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Year 6 > Vascular/cardio Exam > Flashcards

Vascular/cardio Exam Flashcards

1
Q

How to finish vascular exam?

A

‘To complete my examination, I would perform a full cardiovascular examination, test sensation, and use Doppler ultrasound to further assess pulses.’
Summarise and suggest further investigations you would consider after a full history (e.g. ABPI, duplex USS, MR or CT angiography, catheter angiography, bloods, ulcer swabs, ECG, HbA1C etc.)

Cardiovascular examination: to complete assessment of the vascular system.
Ankle-brachial pressure index (ABPI) measurement: to further assess lower limb perfusion.
Upper and lower limb neurological examination: if gross neurological deficits were noted during the peripheral vascular examination.

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2
Q

Vascular exam?

A

Look (between toes, for scars/ulcers etc)
Feel - for temperature, cap refill, pulses and auscultate for bruits
Neurovascular exam
Buerger’s test

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3
Q

Muscle wasting indicates what?

A

Associated with chronic peripheral vascular disease.

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4
Q

Auscultate over the femoral pulse to screen for bruits:

A

Bruits in this region suggest either femoral or iliac stenosis.Auscultate over the femoral pulse to screen for bruits:

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5
Q

Femoral pulse: what to do?

A

Radio-femoral pulse
Palpation
Ausculatate for bruits

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6
Q

Ishcaemic stroke CT signs?

A

hyperdense clot in vessel, loss of grey-white matterdifferentiation, cortical hypodensity

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7
Q

Intra-ventricular haemorrhage findings CT?

A

On CT imaging it appears as hyperdensity within the dark CSF spaces within the ventricles.

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8
Q

EAA (eosinophilic allergic alveolitis)

A

ground glass nodules

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9
Q

COPD:

A

Bronchial wall thickening, alveolar spectal destruction, airspace enlargement, bullae

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10
Q

Acute limb ischaemia?

A

6Ps - pulseless, paraesthesia, pallor, pain, paralysis, perishingly cold

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11
Q

Causes of acute limb ischaemia?

A

Embolism or thrombosis

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12
Q

What is peripheral arterial disease?

A

Narrowing of arteries supplying the limbs and periphery, reducing the blood supply to these areas. Typically resulting in symptoms of claudication.

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13
Q

Critical limb ischaemia?

A

end-stage of peripheral arterial disease, where there is an inadequate supply of blood to a limb to allow it to function normally at rest.

There is a significant risk of losing the limb.

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14
Q

Buerger’s test assesses what?

A

Peripheral arterial disease

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15
Q

Arterial ulcer treatment?

A
  • urgent referral to vascular
  • surgical revasculisation
  • NOT debridement and compression
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16
Q

Investigations for PAD?

A
  • Ankle-brachial pressure index
  • Duplex ultrasound
  • Angiography (CT or MRI with contrast
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17
Q

Treatment for intermittent claudication?

A
  • Medical: atrovastatin, clopidogrel, Naftidrofuryl oxalate
  • Surgical: endovascular angioplasty and stening, endoarterectomy (cut out plaque), bypass
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18
Q

Tx for critical limb ischaemia?

A
  • endovascular angioplasty and stening
  • Endoarterectomy
  • Bypass surgery
  • Amputation
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19
Q

What are varicose veins?

A

distended superficial veins measuring more than 3mm in diameter, usually affecting the legs

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20
Q

Features of chronic venous insufficiency

A

occurs when blood pools in distal veins, causing venous hypertension therefore:
- Brown discoloration, haemosiderin
- Venous excema (dry, itchy, flakey, red)
- Lipodermatosclerosis (bc soft tissue becomes fibortic)
- narrowing of lower legs “inverted champagne bottle appearance”
- Atrophie blache (patches of smooth, porvelain-white scar tissue of skin)

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21
Q

What is the treatment of Chronic venous insufficiency?
Explain this

A
  • Keep skin healthy (emolients such as diprobase, topical steroids for eczema or lipodermatosclerosis)
  • improve venous drainage (keep active, weight loss, compression stockings)
  • manage complications
22
Q

What special tests are ordered for varicose veins?

A
  • Tap test: apply pressure to saphenofemoral junction, tap distal varicose vein, if thrill felt, = bad valve
  • Cough test: apply prssure to SFH, ask patient to cough, feel for thrill
  • Trendelenburg’s test: lay patient down, drain blood out of legs, apply tourniquet, make stand up, if varicose veins appear, incompetent valve is below
23
Q

Quincke’s sign

A

visible capillary pulsations under the nailbed, caused by AR

24
Q

Note that you would check the blood pressure

A

You may find a wide pulse pressure in AR; or a narrow pulse pressure in AS

25
Q

Collapsing pulse?

A

AR

26
Q

malar flush

A

flushed cheeks that may be seen in MS

27
Q

Corrigan’s sign

A

(visible carotid pulsation; AR)

28
Q

de Musset’s sign

A

(head bobbing in time with pulse; AR)

29
Q

Apex beat displacement causes?

A

LV dilatation (AR, MR), cardiomegaly, mediastinal shift?

30
Q

Parasternal heave?

A
31
Q

Thrill - what is it?

A
32
Q

If you hear a murmur, note:

A

Site heard loudest, pulse timing, character, volume and radiation.

33
Q

Mitral valve

A

with patient lying at 45˚, feel apex beat then place stethoscope over it. Then listen in the left axilla for radiation (MR). Then roll patient onto their left side and listen with the bell over the apex on expiration (accentuates MS low tones).

34
Q

Aortic valve:

A

listen with patient lying at 45˚. Then listen over right carotid artery with breath held for radiation (AS). Then sit patient forward and listen at Erb’s point (3rd intercostal space, left sternal edge) on expiration (accentuates AR).

35
Q

Last manoevures of cardio exam?

A

Pulmonary oedema: auscultate lung bases for fine crepitations while patient is still sitting (LVF)
Peripheral oedema: push over the sacrum for 10 seconds, then run finger over feeling for indent (occurs in RVF and hypoalbuminaemia)
Do the same on the tibia (note how far it extends)
Also look at the legs for a vein grafting scar if the patient had a midline sternotomy scar (indicates they had a CABG)

36
Q

How to finish cardio exam?

A

‘To complete my examination, I would examine for peripheral pulses, feel for hepatomegaly (RVF), look at observation charts and dipstick the urine (haematuria in IE).’
Summarise and suggest further investigations you would consider after a full history

37
Q

Causes of mitral stenosis?

A

Rheumatic heart disease

Congenital MS
Mitral annular calcification
Radiation associated MS
Carcinoid associated valve disease
Fabry’s disease

38
Q

mitral stenosis features?

A

Mitral stenosis normally presents with exertional dyspnoea.
percutaneous mitral commissurotomy (PMC) is the treatment = transcatheter procedure for the management of mitral stenosis.

39
Q

Chronic MR causes?

A

Degenerative valve disease
Infective endocarditis
Rheumatic heart disease
Congenital anomalies
Medications (e.g. ergotamine, bromocriptine, pergolide)

40
Q

Acute MR

A

Can occur following myocardial ischaemia/infarction with secondary papillary muscle rupture and valvular incompetence.

Non-ischaemic forms include ruptured chordae tendineae and valvular disease secondary to infective endocarditis and rheumatic heart disease.

41
Q

Clinical features?

A

The clinical features of MR include the signs and symptoms of heart failure and a pansystolic murmur.

42
Q

MR murmur?

A

Pansystolic murmur

43
Q

Treatment for mitral regurgitation

A

Medical therapy: In patients with chronic MR and heart failure, ACE inhibitors, beta-blockers and spironolactone may all be considered. Cardiac resynchronisation therapy (CRT) is used when appropriate.

Surgical therapy: Surgery is considered in symptomatic patients with a LVEF > 30%. It is also considered in other patients (both symptomatic and asymptomatic) based on a complicated set of criteria. Other surgical measures include ventricular assist devices, cardiac restraint devices and heart transplantation.

44
Q

Aortic regurg causes?

A

The most common causes are degenerative disease (calcification) and congenital bicuspid valve.
Rheumatic heart disease, IE
Aortic dissection
Marfan’s/EDS

45
Q

Signs of AR?

A

Water hammer pulse
Wide pulse pressure
Chest signs:
Displaced apex
Ejection diastolic murmur
Soft S1 and S2

de Musset’s - head nodding with the heart beat.
Quincke’s - pulsation of nail beds.
Traube’s - pistol shot femorals.
Duroziez’s - to and fro murmur heard when stethoscope compresses femoral vessels.
Müller’s - pulsation of uvula.

46
Q

Valvular heart disease ix?

A

Echo, CXR, ECG, angiography, MRI,

47
Q

Aortic stenosis causes?

A

Calcification
Congenital bicuspid valve
Rheumatic heart disease

48
Q

Tricuspid regurgitation causes?

A

Most commonly due to RV dilation in pulmonary hypertension (e.g. in chronic lung disease or left heart/valve disease)
Rheumatic heart disease
Infective endocarditis (IV drug user)
Ebstein’s anomaly (if split S1 and S2)

49
Q

Tricuspid regurg signs?

A

Pansystolic murmur
Differentiate from MR by…
louder on inspiration because it’s on the right
Giant JVP
Non-displaced apex
Best heard: lower left sternal edge; loudest on inspiration
Radiation: none

Signs:
Giant ‘v’ waves in JVP (giant JVP waves without RVF = TR)
Backflow signs (peripheral oedema, ascites, pulsatile hepatomegaly)
Signs of lung disease and pulmonary hypertension (RV heave, loud P2) if that is the cause

50
Q

Mitral regurg signs?

A

Character: pansystolic murmur
Best heard: apex; loudest on expiration
Radiation: left axilla
(ask the patient to lie on left side)

Signs:
AF
Displaced thrusting apex (volume-loaded)
Soft S1
Signs of pulmonary hypertension (RV heave, loud P2)
May be signs of LVF (S3, pulmonary oedema)

51
Q

Completing resp assessment?

A

Consider oxygen sats, peak flow, chest x-ray, spirometry with reversibility,

(FENO test and blood test (eosinophil count))
May consider high resolution CT chest
Sputum culture.

52
Q
A

Year 6 (26 decks)

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