Examination Flashcards
Give examples of diastolic murmurs. Where would you auscultate these?
- aortic regurgitation (5th ICS left sternal edge OR Erb’s point = 3rd intercostal space, left sternal edge; patient leans forwards and takes a breath in)
- mitral stenosis (5th intercostal space, left midclavicular line, patient lying on their side, listen with bell)
Give examples of systolic murmurs. Where would you auscultate these?
- mitral regurgitation (left axilla)
- aortic stenosis (carotids)
What happens to the estimation of blood pressure if the cuff is too small or too big?
Too small = overestimation
Too big = underestimation
Why can you feel the radial artery?
Superficial artery compressed against the radius
What is the explanation for the Korotkoff sounds?
Inflate cuff to pressure greater than systolic pressure in brachial artery - no sounds
Decrease pressure in cuff until it falls just below systolic pressure in brachial artery - turbulent blood flow in artery (1st sound)
Decrease pressure in cuff below diastolic pressure in brachial artery - sounds disappear - laminar blood flow resumes
What would you expect to hear in auscultation in right ventricular hypertrophy?
Displaced apex beat towards axilla due to increase in size of right ventricle
What is the difference in appearance and cause of central and peripheral cyanosis?
CENTRAL = cyanosis of tongue/lips
- problem in pumping to heart/lungs e.g. respiratory problem
- e.g. tetralogy of Fallot, atrial stenosis, transposition of great arteries
- e.g. asthma, emphysema
PERIPHERAL = cyanosis of peripheries e.g. fingers
- problem in circulation/vasculature
- e.g. hypothermia, anaemia
note: blue colouration due to presence of deoxygenated blood in arteries
What does a constant “machine-like” murmur during diastole and systole indicate?
Patent ductus arteriosus
Why is the popliteal pulse difficult to palpate? Where should you palpate this pulse?
Popliteal artery is the deepest structure in the popliteal fossa
Palpate medial to midline of fossa (descends from upper medial side) whilst knee is flexed (relax fascia and hamstrings)
What is the cause of splinter haemorrhages?
Trauma
Infective endocarditis
What is the jugular venous pressure an indication of? How should you measure it?
Right filling pressure (column of blood with no valves)
- patient at 45 degrees with head turned to left
- look along line of IJV (line from medial clavicle to earlobe)
What is a heave and what does it indicate?
HEAVE = palpable, abnormal pulsation of chest wall
Indicates right atrial enlargement (or severe left atrial enlargement)
What is a thrill and what does it indicate?
THRILL = palpable murmurs
What is the difference between the bell and the diaphragm?
BELL = detects lower pitched sounds
DIAPHRAGM = detects higher pitched sounds
How would you assess the size of the heart?
Chest X-ray (cardiothoracic ration should be <50%)
Echocardiogram
