CVS Examination and History

Question 1

Describe questions to ask in a CVS history

Answer 1

History of presenting compliant
- What have you come to see us with today?
- Do you have any other symptoms?
- How are you feeling at the moment
- How long has it gone on for
- Has this happened before and when did it start
- What does it (pain) feel like
- Do it start suddenly or a gradual onset
- Where speficially is the pain and does it spread
- What is the character of the pain
– does anything make it better or worse
- How are you generally – are you fit and well

Then go into more specific questions about symptoms:
– have you had any shortness of breath
- What were you doing when the pain happens
- does the pain spread anywhere else
- is there anything you can do to lessen the pain/ or make it easier to breath
- have you taken anything for the pain
- does the pain start suddenly

Ideas Concerns Expectations

• Do you have any idea of what might be going on
• Is there anything that is worrying you specifically
• What were you hoping id be able to do for you today

Past Medical history 
- Do you have any medical conditions 
- Have you seen anyone for this before 
Specific questions 
-	Have you had contact with those that are unwell recently 
- how's your blood pressure 

Drug history and allergies

• What prescribed medication do you take
• What over the counter medication do you take
• Have you taken any illicit substances?
• Do you have any allergies?

Social history

• What do you do for a living
• Do you smoke – how long have you smoked, how many cigarettes do you smoke a day
• Do you drink
• Where do you currently live
• Do you have a support network that helps you
• Do you require any assistane in day to day life
• How much exercise do you do – how often and what type

Family History

• Has your family had any significant illness
• Are they well and still alive

Systematic review
Now just before we finish I just have some quick general questions to ask
- Have you had a fever
- Any weight changes
- Do you fill fatigued
- Have you had a cough?
- Do you get any stomach pain or nausea and vomiting
- Are you going to the toilet as usually?
- Have you had a headache, any visual changes, or motor and sensory disturbances
- Any chest wall pain, or trauma
- Do you have any rashes or other skin problems

Before I examine you is there anything else that you would like to add or think that I have missed

Question 2

Describe CVS clinical skills examination

Answer 2

WIPER

• wash hands
• introduce yourself
• permissions and pain
• expose the patient
• reposition the patient lying down at a 45 degree angle

Inspection from the end o the bed

• breathlessness
• distress
• scars
• surrounding environment - oxygen, fluid restriction signs, GTN

peripheral inspection

• start with the hands - look for peripheral cyanosis, clubbing, splinter haemorrhages, Osler nodes, janeway lesions
• feel the hands for warmth, sweating and clamminess
• test capillary refill time - should be less than 2 seconds

pulses

• look for rate, rhythm and character
• radial
• brachial
• then do collapsing radial pulse - while doing the pulse in the radius raise it above the heart and note changes in volume and character
• measure the blood pressure

eyes

• corenal arcus
• and periorbital region xanthelasma
• conjuctiva for palor

Mouth and tongue
- central cyanosis

• jugular venous pressure height
• measure ether level of the jugular venous pressure with reference to the height above the sternal angle
• carotid pulse - assess volume and character on both sides
• insect the chest wall for previous scars, pacemakers, abnormal pulsations and an apex beat

Palpate for

• apex beat
• heaves
• thrills

Ascultate

• listen with both bell and diaphragm at the apex base, aortic and pulmonary regions
• when listening to the heart sounds they should be timed against the carotid pulse
• roll the patient onto the left side and listen to murmur - should be timed with the carotid pulse
• to listen for an early diastolic murmur which means there is aortic problem - ask the patient to sit forwards take a deep breath breath out and hold there breath
• listen over the carotid pulses for bruits
• listen over the lung bases for creptations which result from pulmonary oedema
• check sacral oedema
• move to the lower limbs
• check for ankle oedema - check both legs
• check the peripheral pulses on both legs - the femoral pulse, asculatate for bruits
• popliteal pulse
• the posterior tibial pulse - dorsals pedis pulse

Question 3

What should you look for in the hands and what should you test for in a CVS examination

Answer 3

Look for:

• peripheral cyanosis,
• clubbing
• splinter haemorrhages,
• Osler nodes
• janeway lesions - endocarditis
• tar stains

Feel for:

• warmth
• sweating
• clamminess
• test for capillary refill time - should be less for two seconds

Question 4

What should you check the eyes for

Answer 4

• corenal arcus
• and periorbital region xanthelasma
• conjuctiva for palor

Question 5

What do you palpate for

Answer 5

• apex beat
• heaves
• thrills

Question 6

Where do you listen with the bell and diaphragm

Answer 6

• listen with both bell and diaphragm at the apex base, aortic and pulmonary

Question 7

name where the 
- aortic 
- pulmonary 
- mitral 
- tricuspid
areas are

Answer 7

• aortic - 2nd intercostal space right sternal edge
• pulmonary - 2nd intercostal space left sternal edge
• mitral - 4th intercostal space left sternal edge
• tricuspid - 5th intercostal space - mid clavicular line

Question 8

What makes COVID unlikely

Answer 8

• wet cough

- COVID is a dry cough

Question 9

what is bronchial breathing

Answer 9

• when the expiration is longer than the inspiration

Question 10

What do you ask when they say they are coughing up blood

Answer 10

• fresh blood, clotted blood
• frequency
• when did it start - what do you think caused it to start
• what is the amount of blood
• is it mixed with phelgm, is there no phlegm or just phlegm sometimes