cardiovascular

Question 1

what should you say about the pulse

Answer 1

rate and rhythm

Question 2

what does a fine tremour suggest

Answer 2

B2 agonist

Question 3

name some cardiovascular causes of clubbing

Answer 3

hypoxia
endocarditis
some congenital heart diseases

Question 4

what extra tests should you offer

Answer 4

abdo 
blood pressure
fundoscopy 
ecg
obs chart
urine

Question 5

what are you looking for in fundoscopy

Answer 5

hypertensive retinopathy

Question 6

what does hypertensive retinopathy look like

Answer 6

arteriolar narrowing 
arteriosclerosis
haemorrhage
cotton wool spots
microaneurysms 
hardened exudate

Question 7

what parts of an abdo exam would you do as part of a cardiovascular exam

Answer 7

aortic aneurysms
superficial palpation over left and right upper quadrants
enlarged liver
renal and femoral bruits

Question 8

what would you comment on in the obs chart

Answer 8

pulse
bp
Temperature
urine output (renal perfusion)

Question 9

how do you assess for mitral stenosis

Answer 9

roll pt to left lateral in expiration. listen with bell at apex

Question 10

how do you assess for mitral regurgitation

Answer 10

diaphragm in the left axilla

Question 11

how do you assess for aortic regurge

Answer 11

sit patient forwards listen with diaphragm in expiration at lower left sternal edge

Question 12

how do you assess aortic stenosis

Answer 12

with diaphragm in held inspiration over both carotids

also carotic bruits

Question 13

how do you assess for oedema

Answer 13

press for 10 seconds

Question 14

what is the tricuspid area

Answer 14

4th left intercostal space LSE

Question 15

what is the pulmonary area

Answer 15

2nd left ICS lateral to the sternum

Question 16

what is the aortic area

Answer 16

2nd right ICS LSE

Question 17

where do you feel for thrills

Answer 17

sternal notch, apex and upper part of the praecordium

Question 18

how do you assess for heaves

Answer 18

place your right outstretched hand to the left of the sternum
a heave will lift the heel of the hand off
ie right ventricular hypertrophy

Question 19

what does a raised JVP indicate

Answer 19

right heart failure and volume

look between the heads of sternocleidomastoid above the clavicle

Question 20

what is the maximum normal height of the JVP

Answer 20

3cm

Question 21

how do you calculate the right atrial pressure of water

Answer 21

add 5cm to the JVP

Question 22

what pathology would give a collapsing pulse

Answer 22

aortic regurge

Question 23

what manoever should be done with the bell

Answer 23

mitral stenosis

Question 24

what manoever should be done with the diaphragm

Answer 24

mitral regurge, aortic stenosis and regurg

Question 25

what is easy to forget

Answer 25

blood pressure
abdo exam
auscultating the carotids
flapping tremor

Question 26

what manoevers are done in expiration

Answer 26

mitral stenosis

and aortic regurge

Question 27

in what condition would you find a narrow pulse pressure

Answer 27

aortic stenosis

Question 28

in what condition would you find a wide pulse pressure

Answer 28

aortic regurgitation

Question 29

in what condition would the pulse have a slow rising character

Answer 29

aortic stenosis

Question 30

what does a raised JVP indicate

Answer 30

fluid overload
right ventricular failure
tricuspid regurgitation

Question 31

what is the hepatojugular reflex (offer)

Answer 31

apply pressure over the liver

observe JVP rise