examination of the cardiovascular system

Question 1

what is a malar flush a sign of? (a reddish/blueish tinge over cheekbones)

Answer 1

mitral valve disease which often follows rheumatic fever

Question 2

what is a butterfly rash caused by?

Answer 2

SLE (systemic lupus erythematosus)

Question 3

what would you look for in the eyes?

Answer 3

anaemia under the eyelids, corneal arcus (ring around the cornea caused by high blood lipids), Xanthelasmata (LDL deposits in the eyelids)

Question 4

what would you look for in the fingernails?

Answer 4

koilonychia (spoon shaped nails caused by iron deficient anaemia); clubbing (caused by heart and lung conditions that reduce the oxygen in the blood), painter haemorrhages (caused by infective endocarditis); osler’s nodes (bacterial endocarditis)

Question 5

Which condition is cause by the following signs and symptoms?:
fever (low grade and intermittent); heart murmurs; splinter hemorrages, osler nodes, laneway lesions, roth spots

Answer 5

infective endocarditis

Question 6

which one (osler nodes or laneway lesions) are tender?

Answer 6

osler nodes

Question 7

which one (osler nodes or laneway lesions) are indicative of acute rather than subacute infective endocarditis?

Answer 7

laneway lesions

Question 8

what does the histology of laneway lesions usually confirm?

Answer 8

septic micro emboli

Question 9

what is the cause of laneway lesions?

Answer 9

septic microemboli

Question 10

what is the cause of osler nodes?

Answer 10

vasculitis

Question 11

what is a ‘roth spot’?

Answer 11

a red spot caused by haemorrhage found in the retina with a white centre (fibrin-platelet plug)

Question 12

what is a zanthelasma a sign of?

Answer 12

a cutaneous marker of underlying atherosclerosis and increased level of serum cholesterol and LDL cholesterol

Question 13

what does a REGULARLY irregular heartbeat indicate?

Answer 13

an ectopic heart beat (occasionally irregular)

Question 14

what does an IREGULARLY irregular heartbeat indicate?

Answer 14

atrial fibrillation

Question 15

what is a ‘water hammer pulse’ the sign of?

Answer 15

aortic regurgitation

Question 16

what does a an elevated jugular venous pressure indicate?

Answer 16

an elevated right atrial pressure

Question 17

where is the apex beat felt?

Answer 17

at the 5th intercostal space in the mid clavicular line

Question 18

where on the chest would ‘heaves’ be felt?

Answer 18

on the left sternal edge (sign of right ventricular enlargement)

Question 19

where on the chest would ‘thrills’ be felt?

Answer 19

on the apex and sternal notch

Question 20

what are the 4 places on the chest which are listened to for abnormalities?

Answer 20

aortic valve (2nd right intercostal space), pulmonary valve (2nd left intercostal space), tricuspid valve (lower left sternal border) and mitral (apex)

Question 21

what murmur may be heard at the apex of the chest?

Answer 21

early diastolic murmurs of mitral stenosis

Question 22

what may be heard at the lower left border of the sternum?

Answer 22

early diastolic murmurs of aortic and tricuspid regurgitation

Question 23

what sounds may be heard at the left 2nd intercostal space?

Answer 23

mitral stenosis, pulmonary valve murmurs

Question 24

what sounds may be heard at the right 2nd intercostal space?

Answer 24

systolic ejection sounds (e.g. aortic stenosis, hypertrophic obstructive cardiomyopathy)

Question 25

what type of murmur may be heard at the left axilla?

Answer 25

mitral regurgitation

Question 26

what murmur may be heard just below the left clavicle?

Answer 26

continuous ‘machinery’ murmur of a persistent patent ductus arteriosus

Question 27

what is a grade 3 murmur?

Answer 27

easily heard but no thrill

Question 28

what is a grade 1 murmur?

Answer 28

heard by an expert in optimum conditions

Question 29

what is a grade 2 murmur?

Answer 29

heard by a non-expert in optimum conditions

Question 30

what is a grade 6 murmur?

Answer 30

extremely loud heard without stethescope

Question 31

what is a grade 4 murmur?

Answer 31

a loud murmur with a thrill

Question 32

what is a grade 5 murmur?

Answer 32

very loud, often heard over a wide area with a thrill

Question 33

how would you accentuate a diastolic murmur of mitral stenosis?

Answer 33

bell at apex in expiration in left lateral position

Question 34

how would you accentuate a systolic murmur of mitral regurgitation?

Answer 34

at left axilla (with diaphragm of stethoscope)

Question 35

how would you accentuate a diastolic murmur of aortic regurgitation?

Answer 35

at lower left sternal edge with patient sat forwards

Question 36

how would you accentuate a murmur of aortic stenosis?

Answer 36

over carotids with diaphragm in held inspiration