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Cardiovascular exam Flashcards

(68 cards)

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1
Q

Why are the number of pillows relevant?

A

Orthopnea:

Shortness of breath with change in body position. Pulmonary effusion oedema or left ventricular heart failure.

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2
Q

What things would you look for around the bed?

A 
Oxygen
GTN spray
ECG machine
Medication
IV drips
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3
Q

What do splinter haemorrhages indicate?

A

Infective endocarditis

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4
Q

What causes Quinke’s sign?

A

Aortic regurgitation

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5
Q

What 2 things cause clubbing?

A

Cyanotic congenital heart disease

Infective endocarditis

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6
Q

Name one tender and non-tender manifestation of infective endocarditis.

A 
Osler's nodes (tender) (finger pulps)
Janeway lesions (non-tender) (palms)
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7
Q

What is a nail sign of vasculitis?

A

Nail fold infarcts (small red spots around nails).

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8
Q

how would hyperlipidaemia manifest?

A

Tendon xanthomata

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9
Q

Why check for radial-radial delay? 3 things.

A

Aortic coarctation
Aortic dissection
Aortic arch aneurysm

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10
Q

What is aortic coarctation?

A

The aorta narrows in the area where the ductus arteriosus inserts.

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11
Q

What are you feeling the radial pulse for?

A

Rate and rhythm (regularly regular)

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12
Q

What would a collapsing pulse indicate?

A

Aortic regurgitation
Patent ductus arteriosus
(PDA = failure to close. Allows irregular transmission of blood between the aorta and the pulmonary artery)

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13
Q

Why check for radial-femoral delay?

A

Aortic arch aneurysm

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14
Q

Large pulse pressure indicates what?

A

Aortic regurgitation

Septic shock

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15
Q

Narrow pulse pressure indicates what?

A

Aortic stenosis

Hypovolaemia

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16
Q

How does corneal arcus present?

A

A white, blue, grey opaque ring around the corneal margin.

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17
Q

What causes corneal arcus?

A

Cholesterol deposits (dyslipidaemia; hypercholesterolemia)

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18
Q

What might pallor indicate?

A

Anaemia

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19
Q

Malar flush indicates?

A

Mitral stenosis

Low cardiac output

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20
Q

Swollen cyanotic face?

A

SVC obstruction

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21
Q

What would conjunctival pallor indicate?

A

Anaemia

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22
Q

What would conjunctival haemorrhages indicate?

A

Infective endocarditis

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23
Q

How would hyperlipidaemia present (eyes).

A

Xanthelasma

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24
Q

How would central cyanosis present in the mouth?

A

Under tongue, cyanosed.

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25
How would infective endocarditis present in the mouth?
Petechial haemorrhages. | Poor dental hygiene
26
What does the JVP indirectly measure?
Right atrial pressure
27
What two things should you look for in JVP?
Height | Waveform
28
What does a consistently raised JVP indicate?
Fluid overload | Right heart failure
29
What is the abdominojugular reflux sign?
Pressing on RUQ produces a transient rise in JVP. If it stays high throughout a 15s compression then it is positive sign. This is an inability to eject increased venous return = right heart failure.
30
What is a fast pulse?
>100bpm
31
What is a slow pulse?
< or = 60 bpm
32
What is the mneumonic for raised JVP?
``` P Q R S T ```
33
What does PQRST stand for (JVP)?
P= pulmonary hypertension/oedema/stenosis; pericarditis; pericardial effusion. ``` Q = quantity of fluid (i.e. overload) R = right heart failure S= Superior vena cava obstruction T = tamponade; tricuspid regurgitation ```
34
What do you check in the carotid pulse?
Character and volume
35
Corrigan's sign?
Visible carotid pulsation: aortic regurgitation
36
De Musset's Sign?
head bobbing with carotid pulse : aortic regurgitation
37
Inspect chest for what 3 scars?
Midline sternotomy Lateral thoractomy Pacemaker scars
38
Where would you see a pacemaker scar?
Near left shoulder
39
Name two chest deformities that could affect the heart?
Pectus excavatum | Pectus carinatum
40
What may be visible on inspection in the mid-clavicular line, 5th intercostal?
Visible apex beat.
41
How would a superior vena cava obstruction present on inspection of the chest?
Distended veins over precordium
42
How do you correctly palpate the apex beat?
Use whole hand, then localise to a finger. Then count down with other hand.
43
What might a displaced apex beat indicate?
LV dilation (mitral regurgitation or tension pneumothorax)
44
What might a thrusting apex beat indicate?
Systemic hypertension | Left ventricular hypertrophy
45
What might a 'tapping; apex beat indicate?
Mitral stenosis
46
How do you check for heaves?
Left hand: over left parasternal area | Right hand: over apex beat
47
What might a parasternal 'heave' indicate?
Right ventricular hypertrophy e.g. mitral stenosis Pulmonary stenosis Cor pulmonale
48
How do you check for thrills?
Medial border of hand over valve locations.
49
What is dextrocardia?
Apex of heart situated on the right hand side of the body.
50
What is a thrill?
Transmitted murmur.
51
What do check when auscultating?
Carotid pulse
52
What is the easiest order for the patient when auscultating?
1) Mitral (+axilla) 2) Tricuspid 3) Pulmonary 4) Aortic (+carotid)
53
Where do you auscultate the mitral valve?
5th intercostal; mid-clavicular.
54
Where do you auscultate the tricuspid valve?
4th intercostal; left sternal edge.
55
Where do you auscultate the pulmonary valve?
2nd intercostal; left sternal edge.
56
Where do you auscultate the aortic valve?
2nd intercostal; right sternal edge.
57
How do you auscultate the mitral valve?
Localise apex beat with finger, place stethoscope, roll patient left (accentuates), then check for radiation in axilla, then listen with bell on expiration.
58
What does radiation in the axilla indicate?
Mitral regurgitation.
59
What does listening in the axilla on expiration with the bell let you hear?
Low tone mitral stenosis
60
How do you auscultate the aortic valve?
Listen with patient lying, then sit up and forward, on expiration, then over right carotid artery for radiation.
61
What does a carotid bruit indicate when auscultating?
Aortic stenosis Atherosclerosis (old) Vasculitis (young)
62
Systolic or diastolic murmurs radiate?
Systolic
63
Systolic or diastolic murmurs require manoeuvring as they are quiet?
Diastolic
64
Ausculate lung bases for crackles, what does this indicate?
Pulmonary odema
65
2 causes of ankle/sacral oedema?
Right ventricular failure | Hypoalbuminaemia
66
How would you detect Roth's spots
Fundoscopy
67
What do Roth's spots indicate?
Infective endocarditis
68
How would you complete this exam?
Peripheral pulses, O2 sats, dipstick urine, fundoscopy, look at observation charts, feel for hepatomegaly.

Physical Examinations (2 decks)

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