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Y1S2 > CLIN Cardiovascular Exam > Flashcards

CLIN Cardiovascular Exam Flashcards

1
Q

Process of General Inspection

A

a. Pain/discomfort
b. ‘Noting body habitus’
c. Signs of dysnoea, fatigue or cachexia
d. Congenital abnormalities
e. Hydration

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2
Q

Process of Hand Examination

A

a. Look
i. Fingernails
1. Clubbing
a. Use Schamroth window/diamond test
2. Splinter haemorrhages
ii. Fingertips
1. Peripheral cyanosis
a. Assess colour of nails & fingers
iii. Fingers
1. Osler’s nodes
2. Tendon xanthomata
3. Tar staining
iv. Palm
1. Janeway lesions
b. Feel
i. Cold/sweaty
ii. Capillary return/refill
1. 5 sec pressure

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3
Q

Causes of congenital abnormalities associated with CVS findings

A

Marfan’s, Turner’s, Down’s syndrome

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4
Q

Characteristic of Osler’s nodes and associated condition

A

Painful nodules - may suggest infective endocarditis
Remember fingers more sensitive, therefore painful.

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5
Q

Tendon xanthomata associated condition

A

Hypercholesterolaemia

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6
Q

Characteristic of Janeway lesions and associated condition

A

Non-painful, red, flat lesions on palms - may suggest infective endocarditis
Remember palms less sensitive, therefore not painful.

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7
Q

Radio-radial delay may indicate what associated condition/s

A

Aortic dissection/stenosis

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8
Q

Radio-femoral delay may indicate what associated condition/s

A

Coarctive delay

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9
Q

Process of Wrist Examination

A
  1. Wrists
    a. Palpate
    i. Arterial pulses for 30secs
  2. Rate
  3. Rhythm
    a. Classify as regular/irregular
  4. Radial-radial delay
  5. Radio-femoral delay
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10
Q

Process of Elbow Examination

A
  1. Elbows
    a. Look
    i. Tendon xanthoma
    b. Palpate
    i. Brachial pulse
    c. Measure
    i. Blood pressure
    ii. Temperature & Respiratory Rate
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11
Q

Process of Face Examination

A
  1. Face
    a. Look
    i. Eyes
  2. Pallor of the conjunctiva
  3. Colour of the sclera
  4. Corneal arcus
    ii. Eyelids
  5. Xanthelasma
    iii. Cheeks
  6. Malar flush
  7. Mitral facies (rosy flushed cheeks)
    iv. Mouth
  8. Tongue & inner surface of the lips (use torch & tongue depressor)
    a. Central cyanosis
  9. Inner surface of the lips & palate
    a. High arched palate
    b. Mucous membrane petechiae
  10. Teeth & gums
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12
Q

Pale pallor of conjunctiva may indicate what associated condition/s

A

Anaemia

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13
Q

Yellow discoloration of the sclera may indicate what associated condition/s

A

Jaundice/icterus

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14
Q

Mitral facies may indicate what associated condition/s

A

Mitral stenosis

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15
Q

High arched palate is often associated with what condition

A

Marfan’s syndrome

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16
Q

A wave is associated with what part of heart contraction and is classified as +ve/-ve

A

Atrial contraction. +ve

17
Q

C wave is associated with what part of heart contraction and is classified as +ve/-ve

A

Closure of tricuspid valve & slight bulge into R atrium. +ve

18
Q

X wave is associated with what part of heart contraction and is classified as +ve/-ve

A

Atrial relaxation. -ve (descent)

19
Q

V wave is associated with what part of heart contraction and is classified as +ve/-ve

A

Atrial ‘V’illing. +ve

20
Q

Y wave is associated with what part of heart contraction and is classified as +ve/-ve

A

Atrial emptying. -ve (descent).

21
Q

Process of Neck Examination

A
  1. Neck
    a. Palpate
    i. Carotid artery palpation ONE AT A TIME
  2. Comment on pulse character & volume
  3. Listen for bruits – pt may need to hold breath (use bell)
  4. Note pulse character
    ii. JVP examination
  5. Examine pulsation
  6. Check height (3cm normal )
    a. Place one ruler on sterno-clavicular angle
    b. Point this ruler vertically
    c. Line other ruler up perpendicularly
    d. Note height and angle of bed when measured
  7. Perform abdomino-jugular reflex test
    a. Check if the pt has any abdominal pain first
22
Q

Normal height of JVP

A

<3cm
Remember J V P = 3

23
Q

Process of Precordium Examination

A
  1. Precordium
    a. Inspect
    i. Scars
    ii. Rashes
    iii. Presence of pacemaker/defibrillator box
    iv. Breathing pattern
    v. Thoracic cage abnormalities
  2. Barrel chest
  3. Pigeon chest
  4. Funnel chest
    vi. Apex beat
    vii. Abnormal pulsations
    b. Palpate – pt 45
    i. Apex beat
  5. Locate 2nd intercostal space
  6. Locate apex beat (usually near 5th intercostal space, may help for pt to roll L)
  7. Classify the apex beat as normal, heaving, tapping, double impulse
    ii. Heaves
  8. Place heel of hand over lower L parasternal border .
    iii. Thrills
  9. Place flat of hand over APTM areas
  10. Comment on presence/absence.
    c. Auscultation
    i. Pt at 45
  11. Mitral area (bell then diaphragm)
    a. Lying down first
    b. Then rolls left
  12. Tricuspid area (diaphragm)
  13. Pulmonary area (diaphragm)
  14. Aortic area (diaphragm)
    a. Mention listening to heart sound
    b. Mention presence/absence of murmurs
    c. Mention presence/absence of additional sounds
    ii. Pt at 90
  15. Mitral area (bell then diaphragm)
  16. Tricuspid area (diaphragm)
  17. Pulmonary area (diaphragm)
  18. Aortic area (diaphragm)
    a. Mention listening to heart sound
    b. Mention presence/absence of murmurs
    c. Mention presence/absence of additional sounds
    d. Palpate
    i. Sacral oedema
24
Q

Apex beat may indicate what condition/s

A

Cardiomegaly

25
Q

Apex beat heave may indicate what condition/s

A

L ventricular hypertrophy

26
Q

Apex beat tapping may indicate what condition/s

A

Mitral stenosis

27
Q

Apex beat double impulse may indicate what condition/s

A

Hypertrophic cardiomyopathy

28
Q

Heave over lower L parasternal border may indicate what condition/s

A

R ventricular hypertrophy

29
Q

Inspiration makes what murmurs louder? Expiration makes what murmurs louder?

A

P & T - inspiration makes louder
A & M - expiration makes louder

30
Q

Process of Lower Limb Exam

A
  1. Lower limbs
    a. Inspect
    i. Leg
  2. Hair loss
  3. Skin colour changes
  4. Varicose veins
    ii. Ankle
  5. Ankle oedema
    a. Check how high oedema extends upwards (towards the head)
  6. Achilles tendon xanthomata
    iii. Feet
  7. Ulcers
  8. Janeway lesions
    iv. Toes
  9. Clubbing
  10. Cyanosis
  11. Osler’s nodes
    b. Palpate
    i. Capillary refill
    ii. Temperature
    iii. Peripheral pulses
  12. Femoral
  13. Popliteal
  14. Posterior Tibial
  15. Dorsalis pedis
31
Q

Clinical findings associated with aortic/pulmonary stenosis

A

Early systolic murmur.

32
Q

Clinical findings associated with mitral/tricuspid valve regurgitation

A

Pan systolic murmur

33
Q

Clinical findings associated with mitral/tricuspid valve regurgitation

A

Pan systolic murmur.

34
Q

What valve murmur is heard loudest on auscultation of the apex beat during systole?

A

Mitral valve.

35
Q

Causes of valve murmur during systole

A

Pulmonary and aortic stenosis/
Mitral and tricuspid insufficiency
Remember PASS PAID

36
Q

Causes of valve murmur during diastole

A

Pulmonary and aortic insufficiency/
Mitral and tricuspid stenosis
Remember PASS PAID

Y1S2 (63 decks)

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