Cardio Exam

Question 1

End of bed cardio exam

Answer 1

SOB
Cyanosis
Pallor
Malar flush
Oedema

O2 delivery
ECG leads
Pillows
Mobility aids
Charts

Question 2

Hands cardio exam

Answer 2

LOOK:
- color
- tar staining
- xanthomata
- aracnodatyly (marfans)
- splinter haem (endo, sepsis, vasculitis)
- janeway lesions and oslers nodes (infective endo)

FEEL:
- clubbing
- CRT
- temp
- radial pulse

MOVE:
- radio-radio delay
- collapsing pulse
- brachial pulse
- BP

Question 3

Causes of collapsing pulse

Answer 3

Normal physiological states e.g. fever, pregnancy

Cardiac lesions e.g. aortic regurg, PDA

High output e.g. anaemia, AV fistula

Question 4

Causes of raised JVP cardio

Answer 4

Right-sided heart failure

Tricuspid regurg

Constrictive pericarditis

Question 5

Face cardio exam

Answer 5

EYES:
- conjunctival pallor
- corneal arcus (cholesterol)
- xanthelasma
- Kayser-fleischer rings (Wilson’s)

MOUTH:
- central cyanosis
- angular stomatitis (e.g. IDA)
- high arched palate (marfans)
- dental hygeine

Question 6

Cause of displaced apex beat

Answer 6

Ventricular hypertrophy

Question 7

Cause of parasternal heaves

Answer 7

Right ventricular hypertophy

Question 8

Cause of thrills

Answer 8

Turbulent blood flow through a heart valve (i.e thrills are palpable murmurs )

Question 9

Maneuvers cardio exam

Answer 9

• Auscultate carotid arteries while holding breath for aortic stenosis (ejection systolic murmur)
• sit forwards and listen to jut above tricuspid area during expiration for aortic regurg (early diastolic murmur)
• roll onto left and listen to mitral area during expiration for mitral regurg (pansystolic murmur)- up to axilla for radiation
• turn to bell for mitral stenosis (mid-diastolic murmur)

Question 10

Which manouvre for aortic stenosis

Answer 10

Auscultate carotid arteries while holding breath

(Ejection systolic murmur)

Question 11

Which manouvre for aortic regurg

Answer 11

Sit pt forward and listen to lower left sternal border (just above tricuspid) during expiration

Early diastolic murmur

Question 12

Which manouvre for mitral regurg/ stenosis

Answer 12

Roll pt on to left side

Mitral area during expiration

Diaphragm for mitral regurg

Bell for mitral stenosis

Question 13

Further assessments and investigations cardio exam

Answer 13

BP
Peripheral vascular exam
ECG
Urine dip
CBG
Fundoscopy

Question 14

3 causes of radio-radial delay

Answer 14

Subclavian artery stenosis (e.g. compression by a cervical rib)

Aortic dissection

Aortic coarctation