Clinical Skills

Question 1

What abnormalities may be seen on inspection in precordial examination?

Answer 1

Pectus excavatum
Pectus carinatum
Scars indicating surgery
Visible pulsations
Pacemaker

Question 2

What are ‘thrills’? and how do you feel for them?

Answer 2

A palpable vibration associated with an underlying cardiac murmur
Lying hand flat in a transverse position with the fingers over the relevant area

Question 3

Where should you feel for thrills in a precordial examination?

Answer 3

4 auscultation areas

Question 3

What is a heave and how is it palpated?

Answer 3

Palpable precordial impulse causing an upward push
Place hand flat on the chest vertically in the left parasternal region

Question 4

What would the presence of a parasternal heave indicate?

Answer 4

Ventricular hypertrophy

Question 5

What is cardiomegaly?

Answer 5

Displacement laterally of the apex beat by enlargement of the heart

Question 6

What can cause cardiomegaly?

Answer 6

Congestive heart failure
Valvular heart disease
Cardiomyopathy

Question 7

What type of apex beat may indicate left ventricular hypertrophy?

Answer 7

Forcible and sustained

Question 8

What are the palpation aspects of a precordium exam?

Answer 8

Heaves and thrills
Apex beat

Question 9

What are the 4 areas of cardiac auscultation

Answer 9

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

Question 10

What valves close to create the first heart sound?

Answer 10

Mitral
Tricuspid

Question 11

What valves close to create the second heart sound?

Answer 11

Aortic
Pulmonary

Question 12

What are you listening for in precordium auscultation?

Answer 12

Splitting of heart sounds
Added heart sounds
Murmurs

Question 13

What are murmurs?

Answer 13

Noises caused by turbulent blood flow in the heart

Question 14

Where is aortic stenosis best heard?

Answer 14

Aortic area

Question 15

Why are the carotids auscultated?

Answer 15

Listen for any radiating sounds

Question 16

What manoeuvre accentuates aortic regurgitation?

Answer 16

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

Question 17

Describe the murmur associated with aortic regurgitation.

Answer 17

Soft, high pitched, early diastolic

Question 18

What manoeuvre accentuates the murmur of mitral stenosis?

Answer 18

Roll onto left hand side no breath hold required
Listen at mitral region

Question 19

Describe the murmur associated with mitral stenosis.

Answer 19

Low pitched and rumbling

Question 20

Name the pulses of the lower limb

Answer 20

Femoral
Popliteal
Posterior tibial
Dorsalis pedis

Question 21

What is buergers test?

Answer 21

Lift the legs 45 degrees and hold ~2 minutes
Turn to sit with legs over edge of bed
Positive would be colour change

Question 22

What is telangiectasia?

Answer 22

Small widened blood vessels on the skin

Question 23

What is haemosiderin deposition?

Answer 23

Areas of darkened or discoloured skin on the legs by deposition of a haemoglobin breakdown product

Question 24

What is lipodermatosclerosis?

Answer 24

Chronic inflammatory condition caused by venous insufficiency causes thickening and hardening of the skin on the lower legs

Question 25

What is corona phlebectatica?

Answer 25

Fanned out discoloured veins around the ankle area