Physical exam Flashcards
1
Q
What are the 8 big steps of CV physical examination?
A
- Inspection
- Blood Pressure
- Heart Rate
- Respiratory rate
- Orthostatic Hypotension
- JVP assessment
- Carotid Pulse
- Palpation and auscultation of the heart
2
Q
What are the things that we inspect?
A
- Is the patient in acute distress?
- Is the patient using accessory muscles for respiration?
- INSPECTION OF THE SKIN:
1. Cyanosis (central or peripheral)
2. Temperature
3. Xanthomata (tendinous, tuberous or eruptive)
4. Osler’s note or Janeway lesions - Inspection of the nails
- Inspection of favies (earlobe creases)
- Xanthelasma (yellow plates on eyelids)
- Arcus Senilis
- Palatal petchiae
- Chest configuration
- Extremities (congenital syndromes)
3
Q
How do we take the BP?
A
PALPATION
- Palpate the brachial artery
- Lower border 2.5 above antecubital crease
- Inflate until radial pulse dissapears and add 30 mm Hg
STETHOSCOPE (bell)
- Deflate, FIRST SOUND IS SYSTOLIC BP
- Continue deflating, when SOUND STOPS IS DIASTOLIC BP
Take more than once and wait a few minutes (3 times)
4
Q
How do we assess JVP?
A
Reflects the right heart pressure
1- Positioning the patient - Inclination 30*
- Leaning on the side evaluated
- Head on the other side
- Tangetinal lighting
2- Distinguishing internal jugular with carotid pulsations
3- Estimation of the height of the JVP from atria (5 cm + X)
4- Evaluation of the various waveforms
5
Q
Where do you stand when we evaluate the patient?
A
To his RIGHT
6
Q
What distance between the sternum and the right atria?
A
5 cm
