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OSCE 2021 > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What angle for the bed and what exposure?

A

45 degrees and exposed from the waist up. Also exposure of lower legs for CABG harvest, peripheral oedema and peripheral vascular disease signs. Ask the patient if they are in any pain

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2
Q

What signs are you looking for on general inspection?

A
  • Cyanosis due to poor circ (peripheral vasoconstriction 2nd to hypovolaemia) or inadequate oxygenation (right to left cardiac shunting)
  • SOB (Cardio = congestive heart failure) (resp = pneumonia, PE)
  • Pallor from anaemia (haemorrhage, chronic) or poor perfusion (congestive cardiac failure)
  • Malar flush (mitral stenosis)
  • Oedema = pedal or ascites. Congestive heart failure main cause for cardio
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3
Q

What objects and equipment should you look for?

A 
Medical = ECG, GTN spray, catheters
Mobility = zimmer frame
Pillows = (congestive heart failure = orthopnoea)
Vital signs and Fluid balance
Prescriptions
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4
Q

What do you inspect for on the hands?

A
  • Pallor for PPP (CHF) and cyanosis (hypoxaemia)
  • Tar staining (coronary artery disease and hypertension)
  • Xanothomata (coronary artery disease 2nd to hypercholesteraemia)
  • Arachnodactyly (Marfans therefore mitral/aortic valve prolapse and aortic dissection)
  • Finger clubbing
  • Endocarditic features
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5
Q

What are the cardio causes of finger clubbing?

A

Congenital cyanotic heart disease, infective endocarditis and atrial myxoma

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6
Q

Infective endocarditis signs?

A

Janeway lesions, splinter haemorrhages, Oslers nodes, clubbing

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7
Q

What do you palpate for in the hands?

A
  • Temperature (Cool = PPP = CHF or ACS)
    Cool + clammy = ACS
  • Cap refill time (>2 seconds = CHF)
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8
Q

What do you assess for in radial HR?

A

Rate and rhythm.

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9
Q

Common causes of bradycardia?

A

Healthy athletes, atrioventricular block, medications

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10
Q

Common causes of tachycardia?

A

Anxiety, supraventricular tachycardia, hypovolaemia and hyperthyroidism

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11
Q

Causes of irregular rhythm?

A

Atrial fibrillation

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12
Q

What are the causes of radio-radio delay?

A
  • Subclavian artery stenosis (compression by cervical rib)
  • Aortic dissection
  • Aortic coarction
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13
Q

How to assess collapsing pulse?

A

Ask patient if any pain in the right shoulder. Palpate radial pulse with right hand and brachial pulse with left hand. Raise arm above their head briskly. Should feel tapping impulse through muscle bulk of the arm due to the sudden retraction of blood during diastole

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14
Q

Causes of collapsing ulse?

A

Normal = fever, pregnancy
Cardiac lesions = aortic regurgiation, patent ductus arteriosus
high output states = anaemia, arteriovenous fistula and thryotoxicosis

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15
Q

What are you looking for in brachial pulse?

A

Pulse volume and character

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16
Q

What are the types of pulse character?

A

Normal, slow rising (aortic stenosis), bounding (aortic regurgitation), thready (intravascular hypovolaemia in sepsis)

17
Q

What are the types of BP abnormalities?

A
  • Hypertension + hypotension
  • Narrow pulse pressure (<25mmHg. CHG, aortic stenosis, cardiac tamponade)
  • Wide pulse pressure (>100mmHg. aortic regurgiation and aortic dissection)
    Difference between arms = >20mmHg . may be aortic dissection
18
Q

What are we auscultating/palpating for on carotid pulse?

A

Bruit (indicates aortic stenosis. if present, palpation could dislodge carotid plaque = ischaemic stroke)
Assess the character and volume

19
Q

What are the causes of raised JVP?

A

Venous hypertension from 1) right sided heart failure (2nd to left or pulmonary hypertension (from COPD)). 2) Tricuspid regurgitation (infective endocarditis/rheumatic heart disease) 3) constrictive pericarditis (idiopathic/rheumatoid arthritis/TB)

20
Q

What conditions are associated with positive hepatojugular reflex?

A

constrictive pericarditis
Right and left ventricular failre
Restrictive cardiomyopathy

21
Q

What are you looking for in the eyes?

A
  • Conjunctival Pallor (anaemia)
  • Corneal Arcus
  • Xanthelasma
    Kayser-Fleischer Rings (Wilsons therefore copper deposition = cardiomyopathy)
22
Q

What are you looking for in the mouth?

A

Central cyanosis - (hypoxaemia from righ to left cardiac shunt)
Angular Stomatitis - anaemia
High arched palate - Marfans (aortic/mitral valve prolapse and aortic dissection)
Dental Hygiene - Infective endocarditis

23
Q

What chest features are we inspecting for?

A

Scars, pectus excavatum and cariatum. Visible pulsations from ventricular hypertrophy

24
Q

What scars and why?

A

Median Sternotomy = Cardiac valve replacement and CABG
Anterolateral thoracotomy = (Between lateral sternum border + MAL in 4th/5th ICS) for minimally invasive valve replacement surgery
Infraclavicular = pacemake insertion
Left Mid-axillary scar = Subcut implantable cardioverter-defibrillator

25
Q

What do we palpate the chest for?

A

Apex beat and location. Displacement may be ventricular hypertrophy.
Heaves (parasternal) typically associated with right ventricular hypertrophy
Thrills over each valve.

26
Q

What are the valve locations?

A

ALL PROSTITUTES TAKE MONEY

2nd right Sternal edge to MAL 5th ICS

27
Q

How should you auscultate?

A

Palpate the carotid pulse to determine the first heart sound. Ausculate upwards using the diaphragm through the valves. Then repeat using the bell.

28
Q

What are the accentuation manouevres?

A

1) auscultate the carotid arteries with diaphragm whilst patient holds breath for ejection systolic murmur from aortic stenosis
2) Sit patient forward and auscultate aortic area with diaphragm during expiration for early diastolic murmur caused by aortic regurgitation
3) Roll the patient onto the left side and listen over the mitral area with the diaphragm of stethoscope during expiration to listen to pansystolic murmur from mitral regurgitation. auscultate axilla to identify radiation
4) With patient on left still, listen over mitral with bell during expiration to hear mid-diastolic murmur caused by mitral stenosis

29
Q

Difference between bell and diaphragm?

A

Bell is better for low-frequency sounds like mid-disatolic murmur of mitral stenosis

Diaphragm is better for high-frequency soynds such as ejection systolic murmur or aortic stenosis, early diastolic murmur of aortic regurgiation and pansystolic murmur of mitral regurgitation.

30
Q

What are the 3 final step areas?

A

Investigate posterior chest wall for scars and deformities e.g.posterolateral scar from lung surgery.

Auscultate the lungs for coarse crackles in pulmonary oedema (LV failure) and absent air entry/dullness in pleural effusion (LV failure).

Check for sacral oedema and pedal pitting oedema in legs. Check for saphenous vein harvesting for CABG.

31
Q

What further examinations might you do?

A
  • measure BP
  • Peripheral vascular examination
  • 12 lead ECG
  • Dipstick urine
  • bedisde capillary blood glucose
  • perform fundoscopy if concerns of malignant hypertension (looking for papilloedema

OSCE 2021 (6 decks)

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