Cardiovascular Disease Exam

Question 1

Before beginning the examination or gaining consent what should you confirm with the patient?

Answer 1

Name, address and date of birth

Question 2

What should you ask the patient before you start the examination?

Answer 2

You should gain consent and ask the patient whether they have any pain before you start the exam

Question 3

What can you gain from an “End-of-bed-ogram”?

Answer 3

You can tell whether the patient is on any medication or whether they have any medical aids etc

Question 4

How should you carry out the assessment, where should you start and where should you end?

Answer 4

Start at the fingers tips, make your way up the arm to the neck, then back down to the chest, to the legs and toes

Question 5

When assessing the hands what are the 3 things that you should be looking for?

Answer 5

~ Any instant visual changes eg colour, tar staining, clubbing etc
~ Assess and compare the temperature of the patients hands
~ Assess the capillary refill time of the patient

Question 6

Whats the normal capillary refill time?

Answer 6

Less than 2 seconds

Question 7

When you are assessing the temperature of the patients hands, should you use the back or the front of your hands?

Answer 7

The back of your hands

Question 8

If the capillary refill time is more than 2 seconds what should you query?

Answer 8

Hypotension and dehydration

Question 9

If you pick up that the patient has clubbing of their fingers what can this be a sign of?

Answer 9

Congenital heart disease, cystic fibrosis and lung cancer

Question 10

What are the 6 stages of checking and assessing the patients pulse and BP?

Answer 10

1. Palpate the radial pulse; assess HR and rhythm
2. Assess radial-radial delay, it should be the same
3. Assess for a collapsing pulse
4. Palpate brachial, assess volume and character
5. Offer BP on both arms
6. Auscalate the carotid and if okay palpate and assess the pulse

Question 11

If your radial-radial delays are not the same what can this be a sign of?

Answer 11

Aortic dissection, aortic coarctation and subclavian artery stenosis

Question 12

After the 6 steps of the BP and pulse whats the next step?

Answer 12

To check the collapsing pulse

Question 13

How do you check the collapsing pulse?

Answer 13

You palpate to find the radial pulse and then quickly raise up the patients arm to see if theres a change in the pulse

Question 14

What must you check before carrying out a collapsing pulse investigation on the patient?

Answer 14

That the patient has no prior or historical shoulder pain or injury

Question 15

If you see a change in the collapsing pulse, what can this indicate?

Answer 15

A primary aortic regurgitation

Question 16

After you’ve checked the hands, pulse and BP what do you need to check next?

Answer 16

The neck of the patient

Question 17

What pulse are you checking in the neck?

Answer 17

The carotid pulse

Question 18

What do you need to do before palpating the carotid?

Answer 18

That there’s no blockages in the artery that could cause harm

Question 19

After assessing the carotid in the neck what else should you assess?

Answer 19

Jugular venous presssure (JVP)

Question 20

What angle does the patient need to be at to correctly assess the JVP?

Answer 20

45 degree angle

Question 21

What side will you see the JVP on?

Answer 21

Right side

Question 22

If you can see the JVP what would this be a sign of?

Answer 22

Right sided heart failure

Question 23

What’s it called when you press on the liver to see the JVP?

Answer 23

Hepatojugular AR reflex

Question 24

After inspecting the neck what should you move onto next?

Answer 24

The face

Question 25

What should you be looking at on the face in particular?

Answer 25

The eyes and the mouth

Question 26

If the patient has facial flushing what can this be a sign of?

Answer 26

Mitral stenosis

Question 27

After assessing the face what’s the next area to assess?

Answer 27

The chesst

Question 28

What should you be looking at on the chest to help you with a patient’s history?

Answer 28

Any scars, deformaties or pulsations

Question 29

What’s the first thing you should do when physically assessing the chest?

Answer 29

You should palpate the chest

Question 30

When you’re palpating the chest what should you be looking for?

Answer 30

Any vibrations or abnormal feelings of the chest

Question 31

After you’ve palpated the chest whats your next step?

Answer 31

To listen to the chest

Question 32

What are you listening to on the chest?

Answer 32

The valves, which are
~Aortic
~Pulmonary
~Tricuspid
~Mitral

Question 33

If when you have listened to the chest you believe there to be some abnormalities what should you do?

Answer 33

Carry out further investigation, listening to other areas of the chest

Question 34

What is the final thing to assess on a cardiovascular exam?

Answer 34

The legs and feet

Question 35

How do you assess the feet?

Answer 35

~ Palpate the ankles to check of pitting oedema
~ Inspect the legs for evidence of saphenous vein harvesting

Question 36

If you find no abnormalities in the patients exam what should you say?

Answer 36

No peripheral stigmata of cardiovascular disease

Question 37

Whats the biggest factor that can cause splinter haemorrhages?

Answer 37

Infective endocarditis or sepsis

Question 38

What can Janeway lesions and Olser Nodes both be a symptom of?

Answer 38

Infective endocarditis

Question 39

When would you feel a water hammer pulse?

Answer 39

Aortic stenosis

Question 40

When may you feel a collapsing pulse?

Answer 40

Aortic regurgitation

Question 41

What can a narrow pulse pressure indicate?

Answer 41

Aortic stenosis, congenital heart failure or cardiac tamponade

Question 42

What is classed as a narrow pulse pressure?

Answer 42

<25mmHg

Question 43

What is classes as a wide pulse pressure?

Answer 43

> 100mmHg

Question 44

What can a wide pulse pressure indicate?

Answer 44

Aortic dissection or aortic regurgitation

Question 45

When should you be concerned if you notice corneal arcus in a patients eye?

Answer 45

When they are below 50

Question 46

What can a high arched palate indicate in terms of genetic disorders?

Answer 46

Marfan’s syndrome