Cardiovascular Exam

Question 1

What does finger clubbing suggest?

Answer 1

Congenital cyanotic heart disease and endocarditis

Question 2

What are other signs of infective endocarditis found on the hands?

Answer 2

Splinter haemorrhages, Osler’s nodes (tender nodules) and Janeway lesions (red macules on palms)

Question 3

What does radio-femoral delay suggest?

Answer 3

Coarctation of the aorta

Question 4

What does radio-radial delay suggest?

Answer 4

Aortic arch aneurysm

Question 5

When is pulse pressure narrow?

Answer 5

Aortic stenosis and hypovolemia

Question 6

When is pulse pressure wide?

Answer 6

Aortic regurgitation, arteriosclerosis and septic shock

Question 7

What signs are you looking for in the face?

Answer 7

Corneal arcus and xanthelasma - dyslipidemia

Malar flush/mitral facies - mitral stenosis, low cardiac output

Question 8

What causes a heaving apex beat?

Answer 8

Outflow obstruction e.g. Aortic stenosis or systemic hypertension

Question 9

What causes a thrusting apex beat?

Answer 9

Volume overload e.g. Mitral or aortic incompetence

Question 10

What causes a tapping apex beat?

Answer 10

Mitral stenosis

Question 11

What causes a diffuse apex beat?

Answer 11

LV failure, dilated cardiomyopathy

Question 12

What can be seen on fundoscopy in infective endocarditis?

Answer 12

Roth spots

Question 13

What causes bounding pulses?

Answer 13

CO2 retention, liver failure and sepsis

Question 14

What causes small volume pulses?

Answer 14

Aortic stenosis, shock and pericardial effusion

Question 15

What causes collapsing pulses?

Answer 15

Aortic incompetence, patent ductus arteriosus

Question 16

How can you tell the pulse is venous not arterial when assessing the JVP?

Answer 16

Should be impalpable
Rises transiently with pressure on liver or abdomen
Double pulse for every arterial pulse

Question 17

What does the a wave on the JVP waveform show?

Answer 17

Atrial systole

Question 18

What does the c wave on the JVP waveform show?

Answer 18

Closure of tricuspid valve (not normally visible)

Question 19

What does the x descent on the JVP waveform show?

Answer 19

Fall in atrial pressure during ventricular systole

Question 20

What does the v wave on the JVP waveform show?

Answer 20

Atrial filling against a closed tricuspid valve

Question 21

What does the y descent on the JVP waveform show?

Answer 21

Opening of tricuspid valve

Question 22

What can cause a raised JVP?

Answer 22

Fluid overload, right heart failure

Question 23

When may a pathological 3rd heart sound be heard?

Answer 23

Mitral regurgitation, VSD, post MI, dilated cardiomyopathy

Question 24

When may a 4th heart sound be heard?

Answer 24

Aortic stenosis or hypertensive heart disease

Question 25

When would an ejection-systolic murmur (e.g. aortic stenosis) be heard?

Answer 25

Between S1 and S2

Question 26

When would you hear a mitral/tricuspid regurgitation murmur?

Answer 26

Between S1 and S2

Question 27

When would you hear an aortic regurgitation murmur?

Answer 27

Straight after S2

Question 28

How would you listen for mitral regurgitation?

Answer 28

Listen in the axilla

Question 29

How would you listen for mitral stenosis?

Answer 29

Roll patient to left and ask them to breathe out and hold it, then use bell to listen at apex

Question 30

How would you listen for aortic stenosis?

Answer 30

Listen over carotids

Question 31

How would you listen for aortic regurgitation?

Answer 31

Sit patient up and listen at lower left sternal edge with patient held in expiration