CVS examination

Question 1

CVS causes of clubbing are (3)

Answer 1

Infective endocarditis
Cyanotic congenital heart disease
Atrial Myxoma (benign tumour)

Question 2

What are the 4 causes of Radio-radio (femoral) delay

Answer 2

Aortic coarctation
Aortic dissection
Aortic embolism
Cervical rib (just R-R)

Question 3

When assessing character of pulse, a … is indicative of aortic stenosis

Answer 3

slow rising

Question 4

When assessing character of pulse, a bisferious pulse feels like what

Answer 4

A double peak per cardiac cycle (translates as ‘striking twice’)

Question 5

What does a Bisferious pulse character indicate

Answer 5

Mixed AR and AS

Question 6

A … pulse pressure indicates AR

Answer 6

wide

Question 7

A … pulse pressure indicates AS

Answer 7

Narrow

Question 8

… can present with … and looks like flushing of cheeks with labial sparing

Answer 8

Mitral Stenosis … Malar flush

Question 9

What does corrigans sign look like

Answer 9

Ear movement or head nodding as a result of powerful carotid pulsation

Question 10

Corrigans sign is caused by …

Answer 10

Aortic regurgitation

Question 11

How can you exacerbate JVP

Answer 11

Hepatojugualr reflex (ask if in pain)

Question 12

Persistent elevation of JVP after pressing in RUQ indicates ….

Answer 12

RHF

Volume overload

Question 13

…. and …. surgery will be visible as midline sternotomy scars

Answer 13

CABG

Valve replacement

Question 14

A left submammary scar would indicate

Answer 14

Mitral valve replacement

Pericardial window

Question 15

When is a pericardial window done

Answer 15

Pericardial effusion, fluid drains into pleural cavity where it is not dangerous.

Question 16

What 3 types of character can you assess for when feeling the apex beat?

Answer 16

Thrusting
Heaving
Tapping

Question 17

A thrusting apex beat indicates (3)

Answer 17

AR
MR
LVF

Question 18

A heaving apex beat = LVH, which indicates what (4)

Answer 18

HOCM (hypertrophic cardiomyopathy)
Aortic stenosis
Hypertension
Aortic coarctation

Question 19

A Tapping apex beat indicates what one thing

Answer 19

MS

Question 20

What minimum grade of murmur can be found as a thrill

Answer 20

grade 4 and above

Question 21

What would a left parasternal heave indicate

Answer 21

RVH

Question 22

Lung crepitations would indicate … sided heart failure

Answer 22

Left

Question 23

When auscultating where MUST your left hand be?

Answer 23

palpating carotid pulse

Question 24

… radiates to axilla

Answer 24

MR

Question 25

All RIGHT sided murmurs can be made louder by

Answer 25

inspiration (lower intrathoracic pressure increases venous return)

Question 26

Mitral and Aortic murmurs can be made louder by asking the patient to ...

Answer 26

hold their breath on expiration (increased pressure)

Question 27

To increase the volume of the MS diastolic murmur you would ask the patient to move ... and hold their breath on .... whilst listening with the ... of stethoscope

Answer 27

Roll onto LHS expiration bell

Question 28

How would you amplify AS (2)

Answer 28

sit forward | Hold breath on expiration

Question 29

How would you better differentiate between a CABG and valve replacement scar.

Answer 29

Is there an accompanying leg scar

Question 30

Central cyanosis will present with ... feeling hands (unless severe) and blue lips/tongue.

Answer 30

warm

Question 31

What 3 things might causes central cyanosis

Answer 31

Hypoxic lung disease R-L cardiac shunt Methaemoglobinaemia

Question 32

What are the 2 causes of R-L cardiac shunt

Answer 32

Cyanotic congenital heart disease | Eisenmengers syndrome

Question 33

∆∆ for atrial fibrillation (3)

Answer 33

AF VEBs (ventricular ectopic beats - disappear on exercise) Complete heart block + ventricular escape

Question 34

The 6 important causes of atrial fibrillation are remembered by the mneumonic PPARTI . What are the first 3

Answer 34

PE Pneumonia Alcohol

Question 35

The 6 important causes of atrial fibrillation are remembered by the mneumonic PPART. What are the last 3

Answer 35

Rheumatic heart disease Thyrotoxicosis Ischaemic heart disease

Question 36

An abnormally large decrease in pulse wave amplitude and BP during inspiration despite the heart being heard on auscultation is called a ...

Answer 36

Pulsus paradoxus

Question 37

In pulsus paradoxus key thing to remember is that it is due to a decreased ability of the heart to contract when pressure increases e.g. during inspiration. Knowing this, what are the 4 main causes (4)

Answer 37

Severe obstructive lung disease Tamponade Restrictive cardiomyopathy Constrictitive pericarditis *same as Kussmauls except for SOLD*

Question 38

Describe Kussmauls signs

Answer 38

Increased JVP on inspiration

Question 39

What is physiologically causes Kussmauls sign

Answer 39

impaired RV filling

Question 40

What are the causes of Kussmauls sign

Answer 40

Tamponade Constrictive pericarditis Restricitve cardiomyopathy *same as pulsus paradoxus*

Question 41

there are 5 logical causes of an impalpable apex beat

Answer 41

``` Fat Fluid (pericardal/pulm. effusion) Air (pneumothorax) Displaced (LHF) Dextrocardia ```

Question 42

An elevated JVP can be caused by (4)

Answer 42

Constrictive pericarditis PE RHF Volume overload

Question 43

Continued elevated JVP can only be caused by one thing

Answer 43

SVC obstruction

Question 44

A decreased BP with an increased JVP can be caused by 3 things

Answer 44

Massive PE Tamponade T pneumothorax