LEVY MWANAWASA MEDICAL UNIVERSITY (LMMU)

Clinical Skills
CVS
Cardiovascular Exam

NAME:
Comp#
Group #
TOTAL
EVALUATOR:
SCORE:
Introduction Not done (0) Incomplete (1) Complete (2)
Greets, states full name, designation, asks for Pt
full name, explains   
procedure and obtains consent
Privacy and asks for chaperone   
Cleans stethoscope and washes hands   
Positons patient (45°), exposes adequately and asks
  
for pain
General Appearance
Observes patient for habitus, posture, level of
comfort, and signs of   
respiratory distress
Observes surrounding for IV line, catheter, O2
  
Mask, ECG etc.
Peripheral Cyanosis and Pallor   
Checks for nail clubbing (grades it)   
Checks Capillary Refill Time (<2 seconds) and
   
Quincke’s Sign
Checks for Oslers Nodes, Janeway Lesions,
Splinter Hemorrhages,   
erythema marginatum and subcutaneous nodules
Any peripheral signs e.g. tendon xanthoma &
  
petechial rashes etc.
Palpates Radial and Brachial pulses (rate, rhythm
and strength,   
comparisons, collapsing)
Scleral Jaundice, Conjunctival pallor, Conjunctival
hemorrhages and   
Xanthelasma
Lips for peripheral Cyanosis, tongue for central
cyanosis and mitral   
facies
Neck
Inspects for Jugular Venous Distension (JVD)   
Palpates carotid one side at a time   
Auscultates carotid bilaterally with the bell (patient
instructed to hold   
their breath briefly)
Measures JVP and interprets result out loud   
Chest
Inspection of precordium for scars(surgical e.g.
midline sternotomy or
  
Traumatic), moles, rash, symmetry, deformity,
visible pulsations etc.
Warm hands and ask for areas of pain   
Locates apex beat and parasternal Heave   
Checks for Pulsations   
Palpation of Aortic, Pulmonic, Tricuspid and Mitral
  
areas(PMI) for thrills
Auscultates Aortic, Pulmonic, Tricuspid and Mitral
areas (PMI)with   
diaphragm for S1 and S2
Auscultates Aortic, Pulmonic, Tricuspid and Mitral
  
areas with bell
Turns patient on side (LLD) and auscultates with
the bell for S3 and S4   
gallops
Comments on heart sounds, Murmurs (Timing, Site
Of Maximum
  
Intensity, Radiation, Grade (Levin Grading) etc.)
and added sounds

Patient Seated and leaning forward slightly

Auscultate with diaphragm Atrial, Pulmonic,
Tricuspid and Mitral areas
  
especially for pericardial rub and aortic
regurgitation
Auscultates Lung Bases for Crackles   
Checks for Sacral Edema   
Abdominal Exam
Inspection of abdomen for pulsation, ascites,
  
distension etc.
Palpation of aorta left of midline, above umbilicus   
Auscultates for renal artery stenosis   
Presses upward on liver margin and assesses for
HepatoJugular Reflux   
(while observing Jugular veins)
Extremities
Palpates femorals (verbalized only during exams)   
Palpates Popliteals (may need patient prone)   
Palpates Posterior tibialis and Dorsalis Pedis   
Uses thumb to assess for pedal, ankle and pretibial
  
edema bilaterally
Thanks pt, allows pt to dress up, explains findings
  
and documents
Comments:
Total