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PCM I Final > Cardiovascular OSCE > Flashcards

Flashcards in Cardiovascular OSCE Deck (28)
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1

Differentiate between bell and diaphragm of stethoscope

Diaphragm for high pitched sounds: S1, S2, AR, MR, friction rubs

Bell for low pitched sounds: S3, S4, MS, carotid bruit

2

4 primary steps to CV exam

1. Inspection
2. Palpation
3. Percussion
4. Auscultation

3

General appearance findings for CV exam

Consciousness
Cyanosis
Flushing
Respiratory patterns
Anxiety/distress
Body habitus
Diaphoresis
Neck veins - JVD

Look at shape, landmarks, scars/signs of trauma

4

What palpation area is used to estimate the location of the apex/left border of the heart?

PMI

5

Patient position for assessing PMI

Upright, supine, or lateral decubitus

6

Where is PMI usually palpated

Near 4-5th intercostal space in midclavicular line

7

T/F: PMI may not be felt in healthy heart/patient

True

8

Describe a normal PMI

Impulse should be a small, brisk beat and measure less than 2.5 cm. The impulse should last through the first 2/3 of the systolic period (or less). It should not be felt through the second heart sound

9

What palpation technique is used when PMI is not felt? Describe this technique

Percussion

Start far left where "resonant" and move medially to find cardiac "dullness"

10

4 auscultation listening posts for CV exam

Aortic valve - R 2nd ICS at SB

Pulmonic valve - L 2nd ICS at SB

Tricuspid valve - L 4th ICS at SB

Mitral valve - L 5th ICS at midclavicular line

11

How do heart sounds correspond with systole and diastole?

Diastole --> S1 --> systole --> S2 --> diastole

12

Heart sound S1

Closure of tricuspid and mitral valves

13

Heart sound S2

Closure of aortic and pulmonic valves

[may split with inspiration]

14

Heart sound S3

Dull, low pitch, best heart with bell

[due to high pressures and abrupt deceleration of inflow across the mitral valve at the end of rapid filling phase]

Physiologic in children/young adults, pathologic in greater than 40 y/o

KENTUCKY

15

Heart sound S4

Dull, low pitch, best heart with bell

[atrial gallop from forceful contraction of atria against a stiffened (low compliant) ventricle]

Can be normal in trained athletes

TENNESSEE

16

Where are systolic murmurs heard in relation to heart sounds

Between s1 and s2

17

What are the 4 major causes of systolic murmurs

Aortic stenosis
Pulmonic stenosis
Mitral regurg
Tricuspid regurg

18

Where are diastolic murmurs heard in relation to heart sounds

Between S2 and S1

19

4 major causes of diastolic murmurs

Aortic regurg
Pulmonic regurg
Mitral stenosis
Tricuspid stenosis

20

Murmur grading scale

Grade 1 = very faint

Grade 2 = quiet, but heard easily with stethoscope

Grade 3 = moderately loud, no thrill

Grade 4 = loud with palpable thrill

Grade 5 = very loud with thrill, may be heard with steth partly off chest

Grade 6 = heard with steth entirely off chest

21

Assessing the carotid pulse

Medial to SCM

Assess for thrills and bruits

Do not assess both carotid pulses simultaneously

22

Possible locations for assessing peripheral pulses

Radial
Brachial
Femoral
Popliteal
Dorsalis pedis
Posterior tibial

23

Pulse grading scale

0/4 = absent, not palpable

1/4 = diminished, barely palpable

2/4 = average intensity, expected, normal

3/4 = strong, full, increased

4/4 = bounding

24

Should you be concerned if you are only able to locate and palpate EITHER the dorsalis pedis OR posterior tibial pulse?

No, not as long as patient's lower extremity is otherwise intact

25

An abnormal cap refill might indicate what possible conditions?

Arterial occlusion
Hypovolemic shock
Hypothermia

26

What is normal cap refill time?

2 seconds or less

27

Pitting edema test

Press firmly for 5 seconds over the:

1. Dorsum of the foot
2. Anterior tibia
3. Behind medial malleolus

28

Grading scale for pitting edema

0 = absent

1 = barely detectable, slight pitting (2 mm); disappears rapidly

2 = slight indentation (4mm); 10-15 seconds

3 = deeper indentation (6 mm); may be >1min

4 = very marked indentation (8 mm); 2-5 min