Cardiovascular Mini-Cex Flashcards
(28 cards)
What is the first step in the cardiovascular examination?
Step 1: Introduction - Actions
Perform hand wash/hand rub.
Introduce yourself – state your name and your role (e.g., year medical student).
Explain the purpose of the examination (cardiovascular examination). Mention that it will involve examining parts of the hands, arms, face, neck, chest, abdomen, and legs.
Explain that you will use a stethoscope. Note that for later parts, the patient will need to remove their shirt.
Explain that you will be reporting some findings to your supervisor as you go along.
Obtain consent – ask if this sounds okay.
Position the patient: adjust the examination bed if needed to ensure the patient is propped up at 45 degrees.
What is the key output of Step 1: Introduction?
The key output of this step is obtaining consent and positioning the patient.
What should be observed during Step 2: General Inspection?
Observe the patient’s posture, comfort, body habitus, color, respiratory distress, and dysmorphic features.
What is the reporting comment for general inspection?
“Upon general inspection…”.
“The patient is comfortable, appears alert, has normal body habitus and normal color.”
“The patient is not in any respiratory distress and has no dysmorphic features.”
What actions are taken during Step 3: Hands and Upper Limb?
Explain to the patient: “Can you please show me your hands?”. Inspect the dorsal and palmar sides of the hands for palmar crease pallor, peripheral cyanosis, clubbing, xanthomata, and signs of infective endocarditis. Look across the nail bed angle or demonstrate the Schamroth window test to check for clubbing.
What findings should be reported after inspecting the hands?
“There is no Palmar Crease Pallor, Xanthomata, Peripheral Cyanosis, Osler nodes, Janeway lesions, Splinter hemorrhages.”
“There is no clubbing.”
What actions are taken during Step 4: Perform Vital Signs?
Tell the patient: “I’m going to check the pulse at your wrist now.” Examine the right Radial Pulse. Note its rate and rhythm.
Examine the Respiratory Rate discreetly.
Check both radial pulses simultaneously.
Comment on, but are NOT REQUIRED TO PERFORM: Blood Pressure measurement and Radio-femoral delay.
What findings should be reported for vital signs?
“The radial pulse is …. beats per minute, regular and strong.”
“The respiratory rate is … breaths per minute.”
“There is no radio‐radial delay.”
“I would also take the patient’s blood pressure.”
What actions are taken during Step 5: Face – Eyes and Mouth?
Explain to the patient: “I’m going to examine your eyes now.”
Ask the patient: “Can you please pull down your lower eyelids for me?”. Inspect the eyes for xanthelasma, conjunctival pallor, and jaundice.
Explain to the patient: “Can you please open your mouth?”. Illuminate the oral cavity and inspect for central cyanosis, palate, teeth, and gums.
What findings should be reported for the eyes and mouth?
“There is no jaundice, conjunctival pallor or xanthelasma.”
“The teeth, gums and palate are normal.”
“There is no central cyanosis.”
What actions are taken during Step 6: Neck?
Ask the patient: “Can you please turn your head slightly to your left?”. Ensure the patient is propped up at 45 degrees.
Inspect the JVP (Jugular Venous Pulse) with their neck relaxed and head rotated 45 degrees. Estimate the JVP height.
Take the right carotid pulse, then the left carotid pulse. Listen over the carotids for bruits.
What findings should be reported for the neck?
“The JVP is normal, with a height of …. cm above the sternal angle”
“The carotid pulses are strong and symmetrical.”
“There are no carotid bruits.”
What actions are taken during Step 7: Chest Inspection?
Ask the patient: “Can you please remove your shirt? I will now examine your chest.”
Look for chest shape/deformities, implantable devices, scars, and apex beat.
What findings should be reported for chest inspection?
“The apex beat is visible/not visible. There are no scars, chest deformities or implantable devices seen.”
What actions are taken during Step 8: Palpation of Chest?
Inform the patient: “I am now going examine parts of your chest with my hands.”
Palpate the apex beat and localize it. Palpate for thrills and heaves.
What findings should be reported for palpation of the chest?
Report findings for apex beat: “The apex beat is normal and not displaced.” Report findings for thrills and heaves: “There are no thrills or (parasternal) heaves.”
What actions are taken during Step 9: Auscultation of Chest?
Inform the patient: “I am now going to have a listen to your chest with my stethoscope. Would that be, okay?”. Auscultate the Mitral Area, Tricuspid Area, and along the Left sternal margin.
What findings should be reported for auscultation of the chest?
Report findings: “The heart sounds are normal, there are no added heart sounds or murmurs.”
What actions are taken during Step 10: Further Auscultation of Chest?
For Left Lateral position: Ask your patient to roll onto their left side and auscultate the Mitral area. For Leaning Forward position: Ask the patient to sit upright and lean forward, then auscultate the heart base.
What findings should be reported for further auscultation of the chest?
Report findings: “There are no added heart sounds, friction rubs or murmurs.”
What actions are taken during Step 11: Back?
Ask the patient: “Could you lean forward slightly so I can have a look at your back please?”. Inspect the posterior chest, put pressure on the lower back, and percuss the lung bases.
What findings should be reported for the back?
Report findings: “On inspection of the back there are no deformities. There are no signs suggestive of cardiac failure with no sacral oedema, a resonant percussion notes, and normal breath sounds on auscultation of the lung bases.”
What actions are taken during Step 12: Lower Limbs?
Tell the patient you will examine their lower limbs. Inspect the legs and feet for varicose veins, color, temperature, trophic changes, ulceration, clubbing, and xanthomata.
What findings should be reported for the lower limbs?
Report findings: “The lower limbs have normal color, temperature, and symmetrical, strong pulses. There were no trophic skin changes, ulceration, clubbing of the toes, xanthomata, or peripheral oedema. There were no varicose veins or calf tenderness.”
