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*3. Thorax > Clinical skills: cardiovascular exam > Flashcards

Clinical skills: cardiovascular exam Flashcards

1
Q

What are the components of the cardiovascular exam?

A

Initial approach
General inspection
Vital signs
Upper limb (hands, wrists, elbows/arms)
Face
Neck
Chest
Lungs
Liver
Lower limb
Conclude exam

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2
Q

INITIAL APPROACH:
What do you need to do?

A

7 normal steps
Ask if they’re in any pain or discomfort before beginning the exam, and ask throughout

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3
Q

GENERAL INSPECTION:
What to look for?

A

Body build
Comfort
Congenital abnormality
Dyspnoea
Distress/pain
Debility
Hydration

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4
Q

What are the 3 congential abnormalities and their features?
Why is it relevant to CVD?

A

Turner’s syndrome: webbed neck, short
Marfan syndrome: tall, skinny, long limbs/fingers, kyphosis
Down syndrome: almond shaped eyes
As they confer increased risk to CVD

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5
Q

VITAL SIGNS
- What are they?
- Do you have to perform them in the APEX?

A

Respiratory rate
Pulse: radial pulse rate and rhythm
Blood pressure
Temperature

No - can say you’d ordinarily do them but skipping today

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6
Q

UPPER LIMB: HANDS
- What are you looking for?
- What are you feeling for?

A

LOOK
General:
- Clubbing
- Peripheral cyanosis

Lesions (pictured!)
- Janeway lesions
- Osler nodes
- Splinter haemorrhage
- Tar staining
- Xanthomata

FEEL
- Cold
- Sweat
- Capillary refill

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7
Q

What is endocarditis?
What is its usual cause?
How does it contribute to Janeway lesions, Osler nodes, splinter hemorrhage?

A

Inflammation of the inner lining of the heart’s chambers and valves.
Due to infection.
Infective emboli go from heart and are deposited in capillaries

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8
Q

Are Janeway lesions and Osler nodes rare?

A

Yes

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9
Q

Difference between Janeway lesiosn and Osler nodes? How to remember?

A

Janeway lesions: palpable but not painful.
Osler nodes: palpable and painful (O for ouch/oh that hurts)

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10
Q

UPPER LIMBS: WRISTS
What to do?
Is it okay to skip?

A

Radio-radio delay
Radio-femoral delay

Yes - if you acknowledge

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11
Q

UPPER LIMBS: ELBOWS AND ARMS
What to do?

A

Xanthomata
Brachial pulse

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12
Q

Xanthomata
- What is the singular name?
- What are they?
- What are they caused by?

A

Xanthoma
Yellow skin lesions
Fat within macrophages is deposited in the skin. Usually due to primary lipid disorders.

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13
Q

Xanthomata
- What is the singular name?
- What are they?
- What are they caused by?

A

Xanthoma
Yellow skin lesions
Fat within macrophages is deposited in the skin. Usually due to primary lipid disorders.

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14
Q

FACE
What 3 parts of the face do you look at?

A

Cheeks
Eyes
Mouth

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15
Q

FACE
Overall, what do you look for?

A

Cheeks: mitral facies
Eyes:
- Jaundice (whites)
- Pallour (conjunctiva)
- Corneal arcus/arcus senilis
- Xanthelasma

Mouth
- Lips: central cyanosis, petechiae
- Tongue: central cyanosis
- High arched palate
- Teeth and gums

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16
Q

FACE
What does conjunctival pallour indicate?
Xanthelasma are ________ but around the eyelids
What are petechiae and their causes?
Where should you look on the tongue for central cyanosis?
High arched palate is a sign of

A

Anemia
Xanthomata
Red dots, due to capillaries bursting. Due to impaired blood clotting/vascular integrity
Underneath
Marfan syndrome

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17
Q

FACE
Mitral facies
-What is the cause?
- What is the effect?

A

Severe mitral valve stenosis –> cutaneous vasodilation –> abnormal flushing of the cheeks

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18
Q

FACE
Corneal arcus
- What causes it?
- Is it normal in older people? What is it called?
- Is it normal in younger people? What is its cause?

A
  • Deposits of lipids around the corneal margin, forming an arc (thus the name)
  • Yes, arcus senilis
  • No, lipid metabolism disorders
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19
Q

NECK
- What must you do before the tests?

A
  • Make table 45 degrees
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20
Q

NECK
What are the tests

A

Internal jugular vein:
- Jugular venous pressure
- Abdominojugular reflex

Carotid artery
- Palpation (2 fingers)
- Thrills (palm of hand)
- Bruits (auscultate)

21
Q

NECK
Jugular venous pressure
- What does it approximate?
- How to locate the internal jugular vein?

A

central venous pressure

Turn head 45 degrees to the left
Should see double flickering - if not, light and abdominojugular reflex can help

22
Q

NECK
Jugular venous pressure
- How to measure

A

Measure vertically from the sternal angle to the top of the jugular vein.

With ruler going up, stick going across.

23
Q

NECK
Jugular venous pressure
- What is normal?
- What does above and below this mean?

A

3-4cm is normal
Above: elevated central venous pressure
Less: dehydration, low blood volume

24
Q

NECK
Abdominojugular reflex
- How to conduct?
- Normal and abnormal results?

A

Place hand firmly in middle part of upper abdomen, then look at internal jugular vein.
Normal: temporary jugular vein distension
Abnormal: persistent distension

25
Q

NECK
- When should you palpate both carotids at once?
- Carotid bruits: when do they occur? NOrmal and abnormal findings?

A
  • Never
  • During turbulent flow. So don’t hear normally, only during narrowing
26
Q

CHEST
What are the 4 parts of the chest exam?

A

Inspect
Palpate
Auscultate
Specialised manouevres

27
Q

CHEST
Inspect: what do you inspect for?

A

Skin:
- Scars
- Rashes

CVS:
- Apex beat
- Abnormal pulsation
- Breathing pattern

Other deformities
- Skeletal deformities (barrel chest, funnel chest, pigeon chest)
- Sacral oedema
- Pacemaker

28
Q

CHEST
Inspect: do you know what barrel chest, pigeon chest, funnel chest deformities look like?

A

Yes

29
Q

CHEST
Palpate: what 3 things do you palpate for?

A

Apex beat
Heaves
Thrills

30
Q

CHEST
Palpate:
- How do you palpate the apex?
- Is it palpable in all people?
- Who is it harder to palpate in?

A

With fingertips
Not all - 50%
Women, larger people

31
Q

CHEST
Palpate: heaves
-How do you do heaves?
- Where do you palpate?

A

Palpate the left of the sternum with the heel (H for heaves and heel) of your hand

32
Q

CHEST
Palpate: thirlls
- How do you palpate thrills?
- Where do you palpate thrills?

A

with palm of hand
Over aortic, pulmonary, tricuspid, mitral areas

33
Q

CHEST
Palplate: where is the
- Base
- Apex
- Aortic area
- Pulmonary area
- Tricuspid area
- Mitral area

A
34
Q

CHEST
Auscultate
- Which areas do you ausculate and with bell, diaphragm, or both?
- What additional step must you complete?

A
  • Aortic: diaphragm only
  • Pulmonary: diaphragm only
  • Tricuspid: diaphragm only
  • Mitral: diaphragm and bell

Comment on heart sounds S1 (lub) and S2 (dub), and additional sounds

35
Q

CHEST
Special manoeuvres
What are the 5 you must perform? With bell, diaphragm, or both?

A

Left lateral decubitus: lie on left side. Auscultate with bell over the mitral valve.
aOrtic: get patient to breathe Out, hold breath, auscultate with diaphragm over aortic area
Pulmonary: get patient to breathe in, hold breath, auscultate with diaphragm over the pulmonary area
Tricuspid: get patient to breathe in, hold breath, auscultate with diaphragm over the tricuspid area
Leaning fOrward: get patient to lean fOrward, breathe Out, hold breath, auscultate with diaphragm over 3rd left intercostal space.

36
Q

CHEST
What are some symptoms of right heart failure

A

Lower limb pitting odema
Sacral odema
GI tract congestion (abdominal pain, anorexia, weight loss)
Hepatomegaly

37
Q

CHEST
What are some symptoms of left heart failure

A

Decreased CO –> cyanosis, decreased exercise tolerance
Fluid in lungs:
- Orthopnoea, paroxysmal nocturnal dyspnoea
- Cough with frothy sputum
- Cyanosis, hypoxia

38
Q

LUNGS
Percussion (generally): what structures lead to dull sounds? Resonant sounds?

A

Solid/liquid structures
Gas structures

39
Q

LUNGS
Auscultation of lungs
- What leads to normal breath sounds? Crackles? No breath sounds?

A

Normal lungs, pulmonary oedema, loss of lung tissue (eg. pleural effusion which pushes lungs up)

40
Q

LUNGS
Complete the table

A
41
Q

LUNGS
- What positiondoes the patient need to be at?
- What two steps need to be done (in how many places?)

A

Sitting up
Percuss (4 spots)
Auscultate (4 spots)

42
Q

LIVER
- What position/angle should the patient be at?
- What two steps do you need to do?
- What is the goal of these steps?

A

Flat/0 degrees
Palpate
Percuss
Determining liver size - hepatomegaly may indicate right heart failure

43
Q

LIVER
How to palpate the liver?

A

Get patient to breathe in and out
During out breaths, move, fingers up. Should be able to feel the curvature of the liver just under the right ribcage.

44
Q

LIVER
How to percuss the liver?
What percussion sound should it be?

A

Go straight up then diagonally up
Dull

45
Q

LOWER LIMB
What should you look for?

A

Achilles tendon xanthomata
Colour change/cyanosis
Clubbing of toenails
Hair loss
Janeway lesions
Osler nodes
Pitting oedema
Ulcers
Varicose veins

46
Q

LOWER LIMB
What should you feel for?

A

Pitting odema
Temperature
Capillary refill
Pulses - femoral, popliteal, posterior tibial, dorsalis femoris

47
Q

BEFORE FINISHING THE EXAM
- What two things could you consider examining?

A

Urinanalysis for assessment of white blood cells if endocarditis is suspected
Examine the fundi for vascular changes if appropriate

48
Q

FINISHING THE EXAM
What 3 steps?

A
  • Report findings to supervising clinician
  • Ask if they have any questions
  • Thank patient for their time

*3. Thorax (33 decks)

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