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Year 3 - OSCE Cardio - Imperial > Cardio Station > Flashcards

Cardio Station Flashcards

1
Q

What are you looking out for when ‘inspecting from the end of the bed’?

A 
GTN spray
ECG
Pacemaker
Pillows (HF or pulmonary oedema)
Catheter bags
IV fluids
Oxygen
Cigarettes
***
SOB
Pallor
Oedema
Cyanosis
Malar rash 
Oedema
Syndromic features (Down's, Marfan's)
Mitral valvotomy
Thoracotomy
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2
Q

What would cyanosis be suggestive of? (Name 2 things)

A 
Hypovolemia
Inadequate oxygenation (right to left shifting)
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3
Q

What would shortness of breath be indicative of?

A

Cardiac problems:
Congestive heart failure
Pericarditis

Respiratory problems:
Infection (pneumonia)
Pulmonary embolism

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4
Q

What can malar flush be indicative of?

A

Mitral stenosis

SLE

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5
Q

What is mitral stenosis?

A

Narrowing of the mitral valve (LA to LV)

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6
Q

What is pallor indicative of?

A

Poor perfusion -> congestive heart failure

Anaemia -> haemorrhage, chronic disease

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7
Q

What would pillows, to prop up the patient during sleep, suggest?

A

Orthopnoea (congestive heart failure)

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8
Q

What are you looking for when inspecting the dorsum of the hands?

A

Splinter haemorrhages

Peripheral cyanosis

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9
Q

What would peripheral cyanosis suggest?

A

Heart failure

Congenital heart disease

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10
Q

What are splinter haemorrhages and what do they indicate?

A

Like blood spatters under the nails

Suggest infective endocarditis

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11
Q

What are you looking for when inspecting the palmar side of the hands?

A 
Tar staining
Xanthomata
Osler's nodes (node); Janeway lesions (non tender on thenar and hypothenar areas)
Arachnodactyly
Clubbing
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12
Q

What is xanthomata and what does it suggest?

A

Yellowish cholesterol deposits under the skin, indicative of hyperlipidemia/familial hypercholestremia

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13
Q

Describe the characteristics, pathophysiology and pain associated with Osler’s nodes

A

Osler’s nodes are on the TIP of fingers and toes
Painful
Immunological infiltrates

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14
Q

Describe the characteristics, pathophysiology and pain associated with Janeway lesions

A

Janeway lesions are on the palm or sole of food
Not painful
Septic microemboli (a type of embolism with bacteria inside)

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15
Q

What could clubbing of the fingers be suggestive of?

A

Infective endocarditis
Congential cyanotic heart disease
Atrial myxoma

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16
Q

What is atrial myxoma?

A

A non-cancerous tumour in one of the atria of the heart

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17
Q

Turners

A

45 X
Cooarctation of aorta
Bicuspid instead of tricuspid valve

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18
Q

What else might you look for in the hands?

A

Tendon xanthoma

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19
Q

Give three signs of infective endocarditis

A

Clubbing
Poor dentition
Splinter haemorrhages

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20
Q

State another sign in the nails

A

Quincke’s sign (pulsation of nail bed)

aortic regurgitation

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21
Q

What may cause bradycardia?

A

Heart block

Heart rhythms

22
Q

What may cause tachycardia?

A

Supraventricular arrhthmias
Sepsis
Phaeochromocytoma
Anxiety

23
Q

State two irregular rhythms

A

AF -irregularly irregular

regular irregular - Heart block

24
Q

State reasons for radio-radial delay

A

Stenosis of subclavian artery

Aortic coarctation

25
Q

Brachial pulse -

A

Feel character - slow rising, bounding (CO2 rentention, aortic regurgitation)
Volume (thready - sepsis, hypovolemia)

26
Q

Collapsing PULSE

A

Feel radial pulse
Feel brachial pulse

Don’t do it if they have pain in their arm

Aortic regurgitation

27
Q

Difference of more than 20mmHg between two arms?

A

Aortic dissection

Atherosclerosis

28
Q

Narrow pulse pressure (between systolic and diastolic)

A

Less than 25mmHg difference

Aortic stenosis, congestive heart failure

29
Q

Wide pulse pressure ???????

A

Aorti regurg

aortic dissection

30
Q

What heart conditions are associated with Marfan’s syndrome?

A 
Aortic aneurysm
mitral valve prolapse
Cardial myopathy 
Lots of heart problems
Cataracts
Subluxation
31
Q

Other conditions associated with heart conditions

A

Noonan

Edwards

32
Q

What do you look for in the mouth?

A

Poor dentititon
High arched palate (marfan’s)
Central syanosis

33
Q

What is JVP a measure of?

A

Indirect measure of central venous pressure because IJV connects to right atrium without a valve

34
Q

How do you measure for JVP?

A

Between two heads of SCM

Try pressing on abdomen at liver and see if JVP comes up

35
Q

Describe

A

Normally no pulse

VOICE

Visible
Obliterablle
Impalpable
copmles valve form

RVF
Fluid overload

36
Q

What would a raised JVP be caused by?

A

PQRST

Pulmonary HTN, PE, pericarditis, pericardial effusion
Quantitiy of fluid (overload)
Right heart failure
Superior vena cava obstruction (e.g. due to cancer)
Tamponade (fluid in pericardium)

37
Q

Chest inspection - Scars

go back to the slide

A

Scars:
Median sternotomy scar;
cabg
coronoary artery bipass graft

Mitral valve replacement - lateral thoracotomy

38
Q

Chest inspection

A

Ventricular hypertrophy

Visible pulsation / heaves

39
Q

Reasons for apex beat displacement

A

ventricular hypertrophy

40
Q

tapping on apex beat?

A

mitral stenosis

41
Q

Thrusting/heaving

A

mitral or aortic regurgitation

42
Q

What is a heave and how do you feel for it?

A

Pulsation felt through chest wall

43
Q

Thrills

A

Vibration felt due to turbulent blood flow through valves
Basically palpable murmur

Felt using fingers in valve areas

44
Q

????????????

A

Ask pt to move to left an dlisten to axilla (radiation of mitral regurgitation

Left lateral postiion - mitral stenosis

45
Q

Acronym for thinking about murmur?

A

SCRIPT

Site - where is it loudest?
Character
Radiation 
Intensity (grade 1 = faint, 6 = very loud with a thrill, heart without a stethoscope) 
Pitch
Timing - systolic or diastolic
46
Q

Aortic stenosis

A

radiates to carotides
peripheral pulses often weak and delayed
‘cresendo and descendo)

47
Q

Mitral stenosis

A

‘loud 51 type sound)
early diastolic flap

rumbling diastolic murmur

rheumatic heart disease

complciations:
pulmonary HTN
??

48
Q

Aortic regurgitation

A

Flowing

heard at axilla

49
Q

Back

A

sacral oedema

?

50
Q

Leg

A

Pitting oedema

Year 3 - OSCE Cardio - Imperial (12 decks)

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