Cardio examination

Question 1

Give two examples of high volume pulse

Answer 1

exercise, pregnancy, anaemia, thyrotoxicosis, sepsis, aortic regurg

Question 2

Give one example of low volume pulse

Answer 2

LV failure, hypovolaemia/shock, septic shock, aortic stenosis

Question 3

Name two characters that a pulse can have

Answer 3

collapsing
slow rising + low volume
radial radial delay
pulsus paradoxus

Question 4

When would you see a slow rising + low volume pulse?

Answer 4

AS

Question 5

When would you see a collapsing pulse?

Answer 5

AR

Question 6

When would you observe radial radial delay?

Answer 6

coarctation

Question 7

When would you observe pulsus paradoxus?

Answer 7

=inspiratory reduction in systolic blood pressure of >10mmHg

tamponade
severe asthma

Question 8

What does the JVP reflect?

Answer 8

pressure in the right atrium

Question 9

What does an elevated JVP indicate?

Answer 9

right HF
fluid overload
tricuspid regurgitation
pericardial effusion/tamponade

Question 10

What does an absent JVP suggest?

Answer 10

dehydrated
hypovolaemic

Question 11

List three differences between carotid and JVP?

Answer 11

JVP is collapsible, compressible, falls with inspiration, biphasic waveform, laterally located, hepatojugular reflex rise

Question 12

Where is the JVP located?

Answer 12

2 heads of sternocleidomastoid- angle of the jaw

Question 13

What is deemed to be elevated JVP?

Answer 13

> 4cm

Question 14

What does an absent a wave in JVP waveform indicate and in which condition does this arise?

Answer 14

absent atrial contraction- AF

Question 15

Cannon a waves in JVP waveform are seen in?

Answer 15

complete HB

Question 16

Patient has midline sternotomy. What surgery could they have had?

Answer 16

valve replacement
CABG
transplant

Question 17

Patient has subclavicular scar. What cardiac surgery could they have had?

Answer 17

pacemaker

Question 18

Patient has posteriolateral thoracotomy scar. What surgery could they have had?

Answer 18

lung resection

Question 19

Patient has axillar scar. What surgery could they have had?

Answer 19

pneumothorax

Question 20

What does a parasternal heave suggest?

Answer 20

right ventricular hypertrophy

Question 21

What effect does squatting have on preload and afterload?

Answer 21

increases them and therefore increases blood flow through all valves

Question 22

How is mitral stenosis murmur described?

Answer 22

mid-diastolic
rumbling, low pitched

Question 23

Which is the most common valve disease seen in pregnancy?

Answer 23

mitral stenosis

Question 24

List two signs on examination of mitral stenosis

Answer 24

malar flush
right ventricular heave
Raised JVP, peripheral oedema

Question 25

How is aortic regurgitation murmur described?

Answer 25

early diastolic murmur, decrescendo

Question 26

Where is AR heard loudest?

Answer 26

Erb’s point= left sternal edge, 3rd intercostal space

Question 27

What are the features of the pulse in AR?

Answer 27

collapsing=corrigan’s sign
widened pulse pressure

Question 28

Name on non valvular condition that produces a murmur

Answer 28

septal defects- ASD, VSD

hypertrophic obstructive cardiomyopathy (HOCM)