EPC III Advanced Cardiovascular Exam

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Questions and Answers

Which symptom would most likely prompt the application of a cardiovascular exam?

Nausea and vomiting

Complaints of chest pain (correct)

Fatigue and muscle pain

Headache and dizziness

What is the primary purpose of checking capillary refill during the exam?

To assess hydration levels

To evaluate arterial blood flow (correct)

To measure blood pressure

To check for skin infections

When examining the lower extremity for signs of cardiovascular issues, which assessment is essential?

Monitoring for muscle cramps

Testing reflex responses

Checking for skin color and hair distribution (correct)

Assessing joint mobility

What does the absence of pitting edema in a patient indicate during the cardiovascular exam?

Heart failure is unlikely Signup and view all the answers

Which anatomical area is not typically auscultated during the cardiovascular examination?

The liver Signup and view all the answers

What is central cyanosis primarily caused by?

Hypoxemia from lung disorders Signup and view all the answers

Which of the following conditions can lead to pallor?

Cardiac output decrease Signup and view all the answers

What sign indicates clubbing in fingers?

Angle of nail bed greater than 160 degrees Signup and view all the answers

Which of the following is NOT a cause of peripheral cyanosis?

Anemia causing systemic hypoxemia Signup and view all the answers

Which condition is associated with clubbing of the fingers?

Chronic interstitial lung disease Signup and view all the answers

What is a common result of peripheral cyanosis?

Increased extraction of oxygen Signup and view all the answers

Which of the following conditions does NOT typically lead to pallor?

Increased blood volume Signup and view all the answers

What might indicate a problem with cardiovascular health when assessing skin color?

Extreme pallor in palms Signup and view all the answers

What position should the patient be in for optimal lung auscultation?

Sitting position Signup and view all the answers

Which of the following is an important factor to assess when palpating for a palpable impulse in the chest?

Presence of a thrill Signup and view all the answers

What is cyanosis a sign of in a patient?

Deoxygenated hemoglobin levels Signup and view all the answers

Which heart pathology position is ideal for auscultation?

Left lateral decubitus Signup and view all the answers

Which of the following conditions is NOT a risk factor for heart disease?

Excessive physical activity Signup and view all the answers

What is the significance of assessing skin color during a physical examination?

To evaluate for cyanosis Signup and view all the answers

When auscultating the vessels of the abdomen, which technique is important?

Auscultate after palpation Signup and view all the answers

What clinical sign could indicate a local issue when assessing for cyanosis?

Cyanosis of one upper limb Signup and view all the answers

What is a significant factor that can delay capillary refill time?

Dehydration or low blood volume Signup and view all the answers

What could a capillary refill time of 4 seconds indicate?

Reduced pump pressure due to congestive heart failure Signup and view all the answers

Which condition is NOT typically associated with a positive pressure test in the context of heart issues?

Hypotension Signup and view all the answers

What method is used to check capillary refill?

Compress the skin until it blanches and observe the return of color Signup and view all the answers

Which of the following can influence capillary perfusion?

Increase in systemic vascular resistance Signup and view all the answers

What is the grade classification for pitting edema that indents 3–4 mm?

Grade 2 Signup and view all the answers

Which of the following is NOT a cause of pitting edema?

Exercise-induced hypertension Signup and view all the answers

What should you do while auscultating the carotid arteries?

Listen with light contact using the bell of the stethoscope Signup and view all the answers

What characteristic of a bruit indicates a significant narrowing of the carotid artery?

Early systolic bruit Signup and view all the answers

What is the maximum depth for Grade 4 pitting edema?

8 mm or deeper Signup and view all the answers

Which patient position is appropriate for performing carotid auscultation?

Sitting upright or supine at 30 degrees Signup and view all the answers

What happens to the bruit sound if a carotid artery is completely occluded?

No sound at all Signup and view all the answers

Which condition is most likely NOT associated with dysfunctional lymphatic systems?

Normal physiological states Signup and view all the answers

What does a sustained lifting motion of the precordium indicate?

Right ventricular hypertrophy Signup and view all the answers

During auscultation, what is a crucial aspect to evaluate?

Rate and rhythm Signup and view all the answers

Which of the following murmurs is described as crescendo-decrescendo and loudest at the right upper sternal border?

Aortic stenosis murmur Signup and view all the answers

Which arteries should be examined during auscultation of the abdominal vessels?

Renal arteries and aorta Signup and view all the answers

What is the expected finding if there are no heaves or lifts during the palpation of the anterior chest wall?

Normal right heart function Signup and view all the answers

When auscultating for bruits, which of these locations is NOT typically assessed?

Pulmonary artery Signup and view all the answers

What could the presence of S3 and S4 sound indicate during heart auscultation?

Possible heart failure or volume overload Signup and view all the answers

What should be done during auscultation if a prominent murmur is detected?

Perform further tests for heart disease Signup and view all the answers

Study Notes

EPC III Competencies for the Advanced Cardiovascular Exam

General Evaluation: Assess patient's self-reported feeling, examine hands and nails for color and pathology, and evaluate pulses bilaterally checking capillary refill.
Upper Extremity Assessment: Position the patient at 45-degree elevation, check for color/hair distribution, pulses, and pitting edema (if patient positioned supine for an extended period check sacrum).
Lower Extremity Assessment: Similar assessment as upper extremity: examine legs and feet for color/hair distribution, pulses, and pitting edema (if patient positioned supine for an extended period check sacrum).
Jugular Venous Pressure (JVD): Visually assess JVD.
Carotid Auscultation: Listen for sounds/murmurs.
Cardiac Auscultation: Assess heart sounds in different positions (e.g., left lateral decubitus), palpate for thrills/PMI (Point of Maximal Impulse) if murmurs/irregular sounds are present.
Lung Auscultation: Listen in 4 anterior and 6 posterior areas, and in one right axillary area in the sitting position
Abdominal Vessel Auscultation: Listen to vessels in the abdomen.
Screening Exam Indications: This exam is for patients with suspected cardiovascular disease, chest pain, dyspnea, suspected heart failure, CAD, vascular disease, diabetes, history of hypertension (HTN), and smoking history.

Inspection (General Appearance)

Evaluation for Distress: Assess posture, facial expression, respiratory distress, and any signs of anxiety/irritability.
Interpretation: Note if the patient appears ill, diaphoretic (sweaty), lying supine, and responsive.
Cyanosis: Blue coloration due to deoxygenated hemoglobin, assess if localized(limbs) or central(body), caused by arterial obstructions, venous stasis.
Central Cyanosis: Caused by low blood oxygen levels or abnormal hemoglobin, related to right-to-left heart shunts or lung disorders.
Peripheral Cyanosis: Normal arterial oxygenation, but restricted peripheral oxygen delivery. Related to cold exposure or decreased cardiac output (reflex response).
Pallor: Lack of skin color indicating conditions like anemia, shock, or hypoglycemia.
Clubbing: Enlarged, nail beds indicating underlying disease(e.g., lung cancer, inflammatory bowel disease, cystic fibrosis.)
Nail-bed Angle: Normal angle is less than 160 degrees; greater than 180 degrees suggests clubbing.

Lower Extremity Specific

Edema: Caused by increased venous pressure, reduced interstitial pressure, and decreased plasma oncotic pressure.
Grade of Edema: 0-2mm (mild), 3-4mm (moderate), 5-6mm (moderate-severe), 8mm (severe).
Specific Potential Diagnoses: Congestive heart failure, liver disease, nephrotic syndrome, renal failure, venous insufficiency, pregnancy, malignancy, hypoalbuminemia.

Auscultation of the Heart

Early systolic bruit: Could be cardiovascular disease causing narrowed/occluded carotid artery.
No carotid bruit: May be normal/no blockage.

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Description

This quiz assesses competencies related to the advanced cardiovascular exam, focusing on patient evaluation techniques and specific assessments for both upper and lower extremities. It covers jugular venous pressure assessment, carotid auscultation, cardiac auscultation, and lung auscultation. Perfect for students in advanced cardiovascular study or practitioners seeking to refine their skills.