Examination Bundles

Question 1

PE

Answer 1

Fever, tachypnoea, tachycardia, hypotension

pHTN

rHF

Question 2

pHTN

Answer 2

loud and palpable P2
Parasternal heave
elevated JVP
Systolic murmur from TR

Question 3

rHF

Answer 3

Raised JVP
peripheral oedema
Hepatomegaly

Question 4

AS

Answer 4

Pulse - slow rising pulse, narrow pulse pressure

Palpation for diaplaced apex beat, thrill or heave

Auscultate for ejection systolic murmur

Question 5

MR

Answer 5

Tachypnoea, AF
Displaced and forceful apex beat, parasternal thrill

Pan-systolic murmur at apex radiating to axilla

MR murmur gets softer with valsalva -> reduced preload, smaller LV, improves geometry.

Question 6

Mitral prolapse

Answer 6

Mid systolic click
Louder with valsalva and with standing
–> small LV, less tension on the chordae, more prolapse

Question 7

MS

Answer 7

Low pitched, rumbling diastolic murmur best heard left lateral.

Open snap
Loud S1, Loud P2

RHF, pHTN
AF

Question 8

AR

Answer 8

Associated Marfan, ank spend, seronegative arthropathies

Waterhammer, collapsing pulse. Widened pulse pressure, low DBP.

Corrigan’s sign (visible neck pulsation)

De Musset’s sign (head nodding)

Quicke’s sign (visible pulsations of nailbed).

Hill’s sign - >20mmhg difference in pop + brachial BP

Decrescendo high pitched early systolic murmur.

Question 9

Congenital heart disease with Systolic murmur

Answer 9

ASD - ESM left IC space
VSD - holosystolic murmur
Pulmonary stenosis
Bicuspid valve

Question 10

Tricuspid regurgitation

Answer 10

Signs of PHTN
Giant V wave JVP
Pansystolic murmur maximal at lower left sternal edge.
Pulsatile liver
Peripheral oedema

Question 11

Marfan’s exam

Answer 11

Skeletal - long arms and legs, pectus, exacavatum, arachnodactyly, scoliosis, medial displacement of medial malleolus, deformed hip joint

CVS - dilated aorta, AR, MR

Opthal - ectopic lens

CNS - enlarged neural canal

Striae skin

MSK - joint hyper mobility

Airway - high arched palate, crowding of teeth, C-spine instability

Question 12

Eisenmenger’s exam

Answer 12

central cyanosis
Clubbing,
polycythemia
pHTN, RVF

Question 13

HOCM

Answer 13

Heart failure - SOB
Exertional CP, arrhythmia

sharp rising pulse, rapid ejection

Prominent a wave due to forceful atrial contraction against a non-compliant RV

Double or triple apical impulse

Late systolic murmur lower L sternal edge, or pansystolic murmur

S4

Murmur increases with valsalva and standing

Question 14

pHTN haemodynamic targets

Answer 14

systolic pressure >90, or 40 above PASP

MAP >65, or 20 above mPAP

Question 15

Formula for calculating Paeds
SBP and MAP

Answer 15

SBP = 70 + 2 x age

MAP = 1.5 x age + 55

Question 16

Brugada syndrome ECG finding?

Answer 16

Coved ST elevation V1-V3 with negative T wave

Question 17

Peripheral vascular disease exam

Answer 17

Absent or weak peripheral pulses

Skin changes, hair less, temperature difference in limbs

Ulcers

Carotid murmur, heart murmur, palpate abdomen for AAA

Buerger’s test - passive leg raise -> pale, then flushing in a dependent position.

Question 18

Asthma Exam

Answer 18

Increased WoB
Pursed lips
Wheezing, cough
Hyperinflated chest
Global wheeze
Reduced chest expansion

Question 19

COPD Exam

Answer 19

Peripheral
Pursed lips
Increased WoB
Cyanosis

Central
Hyperinflation
Increase resonance on percussion
Decreased breath sound and end exp wheeze

Complications - RHF, cachexia

Question 20

Bronchiestasis exam

Answer 20

Peripheral - fever, WoB, cyanosis, large volume offensive sputum

Central - coarse crepitation

Complications - cor pulmonale, RHF