Cardiovascular Examination

Question 1

what should be looked for in general inspection in CV exam?

Answer 1

patient: well/unwell, comfortable, alert, breathless, pallor, cyanosis
around bed: oxygen, medication, IV infusions

Question 2

what should be checked for on the hands?

Answer 2

perfusion: temperature, CRT, peripheral cyanosis
nails: clubbing, splinter haemorrhages, Quincke’s sign
dorsum: extensor tendon xanthomata
palms: osler nodes, janeway lesions

Question 3

what should be checked on the arms

Answer 3

inspect for bruising
radial pulse (rate, rhythm, radio-radial delay)
collapsing pulse

Question 4

what should be check on head and neck?

Answer 4

face
eyes
mouth
neck

Question 5

what may be seen in the face?

Answer 5

malar flush

Question 6

what may be seen in the eyes?

Answer 6

conjunctival pallor/haemorrhages
corneal arcus
xanthelasma

Question 7

what may be seen in the mouth?

Answer 7

central cyanosis under tongue
petechial haemorrhages
poor dental hygiene
high arches palate

Question 8

what may be seen in the neck?

Answer 8

JVP
hepatojugular reflex test
carotid pulse

Question 9

what disease is associated with Mitral regurgitation, aortic regurgitation and mitral prolapse?

Answer 9

marfan’s syndrome

Question 10

what disease is associated with aortic stenosis?

Answer 10

turner’s syndrome

Question 11

what disease is associated with congential heart disease?

Answer 11

Down’s syndrome

Question 12

what does a CRT >2s indicated

Answer 12

hypoperfusion

Question 13

what disease may cause clubbing

Answer 13

cyanotic congential heart disese

infective endocarditis

Question 14

what disease may cause splinter haemorrhages?

Answer 14

infective endocarditis

Question 15

what is Quincke’s sign?

Answer 15

visible pulsations in the nails

Question 16

what disease may cause Quincke’s sign?

Answer 16

aortic regurgitation

Question 17

what is extensor tendon xanthomata

Answer 17

irregular nodules overlying tendons

Question 18

what may cause extensor tendon xanothomata?

Answer 18

hyperlipidemia

Question 19

what are Osler’s nodes

Answer 19

painful purple papules on pulps

Question 20

what may cause Osler’s nodes?

Answer 20

infective endocarditis

Question 21

what are Janeway lesions?

Answer 21

erythematous macules on palms

Question 22

what may cause Janeway lesions?

Answer 22

infective endocarditis

Question 23

what does bruising on arms suggest?

Answer 23

anticoagulation

Question 24

what does a radio-radial delay in pulse suggest?

Answer 24

aortic dissection/ aneurysm

or proximal coarctation

Question 25

how do you measure a collapsing pulse?

Answer 25

while feeling the radial pulse quickly lift their arm up check for shoulder pain first a strong tapping is felt when arm elevated

Question 26

what are the causes of a collapsing pulse?

Answer 26

classically aortic regurgitation patient ductus arteriosus high output states (anaemia, thyrotoxicosis) physiological states (pregnancy, fever)

Question 27

what does a wide pulse pressure in BP suggest?

Answer 27

aortic regurgitation

Question 28

what does a narrow pulse pressure in BP suggest?

Answer 28

aortic stenosis

Question 29

what disease may cause malar flush?

Answer 29

mitral stenosis

Question 30

what may cause conjunctival pallor?

Answer 30

anaemia

Question 31

what may cause conjuntival haemorrhages?

Answer 31

infective endocarditis

Question 32

what may cause xanthelasma?

Answer 32

hyperlipidaemia

Question 33

what is xanthelasma?

Answer 33

periorbital yellow plaques

Question 34

what is central cyanosis under tongue a sign of?

Answer 34

hypoxia

Question 35

what cause petecial haemorrhages?

Answer 35

infective enodcarditis

Question 36

what is poor dental hygiene a risk for?

Answer 36

infective endocarditis

Question 37

what disease does a high arched palate suggest?

Answer 37

marfan's syndrome

Question 38

how do you meausre JVP?

Answer 38

turn head slightly and look for double pulsation of internal jugular vein up to 3cm above sternal angle is normal

Question 39

what are some causes of a raised JVP?

Answer 39

``` PQRST pulmonary hypertension/ Pulmonary emolism/ pulmonary stenosis/pericardial effusion quantity of fluid i.e overload right ventricular failure SVC obstruction tamponade/ tricuspid regurgitation ```

Question 40

how do you carry out the hepatojugular reflex test?

Answer 40

apply pressure over RUQ while observing JVP | transient rise= normal

Question 41

what does a sustained rise in JVP with hepatojugular reflex test suggest?

Answer 41

right ventricular failure

Question 42

what does a slow rising low volume carotid pulse suggest?

Answer 42

aortic stenosis

Question 43

what does a bounding/ collapsing carotid pulse suggest?

Answer 43

aortic regurgitation or patent ductus arteriosus

Question 44

what is Corrigan's sign?

Answer 44

visible carotid pulsation

Question 45

what is Corrigan's sign a sign of?

Answer 45

aortic regurgitation

Question 46

what is Musset's sign?

Answer 46

head bobbing in time with pulse

Question 47

what is Musset's sign a sign of?

Answer 47

aortic regurgitation

Question 48

what may cause an impalpable apex beat?

Answer 48

``` DOPE dextrocardia obese pericaridal effusion emphysema ```

Question 49

what may cause a displaced apex beat?

Answer 49

LV dilation cardiomegaly mediastinal shift

Question 50

what may cause parasternal heave and thrills?

Answer 50

pulmonary hypertension

Question 51

how do you auscultate the aortic valve?

Answer 51

2nd ICS | right sternal edge