Cardio Exam

Question 1

When approaching the patient, what do you need to do?

Answer 1

Wash hands, introduce yourself and gain consent, explaining the examination, position at 45 degrees, expose chest. Ask if the patient is in any pain and confirm name and date of birth

Question 2

What do you look at in general inspection?
Cardio

Answer 2

Body habitus, any pallor, shortness of breath, cyanosis, any equipment or medication (GTN spray, walking aids)

Question 3

What do you look at in the hands?
Cardio

Answer 3

Nails- koilinichyia, clubbing, splinter haemorrhage, Jane way lesions, oslers nodes, temperature (compare the two hands), erythema, peripheral cyanosis, tar staining, xanthomata, CRT

Question 4

What do you look at in the rest of the upper limb
Cardio

Answer 4

Radial pulse (rate, rhythm, character), radio-radio delay, radio-femoral delay, collapsing pulse, brachial pulse, blood pressure

Question 5

What do you look at in the face?
Cardio

Answer 5

Jaundice in the sclera, conjunctival pallor, xanthelasma, glossitis, angular stomatitis, central cyanosis, corneal arcus, dental hygiene

Question 6

What do you look at in the neck?
Cardio

Answer 6

Raised JVP (hepatojugular reflex if needed)
Carotid pulse (palpate and auscultate)

Question 7

What do you look at in the chest?
Cardio

Answer 7

Any scars, obvious deformities, pulsations

Question 8

What do you palpate for in the chest?
Cardio

Answer 8

Palpable thrills, heaves (left eternal edge- LV hypertrophy), apex beat

Question 9

What do you auscultate for?
Cardio

Answer 9

Over heart valve locations, then same places but with bell whilst palpating carotid arteries

Question 10

Where do you put stethoscope to accentuate murmurs or hear radiations?
Cardio

Answer 10

Over carotids when holding breath (aortic murmur radiation)
Sit patient forward, listen over aortic region (early diastolic murmur-aortic regurgitation)
Roll patient to left, over mitral then to axilla for radiation then with bell (mitral stenosis- mid diastolic murmur)

Question 11

What do you do for the back?
Cardio

Answer 11

Inspect for any scars, deformities and listen at the lung bases for crackles (HF), press on lower back for sacral oedema

Question 12

What else is next?
Cardio

Answer 12

Feel over bottom of legs for pitting oedema, then feel calves (if SNT then no signs of DVT)

Question 13

How to finish the examination
Cardio

Answer 13

Thank patient, tell them that the exam is over and to cover up, wash your hands, summarise your findings, suggest further examinations (respiratory or vascular examinations), further investigations (FBC, ECG, urine dipstick)