Cardio Examination

Question 1

What should be done first before anything else?

Answer 1

Clean hands
Introduce, check patient name and get consent after explaining clearly
Ask if patient has any pain

Observe at the end of bed and surroundings

Question 2

What is looked for on the hands

Answer 2

Same as general

Question 3

What is looked for in the radial pulse?

Answer 3

Rate - 15s
Rhythm - regular/irregular
Volume - High/Low
Character - collapsing

Question 4

What should be done with the radial pulse next?

Answer 4

Check for a collapsing pulse by raising patients arm above head - warn and ask about pain

Check radial-radial delay

Question 5

What should be done after finishing with the radial pulses?

Answer 5

Check both brachial pulses
Inspect arms
Check skin turgor

Question 6

What should be done after brachial pulses have been checked?

Answer 6

Check ears - gouty tophy
Face - mallar flush, symmetry
Eyes - corneal arcus, xanthalasma, conjunctivi and sclera
Mouth - central cyanosis, sore red tongue hydration, tonsils, etc

Question 7

What should be done after the head?

Answer 7

Assess the JVP
Carotid pulse
Tracheal position

Question 8

What should be done after assessing the JVP?

Answer 8

Examination of the precordium - inspect first for scars, symmetry, pacemakers, pectus excavatum or pectus carinatum or pulsations

Question 9

What should be done after visually assessing the chest?

Answer 9

Feel for a pacemaker
Feel for an apex
Feel for a heave on left side
Feel for thrills on all valve areas

Question 10

What should be done after palpating the chest?

Answer 10

Listen to all four heart valves with both sides of the stethoscope while palpating the carotid pulse to time S1

Question 11

How do we listen for aortic stenosis? What type of murmur is it?

Answer 11

Listen over the aortic valve and the carotids for radiation of the murmur

Ejection systolic

Also listen over carotids for bruits

Question 12

What causes bruits?

Answer 12

Turbulent blood flow

Question 13

How do we check for mitral regurgitaion? What type of murmur is it?

Answer 13

Listen over apex and in the left axilla

Pansystolic

Question 14

How do we check for mitral stenosis? Type of murmur?

Answer 14

Ask patient to roll on left side
Use bell to listen in apex on expiration

Low pitched rumbling diastolic murmur

Question 15

How to check for aortic regurgitation? Type of murmur?

Answer 15

Ask the patient to sit up and listen to the lower left sternal edge on expiration

High pitched early systolic murmur

Question 16

While patient is sat up for aortic regurg check - what else should you do?

Answer 16

Listen at lung base for basal crackles a sign of heart failure

Question 17

What should be done after auscultating the chest?

Answer 17

Palpate the femoral pulse
Check for femoral radial delay
Listen for bruits on femoral pulse

Question 18

What should be done after feeling for the femoral?

Answer 18

Palpate the popliteal - try and push vessels against tibula

Question 19

What should be done after palpating the politeal pulse?

Answer 19

Observe legs for loss of hair, sweating, temperature VVs (later get patient to stand up at end) , and ankle oedema by pressing for 10 seconds

Question 20

What should be done after inspecting legs?

Answer 20

Palpate the posterior tibial and dorsalis pedis pulses
Observe toes for joint swelling or deformaties
Observe soles for callouses
Ask patient to stand to observe VVs

Tell patient to relax, redress and thank them for time