Cardiovascular exam

Question 1

What would you investigate the hands for in a cardiovascular examination?

Answer 1

1. CRT and cyanosis
2. Temperature
3. Tendon xanthomata
4. Osler’s nodes and Janeway lesions

Question 2

What is peripheral cyanosis a sign of?

Answer 2

PVD
Raynaud’s
CCF

Question 3

How would you describe temp and CRT?

Answer 3

Warm and well perfused

Peripherally shut down

Question 4

How would you identify Osler’s nodes?

Answer 4

On the pulp of hands and feet
Pinhead size to pea size
Pink to purple
Painfful

Question 5

How would you identify Janeway lesions?

Answer 5

Flat, painless, red-blue spots on the palms of the hands and sole of feet

Question 6

What are all the signs of acute bacterial infective endocarditis?

Answer 6

Janeway lesions
Osler’s nodes
Splinter haemorrhages
Roth spots

Question 7

What would you investigate the nails for in a cardiovascular examination?

Answer 7

Clubbing
Koilonychia
Splinter haemorrhages
Nailfold infarcts

Question 8

What are cardiac causes of clubbing?

Answer 8

IE
Cyanotic congestive heart disease
Atrial myxoma

Question 9

What causes splinter haemorrhages?

Answer 9

IE

Trauma (gardening)

Question 10

What causes nailfold infarcts?

Answer 10

Vasculitis

SLE

Question 11

What would you look for in the wrist in a cardiovascular exam?

Answer 11

Radial pulse (rate, rhythm, volume, character)

Radial-radial delay

Radial-femoral delay

Collapsing pulse

Question 12

How would you describe the radial pulse?

Answer 12

Rate: tachycardia/bradycardia

Rhythm: regular, irregular, regularly irregular

Volume: bounding, normal, thready

CharacterL bisferiens (AR/AS), slow-rising

Question 13

What is a collapsing pulse a sign of?

Answer 13

AR

Question 14

What is R-R delay a sign of?

Answer 14

Cervical rib, aortic coarctation or dissection, embolism

Question 15

What is R-F delay a sign of?

Answer 15

Aortic coarctation or dissection, embolism

Question 16

When is the pulse pressure wide?

Answer 16

AR

Question 17

When is the pulse pressure narrow?

Answer 17

AS

Question 18

What would you look for in the face in a cardiovascular exam?

Answer 18

Malar flush, sign of MS

Question 19

What would you look for in the eyes in a cardiovascular exam?

Answer 19

Corneal arcus and xanthelasma

Conjunctival pallor

Question 20

What would you look for in the mouth in a cardiovascular exam?

Answer 20

Dentition

Central cyanosis

Question 21

What are some causes of central cyanosis

Answer 21

Lung disease
Cardiac shunt
Abnormal Hb

Question 22

What would you look for in the neck in a cardiovascular exam?

Answer 22

Carotid pulse (briefly palpate)

JVP

Question 23

What is Corrigan’s sign?

Answer 23

Exaggerated pulsation: AR

Question 24

What are causes of an elevated JVP?

Answer 24

RHF
Volume overload
Constrictive pericarditis

Question 25

What are causes of an elevated JVP with a low BP?

Answer 25

Tension pneumothorax Cardiac tamponade Massive PE Severe asthma

Question 26

What would you inspect in the precordium?

Answer 26

1. Scars: pacemaker, middling sternotomy, left submammary | 2. Visible heave

Question 27

How would you palpate the precordium?

Answer 27

Locate apex beat Left parasternal heave (right ventricular hypertrophy) Thrills

Question 28

What are the different characters of the apex beat?

Answer 28

Heaving: LVH Tapping: MS Thrusting: MR/AR

Question 29

How would you auscultate the precordium?

Answer 29

1. The valves | 2. Areas of murmur: axilla and carotid (breath on expiration)

Question 30

What murmur radiates to the axilla?

Answer 30

MS

Question 31

What murmur radiates to the carotids?

Answer 31

AS

Question 32

What manoeuvres would you do to amplify murmurs?

Answer 32

Apex, pt on LHS, breath on expiration (B): MS LLSE, pt sitting forward, breath on expiration (D): AR

Question 33

What would you look for in the ankles and back in a cardiovascular exam?

Answer 33

Peripheral oedema: RHF Sacral oedema: RHF Crepitations: LHF

Question 34

What investigations would you suggest after a cardiovascular examination?

Answer 34

``` ECG CXR Echocaridogram Urinalysis Abdo exam Peripheral pulses ```

Question 35

What are 6 causes of AF?

Answer 35

``` Ischaemic heart disease Rheumatic heart disease Thyrotoxicosis Pneumonia PE Alcohol ```

Question 36

What are features of JVP versus carotid?

Answer 36

1. Double pulsation 2. Rises with hepatojugular reflex 3. Non palpable 4. Obliterated when pressure applied at the base of the neck 5. Height changes with respiration 6. Height changes with angle of patient

Question 37

When does the JVP normally rise?

Answer 37

On expiration