Cardiac Examination

Question 1

How to begin a CVS examination

Answer 1

Wash hands
Bare forearms
Introduce yourself
Consent
Comfortable
45 degrees
Head support, chest exposed
Good light

Question 2

General inspection

Answer 2

Stand back
Well or ill
Distress
Pale
Sweaty
Cyanosed
Tachypnoeic
Scars
Clues

Question 3

Causes of irregularly irregular pulse

Answer 3

Ventricular etopics, AF, A flutter, wandering atrial pacemaker

Question 4

Causes of regularly irregular pulse

Answer 4

Sinus arrythmia or second degree heart block

Question 5

Cardiac causes of clubbing

Answer 5

Myoma, congential cyanotic heart disease, any chronic hypoxia and endocarditis

Question 6

Hand examination

Answer 6

Look
Clubbing, splinter haemorrhages
Feel the temperature
Feel tendon xanthomata
Feel the radial pulses bilaterally
Pulse rate and rhythm

Question 7

Causes of splinter haemorrhage

Answer 7

Endocarditis, vasculitis e.g SLE, trauma

Question 8

Examine pulses

Answer 8

Brachial pulse for character
Lift arm and feel for waterhammer or collapsing
Palpate R carotid

Question 9

How do you palpated R carotid pulse

Answer 9

Left thumb

Question 10

Slow rising pulse causes

Answer 10

Aortic stenosis

Poorly functioning left ventricle

Question 11

Collapsing pulse causes

Answer 11

Aortic regurgitation
Little blood (anaemia, thyroxicosis)

Question 12

Corneal arcus

Answer 12

Can be normal in the elderly, arcus senilis

Question 13

Why wont an anaemic person be cyanosed

Answer 13

Not adequate Hb to have 4g deoxygenated

Question 14

What are you looking at the eyes for

Answer 14

Conjuctival pallor, corneal arcus, eyelids for xanthelasmata

Question 15

What are you looking at the cheeks for

Answer 15

Malar flush (mitral stenosis)

Question 16

What are you checking under the tongue and inside the lower lip for

Answer 16

Central cyanosis

Question 17

How do you examine the JVP

Answer 17

Head slightly to left
Assess pulsation
Fixed?
Examine height above sternal angle

Question 18

Cause of high JVP

Answer 18

Right heart failure

Question 19

Cause of exaggerated JVP

Answer 19

Tricuspid regurg

Question 20

Cause of fixed JVP

Answer 20

Tamponade

Question 21

How does JVP differ from JVP

Answer 21

Double pulse, occlude, impalpable, varies with respiration and head tilt

Question 22

How does hepatojugular reflux cause

Answer 22

Squeezing liver sinusoids and returning blood to the heaptic and the great veins

Question 23

Apex beat displaced laterally

Answer 23

Cardiomegaly, lung or chest wall disease

Question 24

Apex beat displaced medialy

Answer 24

Left pneumothorax or large left pleural effusion

Question 25

How do you find apex beat

Answer 25

5th intercostal space and mid clavicular space

Question 26

How do you examine apex beat

Answer 26

Palpate chest for heave, thrill, tap and identify apex ebat

Question 27

How to find the 5th ICS more easily

Answer 27

Angle of lewy then count down three

Question 28

Parasternal heave is a sign of

Answer 28

Enlarged right ventricle

Question 29

Define heave

Answer 29

Outward movement of the palpating hand by the cardiac contraction

Question 30

Define thrill

Answer 30

Palpable murmurs

Question 31

When to use bell

Answer 31

Low pitched sounds, mitral and aortic stenosis

Question 32

When to use diaphragm

Answer 32

High pitched sounds, aortic and mitral regurgitation

Question 33

What is aortic sclerosis

Answer 33

Thickening of the valves but not stiffening

Question 34

Where do you auscultate

Answer 34

``` Diaphragm Apex Left sternal angle Right sternal angle Base Bell, repeat Carotids ```

Question 35

How do you accentuate AR

Answer 35

Patient sitting forward and breath held in expiration

Question 36

How do you accentuate MS

Answer 36

Patient in the left lateral position

Question 37

Whats valvasalva maneuver

Answer 37

Maximum handgrip, decrease venous return and supsequently decreased LV filling. Louder murmur

Question 38

1st heart sound

Answer 38

Mitral and tricuspid valve closure

Question 39

2nd heart sound

Answer 39

AV and PV

Question 40

Why do you raise the arm when taking pulse

Answer 40

Mitral regurg

Question 41

What is an alternative to measuring the JVP

Answer 41

Raise the hand above the level of the heart and look at vein in the back of the hand

Question 42

Cause of physiological splitting of heart sound

Answer 42

Inspiration, increased venous return to RA. RV more blood, RV longer to systole

Question 43

Cause of reversed splitting of heart sound

Answer 43

Expiration, Aortic Stenosis or LBBB. Aortic closes after pulmonary.

Question 44

Cause of fixed splitting

Answer 44

Atrial septal defect causes left to right shunt. Pulmonary closes after aortic, independent of breathing.

Question 45

Cause of paradoxical splitting

Answer 45

Due to RBBB or pulmonary stenosis. P2 then A2

Question 46

3rd heart sounds

Answer 46

Abnormal in adults over 40, LV overload

Question 47

4th heart sound

Answer 47

increased ventricular

Question 48

How to make heart sounds easier to hear with fat people

Answer 48

Ask them to sit forward

Question 49

How to tell if its the first heart sound

Answer 49

Feel for the carotid pulse

Question 50

What is a murmur

Answer 50

Turbulent blood flow through a valve or stenosed/regurgitant

Question 51

AS murmur

Answer 51

Ejection, systolic, crescendo decrescendo

Question 52

AR murmur

Answer 52

Early diastolic decrescendo

Question 53

PDA murmur

Answer 53

Continuous machinery murmur

Question 54

Causes of pitting bilateral lower limb oedema

Answer 54

Liver failure, heart failure, renal failure, hypoalbuminaemia, bilateral venous insufficiency

Question 55

Causes of non pitting bilateral lower oedema

Answer 55

Lymphoedema

Question 56

Causes of unilateral pitting oedema

Answer 56

DVT, pelvic mass, ruptured bakers cyst, post thrombotic syndrome, cellulitis

Question 57

Non chest parts of CVS examination

Answer 57

``` Percuss and auscultate lung bases Sacral oedema Feel liver, assess ascites Examine peripheral pulses and check for radiofemoral delay Ankle oedema Blood pressure ```

Question 58

Signs of heart failure

Answer 58

``` JVP Ankle oedema Crackles in lungs 3rd/4th heart sound Displaced apex MR ```

Question 59

Where are you auscultating

Answer 59

Apex, base, aortic, pulmonic

Question 60

Tennis ball sign on CT

Answer 60

Aortic dissection