Archive:Precordial exam - Revision history

wikademia>Wikademia: moved Precordial exam to Archive:Precordial exam

2009-06-06T21:09:26Z

moved Precordial exam to Archive:Precordial exam

← Older revision	Revision as of 21:09, 6 June 2009
(No difference)

wikademia>Wikademia: moved Precordial Exam to Precordial exam

2009-05-11T21:18:46Z

moved Precordial Exam to Precordial exam

← Older revision	Revision as of 21:18, 11 May 2009
(No difference)

wikademia>Wikademia: moved Precordial Exam (OSCE) to Precordial Exam

2009-04-21T01:24:12Z

moved Precordial Exam (OSCE) to Precordial Exam

← Older revision	Revision as of 01:24, 21 April 2009
(No difference)

wikademia>Wikademia at 01:17, 21 April 2009

2009-04-21T01:17:42Z

← Older revision		Revision as of 01:17, 21 April 2009
Line 6:		Line 6:
	**visible apical beat		**visible apical beat
	**impulses (under xiphoid – can mean RVH or Aorta).		**impulses (under xiphoid – can mean RVH or Aorta).
			{{ntnes}}
	==Palpation==		==Palpation==
	*using finger pads, palpate for apex impulse (PMI) - ''accurately measure MCL''		*using finger pads, palpate for apex impulse (PMI) - ''accurately measure MCL''

wikademia>Wikademia: 16 revisions

2009-04-21T01:15:23Z

16 revisions

← Older revision	Revision as of 01:15, 21 April 2009
(No difference)

wikademia>Donek at 01:06, 25 June 2008

2008-06-25T01:06:21Z

← Older revision		Revision as of 01:06, 25 June 2008
Line 114:		Line 114:
	==Other OSCE modules==		==Other OSCE modules==
	{{OSCE2}}		{{OSCE2}}
	[[Category:Medicine]][[Category:OSCE]]		[[Category: Cardiovascular Medicine]][[Category:OSCE]][[Category: Clinical Skills]]

wikademia>HappyCamper: Reverted edits by Captain Sockpuppet (Talk) to last version by 80.98.166.160 using rollback

2007-08-24T15:56:23Z

Reverted edits by Captain Sockpuppet (Talk) to last version by 80.98.166.160 using rollback

← Older revision		Revision as of 15:56, 24 August 2007
Line 1:		Line 1:
	~~DADADADADAAAAAAA CAPTAIN VANDAL STRIKES AGAIN!!!!!!!!!!!!!!!!!!!!!~~		==Inspection==
			*from the foot of the bed
			**chest wall deformity (pectus excavatum, carinatum)
			**scars (thoracotomy, pacemaker)
			**heaves (ventricular hypertrophy) and lifts
			**visible apical beat
			**impulses (under xiphoid – can mean RVH or Aorta).

			==Palpation==
			*using finger pads, palpate for apex impulse (PMI) - ''accurately measure MCL''
			**location, size - one ICS
			**amplitude - if increased, suggests volume/pressure overload
			**duration - check in relation to carotid pulse (> 2/3 systole → sustained, LVH)
			**if carotid is delayed = '''parvus et tardus''' → AV stenosis

			*thrills - palpate at each of the 4 valve zones = grade 4 murmur
			*heaves (with heel of hand)
			**left sternal border → LVH
			**PV → pulmonary hypertension
			**AV → systemic hypertension
			**inferior to xiphoid - RVH

			==Auscultation==
			*listen specifically for one sound at a time
			*calibrate your timing to the radial pulse
			*S1 > S2 in LLSB
			*S2 > S1 in LUSB

			===S1===
			*louder → ↓ PR interval, ↑CO, ↑HR
			*quieter → ↑ PR interval, MR, severe MS
			*splitting → RBBB

			===S2===
			*splitting ↑ by continued inspiration (while patient not holding in breath)
			*Loud S2 → hypertension (systemic or pulmonary circulation)
			*Wide split S2 - RBBB, Pulmonary stenosis
			*Fixed split S2 - ASD
			*Paradoxical: LBBB, severe AS

			===S3 (Ventricular Gallop)===
			*lightly use bell at apex, best heard in LLD
			*can be normal in young people and the pregnant
			*noted in volume overload, increased transvalvular flow (TR, MR)

			===S4 (Atrial Gallop)===
			*lower pitched
			*indicates stiff LV– LVH, post-MI

			===Other sounds===
			* '''Ejection click''' - between S1 and S2
			* '''Carotid bruit'''
			* '''Pericardial friction'''

			===Murmurs===
			Describe a murmur in its ''timing'', ''shape'', ''intensity'' and ''radiation''

			{\| border="1" cellpadding="2" cellspacing="0"
			\|-
			\|Type
			\|Character
			\|Best Heard
			\|Radiation
			\|-
			\|Aortic stenosis
			\|systolic, crescendo-decrescendo
			\|AV, lean forward
			↓with Valsalva
			\|carotids, clavical
			\|-
			\|Aortic regurg
			\|early diastolic
			decrescendo
			\|L2-4 ICS
			Lean foward
			\|Apex
			\|-
			\|Mitrial Stenosis
			\|Mid diastolic rumble
			\|Apex, LLD
			\|No radiation
			\|-
			\|Mitrial Regurge
			\|pansystolic
			\|apex
			\|L axilla
			\|-
			\|VSD
			\|pansystolic, harsh
			\|L sternal border
			\|-
			\|PDA
			\|continuous
			\|aortic valve
			\|L clavical
			\|}

			====Intensity====

			1/6 = quieter than S1<br>
			2/6 = same as S1<br>
			3/6 = louder than S1 with no thrill<br>
			4/6 = thrill present<br>
			5/6 = heard with edge of scope in contact with skin<br>
			6/6 = heard with scope off of the chest<br>

			==Special tests==

			*↑ blood flow to heart (leg raise, squatting)
			**↑ AS, ↓HoCM, ↓MR
			*↓ blood flow to heart (Valsalva)
			**↓ AS, ↑ MR, ↑HoCM

			==Other OSCE modules==
			{{OSCE2}}
			[[Category:Medicine]][[Category:OSCE]]

wikademia>Captain Sockpuppet: Replacing page with 'DADADADADAAAAAAA CAPTAIN VANDAL STRIKES AGAIN!!!!!!!!!!!!!!!!!!!!!'

2007-08-24T15:55:45Z

Replacing page with 'DADADADADAAAAAAA CAPTAIN VANDAL STRIKES AGAIN!!!!!!!!!!!!!!!!!!!!!'

← Older revision		Revision as of 15:55, 24 August 2007
Line 1:		Line 1:
	~~==Inspection==~~		DADADADADAAAAAAA CAPTAIN VANDAL STRIKES AGAIN!!!!!!!!!!!!!!!!!!!!!
	*from the foot of the bed
	**chest wall deformity (pectus excavatum, carinatum)
	**scars (thoracotomy, pacemaker)
	**heaves (ventricular hypertrophy) and lifts
	**visible apical beat
	**impulses (under xiphoid – can mean RVH or Aorta).

	~~==Palpation==~~
	*using finger pads, palpate for apex impulse (PMI) - ''accurately measure MCL''
	**location, size - one ICS
	**amplitude - if increased, suggests volume/pressure overload
	**duration - check in relation to carotid pulse (> 2/3 systole → sustained, LVH)
	**if carotid is delayed = '''parvus et tardus''' → AV stenosis

	*thrills - palpate at each of the 4 valve zones = grade 4 murmur
	*heaves (with heel of hand)
	**left sternal border → LVH
	**PV → pulmonary hypertension
	**AV → systemic hypertension
	**inferior to xiphoid - RVH

	~~==Auscultation==~~
	*listen specifically for one sound at a time
	*calibrate your timing to the radial pulse
	*S1 > S2 in LLSB
	*S2 > S1 in LUSB

	~~===S1===~~
	*louder → ↓ PR interval, ↑CO, ↑HR
	*quieter → ↑ PR interval, MR, severe MS
	*splitting → RBBB

	~~===S2===~~
	*splitting ↑ by continued inspiration (while patient not holding in breath)
	*Loud S2 → hypertension (systemic or pulmonary circulation)
	*Wide split S2 - RBBB, Pulmonary stenosis
	*Fixed split S2 - ASD
	*Paradoxical: LBBB, severe AS

	~~===S3 (Ventricular Gallop)===~~
	*lightly use bell at apex, best heard in LLD
	*can be normal in young people and the pregnant
	*noted in volume overload, increased transvalvular flow (TR, MR)

	~~===S4 (Atrial Gallop)===~~
	*lower pitched
	*indicates stiff LV– LVH, post-MI

	~~===Other sounds===~~
	* '''Ejection click''' - between S1 and S2
	* '''Carotid bruit'''
	* '''Pericardial friction'''

	~~===Murmurs===~~
	~~Describe a murmur in its ''timing'', ''shape'', ''intensity'' and ''radiation''~~

	~~{\| border="1" cellpadding="2" cellspacing="0"~~
	\|-
	~~\|Type~~
	~~\|Character~~
	~~\|Best Heard~~
	~~\|Radiation~~
	\|-
	~~\|Aortic stenosis~~
	~~\|systolic, crescendo-decrescendo~~
	~~\|AV, lean forward~~
	~~↓with Valsalva~~
	~~\|carotids, clavical~~
	\|-
	~~\|Aortic regurg~~
	~~\|early diastolic~~
	~~decrescendo~~
	~~\|L2-4 ICS~~
	~~Lean foward~~
	~~\|Apex~~
	\|-
	~~\|Mitrial Stenosis~~
	~~\|Mid diastolic rumble~~
	~~\|Apex, LLD~~
	~~\|No radiation~~
	\|-
	~~\|Mitrial Regurge~~
	~~\|pansystolic~~
	~~\|apex~~
	~~\|L axilla~~
	\|-
	~~\|VSD~~
	~~\|pansystolic, harsh~~
	~~\|L sternal border~~
	\|-
	~~\|PDA~~
	~~\|continuous~~
	~~\|aortic valve~~
	~~\|L clavical~~
	\|}

	~~====Intensity====~~

	~~1/6 = quieter than S1<br>~~
	~~2/6 = same as S1<br>~~
	~~3/6 = louder than S1 with no thrill<br>~~
	~~4/6 = thrill present<br>~~
	~~5/6 = heard with edge of scope in contact with skin<br>~~
	~~6/6 = heard with scope off of the chest<br>~~

	~~==Special tests==~~

	*↑ blood flow to heart (leg raise, squatting)
	**↑ AS, ↓HoCM, ↓MR
	*↓ blood flow to heart (Valsalva)
	**↓ AS, ↑ MR, ↑HoCM

	~~==Other OSCE modules==~~
	~~{{OSCE2}}~~
	~~[[Category:Medicine]][[Category:OSCE]]~~

80.98.166.160: /* Other sounds */

2007-07-11T21:29:30Z

Other sounds

← Older revision		Revision as of 21:29, 11 July 2007
Line 49:		Line 49:

	===Other sounds===		===Other sounds===
	'''Ejection click''' - between S1 and S2		* '''Ejection click''' - between S1 and S2
	'''Carotid bruit'''		* '''Carotid bruit'''
	'''Pericardial friction'''		* '''Pericardial friction'''

	===Murmurs===		===Murmurs===

80.98.166.160: /* Inspection */

2007-07-11T21:27:59Z

Inspection

← Older revision		Revision as of 21:27, 11 July 2007
Line 3:		Line 3:
	**chest wall deformity (pectus excavatum, carinatum)		**chest wall deformity (pectus excavatum, carinatum)
	**scars (thoracotomy, pacemaker)		**scars (thoracotomy, pacemaker)

	**heaves (ventricular hypertrophy) and lifts		**heaves (ventricular hypertrophy) and lifts
	**visible apical beat		**visible apical beat