Cardiac Evaluation and Medical History Quiz

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Questions and Answers

What can splinter hemorrhages under the nail bed indicate?

Skin infection

Infective endocarditis (correct)

Normal nail growth

Nail trauma

What is a sign of cardiac edema in right-sided heart failure?

Rapid heart rate

Puffiness in the abdomen

Cyanosis of the lips

Swelling in the lower extremities (correct)

Which measurement is important for determining central venous pressure (CVP)?

Height of the patient's bed

Distention of the internal jugular veins (correct)

Depth of respiration

Body temperature

What is the normal limit for jugular venous pulsation above the angle of Louis?

3 cm Signup and view all the answers

Which position should a patient be in to evaluate the internal jugular veins?

Supine with head elevated 45 degrees Signup and view all the answers

What does an elevated central venous pressure indicate?

Increased intravascular volume status Signup and view all the answers

What is assessed by palpating the pulse?

Arterial wall pressure waves Signup and view all the answers

What symptom is commonly associated with chronic cardiac conditions?

Blue clubbing of the nails Signup and view all the answers

Which physical examination position is recommended for the patient during a cardiac exam?

At a 30- to 45-degree angle Signup and view all the answers

What does dyspnea indicate in relation to cardiac function?

Left ventricular heart strain Signup and view all the answers

Which sign indicates central cyanosis?

Bluish color in the lips and tongue Signup and view all the answers

What may pallor indicate during a physical examination?

Hypovolemia or anemia Signup and view all the answers

What does peripheral cyanosis typically indicate?

Low blood flow to peripheries Signup and view all the answers

What is considered a normal pulse rate?

60-90 b/min Signup and view all the answers

Which condition is often evaluated with the symptom of orthopnea?

Heart Failure Signup and view all the answers

What appearance of the body might indicate obesity during a general examination?

Broad and round body shape Signup and view all the answers

Which of the following is NOT a peripheral pulse that should be palpated?

Coronary Signup and view all the answers

What is the normal systolic blood pressure range?

100 – 140 mmHg Signup and view all the answers

What inspection finding may indicate hepatic engorgement due to right ventricular failure?

Jaundice in the sclera and lips Signup and view all the answers

Which of the following defines the diastolic blood pressure?

Lowest pressure during the cardiac cycle Signup and view all the answers

During which phase of the cardiac cycle is systolic blood pressure measured?

Ventricular systole Signup and view all the answers

What is the formula for calculating Mean Arterial Pressure (MAP)?

SBP + 2(DBP)/3 Signup and view all the answers

Which method of blood pressure measurement involves inserting a catheter into an artery?

Invasive method Signup and view all the answers

What should the position of the forearm be when measuring blood pressure?

Supported at heart level Signup and view all the answers

What indicates the systolic pressure during the palpatory step of blood pressure measurement?

The disappearance of the radial pulse Signup and view all the answers

In the auscultatory step, what signifies the diastolic blood pressure?

When sounds start to muffle Signup and view all the answers

Where is the lower border of the cuff placed during blood pressure measurement?

About 2 cm above the antecubital space Signup and view all the answers

What type of edema is characterized by skin that does not depress upon palpation?

Non-pitting edema Signup and view all the answers

What is indicated by the 1st phase of Korotkoff sounds?

Systolic pressure Signup and view all the answers

Where is the point of maximum impulse (PMI) typically found during palpation of the precordium?

Fifth intercostal space medial to the midclavicular line Signup and view all the answers

What causes the transition from silent to noisy flow in Korotkoff sounds?

Compression of the brachial artery by the cuff Signup and view all the answers

What is the significance of a soft and longer sound during the second phase of Korotkoff sounds?

It indicates pulse pressure Signup and view all the answers

What diameter is typically indicative of a normal impulse when assessing the PMI?

1 cm Signup and view all the answers

Which of the following conditions would likely push the heart away from the lesion?

Pleural effusion Signup and view all the answers

What does an area greater than 3 cm in the PMI assessment usually indicate?

Pathological condition Signup and view all the answers

Where is the mitral area best auscultated?

5th left intercostal space, medial to the midclavicular line Signup and view all the answers

Which area is primarily assessed to examine the aortic valve?

2nd right intercostal space Signup and view all the answers

What is one potential cause of downward apex displacement from cardiac origin?

Left ventricular hypertrophy Signup and view all the answers

Where should the carotid artery be palpated?

At the level of the thyroid cartilage Signup and view all the answers

What effect does abdominal distension have on the apex location?

Displaces it upwards and to the left Signup and view all the answers

Study Notes

Cardiac History and Physical Examination

Chief Complaint and History of Present Illness:
- Chest pain
- Dyspnea
- Edema of the feet and ankles
- Palpitations
- Syncope
- Cough and hemoptysis
- Nocturia
- Cyanosis
- Intermittent claudication

Past Medical History

Any previous cardiac conditions
Hypertension
Diabetes
Other relevant health conditions

Current Health Status and Risk Factors

Current medications
Lifestyle factors (e.g., smoking, alcohol consumption, exercise)

Family History

History of heart disease in the family

Occupation
Hobbies
Social support network

General Examination

Vital signs:
- Temperature
- Pulse
- Blood pressure
- Respiratory rate
General Appearance:
- Body build (obese, cachectic)
- Decubitus (orthopnea, prayers' position, squatting)
- Color (pallor, cyanosis, jaundice)
  - Pallor: may indicate hypovolemia or anemia
  - Cyanosis: (bluish color)
    - Central cyanosis: observed in the lips, oral mucosa, and tongue (in congenital heart diseases, cor-pulmonale, and advanced heart failure)
    - Peripheral cyanosis: low cardiac output, low blood flow to peripheries like cardiogenic shock
  - Jaundice: may present in the sclera, lips, hard palate, under the tongue, and may be indicative of hepatic engorgement due to right ventricular failure
Inspection:
- Nails (finger clubbing): broadening of the distal phalanges of digits, giving them a drumstick or club-like appearance accompanied by abnormally curved and shiny nails. Indicates chronic poor oxygen perfusion to the distal tissues of the hand and feet (as in patients with chronic cardiac conditions, such as cyanotic congenital heart disease)
- Subcutaneous nodules: subcutaneous firm swelling found in active rheumatic fever
- Lower extremities: cardiac edema typically present in right-sided heart failure
- Neck: vigorous pulsations
- Fever: associated with rheumatic fever and infective endocarditis
- Respiration: dyspnea may indicate left ventricular heart strain

Jugular Venous Distention

Rationale: The internal jugular vein is in direct communication with the right atrium, serving as a manometer. Distention indicates elevated central venous pressure (CVP).
Assessment: Measured as the vertical distance above the sternal angle (angle of Louis) with the patient supine and head elevated at 45 degrees.
Normal: Jugular venous pulsation should not exceed 3 cm above the Angle of Louis.

Examination of Pulse

Definition: Pressure wave in the arterial system produced by left ventricular ejection.
Palpation: Carotid, brachial, radial, femoral, popliteal, posterior tibial, dorsalis pedis pulses should be palpated.
Pulse Characteristics:
- Rate (60-90 bpm)
- Rhythm (regular or irregular)
- Volume/Amplitude (strong or weak)
- Equality (same on both sides)

Blood Pressure

Definition: Lateral pressure exerted by blood on arterial walls.
Measurement:
- Systolic (highest pressure): occurs during ventricular systole.
- Diastolic (lowest pressure): occurs during ventricular diastole.
Methods:
- Invasive (direct): using a catheter inserted into an artery
- Non-invasive (indirect):
  - Palpatory step: used to determine systolic pressure
  - Auscultatory step: used to determine systolic and diastolic pressure

Auscultation

Auscultation points:
- Aortic area: second intercostal space close to the sternum on the right
- Pulmonary area: second intercostal space to the left of the sternum
- Tricuspid area: lower left sternal border, approximately the fourth to fifth intercostal space
- Mitral area (apex of heart): fifth left intercostal space, medial to the midclavicular line
Procedure: Auscultate each area using the diaphragm of the stethoscope for the four heart sounds.

Local Examination

Palpation:
- Skin: palpate for edema (pitting or non-pitting)
- Precordium: locate the point of maximal impulse (PMI)
  - Normally located in the fifth intercostal space medial to the midclavicular line.
  - Assess location, diameter, and amplitude: A normal impulse is felt as a light tap extending over 1 cm. An area greater than 3 cm is usually pathological.
Causes of Shifted Apex:
- Factors outside the heart: chest and abdominal diseases, fibrosis, pleural effusion, pneumothorax, deformities of the chest, mediastinal lesions, abdominal distension.
- Causes from the heart (cardiac enlargement): left ventricular hypertrophy, right ventricular hypertrophy.
Carotid Artery Palpation: located by sliding the fingers along the side of the trachea at the level of the thyroid cartilage. Pulsations should be easily palpable.

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Assess your knowledge on cardiac history and physical examination through this detailed quiz. Explore topics including chief complaints, past medical history, current health status, and vital signs. Perfect for medical students and healthcare professionals.