4.1 A) Cardiovascular Examination

Front 1

5 findings of hand in CVS exam

Back 1

1. clubbing
2. Peripheral cyanosis
3. Infective endocarditis
4. Xanthomata
5. Radiofemoral delay

Hint 1

Infective endocarditis:
1. splinter haemorrhages
2. Osler's Nodes
3. Janeway Lesions

4.Tendon xanthomata: Type II hyperlipidaemia
5. Coarctation of aorta.

Front 2

5 findings of face in CVS exam

Back 2

1. Malar flush
2. Conjunctival pallor
3. Jaundice
4. Argyll Robertson Pupil
5. High-arched plate
6. Dentition {poor}

Hint 2

1.Malar flush = mitral stenosis / pulmonary stenosis
2. Pallor = anaemia
3. Valve haemolysis
4. Argyll Rob pupil = Aortic Regurgitaiton
5. High arched palate = Marfan's
6. Poor dentition relationship with infective endocarditis

Front 3

5 findings on General examination of CVS System.

Back 3

1. Dyspnoea
2. Marfan's Syndrome
3. Down's Syndrome
4. Turner's Syndrome/ Acromegaly
5. cachexia / obesity

Front 4

Features of Neck examination in CVS exam.

Back 4

JVP:
1. JVP: height
2. JVP character: wave form
Carotid pulsation
1. pulse character

Hint 4

Kussmaul's Sign of JVP : rise in JVP on inspiration- cardiac tamponade / constrictive pericarditis / Right ventricular infarction

Front 5

Inspection and palpation of Praecordium in CVS examination

Back 5

INSPECTION
1. scars { CAGS}

PALPATION
1. Apex beat {position and character}
2. Thrills
3. pacemaker boxes
BEWARE OF DEXTROCARDIA

Hint 5

apex beat is in 5th ICS , one cm medial to MCL
1. pressure loaded apex beat: hyperdynamic, systolic overloaded - forced and sustained impulse [ AORTIC STENSOSIS / HYPERTENSION]
2. Volume loaded {hyperkinetic, diastolic overloaded}-forceful unsustained-displaced downward and laterally [ AORTIC REGURGITATION / MITRAL REGURGITATION]
3. Dyskinetic apex beat: CARDIAC FAILURE
4. Tapping apex beat : MITRAL STENOSIS {palpable first heart sound}
5. Double / triple apical impulse : HCOM

Left parasternal impulse = Right ventricular OR Left atrial enlargement

Front 6

Auscultation of Heart in CVS exam

Back 6

1. Heart Sounds
2. Murmurs

Positioning {left lateral and sitting forward}
Dynamic auscultation
1. Respiratory phases
2. Valsalva
3. Exercise
4. Carotids

Hint 6

MITRAL AREA
LSE
BASE OF HEART { aortic and pulmonary areas}
CAROTID auscultation

1. First heart sound
2. Second heart sound - normal splitting
3. Extra heart sounds
4. Murmurs

POSITIONING
1. Sitting
2. Left Lateral
3. Sitting forward

MANOUEVRES
1. Valsalva performed for any pure systolic murmurs

Front 7

Back examination in CVS Exam: 4 features

Back 7

1. Scars / deformity
2. auscultation : LVF
3. percussion : pleural effusion
4. sacral oedema

Hint 7

Back deformity : ankylosing spondylitis {AR}
Listen for coarctation over back {if radiofemoral delay}

Front 8

Abdominal examination in CVS exam: 5 features

Back 8

1. Liver
2. Spleen
3. aorta
4. Ascites
5. Femoral arteries {palpation}

Hint 8

1. hepatomegaly = Right ventricular failure
pulsatile liver = TR
abdomino-jugular reflex
2. Splenomegaly = infective endocarditis

Front 9

Leg examination in CVS exam.

Back 9

1. Cyanosis
2. Pulses
3. Cold limbs
4. Ulceration {PVD}
5. Oedema {pitting}
6. calf tenderness

Front 10

"other" bedside findings in CVS examination.{specific for infective endocarditis}

Back 10

1. Fundoscopy
2. Temperature
3. Urine dipstick

Hint 10

1. Roth's Spots AND hypertensive changes
2. fever
3. haematuria

Front 11

The diaphragm is used for which high-pitched heart sounds?

Back 11

1. S1
2. S2
3. Mitral Regurgitation {MR}
4. Aortic Regurgitation {AR}
5. Pericardial friction rubs

Front 12

The bell is used for which low-pitched heart sound auscultation?

Back 12

1. S3
2. S4
3. Mitral Stenosis {MS}

Front 13

S2 is usually louder than S1 in which 2 auscultation areas?

Back 13

Aortic and Pulmonic areas

Front 14

In cardiac Auscultation, in regards to S2 , which answers are correct ?
1. It is maximal in the aortic and pulmonic areas
2. It is maximal in end expiration
3. Aortic valve closure {A2}is the first sound heard
4. Pulmonary valve closure {P2} is the second sound heard
5. It is maximal at end inspiration.

Back 14

2. S2 is maximal at end inspiration

Front 15

Aortic regurgitation {Aortic murmurs} is best heard with { position/ location/stethoscope side / respiratory cycle}

Back 15

Sitting forward
Left 2nd interspace LSE--> apex
Diaphragm
end expiration-hold

Front 16

Definition of a "thrill"?

Back 16

Palpable vibrations associated with a heart murmur

Front 17

5 causes of Orthopnoea

Back 17

1. Cardiac Failure
2. Massive ascites
3. Large pleural effusion
4. Severe pneumonia
5. Pregnancy

Front 18

In regards to "collapse", which is incorrect?
1. Presence of nausea and clamminess supports VASOVAGAL SYNCOPE
2. Orthostatic hypotension is more common when dehydrated or fasting.
3. Syncope from Left ventricular outflow obstruction {Aortic stenosis ; HCOM} occurs more commonly at rest
4. The onset of Orthostatic hypotension occurs when getting up quickly
5. The use of antihypertensive medication favours Orthostatic hypotension.

Back 18

3. Exertional

Front 19

Broad categories for drugs causing QT prolongation and Ventricular arrhythmias?

Back 19

1. Antiarrhythmics
2. Gastric motility promoters
3. Antibioitcs
4. Antipsychotics
{Side 3 has further details}

Hint 19

1. Flecainide
Quinidine
Sotalol
Procainamide
Amiodarone
2. Cisapride
3. Erythromycin
Clarithromycin
4. Chlorpromazine
Haloperidol

Front 20

Common Causes of Clubbing { Cardiovascular and Respiratory}

Back 20

Cardiovascular
1. Cyanotic congenital heart disease
2. Infective endocarditis
Respiratory
1. Lung Ca {NOT SMALL CELL}
2. Chronic pulmonary suppuration
a. Bronchiectasis
b. Lung abscess
c. Empyema
3. Idiopathic Pulmonary Fibrosis

Front 21

Uncommon causes of Clubbing: Respiratory/Gastrointestinal/Other

Back 21

Respiratory
1. Cystic fibrosis
2. Asbestosis
3. PLeural mesothelioma
Gastrointestinal
1. Cirrhosis {biliary}
2. Inflammatory bowel disease
3. Coeliac disease
Other
1. Thyrotoxicosis {Familial or idiopathic}
2. Pregnancy
3. Secondary hyperparathyroidism

Front 22

Causes of Splinter Haemorrhages

Back 22

Common/Main
1. Trauma
2. Infective endocarditis
Rare
2. Vasculitis
a. RA
b. Polyarteritis nodosa
c. Antiphospholipid syndrome
3. Sepsis
4. haematological malignancy
5. Profound anaemia