Cardiovascular examination

Question 1

What to look for in general inspection of hands?

Answer 1

1. temperature
2. cap refill
3. peripheral cyanosis

Question 2

Name 3 things to inspect on nails?

Answer 2

1. clubbing - sign of congenital heart disease
2. Splinter haemorrhages - Infective endocarditis
3. Quincke’s sign - visible pulsation (aortic regurgitation)

Question 3

Name 1 things to inspect on the dorsum of the hand?

Answer 3

1. Extensor tendon xanthomata - hyperlipidemia

Question 4

3 components of arm examination are what?

Answer 4

1. Inspect for coagulopathy
2. Radial pulse
3. Brachial pulse

Question 5

4 components of examining the radial pulse?

Answer 5

1. Rate
   - > 100 tachycardia / < 60 bradycardia
2. Rhythm
   - irregularly irregular ( AF/ectopics/flutter )
3. Radio radial delay
   - aortic coarction
4. Collapsing pulse
   - aortic regurgitation

Question 6

1 component of examining the brachial pulse?

Answer 6

1. Rate and rhythm
2. Blood pressure
   - wide pulse pressure (AR)
   - narrow pulse pressure (AS)

Question 7

Components of inspection of face

Answer 7

Malar flush - mitral stenosis

Question 8

Eyes

Answer 8

1. Conjunctival pallor - ( anaemia )
2. Corneal arcus - hypercholesterolaemia
3. Xantholasma - hyperlipidaemia

Question 9

Mouth

Answer 9

1. Central cyanosis under tongue (hypoxia)
2. Poor dental hygiene - Infective endocarditis
3. High arched palate - Marfan’s

Question 10

Neck

Answer 10

1. JVP - check for raised JVP, anything above 3 cm above the sternal angle
2. Carotid pulse
   - slow rising / low volume : Aortic stenosis
   - bounding / collapsing = Aortic regurgitation

Question 11

Name 4 causes of raised JVP

Answer 11

QRST

1. Quantity of fluid - fluid overload
2. RVF - right ventricular failure
3. SVC - superior vena cava
4. Tamponade

Question 12

Inspection of the chest

Answer 12

1. Chest deformities - pectus evacutum
2. Scars
3. Visible apex beat

Question 13

Palpation of chest

Answer 13

1. Apex beat position and character
2. Heaves
3. Thrills

Question 14

Auscultation of the chest

Answer 14

1. Auscultate all heart valves with diaphragm whilst simultaneously palpating the carotid pulse

Question 15

where is the aortic valve

Answer 15

2nd intercostal space, right sternal edge

Question 16

where is the pulmonary valve

Answer 16

2nd intercostal space, left sternal edge

Question 17

where is the tricuspid valve

Answer 17

4th intercostal space left sternal edge

Question 18

where is the mitral valve

Answer 18

5th intercostal space mid clavicular line

Question 19

Auscultating for mitral regurgitation

Answer 19

auscultate with bell in the left axilla for radiation

Question 20

Ausculatating for mitral stenosis

Answer 20

roll patient on the left and listen with bell on apex during expiration

Question 21

Ausculatating for aortic regurgitation

Answer 21

Use bell to listen over Erb’s point (3rd intercostal space, left sternal edge) during *expiration+

Question 22

Auscultating for aortic stenosis

Answer 22

Use bell to listen over right carotid artery for radiation of aortic stenosis