Clinical Skills Flashcards
What abnormalities may be seen on inspection in precordial examination?
Pectus excavatum
Pectus carinatum
Scars indicating surgery
Visible pulsations
Pacemaker
What are ‘thrills’? and how do you feel for them?
A palpable vibration associated with an underlying cardiac murmur
Lying hand flat in a transverse position with the fingers over the relevant area
Where should you feel for thrills in a precordial examination?
4 auscultation areas
What is a heave and how is it palpated?
Palpable precordial impulse causing an upward push
Place hand flat on the chest vertically in the left parasternal region
What would the presence of a parasternal heave indicate?
Ventricular hypertrophy
What is cardiomegaly?
Displacement laterally of the apex beat by enlargement of the heart
What can cause cardiomegaly?
Congestive heart failure
Valvular heart disease
Cardiomyopathy
What type of apex beat may indicate left ventricular hypertrophy?
Forcible and sustained
What are the palpation aspects of a precordium exam?
Heaves and thrills
Apex beat
What are the 4 areas of cardiac auscultation
Aortic - 2nd intercostal space right sternal age
Pulmonary - 2nd intercostal space left sternal edge
Tricuspid - 4th intercostal space left left sternal edge
Bicuspid - 5th intercostal space mid clavicular line
What valves close to create the first heart sound?
Mitral
Tricuspid
What valves close to create the second heart sound?
Aortic
Pulmonary
What are you listening for in precordium auscultation?
Splitting of heart sounds
Added heart sounds
Murmurs
What are murmurs?
Noises caused by turbulent blood flow in the heart
Where is aortic stenosis best heard?
Aortic area
Why are the carotids auscultated?
Listen for any radiating sounds
What manoeuvre accentuates aortic regurgitation?
Sit upright leaning forwards and breathe fully out then hold breath
Listen at full expiration a the 3rd intercostal space adjacent to left sternal border
Describe the murmur associated with aortic regurgitation.
Soft, high pitched, early diastolic
What manoeuvre accentuates the murmur of mitral stenosis?
Roll onto left hand side no breath hold required
Listen at mitral region
Describe the murmur associated with mitral stenosis.
Low pitched and rumbling
Name the pulses of the lower limb
Femoral
Popliteal
Posterior tibial
Dorsalis pedis
What is buergers test?
Lift the legs 45 degrees and hold ~2 minutes
Turn to sit with legs over edge of bed
Positive would be colour change
What is telangiectasia?
Small widened blood vessels on the skin
What is haemosiderin deposition?
Areas of darkened or discoloured skin on the legs by deposition of a haemoglobin breakdown product
