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Year 3 Examinations > Cardiovascular Examination > Flashcards

Cardiovascular Examination Flashcards

1
Q

What should you try notice in the patient upon general inspection during a cardiovascular examination? (3)

A

Dyspnoea, pallor or cyanosis

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2
Q

What sign shows clubbing?

A

Schamroth’s sign

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3
Q

What is Schamroth’s sign used to diagnose?

A

Clubbing

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4
Q

What should you inspect the finger nails for during a cardiovascular examination?(2)

A

Splinter haemorrhages and clubbing

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5
Q

What are splinter haemorrhages a sign of? (2)

A

Infective endocarditis or trauma

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6
Q

What should you examine the dorsum of the hands for? (6)

A 
Xanthomata
Osler nodes
Janeway lesions
Temperature and colour of skin
Capillary refill time
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7
Q

Difference between Janeway lesions and Osler nodes? (4)

A

Osler: on fingers, painful, raised nodules
Janeway: on palms, flat, red macules

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8
Q

What are xanthomata associated with?

A

Hypercholesterolaemia and elevated LDL levels

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9
Q

What is a normal capillary refill time?

A

Less than 3 seconds

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10
Q

What can cause poor perfusion and a high capillary refill time?(4)

A

Hypovolaemia, hypothermia, peripheral vascular disease or just cool peripheries
(with associated vasoconstriction).

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11
Q

What are Janeway lesions associated with?

A

Infective endocarditis

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12
Q

What are Osler’s nodes associated with?

A

Infective endocarditis

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13
Q

When is a pulse described as bounding?

A

If it has an increased up-stroke and down-stroke

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14
Q

What is a bounding pulse a sign of?

A

CO2 retention

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15
Q

What type of pulse is associated with CO2 retention?

A

Bounding

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16
Q

When is a pulse described as slow-rising?

A

If it has a delayed up-stroke

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17
Q

What is a slow-rising pulse a sign of?

A

Aortic stenosis

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18
Q

What is a jerky pulse a sign of?

A

Hypertrophic cardiomyopathy

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19
Q

What type of pulse is associated with hypertrophic cardiomyopathy?

A

Jerky

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20
Q

What type of pulse is associated with aortic stenosis?

A

Slow-rising

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21
Q

What is radio-radial delay?

A

Inequality in timing between the two radial pulses

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22
Q

What is radio-radial delay a sign of?

A

Aortic coarctation

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23
Q

What is strength inequality of pulses a sign of?

A

Aortic dissection

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24
Q

What characteristic of pulses is associated with aortic dissection?

A

Radio-radial strength inequality

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25
Q

What characteristic of pulses is associated with aortic coarctation?

A

Radio-Radial and radio-femoral delay

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26
Q

What type of pulse is associated with aortic regurgitation?

A

Water hammer/collapsing pulse

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27
Q

What does a small pulse pressure indicate?

A

Aortic stenosis

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28
Q

What does a large pulse pressure indicate?

A

Aortic regurgitation

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29
Q

What pulse pressure indicates aortic stenosis?

A

Narrow

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30
Q

What pulse pressure indicates aortic regurgitation?

A

Wide

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31
Q

What should a full cardiovascular examination involve regarding blood pressure?

A

Checking lying and standing blood pressure to check for a postural hypotension

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32
Q

What is a postural drop in blood pressure quantified as?

A

A fall on standing of greater than 15mmHg in systolic BP or 10mmHg diastolic

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33
Q

What is conjunctival pallor a sign of?

A

Anaemia

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34
Q

What should you examine the face for in a cardiovascular examination? (6)

A 
Xanthelasma
Senile arcus
Conjunctival pallor
Central cyanosis under tongue and in the skin
Petechiae in mucosa of mouth
Dental hygiene
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35
Q

What signs of hyperlipidaemia are in the face? (2)

A

Xanthelasma and senile arcus

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36
Q

What are xanthelasma a sign of?

A

Hyperlipidaemia

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37
Q

What is senile arcus a sign of?

A

Hyperlipidaemia

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38
Q

What causes a blue colour to the skin and below the tongue?

A

Hypoxia

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39
Q

Where do you check for hypoxia?

A

Below the tongue and in the skin

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40
Q

What signs of infective endocarditis are in the face? (2)

A

Petechiae in the mucosa of the mouth and poor dental hygiene

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41
Q

What can be used to provide a measure of the central venous pressure?

A

Jugular veinous pulse/pressure

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42
Q

How can we illicit the JVP to be more obvious?

A

Hepatojugular reflux

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43
Q

What height of JVP is a sign of right ventricular failure?

A

4cm or greater throughout the hepatojugular reflux

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44
Q

What is Kussmaul’s sign?

A

A paradoxical increase in the JVP with inspiration

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45
Q

What conditions can cause Kussmaul’s sign?(2)

A

Constrictive pericarditis or cardiac tamponade

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46
Q

What can the JVP used to help diagnose? (3)

A

Right ventricular failure
Constrictive pericarditis
Cardiac tamponade

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47
Q

After looking at the JVP what should you look at?

A

Carotid pulse

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48
Q

What cardiovascular causes of clubbing are there? (3)

A

Infective endocarditis
Cyanotic congenital heart disease
Atrial myxoma

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49
Q

What does a median sternotomy scar indicate?(2)

A

Previous valve surgery or a coronary artery by-pass graft.

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50
Q

What should you inspect the precordium for? (4)

A

Scars (median sternotomy, lateral thoracotomy)
Cardiac pacemaker
Defibrillator
Visible cardiac impulses

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51
Q

Which direction of displacement of the apex beat suggests cardiomegaly?

A

Infero-laterally

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52
Q

What are the three characters of the apex beat?

A

Normal/pressure-overloaded/volume-overloaded

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53
Q

What may cause a pressure overloaded apex beat? (?)

A

Aortic stenosis or hypertension

54
Q

What may cause a volume overloaded apex beat? (?)

A

Mitral regurgitation, dilated cardiomyopathy or ventricular damage due to ischaemic heart disease

55
Q

What does an infero-lateral displacement of the apex beat indicate?

A

Cardiomegaly

56
Q

Which types of pulse is palpable at the apex?(2)

A

Tapping

Double impulse

57
Q

Which type of apex beat can indicate aortic stenosis?

A

Pressure overloaded

58
Q

Which type of apex beat can indicate hypertension?

A

Pressure overloaded

59
Q

Which type of apex beat can indicate mitral regurgitation?

A

Volume overloaded

60
Q

Which type of apex beat can indicate dilated cardiomyopathy?

A

Volume overloaded

61
Q

Which type of apex beat can indicate ventricular damage due to ischaemic heart disease?

A

Volume overloaded

62
Q

Which type of apex beat feels heaving, sustained and forceful?

A

Pressure overloaded

63
Q

Which type of apex beat feels diffuse and displaced laterally and/or inferiorly?

A

Volume overloaded

64
Q

How does a pressure overloaded apex beat feel?

A

Heaving, sustained and forceful

65
Q

How does a volume overloaded apex beat feel?

A

Diffuse and displaced laterally and/or inferiorly

66
Q

What type of apex beat is associated with mitral stenosis?

A

Tapping apex beat

67
Q

What type of apex beat is associated with hypertrophic cardiomyopathy?

A

Double impulse

68
Q

What disease is a double impulse apex beat associated with?

A

Hypertrophic cardiomyopathy

69
Q

What disease is a tapping apex beat associated with?

A

Mitral stenosis

70
Q

How can you detect right ventricular hypertrophy?

A

Place the heel of your hand over the lower left sternal edge and feel for a right ventricular heave as a push against your hand

71
Q

What does placing the heel of your hand over the lower left sternal edge and feeling for a right ventricular heave suggest?

A

Right ventricular hypertrophy

72
Q

How do you feel for cardiac thrills?

A

By systematically placing the flat of your hand over the apex (mitral valve area), lower left sternal edge (tricuspid valve area), right 2nd intercostal space (aortic valve area) and left 2nd intercostal space (pulmonary valve area).

73
Q

What order should you auscultate the heart valves in?

A

Mitral tricuspid aortic pulmonary

74
Q

What does auscultating over the carotid arteries help identify? (2)

A

Aortic stenosis and stenotic carotid bruit

75
Q

What does auscultating over the left axilla help identify?

A

Mitral regurgitation

76
Q

Where should you auscultate for aortic stenosis?

A

Over the carotid arteries

77
Q

Where should you auscultate for mitral regurgitation?

A

Left axilla

78
Q

How do differentiate between the murmur of aortic stenosis and stenotic carotid bruit?

A

by identifying the site of the sound’s maximal intensity; stenotic carotid bruits are heard loudest above the thyroid cartilage, aortic stenosis over the precordium.

79
Q

Which heart sound is caused by closure of the AV valves?

A

S1

80
Q

Which heart sound is caused by closure of the semi-lunar valves?

A

S2

81
Q

What causes the S1 heart sound?

A

Closure of the AV valve

82
Q

What causes the S2 heart sound?

A

Closure of the semi-lunar valve

83
Q

When does physiological splitting of S2 increase?

A

Upon end of inspiration

84
Q

What are the pathological splittings of S2 known as? (3)

A

Wide splitting
Fixed splitting
Reverse splitting

85
Q

What is wide S2 splitting?

A

Exaggerated physiological splitting

86
Q

What is fixed S2 splitting?

A

Unaffected by inspiration

87
Q

What is reverse S2 splitting?

A

Widens in expiration

88
Q

What type of S2 splitting widens in expiration?

A

Reverse splitting

89
Q

What type of S2 splitting is unaffected by respiration?

A

Fixed splitting

90
Q

What type of S2 splitting is exaggerated physiological splitting?

A

Wide splitting

91
Q

What does the cadence of S1, 2 and 3 resemble?

A

Ken-tuck-y

92
Q

When does S3 occur?

A

Occurs in early diastole, just after S2

93
Q

Where is S3 best heard?

A

Over the apex

94
Q

What pitch is S3?

A

Low-pitched

95
Q

What does the presence of S3 indicate? (3)

A

Left ventricular failure,

mitral regurgitation or high output cardiac states

96
Q

When is S3 physiological?

A

In the young

97
Q

What does the cadence of S1, 2 and 4 resemble?

A

Ten-nes-see

98
Q

When does S4 occur?

A

In late-diastole, immediately before S1

99
Q

What does the presence of S4 indicate?

A

Poorly compliant ventricle

100
Q

What is S4 associated with? (3)

A

Aortic stenosis, hypertension and left ventricular failure

101
Q

What is a high-pitched ringing sound heard in early systole shortly after S1 known as?

A

Ejection click

102
Q

What does an ejection click sound like and when does it occur?

A

A high-pitched ringing sound heard in early systole shortly after S1

103
Q

What is an ejection click associated with?

A

Aortic or pulmonary stenosis

104
Q

What causes the ejection click?

A

Sudden opening of the deformed valve

105
Q

What is a mid-systolic click associated with?

A

Mitral valve prolapse

106
Q

What is a mid-systolic click often followed by?

A

A late systolic murmur

107
Q

What is an opening snap in early diastole associated with?

A

Mitral stenosis

108
Q

What causes the opening snap in early diastole in mitral stenosis?

A

The rapid opening of a stenosed but pliable mitral valve under high left atrial pressure

109
Q

What does the sound of pericardial friction rub sound like?

A

Walking on snow

110
Q

What is the sound resembling walking on snow throughout the cardiac cycle caused by?

A

Pericardial friction rub by pericarditis

111
Q

What causes pericardial friction rub?

A

Pericarditis

112
Q

What does pericarditis cause that can be auscultated?

A

Pericardial friction rub

113
Q

What should you assess when detecting a murmur?

A

Timing, site of greatest intensity, character, loudness, and radiation

114
Q

How do you assess the investing of a murmur?

A

Levine’s grading system

115
Q

Which is the most important feature of a murmur?

A

Timing

116
Q

Expiration accentuates left or right murmurs?

A

Left

117
Q

Inspiration accentuates left or right murmurs?

A

Right

118
Q

What are you auscultating for when you auscultate the apex whilst the patient holds their breath on expiration on their side?

A

Mid diastolic murmur of mitral stenosis

119
Q

What are you auscultating for when you auscultate the lower left sternal edge whilst the patient holds their breath on expiration whilst sitting forward?

A

The accentuated early diastolic murmur of aortic regurgitation

120
Q

Right sided murmurs are accentuated by inspiration or expiration?

A

Inspiration

121
Q

Left sided murmurs are accentuated by inspiration or expiration?

A

Expiration

122
Q

A pansystolic murmur that increases in intensity in expiration is most likely due to…?

A

Mitral regurgitation

123
Q

A pansystolic murmur that increases in intensity in inspiration is most likely due to…?

A

Tricuspid regurgitation

124
Q

What are fine inspiratory crackles auscultated from the lung bases indicative of?

A

Heart failure

125
Q

What is pulsus paradoxus?

A

Defined as an inspiratory decline in systolic BP that exceeds 10mmHg, but a more appropriate threshold may be 12mmHg

126
Q

What should you always check for in patients with suspected pericardial disease?

A

Pulsus paradoxus

127
Q

Which patients should you always check for pulsus paradoxus?

A

Patients with suspected pericardial disease

128
Q

What is pulsus paradoxus a sign of?

A

Cardiac tamponade

129
Q

What sign strongly indicates cardiac tamponade?

A

Pulsus paradoxus

130
Q

What is a water hammer pulse associated with?

A

Atrial regurgitation

Year 3 Examinations (5 decks)

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