CVS EXAMINATION Not Poorly Well
done done done
0 1/2 1
Greet examiner
Greet patient, Introduce self, tells mission and asks for
consent
Sanitizes hand
Asks for screen
Places patient in cardiac position & exposes chest
Inspects both from side of bed and from foot of bed
Examines for pulse rate, rhythm and volume
Checks for arterial wall thickness
Checks radio-radial synchrony
Checks radiofemoral delay
Flexes the knee one after the other and checks for each
popleteal artery with two hands
Palpates both posterior tibial arteries together
Palpates both dorsalis pedis arteries together
Palpates carotid arteries one after the other
Palpates both temporal arteries together
Checks for collapsing pulse
Checks for Locomotor brachialis with the elbow flexed and
laterally rotated and with a pen tourch correctly shining
across the medial border of the arm
Asks to do blood pressure
Inspects the JVP correctly with a pen tourch and with the
neck rotated to the left and patient in cardiac position
Examines with patient on cardiac position
Asks patient to take deep inspiration and examines
again
Asks patient to sit up and examines again
Palpates the JVP still with the neck rotated to the left and
patient in cardiac position
Palpates the JVP to check weather it is pulsatile
Does abdominojugular reflux
Measures JVP with two rulers
Inspects the precaurdium with a pen tourch
Correctly Localizes the apex beat
Palpates the localised apex (for heave & thrill)
Palpates the left sternal border @ 4th intercostal space (for
heave and thrill)
Palpates the left sternal border @ 2nd intercostal space (for
palpable P2 & thrill)
Palpates the right sternal border @ 2nd intercostal space
(for palpable A2 & thrill).
Auscultates the apex with diaphragm
Still with the he diaphragm, auscultates from the apex to
the left axilla, tracing murmur
Auscultates the apex using the bell side
Auscultates the left sternal border @ 4th intercostal space
i. Using the diaphragm
ii. Using the bell
Auscultates over A2 & P2
Asks patient to sit up and auscultates again over A2 & P2
Auscultates over the Erbs point (left sternal border @ the
3rd intercostal space)
Auscultates over the carotid artery for bruits
Auscultates over both lung bases for fine crepitation
Checks for hepatomegaly
Checks for splenomegaly
Asks to do general Examination:
Respiratory rate
Features of reapiratory distress
Pallor
Cyanosis
Pedal oedema
Finger clubbing
Lymphadenopathy
Thanks patient
NOTE:
The time for each station in MB is usually 3mins
So, In exam, no one may ask you to do the whole CVS exam in; that will be unfair
The likely qs to get is:
Examine the pulse (not pulse rate but pulse, which means the whole thing in pulse): I
highlighted pulse Examination with red
Examinee the JVP: I highlighted or with blue
Examine the precaudium: I highlighted it with green
E
Erbs point The cardiac apex.
Normally at the 5th
LICS MCL
The Erbs point
Located at the left sternal border, in the 3rd intercostal space
A diastolic murmur of aortic regurgitation radiates down to the
Erbs point
In pulse exam:
If you get an irregular pulse (especially if it's irregularly irregular),
then, at the end of the pulse exam, you should tell the examiner
that you would want to count the heart rate with your
stethoscope so as to check the pulse deficit; if the pulse deficit is
>15b/minute, it is in keeping with atrial fibrillation.
Pulse deficit = HR ➖ PR
In a normal person, the HR should be equal to pulse rate. But with
arthrythmia, some heart beats may be weak that they won't be
able to be successfully transmitted down to the peripheral pulses
and as such HR becomes > PR. In atria fibrilation,bthis difference is
usually very marked (>15).
THANK YOU
