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OSCEs > Cardiology > Flashcards

Cardiology Flashcards

1
Q

what questions should be asked in a cardiovascular history?

A 
presenting complaint
chest pain; site, severity, character, duration, radiation, periodicity, frequency, episodic duration, precipitating/relieving factors, associated symptoms
dyspnoea
orthopnoea
paroxysmal nocturnal dyspnoea
ankle swelling
palpitations
syncope
claudication
PMHx: diabetes, HTN, MI, stroke, angina
DHx
FHX; IHD, diabetes, hyperlipidaemia, stroke, HTN
SHx
systematic questioning
summary
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2
Q

what are the causes of dyspnoea?

A 
anxiety
obesity
anaemia
heart failure
pulmonary disease
pleural effusions
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3
Q

what are the causes of exertional dyspnoea?

A

cardiac failure
chronic pulmonary disease
poor physical condition

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4
Q

what are the causes of paroxysmal nocturnal dyspnoea?

A

congestive cardiac failure

asthma

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5
Q

what questions should be asked about palpitations?

A 
fast
regular
irregular
skipped beats
how long they lasted for
associated symptoms; dyspnoea, chest pain, syncope
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6
Q

describe the general inspection in the cardiovascular examination

A

cyanosis; peripheral vasoconstriction secondary to hypovolaemia, right-to-left cardiac shunting
dyspnoea; congestive heart failure, pericarditis, pneumonia, PE
pallor; haemorrhage, congestive heart failure
malar flush; mitral stenosis
oedema; congestive heart failure
medical equipment
mobility aids
pillows
vital signs
fluid balance
prescriptions

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7
Q

describe the inspection of the hands in the cardiovascular examination

A

pallor; poor peripheral perfusion, congestive heart failure
tar staining
xanthomata; hyperlipidaemia
arachnodactyly; Marfan’s syndrome
finger clubbing; congenital cyanotic heart disease, infective endocarditis, atrial myxoma
temperature
cool; poor peripheral perfusion, CCF, acute coronary syndrome
sweaty/clammy; acute coronary syndrome
CRT; increased in hypovolaemia, CCF

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8
Q

what signs in the hands are associated with endocarditis?

A

splinter haemorrhages
janeway lesions
osler’s nodes

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9
Q

what is examined after hands in a cardiovascular examination?

A 
radial pulse
collapsing pulse
brachial pulse
blood pressure
carotid pulse; palpation and auscultation
JVP; hepatojugular reflex
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10
Q

what are the causes of radio-radial delay?

A

subclavian artery stenosis; compression by cervical rib
aortic dissection
aortic coarctation

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11
Q

what are the causes of carotid bruits?

A

underlying carotid stenosis

radiating cardiac murmur; aortic stenosis

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12
Q

what are the causes of a raised JVP?

A

venous hypertension
right-sided heart failure
tricuspid regurgitation
constrictive pericarditis

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13
Q

what conditions are associated with a positive hepatojugular reflex?

A 
right ventricle is unable to accommodate an increased venous return
constrictive pericarditis
right ventricular failure
left ventricular failure
restrictive cardiomyopathy
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14
Q

describe the inspection of the face in the cardiovascular examination

A

eyes; conjunctival pallor, corneal arches, xanthelasma, Kayser-fleischer rings
mouth; central cyanosis, angular stomatitis, high arched palate, dental hygiene

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15
Q

what are the causes of bradycardia?

A

healthy athletic individuals
atrioventricular block
sick sinus syndrome
medications

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16
Q

what are the causes of tachycardia?

A

anxiety
supra ventricular tachycardia
hypovolaemia
hyperthyroidism

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17
Q

what are the causes of a collapsing pulse?

A 
fever
pregnancy
aortic regurgitation
patient ductus arteriosus
anaemia
arteriovenous fistula
thyrotoxicosis
18
Q

describe the inspection of the chest in the cardiovascular examination

A

scars; previous thoracic surgery
Pectus excavatum
Pectus carinatum
visible pulsations; ventricular hypertrophy

19
Q

describe the palpation of the chest in the cardiovascular exam

A

apex beat
heaves; parasternal heaves (RVH)
thrills

20
Q

name the steps of the entire cardiovascular exam

A 
introduction
general inspections
hands
pulses
blood pressure
JVP
face
inspection of the chest
palpation of the chest
auscultation of the chest
thank patient
21
Q

describe the auscultation of the chest in the cardiovascular exam

A

hold carotid pulse
diaphragm; mitral, tricuspid, pulmonary, aortic
bell; mitral, tricuspid
special manoeuvre; roll onto left lateral position, palpate the apex beat, listen with the bell for mitral stenosis and axilla (mitral incontinence)
learn forward, inhale, exhale, hold breath; aortic and tricuspid (aortic incompetence)
carotids; aortic stenosis, bruits

22
Q

describe the process of taking an ECG

A 
introduction; explanation
chest electrode placement
limb electrode placement
ask the patient to stay still
check the electrodes are placed correctly
press button to record ECG
once recorded, switch off the machine
remove the leads
thank the patient
label the ECG with the patient's details; name, DOB, H&C, indication for ECG
23
Q

describe the placement of the ECG chest leads

A

V1; 4th intercostal space right sternal edge
V2; 4th intercostal space left sternal edge
V3; between V2 and V4
V4; 5th intercostal space mid-clavicular line
V5; left anterior axillary line at the same level as V4
V6; left mid-axillary line at the same level as V4 and V5

24
Q

describe the placement of the ECG limb leads

A

red; ulnar styloid process of RA
yellow; ulnar styloid process of LA
green; medial/lateral malleolus of LL
blue; medial/lateral malleolus of RL

25
Q

describe the process of interpreting an ECG

A 
confirm details
heart rate
heart rhythm
cardiac axis
P waves
PR interval
QRS complex
ST segment
T waves
U waves
document interpretation
26
Q

what questions should be asked in the presenting compliant of a haematology history?

A 
fatigue
weakness
palpitations
swollen ankles
postural dizziness
bleeding
bruising
fever
night sweats
weight loss
jaundice
lymph node enlargement
lumps
bone pain
tingling and loss of sensation
skin rash
27
Q

what questions should be asked in the past medical history and family history of a haematology history?

A 
pregnancy
menstrual history
frequency infection
diarrhoea
tarry stools
blood in stools
recent trauma with bleeding
radiotherapy
previous cancers
GIT surgery
transplants
bleeding disorders
previous transfusions
rheumatoid arthritis
28
Q

what drugs are important to ask about in the social history of a haematology history?

A 
NSAIDs
anticoagulants
thrombolytics
steroids
vitamin supplements
allergies
29
Q

name the steps of a haematology exam

A 
inspection;
general
hands
arms
axilla
face
neck
chest
abdomen
legs
30
Q

describe the general inspection in a haematology exam

A 
race; thalassaemia, sickle cell anaemia
gender
pale; anaemia
jaundice; haemolytic anaemia
cyanosis; haemoglobinopathy, polycythaemia
bruising; clot disorder
scratch marks; lymphoid cancer
plethoric red face; polycythaemia
wasted/cachexic; cancer
31
Q

describe the inspection of the hands in a haematology exam

A 
nicotine staining
koilonychia; iron deficiency
pale nails; anaemia
clubbing; cancer
vasculitis of the nail bed; bacteraemia
palmar creases; anaemia
joints
gouty topi; secondary to myeloproliferative disease
hot hands; febrile
pulse; shock, peripheral B12 neuropathy
32
Q

describe the inspection of the arms and axilla in a haematology exam

A

blood pressure
scratch marks
palpable purpura; vasculitis, septicaemia
enlarged nodes; central, lateral, pectoral, intraclavicular, subscapular

33
Q

describe the inspection of the face in a haematology exam

A

eyes; jaundice, conjunctiva pallor, haemorrhage, injected sclera
mouth; hypertrophied gums, bleeding, scurvey
tongue; glossitis, ulcerated, tonsillar/adenoid enlargement

34
Q

describe the examination of the neck and chest in a haematology exam

A

auscultation; carotid bruit
inspect nodes; submental, submandibular, preauricular postauricular, occipital, jugular chain, post triangle, supraclavicular, paratracheal

bone pain; knock on ribs
feel for apex beat

35
Q

describe the examination of the abdomen in a haematology exam

A 
lie patient down
abdominal breathing; anaemia dyspnoea
palpate liver and spleen with respiration
scars
pulsatile
stretch marks
ascites
black umbilicus
portal hypertension; caput medusae
inguinal nodes
36
Q

describe the inspection of the legs in a haematology exam

A 
ulcers
bruising
ecchymosis
petechiae
peripheral stocking neuropathy; B12 deficit
popliteal nodes
swollen leg; uni/bilateral
purpura
varicosity
toe clubbing
nail changes; similar to fingers?
37
Q

what aspects are assessed in examining the arterial pulses?

A 
rate
rhythm
character; collapsing pulse
volume
symmetry
vessel wall character
presence of bruits

examine on both sides

38
Q

which arterial pulses are examined?

A

radial
brachial; medial to the medial head of biceps
carotid; medial border of sternocleidomastoid muscle and lateral to thyroid cartilage, should not examine both at the same time
femoral; inferior to mid inguinal point
popliteal; deep in the popliteal fossa
posterior tibial; against the tarsal bones
dorsalis pedis; usually 1cm behind the medial malleolus

39
Q

what are the causes of a raised JVP?

A

right sided heart failure
fluid overload
tricuspid regurgitation
massive PE

40
Q

how do you examine JVP?

A

semi-supine position
rest their head against a pillow
neck flexed slightly and looking to the left
inspect between the heads of the sternocleidomastoid muscle just above the clavicle
hepatojugular reflex; press on the RUQ
should return to normal after a few seconds
if it remains at the new high level; right sided heart failure

OSCEs (11 decks)

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