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Questions and Answers
What should be the initial position of the patient during the physical examination?
What should be the initial position of the patient during the physical examination?
- Prone position
- Sitting upright
- Supine position (correct)
- Standing position
Which of the following is NOT a preparation step for the room prior to examination?
Which of the following is NOT a preparation step for the room prior to examination?
- Ensuring privacy
- Keeping the room's temperature warm
- Arranging a comfortable environment
- Setting up surgical instruments (correct)
What is the normal range for jugular venous pressure during examination?
What is the normal range for jugular venous pressure during examination?
- 2-3 cm above sternal angle (correct)
- 0-1 cm above sternal angle
- 4-5 cm above sternal angle
- 1-2 cm above sternal angle
Which equipment is necessary for auscultating heart sounds during a cardiac examination?
Which equipment is necessary for auscultating heart sounds during a cardiac examination?
Which sign indicates a potential cardiovascular issue during neck vessel examination?
Which sign indicates a potential cardiovascular issue during neck vessel examination?
What is the first step in starting the examination of a patient?
What is the first step in starting the examination of a patient?
What condition is associated with the presence of an S3 sound?
What condition is associated with the presence of an S3 sound?
When does an S4 sound occur in the cardiac cycle?
When does an S4 sound occur in the cardiac cycle?
What characterizes a pathologic S4 sound?
What characterizes a pathologic S4 sound?
Which of the following conditions does NOT cause a murmur?
Which of the following conditions does NOT cause a murmur?
What is typically required to best hear an S4 sound?
What is typically required to best hear an S4 sound?
Which of the following describes a murmur?
Which of the following describes a murmur?
What kind of S4 sound is typically heard in older adults without cardiovascular disease?
What kind of S4 sound is typically heard in older adults without cardiovascular disease?
What condition can lead to an S3 sound unrelated to heart disease?
What condition can lead to an S3 sound unrelated to heart disease?
What causes the heart sound S1?
What causes the heart sound S1?
When does the heart sound S2 occur in the cardiac cycle?
When does the heart sound S2 occur in the cardiac cycle?
Which heart sound is commonly described as 'Lub'?
Which heart sound is commonly described as 'Lub'?
What is the significance of the third heart sound (S3)?
What is the significance of the third heart sound (S3)?
How is the second heart sound (S2) generally best heard?
How is the second heart sound (S2) generally best heard?
What might normal splitting of heart sound S2 indicate?
What might normal splitting of heart sound S2 indicate?
Where is S3 best heard in a patient?
Where is S3 best heard in a patient?
What is a common feature of the physiologic S3 heart sound?
What is a common feature of the physiologic S3 heart sound?
What does it indicate if a murmur coincides with the carotid upstroke?
What does it indicate if a murmur coincides with the carotid upstroke?
Which of the following is NOT a pitch descriptor for heart murmurs?
Which of the following is NOT a pitch descriptor for heart murmurs?
What is the highest grade on the murmur grading scale that requires an accompanying thrill?
What is the highest grade on the murmur grading scale that requires an accompanying thrill?
Which murmur shape is characterized by increasing then decreasing intensity?
Which murmur shape is characterized by increasing then decreasing intensity?
Which term is used to describe the quality of a heart murmur?
Which term is used to describe the quality of a heart murmur?
In a normal physical examination, what is the expected quality of S1 and S2 sounds?
In a normal physical examination, what is the expected quality of S1 and S2 sounds?
What position should the head of the bed be elevated to assess the JVP?
What position should the head of the bed be elevated to assess the JVP?
Which of the following must be present for grades 4-6 murmurs?
Which of the following must be present for grades 4-6 murmurs?
What is a normal finding for the size of the apical impulse?
What is a normal finding for the size of the apical impulse?
When palpating the apical impulse, where should it be located?
When palpating the apical impulse, where should it be located?
What indicates a sustained apical impulse?
What indicates a sustained apical impulse?
What does a thrill during palpation indicate?
What does a thrill during palpation indicate?
What best describes an abnormal apical impulse?
What best describes an abnormal apical impulse?
What is a normal duration for the apical impulse during systole?
What is a normal duration for the apical impulse during systole?
What does a heave during palpation suggest?
What does a heave during palpation suggest?
What is the effect of light pressure on palpable pulsations?
What is the effect of light pressure on palpable pulsations?
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Study Notes
Systole and Heart Sounds
- Systole occurs when the ventricles fill with blood.
- Increased pressure in the ventricles exceeds that in the atrium, causing closure of the atrioventricular valves (AVV), resulting in the first heart sound (S1).
- When ventricular pressure rises above the pressure in the semilunar valves (SLV), it leads to their opening.
- A decrease in ventricular pressure causes the SLV to close, producing the second heart sound (S2).
Normal Heart Sounds
-
S1 (Lub):
- Result of atrioventricular valve closure (mitral and tricuspid).
- Marks the beginning of systole.
- Louder than S2 at the apex, detected with a diaphragm.
- Coincides with the carotid artery pulse.
-
S2 (Dup):
- Caused by closure of semilunar valves (aortic and pulmonic).
- Marks the start of diastole.
- Best heard at the base of the heart with a diaphragm.
- Normal splitting occurs during inspiration, with aortic and pulmonic valves closing separately.
Extra Heart Sounds
-
S3:
- Occurs during the early rapid filling phase right after S2 when the AV valves open.
- Best heard in a quiet room at the apex, typically with the patient in the left lateral position.
- Can be normal in young adults or children; abnormal in adults, indicating decreased ventricular compliance (e.g., heart failure).
- Pathologic S3, known as a ventricular gallop, persists in any position.
-
S4:
- Arises at the end of diastole when atria contract against a noncompliant ventricle.
- Soft, low-pitched sound best heard at the apex, requiring a good bell.
- Physiologic S4 can occur in older adults post-exercise; pathologic S4 may indicate issues such as coronary artery disease or aortic stenosis.
Murmurs
- Characterized as soft, blowing, swooshing sounds from turbulent blood flow.
- Caused by factors like exercise, structural defects (stenotic or regurgitant valves), or abnormal openings (septal defects).
Physical Examination
Neck Vessels
- Palpate carotid arteries and jugular veins for pulsations, thrills, or bruits.
- Normal jugular venous pressure is 2-3 cm above the sternal angle.
General Inspection
- Observe patient appearance, alertness, skin color, and presence of shortness of breath.
- Check for pallor in mucous membranes and clubbing in fingers.
Beginning the Examination
- Vital signs include blood pressure and radial/apical heart rates.
Precordial Examination
- Inspect the anterior chest and palpate apical impulse.
- Auscultate over regions of the heart, noting any abnormal findings like thrills or heaves.
Documenting Findings
- Detailed description of neck vascular assessment and precordial examination, including:
- Carotid upstrokes, jugular venous pressure, precordium pulsations, and heart sounds.
- Record rate, rhythm, and presence of any extra heart sounds or murmurs.
Documentation of Objective Data
- Example of findings:
- Carotids with brisk upstrokes, JVP of 3 cm above sternal angle, no pulsations or thrills in precordium.
- Heart rate of 68 bpm, regular rhythm, crisp S1 and S2 without additional sounds or murmurs.
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