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Y1 Cardiovascular > Clinical Skills > Flashcards

Clinical Skills Flashcards

1
Q

Cardiovascular examination of the hands

A

capillary refill, peripheral cyanosis, xanthomaa, Janeway lesions (not-painful), oeslers nodes (painful), splinter haemorrhages, clubbing

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2
Q

Which lesions are painful?

A

oslers nodes

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3
Q

What are splinter haemorrhages the result of?

A

infective endocarditis

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4
Q

Which pulses should be examined in the cardiovascular system?

A

carotid, brachial, radial

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5
Q

Why would you take blood pressure and pulses on each arm?

A

to compare any significant differences - these might indicate an aortic dissection or valvuler disorder if difference > 20mmHg

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6
Q

Procedure for checking BP

A

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confirm patient details, inform that it may need to be done more than once, gain consent, inform that this may be withdrawn at any time, do BP, wash hands, thank patient, explain findings

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7
Q

Other pulse issues to be checked in arm?

A

collapsing pulse - CHECK FOR SHOULDER PAIN

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8
Q

Angle patient should be at during cardiovascular examination

A

45˚

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9
Q

The JVP should be measured from where?

A

the sternal angle

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10
Q

Where will the JVP be found?

A

above the supra-clavicular fossa

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11
Q

How might the JVP be accentuated?

A

asking the patient to take a deep breath or pressing in an upward motion on the liver

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12
Q

A raised JVP may be indicative of?

A

RHF, Right valvuler disease

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13
Q

What else should be checked at the carotids?

A

carotid bruits - ask patient to hold breath if necessary

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14
Q

A collapsing pulse is felt as…

A

a waterhammer pulsation

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15
Q

Things to report about a pulse (4)

A

rate, rhythm, character and volume

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16
Q

An irregularly irregular pulse is indicative of?

A

atrial fibrillation

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17
Q

A bounding pulse may indicate?

A

CO2 retention, liver failure, sepsis

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18
Q

A visible carotid pulse may indicate?

A

aortic regurgitation

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19
Q

Corneal arcus is a sign of…

A

hyperlipidaemia

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20
Q

Xanthelasma is a sign of…

A

hyperlipidaemia

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21
Q

Grey conjunctiva may indicate…

A

anemia

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22
Q

Anemia may cause which respiratory symptom?

A

breathlessness

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23
Q

malar flush can be described as…

A

butterfly pattern redness on cheek

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24
Q

Malar flush is a result of…

A

mitral stenosis

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25
Q

What is it important to palpate on the precordium?

A

the apex beat, heaves and thrills

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26
Q

Where should the apex beat be found?

A

mid-clavicular line, 5th intercostal space

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27
Q

A displaced apex beat may indicate?

A

cardiac hypertrophy

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28
Q

A heave is indicative of…

A

right ventricular enlargement

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29
Q

A heave is likely to be felt at…

A

the left sternal edge

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30
Q

A thrill is…

A

a palpable murmur felt as a vibration beneath the hand

31
Q

Upon auscultation, what should you be listening for?

A

added sounds, murmurs

32
Q

A pansystolic murmur heard in the mitral area may radiate where?

A

axilla

33
Q

A pansystolic murmer heard in the mitral area is indicative of…

A

mitral regurgitation

34
Q

A diastolic murmur heard in the mitral area is indicative of…

A

mitral stenosis

35
Q

disease associated with mitral stenosis

A

rheumatic fever

36
Q

mitral stenosis may be accentuated by asking the patient to do what?

A

lie on their left hand side while listening to the apex with the BELL

37
Q

mitral stenosis may be heard with the…

A

BELL

38
Q

in the tricuspid area, a diastolic murmur indicates…

A

tricuspid stenosis

39
Q

in the tricuspid area, a pansystolic murmur indicates…

A

tricuspid regurgitation

40
Q

the triscupid may be auscultated where?

A

left sternal edge, 4th intercostal space

41
Q

The pulmonary valve may be auscultated where?

A

left of sternum, 2nd intercostal space

42
Q

A split S2 sound might be heard normally because of?

A

differences in pulmonary and aortic pressures - normal in young people, heard just after S2

43
Q

the aortic valve may be auscultated where?

A

right of sternum, 2nd intercostal space

44
Q

an ejection systolic murmur heard in the aortic area indicates…

A

aortic stenosis

45
Q

Aortic stenosis may radiate to…?

A

the carotids

46
Q

how may aortic regurgitation be accentuated?

A

sitting the patient up and ask the patient to hold their breath at expiration

47
Q

an early diastolic murmur heard in the aortic area may indicate…

A

aortic regurgitation

48
Q

where should oedema be palpated for in CV exam?

A

sacral and ankle

49
Q

in the cardiovascular exam, you should listen to the lung bases for signs of?

A

inspiratory crackles - sign of oedema because of l.sided HF

50
Q

LHF will causes oedema in which location and why?

A

the lungs because of back pressure through the l.atrium pushes fluid back to the lungs

51
Q

RHF will cause oedema where and why?

A

systemically because the back pressure through the r.atrium pushes fluid back to the body, particularly the legs

52
Q

you should palpate the abdomen in a CV exam for?

A

a pulsatile liver and aortic aneurysm

53
Q

which peripheral pulses should be checked in the CV exam?

A

femoral, popliteal, posterior tibial, dorsalis pedis, capillary refill

54
Q

An absence of a peripheral pulse may indicate?

A

peripheral vascular disease

55
Q

Skin indicators of peripheral vascular disease?

A

shiny skin, hair loss, lack of healing of sore, ulcers, signs of amputation, colouring

56
Q

factors that increase likelihood of vascular disease?

A

diabetes, smoking, obesity

57
Q

Beurgers test involves?

A

lifting patients legs, holding for 2 minutes, then asking to sit over side of bed

58
Q

A positive result of beurgers test is…

A

when one leg or both, develop a rush of redness as the blood returns - indicates a vascular disease

59
Q

arterial disease will cause pain in what position?

A

when legs are raised - as decreases the amount of blood the leg/foot is getting

60
Q

venous disease will cause pain in what position?

A

when legs are lowered - as blood begins to pool in the ankles

61
Q

Signs of infective endocarditis (4)

A

splinter haemorrhages, oslers nodes, janeway lesions, roth spots

62
Q

Roth spots are found where?

A

retina - should check if find other signs of IE

63
Q

a radial-femoral delay in pulses may indicate…

A

aortic coarction

64
Q

a radial-radial delay in pulses may indicate…

A

aortic aneurysm

65
Q

postural hypotension is defined as…

A

a drop of >20mmHg systolic, or 10mmHg diastolic

66
Q

a difference between ankle and arm blood pressures indicates?

A

peripheral vascular disease

67
Q

a ABPI of <0.9 is indicative of…

A

peripheral vascular disease

68
Q

when might right ventricular enlargement be felt?

A

with pulmonary stenosis, cor pulmonale, atrial septal defect

69
Q

causes of carotid bruits?

A

atherosclerosis (elderly), vasculitis (young)

70
Q

What might haematouria be indicative of?

A

infective endocarditis (IE)

71
Q

Considerations if a patient presents with high BP

A

white coat effect

72
Q

difference between a venous and arterial pulse

A

venous is not usually palpable

73
Q

small volume pulse may indicate?

A

aortic stenosis

74
Q

a collapsing pulse indicates

A

aortic incompetence

Y1 Cardiovascular (12 decks)

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