CVS exam

Question 0

1. General observations

Answer 0

Age
Gender
General health
Colour
Mental state
Dysmorphic features - downs, turners, marphan (aortic valve regurgitation, marphan has defective collagen, commonly have aortic dissection)
Cigarettes, O2, GTN spray, IV presence 
Chart - BP HR RR BGl temp urinalysis O2

Question 1

0. Pre-exam checklist

Answer 1

Wash hands
Explain procedure
Obtain consent
Ensure hands are warm

Question 2

2. Hands

Answer 2

Dysmorphic features - arachnodactyly
Pallor of nail beds - anemia
clubbing - cyanotic congenital cardiac disease, subacute bacterial endocarditis
Peripheral cyanosis - poor circulation
Oslers nodes, jane way lesions, splinter hemorrhages - infective endocarditis
Pale palmar creases - anemia
Xanthomata - hypercholesteremia

Question 3

3. Pulses and BP (hands/arms)

Answer 3

Radial pulse rate rhythm character (60-100bpm)

Radio-radial delay- subclavian stenosis, arterial occlusion, coarctation of the aorta, dissecting aneurism

BP both arms (<10mmHg dif)

BP inspiration - pulsus paradoxis (15-30 drop sys) - cardiac tamponade, constrictive pericarditis, severe asthma

BP standing - postural hypotension (>20 sys, >20 dias) - Hypovalemia, ANS neuropathy, drugs

Question 4

4. Eyes and mouth

Answer 4

Eyes:
Xantholasma - hypercholesteremia 
Pallor of conjunctival rim - anemia
Jaundice of sclera - severe ccf, hepatic failure
Mouth:
Central cyanosis - reduced oxygenation
Gums + teeth - heart disease
Palate - high arch = Marchand

Question 5

5. Neck

Answer 5

JVP jugular venous pulse should be 3-4cm above sternal angle - RHF, constrictive pericarditis, tricuspid stenosis, SVC obstruction

Carotid pulse rate rhythm character

Carotid Bruits in-out-hold - listen for radiating murmur

Question 6

6. Chest inspection

Answer 6

Scars
Deformities
Pacemakers or defib boxes
Visible Apex beat

Question 7

7. Chest palpitation

Answer 7

Position and character of apex beat - 5th IC space, midclavucar line - cardiac enlargement, chest wall deformity, pleural or pulmonary disease

Abnormal pulses / thrills - flat of hand over apex and left sternal angle

Question 8

8. Chest auscultation

Answer 8

Aortic area - 2nd IC space, R sternal border
Pulmonary area - 2nd IC space, L sternal border
Tricuspid - 5th IC space, L sternal border
Mitral - 4-5th IC space, L midclavicular

S3+S4 = stenosis
S1 = T+M closure
S2 = A+P closure

Sit forward -

Question 9

9. Back

Answer 9

Scars/ deformities

Sacral edema

Percuss for pleural effusion

Auscultate lung bases - crackles are pulmonary edema

Question 10

10. Abdomen palpation

Answer 10

Liver - enlarged/tender - hepatic vein congestion, RH failure

Spleen - enlarged - infective endocarditis

Kidneys

Ascites- RH failure

Aortic aneurism

Question 11

11. Abdomen auscultation

Answer 11

Bruits:
Aortic = midline, level of iliac crest
Renal = lateral to midline, halfway xipisternum + umbilicus
Iliac = above in inguinal crease
Femoral = below inguinal crease

Question 12

12. Lower limb inspection

Answer 12

Varicose veins

Colour

Trophic changes - thin/dry/shiny skin, ulcers, nail growth, absence of hair

Xanthomata

Clubbing of toes

Question 13

13. Lower limb palpation

Answer 13

Temp - asymmetrical is PVD
Pitting edema - with increase JVP cardiac/pulmonary, without increase JVP liver/kidney
Non-pitting edema - lymphedema
Calf - swelling unilateral >2cm DVT
PULSES:
Femoral - below femoral, been ASIS and symphis pubis
Popliteal - behind knee
Posterior tibial - behind, slightly below medial malleolus
Dorsalis pedis - dorsum lateral to big toe tendon

Question 14

14. Further analysis

Answer 14

ECG
urinalysis
Fundoscopy