CVS Examination

Question 1

What position should a patient be in for a CV exam?

Answer 1

45 degrees with chest adequately exposed

Question 2

What should you look for in a patients hands?

Answer 2

Cap refill, peripheral cyanosis, tar staining, splinter haemorrhages, janeway lesions, osler’s nodes and koilonychia.

Question 3

What should you look for in a patients face?

Answer 3

Examine the face, eyes and mouth for signs of malar flush, pallor, anaemia, xanthelasmata, corneal arcus and central cyanosis

Question 4

What is malar flush?

Answer 4

A high colour over the cheakbones with a bluish tinge caused by reduced oxygen concentration in the blood.

Question 5

What is a butterfly rash?

Answer 5

Erythema that occurs in a butterfly distribution over the cheeks and nose. Often occurs in systemic lupus erythematosus

Question 6

What is koilonychia

Answer 6

Spooning of the nails which often common in chronic iron deficiency.

Question 7

What is clubbing?

Answer 7

The ends of fingers appear large or bulging, may be warm and red. Occurs in heart and lung diseases

Question 8

What are the causes of clubbing?

Answer 8

Lung cancer (most common), congenital cyanotic heart disease, chronic lung infections, coeliac disease, cirrhosis, overactive thyroid, other cancers and infective endocarditis.

Question 9

What are the classic signs of infective endocarditis

Answer 9

Petechiae, subungual hemorrages, oslar nodes, janeway lesions and roth spots

Question 10

What are Subungual hemorrhages?

Answer 10

Dark red linear lesions in the nail bed

Question 11

What are Osler nodes?

Answer 11

Tender subcutaneous nodules usually found on distal pads of fingers (culture = neg)

Question 12

What are Janeway lesions

Answer 12

Nontender maculae (flat dots) on palms and soles (culture = pos)

Question 13

What are roth spots?

Answer 13

Retinal hemorrages with small, clear centres

Question 14

What is Xanthelasma

Answer 14

Yellowish flat plaques on upper and lower eyelids. Cutaneous marker of atherosclerosis

Question 15

What is Corneal Arcus?

Answer 15

deposition of lipids around the outer iris. It appears light grey in colour (grey rim)

Question 16

Name some abnormal pulse and an example of an explanation.

Answer 16

Fast and regular (anxiety, exercise, pain, meds, hyperthyroidism).
Regularly irregular (ectopic beat)
Irregularly irregular (atrial fibrillation).
Slow and regular (Athlete, meds, hypothyroidsm).
Slow are irregular (heart block and sick sinus syndrome)

Question 17

What may be the cause of a low volume pulse?

Answer 17

Hypovolaemic or left ventricular failure

Question 18

What may be the cause of an increased volume pulse?

Answer 18

Anaemia or fever

Question 19

What may be the cause of a slow rising and slow falling pulse

Answer 19

Aortic stenosis (stenosis meaning tight)

Question 20

What may be the cause of a collapsing pulse

Answer 20

This is where there is a rapid raise and fall of pulse. This is due to aortic regurgitation (leaky valve)

Question 21

why do you preform a jugular venous pulse assesment?

Answer 21

The jugular vein closely reflects the pressure changes in the right atrium.

Question 22

What is an abnormal JVP and what does this mean?

Answer 22

The venous column will be seen about the right sternoclavicular joint meaning the right arterial pressure is increased. The further up the neck it is then the larger the increased pressure is.

Question 23

Describe the differences between the carotid and jugular pulses

Answer 23

Jugular - Inward movement, not palpable, two peaks per beat, raises with abdominal pressure.

Carotid - outward movement, one peak per pulse, palpable, independent of abdo pressure.

Question 24

Where are the four areas you should listen too for a precordial exam?

Answer 24

Aortic valve - The right 2nd intercostal space.
Pulmonic valve - Left 2nd intercostal. space.
Tricuspid - Left 4th intercostal space.
Mitral - 5th intercostal space at the midclavicular line

Question 25

Picture of murmers blanked… Identify the murmers

Answer 25

Normal, Aortic regurgitation (diastolic), Aortic stenosis (systolic), mitral regurgitation (systolic), mitral stenosis (diastolic)

Question 26

Where are some other areas you could consider examining?

Answer 26

Ausculate lung base, look for sacral oedema, offer abdo exam, peripheral vascular exam, ankel oedema, check BP, urinalysis, fundoscopy and obs chart

Question 27

What are the features of an innocent murmer?

Answer 27

Occurs in systole, Ejection (blood flow through narrow vessel), Sort or vibratory, Grade 1/2, Normal S1 S2, no extra sounds and louder when supine

Question 28

What are the features of a pathological murmer?

Answer 28

Occurs in diastole, holosystolic (murmer that beings at S1 and continues to S2, Harsh, grade 3-6, abnormal split S2, extra sounds and louder when standing