Physical Assessment: Cardiovascular Study Guide

Questions and Answers

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.

True

The technique to assess for splenomegaly involves ______ percussion.

tympanic

Which of the following sounds indicates an enlarged spleen?

Dullness Signup and view all the answers

What should you listen for when auscultating vascular sounds?

Bruits Signup and view all the answers

Low bowel sounds can indicate recent abdominal surgery.

True Signup and view all the answers

Which of the following are cardiac risk factors? (Select all that apply)

Obesity Signup and view all the answers

What is the average normal frequency of bowel sounds?

5-30 sounds/minute Signup and view all the answers

Systole refers to the relaxation phase of the ventricles.

False Signup and view all the answers

Match the abnormal physical findings with their corresponding details:

Ascites = Fluid in the abdomen Hepatomegaly = Enlarged liver Splenomegaly = Enlarged spleen Rebound tenderness = Pain upon withdrawal of pressure Signup and view all the answers

What does a positive Murphy's sign indicate?

Acute cholecystitis Signup and view all the answers

What is the formula for calculating cardiac output?

Stroke volume x Heart rate Signup and view all the answers

Which technique is used to assess for kidney enlargement?

Costovertebral angle tenderness Signup and view all the answers

The pressure generated by blood remaining in the arterial tree during diastole is called ___ BP.

Diastolic Signup and view all the answers

What does JVP stand for?

Jugular Venous Pressure Signup and view all the answers

Match the following cardiac symptoms with their descriptions:

Dyspnea = Shortness of breath, uncomfortable awareness of breathing Orthopnea = Dyspnea that occurs soon after the patient lies down Palpitations = Subjective sensations of a racing heart Syncope = Rapid onset, transient loss of consciousness Signup and view all the answers

What is the normal grading for absent pulse?

0 Signup and view all the answers

Which of the following is a cause of dyspnea? (Select all that apply)

Heart failure Signup and view all the answers

What does edema refer to?

Swelling due to excess accumulation of fluid in connective tissue Signup and view all the answers

What does a +1 pulse grading indicate?

Weak/thready pulse Signup and view all the answers

Where should you palpate the carotid arteries?

One carotid artery at a time Signup and view all the answers

Cyanosis can occur due to reduced blood flow through capillaries.

True Signup and view all the answers

What should you use to listen for bruits over the carotid artery?

Bell of the stethoscope Signup and view all the answers

What is a normal jugular venous pressure measurement?

2-3 cm H2O above sternal angle Signup and view all the answers

What is Paroxysmal Nocturnal Dyspnea?

Dyspnea after lying down for several minutes or hours, leading to awakening SOB. Signup and view all the answers

What is PMI?

Point of Maximal Impulse Signup and view all the answers

S1 is heard louder than S2.

True Signup and view all the answers

Acrocyanosis is considered normal in infants.

True Signup and view all the answers

What heart sound is associated with the closing of the AV valves?

S1 Signup and view all the answers

Pallor can be an abnormal physical exam finding indicating poor circulation or _____ disease.

Raynaud's Signup and view all the answers

Match the heart sounds to their definitions:

S1 = Closing of the AV valves S2 = Closing of the semilunar valves S3 = Ventricular gallop S4 = Atrial gallop Signup and view all the answers

Which of the following is an abnormal finding during a physical assessment? (Select all that apply)

Pallor Signup and view all the answers

What is an S3 sound commonly associated with?

Heart failure or volume overload Signup and view all the answers

What could cause a local or distal infection reflected in lymph node enlargement?

Lesion in the area Signup and view all the answers

The murmur associated with mitral regurgitation is classified as ___ murmur.

pansystolic Signup and view all the answers

Which of the following could indicate cardiomegaly?

Displaced PMI Signup and view all the answers

What grading indicates a thready pulse?

1+ Signup and view all the answers

The Allen test is used to determine the patency of the _____ artery prior to puncturing.

ulnar Signup and view all the answers

What are the symptoms of chronic arterial insufficiency? (Select all that apply)

Cool temperature Signup and view all the answers

What does bilateral coldness in the limbs suggest?

Coldness or anxiety Signup and view all the answers

Dorsalis pedis and popliteal pulses may become more difficult to palpate in older adults.

True Signup and view all the answers

Intermittent claudication is a symptom associated with _____ insufficiency.

chronic arterial Signup and view all the answers

Match the terms with their definitions:

Anorexia = Lack of appetite Dysphasia = Difficulty swallowing Melena = Black or tarry stools Odynophagia = Pain with swallowing Signup and view all the answers

What does a positive Obturator sign indicate?

Appendicitis Signup and view all the answers

What indicates a positive Murphy's sign?

Cholecystitis Signup and view all the answers

What is the scale used to grade muscle strength?

0 to 5 scale Signup and view all the answers

Match the skeletal muscle movements with their descriptions:

Flexion = Bending at a joint Extension = Straightening at a joint Abduction = Limb away from the midline Adduction = Limb toward the midline Signup and view all the answers

What is considered normal muscle strength?

Grade 5 Signup and view all the answers

Heberden’s nodes are typically found in Metacarpophalangeal joints.

False Signup and view all the answers

The positive test for carpal tunnel syndrome using Phalen's test requires the patient to hold the wrist in ______ position for 60 seconds.

flexed Signup and view all the answers

What are the symptoms associated with rheumatoid arthritis?

Tender, painful, stiff joints worse in the morning, better with movement Signup and view all the answers

What is the average age for menopause in the United States?

51 years old Signup and view all the answers

What should a person consistently be aware of?

Reality Signup and view all the answers

What should be screened for when assessing perceptions?

Depression Signup and view all the answers

What is judgment in the context of mental assessment?

The process of comparing and evaluating different possible courses of action. Signup and view all the answers

What does insight refer to in a psychological assessment?

Awareness that thoughts, symptoms, or behaviors are normal or abnormal. Signup and view all the answers

What does the Mini-Mental State Examination (MMSE) assess?

Cognitive functions. Signup and view all the answers

How long does it typically take to administer the MMSE?

5-10 minutes. Signup and view all the answers

What is considered a normal result on the MMSE?

24-30. Signup and view all the answers

What score range indicates mild cognitive impairment on the MMSE?

18-23. Signup and view all the answers

What score indicates severe cognitive impairment on the MMSE?

0-17. Signup and view all the answers

What is an abnormal finding in cognitive assessment?

Inability to recall immediate or long-term information. Signup and view all the answers

What should you allow the patient to do before the exam?

Empty their bladder Signup and view all the answers

What should be present during the examination?

Chaperone Signup and view all the answers

Patients can say STOP at any moment during an exam.

True Signup and view all the answers

What position should the patient be in for a pelvic exam?

Lithotomy position Signup and view all the answers

What does a normal glans penis look like?

It should be smooth without lesions. Signup and view all the answers

The narrowed opening of the prepuce that prevents retraction of the foreskin is known as _____

Phimosis Signup and view all the answers

What may be a symptom of testicular torsion?

Excruciating unilateral pain Signup and view all the answers

What is a common symptom of testicular cancer?

Painless lump Signup and view all the answers

A narrowed opening of the prepuce is known as paraphimosis.

False Signup and view all the answers

What should be checked for during the perianal inspection?

Lesions or masses Signup and view all the answers

Prostatitis is characterized by fever, chills, and _____

urinary frequency Signup and view all the answers

At what age should AMABs have their first prostate exam according to the ACS?

50 Signup and view all the answers

What is a risk factor for prostate cancer?

Age Signup and view all the answers

Which condition is indicated by urinary frequency and urgency in elderly patients?

Benign Prostatic Hypertrophy (BPH) Signup and view all the answers

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 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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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.