Cardio

Question 1

Position of the patient

Answer 1

45 degrees, expose the chest

And ask if they have any pain

Question 2

General inspection

Answer 2

Bedside equipment

Comfortable at rest or SOB?

Question 3

Hands

Answer 3

Splinter haemorrhages
finger clubbing
colour (hypoxia)
temperature/sweaty
Janeway lesions
Oslers nodes
Tar staining 
Xanthelasma
Cap refill

Question 4

Splinter hemorrhages suggestive of…

Answer 4

bacterial endocarditis
(seen on nail bed)

Question 5

Finger clubbing test

Answer 5

place nails of index fingers together
should see small window (Schamroth’s window)= normal
loss of window=abnormal

Question 6

Finger clubbing suggestive of…

Answer 6

infective endocarditis

congenital cyanotic heart disease

Question 7

Cool peripheries suggestive of…

Answer 7

poor cardiac output / hypovolaemia

Question 8

Sweaty/clammy hands suggestive of…

Answer 8

acute coronary syndrome

Question 9

Janeway lesions, what are they and what do they suggest?

Answer 9

Non tender maculopapular erythematous nodules

bacterial endocardities

Question 10

Oslers nodes, what are they and what do they suggest?

Answer 10

Tender red nodules on finger pulps

infective endocarditis

Question 11

Xanthomata?

Answer 11

raised yellow lesions tend to be on wrist

hyperlipidaemia

Question 12

What pulses do you feel?

Answer 12

Radial pulse
Radio-radial delay
Collapsing pulse
(check BP here)
carotid pulse

Question 13

What do you assess when feeling a pulse?

Answer 13

Rate, rhythm, volume and character

Question 14

Radio-radial delay?

Answer 14

Aortic coarctation

Question 15

Collapsing pulse?

Answer 15

Check the patient has no pain in shoulder before performing!!!!
Physiological in fever and pregnancy

Question 16

Pathological causes of collapsing pulse?

Answer 16

Pathological: aortic regurg, patent ductus arteriosis, anaemia or thyrotoxicosis

Question 17

Carotid pulse

Answer 17

Auscultate for bruit first!! As palpation could dislodge emobli or thrombus > stroke

Question 18

How to measure JVP?

Answer 18

cm from sternal angle to upper border of pulsation

Question 19

What causes raised JVP?

Answer 19

fluid overload
RVF
Tricuspid regurg

Question 20

Eye signs and what they mean.

Answer 20

Conjunctival pallor > anaemia
Corneal arcus- yellow/greyish ring surrounding the iris > hypercholesterolaemia
Xanthelasma- yellow nodules surrounding eyes> hypercholesterolaemia

Question 21

Mouth signs

Answer 21

Central cyanosis
Angular stomatitis > iron deficiency
high arched palate
dental hygiene

Question 22

Why is dental hygiene important?

Answer 22

Endocarditis

Question 23

What is important about a high arched palate?

Answer 23

Suggestive of Marfans > increased risk of aortic dissection/aneurysm

Question 24

Clavicular scar

Answer 24

Pacemaker

Question 25

Pectus excavatum

Answer 25

sunken chest

Question 26

Pectus carinatum

Answer 26

pigeon chest- chest is pushed out

Question 27

Chest process

Answer 27

Inspect Palpate Auscultate

Question 28

Chest inspection

Answer 28

Scars | remember to check underarms

Question 29

Palpation

Answer 29

Heaves, thrills, apex beat

Question 30

Heaves

Answer 30

L sternal edge = Ventricular hypertrophy

Question 31

What is a thrill?

Answer 31

Palpable murmur

Question 32

Where is the apex beat?

Answer 32

5th intercostal space, midclavicular line | point this out to the examiner

Question 33

Displacement of the apex beat?

Answer 33

Cardiomegaly

Question 34

During auscultation what do you do?

Answer 34

Palpate the carotid as well to time the pulse | Use diaphragm and bell

Question 35

Location of aortic valve

Answer 35

R upper sternal edge (2nd intercostal space)

Question 36

Location of pulmonary valve

Answer 36

L upper sternal edge (2nd intercostal space)

Question 37

Location of tricuspid valve

Answer 37

L lower border of sternum (4th/5th intercostal space)

Question 38

Location of mitral valve

Answer 38

Apex (5th intercostal space, midclavicular line)

Question 39

What murmur radiates to the axilla?

Answer 39

Mitral regurg

Question 40

What murmur radiates to the carotids?

Answer 40

Aortic stenosis

Question 41

Auscultation manoeuvre for mitral murmur

Answer 41

Roll onto left side and listen at apex with bell

Question 42

Auscultation manoeuvre for aortic murmur

Answer 42

Lean forward and listen with diaphragm and L lower sternal edge and during held expiration

Question 43

To end precordial exam:

Answer 43

Auscultate posterior lower lung bases (for pulmonary oedema- LVF) Palpate for sacral oedema (RVF)

Question 44

Suggestion for further exam

Answer 44

``` peripheral vascular examine 12 lead ECG Fundoscopy if hypertensive Urine dipstick if hypertensive BG level if diabetic ```

Question 45

Peripheral vascular examine includes...

Answer 45

Upper AND lower limb | and potentially abdomen for aorta

Question 46

Inspection of the legs

Answer 46

``` Scars hair loss- PVD discolouration pallor- poor perfusion missing limbs or toes- look between toes and posterior leg! ulcers muscle wasting- PVD ask patient to wiggle their toes ```

Question 47

Palpation of leg

Answer 47

Temperature Cap refill Pulses

Question 48

What pulses do you palpate in lower limb?

Answer 48

Femoral Popliteal Posterior tibial Dorsalis pedis

Question 49

Femoral pulse

Answer 49

Halfway between ASIS and pubic symphasis | Assess for radio-femoral delay (coarctation of aorta)

Question 50

Popliteal pulse

Answer 50

Flex knee to 45 degrees Place thumbs on tibial tuberosity Place fingers in popliteal fossa, press quite hard as it is a deep pulse

Question 51

Posterior tibial pulse

Answer 51

Posterior to medial malleolus of tibia | compare to other foot

Question 52

Dorsalis pedis

Answer 52

lateral to EHL tendon Over 2nd/3rd cuneiform compare to other foot

Question 53

Buerger test

Answer 53

patient is supine raise patients feet to 45 degrees for 2-3 mins note any pallor then ask patient to place legs over the edge of bed- watch for any extreme redness

Question 54

Suggestion for further exam

Answer 54

ABPI | lower limb neuro exam