Flashcards in CV and Muskuloskeletal Deck (37)
ID and locate the apex and base of the heart.
- Base is the junction b/w the heart and great vessels; lies just below the sternal angle
- Apex is the tip of the LV; normally found at the mid-clavicular line, ~ 5th intercostal space
ID and locate the "aortic area"
Right 2nd ICS (intercostal space)
ID and locate the "pulmonic area"
Left 2nd ICS
ID and locate the surface projection on the precordium of the right atrium
Right heart border, from right 2nd ICS to ~ 3rd or 4th ICS
ID and locate the surface projection on the precordium of the right ventricle
- RV occupies most of the anterior cardiac surface
- RV is a wedge-like structure behind and to the left of the sternum w/the interior border just below the junction of the sternum and xiphoid process, the RV narrows superiorly and meets the pulmonary artery at the left 3rd ICS near the sternum
ID and locate the surface projection on the precordium of the left ventricle
LV is the left lateral border of the anterior cardiac surface
Name the 4 principle factors that influence arterial BP
1. Left ventricular SV
2. Distensibility of aorta and large aa.
4. Blood volume
Locate and count and describe the pt's radial pulse
(Describe BPM and rhythm)
Locate and count and describe the pt's carotid pulse
- Only check for 1 at a time
- Finger pads to lower 1/2 to lower 1/3 of neck, usually medial to SCM m., about the level of the cricoid cartilage
How do you determine correct BP cuff size for pt? (demonstrate as well)
- Width of cuff should be ~ 40% of circumference of pt's arm
- Length of bladder (not entire cuff) should be ~ 80% of circumference of pt's arm
What happens to BP if cuff is too small for pt?
First describe the technique and then correctly measure the pt's BP by palpation in 1 arm
- Place cuff on skin directly ~ 2-3cm above antecubital fossa
- Find radial pulse, blow up 20mmHg past point where pulse disappears, then slowly release air. Return of pulse indicates systolic BP (tell proctor reading)
Correctly measure (auscultate) BP in 1 arm
- As previous answer, except pt's arm is relaxed and brachial a. is elevated to ~ heart level, pt is sitting
- Blow up cuff ~ 20-30mmHg above pulse systolic BP reading
Describe what the max height of the IJV represents
Reflection or indication of right atrial pressure, which reflects hydration or volume status of the pt
ID the point of maximal height of the IJV on the pt and measure the JVP
- Be on pt's right side
- Pt lays back, exam table at 30-45 degrees
- Turn pt's head slightly left to ID right IJV
- Place ruler on sternal angle, use horizontal surface from point of maximal height on right IJV
- Add 5cm to measurement to get JVP
Palpate the precordium in 4 areas, ID the PMI (apical impulse)
- Pt uses palmar surface of hand, gently placing ball of hand on precordium
- In any order, palpate apex (PMI), left parasternal area (left 3rd to 5th ICS), left 2nd ICS (pulmonic area), right 2nd ICS (aortic area)
Correctly auscultate the heart in 4 locations
- Supine or 30 degrees, be on the right, do directly on skin
- Use both diaphragm and bell at apex, left sternal border, left 2nd ICS, right 2nd ICS
ID and locate the area on the precordium where splitting of S2 is best auscultated
Left 2nd ICS (pulmonic area)
What do you do when inspecting hand?
- Inspect/palpate nails, palms, skin, and joints
- Inspect/demonstate passive and active ROM at metacarpophalangeal joints (flexion/extension, add/abduction) and wrist (flexion, extension, radial/ulnar deviation, supination, pronation)
What is the anatomical snuff box? What is it formed by? What bone may be palpable there?
Hollowed depression just distal to the radial styloid process formed by the abductor pollicis longus and extension pollicis longus of the thumb where the scaphoid may be palpable
Where is the extensor carpi ulnaris tendon palpated?
Felt best just distal to the ulnar styloid w/wrist in ulnar deviation
W/r/t the shoulder, where are the medial and lateral epicondyles located? What are common origins at each?
- They are bony protuberances located on the distal aspect of the humerus
- Common extensor origin (lateral epicondyle), common flexor origin (medial epicondyle)
What's another name for the main shoulder joint?
How would you test pt for internal and external rotation of the shoulders?
- Internal rotation: place hand behind back w/elbow in flexion and elevate thumb as much as possible
- External rotation: Done at 0 degrees abduction; can also do at 90 degrees abduction (young pts)--hands behind head(?)
What runs b/w the greater and lesser tuberosities of the humerus?
How should you instruct pt to perform neck flexion, extension, lateral rotation, and side bending?
- Flexion: "chin to chest"
- Extension: "look up at ceiling"
- Lateral rotation: "turn chin towards shoulder"
- Side bending: "tilt ear to shoulder (no shrugging)"
How do you know you've found C7 (vs. T1)?
Moves w/lateral rotation of the neck
What is the first step in a hip/pelvis exam?
How would you perform internal and external rotation of the hip?
Supine position, bend knees, then move the knees in either direction
- Can also do from seated position by grabbing the ankle and pushing it in either direction