cardio

Question 1

where is aortic valve listened to

Answer 1

upper right sternal border at level of 2nd right intercostal space

Question 2

where is pulmonary valve listened to

Answer 2

upper left sternal border at level of 2nd left intercostal space

Question 3

where is tricuspid valve listened to

Answer 3

lower left sternal border at level of 4ths left intercostal space

Question 4

where is mitral valve listened to

Answer 4

apex beat point - mid-clavicular line at level of 5th left IC spce

Question 5

differences between JVP and carotid pulse

Answer 5

JVP is multiphasic
JVP not palpable
JVP is occludable
JVP varies with with head up tilt (HUT) 
JVP varies with respiration - decreases with deep inspiration

Question 6

what does JVP reflect

Answer 6

right atrial pressure

Question 7

when we say JVP is multiphasic what do we mean

Answer 7

it beats twice in quick succession in the cardiac cycle

first is ‘a’ wave then second ‘v’ wave

Question 8

when is JVP elevated

Answer 8

fluid overload + heart failure (esp right ventricular failure)
acute PE
COPD

Question 9

what heart sound is heard same time carotid pulse

Answer 9

S1

Question 10

what does S1 correlate with

Answer 10

beginning systole

when atrioventricular valves (mitral and tricuspid) close

Question 11

what does S2 correlate with

Answer 11

closure of semilunar (aortic and pulmonary) valves

Question 12

3rd heart sound

Answer 12

in diastole - after S2

can be physiological but >40yrs more likely pathological - left ventric failure, mitral regurg

Question 13

4th heart sound

Answer 13

just before S1

left ventric hypertrophy

Question 14

pericardial friction rub sound

Answer 14

coarse scratching sound

Question 15

hands

Answer 15

colour
tar staining 
cyanosis 
clubbing
splinter haemorrhages
janeway lesions
osler's nodes
temp
cap refill

Question 16

hand signs of infective endocarditis

Answer 16

splinter heamorrhages
Janeway lesions
osler’s nodes

Question 17

what do need to comment on when taking radial pusle

Answer 17

rate

rhythm: regular, irregularly irregular, regularly irregular
volume: normal, bounding, thready
character: normal, slow rising, collapsing

Question 18

face

Answer 18

malar flush: mitral stenosis 
anaemia eyes
corneal arcus 
xanthelasmata
central cyanosis 
red tongue (anaemia) 
angular stomatitis

Question 19

chest

Answer 19

back chest lung bases for crackles - left sided heart failure

sacral oedema if bes bound

Question 20

lower limbs

Answer 20

pitting oedema (15 secs pressure)
temp
hair loss
cap refill 
ulcers
varicose veins

Question 21

measuring JVP

Answer 21

verticla distance between sternal angle and top of pulsation JVP

normally <4cm

Question 22

inspection of precordium

Answer 22

chest deformities - pectus excavatum
scars
pacemaker
visible pulsation

Question 23

palpation of precordium

Answer 23

tracheal position 
cardiac pacemaker
apex beat
heaves
thrill

Question 24

what is a heave and where do you feel for them

Answer 24

hand easily lifted with chest wall mocement - ventricular hypertrophy

L of sternum

Question 25

what is a thrill and where do you feel for them

Answer 25

palpable murmur both sides of sternum apex point

Question 26

auscultation of precodrium

Answer 26

4 valve areas with diaphragm and bell left sided systolic murmurs left sided diastolic murmurs

Question 27

what are the left sided systolic murmurs

Answer 27

aortic stenosis | mitral regurgitation

Question 28

what are the left sided diastolic murmurs

Answer 28

mitral stenosis | aortic regurgitation

Question 29

listening for aortic stenosis

Answer 29

aortic valve area and carotid arteries

Question 30

listening for mitral regurgitation

Answer 30

mitral valve area (apex) and L axilla for radiation

Question 31

listening for mitral stenosis

Answer 31

patient rolled onto left side, listen at apex with bell of stethoscope, breath held in expiration

Question 32

listening for aortic regurgitation

Answer 32

patient sit up leaning forwards, breath held in expiration, listen lower left sternal edge

Question 33

which peripheral pulses need to be felt

Answer 33

``` radial brachial carotid femoral (+ radiofemoral delay) popliteal posterior tibial dorsalis pedis ``` also ascultate for bruits carotid and femoral a

Question 34

where is radial pulse

Answer 34

proximal to wrist joint on radial side of flexor surface wrist lateral to tendon of flexor carpi radialis

Question 35

where is brachial pusle

Answer 35

antecubital fossa medial to biceps tendon

Question 36

where is carotid pulse

Answer 36

in neck medial to SCM muscle

Question 37

where is femoral pusle

Answer 37

inferior to inguinal ligament, half-way between anterior superior iliac spine and symphysis pubis

Question 38

where is popliteal pulse

Answer 38

behind knww joint deep in popliteal fossa

Question 39

where is posterior tibial pulse

Answer 39

behind and ~2cm below medial

Question 40

where is dorsalis pedis pulse

Answer 40

dosrum of foot lateral to tendon of extensor hallucis longus

Question 41

CVS systemic enquiry

Answer 41

``` chest pain dyspnoea palpitations ankle oedema varicose veins claudicatoin ```

Question 42

CVS causes syncope

Answer 42

postural changes: postural hypotension exertion: aortic stenosis random: arrhythmia