Cardiovascular examination signs

Question 1

Clinical signs

Answer 1

• cyanosis
• SOB
• pallor
• malar flush
• oedema

Question 2

objects and equipment

Answer 2

• medical equipment
• mobility aids
• pillows
• vital signs
• fluid balance
• presciptions

Question 3

Hands

Answer 3

• colour
• tar staining
• xanthomata
• arachnodactyly (‘spider fingers’) - sign of marfans

Question 4

Signs in the hands associated with endocarditis?

Answer 4

• splinter haemorrhages
• janeway lesions
• osler’s nodes

Question 5

What do cool hands suggest?

Answer 5

poor peripheral perfusion (e.g. congestive heart failure, ACS)

Question 6

What do cool and sweaty/clammy hands suggest?

Answer 6

ACS

Question 7

What does a cap refill time of greater than 2 suggest?

Answer 7

poor peripheral perfusion e.g. hypovolaemia, congestive heart failure.
* Need to assess central cap refill time

Question 8

What are the causes of radio-radial delay?

Answer 8

• subclavian artery stenosis (e.g. compression by cervical rib)
• aortic dissection
• aortic coarctation

Question 9

Causes of a collapsing pulse?

Answer 9

• normal physiological states (e.g. fever, pregnancy
• cardiac lesions (e.g. aortic regurg, patent ductus arteriosus)
• high output states (e.g. anaemia, arteriovenous fistula, thyrotoxicosis)

Question 10

What is a slow rising pulse associated with?

Answer 10

aortic stenosis

Question 11

What is a bounding pulse associated with?

Answer 11

aortic regurg as well as CO2 retention

Question 12

What is a thready pulse associated with?

Answer 12

intravascular hypovolaemia in conditions such as sepsis

Question 13

What does a raised JVP indicate?

Answer 13

Venous hypertension.

Question 14

Cardiac causes of a raised JVP include?

Answer 14

• right-sided heart failure: commonly caused by left-sided heart failure. Pulmonary hypertension is another cause of right-sided heart failure, often occurring due to chronic obstructive pulmonary disease or interstitial lung disease.
• tricuspid regurgitation: causes include infective endocarditis and rheumatic heart disease.
• constrictive pericarditis: often idiopathic, but rheumatoid arthritis and tuberculosis are also possible underlying causes.

Question 15

What does a positive hepatojugular reflux result suggest?

Answer 15

Right ventricle is unable to accommodate an increased venous return.

Question 16

Conditions that frequently produce a positive hepatojugular reflux test include

Answer 16

• constrictive pericarditis
• right ventricular failure
• left ventricular failure
• restrictive cardiomyopathy

Question 17

Eyes

Answer 17

• conjunctival pallor
• corneal arcus
• xanthelasma
• kayser-fleischer rings

Question 18

Mouth

Answer 18

• central cyanosis
• angular stomatitis
• high arched palate
• dental hygiene

Question 19

Displacement of apex beat suggests what?

Answer 19

Ventricular hypertrophy

Question 20

Parasternal heaves are typically associated with

Answer 20

Right ventricular hypertrophy

Question 21

What is a thrill?

Answer 21

A palpable vibration caused by turbulent blood flow through a heart valve (a thrill is a palpable murmur)

Question 22

Aortic stenosis murmur

Answer 22

Ejection systolic murmur

Question 23

Aortic regurgitation murmur

Answer 23

Early diastolic murmur

Question 24

Mitral regurgitation murmur

Answer 24

Pansystolic murmur - auscultation into the axilla to identify radiation of this murmur

Question 25

Bell of diaphragm: mitral stenosis murmur

Answer 25

Mid-diastolic murmur

Question 26

Coarse crackles

Answer 26

pulmonary oedema (associated with left ventricular failure)

Question 27

Absent air entry and stony dullness on percussion are suggestive of what?

Answer 27

An underlying pleural effusion (associated with left ventricular failure)

Question 28

Pitting pedal oedema

Answer 28

Right ventricular failure

Question 29

Why do you inspect the legs for evidence of saphenous vein harvesting?

Answer 29

It is performed as a part of a coronary artery bypass graft.