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CARDIOVASCULAR MEDICINE > CARDIOVASCULAR EXAMINATION > Flashcards

CARDIOVASCULAR EXAMINATION Flashcards

1
Q

How would you start any examination?

A 
WIPER QQ
Wash hands
Introduce yourself
Ask permission
Expose the patient
Reposition the patient

Ask if they are in any pain or discomfort

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2
Q

How exposed should the patient be for the cardiovascular examination?

A

Top half of their body fully exposed

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3
Q

How should the patient be positioned for the cardiovascular examination?

A

Lying down at 45 degrees

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4
Q

What are you looking for from the end of the bed at the beginning of your cardiovascular examination?

A 
Is patient well within themselves
Obvious cyanosis
Respiratory rate
Flushed
ECG leads
GTN spray
Oxygen mask
PCA (patient controlled analgesia) machine
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5
Q

What are you looking for in the hands during a cardiovascular examination?

A 
Peripheral cyanosis
Warmth
Clamminess
Nail clubbing
Splinter haemorrhages
Osler's nodes
Janeway lesions
Palmar erythema
Nicotine staining
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6
Q

What are the cardiovascular causes of clubbing?

A 
Any disease featuring chronic hypoxia
Congenital cyanotic heart disease 
Subacute bacterial endocarditis
Atrial myxoma (benign tumor)
Tetralogy of Fallot
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7
Q

What is the most common cardiac cause of clubbing?

A

Congenital cyanotic heart disease

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8
Q

What can splinter haemorrhages, Osler’s nodes and Janeway lesions all be a sign of?

A

Infective endocarditis

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9
Q

Describe a Janeway lesion.

A

Non-tender, small erythematous or haemorrhagic macular or nodular lesion on the palm or sole only a few millimeters in diameter.

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10
Q

Describe an Osler’s node.

A

Painful, red, raised lesion found on the hands and feet.

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11
Q

Other than infective endocarditis, what might Osler’s nodes signify?

A

Systemic lupus erythematosus
Marantic endocarditis
Disseminated gonococcal infection
Distal to infected arterial catheter

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12
Q

Describe splinter haemorrhages.

A

Tiny blood clots that tend to run vertically under the nails

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13
Q

Other than infective endocardities, what might the presence of splinter haemorrhages signify?

A 
Scleroderma
Trichinosis 
Systemic lupus erythematosus (SLE)
Rheumatoid arthritis
Psoriatic nails
Antiphospholipid syndrome
Haematological malignancy
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14
Q

What is palmar erythema?

A

Reddening of the palms at the thenar and hypothenar eminences

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15
Q

What is palmar erythema a sign of?

A 
Portal hypertension
Chronic liver disease
Pregnancy
Polycythemia
Thyrotoxicosis
Rheumatoid Arthritis
Eczema and Psoriasis
Deep telangiectasias
Coxsackievirus A infection 
Secondary Syphilis
Kawasaki disease - vasculitis
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16
Q

What two things is it important to take note of when feeling the radial pulse?

A

Rate

Rhythm

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17
Q

How do you assess whether the patient has a collapsing pulse?

A

Locate the radial pulse and place your palm over it, then raise the arm above the patient’s head. A collapsing pulse will present as a knocking on your palm.

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18
Q

What must you ask the patient before checking for a collapsing pulse?

A

Whether the patient has any shoulder pain

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19
Q

What is a collapsing pulse a sign of?

A

Aortic incompetence (regurgitation)

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20
Q

What might you look for on the extensor aspect of the elbow during a cardiovascular examination?

A

Xanthomata

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21
Q

What are xanthomas a sign of?

A

Hypercholesterolemia

Hyperlipidemia

22
Q

Why must you check the brachial pulse as well as the radial pulse?

A

The radial pulse cannot be used to assess character of the pulse

23
Q

How might the character of the pulse be abnormal?

A

Weak
Bounding
Abnormalities in the form of the pulse wave (e.g. double wave in mild aortic stenosis)

24
Q

What would you tell the examiner that you would like to assess having checked the brachial pulse?

A

Blood pressure

25
Q

What would you look for in the neck during a cardiovascular exam?

A

Jugular venous pressure

Carotid pulse

26
Q

What might a raised JVP be a sign of?

A

Right sided heart failure

Hypervolaemia

27
Q

Should the JVP naturally go and up with breathing?

A

Yes, there should be a decrease in the JVP with inspiration.

28
Q

What is the Kussmaul sign?

A

This is when the JVP paradoxically increases during inspiration. It is indicative of limited right ventricular filling.

29
Q

What is the test that you can do if you are struggling to see the JVP?

A

The hepato-jugular reflex. Press firmly over the right upper quadrant of the abdomen for 10 seconds. Patient must not perform the Valsava maneuver. You are looking at the JVP once you have removed your hand.

30
Q

Where would the JVP be found?

A

Between the two heads of the sternocleidomastoid.

31
Q

How can you discern whether the pulsation you are seeing is the JVP or the carotid?

A

The JVP is a non palpable pulsation.

32
Q

What might you be looking for in and around the eyes of the patient during a cardiovascular exam?

A

Conjunctival pallor as a sign of anaemia.
Corneal arcus
Xanthelasma

33
Q

What is corneal arcus a sign of?

A

Hypercholesterolemia

34
Q

What are you looking for in the mouth of the patient during a cardiovascular exam?

A

Glossitis
Central cyanosis
Angular stomatitis

35
Q

What might glossitis be a sign of?

A

Anaemia

36
Q

What is angular stomatitis

A

Anaemia

37
Q

What are you looking for on the precordium during inspection?

A

Pulsations
Abnormalities such as pectus excavatum
Scars

38
Q

What is pectus excavatum?

A

Most common congenital deformity of anterior chest wall. The chest wall has a caved-in or sunken appearance. It can impair both cardiac and respiratory function. It is associated with Marfan’s syndrome and Ehler’s Danlos syndrome.

39
Q

If you see a scar from a sternotomy, what other body part could you check to help you make a discern what procedure this scar was a result of?

A

A scar on the leg would tell you that the sternotomy was probably as a result of a CABG.

40
Q

Where would you look for the apex beat?

A

5th intercostal space

Mid-clavicular line

41
Q

What is a thrill?

A

A palpable murmur

42
Q

What is a heave a sign of?

A

Left ventricular hypertrophy

43
Q

Where would you listen to the mitral valve?

A

5th intercostal space

Mid-clavicular line

44
Q

Where would you listen to the tricuspid valve?

A

4th intercostal space

Left sternal edge

45
Q

Where would you listen to the pulmonary valve?

A

2nd intercostal space

Left sternal edge

46
Q

Where would you listen to the aortic valve?

A

2nd intercostal space

Right sternal edge

47
Q

What should do with the hand not holding the stethoscope?

A

Feel for the carotid pulse to distinguish between the two heart sounds

48
Q

Do you feel S1 or S2 in the carotid?

A

S1

49
Q

What maneuver could you do to check for mitral stenosis?

A

Lay the patient on their left side, ask them to breathe in, out and then to hold. You should then listen at the apex and the axilla with the bell of the stethoscope.

50
Q

What maneuver could you do to check for aortic regurgitation?

A

Ask the patient to sit forward. Ask them to breathe in, out and hold. You should then listen over the aortic region with the diaphragm.

51
Q

How should you finish your cardiovascular examination?

A

Check peripheral pulses
Check for sacral and ankle oedema
Check the lung bases for reduced breath sounds.

52
Q

If you have found any abnormalities, what tests might you say you would like to arrange?

A

ECG

Echocardiogram

CARDIOVASCULAR MEDICINE (15 decks)

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