Cardiovascular

Question 1

What to look for on inspection of the hands?

Answer 1

General - Colour, tar staining, xanthomata, arachnodactyly, clubbing
Endocarditis - splinter haemorrhages, Janeway lesions, Osler’s nodes

Question 2

Pallor/cyanosis of the hands indicates what medical condition/aetiology?

Answer 2

Congestive heart failure, peripheral vascular disease, Raynaud’s etc

Question 3

Xanthomata indicates what?

Answer 3

Hyperlipidaemia

Question 4

Typical locations for xanthomata?

Answer 4

Palms, wrist/elbow tendons

Question 5

What is arachnodactyly and what does it indicate?

Answer 5

Fingers/toes are abnormally long + slender relative to palm of hand/arch of foot.
Indicates Marfan’s syndrome

Question 6

Cardiovascular associations with Marfan’s?

Answer 6

Aortic/mitral prolapse + aortic dissection

Question 7

Name of window seen in individual’s without clubbing?

Answer 7

Schamroth’s window

Question 8

3 cardiovascular causes of clubbing?

Answer 8

Congenital cyanotic heart disease, endocarditis, atrial myxoma (rare)

Question 9

What are Janeway lesions + Osler’s nodes + location + differences?

Answer 9

Janeway Lesions - haemorrhagic non-tender lesions on thenar/hypothenar eminences of palms/soles - septic emboli (embolic-related)
Osler’s nodes - red-purple, slightly raised, tender lumps with pale centre on fingers/toes - deposition of immune complexes (immune-related)

Question 10

3 causes of radio-radial delay?

Answer 10

Subclavian artery stenosis (e.g. cervical rib compression)
Aortic dissection
Aortic coarctation

Question 11

3 causative areas of a collapsing pulse?

Answer 11

Normal physiological stress states e.g. fever, pregnancy
Cardiac lesions e.g. aortic regurgitation, PDA
High output states e.g. anaemia, AV fistula, thyrotoxicosis etc

Question 12

Types of pulse character + associated pathology?

Answer 12

Normal
Slow-rising - aortic stenosis
Bounding - aortic regurg, CO2 retention
Thready - intravascular hypovolaemia (sepsis)

Question 13

Causes of narrow pulse pressure?

Answer 13

Aortic stenosis, congestive heart failure, cardiac tamponade

Question 14

Causes of wide pulse pressure?

Answer 14

Aortic regurgitation, aortic dissection

Question 15

Causes of raised JVP?

Answer 15

Venous hypertension(!)
- right-sided heart failure (due to pulmonary hypertension from COPD/ILD, or due to left-sided heart failure)
- tricuspid regurgitation (infective endocarditis, rheumatic heart disease)
- constrictive pericarditis (rheumatoid arthritis, TB)

Question 16

4 conditions associated with positive hepatojugular reflex?

Answer 16

Constrictive pericarditis
R ventricular failure
L ventricular failure
Restrictive cardiomyopathy

Question 17

4 things to look for in eyes?

Answer 17

Conjunctival pallor (anaemia)
Corneal arcus (hypercholesterolaemia)
Xanthelasma (hypercholesterolaemia)
Kayser-Fleischer rings (Wilson’s)

Question 18

4 things to look for in mouth?

Answer 18

Central cyanosis (hypoxaemia e.g. L>R shunt)
High arched palate (Marfan’s)
Angular stomatitis (lots but anaemia)
Dental hygiene (poor = infective endocarditis)

Question 19

4 thoracic scars to look for?

Answer 19

Median sternotomy
Anterolateral thoracotomy
Infraclavicular
Left mid-axillary

Question 20

Locations +indication of the 4 thoracic scars?
Median sternotomy
Anterolateral thoracotomy
Infraclavicular
Left mid-axillary

Answer 20

Median sternotomy - midline of thorax, valve replacement or coronary artery bypass grafts
Anterolateral thoracotomy - lateral border of sternum or mid-axillary line 4th/5th intercostal space, minimally invasive valve surgery
Infraclavicular - infraclavicular region either side, pacemaker insertion
Left mid-axillary - left mix-axillary line, subcut implantable cardioverter-defibrillator (ICD)

Question 21

Apex beat displacement and heaves due to what, respectively?

Answer 21

Apex displacement = ventricular hypertrophy
Heave = typically Right ventricular hypertrophy

Question 22

4 valve locations?

Answer 22

Mitral - 5th ICS, midclavic
Tricuspid - 4th/5th ICS, LLSE
Pulmonary - 2nd ICS, LSE
Aortic - 2nd ICS, RSE

Question 23

Aortic stenosis murmur?

Answer 23

Ejection systolic, may radiate to carotids

Question 24

Aortic regurgitation murmur?

Answer 24

Early diastolic murmur, loudest pt sitting forward + breath out

Question 25

Mitral regurgitation murmur?

Answer 25

Pansystolic murmur, loudest pt on left + breath out + diaphragm (high freq)

Question 26

Mitral stenosis murmur?

Answer 26

Mid-diastolic murmur, loudest pt on left + breath out + bell (low freq)

Question 27

Further tests and investigations to perform post-examination + why?

Answer 27

BP
Vascular exam (peripheral)
12-lead ECG
Urine dip
Bedside cap glucose
Fundoscopy

BP - hypo/hypertension, BP discrepancies
Vascular exam (peripheral) - peripheral vascular disease
12-lead ECG - myocardial ischaemia, arrhythmias
Urine dip - proteinuria/haematuria due to hypertension
Bedside cap glucose - underlying T1/T2DM (CVD risk factor)
Fundoscopy - malignant hypertension (papilloedema)