Cardiovascular Examination
What are the general auscultation areas of the heart?
What are palm and nail signs, and why are they important?
Nail signs (Koilonychia، Leukonychia)
Finger clubbing
Asterixis (flapping tremor)
How do you assess tactile vocal fremitus?
Technique
Patient repeats “99”.
Use ulnar hand border to palpate chest.
Compare both sides, all regions.
Abnormal tactile vocal fremitus:
Increased → consolidation, tumor, lobar collapse.
Decreased → pleural effusion, pneumothorax.
Which reflexes are mediated by the trigeminal nerve (CN V)?
Jaw jerk reflex
Corneal reflex
How many types of second-degree AV block are there, and how can you differentiate between them on an ECG?
Types: 2
Type 1 (Wenckebach / Mobitz I)
PR interval progressively lengthens until a dropped QRS.
Type 2 (Mobitz II)
PR interval constant, but intermittent dropped QRS.
How do you hear the 1st and 2nd heart sounds?
1. Palpate the carotid pulse to determine the first heart sound.
2. Auscultate ‘upwards’ through the valve areas using the diaphragm of the stethoscope whilst continuing to palpate the carotid pulse
How do you auscultate the aorta and renal arteries for bruits?
Abdominal bruits:
Aortic → 1–2 cm above umbilicus; may indicate AAA.
Renal → 1–2 cm above umbilicus, lateral to midline; may indicate renal artery stenosis.
What are percussion notes, and what do they indicate?
Resonance
Hyper resonance
Dull
Stony dull
Resonant: Normal lungs
Hyper-resonant: Pneumothorax, COPD/emphysema
Dull: Pneumonia, tumor, atelectasis
Stony dull: Large pleural effusion
How do you assess the motor function of the trigeminal nerve during a neurological exam?
Motor assessment of V3 (mandibular nerve):
Inspect temporalis & masseter for wasting.
Palpate masseter while patient clenches teeth.
Test lateral pterygoid: ask patient to open mouth against resistance; note weakness or jaw deviation.
An apple a day keeps _____ away?
wellllll
What is the Hepatojugular Reflux test and how is it performed?
The hepatojugular reflux test involves the application of pressure to the liver whilst observing for a sustained rise in JVP.
To be able to perform the test, there should be at least a 3cm distance from the upper margin of the baseline JVP to the angle of the mandible:
How do you palpate the bladder?
A distended bladder can be felt in the suprapubic area, arising from behind the pubic symphysis.
In most healthy patients who urinate regularly, the bladder is not palpable.
What are the areas to percuss in a respiratory exam?
Supraclavicular region: lung apices.
Infraclavicular region down to lung bases
Sides:Mid-axillary line.
A patient has difficulty swallowing and a hoarse voice. On examination, the uvula deviates to the left. Which nerves are most likely affected?
Vagus (CN X)
Tip:
CN IX: impaired gag reflex, loss of taste from posterior 1/3 tongue.
CN X: uvula deviates away from lesion, hoarseness, dysphagia.
A 65-year-old patient presents with exertional dyspnea and chest pain. On auscultation, you hear a crescendo-decrescendo systolic murmur.
Identify the murmur, its location
Right 2nd intercostal space (aortic area), radiates to carotids.
What should you check when taking the radial pulse?
rate and rhythm
Radio-radial delay
Collapsing pulse
How do you palpate the spleen?
-Start palpation in the right iliac fossa at the anterior superior iliac spine using the flat of your hand.
-Ask the patient to take a deep breath; palpate along the left costal margin to feel for the splenic edge during inspiration.
-Move 1–2 cm superiorly with each palpation toward the left costal margin.
-Normal finding: Spleen not palpable.
How do you assess cricosternal (cricothyroid) distance?
1. Measure the distance between the suprasternal notch and cricoid cartilage using your fingers.
2. In healthy individuals, the distance should be 3-4 fingers.
Which part of the tongue is innervated by the facial nerve for taste sensation?
anterior two-thirds of the tongue.
how would you treat a patient who has blood sugar high?
I will just tell him not to eat sugar
What is the main important finding in the abdomen during cardiovascular exam?
1.Abdomen:
Hepatomegaly → right heart failure
Pulsatile liver → tricuspid regurgitation
Pulsatile abdominal mass → abdominal aortic aneurysm
2.Spleen:
Splenomegaly → endocarditis
3.Kidneys:
Palpation → enlargement/tenderness
Auscultation → renal artery bruits
How do you palpate the liver and gallbladder?
Liver Palpation:
-Start in right iliac fossa at the anterior superior iliac spine using the flat of your hand.
-Ask the patient to take a deep breath; palpate upward along the right costal margin to feel the liver edge.
-Move 1–2 cm superiorly each time toward the right costal margin.
-Normal finding: Liver edge may be palpable 1–2 cm below costal margin in healthy individuals.
Gallbladder Palpation:
Palpate at right costal margin, mid-clavicular line (tip of 9th rib), Normally not palpable.
How do you measure the Jugular Venous Pressure (JVP)?
Position patient at 45°.
Turn head slightly left.
Inspect IJV pulsation (double waveform, between SCM heads).
Measure height above sternal angle → normal ≤ 3 cm
How is the motor function of the facial nerve (CN VII) tested?
Facial nerve (CN VII) assessment:
1-Hearing: Ask about changes (hyperacusis → stapedius paralysis).
2-Inspection at rest: Look for asymmetry in forehead, nasolabial folds, mouth angles.
3-Facial movements:
Raise eyebrows → frontalis
Close eyes tightly → orbicularis oculi
Blow out cheeks → orbicularis oris
Smile → levator anguli oris, zygomaticus major
Pursed lips/whistle → orbicularis oris, buccinator
We fell in ...... in October
A- finals
B- love
C- Osce
D- CBL
A , C and D