Cardiovascular exam

Question 1

signs of endocarditis?

Answer 1

splinter haemorrhages
janeway lesions (non-tender, on thenar and hypothenar eminences)
osler's nodes (red-purple, tender lumps)

Question 2

arachnodactyly?

Answer 2

long, slender fingers and toes
-feature of Marfans
-linked to:
Mitral/aortic valve prolapse
Aortic dissection

Question 3

reasons for radio-radial delay?

Answer 3

subclavian artery stenosis
aortic dissection
aortic coarctation

Question 4

reasons for collapsing pulse?

Answer 4

fever, pregnancy
cardiac: aortic regurgitation, patent ductus arteriosus
anaemia, arteriovenous fistula, thyrotoxicosis

Question 5

meaning of types of brachial pulse?

Answer 5

slow rising= aortic stenosis
bounding= aortic regurgitation or co2 retention
thready= intravascular hypovolaemia (e.g. sepsis)

Question 6

carotid pulse exam steps?

Answer 6

auscultate first to rule out bruit (due to carotid stenosis)

then palpate if no bruit

Question 7

causes of raised JVP?

Answer 7

right-sided HF
tricuspid regurgitation
constrictive pericarditis

Question 8

causes of +ve hepatojugular reflux test?

Answer 8

constrictive pericarditis
right and left ventricular failure
restrictive cardiomyopathy

Question 9

kayser-gleischer rings?

Answer 9

dark rings around iris

linked to Wilson’s disease

Question 10

corneal arcus?

Answer 10

hypercholesterolaemia

hazy white, grey, blue opaque ring in peripheral cornea

Question 11

sunken/caved-in chest vs protruded sternum?

Answer 11

pectus excavatum vs pectus carinatum

Question 12

parasternal heaves?

Answer 12

right ventricular hypertrophy

heel of hand on left sternal edge

Question 13

how to assess thrills (palpable murmur)?

Answer 13

hand horizontal across chest wall, flat fingers and palms over valve

Question 14

valve locations?

Answer 14

mitral= 5th intercostal space in midclavicular line
tricuspid= 5th intercostal space lower left sternal edge
pulmonary= 2nd intercostal space left sternal edge
aortic= 2nd intercostal space right sternal edge

Question 15

how to examine ejection systolic murmur of aortic stenosis?

Answer 15

auscultate carotid arteries while patient holds breath

Question 16

how to examine early diastolic murmur from aortic regurgitation?

Answer 16

sit forward and auscultate aortic area during expiration

Question 17

how to examine pansystolic murmur from mitral regurgitation?

Answer 17

roll onto left side- listen to mitral area during expiration

continue to auscultate into axilla (for radiation)

Question 18

how to examine mid-diastolic murmur from mitral stenosis?

Answer 18

roll onto left side- listen to mitral area (bell side of stethoscope)
during expiration