Cardiovascular

Question 1

How do you approach the CVS examination?

Answer 1

• Introduction
• General inspection of the patient and around the bed
• Hands
• Face
• Neck
• PIPPA of the chest
• Lung bases
• Oedema

Question 2

List signs observed in the nails

Answer 2

• Finger clubbing (tetralogy of Fallot, cancer, infective endocarditis (IE))
• Splinter haemorrhages (IE)
• Koilonychia (iron deficiency anaemia)
• Leukonychia (anaemia)
• CRT (<2seconds is normal)

Question 3

List signs observed in the hands

Answer 3

• Tobacco staining
• Skin crease pallor (anaemia)
• Peripheral cyanosis
• Janeway lesions (IE)
• Osler’s nodes (IE)
• Xanthomata (hyperlipidaemia)
• Temperature

Question 4

What would you offer to perform in an OSCE on the arm?

Answer 4

• Radial pulse
• Radio-radial delay
• Collapsing pulse
• Brachial pulse
• BP

Question 5

What signs would you look for in the eyes?

Answer 5

• Xanthelasmata (hyperlipidaemia)
• Corneal arcus
• Fundoscopy - Roth spots, cotton wool haemorrhage
• Conjunctival pallor

Question 6

What signs would you look for in the mouth?

Answer 6

• Central cyanosis

- Poor dentition (IE)

Question 7

How would you assess a pulse?

Answer 7

1. Rate
2. Rhythm
3. Volume
4. Character

Question 8

What signs are you looking for in the neck?

Answer 8

• Raised JVP
• Carotid bruits
• Carotid pulse character

Question 9

Which murmur may radiate to the carotids?

Answer 9

Aortic stenosis

Question 10

What might you do to hear a carotid bruit better?

Answer 10

Ask the patient to hold their breath

Question 11

What are you looking for on the chest?

Answer 11

• Midline sternotomy scarAnterolateral thoracotomy
• Posterolateral thoracotomy
• Clamshell
• Sub-clavicular
• Chest drain incisions
• Video-assisted thoracoscopic surgery (VATS) incisions

Question 12

What surgery might have been performed to have a midline sternotomy scar?

Answer 12

• Coronary artery bypass graft (CABG)
• Open valve surgery
• Correction of congenital abnormalities

Question 13

What surgery might have been performed to have a thoracotomy scar?

Answer 13

• Lobectomy
• Open lung biopsy
• Single lung transplant

Question 14

What surgery might have been performed to have a clamshell incision scar?

Answer 14

• Widespread traumatic chest injury

Question 15

What surgery might have been performed to have a sub-clavicular scar?

Answer 15

• Pacemaker insertion

- Cardioversion device insertion