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Phase 2b OSCEs > Cardiac History and Examination > Flashcards

Cardiac History and Examination Flashcards

1
Q

List some of the general symptoms of cardiovascular disease?

A

● Chest pain
● Dyspnoea (shortness of breath)
● Orthopnoea (SOB on lying flat that is relieved by sitting upright)
● Paroxysmal nocturnal dyspnoea (acute dyspnoea that wakes the patient from sleep)
● Ankle oedema
● Cough, sputum & haemoptysis
● Dizziness
● Light-headedness
● Presyncope & syncope
● Palpitations
● Nausea & sweating
● Claudication
● Systemic symptoms e.g. fatigue, weight loss, anorexia, fever

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2
Q

List some ischemic heart disease risk factors?

A

● Male sex
● Age
● Smoking
● Hypertension
● Diabetes mellitus
● Family history of IHD
● Hypercholesterolaemia
● Physical inactivity and obesity

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3
Q

Where may a patient describe the chest pain during a cardiac history?

A

● Central substernal
● Across mid-thorax anteriorly
● In both arms / shoulders
● In the neck / cheeks / teeth
● In the forearms / fingers
● In the interscapular region

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4
Q

What character may the patient describe chest pain as during a cardiac history?

A

● Crushing
● Tight
● Constricting
● Squeezing
● Burning
● Heaviness

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5
Q

Where may the patient complain that the pain radiates to during a cardiac history?

A

● Neck
● Jaw
● Left arm

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6
Q

What associated symptoms may a patient present with during a cardiac history?

A

● Sweating
● Nausea
● SOB
● Palpitations

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7
Q

What questions may you have to ask the patient about the timing of chest pain during a cardiac history?

A

● On exertion?
● At rest?

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8
Q

What are some exacerbating factors that a patient may mention that are associated with chest pain during a cardiac history?

A

● Exercise
● Excitement
● Stress
● Cold weather
● After meals
● Smoking
● lying flat (decubitus angina 2° to left heart failure)

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9
Q

What alleviating factors may a patient say helps with chest pain during a cardiac history?

A

● Rest
● Medication
● Oxygen

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10
Q

How would you ask a patient to assess the severity of chest pain during a cardiac exam?

A

● A scale of 1-10

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11
Q

What examples would lead you away of the thought that chest pain is being caused by cardiac ischemia?

A

● Character of pain - ‘knife-like’, sharp, stabbing, aggravated by respiration
● Location of pain - left submammary area, left hemithorax
● Exacerbating factors - pain after completion of exercise, specific body motion

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12
Q

What mnemonic can you use to explore the idea of chest pain with a patient?

A

● SOCRATES
● Site
● Onset
● Character
● Radiation
● Associated symptoms
● Timing
● Exacerbating factors
● Severity

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13
Q

What mnemonic can you use to explore the idea of shortness of breath with a patient?

A

● OATES
● Onset
● Associated symptoms
● Timing
● Exacerbating factors
● Severity

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14
Q

What questions can be asked about onset when exploring SOB during a cardiac history?

A

● Acute
● Chronic
● Acute-on-chronic

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15
Q

What questions can be asked about the associated symptoms when exploring SOB during a cardiac history?

A

● Sweating?
● Nausea? (due to hepatic/gastric congestion)
● Pain?
● Cough?
● Sputum? (watery/frothy/blood-tinged)
● Swollen ankles?
● Palpitations
● Nocturnal micturition
● Rapid weight gain (could be due to oedema)

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16
Q

What questions can be asked about timing when exploring SOB during a cardiac history?

A

Relation to exertion, time of day (morning dips in asthma)

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17
Q

What position should the patient be in during a cardiovascular exam?

A

● Patient should be 45º
● Expose the patients chest and offer them a blanket to allow for exposure only when required.
● Expose the patients lower legs to check for peripheral vascular disease

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18
Q

What should you ask the patient before beginning a cardiovascular exam?

A

● Ask the patient of they have any pain before proceeding with the clinical exam

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19
Q

What clinical signs would you look for during a general inspection for a cardiovascular exam?

A

● Cyanosis
● SOB
● Pallor
● Malar flush (mitral stenosis)
● Oedema

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20
Q

What is cyanosis and what may it suggest during a cardiovascular exam?

A

● A bluish discolouration of the skin due to poor circulation (e.g. peripheral vasoconstriction secondary to hypovolaemia) or inadequate oxygenation of the blood (e.g. right-to-left cardiac shunting).

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21
Q

What may SOB suggest during a cardiovascular exam?

A

● May indicate underlying cardiovascular (e.g. congestive heart failure, pericarditis) or respiratory disease (e.g. pneumonia, pulmonary embolism).

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22
Q

What is pallor and what may it suggest during a cardiovascular exam?

A

● A pale colour of the skin that can suggest underlying anaemia (e.g. haemorrhage, chronic disease) or poor perfusion (e.g. congestive cardiac failure). It should be noted that a healthy individual may have a pale complexion that mimics pallor, however, pathological causes should be ruled out.

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23
Q

What is malar flush and what may it suggest during a cardiovascular exam?

A

● Plum-red discolouration of the cheeks associated with mitral stenosis.

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24
Q

What may oedema suggest during a cardiovascular exam?

A

● Typically presents with swelling of the limbs (e.g. pedal oedema) or abdomen (i.e. ascites). There are many causes of oedema, but in the context of a cardiovascular examination OSCE station, congestive heart failure is the most likely culprit.

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25
Q

What objects and equipment around a patient should you look out for during a cardiovascular exam?

A

● Medical equipment (O2, ECG leads, Medications, Catheters, Intravenous access).
● Mobility aids
● Pillows
● Vital signs
● Fluid balance
● Prescriptions

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26
Q

Why would a patient with pillows be relevant during a cardiovascular exam?

A

● Patients with congestive heart failure typically suffer from orthopnoea, preventing them from being able to lie flat. As a result, they often use multiple pillows to prop themselves up.

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27
Q

What clinical signs can be seen on the hands during a cardiovascular exam?

A

● Colour
● Tar staining
● Xanthomata
● Arachnodactyly
● Finger clubbing
● Splinter haemorrhages
● Janeway lesions
● Osler’s nodes

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28
Q

How can the colour of a patients hands be suggestive of CVD in a cardiovascular exam?

A

● Pallor suggests poor peripheral perfusion (e.g. congestive heart failure) and cyanosis may indicate underlying hypoxaemia.

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29
Q

How can tar staining be suggestive of CVD in a cardiovascular exam?

A

● Caused by smoking, a significant risk factor for cardiovascular disease (e.g. coronary artery disease, hypertension).

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30
Q

How can xanthomata be suggestive of CVD in a cardiovascular exam?

A

● Raised yellow cholesterol-rich deposits that are often noted on the palm, tendons of the wrist and elbow. Xanthomata are associated with hyperlipidaemia (typically familial hypercholesterolaemia), another important risk factor for cardiovascular disease (e.g. coronary artery disease, hypertension).

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31
Q

How can arachnodactyly be suggestive of CVD in a cardiovascular exam?

A

● Fingers and toes are abnormally long and slender, in comparison to the palm of the hand and arch of the foot. Arachnodactyly is a feature of Marfan’s syndrome, which is associated with mitral/aortic valve prolapse and aortic dissection.

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32
Q

Describe the pathophysiological process of finger clubbing?

A

● Finger clubbing involves uniform soft tissue swelling of the terminal phalanx of a digit with subsequent loss of the normal angle between the nail and the nail bed.
● Finger clubbing is associated with several underlying disease processes.

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33
Q

How would you assess a patient for finger clubbing during a cardiovascular exam?

A

● Ask the patient to place the nails of their index fingers back to back.
● In a healthy individual, you should be able to observe a small diamond-shaped window (known as Schamroth’s window)
● When finger clubbing develops, this window is lost.

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34
Q

What three signs would you find on the hands of a patient, during a cardiovascular exam, that are associated with infective endocarditis?

A

● Splinter haemorrhages
● Janeway lesions
● Osler’s nodes

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35
Q

What are splinter haemorrhages? And causes?

A

● A longitudinal, red-brown haemorrhage under a nail that looks like a wood splinter. Causes include local trauma, infective endocarditis, sepsis, vasculitis and psoriatic nail disease.

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36
Q

What are Janeway lesions?

A

● Non-tender, haemorrhagic lesions that occur on the thenar and hypothenar eminences of the palms (and soles). Janeway lesions are typically associated with infective endocarditis.

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37
Q

What are Osler nodes?

A

● Red-purple, slightly raised, tender lumps, often with a pale centre, typically found on the fingers or toes. They are typically associated with infective endocarditis.

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38
Q

What should be assessed during the palpation section of a cardiovascular exam?

A

● Temperature
● Capillary refill time

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39
Q

How would you assess a patients temperature during a cardiovascular exam?

A

● Place the dorsal aspect of your hand onto the patient’s to assess temperature.

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40
Q

What would a normal finding be when assessing temperature during a cardiovascular exam?

A

● In healthy individuals, the hands should be symmetrically warm, suggesting adequate perfusion.

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41
Q

What would cool hands be suggestive of during a cardiovascular exam?

A

● Cool hands may suggest poor peripheral perfusion (e.g. congestive cardiac failure, acute coronary syndrome).

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42
Q

What would sweaty/clammy hands be suggestive of during a cardiovascular exam?

A

● Cool and sweaty/clammy hands are typically associated with acute coronary syndrome.

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43
Q

How would you assess capillary refill time in a cardiovascular exam?

A

● Apply five seconds of pressure to the distal phalanx of one of a patient’s fingers and then release.

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44
Q

What would a normal finding by for a capillary refill time during a cardiovascular exam?

A

● In healthy individuals, the initial pallor of the area you compressed should return to its normal colour in less than two seconds.

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45
Q

What would an abnormal finding be suggestive of for capillary refill time during a cardiovascular exam?

A

● A CRT that is greater than two seconds suggests poor peripheral perfusion (e.g. hypovolaemia, congestive heart failure) and the need to assess central capillary refill time.

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46
Q

How would you assess the heart rate during a cardiovascular exam?

A

● Palpate the patient’s radial pulse, located at the radial side of the wrist, with the tips of your index and middle fingers aligned longitudinally over the course of the artery.

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47
Q

How long should you assess the heart rate for if there is an abnormal heart rate in a patient?

A

● A full 60 seconds

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48
Q

What are some causes of bradycardia?

A

● Healthy athletic individuals
● Atrioventricular block
● Medications
● Sick sinus syndrome

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49
Q

What are some causes of tachycardia?

A

● Anxiety
● Supraventricular tachycardia
● Hypovolaemia
● Hyperthyroidism

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50
Q

What is radio-radial delay?

A

● Radio-radial delay describes a loss of synchronicity between the radial pulse on each arm, resulting in the pulses occurring at different times.

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51
Q

How would you assess for radio-radial delay on a patient during a cardiovascular exam?

A

● Palpate both radial pulses simultaneously.
● In healthy individuals, the pulses should occur at the same time.
● If the radial pulses are out of sync, this would be described as radio-radial delay.

52
Q

What are some causes of radio-radial delay?

A

● Subclavian artery stenosis (e.g. compression by cervical rib)
● Aortic dissection
● Aortic coarctation

53
Q

What is a collapsing pulse?

A

● A collapsing pulse is a forceful pulse that rapidly increases and subsequently collapses. It is also sometimes referred to as a ‘water hammer pulse’.

54
Q

How would you assess for a collapsing pulse in a patient during a cardiovascular exam?

A
  1. Ask the patient if they have any pain in their right shoulder, as you will need to move it briskly as part of the assessment for a collapsing pulse (if they do, this assessment should be avoided).
  2. Palpate the radial pulse with your right hand wrapped around the patient’s wrist.
  3. Palpate the brachial pulse (medial to the biceps brachii tendon) with your left hand, whilst also supporting the patient’s elbow.
  4. Raise the patient’s arm above their head briskly.
  5. Palpate for a collapsing pulse: As blood rapidly empties from the arm in diastole, you should be able to feel a tapping impulse through the muscle bulk of the arm. This is caused by the sudden retraction of the column of blood within the arm during diastole.
55
Q

What are some normal physiological causes of collapsing pulse?

A

● Fever
● Pregnancy

56
Q

What are some cardiac lesion derived causes of collapsing pulse?

A

● Aortic regurgitation
● Patent ductus arteriosus

57
Q

What are some high output derived causes of collapsing pulse?

A

● Anaemia
● Arteriovenous fistula
● Thyrotoxicosis

58
Q

How would you assess a patients brachial pulse during a cardiovascular exam?

A
  1. Support the patient’s right forearm with your left hand.
  2. Position the patient so that their upper arm is abducted, their elbow is partially flexed and their forearm is externally rotated.
  3. With your right hand, palpate medial to the biceps brachii tendon and lateral to the medial epicondyle of the humerus. Deeper palpation is required (compared to radial pulse palpation) due to the location of the brachial artery.
59
Q

What are the types of pulse character you may encounter and what are their associated pathophysiologies?

A

● Normal
● Slow rising - aortic stenosis
● Bounding - Aortic regurgitation and CO2 retention
● Thready - Intravascular hypovolaemia in conditions such as sepsis

60
Q

What would a comprehensive blood pressure assessment include?

A

● Blood pressure readings when patient is standing up and lying down

61
Q

What is hypertension?

A

● Blood pressure of greater than or equal to 140/90 mmHg if under 80 years old or greater than or equal to 150/90 mmHg if you’re over 80 years old.

62
Q

What is hypotension?

A

● Blood pressure of less than 90/60 mmHg.

63
Q

What is a narrow pulse pressure?

A

● Less than 25 mmHg of difference between the systolic and diastolic blood pressure. Causes include aortic stenosis, congestive heart failure and cardiac tamponade.

64
Q

What is a wide pulse pressure?

A

● More than 100 mmHg of difference between systolic and diastolic blood pressure. Causes include aortic regurgitation and aortic dissection.

65
Q

What would a difference between arms be suggestive of when taking a blood pressure reading?

A

● More than 20 mmHg difference in blood pressure between each arm is abnormal and may suggest aortic dissection.

66
Q

Where is the carotid pulse located?

A

● The carotid pulse can be located between the larynx and the anterior border of the sternocleidomastoid muscle.

67
Q

What should you do before palpating the carotid artery?

A

● Prior to palpating the carotid artery, you need to auscultate the vessel to rule out the presence of a bruit.

68
Q

What does the presence of bruit in the carotid artery suggest, and why would it be dangerous to palpate before auscultating?

A

● The presence of a bruit suggests underlying carotid stenosis, making palpation of the vessel potentially dangerous due to the risk of dislodging a carotid plaque and causing an ischaemic stroke.

69
Q

How would you auscultate the carotid during a cardiovascular exam?

A

● Place the diaphragm of your stethoscope between the larynx and the anterior border of the sternocleidomastoid muscle over the carotid pulse and ask the patient to take a deep breath and then hold it whilst you listen

70
Q

How would you palpate the carotid pulse during a cardiovascular examination?

A
  1. Ensure the patient is positioned safely on the bed, as there is a risk of inducing reflex bradycardia when palpating the carotid artery (potentially causing a syncopal episode).
  2. Gently place your fingers between the larynx and the anterior border of the sternocleidomastoid muscle to locate the carotid pulse.
  3. Assess the character (e.g. slow-rising, thready) and volume of the pulse.
71
Q

What does provide a measure of?

A

● Provides an indirect measure of central venous pressure.

72
Q

In terms of anatomical structure, why can the JVP provide a indirect measure of central venous pressure?

A

● This is possible because the internal jugular vein (IJV) connects to the right atrium without any intervening valves, resulting in a continuous column of blood.
● The presence of this continuous column of blood means that changes in right atrial pressure are reflected in the IJV (e.g. raised right atrial pressure results in distension of the IJV).

73
Q

How would you measure the JVP during a cardiovascular exam?

A
  1. Position the patient in a semi-recumbent position (at 45°).
  2. Ask the patient to turn their head slightly to the left.
  3. Inspect for evidence of the IJV, running between the medial end of the clavicle and the ear lobe, under the medial aspect of the sternocleidomastoid (it may be visible between just above the clavicle between the sternal and clavicular heads of the sternocleidomastoid. The IJV has a double waveform pulsation, which helps to differentiate it from the pulsation of the external carotid artery.
  4. Measure the JVP by assessing the vertical distance between the sternal angle and the top of the pulsation point of the IJV (in healthy individuals, this should be no greater than 3 cm).
74
Q

What does a raised JVP indicate and what are some causes of a raised JVP?

A

● Indicates the presence of venous hypertension:
● Right-sided heart failure: commonly caused by left-sided heart failure. Pulmonary hypertension is another cause of right-sided heart failure, often occurring due to chronic obstructive pulmonary disease or interstitial lung disease.
● Tricuspid regurgitation: causes include infective endocarditis and rheumatic heart disease.
● Constrictive pericarditis: often idiopathic, but rheumatoid arthritis and tuberculosis are also possible underlying causes.

75
Q

What is a hepatojugular reflux test?

A

● The hepatojugular reflux test involves the application of pressure to the liver whilst observing for a sustained rise in JVP.

76
Q

How would you perform a hepatojugular reflux test during a cardiovascular exam?

A
  1. Position the patient in a semi-recumbent position (45º).
  2. Apply direct pressure to the liver.
  3. Closely observe the IJV for a rise.
  4. In healthy individuals, this rise should last no longer than 1-2 cardiac cycles (it should then fall).
  5. If the rise in JVP is sustained and equal to or greater than 4cm this is deemed a positive result.

● This assessment can be uncomfortable for the patient and therefore it should only be performed when felt necessary

77
Q

What would a positive hepatojugular reflux test suggest?

A

● Suggests the right ventricle is unable to accommodate an increased venous return, but it is not diagnostic of any specific condition.

78
Q

What conditions are associated with a positive hepatojugular reflux test?

A

● Constrictive pericarditis
● Right ventricular failure
● Left ventricular failure
● Restrictive cardiomyopathy

79
Q

What clinical signs can be seen in the eyes during a cardiovascular exam?

A

● Conjunctival pallor
● Corneal arcus
● Xanthelasma
● Kayser-Fleischer rings

80
Q

What is conjunctival pallor and what is it suggestive of during a cardiovascular exam?

A

● Suggestive of underlying anaemia. Ask the patient to gently pull down their lower eyelid to allow you to inspect the conjunctiva.

81
Q

What is corneal arcus and what is it suggestive of during a cardiovascular exam?

A

● A hazy white, grey or blue opaque ring located in the peripheral cornea, typically occurring in patients over the age of 60. In older patients, the condition is considered benign, however, its presence in patients under the age of 50 suggests underlying hypercholesterolaemia.

82
Q

What is xanthelasma and what is it suggestive of during a cardiovascular exam?

A

● Yellow, raised cholesterol-rich deposits around the eyes associated with hypercholesterolaemia.

83
Q

What are Kayser-Fleischer rings and what are they suggestive of during a cardiovascular exam?

A

● Dark rings that encircle the iris associated with Wilson’s disease. The disease involves abnormal copper processing by the liver, resulting in accumulation and deposition in various tissues (including the heart where it can cause cardiomyopathy).

84
Q

What clinical signs can be seen in the mouth during a cardiovascular exam?

A

● Central cyanosis
● Angular stomatitis
● High arched palate
● Dental hygiene

85
Q

What is central cyanosis and what are they suggestive of during a cardiovascular exam?

A

● Bluish discolouration of the lips and/or the tongue associated with hypoxaemia (e.g. a right to left cardiac shunt)

86
Q

What is angular stomatitis and what is it suggestive of during a cardiovascular exam?

A

● A common inflammatory condition affecting the corners of the mouth. It has a wide range of causes including iron deficiency.

87
Q

What is a high arched palate suggestive of during a cardiovascular exam?

A

● A feature of Marfan syndrome which is associated with mitral/aortic valve prolapse and aortic dissection.

88
Q

What is poor dental hygiene suggestive of during a cardiovascular exam?

A

● Poor dental hygiene is a risk factor for infective endocarditis.

89
Q

What clinical signs can be observed on the anterior chest during a cardiovascular exam?

A

● Scars suggestive of previous thoracic surgery.
● Pectus excavatum
● Pectus carinatum
● Visible pulsations

90
Q

What is pectus excavatum?

A

● A caved-in or sunken appearance of the chest.

91
Q

What is pectus carinatum?

A

● Protrusion of the sternum and ribs.

92
Q

What is a median sternotomy scar and what is it suggestive of?

A

● Located in the midline of the thorax. This surgical approach is used for cardiac valve replacement and coronary artery bypass grafts (CABG).

93
Q

What is an anterolateral thoracotomy scar and what is it suggestive of?

A

● Located between the lateral border of the sternum and the mid-axillary line at the 4th or 5th intercostal space. This surgical approach is used for minimally invasive cardiac valve surgery.

94
Q

What is a infraclavicular scar and what is it suggestive of?

A

● Located in the infraclavicular region (on either side). This surgical approach is used for pacemaker insertion.

95
Q

What is a left-midaxillary scar and what it is suggestive of?

A

● This surgical approach is used for the insertion of a subcutaneous implantable cardioverter-defibrillator (ICD).

96
Q

What three features should be palpated for on the chest during a cardiovascular exam?

A

● Apex beat
● Heaves
● Thrills

97
Q

How would you palpate the apex beat during a cardiovascular exam?

A

● Palpate the apex beat with your fingers placed horizontally across the chest.
● In healthy individuals, it is typically located in the 5th intercostal space in the midclavicular line. Ask the patient to lift their breast to allow palpation of the appropriate area if relevant.

98
Q

How would you palpate for heaves during a cardiovascular exam?

A

● Place the heel of your hand parallel to the left sternal edge (fingers vertical) to palpate for heaves.
● If heaves are present you should feel the heel of your hand being lifted with each systole.

99
Q

How would you palpate for thrills during a cardiovascular exam?

A

● You should assess for a thrill across each of the heart valves in turn
● To do this place your hand horizontally across the chest wall, with the flats of your fingers and palm over the valve to be assessed.

100
Q

What would displacement of the apex beat indicate during a cardiovascular exam?

A

● Displacement of the apex beat from its usual location can occur due to ventricular hypertrophy.

101
Q

What would parasternal heaves be suggestive of during a cardiovascular exam?

A

● Parasternal heaves are typically associated with right ventricular hypertrophy.

102
Q

What is a parasternal heave?

A

● A parasternal heave is a precordial impulse that can be palpated.

103
Q

What is a thrill?

A

● A thrill is a palpable vibration caused by turbulent blood flow through a heart valve (a thrill is a palpable murmur).

104
Q

Describe anatomically where you would find the mitral valve on the anterior chest wall?

A

● 5th intercostal space in the midclavicular line.

105
Q

Describe anatomically where you would find the tricuspid valve on the anterior chest wall?

A

● 4th or 5th intercostal space at the lower left sternal edge.

106
Q

Describe anatomically where pulmonary valve on the anterior chest wall?

A

● 2nd intercostal space at the left sternal edge.

107
Q

Describe anatomically where aortic valve on the anterior chest wall?

A

● 2nd intercostal space at the right sternal edge.

108
Q

Describe how you would auscultate the four heart valves during a cardiovascular exam?

A
  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:
  3. Repeat auscultation across the four valves with the bell of the stethoscope.
109
Q

Describe the difference of the bell vs the diaphragm of the stethoscope?

A

● The bell of the stethoscope is more effective at detecting low-frequency sounds, including the mid-diastolic murmur of mitral stenosis.
● The diaphragm of the stethoscope is more effective at detecting high-frequency sounds, including the ejection systolic murmur of aortic stenosis, the early diastolic murmur of aortic regurgitation and the pansystolic murmur of mitral regurgitation.

110
Q

What is the next step after auscultating the four heart valves, during a cardiovascular exam?

A

● Auscultate the carotid arteries using the diaphragm of the stethoscope whilst the patient holds their breath to listen for radiation of an ejection systolic murmur caused by aortic stenosis.

111
Q

What is the next step after auscultating the carotid arteries, during a cardiovascular exam?

A

● Sit the patient forwards and auscultate over the aortic area with the diaphragm of the stethoscope during expiration to listen for an early diastolic murmur caused by aortic regurgitation.

112
Q

What is the next step after auscultating the aortic area of the diaphragm, during a cardiovascular exam?

A

● Roll the patient onto their left side and listen over the mitral area with the diaphragm of the stethoscope during expiration to listen for a pansystolic murmur caused by mitral regurgitation. Continue to auscultate into the axilla to identify radiation of this murmur.

113
Q

What is the next step after auscultating the mitral area of the diaphragm, during a cardiovascular exam?

A

● With the patient still on their left side, listen again over the mitral area using the bell of the stethoscope during expiration for a mid-diastolic murmur caused by mitral stenosis.

114
Q

What should you inspect the posterior chest wall for during a cardiovascular exam?

A

● Inspect the posterior chest wall for any deformities or scars (e.g. posterolateral thoracotomy scar associated with previous lung surgery).

115
Q

Where should you auscultate the posterior chest wall during a cardiovascular exam?

A

● The 6 positions that you would normally during a respiratory exam.

116
Q

Where on the patient should you check for oedema at the end of a cardiovascular exam?

A

● Inspect and palpate the sacrum for evidence of pitting oedema.
● Inspect and palpate the patient’s ankles for evidence of pitting pedal oedema

117
Q

What underlying pathology is pitting pedal oedema suggestive off?

A

● Right ventricular failure

118
Q

What scars may be seen on a patients legs that are associated with the cardiovascular system?

A

● Saphenous vein harvesting - CABG.

119
Q

What further assessments and investigations could be performed after a cardiovascular exam?

A

● Measure blood pressure
● Peripheral vascular examination
● record a 12-lead ECG
● Dipstick urine test
● Bedside capillary blood glucose
● Perform fundoscopy

120
Q

Why would you potentially take blood pressure reading at the end of a cardiovascular exam?

A

● To identify hypotension, hypertension or significant discrepancies between the two arms suggestive of aortic dissection.

121
Q

Why would you potentially perform a peripheral vascular examination at the end of a cardiovascular exam?

A

● To identify peripheral vascular disease, which is common in patients with central cardiovascular pathology.

122
Q

Why would you potentially perform a 12-lead ECG at the end of a cardiovascular exam?

A

● To look for evidence of arrhythmias or myocardial ischaemia.

123
Q

Why would you potentially perform a urine dipstick test at the end of a cardiovascular exam?

A

● To identify proteinuria or haematuria which can be associated with hypertension.

124
Q

Why would you potentially perform a bedside capillary blood glucose at the end a cardiovascular exam?

A

● To look for evidence of underlying diabetes mellitus, a significant risk factor for cardiovascular disease

125
Q

Why would you potentially perform a fundoscopy after a cardiovascular exam?

A

● If there were concerns about malignant hypertension, fundoscopy would be performed to look for papillodema.

Phase 2b OSCEs (2 decks)

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