cardiology exam

Question 1

what should you note from the end of the bed?

Answer 1

• SOB
• cyanosis
• pallor
• odema

Question 2

what to look for in the hands?

Answer 2

• peripheral cyanosis
• splinter haemorrhages- infective endocarditis
• janeway lesions on palms and painful oslers nodes on on fingers- suggesting endocarditis
• koilonichia- iron deficiency
• tar staining
• clubbing
• cap refill

Question 3

what to look for in arms and wrists?

Answer 3

• radial pulse rhythm and character- do both to check for aortic anyeurism, coarctation or disection
• check for collapsing radial pulse- make sure to ask if they have any shoulder pain and warm them about what you are going to do
• both brachial pulses- check for brachial brachial delay
• say you would do a blood pressure- a bilateral reading is required, if they are massively different it would suggest aortic dissection

Question 4

what to do when you get to the neck?

Answer 4

• check for elevated jvp- lay patient at 45 degrees, can also apply pressure to the liver and see if there is a rise in JVP
• check the carotid pulse on both sides
• listen for carotid bruit

Question 5

what to look for on the face?

Answer 5

• malor flush- mitral stenosis
• eyes: xanthalasma (hypercholesterolaemia) , corneal arcus (hyperlipidemia), conjunctival pallor (anaemia)

mouth; 
high arched palate (marfans) 
dental hygine (endocarditis) 
central cyanosis 
angular stomatitis- can be seen in anaemia

Question 6

what to look for in the chest?

Answer 6

• chest wall deformities
• scars
• make sure to look under the axilla

Question 7

how should i palpate the chest?

Answer 7

• palpate the apex beat- 5th intercostal space of the midclavicular line
• asses heaves and thrills

Question 8

what should you do when listening to the heart?

Answer 8

• auscultate whilst palpating the carotid pulse

1. mitral- 5th intercostal space midclavicular line- make sure to listen with the bell too to check for mitral stenosis, diaphragm is for regurg
   keep diaphragm there and get the patient to turn to that side to make any murmurs louder- breathe in out and hold
2. listen to tricuspid in 4th intercostal space
3. listen to pulmonary in the 2nd intercostal space of the left sternal border
4. listen to aortic in the 2nd intercostal space of the right sternal border- can sit forward, breathe in out and hold as aortic murmurs are louder on expiration

Question 9

what to do when inspecting the back of the chest?

Answer 9

• look for scars
• percuss the lung bases
• auscultate the lung bases
• feel for sacral odema

Question 10

what to check in the legs?

Answer 10

1. peripheral vasculature-> shiny legs, hair loss, scars from aphenous vein harvest
2. pitting odema