Normal and abnormal findings

Question 1

Chest Pain

Answer 1

Def: Angina occurs when the heart’s vascular supply cannot meet demand. It may also be pulmonary, musculoskeletal, or gastrointestinal in origin.

Normal : No chest pain or tightness.

Abnormal: Crushing, stabbing, or burning pain with associated symptoms (e.g., nausea, dyspnea, diaphoresis). Pain worsens with exertion or stress and is relieved by rest/nitroglycerin.

Question 2

Dyspnea

Answer 2

Def. Indicates insufficient cardiac output or lung disease. Paroxysmal dyspnea and orthopnea are signs of heart failure.

Normal : No difficulty breathing.

Abnormal : Dyspnea on exertion, orthopnea (using multiple pillows to sleep), or paroxysmal nocturnal dyspnea (waking up gasping for air).

Question 3

Orthopnea

Answer 3

Def. Requires upright position to breathe, indicating heart failure.

Normal : No orthopnea; comfortable breathing when lying flat.

Abnormal : Requires multiple pillows or sitting upright to relieve shortness of breath.

Question 4

Cough

Answer 4

Def. May indicate heart failure (pink frothy sputum) or mitral stenosis.

Normal : No cough, or mild occasional coughing with clear mucus.

Abnormal :Persistent, productive cough with pink, frothy, or blood-tinged sputum. Associated with heart failure or mitral stenosis.

Question 5

Fatigue

Answer 5

Def. Decreased cardiac output causes fatigue, usually worse in the evening.

Normal : Energy level appropriate for activity and age.

Abnormal : Fatigue worsening in the evening; difficulty keeping up with family or work.

Question 6

Cyanosis/Pallor

Answer 6

Def. Reflects poor perfusion, often due to heart failure or myocardial infarction.

Normal : Skin tone appropriate for individual’s baseline.

Abnormal : Bluish or pale skin, especially during activity. Seen in low cardiac output states or MI.

Question 7

Edema

Answer 7

Def. Indicates fluid retention, commonly bilateral in heart failure.

Normal : No swelling of feet or legs.

Abnormal : Bilateral swelling, especially worse in the evening, resolving with leg elevation. Associated symptoms include shortness of breath or weight gain.

Question 8

Nocturia

Answer 8

Def. Indicates fluid redistribution and reabsorption at night due to heart failure.

Normal : No frequent urination during the night.

Abnormal : Frequent urination during the night, often associated with heart failure.

Question 9

Cardiac History

Answer 9

Def. Provides context for current symptoms and risk factors.

normal : No history of cardiac disease.

Abnormal: History of heart attack, elevated cholesterol, or hypertension.

Question 10

Family Cardiac History

Answer 10

Def. Family history of CAD, hypertension, or diabetes increases risk.

Normal: No significant family history of cardiovascular disease.

Abnormal: Family history of early CAD, sudden death, or genetic disorders affecting the heart.

Question 11

Personal Habits

Answer 11

def. Lifestyle factors like diet, smoking, alcohol, and stress contribute to heart disease.

Normal : Balanced diet, non-smoker, moderate exercise, minimal stress, adheres to medication regimen.
Abnormal : Poor diet, smoking history, sedentary lifestyle, excessive stress, or medication non-adherence.

Question 12

Leg Pain or Cramps

Answer 12

normal: - No pain or cramping in the legs.
- Normal tolerance for walking and exercise.

Abnormal : - Pain or cramping during activity (claudication).
- Pain aggravated by elevation or worsened at night.
- Sudden or severe leg pain (possible peripheral vascular disease).
- Burning, aching, cramping, stabbing pain indicative of ischemia.

Question 13

Skin Changes on Arms/Legs

Answer 13

Normal : - Skin is of uniform color with no discoloration.
- Normal temperature (warm and dry).

Abnormal : - Redness, pallor, blueness, or brown discoloration.
- Excess warmth (inflammation) or coolness (arterial disease).
- Varicose veins: swollen, twisted veins.
- Leg ulcers (arterial or venous origin).

Question 14

Swelling (Edema)

Answer 14

Normal : - No swelling or symmetrical legs without pitting. -

Abnormal : Unilateral edema (local obstruction or inflammation).
- Bilateral edema (systemic conditions like heart failure).
- Pitting edema graded from 1+ to 4+.
- Swelling with pain, heat, redness, or hardened skin.

Question 15

Lymph Node Enlargement

Answer 15

Normal : - Lymph nodes are non-palpable or small, movable, and non-tender.

Abnormal: - Enlarged, hard, or fixed lymph nodes.
- Painful, swollen glands associated with infection, malignancy, or immunological diseases.

Question 16

Capillary Refill

Answer 16

normal : - Normal capillary refill is <1-2 seconds.

Abnormal : - Capillary refill time >2 seconds indicates vasoconstriction or **decreased** cardiac output (e.g., hypovolemia, shock).
- Cold, clammy, or pale hands.

Question 17

Nail Beds (Clubbing)

Answer 17

Normal : - Normal nail bed angle is 160 degrees with no clubbing.

Abnormal : - Flattened nail bed angle or clubbing indicates congenital cyanotic heart disease or cor pulmonale.

Question 18

Temperature of Legs

Answer 18

Normal : - Skin temperature is warm and symmetrical bilaterally.

Abnormal : - Cool temperature in one leg suggests arterial deficit.
- Sudden drop in temperature moving down the leg indicates arterial insufficiency.

Question 19

Pulses

Answer 19

Normal :- Pulses graded 2+ (normal force) and equal bilaterally.

Abnormal : - Weak, thready pulse (1+): peripheral arterial disease, aortic stenosis.
- Bounding pulse (3+): hyperkinetic states (e.g., fever, hyperthyroidism), HTN.
- Absent pulse (0): arterial occlusion.

Question 20

Hair Distribution on Legs

Answer 20

Normal : - Normal hair distribution, including on toes.

Abnormal : - Hair loss on toes or legs, thin and shiny skin, thick ridged nails: arterial insufficiency.

Question 21

Leg Ulcers

Answer 21

Normal : - No ulcers present on the legs.

Abnormal : - Arterial ulcers: occur on toes, lateral malleoli; pale, ischemic base, well-defined edges.
- Venous ulcers: occur on medial malleoli; bleeding, uneven edges.

Question 22

Varicose Veins

Answer 22

Normal : - No visible, dilated veins. -

Abnormal : Visible, dilated, tortuous veins causing pain, swelling, fatigue, or cramping.

Question 23

Edema and Weight Changes

Answer 23

Normal : - No pitting edema, weight stable.

Abnormal : - Daily weight increase >2.5 kg indicates fluid retention.
- Unilateral edema: local obstruction.
- Bilateral edema: systemic illness (e.g., heart failure).

Question 24

Colour Changes (Elevation Test) -

Answer 24

Normal : Feet remain pink when legs are elevated and regain color within 10 seconds when sitting.

Abnormal: - Elevational pallor (arterial insufficiency).
- Dependent rubor (deep blue-red color due to chronic hypoxia).