Podcast
Questions and Answers
What is the first step in the abdominal physical exam?
What is the first step in the abdominal physical exam?
- Auscultation
- Percussion
- Palpation
- Inspection (correct)
The liver span at the right midclavicular line is normally 6-12 cm.
The liver span at the right midclavicular line is normally 6-12 cm.
True (A)
The technique to assess for splenomegaly involves ______ percussion.
The technique to assess for splenomegaly involves ______ percussion.
tympanic
Which of the following sounds indicates an enlarged spleen?
Which of the following sounds indicates an enlarged spleen?
What should you listen for when auscultating vascular sounds?
What should you listen for when auscultating vascular sounds?
Low bowel sounds can indicate recent abdominal surgery.
Low bowel sounds can indicate recent abdominal surgery.
Which of the following are cardiac risk factors? (Select all that apply)
Which of the following are cardiac risk factors? (Select all that apply)
What is the average normal frequency of bowel sounds?
What is the average normal frequency of bowel sounds?
Systole refers to the relaxation phase of the ventricles.
Systole refers to the relaxation phase of the ventricles.
Match the abnormal physical findings with their corresponding details:
Match the abnormal physical findings with their corresponding details:
What does a positive Murphy's sign indicate?
What does a positive Murphy's sign indicate?
What is the formula for calculating cardiac output?
What is the formula for calculating cardiac output?
Which technique is used to assess for kidney enlargement?
Which technique is used to assess for kidney enlargement?
The pressure generated by blood remaining in the arterial tree during diastole is called ___ BP.
The pressure generated by blood remaining in the arterial tree during diastole is called ___ BP.
What does JVP stand for?
What does JVP stand for?
Match the following cardiac symptoms with their descriptions:
Match the following cardiac symptoms with their descriptions:
What is the normal grading for absent pulse?
What is the normal grading for absent pulse?
Which of the following is a cause of dyspnea? (Select all that apply)
Which of the following is a cause of dyspnea? (Select all that apply)
What does edema refer to?
What does edema refer to?
What does a +1 pulse grading indicate?
What does a +1 pulse grading indicate?
Where should you palpate the carotid arteries?
Where should you palpate the carotid arteries?
Cyanosis can occur due to reduced blood flow through capillaries.
Cyanosis can occur due to reduced blood flow through capillaries.
What should you use to listen for bruits over the carotid artery?
What should you use to listen for bruits over the carotid artery?
What is a normal jugular venous pressure measurement?
What is a normal jugular venous pressure measurement?
What is Paroxysmal Nocturnal Dyspnea?
What is Paroxysmal Nocturnal Dyspnea?
What is PMI?
What is PMI?
S1 is heard louder than S2.
S1 is heard louder than S2.
Acrocyanosis is considered normal in infants.
Acrocyanosis is considered normal in infants.
What heart sound is associated with the closing of the AV valves?
What heart sound is associated with the closing of the AV valves?
Pallor can be an abnormal physical exam finding indicating poor circulation or _____ disease.
Pallor can be an abnormal physical exam finding indicating poor circulation or _____ disease.
Match the heart sounds to their definitions:
Match the heart sounds to their definitions:
Which of the following is an abnormal finding during a physical assessment? (Select all that apply)
Which of the following is an abnormal finding during a physical assessment? (Select all that apply)
What is an S3 sound commonly associated with?
What is an S3 sound commonly associated with?
What could cause a local or distal infection reflected in lymph node enlargement?
What could cause a local or distal infection reflected in lymph node enlargement?
The murmur associated with mitral regurgitation is classified as ___ murmur.
The murmur associated with mitral regurgitation is classified as ___ murmur.
Which of the following could indicate cardiomegaly?
Which of the following could indicate cardiomegaly?
What grading indicates a thready pulse?
What grading indicates a thready pulse?
The Allen test is used to determine the patency of the _____ artery prior to puncturing.
The Allen test is used to determine the patency of the _____ artery prior to puncturing.
What are the symptoms of chronic arterial insufficiency? (Select all that apply)
What are the symptoms of chronic arterial insufficiency? (Select all that apply)
What does bilateral coldness in the limbs suggest?
What does bilateral coldness in the limbs suggest?
Dorsalis pedis and popliteal pulses may become more difficult to palpate in older adults.
Dorsalis pedis and popliteal pulses may become more difficult to palpate in older adults.
Intermittent claudication is a symptom associated with _____ insufficiency.
Intermittent claudication is a symptom associated with _____ insufficiency.
Match the terms with their definitions:
Match the terms with their definitions:
What does a positive Obturator sign indicate?
What does a positive Obturator sign indicate?
What indicates a positive Murphy's sign?
What indicates a positive Murphy's sign?
What is the scale used to grade muscle strength?
What is the scale used to grade muscle strength?
Match the skeletal muscle movements with their descriptions:
Match the skeletal muscle movements with their descriptions:
What is considered normal muscle strength?
What is considered normal muscle strength?
Heberden’s nodes are typically found in Metacarpophalangeal joints.
Heberden’s nodes are typically found in Metacarpophalangeal joints.
The positive test for carpal tunnel syndrome using Phalen's test requires the patient to hold the wrist in ______ position for 60 seconds.
The positive test for carpal tunnel syndrome using Phalen's test requires the patient to hold the wrist in ______ position for 60 seconds.
What are the symptoms associated with rheumatoid arthritis?
What are the symptoms associated with rheumatoid arthritis?
What is the average age for menopause in the United States?
What is the average age for menopause in the United States?
What should a person consistently be aware of?
What should a person consistently be aware of?
What should be screened for when assessing perceptions?
What should be screened for when assessing perceptions?
What is judgment in the context of mental assessment?
What is judgment in the context of mental assessment?
What does insight refer to in a psychological assessment?
What does insight refer to in a psychological assessment?
What does the Mini-Mental State Examination (MMSE) assess?
What does the Mini-Mental State Examination (MMSE) assess?
How long does it typically take to administer the MMSE?
How long does it typically take to administer the MMSE?
What is considered a normal result on the MMSE?
What is considered a normal result on the MMSE?
What score range indicates mild cognitive impairment on the MMSE?
What score range indicates mild cognitive impairment on the MMSE?
What score indicates severe cognitive impairment on the MMSE?
What score indicates severe cognitive impairment on the MMSE?
What is an abnormal finding in cognitive assessment?
What is an abnormal finding in cognitive assessment?
What should you allow the patient to do before the exam?
What should you allow the patient to do before the exam?
What should be present during the examination?
What should be present during the examination?
Patients can say STOP at any moment during an exam.
Patients can say STOP at any moment during an exam.
What position should the patient be in for a pelvic exam?
What position should the patient be in for a pelvic exam?
What does a normal glans penis look like?
What does a normal glans penis look like?
The narrowed opening of the prepuce that prevents retraction of the foreskin is known as _____
The narrowed opening of the prepuce that prevents retraction of the foreskin is known as _____
What may be a symptom of testicular torsion?
What may be a symptom of testicular torsion?
What is a common symptom of testicular cancer?
What is a common symptom of testicular cancer?
A narrowed opening of the prepuce is known as paraphimosis.
A narrowed opening of the prepuce is known as paraphimosis.
What should be checked for during the perianal inspection?
What should be checked for during the perianal inspection?
Prostatitis is characterized by fever, chills, and _____
Prostatitis is characterized by fever, chills, and _____
At what age should AMABs have their first prostate exam according to the ACS?
At what age should AMABs have their first prostate exam according to the ACS?
What is a risk factor for prostate cancer?
What is a risk factor for prostate cancer?
Which condition is indicated by urinary frequency and urgency in elderly patients?
Which condition is indicated by urinary frequency and urgency in elderly patients?
Study Notes
Cardiovascular Overview
- Past medical history should include cardiac illness, surgeries, family history of heart disease, diabetes, and conditions affecting lungs, kidneys, or liver.
- Cardiac risk factors include high blood pressure, high cholesterol, diabetes, obesity, smoking, sedentary lifestyle, age (M > 45, F > 55), stress, diet, alcohol/tobacco/drug use, and ability to perform daily activities.
- Review of systems (ROS) should assess for chest pain, dyspnea, palpitations, orthopnea, cough, weakness or fatigue, weight changes, edema, cyanosis or pallor, dizziness/syncope, and nocturia.
Heart Function and Blood Pressure
- Systole refers to ventricular contraction; diastole indicates ventricle relaxation.
- Heart sounds: S1 is the closing of atrioventricular (AV) valves; S2 marks the closing of semilunar valves.
- Right ventricle pumps into pulmonary arteries; left ventricle pumps into aorta.
- Systolic blood pressure is generated when the left ventricle ejects blood into the aorta; diastolic blood pressure is the pressure remaining in arteries during relaxation.
Cardiac Output and Hemodynamics
- Cardiac Output = Stroke Volume × Heart Rate.
- Blood pressure is influenced by Cardiac Output and Systemic Vascular Resistance (SVR).
- Preload denotes volume overload; afterload refers to pressure overload.
Cardiac Conduction
- Depolarization initiates myocardial contraction; the heart muscle is negatively charged when at rest.
- EKG records depolarization and repolarization in distinct waves.
Chest Pain Considerations
- Chest pain could stem from cardiac or non-cardiac sources. Differentiation is crucial.
- Cardiac-related chest pain:
- Myocardial Ischemia causes lack of blood flow.
- Stable angina is relieved by nitroglycerin; unstable angina occurs at rest and necessitates intervention; variant angina involves coronary artery spasms.
- Myocardial infarction results from coronary artery blockage.
- Non-ischemic cardiac causes include mitral valve prolapse, pericarditis, or dissecting aneurysm.
- Pulmonary causes such as pulmonary embolism, pleurisy, and pneumothorax may lead to dyspnea and chest discomfort.
Dyspnea and Related Symptoms
- Dyspnea is an uncomfortable awareness of breathing; orthopnea occurs when lying down.
- Paroxysmal nocturnal dyspnea awakens patients from sleep due to shortness of breath.
- Left-sided heart failure leads to pulmonary edema, observed as anxious dyspneic patients with pink frothy sputum.
Additional Cardiac Symptoms
- Palpitations can be normal or indicative of underlying issues; sudden onset may signal paroxysmal atrial tachycardia or ectopic beats.
- Syncope involves transient loss of consciousness; vasovagal syncope is the most common form.
- Edema can indicate congestive heart failure, and generalized edema (anasarca) may involve liver or kidney failure.
Cardiovascular Physical Exam Techniques
- General physical examination order includes assessing appearance, blood pressure, neck vessels, and precordium.
- Orthostatic hypotension is significant if SBP drops ≥ 20 mm Hg or DBP drops ≥ 10 mm Hg upon standing.
- Normal jugular venous pulse is 2-3 cm H2O above the sternal angle; jugular venous distention may indicate cardiac dysfunction.
Blood Pressure Assessment
- Assess systolic and diastolic blood pressure to evaluate cardiac health.
- Perform orthostatic blood pressure tests for suspected volume depletion or medication effects.
Neck/Carotid Arteries Examination
- Inspect for jugular venous distention as a sign of heart failure; a healthy venous pulse is indicative of proper cardiovascular function.
- Non-invasive estimation of jugular venous pressure can provide insights into right-sided heart performance.### Jugular Venous Pressure (JVP)
- JVP measured as vertical height (cm) of blood column from sternal angle (angle of Louis).
- For external JVP, direct palpation is possible; internal requires an additional 5 cm adjustment to reflect right atrial pressure.
- JVP indicates hydrostatic pressure in the right side of the heart.
Carotid Arteries Assessment
- Assess carotid arteries bilaterally from a sitting or supine position using index and middle fingers.
- Never palpate both carotid arteries simultaneously to avoid reduced blood flow.
- Pulse grading:
- 0: absent
- +1: weak/thready
- +2: normal
- +3: full/increased
- +4: bounding
- Auscultate carotid arteries with a bell for bruits; bruits may indicate thyroid enlargement.
Physical Examination of the Chest
- Inspect precordium for visible pulsations or lifts (heaves) and palpate for thrills indicating turbulent blood flow.
- PMI typically located at the 4th or 5th intercostal space at the midclavicular line.
- Abnormal findings include:
- Displaced PMI in left ventricular dilation (lower and left).
- Increased PMI size in left ventricular overload.
Heart Auscultation Areas
- Use diaphragm for high-pitched sounds (S1, S2, and most murmurs) and bell for low-pitched sounds (S3, S4, mitral stenosis).
- S1 correlates with the carotid pulse and is louder at the apex; S2 is loud at the base.
- S2 heard strongest at the base, while S1 is strongest at the apex.
Heart Sounds Characteristics
- Systole: S1 marks closing of AV valves; ventricles contract.
- Diastole: S2 marks closure of semilunar valves; ventricles relax.
- Assess S1 and S2 during auscultation; S1 is typically louder than S2.
Abnormal Heart Sounds
- S3 (ventricular gallop) indicates possible heart failure; heard best with the bell in left lateral position.
- S4 (atrial gallop) indicates a stiff left ventricle; usually associated with left ventricular hypertrophy.
Murmurs
- Murmurs are abnormal blowing sounds indicating turbulent blood flow, generally pathologic.
- Classification of murmurs includes timing, duration, location, shape, grade (1-6), pitch, quality, radiation, and patient position.
- Common types include:
- Midsystolic: Aortic stenosis, pulmonic stenosis.
- Pansystolic: Mitral/tricuspid regurgitation.
- Diastolic: Mitral/tricuspid stenosis, aortic/pulmonic regurgitation.
Developmental Considerations
- Aging results in increased systolic blood pressure and wider pulse pressure; diastolic pressure remains stable.
- Older adults at greater risk of orthostatic hypotension and arrhythmias due to decreased pacemaker cells.
- Difficulties in palpating apical impulse and peripheral pulses (Dorsalis Pedis, Popliteal) are common in older adults. ### Vital Signs and Physical Assessment
- Acrocyanosis is normal in infants, indicating healthy circulation.
- Assess peripheral vascular system for signs of pain, numbness, and skin changes in limbs.
- Inspect arms for pallor, temperature, texture, size/symmetry, and capillary refill.
- Erythema, swelling, or clubbing can indicate underlying vascular issues or DVT.
- Grading pulse amplitude:
- 4+ bounding, 3+ full, 2+ brisk (normal), 1+ diminished, 0 absent.
Abdomen Examination
- Normal aortic pulsation: palpate above the umbilicus, 2-3 cm wide.
- Prominent lateral pulsations or a palpable mass may indicate an aneurysm.
- For leg examination, inspect for lesions, skin color, symmetry, temperature, and hair distribution.
- Dorsalis pedis pulse absence suggests occlusive diseases; this is critical for diabetic patients.
Edema Assessment
- Pitting edema graded from 1+ (mild) to 4+ (severe).
- Causes of edema include DVT, chronic venous insufficiency, lymphedema, and congestive heart failure.
Lymph Nodes Examination
- Normal: inguinal nodes may be nonpalpable or small.
- Lymphadenopathy indicates possible infections or malignancies.
Special Tests
- Allen Test: Evaluates ulnar artery patency prior to arterial puncture. Normal results show blood return within 3-5 seconds.
- Homan's Sign: Tests for DVT by dorsiflexing the ankle; a positive sign indicates possible thrombosis.
- Postural Color Changes: Evaluates arterial insufficiency; pallor on elevation is noted.
Chronic Conditions
- Chronic Arterial Insufficiency: Characterized by intermittent claudication, reduced pulses, pale skin on elevation, cool temperature, and potential ulceration.
- Chronic Venous Insufficiency: Presents with aching pain, normal pulses, cyanotic skin on dependency, marked edema, and brown pigmentation.
Developmental Considerations for Older Adults
- Systolic BP typically rises with age, while diastolic BP remains stable, widening pulse pressure.
- Increased risk of orthostatic hypotension and arrhythmias necessitates cautious examination.
- Arterial pulses may become harder to palpate with age.
Abdominal Organ Location
- RUQ: Liver, gallbladder, ascending colon.
- RLQ: Cecum, appendix, bladder.
- LUQ: Spleen, stomach, small intestine.
- LLQ: Sigmoid colon.
GI Terminology
- Upper GI: Anorexia, dysphagia, emesis, hematemesis, and retching define symptoms of esophageal disorders.
- Lower GI: Diarrhea and constipation indicate bowel dysfunction; hematochezia and melena signal potential bleeding.
Abdominal Pain
- Visceral Pain: Generalized and poorly localized, indicating contractions or distensions in hollow organs.
- Parietal Pain: Severe and easily localized, often due to inflammation affecting the peritoneum.
- Referred Pain: Pain felt in a different area from its origin, often linked to shared spinal innervation.
General Clinical Observations
- Shoulder pain may relate to gallbladder issues (referred pain).
- Careful history-taking and symptom analysis are crucial for accurate diagnosis and treatment.
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Description
Prepare for your final exam with this comprehensive study guide on cardiovascular physical assessment. This quiz covers key concepts including cardiac illness history, risk factors, and review of systems related to cardiovascular health. Assess your knowledge and identify areas for further review.