+

In the cardiac auscultation, which 4 areas do you listen to the valves on?

Aortic area, pulmonary area, tricuspid area, mitral area

When is the final phase of ventricular filling?

Atrial systole S4

Which murmur grade is hardly discernible in all positions? Extremely faint a.IV b. I c. V d. III e. VI f. II

B. I

Which of the following is an aspect of cardiac inspection? a. Carotid artery, peripheral pulses, PMI, thrills and heaves on Precordium, Hepatojugular Reflex b. JVP c. Carotid bruits, carotid radiation of murmurs, carotid heart sounds and murmurs

B. JVP

Which positions can you feel a PMI? a. supine b. standing c. seated d. left lateral decubitus

C and D

> 3 cm JVP called jugular venous distention, indicated what?

CHF

>3cm JVP and hepatojugular reflex indicates what?

CHF

A CHF patient would have which of the following symptoms? Select all that apply a. elevated JVP (>3 cm) b. carotid bruit c. RRR d. IIR e. PMI >2.5 cm f. S3 g. S4

CHF: > 3 cm JVP > 2.5 cm PMI Irregularly Irregular Rate S3

Which of the following is an aspect of cardiac palpation? a. Carotid artery, peripheral pulses, PMI, thrills and heaves on Precordium, Hepatojugular Reflex b. JVP c. Carotid bruits, carotid radiation of murmurs, carotid heart sounds and murmurs

Carotid artery, peripheral pulses, PMI, thrills and heaves on Precordium, Hepatojugular Reflex

True or false. I should palpate the carotids above the cricoid cartilage.

FALSE NO YOU DONT WANT TO STIMULATE THE CAROTID SINUS

True or False. I should check the carotids at the same time for the best comparison.

FALSE NO ONE AT A TIME

True or False. Atrial fibillation always has A waves.

False. Atrial fib. doesn't have it

True or False. The patient is seated for most of the exam.

False. Its supine

True or False. I notate a murmur's location where it beats the fastest.

False. Where its the loudest

True or False. You start cardiac palpation with 4 fingers.

False. You start with palm then move to 1-2

I use the bell in cardiac auscultation for which of the following? a. S3 b. S4 c. murmur of reg d. murmur mitral stinosis e. A and B f. ABC g. ABD

G. ABD The bell is mighty low! (low pitched sounds) S3 S4 murmur of mitral stenosis

This occurs when the blood is displaced from firm pressure which overwhelms the failing right hearts ability to compensate for increased venous return so the blood goes to the jugular veins

Hepatojugular reflex

How can you remember diastolic murmurs?

I just Died in your ARMS tonight.... Diastolic Aortic Regurge Mitral Stenosis

How can you remember which murmurs are systolic?

MR PASS has VD Mitral Regerge Pulmonary and Aortic stenosis [aortic and pulmonary stenosis it could also be mitral and tricusp regurgitation] V(s)D- Ventricular Septal defect

When does the mitral valve close? When are all valves closed? When is ventricular volume constant?

QRS on EKG S1 All valves are closed on iso. volumetric vent. contraction

How to remember the descriptors of murmurs?

Queen Idled Through Singing "Rhapsody" Quality Intensity Timing Shape Radiation

What marks the beginning of systole and the rise of carotid pulse?

S1

When does the aortic valve close?

S2 isovol. ventricular relax

When does the mitral valve open

S3 rapid ventricular filling

When does the aortic valve open?

ST on EKG rapid ventricular ejection

Why do we need to make sure patients rest head when measuring JVP?

Stupid sternomastoid muscle needs to relax damnit

Name the 4 patient positions of cardiac auscultation.

Supine upwards upwards leaning forward left lateral decubitus

True or False. Cardiac percussion starts at the far left of the chest and you percuss from resonance to cardiac dullness in 3-6th ICS

True

True or False. I should not compress the carotid artery with bruit because I could dislodge plaque

True

True or False. The aortic area can radiate to the apex

True

Where do I press for the hepatojugular reflex?

Upper RUQ abdomen below costal margin

This special test increases venous return to heart by increasing intrathoracic pressure.

Valsalva

Which murmur grade is loud with a palpable thrill? a.IV b. I c. V d. III e. VI f. II

a. IV (4)

Which disease is elevated JVP related to? a. Right sided CHF b. Left sided CHF c. fibrosis d. COPD

a. Right sided CHF

I look for thrills in cardiac palpation in the 2nd ICS to the R sternal border in which area? a. aortic area b. pulmonic area c. right ventricular area (tricuspid) d. apical area (mitral) e. epigastric area

a. aortic area

What happens in the A wave of JVP? a. atrial contraction b. bulging of tricupsid valve to right atrium c. atrial relaxation d. rise in arterial pressure before tricuspid valve opens e. atrial empty into RV

a. atrial contraction

In palpation of cardiac, if the chest feels like its pushing back at me this is a sign of what? a. heaves b. PMI c. JVP d. bruit

a. heaves

When we inspect on the cardiac exam, we're looking for large area of pulsation with the heart beat also known as: a. heaves b. bruit c. murmur d. fibrillation

a. heaves

JVP falls under which of the following for the cardiac exam? a. inspection b. palpation c. auscultation

a. inspection

Which of the following is FALSE about the hepatojugular reflex? a. the patient is supine with head at 50 degrees b. You press the RUQ firmly to compress the liver c. While compressing liver, look to see if jugular veins distend

a. its 30 degrees

Atrial emptying into the right ventricle happens in what phase of JVP? a. Y descent b. V wave c. X descent d C wave e. A wave

a. y descent

Name the 5 places I palpate for cardiac thrills.

aortic area pulmonic area right ventricular area (tricuspid) apical area (mitral) epigastric area

2 places a murmur could radiate

axille or cartoid

Apical impulse is also known as: a. JVP b. PMI c. CHF

b. Point of max impulse (PMI)

What do I record on measuring JVP? a. rate of pulsation b. highest point of pulsation c. arteries of pulsation d. degrees the patient head is tilted until see the 4 pulses

b. highest point of pulsation on ruler

Which murmur especially increases in valsalva, standing? a. aortic stenosis b. mitral valvue prolapse c. mitral stenosis d. aortic regurge

b. mitral valve prolapse

When we auscultate carotids bruit, why do we ask the patient to take a deep breath and hold it? a. Increased arterial pressure makes it easier to hear b. removes breath sounds easier to hear c. carotid bruit is only heard when we hold our breath

b. removes breathe sounds easier to hear

Jugular Venous Pulsation measures which pressure? a. left venous pressure b. right arterial pressure c. barometric pressure d. left ventricular pressure

b. right arterial pressure

Crescendo, Decrescendo, and plateau are examples of which description of a heart murmur? a. radiation b. shape c. timing d. intensity. e. quality

b. shape

Valsalva and squatting help to identify which murmurs? a. continous b. systolic c. diastolic

b. systolic

Which part of the stethoscope do I use for mitral stenosis?

bell

4 descriptors of quality in cardiac murmur

blowing, harshness, rumbling, muscial

Which of the following is an aspect of cardiac auscultation? a. Carotid artery, peripheral pulses, PMI, thrills and heaves on Precordium, Hepatojugular Reflex b. JVP c. Carotid bruits, carotid radiation of murmurs, carotid heart sounds and murmurs

c. Carotid bruits, carotid radiation of murmurs, carotid heart sounds and murmurs

Which of the following is the correct sequence of writing the cardiac exam? a. JVP cm, angle degree, location, carotid pulse intensity, rate and rhythm, S1 and S2 b. JVP cm with angle degree location and position, PMI location, Y/N murmur S3 S4 splitting friction rub or extra sounds c. JVP cm with angle, degree location and position. PMI location. Carotid pulse intensity and location. Regularity, Rate, Rhythm, S1 and S2, Y/N murmurs, S3, S4, splitting, friction rub other sounds d. PMI location, S1 and S2, Regularity Rate Rhythm, Y/N murmur, S3, S4, splitting, friction rub or other sounds

c. JVP- angle location in cm, PMI size, location, carotid pulse intensity and location, regularity, rhythm, S1 and S2 normal?, Y/N murmurs, S3,S4,splitting, friction rub, other sounds

Which murmur is very loud with thill and may be heard with stethoscope half on the chest? a.IV b. I c. V d. III e. VI f. II

c. V

What might cause a falsely increased JVP? a. increased angle b. hyperventilation c. decreased angle

c. decreased angle

What is a thill? a. feeling alive again b. measurement of right arterial pressure c. feeling of vibration

c. feeling of vibration

For S3 S4 and mitral stenosis, how should the patient be situated? a. supine b. prone c. left lateral decubitus d. right lateral decubtitus

c. left lateral decubitus

which of the following is the chest wall that overlays the heart? a. cartoic area b. epigastric area c. precordium d. All of the above

c. precordium

Where should I look for JVP? a. sternal notch and apex b. sternal notch and 4th ICS c. sternal notch and behind sternomastoid

c. sternal notch and behind sternomastoid

Which of the following is the correct place to record if a murmur is diastolic or systolic? a. radiation b. shape c. timing d. intensity. e. quality

c. timing

What 3 parts do you test for in the cardiovascular neck exam?

carotid artery jugular vein Pressure hepatojugular reflex

List the correct sequence of the cardiac exam techniques a. auscultation, palpation for pmi, inspection, percussion, valve palpation for thrill b. inspection, auscultation, palpation for pmi, percussion, valve palpation for thrill c, inspection, palpation for pmi, valve palpation for thrill, auscultation, percussion d. inspection, palpation for pmi, valve palpation for thrill, percussion, auscultaiton

d.

Which phase isn't usually appreciated and is the bulging of the tricuspid valve into the right atrium ? a. Y descent b. V wave c. X descent d C wave e. A wave

d. C wave

Which murmur is kind of loud but no thrill on palpation? a.IV b. I c. V d. III e. VI f. II

d. III

Which of the following is true about cardiac auscultation? a. You only use the bell b. You only use the diaphragm c. The diaphragm is for mitral stinosis d. The bell is for low pitched sounds of S3 and S4

d. The bell is for low pitched sounds of S3 and S4 EXPLAIN a/b you use the diaphragm and the bell in cardiac auscultation c. the diaphragm is for S1, S2, regurge, and pericardial friction rub

In auscultation, Khalil is seated and leaning forwards holding his breath after exhalation. What are we looking for? a. S3 S4 mitral stenosis b. Pulmonic stenosis c. mitral regurge d. aortic murmurs

d. aortic murmurs aortic regurge aortic stenosis

Where do I place the ruler when measuring JVP? a. sternomastoid muscle b. xiphoid process c. 1/3 supraclavicular fossa d. sternal notch

d. sternal notch

After inspection and palpation of the chest for cardiac, I palpate the valves for what? a. PMI b. JVP c. bruit d. thrills

d. thrills

Which part of the stethoscope do I use for murmurs of regurgitation?

diaphragm

Which part of the stethoscope do I use for pericardial friction rubs auscultation?

diaphragm

Which murmur grade has a thrill and can be heard without stethoscope? a.IV b. I c. V d. III e. VI f. II

e. 6 (VI)

Tricupsid stenosis, pulomary stenosis, and pulmonary hypertension. Which JVP would be the enlarged? a. Y descent b. V wave c. X descent d C wave e. A wave

e. A wave

Which of the following is true about using the diaphragm in cardiac auscultation? a. S1 and S2 b. its for high pitched sounds c. pericardial friction rub d. murmurs of reg. e. all of the above

e. all of the above "I'd die to be high (high pitched) and normal (S1 and S2) but it might cause friction (pericardial friction rub) cause i can't regurgitate information

This area of cardiac palpation for thrills is subxiphoid. a. aortic area b. pulmonic area c. right ventricular area (tricuspid) d. apical area (mitral) e. epigastric area

e. epigastric

Where would we normally find PMI or apical impulse? a. 4th ICS and mid-clavicular line b. 4Th ICS and mid-sternal line c. 5th ICS and mid-sternal line d. 5th ICS and mid-axillary line e. none of the above

e. none of the above APICAL IMPULSE IN 5th ICS AND MID CLAVICULAR LINE

harsh, blowing, rumbling, and musical describe which part of cardiac murmurs? a. radiation b. shape c. time d. intensity. e. quality

e. quality

Which murmur is quiet, but heard immediately after placing stethoscope on chest? a.IV b. I c. V d. III e. VI f. II

f. II

True or false. As long as the patient is still and the head is at 30 degrees, no other factors should impact JVP

false. gravity affects height

I find palpate a thrill. What could this indicate?

heart murmur

Difference between measuring intensity and shape in cardiac murmur.

intensity=scale 1-6 shape- over time. crescendo, decrescendo, plateau

I accidentally increase the angle that I take the JVP. What will happen to the reading?

it decreases falsely

What is the first thing you should do for the cardiac exam? Which side do you start on?

make sure patient exposes chest R side

True or false. Shape in a cardiac murmur measures how thick the ventricles are

no false shape measures how intense it is over time!!!

True or false. I use a bell to auscultate carotid bruit after I palpate the carotid artery.

no. auscultate the carotid bruit first with the bell then palpate Bells make bruits (bruit is sound in french)

What can I use to help assess cardiac dullness if I can't find the PMI?

percussion

In palpation, cardiac hypertrophy possible indication of larger or displaced what? a. heaves b. PMI c. JVP d. bruit

pmi

What 4 locations do we auscultate?

right second ICS left second ICS along L sternal border along 5th ICS to anterior axillary line

This area of cardiac palpation for thrills includes the 3rd 4th an 5th ICS to the lower left of the sternum a. aortic area b. pulmonic area c. right ventricular area (tricuspid) d. apical area (mitral) e. epigastric area

right ventricular area (tricuspid) maybe can remember because there are 3 ICS involved

atrial relaxation phase of JVP

x descent