Clinical Skills Flashcards
Cardiovascular examination of the hands
capillary refill, peripheral cyanosis, xanthomaa, Janeway lesions (not-painful), oeslers nodes (painful), splinter haemorrhages, clubbing
Which lesions are painful?
oslers nodes
What are splinter haemorrhages the result of?
infective endocarditis
Which pulses should be examined in the cardiovascular system?
carotid, brachial, radial
Why would you take blood pressure and pulses on each arm?
to compare any significant differences - these might indicate an aortic dissection or valvuler disorder if difference > 20mmHg
Procedure for checking BP
Wash hands, confirm patient details, inform that it may need to be done more than once, gain consent, inform that this may be withdrawn at any time, do BP, wash hands, thank patient, explain findings
Other pulse issues to be checked in arm?
collapsing pulse - CHECK FOR SHOULDER PAIN
Angle patient should be at during cardiovascular examination
45˚
The JVP should be measured from where?
the sternal angle
Where will the JVP be found?
above the supra-clavicular fossa
How might the JVP be accentuated?
asking the patient to take a deep breath or pressing in an upward motion on the liver
A raised JVP may be indicative of?
RHF, Right valvuler disease
What else should be checked at the carotids?
carotid bruits - ask patient to hold breath if necessary
A collapsing pulse is felt as…
a waterhammer pulsation
Things to report about a pulse (4)
rate, rhythm, character and volume
An irregularly irregular pulse is indicative of?
atrial fibrillation
A bounding pulse may indicate?
CO2 retention, liver failure, sepsis
A visible carotid pulse may indicate?
aortic regurgitation
Corneal arcus is a sign of…
hyperlipidaemia
Xanthelasma is a sign of…
hyperlipidaemia
Grey conjunctiva may indicate…
anemia
Anemia may cause which respiratory symptom?
breathlessness
malar flush can be described as…
butterfly pattern redness on cheek
Malar flush is a result of…
mitral stenosis
What is it important to palpate on the precordium?
the apex beat, heaves and thrills
Where should the apex beat be found?
mid-clavicular line, 5th intercostal space
A displaced apex beat may indicate?
cardiac hypertrophy
A heave is indicative of…
right ventricular enlargement
A heave is likely to be felt at…
the left sternal edge
A thrill is…
a palpable murmur felt as a vibration beneath the hand
Upon auscultation, what should you be listening for?
added sounds, murmurs
A pansystolic murmur heard in the mitral area may radiate where?
axilla
A pansystolic murmer heard in the mitral area is indicative of…
mitral regurgitation
A diastolic murmur heard in the mitral area is indicative of…
mitral stenosis
disease associated with mitral stenosis
rheumatic fever
mitral stenosis may be accentuated by asking the patient to do what?
lie on their left hand side while listening to the apex with the BELL
mitral stenosis may be heard with the…
BELL
in the tricuspid area, a diastolic murmur indicates…
tricuspid stenosis
in the tricuspid area, a pansystolic murmur indicates…
tricuspid regurgitation
the triscupid may be auscultated where?
left sternal edge, 4th intercostal space
The pulmonary valve may be auscultated where?
left of sternum, 2nd intercostal space
A split S2 sound might be heard normally because of?
differences in pulmonary and aortic pressures - normal in young people, heard just after S2
the aortic valve may be auscultated where?
right of sternum, 2nd intercostal space
an ejection systolic murmur heard in the aortic area indicates…
aortic stenosis
Aortic stenosis may radiate to…?
the carotids
how may aortic regurgitation be accentuated?
sitting the patient up and ask the patient to hold their breath at expiration
an early diastolic murmur heard in the aortic area may indicate…
aortic regurgitation
where should oedema be palpated for in CV exam?
sacral and ankle
in the cardiovascular exam, you should listen to the lung bases for signs of?
inspiratory crackles - sign of oedema because of l.sided HF
LHF will causes oedema in which location and why?
the lungs because of back pressure through the l.atrium pushes fluid back to the lungs
RHF will cause oedema where and why?
systemically because the back pressure through the r.atrium pushes fluid back to the body, particularly the legs
you should palpate the abdomen in a CV exam for?
a pulsatile liver and aortic aneurysm
which peripheral pulses should be checked in the CV exam?
femoral, popliteal, posterior tibial, dorsalis pedis, capillary refill
An absence of a peripheral pulse may indicate?
peripheral vascular disease
Skin indicators of peripheral vascular disease?
shiny skin, hair loss, lack of healing of sore, ulcers, signs of amputation, colouring
factors that increase likelihood of vascular disease?
diabetes, smoking, obesity
Beurgers test involves?
lifting patients legs, holding for 2 minutes, then asking to sit over side of bed
A positive result of beurgers test is…
when one leg or both, develop a rush of redness as the blood returns - indicates a vascular disease
arterial disease will cause pain in what position?
when legs are raised - as decreases the amount of blood the leg/foot is getting
venous disease will cause pain in what position?
when legs are lowered - as blood begins to pool in the ankles
Signs of infective endocarditis (4)
splinter haemorrhages, oslers nodes, janeway lesions, roth spots
Roth spots are found where?
retina - should check if find other signs of IE
a radial-femoral delay in pulses may indicate…
aortic coarction
a radial-radial delay in pulses may indicate…
aortic aneurysm
postural hypotension is defined as…
a drop of >20mmHg systolic, or 10mmHg diastolic
a difference between ankle and arm blood pressures indicates?
peripheral vascular disease
a ABPI of <0.9 is indicative of…
peripheral vascular disease
when might right ventricular enlargement be felt?
with pulmonary stenosis, cor pulmonale, atrial septal defect
causes of carotid bruits?
atherosclerosis (elderly), vasculitis (young)
What might haematouria be indicative of?
infective endocarditis (IE)
Considerations if a patient presents with high BP
white coat effect
difference between a venous and arterial pulse
venous is not usually palpable
small volume pulse may indicate?
aortic stenosis
a collapsing pulse indicates
aortic incompetence
