cardio

Question 1

What position should the patient be at for a cardio exam?

Answer 1

45 degrees

Question 2

exposure of the patient

Answer 2

exposed from waist upwards

Question 3

where do you palpate the radial artery

Answer 3

between
tendon of flexor carpi radialis
and
tendon of brachioradialis

Question 4

what rate counts as bradycardia and tachycardia

Answer 4

bradycardia = <60 bpm
tachycardia = >100 bpm

Question 5

what to comment on when assessing pulse

Answer 5

rate and rhythm

Question 6

where do you palpate the ulnar artery

Answer 6

between
flexor digitorum superficialis
and
flexor carpi ulnaris

Question 7

where do you palpate the brachial artery

Answer 7

medial to biceps tendon

Question 8

how to position arm during brachial artery palpation

Answer 8

flex arm to find tendon
then fully extend to assess pulse

Question 9

from which arteries can character and volume be assessed

Answer 9

only from central arteries eg common carotid

Question 10

where do you palpate the common carotid artery

Answer 10

between
medial border of sternocleidomastoid muscle
and
lateral border of thyroid cartilage

Question 11

where do you palpate the apex beat

Answer 11

5th intercostal space at left mid clavicular line
(align middle finger here, then other fingers above and below)

• first identify sternal angle and palpates left 2nd rib down to 5th rib, and then onto the 5th intercostal space at the mid clavicular line

Question 12

where should you start palpating for the apex beat

Answer 12

from lateral side towards midclavicular line

Question 13

what causes a displaced apex beat

Answer 13

cardiomegaly

Question 14

causes of an absent apex beat

Answer 14

obesity
pericardial effusion
pleural effusion
emphysema

Question 15

what is a precordial impulse

Answer 15

Precordial impulses are pulsations originating from the heart or great vessels that are visible or palpable on the anterior chest wall

Question 16

what is a parasternal heave

Answer 16

a precordial impulse that can be palpated

Question 17

where to place hand for parasternal heave

Answer 17

place heel of hand parallel to left sternal edge to palpate for heaves

Question 18

what causes parasternal heaves

Answer 18

right ventricular hypertrophy - would feel heel of hand being lifted with each systole

Question 19

what is a thrill

Answer 19

palpable vibration caused by turbulent blood flow through heart valves

Question 20

how and where to place hand for thrills

Answer 20

horizontally across chest wall, at each of the heart valves

Question 21

which sides of the stethoscope do you use for each of the valves

Answer 21

diaphragm
- aortic
- pulmonary
- tricuspid

bell
- mitral

Question 22

location of aortic valve

Answer 22

right sternal border, 2nd ICS

Question 23

location of pulmonary valve

Answer 23

left sternal border, 2nd ICS

Question 24

location of tricuspid valve

Answer 24

left 5th costo-sternal border

Question 25

location of mitral valve

Answer 25

left 5th ICS at midclavicular line (at apex beat)

Question 26

causes of ejection systolic murmur

Answer 26

aortic stenosis pulmonary stenosis aortic sclerosis hypertrophic obstructive cardiomyopathy (HOCM) atrial septal defect

Question 27

what murmur is heard with aortic stenosis

Answer 27

ejection systolic murmur

Question 28

how to assess for aortic stenosis

Answer 28

auscultate the carotid arteries using diaphragm WHILST PATIENT HOLDS THEIR BREATH

Question 29

what murmur is heard with aortic regurgitation

Answer 29

early diastolic murmur

Question 30

how to assess for aortic regurgitation

Answer 30

sit patient forward and auscultate over aortic area using diaphragm in EXPIRATION

Question 31

which examinations require the left lateral decubitus position

Answer 31

mitral valve regurgitation mitral stenosis

Question 32

how to assess for mitral valve regurgitation

Answer 32

auscultate the mitral area in left lateral decubitus position using diaphragm during EXPIRATION auscultate into axilla to identify radiation of the murmur

Question 33

what murmur is heard for mitral valve regurgitation

Answer 33

pan systolic murmur

Question 34

what murmur is heard for mitral stenosis

Answer 34

mid diastolic murmur

Question 35

how to assess for mitral stenosis

Answer 35

auscultate the mitral area in left lateral decubitus position using bell during EXPIRATION

Question 36

where is the femoral pulse palpated

Answer 36

at the mid inguinal point (midpoint between ASIS and pubic symphysis)

Question 37

where is popliteal pulse felt

Answer 37

inferior region of popliteal fossa

Question 38

how to assess for popliteal pulse

Answer 38

place thumbs on tibial tuberosity passively flex the knee to 30 degrees curl fingers into popliteal fossa (this compresses the popliteal artery against the tibia)

Question 39

where is the posterior tibial pulse felt

Answer 39

posterior to the medial malleulos of the tibia

Question 40

what to remember when palpating posterior tibial pulse

Answer 40

palpate to confirm its presence then compare pulse between the 2 feet

Question 41

where is the dorsal pedis pulse felt

Answer 41

on the dorsum of the foot - lateral to extensor hallucis longus tendon - over the 2nd and 3rd cuneiform bones

Question 42

borders of the heart

Answer 42

right upper: 3rd CC, 1cm from sternal edge left upper: 2nd ICS, 2.5cm from sternal edge right lower: 6th CC, 1 cm from sternal edge left lower: 5th ICS, mid clavicular line

Question 43

which pulse is the strongest pulse

Answer 43

carotid pusle

Question 44

which pulse is used for assessment of character and volume and diagnosis of underlying heart disease

Answer 44

carotid artery pulse

Question 45

where is superficial temporal artery assessed

Answer 45

in front of tragus of ear

Question 46

what is the terminal branch of external carotid artery

Answer 46

superficial temporal artery

Question 47

where is subclavian artery assessed

Answer 47

in supraclavicular fossa region - at the angle between the clavicle and sternocleidomastoid

Question 48

differentiate type A and B aortic dissection

Answer 48

type A = severe chest pain, anterior and posterior type B = back pain, followed by chest and abdominal pain