Cardiovascular Examination

Question 1

Which condition are Janeway lesions & Osler’s nodes commonly associated?

Answer 1

Infective Endocarditis

Question 2

What is the difference between Janeway lesions & Osler’s nodes?

Answer 2

Janeway lesions are painless, whereas Osler’s nodes are painful. They are also of different origin, as Osler’s nodes are of immunologic origin. (they are depositions of immune complexes)

Question 3

Suggest some possible cardiovascular causes of clubbing.

Answer 3

• Congenital cyanotic heart disease (tetralogy of fallot etc.)
• Infective Endocarditis
• Cardiac malignancy e.g. atrial myxoma (benign tumour of the heart)

To be honest, any disease that results in chronic hypoxia.

Question 4

Suggest ONE cardiovascular cause of splinter haemorrhages. Which systemic conditions can cause splinter haemorrhages?

Answer 4

• Vasculitis
• SLE
• RA

N.b. these splinter haemorrhages can also be caused by trauma

Question 5

Describe the underlying cause of peripheral cyanosis. Which cardiovascular conditions can it occur in?

Answer 5

There is inadequate circulation of oxygen rich blood to the peripheries. Some possible causes are:

• Heart failure
• Arterial obstruction
• Venous obstruction

Question 6

What is central cyanosis? How can it occur?

Answer 6

The bluish colouration of the mouth/mucus membranes which is caused by the presence of an elevated level of deoxyhaemoglobin at that area. Possible causes include:

• Heart Failure
• Valvular Disease
• MI
• Congenital Heart Disease

Question 7

What disease does the combination of clubbing and cyanosis suggest?

Answer 7

Congenital heart disease

Question 8

What signs of anaemia may be visible when examining a patient?

Answer 8

• Pallor
• Pale palmar creases
• Pale conjuctiva

Tachycardia & ventricular hypertrophy may be seen in patients with severe anaemia.

Question 9

If a collapsing pulse is found to be positive, what is this suggestive of?

Answer 9

Aortic regurgitation

Question 10

Suggest TWO possible signs of hypercholestrolaemia that may be observed when examining a patients face.

Answer 10

• Corneal arcus

- Xanthelasma

Question 11

Suggest some possible causes of an irregularly, irregular pulse.

Answer 11

• Atrial fibrillation

- Atrial & ventricular ectopics

Question 12

Suggest some possible causes of a regularly, irregular pulse.

Answer 12

• Sinus arrthymia

- Second degree heart block (Wenkenbach - P-R interval gets gradually longer and longer until it drops one)

Question 13

What is pulsus alternans? Why does it occur?

Answer 13

Strong pulse followed by a weak pulse, repeated over and over (alternating) which indicates the heart is struggling to sustain itself during systole.

Question 14

What is a slow rising pulse? What condition is it commonly felt in?

Answer 14

A pulse that is weak and late, commonly seen in aortic stenosis.

Question 15

What is pulsus bisferiens? What type of condition is it commonly felt in?

Answer 15

Where there can be two separate pulses felt for every heartbeat, commonly felt in mitral valve disease.

Question 16

What cardiovascular condition is linked to malar flush?

Answer 16

Malar flush (also known as mitral facies) is often associated with mitral stenosis.

Question 17

What is the normal value for JVP? How is it calculated?

Answer 17

8cm of blood.

The distance between the pulsation of the right IJV and the sternal angle, commonly 3cm. Add 5cm to get the normal JVP.

Question 18

Suggest ONE cardiovascular condition that could lead to displacement of the apex beat.

Answer 18

Ventricular hypertrophy

Some pulmonary conditions & chest wall deformities can also displace the heart and therefore the apex beat.

Question 19

Suggest TWO reasons why an apex beat may be forceful.

Answer 19

• Ventricular hypertrophy (if constantly forceful)

- Ventricular dilatation (if intermittently forceful)

Question 20

What is the difference between a heave & a thrill?

Answer 20

A thrill is a palpable murmur, whereas, a heave is a palpable force probably due to LV hypertrophy.

Question 21

Which valvular disease may radiate to the left axilla?

Answer 21

Mitral regurgitation

Question 22

For which valvular disease may listening to the carotid arteries help?

Answer 22

Aortic stenosis

Question 23

You suspect mitral stenosis after auscultating a patient. What further auscultation could you do to support your diagnosis?

Answer 23

Roll patient to the left and listen to the mitral area with the bell of the stethoscope.

Question 24

Why is fundoscopy useful for completing the cardiovascular examination?

Answer 24

Will show up some particular signs of diabetes, hypertension & endocarditis.