CVS

Question 1

What can be noticed on inspection of the general appearance of patients with aortic stenosis?

Answer 1

They are pale and sweaty

Question 2

Why do patients with aortic stenosis appear the way they do?

Answer 2

Low cardiac output

Question 3

How does the pulse feel on a patient with aortic stenosis?

Answer 3

Rate - elevated

Rhythm - sinus rhythm

Question 4

What blood pressure could you expect in a patient with aortic stenosis?

Answer 4

100 systolic 75 diastolic

Question 5

What pulse characteristic could you expect in a patient with aortic stenosis?

Answer 5

Slow rising carotid impulse

Low volume

Question 6

Where can pulse characteristics be felt?

Answer 6

Brachial artery

Question 7

Will aortic stenosis have any JVP signs? Why?

Answer 7

No as it is a left sided lesion.

Question 8

What will be felt on palpating of the apex beat in a patient with aortic stenosis?

Answer 8

Non displaced, pressure loaded beat.

Question 9

Can any heaves/thrills be felt on palpating in a patient with aortic stenosis?

Answer 9

You may feel a thrill in the aortic or carotid regions.

Question 10

What can be heard on auscultation of aortic stenosis?

Answer 10

Crescendo-decrescendo systolic murmur. S2 can be heard unless stenosis is severe.

Question 11

What can be heard in severe aortic stenosis?

Answer 11

A seagull noise

Question 12

What is a pale and sweaty appearance associated with in the CVS examination?

Answer 12

Aortic stenosis

Question 13

What can sinus rhythm of pulse with tachycardia, but low BP indicate?

Answer 13

Aortic stenosis

Question 14

What is a slow rising carotid impulse with low volume characteristic of?

Answer 14

Aortic stenosis

Question 15

What does a raised JVP indicate?

Answer 15

A Right sided lesions eg tricuspid regurgitation

Question 16

With what can the apex beat be felt non-displaced but pressure loaded?

Answer 16

Aortic stenosis

Question 17

With what may a thrill in the aortic region be felt?

Answer 17

Aortic stenosis

Question 18

With what may a thrill in the carotid region be felt?

Answer 18

Aortic stenosis

Question 19

Which valve lesion can sound like a seagull?

Answer 19

Aortic stenosis

Question 20

Which valve lesion has a pansystolic murmur which has a diamond shape ie crescendo/decrescendo?

Answer 20

Aortic stenosis

Question 21

What can be noticed on inspection of the general appearance of patients with aortic regurgitation?

Answer 21

There are 11 key signs

Question 22

What are the peripheral signs of aortic regurgitation due to?

Answer 22

Volume overload

Question 23

What are the main/most common signs of aortic regurgitation?

Answer 23

Quincke sign (severe AR - nail bed pulsation)
De Musset sign (head nod with pulse)
Corrigans sign (neck pulse - collapsing nature)

Question 24

What is the pulse rate, rhythm and BP with aortic regurgitation?

Answer 24

Sinus rhythm
Normal HR
BP Systolic high eg 200/70

Question 25

What pulse characteristsic can be felt with aortic regurgitation?

Answer 25

Collapsing pulse aka water hammer pulse | High volume

Question 26

Is the JVP raised with aortic regurgitation? Why?

Answer 26

No - it is a Left sided lesion

Question 27

Where is the apex beat felt in aortic regurgitation?

Answer 27

Displaced

Question 28

How does the apex beat feel in aortic regurgitation?

Answer 28

Volume loaded

Question 29

What does aortic regurgitation sound like on auscultation?

Answer 29

Decrescendo after S2 (start of diastole)

Question 30

How long is the sound in aortic regurgitation?

Answer 30

If mild or severe, short. Use other signs to determine severity. If moderate, long.

Question 31

What are the 11 clinical signs including De Musset, Quincke, and Corrigans sign for?

Answer 31

Aortic regurgitation

Question 32

What can normal rate and rhythm but high BP be a sign of?

Answer 32

Aortic regurgitation

Question 33

What can a high volume pulse with a collapsing character be a sign of?

Answer 33

Aortic regurgitation

Question 34

What can a displaced, volume loaded apex beat be an indication of?

Answer 34

Aortic regurgitation

Question 35

What does an early diastolic decrescendo murmur indicate?

Answer 35

Aortic regurgitation

Question 36

What can be noticed on inspection of the general appearance of patients with mitral stenosis?

Answer 36

Malar flush

Question 37

How does the pulse feel on a patient with mitral stenosis?

Answer 37

Irregularly irregular - AF

Question 38

Why does a mitral stenosis pulse feel the way it does?

Answer 38

AF due to LV dilation

Question 39

What pulse characteristic could you expect in a patient with mitral stenosis?

Answer 39

Normal as does not obstruct LV outflow

Question 40

Is JVP raised with mitral stenosis?

Answer 40

It may be raised due to pulmonary hypertension and cor pulmonale etc

Question 41

What will be felt on palpating of the apex beat in a patient with mitral stenosis? Why?

Answer 41

Non displaced | Tapping apex beat (due to increased force of mitral valve closing)

Question 42

Can any heaves/thrills be felt on palpating in a patient with mitral stenosis?

Answer 42

RV heave possible if RV dilated (assoc with raised JVP)

Question 43

What can be heard on auscultation of mitral stenosis?

Answer 43

Soft diastolic sound - abscence of silence (dot dash)

Question 44

Why can this sound be heard on auscultation of mitral stenosis?

Answer 44

Turbulence of flow between La and LV during diastole

Question 45

What is malar flush associated with?

Answer 45

Mitral stenosis

Question 46

What can an irregularly irregulr HR be associated with?

Answer 46

Mitral stenosis | AF

Question 47

What may JVP be raised with due to increased pulmonary BP?

Answer 47

Mitral stenosis

Question 48

What is a tapping apex beat (non displaced) associated with?

Answer 48

Mitral stenosis

Question 49

When may a RV heave be palpable (2)?

Answer 49

1. Mitral stenosis if RV dilated due to pulmoary hypertension etc 2. Tricuspid regurgitation if patient has lung disease

Question 50

What does a soft, diastolic murmur (dot dash) indicate?

Answer 50

Mitral stenosis

Question 51

What can be noticed on inspection of the general appearance of patients with mitral regurgitation?

Answer 51

Normal appearance - tiredness or SoB may be noted from the hx

Question 52

How does the pulse feel on a patient with mitral regurgitation?

Answer 52

Normal (although AF may develop if severe)

Question 53

What is the character of the pulse felt with mitral regurgitation?

Answer 53

Normal

Question 54

Is JVP raised with mitral regurgitation? Why?

Answer 54

No - it is not a R sided lesion

Question 55

How does the apex beat feel with mitral regurgitation? Why?

Answer 55

Displaced and volume loaded as there is an active large stroke volume

Question 56

Can anything be palpated on the chest with mitral regurgitation?

Answer 56

Rarely - thrill in mitral region

Question 57

How does mitral regurgitation sound on auscultation?

Answer 57

Pan systolic murmur with different shapes according to cause of mitral regurgitation

Question 58

What can make mitral regurgitation sound different?

Answer 58

1. Infective endocarditis - low murmur (dash dot dot) | 2. Prolapse (more common) - Crescendo/wedge shaped.

Question 59

What can a displaced apex beat that is volume loaded indicate?

Answer 59

Mitral regurgitation

Question 60

What can a low pansystolic murmur indicate?

Answer 60

Mitral or tricuspid regurgitation caused by infective endocarditis.

Question 61

What can a systolic murmur of increasing volume (wedge shaped) indicate?

Answer 61

Mitral regurgitation due to prolapsed valve

Question 62

What can be noticed on inspection of the general appearance of patients with tricuspid regurgitation? Why?

Answer 62

Elephant ears - ears move due to V waves from internal jugular

Question 63

How does the pulse feel on a patient with tricuspid regurgitation?

Answer 63

Normal as it is a R sided lesion

Question 64

What pulse characteristic could you expect in a patient with tricuspid regurgitation?

Answer 64

Normal as it is a R sided lesion

Question 65

Is the JVP raised with tricuspid regurgitation? Why?

Answer 65

Yes - S waves and V waves are present. Right sided lesion increasing preload on R side of heart

Question 66

What may be palpable in a patient with tricuspid regurgitation?

Answer 66

RV heave if the patient has lung disease

Question 67

How does tricuspid regurgitation sound on auscultation?

Answer 67

May have a murmur or may not depending on cause

Question 68

What can make tricuspid regurgitation sound different?

Answer 68

1. Functional regurgitation - no murmur may be heard | 2. Traumatic TR or infective endocarditis - low pan systolic murmur (valve must be abnormal for murmur)

Question 69

What lesion can cause elephant ears?

Answer 69

Tricuspid regurgitation

Question 70

When can elevated JVP with S waves and V waves be seen?

Answer 70

Tricuspid regurgitation

Question 71

If seen with lung disease, when may a RV heave be palpable?

Answer 71

Tricuspid regurgitation

Question 72

What can be noticed on inspection of the general appearance of patients with a small VSD?

Answer 72

Nothing - normal appearance

Question 73

How does the pulse feel on a patient with a small VSD?

Answer 73

Normal

Question 74

What pulse characteristic could you expect in a patient with a small VSD?

Answer 74

Normal

Question 75

Will a small VSD have any JVP signs?

Answer 75

No

Question 76

What will be felt on palpating of the apex beat in a patient with a small VSD?

Answer 76

It will be normal

Question 77

Can any heaves/thrills be felt on palpating in a patient with a small VSD?

Answer 77

Often a thrill is palpable at the left lower sternal edge

Question 78

What can be heard on auscultation of a small VSD?

Answer 78

A very loud pansytolic murmur

Question 79

Why can this be heard in a patient with a small VSD?

Answer 79

Blood flow between the L side and R side ventricles due to systole