Examination findings

Question 1

What is malar flush associated with?

Answer 1

mitral stenosis

Question 2

Most likely cardiovascular causes of clubbing

Answer 2

congenital cyanotic heart disease
infective endocarditis
atrial myxoma

Question 3

Signs in the hands associated with infective endocarditis

Answer 3

splinter haemorrhages
Janeway lesions
Osler’s nodes

Question 4

What is radio-radial delay?

Answer 4

loss of synchronicity between the radial pulse on each arm resulting in the pulses occurring at different times

Question 5

Causes of radio-radial delay

Answer 5

subclavian artery stenosis (eg. compression by cervical rib)
aortic dissection
aortic coarctation

Question 6

What is a collapsing pulse?

Answer 6

forceful pulse that rapidly increases and subsequently collapses

Question 7

Causes of a collapsing pulse

Answer 7

normal physiological states (eg. fever, pregnancy)
cardiac lesions (eg. aortic regurgitation, patent ductus arteriosus)
high output states (eg. anaemia, arteriovenous fistula, thyrotoxicosis)

Question 8

Types of pulse character

Answer 8

normal
slow-rising (aortic stenosis)
bounding (aortic regurgitation, CO2 retention)
thready (intravascular hypovolaemia in conditions such as sepsis)

Question 9

What is narrow pulse pressure and what can cause it?

Answer 9

less than 25 mmHg difference between the systolic and diastolic blood pressure

aortic stenosis
congestive heart failure
cardiac tamponade

Question 10

What is wide pulse pressure and what can cause it?

Answer 10

more than 100 mmHg difference between systolic and diastolic blood pressure

aortic regurgitation
aortic dissection

Question 11

What causes a difference in blood pressure between arms?

Answer 11

aortic dissection

Question 12

Causes of a raised JVP

Answer 12

indicates the presence of venous hypertension

cardiac causes:
- right-sided heart failure
- tricuspid regurgitation
- constrictive pericarditis

Question 13

What does a positive hepatojugular reflux test suggest?

Answer 13

suggests the right ventricle is unable to accommodate an increased venous return

Question 14

What conditions can cause a positive hepatojugular reflux test?

Answer 14

constrictive pericarditis
right ventricular failure
left ventricular failure
restrictive cardiomyopathy

Question 15

What mouth signs are relevant to the cardiovascular system?

Answer 15

central cyanosis
angular stomatitis
high arched palate (Marfan’s)
dental hygiene (poor = risk factor for IE)

Question 16

What is pectus excavatum?

Answer 16

caved in or sunken appearance of chest

Question 17

What is pectus carinatum?

Answer 17

protrusion of the sternum and ribs

Question 18

What can cause visible pulsations on the anterior chest?

Answer 18

forceful apex beat secondary to underlying ventricular hypertrophy

Question 19

Describe locations of some thoracic scars and surgeries that may have occurred?

Answer 19

median sternotomy scar - cardiac valve replacement, CABG

anterolateral thoracotomy scar - minimally invasive cardiac surgery

infraclavicular scar - pacemaker insertion

left mid-axillary scar - insertion of subcutaneous ICD

Question 20

Describe the valve locations

Answer 20

aortic = 2nd intercostal space, right sternal edge

pulmonary = 2nd intercostal space, left sternal edge

tricuspid = 4th/5th intercostal space, lower left sternal edge

mitral = 5th intercostal space, midclavicular line

Question 21

What sounds does the bell best pick up?

Answer 21

low frequency sounds

eg. mid-diastolic murmur of mitral stenosis

Question 22

What sounds does the diaphragm best pick up?

Answer 22

high frequency sounds

eg. ejection systolic murmur of aortic stenosis, early diastolic murmur of aortic regurgitation and pansystolic murmur of mitral regurgitation