Cardiovascular

Question 1

Three things about general appearance?

Answer 1

Unwell? Breathless/cyanosed? Distressed?

Question 2

SUMMARISE what you are looking for in the hands?

Answer 2

Tobacco staining, peripheral cyanosis, feel temperature, clubbing, splinter haemorrhages, Janeway lesions, Osler’s nodes, xanthomata, petechiae.

Question 3

Cardiovascular causes of clubbing?

Answer 3

CEAAI = cyanotic congenital heart, endocarditis, atrial myoxma, aneurysms, infected grafts.

Question 4

Causes of splinter haemorrhages

Answer 4

Infective endocarditis or some vasculitic disorders

Question 5

Where are Janeway lesions?

Answer 5

Palms

Question 6

What are Janeway lesions?

Answer 6

Painless red spots which blanch on pressure - primarily on thenar/hypothenar eminences.

Question 7

Causes of Janeway lesions?

Answer 7

Infective endocarditis

Question 8

What are Osler’s nodes?

Answer 8

Painful raised erthymatous lesions

Question 9

Causes of Osler’s nodes?

Answer 9

Infective endocarditis

Question 10

Causes of xanthomata?

Answer 10

Lipid deposition

Question 11

Nice phrase to use in OSCE R.E. hands??

Answer 11

There was no peripheral stigmata of infective endocarditis.

Question 12

SUMMARISE What are you looking for in face and eyes?

Answer 12

Central cyanosis, angular stomatitis, xanthelasmata, corneal arcus, petechial haemorrhage, fundoscopy.

Question 13

Where would you look for central cyanosis?

Answer 13

Mouth

Question 14

Causes of central cyanosis?

Answer 14

Heart failure, congenital heart disease

Question 15

Cause of angular stomatits?

Answer 15

Anaemia

Question 16

Where is xanthelasmata? What is the cause?

Answer 16

Eyelids - hyperlipidaemia (soft yellowish plaques)

Question 17

Where is corneal arcus? What is the cause?

Answer 17

The iris - Hyperlipidaemia

Question 18

Where would you look for petechial haemorrhage?

Answer 18

Conjunctivae

Question 19

What are you looking for in the pulse?

Answer 19

Rate, rhythm, volume and character

Question 20

How would you record individual pulses?

Answer 20

Normal, reduced, absent or aneurysmal

Question 21

Which pulses would you primarily take in a CV exam?

Answer 21

Radial and carotid

Question 22

How do you detect collapsing pulse?

Answer 22

Check patient has no shoulder pain, feel pulse with base of fingers, raise patient’s arm vertically about head

Question 23

What is a collapsing pulse a sign of?

Answer 23

Aortic incompetence

Question 24

What else would you do with a radial pulse?

Answer 24

Check for radial-radial delay, or any other discrepancy between the two

Question 25

Where is the carotid pulse?

Answer 25

Between the larynx and the anterior border of sternocleidomastoid

Question 26

What else would you do with a carotid pulse?

Answer 26

Listen for bruits over both carotid arteries - use diaphragm during held inspiration.

Question 27

What would you do before you take BP?

Answer 27

Palpate the systolic BP first

Question 28

What would a difference in BP in each arm >10mmHg suggest?

Answer 28

Aortic or subclavian artery disease

Question 29

Where is the JVP visible?

Answer 29

Between the sternal and clavicular heads of sternocleidomastoid

Question 30

What does JVP reflect?

Answer 30

Right atrial pressure, so it is a sign of right ventricular function

Question 31

When would JVP be elevated?

Answer 31

In states of fluid overload - i.e. heart failure and conditions with right heart dilatation (PE, COPD)

Question 32

Where is the sternal angle in relation to the right atrium? What does this mean for JVP?

Answer 32

5cm above - JVP in health should be <4cm above this angle when the patient lies at 45 degrees.

Question 33

If RA pressure is low/high, how would the patient have to lie?

Answer 33

Low - lie flat | High - sit upright

Question 34

Where would you see the JVP pulsation?

Answer 34

Suprasternal notch or behind sternocleidomastoid

Question 35

Which test would you use to confirm JVP?

Answer 35

Abdomino-jugular test or occlusion (press firmly in right upper quadrant)

Question 36

How is JVP measured?

Answer 36

In cm between upper limit of venous pulsation and sternal angle

Question 37

Explain waveform of JVP?

Answer 37

Double waveform - 'a' wave corresponds to atrial contraction, occurs just before first heart sounds (absent in AF). 'v' wave caused by atrial filling during ventricular systole when tricuspid valve closed.

Question 38

What is pectus excavatum?

Answer 38

Funnel chest - posterior displacement of lower sternum

Question 39

Pectus carinatum?

Answer 39

Pigeon chest - may displace heart and affect palpation and asculatation.

Question 40

What would a midline sternotomy scar indicate?

Answer 40

Previous coronary artery bypass surgery or aortic valve replacement

Question 41

What would a left submammary scar indicate?

Answer 41

A mitral valvotomy

Question 42

What would infraclavicular scars indicate?

Answer 42

Pacemaker or defibrilator implantation.

Question 43

Where is the apex beat?

Answer 43

Fifth left intercostal space, midclavicular line

Question 44

What is a thrill?

Answer 44

A palpable murmur

Question 45

What is a heave?

Answer 45

A palpable impulse that noticably lifts the hand. Ask patient to hold breath in expiration.

Question 46

4 areas for ascultation?

Answer 46

Apex, lower left sternal border, upper right and left sternal borders (DIAPHRAGM)

Question 47

Where would you listen with the bell?

Answer 47

Apex and lower left sternal border

Question 48

What are you listening for in the carotid arteries?

Answer 48

Ejection systolic murmur of aortic stenosis

Question 49

What are you listening for in the axilla?

Answer 49

Pansystolic murmur of mitral regurgitation

Question 50

What should you identify at each ascultation site?

Answer 50

S1 and S2 heart sounds - assess character and intensity. Added sounds and murmurs.

Question 51

How would you listen for mitral stenosis?

Answer 51

Roll patient onto left side -listen at apex using light pressure with bell (mid-diastolic and presystolic murmur of mitral stenosis).

Question 52

How would you listen for aortic regurgitation?

Answer 52

Ask patient to sit up and lean forwards, then breathe out fully and hold breath. Listen over right 2nd intercostal space and over left sternal edge with diaphragm.

Question 53

End pieces?

Answer 53

Check for ankle and sacral oedema, check peripheral pulses.