Clinical Practice - Cardiology

Question 1

Cardio Exam - General Inspection

Answer 1

-Does the patient look unwell or in pain
-is there signs of respiratory distress
-Do they look cachetic/ chec body habitus
-Are they on cardiac monitoring

Question 2

Cardio Exam - Hands

Answer 2

• Clubbing
• Tar Staining
• Splinter heamorrhages
• Osler’s Nodes
• Janeway lesions
• Tendon Xanthomata
• Peripheral Cyanosis
• Pallor of the Palmar crease
• Capillary refill (less than 2s is normal)

Question 3

Answer 3

Clubbing, Cause by chronically low oxygen levels
Congenital heart disease, infective endocarditis, IBS, Coeliac disease

Question 4

Answer 4

Splinter haemorrhages
Most often due to trauma, but can also be ineffective endocarditis

Question 5

Answer 5

Osler’s Nodes
-sign of ineffective endocarditis

Question 6

Answer 6

Janeway lesions
Sign of ineffective endocarditis

Question 7

Answer 7

Tendon Xanthomata
Sign of hyperlipidemia (type II/high levels of LDLs)

Question 8

Answer 8

Peripheral cyanosis
-Congestive heart failure
-Anemia
-COPD
-Pneumonia

Question 9

Answer 9

Pallor of the Palmar creases
To check push fingers don and then also press down of the creases
Sign of anemia

Question 10

Cardio Examination - Arms

Answer 10

-Radial Pulse (rate and rhythm + Check both at the same time for radio radial delay)
-Respiratory rate
-Blood pressure
-Temp and o2 saturdation

Question 11

Radio-radial delay

Answer 11

When the radiation pulses beat at different times
Causes include: Subcalvain artery stenosis, Aortic dissection, or occlusion due to atherosclerotic plaque

Question 12

Cardio Examination- Face

Answer 12

• Xanthelasma
• Jaundice of the sclera
• Acrus Cornelia’s
• Pallor of the cunjuctivae
• Mitral Facies
• Dentition
• Central Cyanosis
  -High arched palate (Marfan’s syndrome)

Question 13

Answer 13

Xanthelasma
Type II Hyperlipidemia (high LDL) or Type III Hyperlipidemia (increase total cholesterol and triglyceride levels, decreased HDL due to genetics)

Question 14

jaudice of the sclera

Answer 14

Yellow white but of the eyes
-serve congestive heart failure and hepatic congestion, gallstones

Question 15

Answer 15

Arcus Cornealis
-normal with aging
-Cornanry artery disease or high lipid levels

Question 16

Answer 16

Pallor of the conjuctivae
Sign of anemia

Question 17

Answer 17

Mitral facies
Pulmonary hypertension, or low cardiac output such as in mitral stenosis

Question 18

Answer 18

Central cyanosis
COPD, Pneumonia, pulmonary embolism, acute asthma attack
Look under younger for this cheeky little thing

Question 19

Cardio Examination - Neck

Answer 19

-Auscultate each carotid artery for Brewis or radiation of aortic heart mummers with bell
-palpate the carotid pulses, one at a time, take note of character and volume of the pulse
-Measure jugular venous pressure for its height and charater get them to look to their left
-perform the hepatojugular reflex to accentuate
- Press down on the liver (if increases then suggests volume over load

Question 20

Raised JVP

Answer 20

Sign of right sided heart failure
-raised = more than 3cm above sternal angle

Question 21

Cardio Exam- Chest

Answer 21

-General inspection for scars, asymmetry, skeletal abnormalities, pacemakers and defibrillators
Get them to lift arms out to check for scars near armpit
-Palpate the apex beat (5th intercostal space in midclavicular line)
-Palpate for heaves (heel of hand vertically on left sternal edge)
-Palpate for thrills with flats of finger in the 5th ICS MC, 4th ICS LSE, 2nd ICS LSE, 2nd ICS RSE

Question 22

Ausculation cardiac exam

Answer 22

Ausculatate all four regions to assess all valves
-listen for normal heart sounds and murmur
-S1= start of ventricular systole/closing of mitral and tricuspid valves
-S2 = end of systole/closing of aortic and pulmonary valves
-S2 splitting = separation of aortic and pulmonary valve closure
-start at mitral area (5th intercostal space in midclavicular line)
-then tricuspid area (4th inter coastal space left sternal border)
-Pulmonary area (2nd intercostal space left sternal border)
-Aortic area (2nd intercostal space right sternal boarder

Question 23

Heart zones for auscultation

Answer 23

NB: auculatet the tricuspid valve on the eft sternal edge, 4th ICS

Question 24

Dynamic manoeuvres.

Answer 24

Mitral stenosis: get patient to roll over onto left side, and listen over mitral area (5th ICS MC) with bell of stethoscope
Mitral Regurgitation: diaphragm over mitral area during expiration, Patient still on their left side
Aortic regurgitation: patient sit foward and deeply breathe out, listening over the left sternal edge 3ICS with the diaphragm

Question 25

Cardio exam - Back

Answer 25

-percussion over the base of the lungs to listen for dullness of cracking
-palpate the sacrum for any odema (middle of hip)
-Auckland base of lungs for crackles

Question 26

Cardio exam legs

Answer 26

-palpate peripheral pulses (posterior tibial behind ankle in middle side and dorsal pedial post, lateral to the high point behind big toe)
-check for pitting oedema