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Clinical Exams > CVS > Flashcards

CVS Flashcards

1
Q

general inspection

A 
cyanosis
SOB
pallor
malar flush - mitral stenosis
oedeoma
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2
Q

assess environment around patient

A 
medical equipment - ECG leads, O2, GTN spray
mobility aids
pillows
vital signs
fluid balance
prescriptions
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3
Q

hands inspection

A 
colour - peripheral cyanosis
tar staining
xanthomata
arachnodactyly - spider fingers (Marfans)
finger clubbing
pale palmar creases
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4
Q

hands signs associated with endocarditis

A

splinter haemorrhages
Janeway lesions - thenar and hypothenar
Olser’s nodes - front of fingers

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5
Q

2 main systolic murmurs

A

aortic stenosis

mitral regurgitation = whoosh whoosh

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6
Q

2 main diastolic murmurs

A

aortic regurgitation

mitral stenosis

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7
Q

hands palpation

A

temp - bilateral, check symmetry

CRT

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8
Q

pulses - rate, rhythm and character

A

radial

check radio-radial delay - aortic dissection, aortic coarctation, subclavian artery stenosis

check radio-femoral delay
collapsing pulse
brachial 
carotid - palpate and listen for bruits
JVP
hepato-jugular reflux?
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9
Q

JVP

A

patient positioned at 45 degrees, vertical distance between sternal angle and top of pulsation point on IJV, should not be more than 3cm, internal jugular vein only

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10
Q

eyes exam

A

conjunctival pallor = anaemia
corneal arcus = high cholesteral
xanthelesma
Kayer-Fleishcer rings = Wilson’ disease > copper

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11
Q

mouth exam

A

central cyanosis
angular stomatitis > iron deficiency
high arched palate > Marfans syndrome
dental hygiene

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12
Q

anterior chest inspection

A 
scars
chest wall deformities
pectus excavatum
pectus carinatum
visible pulsations or heaves
pacemaker?
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13
Q

chest palpation

A

apex beat = 5th intercostal space, mid-clavicular line
parasternal heaves = flat of hand, LVH or RVH
thrills each heart valve = lateral border of hand

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14
Q

auscultation of 4 heart valves

A

right - left top
right - left bottom

aortic - pulmonary = 2nd intercostal space sternal edge
tricuspid - mitral (apex) = 5th intercostal space, mitral is midclavicular line

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15
Q

posterior chest wall inspection

A

deformities or scars

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16
Q

posterior chest wall ausultation

A

coarse crackles

dull percussion

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17
Q

leg exam

A

oedema

saphenous vein harvesting

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18
Q

sacral oedema

A

check bottom of back for pitting oedema

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19
Q

further investigations

A 
measure BP
peripheral vascular exam
record an ECG
urine dipstick test
bedside CBG
fundoscopy
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20
Q

order of exam

A 
intro
general inspection
bedside environment
hands
neck - JVP
face - eyes, mouth, cheeks
anterior chest
posterior chest
sacrum
legs
final assessments
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21
Q

pallor

A

pale skin - underlying anaemia, haemorrhage, chronic disease, poor perfusion

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22
Q

malar flush = butterfly rash as seen in SLE

nose and across cheeks

A

plum-red cheek discolouration = mitral stenosis

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23
Q

oedema indicates

A

congestive heart failure

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24
Q

pillows?

A

congestive heart failure patients often have orthopnoea so use pillows to prop themselves up

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25
Q

xanthomata

A

raised yellow cholesterol deposits on palm, tendons of hand and elbow

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26
Q

arachnodactyly

A

spider fingers = abnormally long and slender, feature of Marfan’s syndrome

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27
Q

Marfan’s syndrome associated with

A

mitral/aortic valve prolapse and aortic dissection

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28
Q

finger clubbing indicates … in CVS

A

congenital cyanotic heart disease, infective endocarditis and atrial myxoma

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29
Q

finger clubbing assessment

A

look for Schamroth’s window, clubbing has loss of normal angle between nail and nail bed

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30
Q

splinter haemorrhages

A

longitudinal red-brown haemorrhage under nail looks like wood splinters > infective endocarditis, sepsis, vasculitis

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31
Q

Janeway lesions

A

non-tender haemorrhagic lesions on thenar and hypothenar eminences of palms and soles > infective endocarditis

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32
Q

Osler’s nodes

A

red-purple slightly raised lumps often with pale centre on fingers and toes > infective endocarditis

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33
Q

temp hand assessment

A

dorsal aspect
symmetry
warm or cold
dry or clammy

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34
Q

CRT procedure

A

5 seconds of pressure to end of finger

how long to return to initial pallor should be less than 2 seconds

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35
Q

CRT greater than 2 secs

A

poor peripheral perfusion - hypovolaemia, congestive heart failure

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36
Q

healthy adult PR

A

60-100bpm

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37
Q

tachycardic PR

A

> 100bpm

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38
Q

irregular PR measure

A

have to record pulse for full 60 seconds

AF indicated

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39
Q

radio-radial delay

A

loss of synchronicity between radial pulse on each arm

40
Q

causes of radio-radial delay

A

subclavian artery stenosis, aortic dissection, aortic coarctation

41
Q

collapsing pulse

aortic valve regurgitation = leaking
think of blood going back into valve

reduced pulse with arm up

in health should be the same

A

palpate radial pulse with right hand wrapped around patients wrist

palpate brachial pulse with left hand

raise patients arm above head briskly

should feel a tapping impulse in muscle bulk of arm as blood empties

collapsing pulse = when arm is raised and pulse is a lot weaker

42
Q

pulse rhythms = check rate and rhythm

A

regular
regularly irregular
irregularly irregular

43
Q

CVS causes of collapsing pulse

A

aortic regurgitation, patent ductus arteriosus, anaemia

44
Q

slow rising pulse indicates

A

aortic stenosis

45
Q

bounding pulse indicates

A

aortic regurgitation and co2 retention

46
Q

thready pulse indicates

A

intravascular hypovolaemia - sepsis

47
Q

first step in investigating carotid pulse

A

auscultate artery to detect presence of a bruit - indicates carotid stenosis which makes palpation of vessel dangerous due to dislodging of carotid plaque causing an ischaemic stroke

48
Q

raised JVP indicates

A

venous hypertension - right sided HF, tricuspid regurgitation, constrictive pericarditis

49
Q

conjunctival pallor

A

underlying anaemia

50
Q

corneal arcus

A

hazy white/grey/yellow/blue opaque ring around cornea

51
Q

xanthelasma

A

yellow cholesterol rich deposits around eyes

52
Q

Kayser-Fleischer rings

A

dark rings around iris in Wilson’s disease = abnormal processing of copper in liver results in deposition

53
Q

angular stomatits

A

inflammation around sides of mouth

anaemia

54
Q

high arched palate

A

feature of Marfan syndrome

55
Q

poor dental hygiene can be a risk factor for

A

infective endocarditis

56
Q

infective endocarditis

A

infective of heart valves or endocardium

57
Q

pectus excavatum

A

caved in/sunken chest

58
Q

pectus carinatum

A

protrusion of sternum and ribs

59
Q

saphenous vein harvesting leg inspection

A

performed as part of coronary artery bypass graft

60
Q

mitral valve located

A

5th intercostal space at midclavicular line

61
Q

tricuspid valve located

A

4th or 5th intercostal space at lower left sternal edge

62
Q

aortic valve located

A

2nd intercostal space at right sternal edge

63
Q

pulmonary valve located

A

2nd intercostal space at left sternal edge

64
Q

thrill

A

palpable murmur = turbulent blood flow,

test each valve by placing horizontal hand across chest wall above

65
Q

how to assess for parasternal heave

A

heel of hand parallel to LHS/RHS of sternal angle, if there is a heave then should feel hand being lifted - right ventricular hypertrophy

66
Q

apex beat bottom corner of heart

A

5th intercostal space midclavicular line

normally next to nipple

67
Q

hepatojugular reflux test

A

pressure on liver whilst observing JVP

positive result = if JVP rise is sustained and equal to or greater than 4cm

68
Q

irregularly irregular pulse caused by

A

AF - often patients go in and out of fibrillation, when heart gets back into rhythm can fire off clots

69
Q

ventricular fibrillation

A

cardiac arrest = no pulse

70
Q

regularly irregular pulse caused by

A

arrhythmias:
ectopics = missed heart beat
bigeminy
trigeminy

71
Q

JVP

A

right sided heart problem - fluid backs up
shown in raised JVP
how visible is the vein

72
Q

pulse in a vein?

A

veins should never have a pulse!

you can press them and it should stop filling

73
Q

sternotomy scar

A

down the sternum = open heart surgery

74
Q

infraclavicular scar

A

pacemaker insertion

75
Q

GTN spray

A

for angina

76
Q

displacement of apex beat

A

lots of reasons for big floppy heart can find apex beat in midclavicular line (in line under armpit)

77
Q

narrow or regurgitation in valve causes

A 
thrill = where you can feel murmur with your hand over the valve 
heave = can feel how hard heart is having to pump with hand due to narrowing (aortic stenosis with LV pumping against resistance)
78
Q

cardiac cycle revision = 3 stages

A
  1. Atrial and Ventricular diastole (chambers are relaxed and filling with blood)
  2. Atrial systole (atria contract and remaining blood is pushed into ventricles)
  3. Ventricular systole (ventricles contract and push blood out through aorta and pulmonary artery)
79
Q

murmur is caused by

A

turbulence in valve as blood struggles to go through

80
Q

murmur is caused by

A

turbulence in valve as blood struggles to go through

81
Q

mitral regurgitation murmur

A

pansystolic murmur

back pressure from ventricles damages and weakens mitral valve, blood leaks back into atria
turbulence around valve during whole of systole phase

82
Q

mitral regurgitation valve murmurs pitch

A

often higher pitched so can use bell of stethoscope to hear better if needed

83
Q

aortic stenosis murmur

A

ejection systolic = crescendo-decrescendo

84
Q

aortic regurgitation murmur

A

early diastolic murmur

85
Q

mitral stenosis murmur

A

mid-diastolic murmur

86
Q

systolic murmur

A

aortic and pulmonary stenosis

mitral and tricuspid regurgitation

87
Q

early diastolic murmur

A

aortic or pulmonary regurgitation

88
Q

murmurs that radiate

A

aortic stenosis = radiates to carotid arteries

mitral regurgitation = radiates to axilla

89
Q

ventricular systole

A

contraction and ejection

90
Q

ventricular diastole

A

relaxation and filling

91
Q

s1 heart sound

A

lub = closure of mitral and tricuspid valves

signals start of systole

92
Q

s2 heart sound

A

dub = closure of aortic and pulmonary valves

signals end of systole

93
Q

mid-late diastolic murmur

A

mitral or tricuspid stenosis

94
Q

murmurs heard better on expiration = increased intrathoracic pressure

A

inc pressure constricts pulmonary vessels so blood is forced into left atrium and through left side of heart so aortic and mitral valves heard better

95
Q

murmurs heard better on inspiration = decreased intrathoracic pressure

A

right side heart fills with more blood so can hear pulmonary and tricuspid valves better

96
Q

tendon xanthoma

A

papules and nodules found in the tendons of the hands, feet, and heel. Also associated with familial hypercholesterolemia (FH)

97
Q

end pieces

A

Fundoscopy: this is to check for hypertensive and diabetic retinopathy

Ausculation for renal and femoral bruits

Palpate: AAA, organomegaly (liver + spleen enlarged from right sided heart failure), femoral pulses

Clinical Exams (3 decks)

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