Cardiology Exam

Question 1

What do you look for in the hands in a CV exam and what do they indicate?

Answer 1

Temperature & cap refill; press for 5sec, should refill in <2sec; poor perfusion

Peripheral cyanosis; blue colour; perpheral vascular disease, low cardiac output

Tar staining; yellowish fingers; smoker (also smell of tobacco)

Xanthomata (tendon xanthoma); raised yellow lesions on tendons; hyperlipidaemia

Janeway lesions; non tender lesions on palm or finger pulps; infective endocarditis

Osler’s nodes; red tender nodules on fingers, hands and feet; infective endocarditis

Question 2

What do you look for in the nails in a CV exam and what do they indicate?

Answer 2

Splinter haemorrhages; small streak bleeds under nail beds (>2); infective endocarditis, trauma, sepsis, RA, vasculitis

Clubbing; curved nails >165*; infective endocarditis, cyanotic heart disease

Koilonychia; spooning of the nails; iron deficiency anaemia

Qunike’s sign; pulsating nail beds; severe aortic regurgitation

Question 3

What do you look for in the nails in a CV exam?

Answer 3

Splinter haemorrhages, clubbing, koilonychia and Qunike’s sign

Question 4

What do you look for in the hands in a CV exam?

Answer 4

Temp and cap refill, tar staining, peripheral cyanosis, Osler’s nodes, Janeway lesions, tendon xanthoma (xanthomata)

Question 5

Which peripheral signs indicate infective endocarditis?

Answer 5

Clubbing
Splinter haemorrhages 
Osler nodes
Janeway lesions
Roth spots - Retinal haemorrhages with small, clear centres; rare and observed in only 5% of patients.

Question 6

Which pulses do you examine in a CV exam?

Answer 6

Radial
Radio-radial
Radio-femoral
Collapsing pulse
Carotid

Question 7

What do you look for in the pulses in a CV exam?

Answer 7

RATE - tachycardia (>100) or bradycardia (<60)

RHYTHM
Regular
Regularly irregular: 2* heart block, ventricular bigeminus (ectopic beats)
Irregularly irregular: AF, multiple ectopics

Radio-radial delay: aortic dissection, coarctation of the aortic arch

Radio-femoral delay: coarctation of the aorta

Collapsing pulse: aortic regurgitation

CAROTID PULSE
Weak: hypotenstion, cardiac failure

Bounding: sepsis

Corrigan’s sign (visibly exaggerated): aortic regurgitation

Pulsus paradoxus (weaker on inspiration): cardiac tamponade

Question 8

What can blood pressure indicate?

Answer 8

Narrow pulse pressure: aortic stenosis, hypovolaemia

Wide pulse pressure: aortic regurgitation, arteriosclerosis, septic shock

Question 9

At what point do you treat hypertension?

Answer 9

160/100

Question 10

How is postural hypotension defined?

Answer 10

Drop in systolic >20 or diastolic >10 after 3-5 minutes of standing.

Question 11

What do you look for in the JVP?

Answer 11

A pressure above 4cm above sternal angle is raised.

Raised, normal wave: Fluid overload, RHF, PE, tension pneumothorax, cardiac tamponade, SVC obstruction

Large ‘a’ wave: PHTN, Pulm stenosis

Cannon ‘a’ wave: complete heart block, ventricular arrhythmias

Absent ‘a’ wave: AF

Large ‘v’ waves (look for ear movement: tricuspid regurgitation

High plateau w/ deep descents: constrictive pericarditis

Question 12

What do you look for in the face?

Answer 12

Mallar flush
De Musset's sign
Corneal arcus
Xanthelasma
Conjunctival pallor
Poor dentition
Central cyanosis
Grave's disease

Question 13

What do the signs of the face tell you?

Answer 13

Mallar flush: mitral stenosis, low CO

De Musset’s sign: head nodding with pulse, aortic regurgitation

Corneal arcus: hypercholesterolaemia

Xanthelasma: hypercholesterolaemia

Conjunctiva pallor: anaemia

Poor dentition: infective endocarditis risk

Central cyanosis: poor perfusion

Question 14

What do you look for upon inspection of chest?

Answer 14

Scars, pulsations, deformities, listen for prosthetic valve click

Question 15

What do you feel for on the chest?

Answer 15

Thrills
Heaves
Apex beat

Question 16

What do thrills and heaves indicate?

Answer 16

Thrills: palpable murmur, grade 4 or above

Heave: RVH

Question 17

What can the apex beat tell you?

Answer 17

Tapping aka a palpable 1st heart sound: mitral stenosis

Hyper-dynamic: aortic regurgitation

Heaving: aortic stenosis, HTN

Absent: ASK TO ROLL OVER, dextrocardia - CHECK OTHER SIDE, behind the rib, obesity, pericardial effusion, emphysema

Question 18

What do you auscultate?

Answer 18

PALPATE CAROTID AT THE SAME TIME
2ICS RSE
2ICS LSE
4ICS LSE
5ICS Mid Clav

Question 19

Which murmurs can you hear at which sites?

Answer 19

Aortic: Aortic stenosis, if murmur audible then listen at carotids

Pulmonary: pulmonary stenosis

Tricuspid: Aortic regurgitation, tricuspid regurgitation

Mitral: Mitral regurgitation, if audible then listen at axilla

Question 20

How do you increase the volumes of mitral stenosis and aortic regurgitation?

Answer 20

Mitral stenosis: press apex lightly with BELL then ask to take a breath in…out…hold it.

Aortic regurgitation: at tricuspid w/ diaphragm, take breath in…..out….hold it.

Question 21

What do you auscultate after the heart? And what can they indicate?

Answer 21

Carotid bruits - carotid stenosis/radiation of aortic stenosis
Lung bases - listen for creps, LHF

Question 22

What do you do after auscultation?

Answer 22

Sacral oedema - RHF

Ankle oedema - RHF