Cardiovascular

Question 1

What do you look for on general inspection?

Answer 1

Oedema (congestive heart failure)
Cyanosis
SOB
Pallor

Question 2

What do you look for on the dorsal surface of the hands?

Answer 2

Splinter haemorrhages (infective endocarditis)
Peripheral cyanosis (heart failure)
Osler's nodes (infective endocarditis, painful)

Question 3

What do you look for on the palm of the hands?

Answer 3

Janeway lesions (infective endocarditis)
Tar staining (smoking)
Xanthoma (hypercholesterolaemia)
Pallor

Question 4

What do you look for in the nails?

Answer 4

Clubbing (Shamroth’s window - infective endocarditis, aortic aneurysm)

Question 5

What do you look for on palpation of the fingers?

Answer 5

Capillary refill time (should be <2 seconds)

Question 6

What are you assessing when you feel the pulse?

Answer 6

Rate and rhythm (peripheral)
Character and volume (carotid)
Radio-radial delay (coarctation of aorta)
Collapsing pulse (aortic regurgitation)

Question 7

Where can you assess JVP?

Answer 7

With patient at 45 degree angle and head turned away

Between 2 heads of sternocleidomastoid

Question 8

When would a JVP be raised?

Answer 8

In right-sided heart failure, tricuspid regurgitation, constrictive pericarditis

Question 9

How do you assess hepatojugular reflux?

Answer 9

Apply pressure to liver
Observe for rise in JVP
Seen in tricuspid regurgitation, heart failure

Question 10

What do you look for in the face and eyes?

Answer 10

Conjunctival pallor (anaemia)
Xanthelasma (hyperlipidaemia)
Corneal Arcus (hyperlipidaemia)

Question 11

What do you look for in the mouth?

Answer 11

Dental hygiene (risk factor for infective endocarditis)
Angular stomatitis (iron deficiency)
Central cyanosis
High arched palate (Marfan)

Question 12

What do you look for when inspecting the chest?

Answer 12

Chest wall deformities

Scars - subcut ICD, pacemaker, sternotomy

Question 13

What are you assessing when palpating the chest?

Answer 13

Apex beat (5th IC space)
Parasternal heave (RV hypertrophy)
Thrills

Question 14

Where do you listen for heart sounds?

Answer 14

1. Aortic (2nd ICS, right sternal edge)
2. Pulmonary (2nd ICS, left sternal edge)
3. Tricuspid (4th ICS, lower left sternal edge)
4. Mitral (5th ICS, mid-clavicular line)
5. Carotid (murmur heard in aortic stenosis)

Question 15

What does the accentuation manoeuvre show?

Answer 15

Aortic murmurs get louder on expiration after sitting up

Mitral murmurs get louder on expiration after turning to the left

Question 16

What do you do when assessing the back?

Answer 16

Auscultate lungs (LV failure --> pulmonary oedema)
Assess for sacral + pedal oedema (RV failure)