CVS Exam Signs

Question 1

Give 2 cardiovascular causes of clubbing

Answer 1

• Cyanotic congenital heart conditions

- Endocarditis

Question 2

What are Janeway lesions and Osler’s nodes?

Answer 2

Microvascular infarctions caused by septic emnboli

Question 3

Where would you see Janeway lesions? Are they painful?

Answer 3

• On palms

- Painless

Question 4

Where would you see Osler’s nodes?

Are they painful?

Answer 4

• On pad of fingers

- Painful

Question 5

Give 3 hand signs of infective endocarditis

Answer 5

• Osler’s nodes
• Janeway lesions
• Splinter haemorrhages

Question 6

What would be a cause of a regularly irregular pulse?

Answer 6

Heart block

Question 7

What would be the rate and rhythm in AF?

Answer 7

• Tachycardic

- Irregularly irregular

Question 8

What is the character of the pulse in:

• Aortic stenosis
• Aortic regurg

Answer 8

• Stenosis - slow rising

- Regurg - collapsing

Question 9

What is JVP a measure of?

Which vein are you looking at?

Answer 9

Right atrial pressure

Internal jugular vein

Question 10

What affects JVP apart from RA pressure (2 factors)?

Answer 10

• Fluid status

- Contractility

Question 11

How is JVP measured?

Answer 11

Height above sternal angle, plus 5cm, as RA is 5cm below sternal angle

Question 12

What is normal JVP?

Answer 12

Less than 3cm (8cm in total)

Question 13

Give 4 causes of a raised JVP

Answer 13

• RV failure
• Cardiac tamponade
• SVC obstruction
• Fluid overload

Question 14

How would distinguish whether you were seeing the JVP or the carotid pulse?

Answer 14

• Carotid - palpable

- JVP - non-palpable, obliterated by compression

Question 15

What is hepatojugular reflux?

Answer 15

Phenomenon whereby firm pressure to RUQ causes transient rise in JVP
If persists - RV dysfunction

Question 16

What is malar flush a sign of?

Why does it occur?

Answer 16

Mitral stenosis

CO2 retention results in vasodilatation

Question 17

What is a thrill?

Answer 17

A palpable murmur

Question 18

What is a heave?

What does it signify?

Answer 18

Sustained forceful pulsation

RV hypertrophy

Question 19

What is a murmur?

Answer 19

Extra/abnormal sound during the heartbeat cycle, caused by turbulent blood flow

Question 20

What are the two major causes of murmur?

Answer 20

• Valvular stenosis

- Valvular incompetence resulting in regurgitation

Question 21

Describe the normal heart sounds in terms of character and what they signify

Answer 21

S1 - crescendo-decrescendo - A-V valves closing - beginning of systole
S2 - shorter duration, higher frequency - outflow valves closing - end of ventricular systole

Question 22

When timing a murmur with the carotids, what does the carotid pulse equate with?

Answer 22

• Pulse = ventricular systole - S1

Question 23

Where would you best hear a murmur of mitral stenosis?

Answer 23

• In apex, with bell, when patient rolled to left - held expiration

Question 24

Which murmur is best heard over the carotids?

Answer 24

Aortic stenosis

Question 25

Which murmur are you listening for if you lean the patient forward in held expiration, and listen over the 5th ICS, left sternal edge?

Answer 25

Aortic regurgitation

Question 26

How would you listen best for mitral regurgitation?

Answer 26

Over axilla

Question 27

You hear a murmur over the apex when the patient is rolled to the left. What is the likely diagnosis? When would you hear the murmur?

Answer 27

Mitral stenosis | Mid-diastolic

Question 28

You identify a pansystolic murmur. What is the likely diagnosis? Where would you best hear it?

Answer 28

Mitral regurgitation | Over axilla

Question 29

Which condition causes an ejection systolic murmur?

Answer 29

Aortic stenosis

Question 30

When and where would you best hear a murmur of aortic regurgitation?

Answer 30

- Early diastolic | - Leaning forward, 5th ICS, left sternal edge, held expiration

Question 31

What would cause a continuous murmur?

Answer 31

Patent ductus arteriosus

Question 32

If you identified basal lung crepitations but no peripheral oedema, which side is the heart failure?

Answer 32

Left

Question 33

Would you be more likely to get peripheral or pulmonary oedema in RHF?

Answer 33

Peripheral

Question 34

Where would you palpate for the dorsalis pedis pulse? | What about posterior tibial?

Answer 34

- Dorsalis pedis - between flexor hallucis longus and flexor digitorum longus tendons - Posterior tibial - posterior to medial malleolus