Cardiovascular Exam

Question 1

What signs do you look for in the nails

Answer 1

Clubbing, splinter haemorrhages

Question 2

What signs do you look for in the fingers and hands

Answer 2

Osler’s nodes, Janeway lesions, tendon xanthomata

Question 3

What signs do you look for in the mouth

Answer 3

Dental state, central cyanosis

Question 4

What signs do you look for in the eyes

Answer 4

Conjunctival rim pallor, corneal arcus

Question 5

What are splinter haemorrhages and what can they indicate

Answer 5

Thin reddish brown lines of blood under the nails

Infective endocarditis

Question 6

What is xanthomata and what can it indicate

Answer 6

fat build-ups under the surface of the skin. Raised, waxy-appearing, frequent yellow-ish skin colour lesions.

Hypercholesterolaemia

Question 7

What are Osler’s nodes and Janeway lesions and what can they indicate

Answer 7

Non-tender, haemorrhagic nodes on the palms or soles

Infective endocarditis

Question 8

What can clubbing indicate

Answer 8

Infective endocarditis and congenital heart disease

Question 9

What capillary refill time is normal

Answer 9

Less than 2 seconds

Question 10

What do you assess in radial pulse

Answer 10

Rate and rhythm

Question 11

What does radial-radial delay indicate

Answer 11

Co-arctation of the aorta

Question 12

What can a collapsing pulse indicate

Answer 12

Aortic regurgitation

Question 13

Where is the bicep pulse

Answer 13

Medial to the biceps tendon (and slightly under)

Question 14

What does a raised JVP indicate

Answer 14

Right heart failure

Question 15

What is a positive hepatojugular reflex sign

Answer 15

A sustained rise of >=4cm

Question 16

What is corneal arcus and what does it indicate

Answer 16

Grey, white or yellow depositions in the peripheral cornea

Could indicate hyperlipidaemia

Question 17

What does conjunctival pallor indicate

Answer 17

Anaemia

Question 18

What do you inspect the chest wall for

Answer 18

Deformities and scars

Question 19

Which chest scars could indicate what

Answer 19

Central chest - sternotomy or thoracotomy

Clavicular - Pacemaker

Left mid-axillary line - Subcutaneous ICD

Underarm - Lateral thoracotomy

Question 20

What can a parasternal heave indicate

Answer 20

Right ventricular hypertrophy

Question 21

Radiation to the carotid of an ejection systolic murmur is often heard in what

Answer 21

Aortic stenosis

Question 22

How can you make aortic and mitral murmurs to be louder

Answer 22

Perform accentuation manoeuvres:
Aortic murmur (Aortic stenosis) - sit up
Mitral murmur (Mitral regurgitation) - Roll over to the left

Get the patient to exhale and hold

Question 23

What do coarse crackles in lung auscultation indicate

Answer 23

Pulmonary oedema secondary to left ventricular failure

Question 24

What does sacral oedema indicate

Answer 24

Right ventricular heart failure

Question 25

What does pedal oedema indicate

Answer 25

Right ventricular heart failure

Question 26

What examinations are necessary to complete findings

Answer 26

full peripheral cardiovascular exam

ECG

Measure blood pressure

Question 27

What is a normal heart rate

Answer 27

60-100

Lower in sportspeople

Question 28

What can a weak pulse indicate

Answer 28

Poor circulating volume/stroke volume

Possible causes include hypovolaemia (haemorrhage, dehydration), shock (cardiac, septic) or peripheral vascular disease

Question 29

What can a high volume pulse indicate

Answer 29

Increased cardiac output

Could be due to pregnancy, emotion, aortic regurgitation, fever and hyperthyroidism

Question 30

What do you look for in inspection from the end of the bed

Answer 30

Shortness of breath
Cyanosis
Pallor
Oedema

Question 31

If you cant see the JVP, how can you ensure it isn’t too high

Answer 31

Lie patient flatter and look for a pulse entering the neck
Hepatojugular reflex
filling and emptying the external jugular

Question 32

Where can you check for a pulse in the feet

Answer 32

Dorsalis Pedis Pulse (lateral to tendon of Extensor Hallucis longus)

Posterior tibial (posterior and inferior to Medial Malleolus)