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Questions and Answers
What can splinter hemorrhages under the nail bed indicate?
What can splinter hemorrhages under the nail bed indicate?
What is a sign of cardiac edema in right-sided heart failure?
What is a sign of cardiac edema in right-sided heart failure?
Which measurement is important for determining central venous pressure (CVP)?
Which measurement is important for determining central venous pressure (CVP)?
What is the normal limit for jugular venous pulsation above the angle of Louis?
What is the normal limit for jugular venous pulsation above the angle of Louis?
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Which position should a patient be in to evaluate the internal jugular veins?
Which position should a patient be in to evaluate the internal jugular veins?
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What does an elevated central venous pressure indicate?
What does an elevated central venous pressure indicate?
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What is assessed by palpating the pulse?
What is assessed by palpating the pulse?
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What symptom is commonly associated with chronic cardiac conditions?
What symptom is commonly associated with chronic cardiac conditions?
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Which physical examination position is recommended for the patient during a cardiac exam?
Which physical examination position is recommended for the patient during a cardiac exam?
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What does dyspnea indicate in relation to cardiac function?
What does dyspnea indicate in relation to cardiac function?
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Which sign indicates central cyanosis?
Which sign indicates central cyanosis?
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What may pallor indicate during a physical examination?
What may pallor indicate during a physical examination?
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What does peripheral cyanosis typically indicate?
What does peripheral cyanosis typically indicate?
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What is considered a normal pulse rate?
What is considered a normal pulse rate?
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Which condition is often evaluated with the symptom of orthopnea?
Which condition is often evaluated with the symptom of orthopnea?
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What appearance of the body might indicate obesity during a general examination?
What appearance of the body might indicate obesity during a general examination?
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Which of the following is NOT a peripheral pulse that should be palpated?
Which of the following is NOT a peripheral pulse that should be palpated?
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What is the normal systolic blood pressure range?
What is the normal systolic blood pressure range?
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What inspection finding may indicate hepatic engorgement due to right ventricular failure?
What inspection finding may indicate hepatic engorgement due to right ventricular failure?
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Which of the following defines the diastolic blood pressure?
Which of the following defines the diastolic blood pressure?
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During which phase of the cardiac cycle is systolic blood pressure measured?
During which phase of the cardiac cycle is systolic blood pressure measured?
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What is the formula for calculating Mean Arterial Pressure (MAP)?
What is the formula for calculating Mean Arterial Pressure (MAP)?
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Which method of blood pressure measurement involves inserting a catheter into an artery?
Which method of blood pressure measurement involves inserting a catheter into an artery?
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What should the position of the forearm be when measuring blood pressure?
What should the position of the forearm be when measuring blood pressure?
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What indicates the systolic pressure during the palpatory step of blood pressure measurement?
What indicates the systolic pressure during the palpatory step of blood pressure measurement?
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In the auscultatory step, what signifies the diastolic blood pressure?
In the auscultatory step, what signifies the diastolic blood pressure?
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Where is the lower border of the cuff placed during blood pressure measurement?
Where is the lower border of the cuff placed during blood pressure measurement?
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What type of edema is characterized by skin that does not depress upon palpation?
What type of edema is characterized by skin that does not depress upon palpation?
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What is indicated by the 1st phase of Korotkoff sounds?
What is indicated by the 1st phase of Korotkoff sounds?
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Where is the point of maximum impulse (PMI) typically found during palpation of the precordium?
Where is the point of maximum impulse (PMI) typically found during palpation of the precordium?
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What causes the transition from silent to noisy flow in Korotkoff sounds?
What causes the transition from silent to noisy flow in Korotkoff sounds?
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What is the significance of a soft and longer sound during the second phase of Korotkoff sounds?
What is the significance of a soft and longer sound during the second phase of Korotkoff sounds?
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What diameter is typically indicative of a normal impulse when assessing the PMI?
What diameter is typically indicative of a normal impulse when assessing the PMI?
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Which of the following conditions would likely push the heart away from the lesion?
Which of the following conditions would likely push the heart away from the lesion?
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What does an area greater than 3 cm in the PMI assessment usually indicate?
What does an area greater than 3 cm in the PMI assessment usually indicate?
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Where is the mitral area best auscultated?
Where is the mitral area best auscultated?
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Which area is primarily assessed to examine the aortic valve?
Which area is primarily assessed to examine the aortic valve?
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What is one potential cause of downward apex displacement from cardiac origin?
What is one potential cause of downward apex displacement from cardiac origin?
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Where should the carotid artery be palpated?
Where should the carotid artery be palpated?
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What effect does abdominal distension have on the apex location?
What effect does abdominal distension have on the apex location?
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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
Social and Personal History
- 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.
