Cardiovascular Exam

Question 1

What is peripheral cyanosis a sign of

Answer 1

Hypoxaemia
Raynaud’s
CCF

Question 2

What is clubbing a sign of

Answer 2

Congenital cyanotic heart disease
Infective endocarditis
Atrialmyxoma

Question 3

What are splinter haemorrhages a sign of

Answer 3

Infective endocarditis

Also: RA, vasculitis, trauma, sepsis

Question 4

What are Osler’s nodes

Answer 4

Red, tender nodules on finger pulps or thenar eminence (immune complex deposition)

Question 5

What are Osler’s nodes a sign of

Answer 5

Infective endocarditis (rare and late sign)

Question 6

What are Janeway lesions

Answer 6

non-tender macular-papular lesions seen on palms or finger pulps (embolic phenomenon)

Question 7

What are Janeway lesions a sign of

Answer 7

Infective endocarditis (rare)

Question 8

Radio-radial delay causes

Answer 8

Aortic coarctation
Aortic dissection
Subclavian artery stenosis

Question 9

Collapsing pulse causes

Answer 9

Aortic regurgitation
PDA
Also- pregnancy, fever, thyrotoxicosis

Question 10

Pulsus paradoxus

Answer 10

Pulse wave volume decreases significantly during inspiration

Question 11

Pulsus paradoxus causes

Answer 11

Cardiac tamponade (late)
Also: severe acute asthma/COPD

Question 12

Mucosal pallor of conjunctivae

Answer 12

Anaemia

Question 13

Jaundice of sclera

Answer 13

Haemolytic anaemia

Question 14

Corneal Arcus

Answer 14

Hypercholesterolaemia- significant only if >50

Question 15

Xanthelasma

Answer 15

Hypercholesterolaemia

Question 16

Mitral facies

Answer 16

Rosy cheeks suggestive of mitral stenosis

Question 17

Central cyanosis

Answer 17

Hypoxaemia e.g. right to left cardiac shunt

Question 18

Dental hygiene

Answer 18

Common source of organisms causing infective endocarditis

Question 19

Carotid pulse

Answer 19

BEFORE palpating, auscultation first for presence of bruits to rule out stenosis disease which may potentially become dislodged during palpating

Question 20

`carotid pulse- comment on

Answer 20

Volume and character

E.g. normal, slow rising, bounding, thready

Question 21

How to differentiate JVP from carotid

Answer 21

Carotid is pulsatile, JVP is not
If it’s easily obstructable, it’s the JVP
JVP is double wave form, carotid is single (examine it)
If it reduces with inspiration it’s the JVP

Question 22

Kussmaul’s sign

Answer 22

JVP will rise with inspiration in pericardial constriction, right ventricular infarction or cardiac tamponade

Question 23

Ways to augment the JVP if you can’t find it

Answer 23

Press on liver to elicit hepatojugular reflex
Ask patient to lie more flat
Lift patient’s leg

Question 24

Height of JVP

Answer 24

Vertical distance between the sternal angle and the top of the pulsation point of the JVP (should be less or equal to 3cm)

Question 25

Causes of right sided heart failure

Answer 25

Increased pressure in the right side of heart Right sided HF- e.g. due to left- sided heart failure or pulmonary hypertension (in turn due to COPD, interstitial lung disease etc.) Tricuspid regurgitation Constrictive pericarditis

Question 26

Chest scars

Answer 26

sternotomy for CABG | Thoracotomy for valvular surgery

Question 27

Thrills

Answer 27

Palpable vibration caused by turbulent blood flow through a heart valve i.e. palpable murmur

Question 28

How to elicit thrills

Answer 28

Press fingertips on sternum at the level of 2nd intercostal space

Question 29

Heaves

Answer 29

Right ventricular hypertrophy

Question 30

How to elicit heaves

Answer 30

Press the heel of your hand over right sternal edge

Question 31

Apex beat- position

Answer 31

Normally at 5th intercostal space mid-clavicle are line

Question 32

Apex beat displacement

Answer 32

``` Cardiomegaly e.g. cardiomyopathy, CCF Mediastinal shift (e.g. pleural effusion, tension pneumothorax) ```

Question 33

Forceful and sustained Apex Beat

Answer 33

Pressure-loaded e.g. left ventricular hypertrophy

Question 34

Forceful and non-sustained apex beat

Answer 34

Volume-loaded e.g. hyper metabolic states, aortic/mitral regurgitation

Question 35

Double impulse apex beat

Answer 35

Hypertrophic cardiomyopathy

Question 36

Aortic valve

Answer 36

2nd intercostal space | Right sternal edge

Question 37

Pulmonary valve

Answer 37

2nd intercostal space | Left sternal edge

Question 38

Tricuspid valve

Answer 38

4th/5th intercostal space | Lower left sternal edge

Question 39

Mitral valve

Answer 39

5th intercostal space | Midclavicular line

Question 40

How do you accentuated manoeuvres

Answer 40

All in expiration | Ask patient to breathe in and out, and hold in expiration

Question 41

Mitral stenosis

Answer 41

Mid diastolic rumble

Question 42

Elicit mitral stenosis

Answer 42

Ask patient to roll onto their left side, and auscultation the mitral area using the bell

Question 43

Mitral regurgitation

Answer 43

Pansystolic murmur

Question 44

Elicit mitral regurgitation

Answer 44

In same position, auscultate in the mitral area again this time using the diaphragm Auscultate into the axils to identify radiation of this murmur

Question 45

Aortic stenosis

Answer 45

Ejection-systolic murmur (crescendo-decrescendo)

Question 46

Aortic stenosis elicit

Answer 46

With patient back into normal seated position, auscultate the carotid arteries using the diaphragm

Question 47

Aortic regurgitation

Answer 47

Early diastolic murmur

Question 48

Aortic regurgitation elicit

Answer 48

Sit patient forwards and auscultate over aortic area with diaphragm

Question 49

Bibasal crackles

Answer 49

E.g. pulmonary oedema due to LVF

Question 50

Scars in legs

Answer 50

Saphenous vein grafts fir CABG

Question 51

Extras in cardio exam

Answer 51

``` Full set of obs Peripheral vascular and respirator exams ECG Bloods CXR Echo ```