- Posture: sitting upright, unwilling to lie down, hand motions toward chest
Identify the components of a routine inspection of chest pain patient - correct answer ✔✔Check
fingertips + nail beds for:
,- cap refill within 3 seconds
- clubbing of fingers
Head + neck for:
- xanthoma (fatty streaking visible just under the skin)
- corneal arcus (grayish ring around the eyes)
JVD for distention
Abdominal jugular test or reflux
- positive result = sustained rise > 3cm or fall > 4cm after releasing pressure
Identify a normal resting pulse pressure - correct answer ✔✔40 mmHg
Dose a widened pulse pressure increase risk of cardiovascular disease? - correct answer ✔✔Yes
Widened pulse pressure = indicator of increased cardiovascular risk
Equate 4mm of moderate indentation that takes 10-15 seconds to disappear with how much pitting
edema is present - correct answer ✔✔2+ pitting edema
Listening to the right lobe of the lung - correct answer ✔✔3 LOBES
*RLL cannot be assessed from the anterior chest
*RML can only be assessed from the anterior chest
Listening to the left lobe of the lung - correct answer ✔✔2 LOBES
,*LLL cannot be auscultated from the anterior chest
Types of sounds we listen to with the bell of the stethoscope - correct answer ✔✔Low-pitched sounds +
murmurs (S3, S4)
Mitral + tricuspid diastolic rumbles
S1, S2 as well
Apply to chest wall w/ minimal pressure
Types of sounds we listen to with the diaphragm of the stethoscope - correct answer ✔✔High-pitched
sounds (S1, S2)
Ejection clicks
Opening snaps
Murmurs produced by stenotic valves
Press against slim firmly to get the best sound effect
Where to listen to the aortic valve - correct answer ✔✔2nd intercostal space, RSB
Where to listen to the mitral valve - correct answer ✔✔5th intercostal space, left midclavicular line =
apex
Where to listen to the pulmonic valve - correct answer ✔✔2nd intercostal space, LSB
Where to listen to the tricuspid valve - correct answer ✔✔5th intercostal space, LSB
, Valves open in ventricular systole and in diastole - correct answer ✔✔Semilunar valves
Mitral + tricuspid valves CLOSE
Anatomic event coinciding with S1 - correct answer ✔✔Closure of MITRAL + TRICUSPID valves
Ventricular systole
Anatomic event coinciding with S2 - correct answer ✔✔Closure of AORTIC + PULMONIC valves
Usually the loudest heart sound
What produces the second heart sound - correct answer ✔✔Closure of AORTIC + PULMONIC valves
Ventricular diastole
What produces the first heart sound - correct answer ✔✔Closure of the AV valves - MITRAL + TRICUSPID
valves
Turbulent blood flow in the ventricles
Ventricular systole
Identify causes of an S3 sound - correct answer ✔✔Resistance to ventricular filling from increased
volume load
Decreased ventricular compliance
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