Podcast
Questions and Answers
Where does the electrical impulse originate in the heart's conduction system?
Where does the electrical impulse originate in the heart's conduction system?
Which structure records the events of the heart's conduction system?
Which structure records the events of the heart's conduction system?
What is the function of the AV node in the heart's conduction system?
What is the function of the AV node in the heart's conduction system?
Which event coincides with the carotid pulse?
Which event coincides with the carotid pulse?
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Which condition is associated with symptoms of blood back up in the lungs, such as crackles?
Which condition is associated with symptoms of blood back up in the lungs, such as crackles?
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What is the main characteristic of Raynaud disease?
What is the main characteristic of Raynaud disease?
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Which condition is a marker for cardiovascular morbidity and mortality and a harbinger of functional decline?
Which condition is a marker for cardiovascular morbidity and mortality and a harbinger of functional decline?
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What is the main symptom of symptomatic limb ischemia with exertion?
What is the main symptom of symptomatic limb ischemia with exertion?
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Which congenital heart defect is characterized by symptoms like systolic murmur, clubbing, poor feeding, and cyanosis?
Which congenital heart defect is characterized by symptoms like systolic murmur, clubbing, poor feeding, and cyanosis?
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What is the main characteristic of Prinzmetal angina?
What is the main characteristic of Prinzmetal angina?
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Which condition is associated with an overriding aorta over the ventricular septal defect?
Which condition is associated with an overriding aorta over the ventricular septal defect?
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Which arterial disorder is characterized by fatty plaques along the artery intima?
Which arterial disorder is characterized by fatty plaques along the artery intima?
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What does jugular venous pressure (JVP) reflect?
What does jugular venous pressure (JVP) reflect?
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Where is JVP best assessed from?
Where is JVP best assessed from?
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What factors can affect JVP?
What factors can affect JVP?
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Where is blood pressure usually measured?
Where is blood pressure usually measured?
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How is blood pressure measured?
How is blood pressure measured?
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How can heart rate be assessed?
How can heart rate be assessed?
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What do EKG waveform P QRS T and health history help in assessing?
What do EKG waveform P QRS T and health history help in assessing?
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What do physical exam techniques include?
What do physical exam techniques include?
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What affects blood pressure levels?
What affects blood pressure levels?
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What affects blood pressure?
What affects blood pressure?
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How is JVP estimated?
How is JVP estimated?
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What does the jugular venous pressure (JVP) reflect?
What does the jugular venous pressure (JVP) reflect?
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Which stethoscope part is better for picking up high-pitched sounds like S1, S2, and aortic regurgitation?
Which stethoscope part is better for picking up high-pitched sounds like S1, S2, and aortic regurgitation?
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How should the patient be positioned to palpate for S3 and S4?
How should the patient be positioned to palpate for S3 and S4?
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How can the detection of aortic regurgitation be improved?
How can the detection of aortic regurgitation be improved?
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How should the stethoscope be positioned to pick up low-pitched sounds like S3, S4, and the murmur of mitral stenosis?
How should the stethoscope be positioned to pick up low-pitched sounds like S3, S4, and the murmur of mitral stenosis?
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How should the palm and fingerpads be used to palpate heaves?
How should the palm and fingerpads be used to palpate heaves?
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How should the ball of your hand be used to check for thrills?
How should the ball of your hand be used to check for thrills?
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How can the apical impulse be located?
How can the apical impulse be located?
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How should the patient be positioned to palpate for the systolic impulse of the right ventricle?
How should the patient be positioned to palpate for the systolic impulse of the right ventricle?
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In which condition may hyperinflation of the lungs prevent palpation of the hypertrophied right ventricle in the left parasternal area?
In which condition may hyperinflation of the lungs prevent palpation of the hypertrophied right ventricle in the left parasternal area?
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What does a pulsation in the pulmonary artery area suggest?
What does a pulsation in the pulmonary artery area suggest?
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What does a pulsation in the aortic outflow tract area suggest?
What does a pulsation in the aortic outflow tract area suggest?
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Which condition is correlated with an elevated jugular venous pressure (JVP)?
Which condition is correlated with an elevated jugular venous pressure (JVP)?
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At what age does breast development typically begin?
At what age does breast development typically begin?
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What is the method to evaluate jugular venous pressure (JVP)?
What is the method to evaluate jugular venous pressure (JVP)?
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What is the potential consequence of palpating the carotid artery without caution?
What is the potential consequence of palpating the carotid artery without caution?
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What are the phases of systolic blood pressure response?
What are the phases of systolic blood pressure response?
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What are the characteristics of abnormal lymph nodes?
What are the characteristics of abnormal lymph nodes?
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What do different types of pulses like left-sided S4, bisferiens pulse, and paradoxical pulse indicate?
What do different types of pulses like left-sided S4, bisferiens pulse, and paradoxical pulse indicate?
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What does an elevated jugular venous pulsation (JVP) correlate with?
What does an elevated jugular venous pulsation (JVP) correlate with?
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What is included in a comprehensive cardiovascular exam?
What is included in a comprehensive cardiovascular exam?
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Where is the spleen located?
Where is the spleen located?
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What should abnormal lymphadenopathy be distinguished between?
What should abnormal lymphadenopathy be distinguished between?
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Study Notes
Cardiac Examination Techniques and Tips
- The left ventricular outflow tract can be brought closer to the chest wall by having the patient sit up, lean forward, and exhale to improve the detection of aortic regurgitation.
- The diaphragm of the stethoscope is better for picking up high-pitched sounds like S1, S2, aortic and mitral regurgitation, and pericardial friction rubs, while the bell is more sensitive to low-pitched sounds like S3, S4, and the murmur of mitral stenosis.
- To palpate heaves, use your palm and/or hold your fingerpads flat or obliquely against the chest.
- For thrills, press the ball of your hand firmly on the chest to check for a buzzing or vibratory sensation caused by underlying turbulent flow.
- S1 and S2 are usually not palpable, but palpable S3 and S4 can be identified by positioning the patient in the left lateral decubitus position and palpating the cardiac apex gently as the patient exhales and briefly stops breathing.
- The apical impulse is usually the PMI and can be located by asking the patient to exhale fully and stop breathing for a few seconds.
- Palpate for the systolic impulse of the right ventricle with the patient supine and the head elevated to 30°, and assess its location, amplitude, and duration to identify various conditions.
- In obstructive pulmonary disease, hyperinflation of the lungs may prevent palpation of the hypertrophied right ventricle in the left parasternal area.
- The pulmonary artery area overlies the pulmonary artery, and a prominent pulsation here often accompanies dilatation or increased flow in the pulmonary artery.
- The aortic outflow tract area overlies the aortic outflow tract, and a pulsation in this area suggests a dilated or aneurysmal aorta.
- Carotid pulse examination provides valuable information about cardiac function, especially in aortic valve stenosis and regurgitation, and should be performed with caution to avoid decreasing blood flow to the brain or inducing syncope.
- Landmarks and the Valsalva maneuver can be used to enhance the cardiac examination.
Clinical Bedside Examination
- Systolic blood pressure response follows four phases: transient increase, sharp decrease, acute drop, and "overshoot" increased blood pressure
- Method to evaluate jugular venous pressure (JVP) involves measuring the vertical distance in centimeters above the sternal angle where the horizontal object crosses the ruler and adding 5 cm
- Breast development typically begins by age 12, and males can also get breast cancer
- Carotid artery palpation should be done cautiously to prevent dislodgment of atherosclerotic plaque, which could lead to stroke
- Jugular venous pulsations (JVP) are usually evident in euvolemic patients and an elevated JVP is correlated with acute and chronic heart failure, tricuspid stenosis, chronic pulmonary hypertension, and other conditions
- Comprehensive cardiovascular exam includes assessment for breast changes, abnormal lymph nodes, and conditions like impaired cardiac output, pericarditis, infective endocarditis, myocarditis, valvular disorders, and cardiomyopathy
- Different types of pulses such as a left-sided S4, bisferiens pulse, and paradoxical pulse indicate specific cardiac conditions
- Electrical alterations like dysrhythmias (bradycardia, tachycardia, atrial fibrillation, atrial flutter) and irregular ventricular rhythm should be assessed
- Heart sounds should be evaluated for variations in intensity
- Spleen located in the left upper quadrant (LUQ) can cause LUQ pain and swelling if inflamed
- Abnormal lymph nodes should be assessed for characteristics like fixed, hard, asymmetric, and swelling, while normal lymph nodes are soft, movable, and symmetric
- Lymphadenopathy should be distinguished between local and generalized, with cervical lymph node swelling being the most common. Supraclavicular swelling requires further investigation.
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Description
"Cardiac Examination Techniques and Clinical Bedside Examination" Quiz Test your knowledge of cardiac examination techniques and clinical bedside assessment with this quiz covering topics such as palpation, auscultation, jugular venous pressure, pulse evaluation, and identifying cardiac conditions based on physical examination findings.
