Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

clinical > Cardio Exam > Flashcards

Cardio Exam Flashcards

1
Q

Splinter haemorrhages

A

Description
-linear haemorrhages in nail beds

Correlation

  • Trauma/manual labour
  • Septic emboli in IE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Osler’s nodes

A

Description

  • red
  • raised
  • tender
  • nodules
  • pulps of fingers/toes
  • thenar/hypothenar eminence

Correlation
-rare finding in IE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Janeway lesion

A

Description

  • non-tender
  • erythematous
  • maculopapular lesions
  • palms or pulps of fingers

Correlation
-rare finding in IE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Tendon xanthomata/xanthelasmata

A

Description

  • yellow/orange deposits
  • xanthomata
  • > in tendons of hands/arm/elbows/knees
  • xanthelasmata
  • > around eyes

Correlation
-hyperlipidaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Unequal/delayed pulses

A

Radio-radial

  • atherosclerosis
  • coarctation of the aorta
  • aortic aneurysm
  • aortic dissection
  • subclavian artery stenosis

Radio-femoral
-coarctation of the aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pulsus alternans

A

Description

  • alternating strong and weak pulse
  • palpated peripherally
  • during BP measurement
  • > Korotkoff 1 initially only appears with strong beat
  • > release pressure and hear Korotkoff 1 with every beat

Correlation

  • LV heart failure (HFrEF)
  • > alternating contractile force of LV
  • > changing preload/afterload with each beat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Bounding pulse

A

Description

  • large upstroke with rapid collapse
  • water hammer pulse
  • > place hand over radial and ulnar pulse
  • > raise arm
  • > feel bounding pulse
  • > occasionally visible as well
  • corrigan’s pulse
  • > visualisation of bounding pulse at carotids

Correlation

  • full LV emptying into low resistance aorta
  • aortic regurgitation
  • increased SV
  • > PDA
  • > AVM
  • > thyrotoxicosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pulsus parvus et tardus with anacrotic pulse

A

Description

  • pulsus parvus et tardus
  • > parvus = small/weak
  • > tardus = late/delayed
  • anacrotic
  • > slow upstroke with notch

Correlation
-aortic stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

pulsus paradoxus

A

Description

  • BP drop of more than 10mmHg with inspiration
  • may be palpable
  • > pulse disappears with inspiration
  • BP measurement
  • > note BP when Korotkoff 1 appears during expiration
  • > release pressure
  • > note BP when Korotkoff 1 appears during inspiration

Correlation

  • tamponade
  • constrictive pericarditis
  • asthma/COPD exacerbation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Postural hypertension

A

Description
-drop >15mmHg for SBP or >10mmHg for DBP

Correlations (HAAND)

  • hypovolaemia
  • age (decreased baroreceptor sensitivity)
  • adrenal insufficiency (Addisons)
  • neurological
  • > synucleinopathies (parkinson’s/lewy body dementia)
  • > peripheral neuropathies
  • drugs
  • > vasodilators/anti HTN
  • > tri-cyclics
  • > diuretics
  • > antipsychotics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

arcus senilis

A

Description
-grey circle around pupil

Correlation

  • normal in elderly
  • familial hyperlipidaemia in young
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

mitral facies

A

Description
-rosy cheeks with bluish tinge

Correlation

  • pulmonary HTN
  • mitral stenosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Causes of raised JVP

A

PQRST

  • pericarditis/pericardial effusion
  • quantity (fluid overload)
  • right heart failure
  • SVC syndrome
  • tricuspid regurgitation/stenosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Kussmaul’s sign

A

Description
-paradoxical rise in JVP with inspiration

Correlation

  • impaired filling of RV causing jugular veins to engorge
  • > RV infarction
  • > RV failure
  • > restrictive cardiomyopathy
  • > constrictive pericarditis
  • > tricuspid stenosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

hepatojugular reflex

A

Description

  • hold hand over liver for 10 seconds
  • > positive = elevation of JVP for 10 seconds
  • > negative = brief elevation

Correlation

  • inability to increase CO with high venous return
  • > heart failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

abnormal PMI

A
  • abnormal position
  • > right 2nd interspace = aortic aneurysm
  • > epigastric = AAA
  • lateral/inferior displacement
  • > cardiac enlargement
  • > right sided pneumothorax
  • > right sided pleural effusion
  • > left sided pulmonary fibrosis
  • hyperdynamic
  • > volume load
  • > high output (anaemia/hyperthyroidism)
  • > MR/AR/VSD
  • forceful and sustained
  • > pressure load
  • > HTN
  • > AS
17
Q

abnormal intensity heart sounds

A

Intensity

  • S1 usually louder over apex
  • S2 usually louder in aortic/pulmonary area
  • Loud S1
  • > mitral stenosis (far apart at end of systole)
  • Soft S2
  • > calcified aortic valve (movement reduced)
  • > aortic regurgitation (less resistance)
  • Soft S1
  • > prolonged filling (heart block)
  • > delayed systole (LBB)
  • > mitral regurgitation (less resistance)
  • Loud S2
  • > systemic or pulmonary HTN (forceful shut)
18
Q

Abnormal splitting S2

A

Splitting of S2

  • normal with inspiration
  • widened (delayed RV emptying)
  • > RBB
  • > pulmonary stenosis
  • > pulmonary HTN (including massive PE)
  • > MR (early A2 due to rapid LV emptying)
  • fixed splitting
  • > ASD
  • > pulmonary HTD
  • > right HF
  • no or paradoxical splitting (during expiration)
  • > RBB
  • > aortic stenosis
19
Q

Opening snap

A

Description

  • > added heart sound after S2 (in diastole)
  • > followed by murmur of MS
  • > best heard with diaphragm at tricuspid
  • very similar to splitting of S2
  • > listen at left 2nd interspace
  • > S1 followed by three sounds during = splitting + snap
  • leg raise = closer to S2
  • expiration = louder

Correlation

  • mitral stenosis
  • > snap due to sudden opening of mitral valve
20
Q

systolic ejection click

A

Description

  • added heart sound (clicky/high pitched)
  • early in systole
  • > sounds like splitting of S1
  • aortic origin = heard all over
  • pulmonary origin = pulmonary area

Correlation

  • deformed and mobile valve
  • > aortic or pulmonary stenosis
  • > aortic regurgitation
  • > aortic aneurysm
  • > bicuspid aortic valve
21
Q

mid-systolic click

A

Description

  • added heart sound (clicky/high pitched)
  • best heard at mitral area
  • standing/valsalva (decreased preload)
  • > click occurs closer to S1
  • supine/squatting/hand grip (increased preload)
  • > click occurs further from S1

Correlation
-mitral valve prolapse

22
Q

S3 gallop

A

Description

  • diastolic added heart sound (low pitch)
  • best heard with bell over mitral area
  • differentiate from splitting S1 or 2
  • > split S1 or 2 sounds are equal pitch
  • > S3 will be louder with bell

Correlation

  • normal in young
  • blood flowing into distended ventricle
  • > HF
  • > MR
  • > dilated cardiomyopathy
  • > aortic valve disease
23
Q

Mid systolic (ejection) murmur

A

Description

  • between S1 and S2
  • crescendo-descrecendo quality
  • distinguish from holosystolic
  • > S1 and S2 audible
  • > softer with isometric handgrip (high afterload)

Correlation

  • > innocent flow murmur
  • > aortic stenosis
  • > pulmonary stenosis
24
Q

Innocent murmur

A

Description

  • always systolic
  • > diastolic murmurs are pathological
  • mid systolic ejection murmur
  • best heard in pulmonary area
  • absence of other findings

Correlation

  • occurs in more than 50% of patients
  • increased flow
  • > anaemia
  • > thyrotoxicosis
  • > pregnancy
  • > children
25
Q

Pulmonary stenosis findings

A

Pulse
-JVP elevated/hyperdynamic

Praecordium
->parasternal heave

Added sounds
->widened or fixed splitting S2

Murmur

  • > mid systolic ejection
  • > loudest in pulmonic area
  • > lean forward and inspire = louder
  • > radiating to back

Additional

  • signs of right HF
  • cyanosis in severe
26
Q

Aortic stenosis findings

A

Pulse

  • carotid (simultaneously with apex)
  • > pulsus parvus et tardus with anacrotic pulse

Praecordium
-forceful and sustained PMI at apex

Added sounds
->single or paradoxical splitting S2

Murmur

  • > mid systolic ejection
  • > loudest in aortic area
  • > radiates to carotids
  • > sit forward and exhale = louder

Additional
-signs of HFrEF

27
Q

Holosystolic murmurs

A

Description

  • from S1 to S2
  • > starts with S1
  • > drowns out S2 at apex

Correlation

  • MR
  • TR
  • VSD
28
Q

Mitral regurgitation/prolapse findings

A

Pulse
-usually normal

Praecordium

  • apex beat hyperdynamic and displaced to left
  • parasternal heave (massive LA)

Added sounds

  • soft S1 (poor leaflet apposition)
  • wide splitting S2 (early A2/delayed P2 with PHTN)
  • mid systolic click

Regurgitation mumur

  • holosystolic
  • blowing and high pitched (best heard w. diaphragm)
  • loudest at apex
  • radiates to axilla
  • louder isometric handgrip
  • softer with leg raise
  • resp has little effect

Additional

  • HFpEF
  • pulmonary HTN
  • pulmonary oedema
29
Q

tricuspid regurgitation findings

A

Pulse

  • JVP elevated
  • Kussmauls sign

Praecordium
-parasternal heave

Murmur

  • holosystolic
  • loudest at tricuspid area
  • doesn’t radiate
  • louder with inspiration/leg raise/liver compression

Additional

  • cachectic
  • cyanosis in severe
  • tender and pulsatile hepatosplenomegaly
  • possibly thrill over liver
  • jaundice (hepatic dysfunction)
  • ascites
  • peripheral oedema
  • pleural effusions
30
Q

VSD findings

A

Pulse
-bounding JVP

Praecordium

  • RV heave
  • thrill along left sternal edge

Murmur

  • holosystolic murmur
  • loudest at tricuspid area
  • louder with expiration

Additional

  • signs of pulmonary HTN
  • signs of right HF
  • eisenmenger complex
  • > absence of murmur
  • > cyanosis
  • > clubbing
  • > pulmonary HTN severe
31
Q

Aortic regurgitation findings

A

Pulse

  • bounding at carotid (corrigans)
  • water hammer at radial

BP

  • widened pulse pressure
  • > SBP >80mmHg more than DBP
  • DBP <50mmgHg

Praecordium

  • apex beat hyperkinetic and displaced inferior/lat
  • check jugular notch/right 2nd interspace
  • > pulsation = ?aneurysm

Added sounds
-systolic ejection click

Murmur

  • early diastolic of varying length
  • decrecendo
  • blowing and high pitched (listen with diaphragm)
  • loudest at aortic area
  • inaudible unless bent forward in expiration
  • flow murmur (across aortic valve)
  • > more commonly heard than AR
  • > ejection systolic similar to AS
  • > heard in aortic area
  • austin flint murmur (jet vibrating mitral leaflet)
  • > mid diastolic
  • > low pitched, rumbling
  • > heard at apex

Additional

  • crackles (pulmonary oedema)
  • HFrEF
32
Q

mitral stenosis findings

A

Pulse

  • pulses reduced
  • irregularly irregular (AF)
  • bounding and increased JVP

Praecordium
-parasternal heave (cor pulmonale)

Added sounds

  • loud S1
  • single S2 (pulmonary HTN)
  • opening snap

Murmur

  • rumbling diastolic
  • low pitch (listen with bell)
  • heard at apex in left lateral decubitus position
  • louder with leg raise/expiration

Additional

  • mitral facies/peripheral cyanosis
  • crackles (pulmonary oedema)
  • pleural effusions
  • right HF
  • > ascites
  • > peripheral oedema
  • > hepatomegaly (pulsatile with TR)
33
Q

Reporting murmurs

A

SCRIPT

  • Site
  • Character
  • Radiation
  • Intensity
  • > Levines grading system
  • Pitch
  • Timing
  • > holosystolic
  • > mid systolic (ejection)
  • > diastolic
  • > continuous
34
Q

Pericarditis

A

.

35
Q

PDA

A

.

36
Q

heart failure findings

A

Appearance
->cachexia

Hands

  • > delayed cap refill
  • > vasomotor = cool, pale/cyanotic
  • > sympathetic = diaphoretic/clammy

Pulse

  • > irregularly irregular (AF) or tachycardia (low CO)
  • > pulsus alternans (high specificity)

BP

  • > narrow pulse pressure (<25mmHg)
  • > pulsus alternans

JVP

  • > elevated
  • > +ive hepatojugular reflex
  • > +ive kussmauls signs in right sided

Praecordium

  • > lateral and inferior displacement apex beat
  • > forceful and sustained apex beat
  • > parasternal heave

Auscultation

  • > S3 gallop
  • > tricuspid regurgitation in right sided

Additional

  • > signs of pulmonary HTN
  • > crackles (more so in acute)
  • > ascites
  • > peripheral oedema
  • > hepato/splenomegaly
37
Q

HTN assessment

A

General appearance

  • obesity
  • obvious causes of secondary (eg cushings)
  • level of alertness

Pulses

  • radiofemoral delay
  • > coarctation of the aorta

Blood pressure
-both arms and postural

Fundoscopy

  • flame haemorrhages
  • cotton wool spots
  • papilledema

Neck

  • carotid bruits
  • thyroid

Cardiovascular
-signs of left HF

Peripheral vascular

  • pulses
  • oedema

Abdomen

  • palpate for AAA
  • listen for renal bruits

Neuro exam

  • visual disturbance
  • focal weakness
  • confusion

clinical (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions