Cardiovascular examination

Question 1

What are xanthomata?

Answer 1

Yellow cholesterol-rich deposits

Question 2

Where are xanthomata found?

Answer 2

Palm
Tendons of the wrist
Tendons of the elbow

Question 3

What are xanthomata associated with?

Answer 3

Hyperlipidaemia (typically familial hyperlipidaemia)
Coronary artery disease
HTN

Question 4

What heart defects is Marfan’s associated with?

Answer 4

Aortic dissection
Mitral valve prolapse
Aortic valve prolapse

Question 5

What are the cardiac causes of clubbing?

Answer 5

Congenital cyanotic heart disease
Infective endocarditis
Atrial myxoma

Question 6

What are causes of splinter haemorrhages?

Answer 6

Infeective endocarditis
Local trauma 
Sepsis 
Vasculitis 
Psoriatic nail disease

Question 7

Where do janeway lesions typically occur?

Answer 7

Thenar and Hypothenar eminences of the palms

Also the soles

Question 8

Where are Osler’s nodes found?

Answer 8

Fingers or toes

Colour = red-purple

Question 9

Which are painful- Osler’s nodes or janeway lesions?

Answer 9

Osler’s nodes

Question 10

What might cool hands in a cardio exam suggest?

Answer 10

Poor peripheral perfusion caused by:

1. Congestive cardiac failure
2. Acute coronary syndrome

Question 11

If you detect an irregular radial pulse, how long do you count for?

Answer 11

60 seconds

Question 12

What are causes of an irregular rhythm in the pulse?

Answer 12

AF
Ectopic beats
AV blocks

Question 13

What are causes of radio-radial delay?

Answer 13

1. Subclavian artery stenosis (e.g. by compression by a cervical rib)
2. Aortic dissection
3. Aortic coarctation

Question 14

What is another name for Collapsing pulse?

Answer 14

Water hammer pulse

Question 15

What are causes of a collapsing pulse?

Answer 15

1. Normal physiological states: fever, pregnancy
2. Cardiac lesions: Aortic regurgitation, patent ductus arteriosus
3. High output states: anaemia, arteriovenous fistula, thyrotoxicosis

Question 16

What causes a slow rising pulse?

Answer 16

Aortic stenosis

Question 17

What causes a bounding pulse?

Answer 17

Aortic regurgitation

CO2 retention

Question 18

What causes a thready pulse?

Answer 18

Intravascular hypovolaemia e.g. in sepsis

Question 19

What does narrow pulse pressure mean?

Answer 19

<25mmHg between SBP and DBP

Question 20

What does wide pulse pressure mean?

Answer 20

> 100mmHg between SBP and DBP

Question 21

What is a significant difference in BP between the left and the right arm?

Answer 21

> 20mmHg

Question 22

What causes a narrow pulse pressure (3)

Answer 22

Aortic stenosis
Congestive heart failure
Cardiac tamponade

Question 23

What causes a wide pulse pressure? (2)

Answer 23

Aortic regurgitation

Aortic dissection

Question 24

What causes a difference in BP between the arms?

Answer 24

Aortic dissection

Question 25

Where does the internal jugular vein connect to?

Answer 25

The Right atrium (via the superior vena cava) - there are no valves

Question 26

What are the causes of a raised JVP?

Answer 26

Venous HTN - can be caused by the following: 1. Right sided HF 2. Tricuspid regurgitation 3. Constrictive pericarditis

Question 27

What are causes of RHF

Answer 27

1. LHF | 2. Pulmonary HTN (due to COPD or interstitial lung disease)

Question 28

What are the causes of tricuspid regurgitation?

Answer 28

Infective endocarditis

Question 29

What are the causes of Constrictive pericarditis?

Answer 29

Idiopathic Rheumatoid arthritis TB

Question 30

What is a positive hepatojugular reflux result?

Answer 30

a rise in JVP which is sustained and =/> 4cm

Question 31

What does a positive hepatojugular reflux result mean?

Answer 31

The RV is unable to accomodate an increased venous return

Question 32

What are the causes of a positive hepatojugular relfux?

Answer 32

Constrictive pericarditis RHF LHF Restrictive cardiomyopathy

Question 33

At what age is corneal arcus normal?

Answer 33

>60 yo

Question 34

If corneal arcus is detected in 50 what can it suggest?

Answer 34

hypercholesterolaemia

Question 35

What are xanthelasma

Answer 35

cholesterol-rich deposits around the eye

Question 36

What may angular stomatitis suggest?

Answer 36

Iron deficiency

Question 37

What are the 4 scars in cardio exam? and state what the procedures occur there

Answer 37

Midline sternotomy (valve replacement surgery and CABG) Anterolateral thoracotomy scar (minimally invasive cardiac valve sugery) Infraclavicular scar (pacemaker insertion) Left mid-axiallary scar (ICD insertion)

Question 38

Where do you feel for a parasternal heave?

Answer 38

left sternal edge

Question 39

What causes a parasternal heave?

Answer 39

RV hypertrophy

Question 40

What are the steps for the auscultations process?

Answer 40

1. Palpate the carotid 2. Listen with diaphragm (4 valves) 3. Listen with the bell (4 valves) 4. Accentuation manoeuvres

Question 41

What are the steps for accentuation manoeuvres?

Answer 41

1. Ausculatate the carotid (pt holds breath) 2. Sit the pt forwards + listen over aortic area using the diaphragm - on EXPIRATION 3. Roll the patient to the left side - listen over mitral area during EXPIRATION - mitral regurg 4. continue to listen into the axilla - mitral regurg radiation 5. With the pt still on theit left - listen over the mitral area with bell during EXPIRATION - mitral stenosis

Question 42

What scar is it important to check for in the legs?

Answer 42

Saphenous vein harvesting

Question 43

How do you complete a cardiovascular exam?

Answer 43

``` Peripheral vascular exam 12-lead ECG Dipstick urine Bedside capillary glucose Fundoscopy ```