Cardiovascular General Examination

Question 1

What is the Cardiovascular General Examination?

Answer 1

This is an general examination of the clinical features seen in the patient, pulse, RR, BP and JVP

Question 2

Name the components which are examined

Answer 2

-End of bed assessment
-Hands- temp, cap refill, radial pulse
-Face
-Eyes
-JVP
-Carotid arteries
-Legs

Question 3

End of Bed Assessment

Answer 3

-General wellness of patient
-Medication, ECG monitor, oxygen, NEWS chart

Question 4

Hands

Answer 4

-Temperature
-Cap Refill (hold for 5 and 2 secs less)
-Tar Staining, finger clubbing, splinter haemhorrages, koilonychia (spooned nails- anaemia)

Question 5

Blood Pressure

Answer 5

-Follow blood pressure measurement steps
-COMPARE BP measurements of BOTH sides

Question 6

Face

Answer 6

-Conjunctival Pallor - anaemia
-Xanthelasma- hypercholesterolemia
-Haemachromatosis- copper ring around the pupil

Question 7

carotid Arteries

Answer 7

-Palpate right and left carotid arteries on both sides of the neck

Question 8

JVP

Answer 8

-Position the patient at 45 degrees angle lying down
-Measure vertical high from the jugular veins pulsation to the sternal angle

Question 9

Pulse and Resp Rate

Answer 9

-Measure the radial pulse, character and volume
-Check for radio-radial delay- the pulse is not in sync on both arms
-Collapsing Pulse- check if patient has pain in their arm and move towards their head

Question 10

How do you safely measure the collapsing pulse?

Answer 10

Place your hand around the right wrist of the patient and palpate the brachial pulse with the other hand.
-Ask the patient if they have pain before raising their arm.
-Raise their arm above their hand and drop back down- tapping impulse is heard in the pulse

Question 11

How can the JVP be made more obvious?

Answer 11

apply pressure to the liver

Question 12

What is a good JVP

Answer 12

less than 2cm

Question 13

Ascultate

Answer 13

Feel:
parasernab heave
base and apex of heart

Percuss:
-Lungs

-Aortic- 2nd intercostal space (right sternum)- find mid clavicular line and below
-Pulmonary- 2nd ICS left
-Tricupsid- 4th ICS (Left)
-Mitral- 5th ICS (Left)- same as Apex

Listen for the back:
-chest signs

ALL PROSTITUTES TAKE MONEY
**MUST push lightly AND very hard down on diaphragm of stethoscope for examiner to see

Question 14

legs

Answer 14

pitting oedema
dot

Question 15

Extra tests

Answer 15

patient lying on left side - listen to mitral valve > mitral stenosis
patient leaning forwards- aortic regurgitation