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Physical Examinations > Cardiovascular exam > Flashcards

Cardiovascular exam Flashcards

1
Q

Why are the number of pillows relevant?

A

Orthopnea:

Shortness of breath with change in body position. Pulmonary effusion oedema or left ventricular heart failure.

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2
Q

What things would you look for around the bed?

A 
Oxygen
GTN spray
ECG machine
Medication
IV drips
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3
Q

What do splinter haemorrhages indicate?

A

Infective endocarditis

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4
Q

What causes Quinke’s sign?

A

Aortic regurgitation

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5
Q

What 2 things cause clubbing?

A

Cyanotic congenital heart disease

Infective endocarditis

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6
Q

Name one tender and non-tender manifestation of infective endocarditis.

A 
Osler's nodes (tender) (finger pulps)
Janeway lesions (non-tender) (palms)
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7
Q

What is a nail sign of vasculitis?

A

Nail fold infarcts (small red spots around nails).

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8
Q

how would hyperlipidaemia manifest?

A

Tendon xanthomata

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9
Q

Why check for radial-radial delay? 3 things.

A

Aortic coarctation
Aortic dissection
Aortic arch aneurysm

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10
Q

What is aortic coarctation?

A

The aorta narrows in the area where the ductus arteriosus inserts.

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11
Q

What are you feeling the radial pulse for?

A

Rate and rhythm (regularly regular)

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12
Q

What would a collapsing pulse indicate?

A

Aortic regurgitation
Patent ductus arteriosus
(PDA = failure to close. Allows irregular transmission of blood between the aorta and the pulmonary artery)

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13
Q

Why check for radial-femoral delay?

A

Aortic arch aneurysm

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14
Q

Large pulse pressure indicates what?

A

Aortic regurgitation

Septic shock

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15
Q

Narrow pulse pressure indicates what?

A

Aortic stenosis

Hypovolaemia

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16
Q

How does corneal arcus present?

A

A white, blue, grey opaque ring around the corneal margin.

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17
Q

What causes corneal arcus?

A

Cholesterol deposits (dyslipidaemia; hypercholesterolemia)

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18
Q

What might pallor indicate?

A

Anaemia

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19
Q

Malar flush indicates?

A

Mitral stenosis

Low cardiac output

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20
Q

Swollen cyanotic face?

A

SVC obstruction

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21
Q

What would conjunctival pallor indicate?

A

Anaemia

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22
Q

What would conjunctival haemorrhages indicate?

A

Infective endocarditis

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23
Q

How would hyperlipidaemia present (eyes).

A

Xanthelasma

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24
Q

How would central cyanosis present in the mouth?

A

Under tongue, cyanosed.

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25
Q

How would infective endocarditis present in the mouth?

A

Petechial haemorrhages.

Poor dental hygiene

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26
Q

What does the JVP indirectly measure?

A

Right atrial pressure

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27
Q

What two things should you look for in JVP?

A

Height

Waveform

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28
Q

What does a consistently raised JVP indicate?

A

Fluid overload

Right heart failure

29
Q

What is the abdominojugular reflux sign?

A

Pressing on RUQ produces a transient rise in JVP. If it stays high throughout a 15s compression then it is positive sign. This is an inability to eject increased venous return = right heart failure.

30
Q

What is a fast pulse?

A

> 100bpm

31
Q

What is a slow pulse?

A

< or = 60 bpm

32
Q

What is the mneumonic for raised JVP?

A 
P
Q 
R
S
T
33
Q

What does PQRST stand for (JVP)?

A

P= pulmonary hypertension/oedema/stenosis; pericarditis; pericardial effusion.

Q = quantity of fluid (i.e. overload)
R = right heart failure
S= Superior vena cava obstruction
T = tamponade; tricuspid regurgitation
34
Q

What do you check in the carotid pulse?

A

Character and volume

35
Q

Corrigan’s sign?

A

Visible carotid pulsation: aortic regurgitation

36
Q

De Musset’s Sign?

A

head bobbing with carotid pulse : aortic regurgitation

37
Q

Inspect chest for what 3 scars?

A

Midline sternotomy
Lateral thoractomy
Pacemaker scars

38
Q

Where would you see a pacemaker scar?

A

Near left shoulder

39
Q

Name two chest deformities that could affect the heart?

A

Pectus excavatum

Pectus carinatum

40
Q

What may be visible on inspection in the mid-clavicular line, 5th intercostal?

A

Visible apex beat.

41
Q

How would a superior vena cava obstruction present on inspection of the chest?

A

Distended veins over precordium

42
Q

How do you correctly palpate the apex beat?

A

Use whole hand, then localise to a finger. Then count down with other hand.

43
Q

What might a displaced apex beat indicate?

A

LV dilation (mitral regurgitation or tension pneumothorax)

44
Q

What might a thrusting apex beat indicate?

A

Systemic hypertension

Left ventricular hypertrophy

45
Q

What might a ‘tapping; apex beat indicate?

A

Mitral stenosis

46
Q

How do you check for heaves?

A

Left hand: over left parasternal area

Right hand: over apex beat

47
Q

What might a parasternal ‘heave’ indicate?

A

Right ventricular hypertrophy e.g. mitral stenosis
Pulmonary stenosis
Cor pulmonale

48
Q

How do you check for thrills?

A

Medial border of hand over valve locations.

49
Q

What is dextrocardia?

A

Apex of heart situated on the right hand side of the body.

50
Q

What is a thrill?

A

Transmitted murmur.

51
Q

What do check when auscultating?

A

Carotid pulse

52
Q

What is the easiest order for the patient when auscultating?

A

1) Mitral (+axilla)
2) Tricuspid
3) Pulmonary
4) Aortic (+carotid)

53
Q

Where do you auscultate the mitral valve?

A

5th intercostal; mid-clavicular.

54
Q

Where do you auscultate the tricuspid valve?

A

4th intercostal; left sternal edge.

55
Q

Where do you auscultate the pulmonary valve?

A

2nd intercostal; left sternal edge.

56
Q

Where do you auscultate the aortic valve?

A

2nd intercostal; right sternal edge.

57
Q

How do you auscultate the mitral valve?

A

Localise apex beat with finger, place stethoscope, roll patient left (accentuates), then check for radiation in axilla, then listen with bell on expiration.

58
Q

What does radiation in the axilla indicate?

A

Mitral regurgitation.

59
Q

What does listening in the axilla on expiration with the bell let you hear?

A

Low tone mitral stenosis

60
Q

How do you auscultate the aortic valve?

A

Listen with patient lying, then sit up and forward, on expiration, then over right carotid artery for radiation.

61
Q

What does a carotid bruit indicate when auscultating?

A

Aortic stenosis
Atherosclerosis (old)
Vasculitis (young)

62
Q

Systolic or diastolic murmurs radiate?

A

Systolic

63
Q

Systolic or diastolic murmurs require manoeuvring as they are quiet?

A

Diastolic

64
Q

Ausculate lung bases for crackles, what does this indicate?

A

Pulmonary odema

65
Q

2 causes of ankle/sacral oedema?

A

Right ventricular failure

Hypoalbuminaemia

66
Q

How would you detect Roth’s spots

A

Fundoscopy

67
Q

What do Roth’s spots indicate?

A

Infective endocarditis

68
Q

How would you complete this exam?

A

Peripheral pulses, O2 sats, dipstick urine, fundoscopy, look at observation charts, feel for hepatomegaly.

Physical Examinations (2 decks)

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