Cardiovascular System

Question 1

What pulses should be palpated?

Answer 1

• radial artery
• ulner artery
• brachial artery
• common carotid artery
• apex beat

Question 2

Whats the range for a normal heart rate?

Answer 2

60-100

Question 3

Where is the radial artery?

Answer 3

between the:
- tendon of the flexor carpi radialis
- tendon of the brachioradialis

Question 4

Where is the ulnar artery?

Answer 4

between the:
- flexor digitorum superficialis
- flexor carpi ulnaris

Question 5

Where is the brachial artery?

Answer 5

medial to the biceps tendon

Question 6

What position should the patient be in for a cardiovascular exam?

Answer 6

• 45 degree angle
• exposed from the waist up

Question 7

Where is the common carotid artery?

Answer 7

• medial border of the sternocleidomastoid muscle
• lateral border of the thyroid cartilage

Question 8

What can be detected from the common carotid artery?

Answer 8

character and volume

Question 9

Where is the apex beat?

Answer 9

5th intercostal space, mid-clavicular line

Question 10

Where should you start palpating for the apex beat?

Answer 10

from the lateral side (mid-axillary line) towards the mid-clavicular line

Question 11

What can cause a displaced apex beat?

Answer 11

cardiomegaly

Question 12

What can cause an absent apex beat?

Answer 12

• pericardial effusion
• obesity
• pleural effusion
• emphysema

Question 13

What is a parasternal heave?

Answer 13

precordial impulse that is palpable

Question 14

How do you palpate for heaves?

Answer 14

place hand parallel to the left sternal edge

Question 15

What would be a positive sign for heaves?

Answer 15

the heel of your hand being lifted with each systole

Question 16

What are parasternal heaves associated with?

Answer 16

right ventricular hypertrophy

Question 17

What is a thrill?

Answer 17

palpable vibration caused by turbulent blood flow through a heart valve

Question 18

Where should you assess thrills?

Answer 18

each heart valve (same sites as auscultation)
place hand horizontally

Question 19

What valves are heard in auscultation?

Answer 19

• pulmonary
• tricuspid
• mitral
• aortic

Question 20

Where do you auscultate for the aortic valve?

Answer 20

• right sternal border
• 2nd intercostal space

Question 21

Where do you auscultate for the pulmonary valve?

Answer 21

• left sternal border
• 2nd intercostal space

Question 22

Where do you auscultate for the tricuspid valve?

Answer 22

• left 5th costo-sternal border

Question 23

Where do you auscultate for the mitral valve?

Answer 23

• left 5th intercostal space at apex beat

Question 24

What can cause an ejection systolic murmur?

Answer 24

• aortic stenosis
• pulmonary stenosis
• aortic sclerosis
• hypertrophic obstructive cardiomyopathy
• atrial septal defect

Question 25

What manoeuvres can be done to accentuate aortic stenosis?

Answer 25

- ask patient to hold their breath - auscultate the carotid arteries

Question 26

What manoeuvres can be done to accentuate aortic regurgitation?

Answer 26

- sit patient forwards - auscultate over the aortic area during expiration

Question 27

What can be done to investigate an mitral valve regurgitation?

Answer 27

- auscultate the mitral area - pansystolic murmur during expiration - auscultate into the axilla to identify radiation

Question 28

What can be done to investigate an mitral stenosis?

Answer 28

- bell, auscultate the mitral area - mid-diastolic murmur heard during expiration

Question 29

What position should the patient be in for suspected mitral regurgitation/stenosis?

Answer 29

left lateral decubitus position

Question 30

What type of murmur is heard in aortic stenosis?

Answer 30

ejection systolic murmur

Question 31

What type of murmur is heard in aortic regurgitation?

Answer 31

early diastolic murmur

Question 32

What type of murmur is heard in mitral stenosis?

Answer 32

mid-diastolic murmur

Question 33

What type of murmur is heard in mitral regurgitation?

Answer 33

pansystolic murmur

Question 34

What arteries can be palpated in the lower limb?

Answer 34

- femoral - dorsalis pedis - posterior tibial artery - popliteal artery

Question 35

Where can the femoral pulse be palpated?

Answer 35

the mid-inguinal point

Question 36

Where is the mid-inguinal point?

Answer 36

midpoint between the anterior superior iliac spine (ASIS) and the pubic symphysis

Question 37

Where can you palpate the popliteal pulse?

Answer 37

inferior region of the popliteal fossa

Question 38

How do you palpate the popliteal pulse?

Answer 38

- thumbs on the tibial tuberosity - passive knee flexion to 90 degrees - curl fingers into the popliteal fossa - compress the popliteal artery against the tibia

Question 39

Where is the posterior tibial pulse?

Answer 39

posterior to the medial malleolus of the tibia

Question 40

Why should the posterior tibial pulse be palpated?

Answer 40

- confirm presence - comparison to the dorsal pedis pulse

Question 41

Where is the dorsal pedis pulse?

Answer 41

- dorsum of the foot - lateral to the extensor hallucis longus tendon

Question 42

Where is the right upper border of the heart?

Answer 42

- 3rd costal cartilage - 1cm from the sternal edge

Question 43

Where is the left upper border of the heart?

Answer 43

- 2nd intercostal space - 2.5cm from the sternal edge

Question 44

Where is the right lower border of the heart?

Answer 44

- 6th costal cartilage - 1cm from the sternal edge

Question 45

Where is the left lower border of the heart?

Answer 45

- 5th intercostal space - mid-clavicular line

Question 46

Where can you palpate the superficial temporal artery?

Answer 46

in front of the tragus of the ear

Question 47

Where can you palpate the subclavian artery?

Answer 47

the supraclavicular fossa region

Question 48

How does Type A aortic dissection typically present?

Answer 48

severe chest pain (anterior and posterior)

Question 49

How does Type B aortic dissection typically present?

Answer 49

- back pain - chest and abdominal pain