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YEAR 4 - CLARK - CARDIO > Cardio exam - GEEKY medics > Flashcards

Cardio exam - GEEKY medics Flashcards

1
Q

What should be looked for when general inspecting around the bedside?

A

•GTN / oxygen / mobility aids / medication

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2
Q

What things should you note when looking at the patient from the end of the bed?

A
  • Are they comfortable at rest?
  • SOB?
  • Malar flush? - mitral stenosis
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3
Q

When inspecting the chest from the end of the bed what should be looked for?

A
  • Scars?

* Visible palpitations?

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4
Q

When inspecting the legs from the end of the bed what should be looked for?

A
  • Harvest site scars
  • Peripheral oedema
  • Missing limbs or toes
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5
Q

When inspecting the hands what should be looked for when the palms are facing down?

A
  • Splinter haemorrhaging - bacterial endocarditis

* Finger clubbing - infective endocarditis / cyanotic congenital heart disease

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6
Q

When inspecting the hands, palms facing up, what should be looked for?

A
  • Colour, cyanosis? - hypoxia
  • Temperature, cool peripheries? - poor cardiac output / hypovolaemia
  • Sweat/clamy - associated with acute coronary syndromes
  • Janeway lesions - bacterial endocarditis
  • Osler’s nodes - infective endocarditis
  • Tar staining - Increased risk of cardiovascular disease
  • Xanthomata - hyperlipidaemia
  • Capillary refil - normal is <2s - if prolonged suggests hypovolaemia
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7
Q

What are you assessing in the radial pulse?

A

• Rate and rhythm

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8
Q

What does radial-radial delay suggest?

A

•Aortic coarctation

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9
Q

What is a collapsing pulse associated with?

A

• Aortic regurgitation

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10
Q

What are you assessing in the brachial pulse?

A

•Volume and character

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11
Q

What is a narrow pulse pressure associated with?

A

• Aortic stenosis

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12
Q

What is a wide pulse pressure associated with?

A

• Aortic regurgitation

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13
Q

What are you assessing in the carotid pulse?

A

• Character and volume

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14
Q

What is a slow rising character found in the carotid pulse associated with?

A

• Aortic stenosis

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15
Q

What does a raised JVP indicate?

A
  • Fluid overload
  • Right ventricular failure
  • Tricuspid regurgitation
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16
Q

What does a positive hepatojugular reflex indicate?

A
  • Right sided heart failure

* Tricuspid regurgitation

17
Q

When inspecting the eyes what signs are you looking for?

A
  • Conjunctival pallor - anaemia
  • Corneal arcus - hypercholesterolaemia
  • Xanthelasma - hypercholesterolaemia
18
Q

When inspecting the mouth what signs are you looking for?

A
  • Central cyanosis
  • Angular stomatitis - iron deficiency
  • High arched palate - suggestive of Marfans which means an increased risk of aortic aneurysm/dissection
  • Dental hygiene - potential source of infective endocarditis
19
Q

When closely inspecting the chest what should you be looking for?

A
  • Scars: thoracotomy = minimal invasive valve surgery, sternotomy = CABG / valve surgery, clavicular = pacemaker
  • Chest wall deformities: pectus excavatium and pectus carinatum
  • Visible pulses: forceful apex beat = hypertension / ventricular hypertrophy
20
Q

Where do you listen to the aortic valve?

A

•2nd intercostal space, right sternal edge

21
Q

Where do you listen to the mitral valve?

A

• 5th intercostal space, midclavicular line

22
Q

What is being listened for when the carotid artery is auscultated when the patient holds their breath?

A

• radiation of aortic stenosis murmur

23
Q

what is indicated if there is radiation of heart murmur into the left axilla?

A

• mitral regurgitation

24
Q

What is indicated if there is radiation of a heart murmur at there left sternal edge?

A

• aortic regurgitation

25
Q

What accentuation manoeuvres are performed when auscultating?

A
  • Roll onto left side and listen to mitral area with bell during expiration - mitral murmurs (stenosis and regurgitation)
  • Lean over and listen over aortic area during expiration - aortic murmurs are louder (stenosis and regurgitation)
26
Q

What would you do to complete the cardiovascular examination?

A
  • Auscultate lung bases - crackles may suggest pulmonary oedema - left ventricular failure
  • Sacral oedema and pedal oedema - may indicate right ventricular failure
27
Q

What further assessments and investigations should you offer for the cardiovascular examination?

A
  • Full peripheral examination
  • Record a 12-lead ECG - arrhythmias / MI
  • Dipstick urine - proteinuria / haematuria - hypertension
  • Bedside capillary blood glucose - diabetes
  • Perform fundoscopy - malignant hypertension - papilloedema

YEAR 4 - CLARK - CARDIO (11 decks)

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