Cardiovascular Examination

Question 1

risk factors for peripheral arterial disease

Answer 1

body habitus, age, smoking, etc

Question 2

inspection of the upper arms may reveal?

Answer 2

skin colour changes (pink, pale, matted)
ischaemic changes (gangrene)
tar stains in fingers
tendon xanthomata

Question 3

what does palpation involves of the upper limbs

Answer 3

check temperature, capillary refill, pulses

Question 4

what is required in upper limb pulse checks?

Answer 4

radial pulse (including radio-radial delay and radio-femoral delay)
brachial pulse
blood pressure (>10 mmHg difference is significant)

Question 5

inspection of face may reveal

Answer 5

eyes: corneal arcus, xantholasma
mouth: central cyanosis
check carotid pulse character and bruits

Question 6

abdomen inspection is required - true or false?

Answer 6

true. check body habitus, scars, aortic pulse and femoral pulse

Question 7

is it imporant to check for aortic pulse even in a focused exam of the legs?

Answer 7

yes. (will reveal if issues may be caused by a AAA)

Question 8

what skin colour changes may be present on a lower limb inspection?

Answer 8

pink, pale, matted

Question 9

true or flase, check for ischaemic changes between toes and at heels?

Answer 9

true

Question 10

give examples of trophic changes

Answer 10

shiny skin, hair loss, thin skin, ulcers

Question 11

why might scars be present on the lower leg?

Answer 11

previous surgeries - CABG venous grafting, femoral-popliteal bypass

Question 12

palpation of lower limbs requires checking temperature, capillary refill and pulses?

Answer 12

yes

Question 13

name the lower limb pulses and their anatomical location

Answer 13

dorsalis pedis - lateral to the extensor hallucis longus tendon
posterior tibial - halfway between the posterior border of the medial malleolus and the achilles tendon
popliteal - within the popliteal fossa

Question 14

tenderness of calves may indicate critical ischaemia - true or false

Answer 14

true

Question 15

describe Buerger’s triangle

Answer 15

with the pateint lying supine, lift their leg until heel becomes pale and hold for 30s (if it does not become pale the test is normal; if it becomes pale, this is Buerger’s angle)

Question 16

pallor followed by reactive hyperaemia on dependancy is a positive test and implies significant peripheral aterial disease - true or false?

Answer 16

true

Question 17

what is the ABPI of intermittent claudication?

Answer 17

ABPI <0.9

Question 18

what is the ABPI of acute ischaemic limb? any other characteristics?

Answer 18

ABPI <0.6

6P’s - pale, pulseless, parasthesia, paralysis, pain, perishingly cold

Question 19

what is the equation for critical ischaemia?

Answer 19

= tissue loss + rest pain + ABPI <0.3

Question 20

clubbing of the fingernails could be suggestive of what diseases?

Answer 20

cyanotic congenital heart disease

infective endocarditis

Question 21

splinter haemorrhages could indicate what infection?

Answer 21

infective endocarditis

Question 22

define Quincke’s sign

Answer 22

visible pulsation of capillary bed

aortic regurgitation

Question 23

extensor tendon xanthomata is due to hypolipidaemia - true or false?

Answer 23

false - indicative of hyperlipidaemia

Question 24

Osler’s nodes and Janeway lesions could indicate infective endocarditis. what are they?

Answer 24

O - painfull red lesions on palms and soles

J - nodular haemorrhaic lesions on palms and soles

Question 25

anticoagulation issue could present as ___ on the skin

Answer 25

bruising

Question 26

tachycardia is defined as a pulse rate <60 bpm, and bradycardia is defined as a pulse rate <100 bpm. true or false?

Answer 26

false | tachycardia is defined as a pulse rate >100 bpm, bradycardia is defined as a rate <60 bpm.

Question 27

irregularly irregular pulse could be suggestive of what?

Answer 27

atrial fibrillation and ventricular ectopics

Question 28

regularly irregular pulse could be suggestive of what?

Answer 28

2nd degree heart block

Question 29

the radio-radial delay and radio-femoral delay may indicate aortic dissecion/coarctation of the aorta/aortic arch aneurysm. true or false

Answer 29

true

Question 30

what conditions could a collapsing pulse indicate?

Answer 30

aortic regurgitation patent ductus arteriosus arteriovenous malformation

Question 31

large pulse pressure is a sign of aortic stenosis. true or false

Answer 31

false. | large pulse pressure would indicate aortic regurgitation. aortic stenosis has a narrow pulse pressure.

Question 32

name 4 facial signs which may be found on examination

Answer 32

pallor malar flush ruddy plethoric complexion swollen cyanotic face

Question 33

name 4 signs you would look for in the eyes

Answer 33

conjunctiva pallor haemorrhages corneal arcus xantholasma

Question 34

a high arched palate may be indicative of which condition?

Answer 34

Marfans

Question 35

what could cause a raised JVP (hint: PQRST)

Answer 35

``` pulmonary hypertension/PE/PS/pericarditis/pericardial effusion quality of fluid eg overload right heart failure SVC obstruction tamponade/TR ```

Question 36

carotid pulse pressure and volume of aortic stenosis

Answer 36

slow rising low volume

Question 37

carotid pulse pressure and volume of aortic regurgitation

Answer 37

bounding/collapsing | same as patent ductus arteriosus

Question 38

define Corrigan's sign

Answer 38

visible carotid pulsation (aortic regurgitation)

Question 39

define de Musset's sign

Answer 39

heart bobbing in time with pulse (aortic regurgitation)

Question 40

define pectus excavatum

Answer 40

congenital deformity producing a 'caved-in/hollowed' chest appearance

Question 41

pigeon chest is an alternate name for pectus excavatum - true or false?

Answer 41

false. pectus carinatum may also be called pigeon chest

Question 42

an impalpable apex beat may be due to

Answer 42

obesity, muscular or hyperinflated chest

Question 43

a displaced apex beat may result from what conditions?

Answer 43

LV dilation eg from mitral/aortic regurgitation

Question 44

what causes a heaving apex?

Answer 44

high pressure pulsation in LVH eg aortic stenosis or systemic hypertension

Question 45

what causes a thrusting apex?

Answer 45

large area pulsation in volume overload eg MR or AR

Question 46

mitral stenosis produces a tapping apex - true or false

Answer 46

true

Question 47

what causes a parasternal heave?

Answer 47

RV hypertrophy in pulmonary hypertension

Question 48

what is a thrill?

Answer 48

a palpable murmur

Question 49

most common cause of a thrill

Answer 49

aortic stenosis

Question 50

why must the lung bases be auscultated?

Answer 50

check from pulmonary oedema in heart failure - heard as fine crackles

Question 51

peripheral oedema would indicate ___ and ___

Answer 51

hypoalbuminaemia and RVF

Question 52

true or false - auscultation of the heart valves is done with the diaphragm of the stethoscope

Answer 52

true. unless stated otherwise