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Clinical Examinations > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Three things about general appearance?

A

Unwell? Breathless/cyanosed? Distressed?

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2
Q

SUMMARISE what you are looking for in the hands?

A

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

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3
Q

Cardiovascular causes of clubbing?

A

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

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4
Q

Causes of splinter haemorrhages

A

Infective endocarditis or some vasculitic disorders

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5
Q

Where are Janeway lesions?

A

Palms

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6
Q

What are Janeway lesions?

A

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

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7
Q

Causes of Janeway lesions?

A

Infective endocarditis

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8
Q

What are Osler’s nodes?

A

Painful raised erthymatous lesions

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9
Q

Causes of Osler’s nodes?

A

Infective endocarditis

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10
Q

Causes of xanthomata?

A

Lipid deposition

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11
Q

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

A

There was no peripheral stigmata of infective endocarditis.

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12
Q

SUMMARISE What are you looking for in face and eyes?

A

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

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13
Q

Where would you look for central cyanosis?

A

Mouth

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14
Q

Causes of central cyanosis?

A

Heart failure, congenital heart disease

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15
Q

Cause of angular stomatits?

A

Anaemia

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16
Q

Where is xanthelasmata? What is the cause?

A

Eyelids - hyperlipidaemia (soft yellowish plaques)

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17
Q

Where is corneal arcus? What is the cause?

A

The iris - Hyperlipidaemia

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18
Q

Where would you look for petechial haemorrhage?

A

Conjunctivae

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19
Q

What are you looking for in the pulse?

A

Rate, rhythm, volume and character

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20
Q

How would you record individual pulses?

A

Normal, reduced, absent or aneurysmal

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21
Q

Which pulses would you primarily take in a CV exam?

A

Radial and carotid

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22
Q

How do you detect collapsing pulse?

A

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

23
Q

What is a collapsing pulse a sign of?

A

Aortic incompetence

24
Q

What else would you do with a radial pulse?

A

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

25
Q

Where is the carotid pulse?

A

Between the larynx and the anterior border of sternocleidomastoid

26
Q

What else would you do with a carotid pulse?

A

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

27
Q

What would you do before you take BP?

A

Palpate the systolic BP first

28
Q

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

A

Aortic or subclavian artery disease

29
Q

Where is the JVP visible?

A

Between the sternal and clavicular heads of sternocleidomastoid

30
Q

What does JVP reflect?

A

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

31
Q

When would JVP be elevated?

A

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

32
Q

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

A

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

33
Q

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

A

Low - lie flat

High - sit upright

34
Q

Where would you see the JVP pulsation?

A

Suprasternal notch or behind sternocleidomastoid

35
Q

Which test would you use to confirm JVP?

A

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

36
Q

How is JVP measured?

A

In cm between upper limit of venous pulsation and sternal angle

37
Q

Explain waveform of JVP?

A

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.

38
Q

What is pectus excavatum?

A

Funnel chest - posterior displacement of lower sternum

39
Q

Pectus carinatum?

A

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

40
Q

What would a midline sternotomy scar indicate?

A

Previous coronary artery bypass surgery or aortic valve replacement

41
Q

What would a left submammary scar indicate?

A

A mitral valvotomy

42
Q

What would infraclavicular scars indicate?

A

Pacemaker or defibrilator implantation.

43
Q

Where is the apex beat?

A

Fifth left intercostal space, midclavicular line

44
Q

What is a thrill?

A

A palpable murmur

45
Q

What is a heave?

A

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

46
Q

4 areas for ascultation?

A

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

47
Q

Where would you listen with the bell?

A

Apex and lower left sternal border

48
Q

What are you listening for in the carotid arteries?

A

Ejection systolic murmur of aortic stenosis

49
Q

What are you listening for in the axilla?

A

Pansystolic murmur of mitral regurgitation

50
Q

What should you identify at each ascultation site?

A

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

51
Q

How would you listen for mitral stenosis?

A

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

52
Q

How would you listen for aortic regurgitation?

A

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.

53
Q

End pieces?

A

Check for ankle and sacral oedema, check peripheral pulses.

Clinical Examinations (10 decks)

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