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Z Year3 Clinical Examinations > Cardio MedEd Part 2 > Flashcards

Cardio MedEd Part 2 Flashcards

1
Q

What scars do you look for on the inspection of the chest?

A
  1. Implantable electronic device
  2. Minimally invasive surgery
  3. Median sternotomy
  4. Left thoractomy
  5. Chest drain scars
  6. Right thoractomy
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2
Q

What are examples of implantable electronic devices?

A
  1. Pacemaker
  2. Defibrillator
  3. Resynchronisation device
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3
Q

What are examples of minimally invasive surgeries?

A
  1. Repair of septal defects
  2. Tricuspid valve surgery
  3. Aortic valve surgery
  4. Mitral valve surgery
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4
Q

What surgeries may cause of a median sternotomy scar?

A
  1. Mitral valve surgery
  2. Repair of the transposition of the great arteries
  3. Fontan circulation with fenestration
  4. Repair of tetralogy of Fallot
  5. Central shunt
  6. Pulmonary artery banding
  7. CABG
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5
Q

What may give a left thoracotomy scar?

A
  1. Repair of coarcation of the aorta
  2. Ligation of patent ductus arteriosus
  3. Pulmonary artery banding
  4. Balock-Taussing shunt
  5. Mitral valve surgery
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6
Q

What would cause a right thoracotomy scar

A
  1. pulmonary artery banding

2. Balock-Taussing shunt

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7
Q

When would you look in legs for scars?

A

If midline sternotomy scar (vein harvesting for CABG)

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8
Q

What may cause a left submammary scar?

A
  1. mitral valvotomy

2. pericardial window

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9
Q

Where is the apex beat usually found?

A

5th intercostal space in midclavicular line

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10
Q

When might the apex beat be displaced?

A

ventricular hypertrophy

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11
Q

What is a parasternal heave?

A

precordial (chest) impulse that can be palpated

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12
Q

How do you feel parasternal heave?

A
  • heel of your handparallel to theleft sternal edge(fingers vertical)
  • you should feel the heel of your hand beingliftedwith each systole
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13
Q

When are parasternal heaves present?

A

right ventricular hypertrophy

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14
Q

What is a thrill?

A

apalpable vibrationcaused byturbulent blood flowthrough a heart valve (a thrill is a palpable murmur)

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15
Q

How do you palpate for thrills?

A
  1. each of the heart valvesin turn
  2. place your handhorizontallyacross the chest wall, with theflats of your fingersandpalm over thevalveto be assessed
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16
Q

Where is the mitral valve?

A

5th intercostal space in mid clavicular line

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17
Q

Where is the tricuspid valve?

A

4th or 5th intercostal space at the lower left sternal edge

18
Q

Where is pulmonary valve?

A

2nd intercostal space at the left sternal edge

19
Q

Where is aortic valve?

A

2nd intercostal space at the right sternal edge.

20
Q

What are the normal heart sounds?

A

LUB DUB

21
Q

What is the s1 sound?

A

lub

22
Q

What is the s2 sound?

A

dub

23
Q

What is a sound between s1 and s2 classified as?

A

systolic

24
Q

What is a sound after s2 classified as?

A

diastolic

25
Q

What is the sound of an ejection systolic murmur?

A

whoosh dub

26
Q

Where would you here an ejection systolic murmur?

A
  1. Aortic valve + radiation to the carotids

2. Patient to hold breath as you listen over the carotids

27
Q

What pathology causes an ejection systolic murmur?

A

aortic stenosis

28
Q

What does an early diastolic murmur sound like?

A

lub whoosh

29
Q

Where would you hear an early diastolic murmur?

A

listen over aortic valve, then get patient to sit forward to extenuate

30
Q

What is the pathology of an early diastolic murmur?

A

aortic regurgitation

31
Q

What does a pansystolic murmur sound like?

A

whooosh

32
Q

Where can you hear a pansystolic murmur?

A
  1. mitral valve + radiation to the axilla
  2. roll patient onto their left and listen during expiration
  3. then move stethoscope up to axilla
33
Q

What is the pathology of a pansystolic murmur?

A

motral regurgitation

34
Q

What does a mid-diastolic murmur sound like?

A

Lub whoosh

35
Q

Where do you hear a mid diastolic murmur?

A

listen over mitral area with the bell during expiration

36
Q

What is the pathology of a mid-diastolic murmur?

A

mitral stenosis

37
Q

How do you systematically listen to hear sounds?

A
  1. Listen to mitral with diphragm + move to axilla
  2. Listen to mitral with bell turn to left deep breath in and out and hold + move to axilla
  3. Tricuspid with D
  4. Pulmonary with D
  5. Aortic with D
  6. Carotid D (hold breath)
  7. Bell sit up and forward, breath in and out and hold
  8. Then listen to lung bases and palpate for sacral oedema
38
Q

Why do you auscultate lung bases?

A

pulmonary oedema (bi-basal crackles)

39
Q

What else do you palpate for?

A

sacral oedema and ankle oedema

40
Q

What would sacral oedema and ankle oedema suggest?

A

heart failure

41
Q

How do you close the exam?

A
  1. Thank patient
  2. Offer to help cover up
  3. Wash hands
  4. Summarise findings
42
Q

What other investigations would you want to do?

A
  1. Check for peripheral stigmata of cardiovascular disease
  2. Check fundi
  3. Abdominal examination check for AAA
  4. Urine dip
  5. BP
  6. ECG

Z Year3 Clinical Examinations (33 decks)

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