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Z Year3 Clinical Examinations > Cardio MedEd > Flashcards

Cardio MedEd Flashcards

1
Q

How do you explain the cardio exam to a patient?

A
  • Which would involve me having a look and feel of your hands, arms, face and neck
  • Then have a look, listen and feel of your chest
  • Would that be ok?
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2
Q

How do you explain exposure to patient?

A

For this examination you would have to be exposed from the waist up so I can get a clear view of your chest (can keep on your bra), would that be ok? Do you need any help removing your shirt?

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3
Q

What must you not forget to ask?

A
  1. Any pain

2. Chaperone

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4
Q

What should you check in patients general state?

A
  1. Sweaty
  2. SOB
  3. Anxiety
  4. Malar flush
  5. Pallor
  6. Cyanosis
  7. Nutritional status
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5
Q

What syndromes can you identify on inspection?

A
  1. Marfan’s
  2. Downs
  3. Turner’s
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6
Q

What are the cardio impacts in Marfan’s?

A
  1. Valve disease
  2. Aortic aneurysm
  3. Dissection
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7
Q

What are the cardio impacts in Down’s?

A

septal defects

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8
Q

What are the cardio impacts in Turner’s?

A

aortic coarctation

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9
Q

What are the syndromic features of Marfan’s?

A
  1. High arched palate

2. Arachnodactyly (‘spider fingers’):fingers and toes are abnormally long and slender

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10
Q

What are the syndromic features of Down’s?

A
  1. low muscle tone
  2. small stature
  3. an upward slant to the eyes
  4. single deep crease across the center of the palm
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11
Q

What are the syndromic features in Turner’s?

A
  1. short neck with a webbed appearance
  2. low hairline at the back of the neck
  3. low-set ears
  4. hands and feet that are swollen or puffy at birth
  5. soft nails that turn upward
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12
Q

What scars do you look for?

A
  1. Midline sternotomy scar (CABG + vein graft in leg)
  2. Thoracotomy scar
  3. Pacemaker
  4. Femoral-popliteal bypass
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13
Q

What other signs do you look for on the chest?

A
  1. Listen for click of prosthetic valve
  2. Visible pulsations on chest
  3. Amputations
  4. Ulceration
  5. Ascites
  6. De Mussets sign
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14
Q

What medical parapehrnalia can you look around for?

A
  1. Cannula, drip, IV fluids
  2. IV antibiotics
  3. Diuretics
  4. GTN spray
  5. Monitors / telemetry
  6. Cigarettes
  7. Other meds
  8. Temp chart
  9. ECG
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15
Q

What could IV antibiotics suggest?

A

infective endocarditis

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16
Q

What could diuretics suggest?

A
  1. Heart failure

2. Pedal oedema

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17
Q

What could GTN spray suggest?

A

angina

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18
Q

What could monitors/telemetry suggest?

A
  • recent chest pain

- arrythmias

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19
Q

What are you looking for on inspection of the hands?

A
  1. Tar staining
  2. Clubbing
  3. Spliter haemorrhages
  4. Osler nodes
  5. Janeway lesions
  6. Tendon Xanthoma
  7. Peripheral cyanosis
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20
Q

What are you doing on palpitation of the hands?

A
  1. Temperature
  2. Cap refill
  3. CO2 retention flap
  4. Radial pulse: collapsing, bounding, radial-radial delay, radial-femoral delay)
  5. Resp Rate
  6. Blood pressure
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21
Q

What would tar staining suggest?

A

smoking

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22
Q

What are the cardiac causes of clubbing?

A
  1. Infective endocarditis
  2. Cyanotic congenital heart disease
  3. Atrial myxoma
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23
Q

What do osler nodes / janeway lesions suggest?

A

infective endocarditis

24
Q

What do splinter haemorrhages suggest?

A

infective endocarditis

25
Q

What does xanothoma suggest?

A
  • hyperlipidaemia (typically familial hypercholesterolaemia)

- important risk factor for cardiovascular disease (e.g. coronary artery disease, hypertension)

26
Q

What does poor pallor suggest?

A

poor peripheral perfusion (e.g. congestive heart failure, hypovoleamia)

27
Q

What could cyanosis indicate?

A

underlying hypoxaemia

28
Q

What could a bounding pulse be due to?

A
  • aortic regurgitation

- CO2 retention

29
Q

What are causes of radio-radial delay?

A
  1. subclavian artery stenosis (e.g. compression by a cervical rib)
  2. aortic dissection
  3. aortic coarctation
30
Q

What are causes of a radio-femoral delay?

A

aortic coarctation distal to the left subclavian artery

31
Q

What are causes of CO2 retention flap?

A
  1. COPD

2. Type 2 resp failure

32
Q

What do you look for in the face?

A
  1. Malar fllush
  2. Xanthelasma
  3. Corneal arcus
  4. Conjunctival pallor
33
Q

What are the causes of malar flush?

A

mitral stenosis

34
Q

What are the causes of xanthelasma?

A

hypercholesterolaemia

35
Q

When is corneal arcus not benign?

A

under 50 suggest hypercholesterolaemia

36
Q

What does conjuctival pallor suggest?

A

anaemia

37
Q

What do you look for on the mouth?

A
  1. Central cyanosis
  2. Hydration
  3. High arched palate
38
Q

What could central cyanosis suggest?

A

hypoxaemia (e.g. a right to left cardiac shunt)

39
Q

What would a high arched palate suggest?

A

feature of Marfan syndrome

40
Q

What is Marfan’s syndrome associated with?

A
  • mitral/aortic valve prolapse

- aortic dissection

41
Q

What do you look for in the neck?

A
  • JVP

- carotid bruits

42
Q

What is the reason for a raised JVP?

A

fluid overload / venous hypertension

43
Q

What are the cardiac causes of a raised JVP?

A
  1. right sided heart failure
  2. tricuspid regurgitation
  3. constrictive pericarditis
44
Q

What can cause right sided heart failure?

A
  1. left sided heart failure

2. pulmonary hypertension (due to COPD or ILD)

45
Q

What can cause tricuspid regurgitation?

A
  1. infective endocarditis

2. rheumatic heart disease

46
Q

What can cause constrictive pericarditis?

A
  1. idiopathic
  2. TB
  3. RA
47
Q

What does a positive hepatojugular reflux suggest?

A
  • right ventricle is unable to accommodate an increased venous return
  • not diagnosticof any specific condition
48
Q

What conditions usually cause a positive hepatojugular reflex?

A
  1. Constrictive pericarditis
  2. Right ventricular failure
  3. Left ventricular failure
  4. Restrictive cardiomyopathy
49
Q

How do you palpate the carotid?

A

listen for bruits first because bruits indicate an underlying carotid stenosis

50
Q

How do you auscultate for carotid bruits?

A
  1. diaphragm of the stethoscope 2. place between larynx and the anterior border of the SCM)
  2. ask the patient to take a deep breath in and hold it
  3. listen when they are holding their breath
51
Q

What is a carotid bruit?

A

a vascular sound usually heard with a stethoscope over the carotid arterybecause of turbulent, non-laminar blood flow through a stenotic area

52
Q

When do you palpate the carotid?

A

if no bruit heard: asses character and volume of pulse

53
Q

What must you avoid with palpating the carotids?

A

NOT at same time

54
Q

What could cause a collapsing pulse?

A
  1. normal physiological states (e.g. fever, pregnancy)
  2. Cardiac lesions (e.g. aortic regurgitation, patent ductus arteriosus)
  3. High output states (e.g. anaemia, arteriovenous fistula, thyrotoxicosis)
55
Q

What are different types of pulse character?

A
  1. Normal
  2. Slow-rising
  3. Bounding
  4. Thready
56
Q

What is a slow rising pulse associated with?

A

aortic stenosis

57
Q

What is a thready pulse associated with?

A

intravascular hypovolaemia in conditions such as sepsis

Z Year3 Clinical Examinations (33 decks)

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