clinical exam Flashcards
General inspection
Bedside
– treatments or adjuncts? – GTN spray / O2 / medication / mobility aids
Check the patient is comfortable at rest
Malar flush – plum red discolouration of cheeks – may suggest mitral stenosis
Inspect chest – scars or visible pulsations?
Inspect legs – scars from saphenous vein harvest for CAGB / peripheral oedema / missing limbs or toes
What to check at end of bed?
SOB, cyanosis, pallor, oedema
What to look for on hands
split haemorrhages, finger clubbing, temp of hands, colour, capillary refill time, janeway lesions, oslers nodules
What does finger clubbing represent
infective endocarditis, cyanotic congenital heart disease
what do janeway lesions and olser nodules represent?
Janeway - bacterial endocardtis
Olser - infective endocarditis
radial radial delay
-can suggest aoritc coarctatin
what does collapsing pulse represent
aortic regurgitation
What does aortic stenosis and aortic regurgitation look like on BP
aortic stensois - small pulse pressure
Aortic regurgitation - large pulse pressure
what can carotid pulse look tell us?
slow rising character - aortic stenosis
What does a raised JVP tell us?
fluid overload / right ventricular failure / tricuspid regurgitation
What to look at on face?
Eyes
Conjunctival pallor – anaemia – ask the patient to gently pull down their lower eyelid
Corneal arcus – yellowish/grey ring surrounding the iris – hypercholesterolaemia
Xanthelasma – yellow raised lesions around the eyes – hypercholesterolaemia
Mouth
Central cyanosis – bluish discolouration of the lips and/or the tongue
Angular stomatitis – inflammation of the corners of the mouth – iron deficiency
High arched palate – suggestive of Marfan syndrome – ↑ risk of aortic aneurysm/dissection
Dental hygiene – important if considering sources for infective endocarditis
What to look at on sternum
- chest wall deformities
- (pectus excavatum, pectus carinatum)
What does displaced apex beat represent?
cardiomegaly
when can a parasternal heave be felt?
right ventricular hypertrophy
