cardiac

Question 1

general appearance

Answer 1

position patient 45 degrees

short of breath
work of breathing
distressed
pain
diaphoretic
alertness
cachexia
surrounds medication/equipment

VSS- bilateral postural BP

Question 2

hands

Answer 2

cap refill
tar stains
clubbing (scharmouths sign) ? thyrotoxicosis, cyanotic congenital heart disease
splinter haemorrhage  ? endocarditis
xanthamata ? cholesterol
janway lesions
oslernodes ? infective endocarditis

Question 3

arms

Answer 3

both arms

radial pulse symmetry/ radio radial delay ? stenosis, aneurysm

brachial pulses/collapsing pulse ? thyrotoxicosis, aortic regurgitation

radio femoral delay ? atherosclerosis of aorta, embolism of aorta

rash/track marks

Question 4

eyes

Answer 4

xanthelasma ? cholesterol

sclera jaundice ? jaundice

conjunctive pallor ? anaemia

Question 5

cheeks

Answer 5

mallor flush ? mitral stenosis

Question 6

mouth

Answer 6

angular stomatitis ? low iron, B12

hydration

dentition

high arch pallet ? marphan

central cyanosis

Question 7

neck

Answer 7

carotid pulse palpate (1 at a time)

JVP measure (under 4cm) and jugular hepato reflex (observe jvp distention when pressure is applied to liver) ? fluid overload, heart failure

auscultate carotid pulse whilst patient holds breath. If bruit present ? Artery stenosis

Question 8

chest

Answer 8

inspect

• scars ? past surgeries
• pacemaker
• deformities funnel/pigeon/barrel chest

auscultate heart sound-for sounds and murmurs

• Aortic 2nd intercoastal space R) parasternal space
• Pulmonary 2nd intercoastal space L) parasternal space
• Mitral 4th intercoastal space L) midclavicular line
• tricusps 5th intercoastal space L) parasternal space

Palpate each heart sound for thrills ? incompetent valve
palpate L) parasternal boarder for heave ? L) ventricular hypertrophy

Question 9

abdo

Answer 9

lay supine

palpate

• Liver inferior margin ? portal HTN R)HF
• spleen ? R)HF

percuss shifting dullness ? acetis

Question 10

legs

Answer 10

check for

• oedema
• pain (calf pain)
• skin condition

palpate dorsal pedis and posterior tubulars pulses

Question 11

back

Answer 11

scars

sacral oedema

percuss each lung lobe ? dullness fluid consolidation

then thank patient hand hygiene suggest ECG and bloods