Cardiorespiratory assessment and management

Question 1

What are the main signs and symptoms of bacterial endocarditis?

Answer 1

Lethargy
SoB
Splinter haemorrhages
Janesway’s legions

Question 2

What does an inspiratory and expiratory wheeze that clears with a cough signify?

Answer 2

Bronchitis

Question 3

What is the difference in breathing drive for patients with and without COPD?

Answer 3

Non-COPD patients’ respiratory drive is regulated by too much CO2
COPD patients have chronic hypercapnia so their respiration is driven by too little oxygen

Over oxygenation of patients with COPD can cause a dangerous reduction in respiratory drive

Question 4

Where can the aortic valve be auscultated?

Answer 4

Second intercostal space
Right sternal border

Question 5

Where can the tricuspid valve be ausculated?

Answer 5

Fifth intercostal space
Left sternal border

Question 6

Where can the mitral valve be auscultated?

Answer 6

Fifth intercostal space
Right mid-clavicular line

Question 7

Where can the pulmonary valve be auscultated?

Answer 7

Second intercostal space
Left sternal border

Question 8

How are thrills assessed?

Answer 8

With a hand placed horizontally over each valve, feeling with fingers and palm

Question 9

What are thrills?

Answer 9

Palpable chest vibrations caused by turbulent blood flow

Question 10

How are heaves assessed?

Answer 10

The palm of hand placed vertically over the apex of the heart

Feel for your hand being lifted with each systole

Question 11

What are heaves and what can they signifty?

Answer 11

A lifting of an assessors hand with each systole, can be a sign of left ventricular hypertrophy

Question 12

What are you looking for during hand inspection during a cardiovascular exam?

Answer 12

Finger clubbing
Cyanosis
Nicotine staining
Cap refill
Osler’s Nodes
Janeway Lesions
Splinter haemorrhages

Question 13

What are you looking for during head, face and neck inspection during a cardiorespiratory exam?

Answer 13

Jaundice of eyes
Anaemia of eyelids
Corneal arcus
Xanthelasma
Malar flush
Cyanosis
Venous distention

Question 14

What are you looking for during chest inspection during a cardiorespiratory exam?

Answer 14

TWELVE
Scars
Pacemakers/ICDs
Barrel/pidgeon/funnel chest
Chest rise and expansion
Inflamed right supra-clavicular lymph node
WoB
Accessory muscle use

Question 15

In the abscence of circulatory compromise, what can cause an increased CRT?

Answer 15

Peripheral Vascular Disease
Old age
Hypothermia/cold ambient temperature

Question 16

Why should special attention be given to knee mottling and what can cause it to be more severe?

Answer 16

It has been shown to independently predict mortality.

Mottling usually begins at the knees and can be quantified according to a mottling score (scored 0-5, with a higher score correlating with increased mortality).

High doses of vasopressors can make skin mottling more severe and lead to purpuric changes.

Question 17

What patients with circulatory collapse may have a bounding pulse?

Answer 17

A strong bounding pulse is associated with the vasodilation of sepsis or anaphylaxis.

Question 18

What can a weak ‘thready’ pulse signify?

Answer 18

A weak thready pulse, or one with a low pulse volume, is associated with low cardiac output, most likely due to hypovolaemia

Question 19

Why should you have a higher index of suspicion for hypotension in elderly or usually hypertensive patients?

Answer 19

Elderly patients and those with known (or untreated) hypertension may require a higher MAP to maintain organ perfusion

Question 20

Why is it important to monitor pulse pressure in patients with circulatory collapse or volume loss?

Answer 20

The systolic and diastolic blood pressures can change in different ways and at different rates.

Generally, the sytolic BP will not reduce until approximately one-third of the circulating blood volume has depleted and the heart begins to fail.

The diastolic BP will start to rise with the vasoconstriction brought about by the compensatory measures.

Question 21

What values are considered narrow and wide pulse pressures?

Answer 21

If the difference is less than 25 percent of the systolic blood pressure, the pulse pressure is considered to be narrow.

A wide pulse pressure is considered to be greater than 50 percent of the systolic blood pressure.

Question 22

In the hypovolaemic patient, what does a narrowing pulse pressure signify?

Answer 22

It indicates a decreasing cardiac output and an increasing peripheral vascular resistance

Question 23

What are the signs and symptoms of a tension pneumothorax?

Answer 23

TENTION P-THORAX

Jugular venous disTENTION
Pleuritic pain/IPsilateral chest rise
-
Tachypnoea/cardia/Trachael deviation
Hypoxia/Hypotension/Hyper-resonance
Onset sudden
Reduced breath sounds/respiratory effort (dyspnoea)
Absent fremitus
X-ray shows lung collapse

Question 24

What may a collapsing pulse signify?

Answer 24

Aortic regurgitation
Patent ductus arteriosus

Question 25

What is the difference between Osler’s nodes and Janesway’s lesions?

Answer 25

Classically, Osler’s nodes are on the tip of the finger or toes and painful. Janeway lesions occur on palm and soles and are non-painful. Osler’s nodes are thought to be caused by localised immunological-mediated response while Janeway lesions are thought to be caused by septic microemboli.