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OSCE > Cardiovascular Exam > Flashcards

Cardiovascular Exam Flashcards

1
Q

What is peripheral cyanosis a sign of

A

Hypoxaemia
Raynaud’s
CCF

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2
Q

What is clubbing a sign of

A

Congenital cyanotic heart disease
Infective endocarditis
Atrialmyxoma

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3
Q

What are splinter haemorrhages a sign of

A

Infective endocarditis

Also: RA, vasculitis, trauma, sepsis

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4
Q

What are Osler’s nodes

A

Red, tender nodules on finger pulps or thenar eminence (immune complex deposition)

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5
Q

What are Osler’s nodes a sign of

A

Infective endocarditis (rare and late sign)

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6
Q

What are Janeway lesions

A

non-tender macular-papular lesions seen on palms or finger pulps (embolic phenomenon)

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7
Q

What are Janeway lesions a sign of

A

Infective endocarditis (rare)

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8
Q

Radio-radial delay causes

A

Aortic coarctation
Aortic dissection
Subclavian artery stenosis

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9
Q

Collapsing pulse causes

A

Aortic regurgitation
PDA
Also- pregnancy, fever, thyrotoxicosis

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10
Q

Pulsus paradoxus

A

Pulse wave volume decreases significantly during inspiration

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11
Q

Pulsus paradoxus causes

A 
Cardiac tamponade (late)
Also: severe acute asthma/COPD
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12
Q

Mucosal pallor of conjunctivae

A

Anaemia

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13
Q

Jaundice of sclera

A

Haemolytic anaemia

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14
Q

Corneal Arcus

A

Hypercholesterolaemia- significant only if >50

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15
Q

Xanthelasma

A

Hypercholesterolaemia

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16
Q

Mitral facies

A

Rosy cheeks suggestive of mitral stenosis

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17
Q

Central cyanosis

A

Hypoxaemia e.g. right to left cardiac shunt

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18
Q

Dental hygiene

A

Common source of organisms causing infective endocarditis

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19
Q

Carotid pulse

A

BEFORE palpating, auscultation first for presence of bruits to rule out stenosis disease which may potentially become dislodged during palpating

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20
Q

`carotid pulse- comment on

A

Volume and character

E.g. normal, slow rising, bounding, thready

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21
Q

How to differentiate JVP from carotid

A

Carotid is pulsatile, JVP is not
If it’s easily obstructable, it’s the JVP
JVP is double wave form, carotid is single (examine it)
If it reduces with inspiration it’s the JVP

22
Q

Kussmaul’s sign

A

JVP will rise with inspiration in pericardial constriction, right ventricular infarction or cardiac tamponade

23
Q

Ways to augment the JVP if you can’t find it

A

Press on liver to elicit hepatojugular reflex
Ask patient to lie more flat
Lift patient’s leg

24
Q

Height of JVP

A

Vertical distance between the sternal angle and the top of the pulsation point of the JVP (should be less or equal to 3cm)

25
Q

Causes of right sided heart failure

A

Increased pressure in the right side of heart
Right sided HF- e.g. due to left- sided heart failure or pulmonary hypertension (in turn due to COPD, interstitial lung disease etc.)
Tricuspid regurgitation
Constrictive pericarditis

26
Q

Chest scars

A

sternotomy for CABG

Thoracotomy for valvular surgery

27
Q

Thrills

A

Palpable vibration caused by turbulent blood flow through a heart valve i.e. palpable murmur

28
Q

How to elicit thrills

A

Press fingertips on sternum at the level of 2nd intercostal space

29
Q

Heaves

A

Right ventricular hypertrophy

30
Q

How to elicit heaves

A

Press the heel of your hand over right sternal edge

31
Q

Apex beat- position

A

Normally at 5th intercostal space mid-clavicle are line

32
Q

Apex beat displacement

A 
Cardiomegaly e.g. cardiomyopathy, CCF
Mediastinal shift (e.g. pleural effusion, tension pneumothorax)
33
Q

Forceful and sustained Apex Beat

A

Pressure-loaded e.g. left ventricular hypertrophy

34
Q

Forceful and non-sustained apex beat

A

Volume-loaded e.g. hyper metabolic states, aortic/mitral regurgitation

35
Q

Double impulse apex beat

A

Hypertrophic cardiomyopathy

36
Q

Aortic valve

A

2nd intercostal space

Right sternal edge

37
Q

Pulmonary valve

A

2nd intercostal space

Left sternal edge

38
Q

Tricuspid valve

A

4th/5th intercostal space

Lower left sternal edge

39
Q

Mitral valve

A

5th intercostal space

Midclavicular line

40
Q

How do you accentuated manoeuvres

A

All in expiration

Ask patient to breathe in and out, and hold in expiration

41
Q

Mitral stenosis

A

Mid diastolic rumble

42
Q

Elicit mitral stenosis

A

Ask patient to roll onto their left side, and auscultation the mitral area using the bell

43
Q

Mitral regurgitation

A

Pansystolic murmur

44
Q

Elicit mitral regurgitation

A

In same position, auscultate in the mitral area again this time using the diaphragm
Auscultate into the axils to identify radiation of this murmur

45
Q

Aortic stenosis

A

Ejection-systolic murmur (crescendo-decrescendo)

46
Q

Aortic stenosis elicit

A

With patient back into normal seated position, auscultate the carotid arteries using the diaphragm

47
Q

Aortic regurgitation

A

Early diastolic murmur

48
Q

Aortic regurgitation elicit

A

Sit patient forwards and auscultate over aortic area with diaphragm

49
Q

Bibasal crackles

A

E.g. pulmonary oedema due to LVF

50
Q

Scars in legs

A

Saphenous vein grafts fir CABG

51
Q

Extras in cardio exam

A 
Full set of obs
Peripheral vascular and respirator exams
ECG
Bloods
CXR 
Echo

OSCE (15 decks)

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