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Dept of Internal Medicine

Dept of Internal Medicine. Cardiovascular examination From Talley and O’Connor 6 th Edition Sem 4 GKV Dr Scarpa Schoeman 0823787333 or schoemanfhs@ufs.ac.za Dept of Internal Medicine UFS. Prep for the examination sessions PLEASE

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Dept of Internal Medicine

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  1. Dept of Internal Medicine Cardiovascular examination From Talley and O’Connor 6th Edition Sem 4 GKV Dr ScarpaSchoeman 0823787333 or schoemanfhs@ufs.ac.za Dept of Internal Medicine UFS

  2. Prep for the examination sessions PLEASE • Talley and O’Connor - ! Yes please ! – DVD and text. • MUST understand cardiac cycle. • There are variations in practice – (it will confuse you probably) • PLEASE ASK QUESTIONS!!!!!! Dept of Internal Medicine Overview

  3. Dept of Internal Medicine Overview Evans-Brown Model to learn clinical skills Taken from: Evans, D. E., & Brown, J. (2009). How to succeed at medical school : an essential guide to learning (p. ix, 179 p.). Oxford: Wiley-Blackwell.

  4. Sem 1-5 Anatomy + Physiology Dept of Internal Medicine Overview Sem 5+ = Experience!! p102 (TC 6th edition) Michels, M. E. J., Evans, D. E., & Blok, G. A. (2012). What is a clinical skill? Searching for order in chaos through a modified Delphi process.

  5. INTRODUCTION (name and role) • Informed consent • Ask pt to undress & Clean hands (you) • Inspection • Palpation • Percussion • Auscultation • Thank pt and help to get dressed Dept of Internal Medicine Cardio exam

  6. From the bedside (Insp) • Level of illness – acute, chronic, acute on chronic • Additional stuff - O2, tubes! • Chest wall – scars, deformities, lumps, pulsations • Hands & Wrists (Insp) • Clubbing • Cyanosis (peripheral) • Splinter bleeds, Osler nodes, Janeway lesions(IE) • Tar staining (smoking) • Palmar erythema (red palms) Dept of Internal Medicine Cardio exam

  7. Hands & Wrists (Palp) • Cap refill (<2sec), temp of hands, • PULSES • Rate (30 sec: REGULAR pulse, 1min IRREGULAR) • Rhythm (AF!!) • Character and Volume (bigger artery) • Hyperdynamic? Weak? • Rad/Rad & Rad/Fem delay (coarctation) • Arms – BLOOD PRESSURE (p54-55) Dept of Internal Medicine Cardio exam

  8. FACE • Eyes • Anaemia + Jaundice • Arctuscornealis/senilis • Xanthelasma • Cheeks redness (?mitral facies) • Mouth • Lips – peripheral cyanosis • Tongue – central cyanosis • Bad teeth – site for bacteraemia • High arch palate (Marfan’s) Dept of Internal Medicine Cardio exam

  9. NECK • Carotid arteries palp (and Auscultation) • JVP (SUPER NB) • Indication of RA pressure • 45° position is NB • Distance from RA to sternal angle(SA) = 5cm • Then vertical height above SA to max pulsation • POSITION yourself in top spot! Dept of Internal Medicine Cardio exam

  10. Precordium • Palpation • Z-manoeuvre (thrills and heaves) • APEX BEAT!!! • Percussion – not very useful at all • Auscultate • M , T , P, A , Carotid (?stenosis) • Diaphragm (+bell for M) • Manoeuvres • Left lateral – MS • Sitting forward - AI Dept of Internal Medicine Cardio exam

  11. BACK • Inspect: scars, deformities, lumps • Palpation • Sacral oedema • Auscultate • Breath sounds (? Different L vs R) • Fine basal creps = Pulm oedema (LHF) • Absent – percuss for pleural effusion • ABDOMEN • Hepatomegaly? (Pulsatile liver – TI) • Splenomegaly? • Ascites? • Aorta aneurism • Fem arteries (palp and Ausc) Dept of Internal Medicine Cardio exam

  12. LEGS • Pulses present? • Toes (same as hand – not tar staining!) • DVT? • Ankle oedema (pitting 1-3+) • Other • Fundoscopy • Urine dipstix • Temp (fever) Dept of Internal Medicine Cardio exam

  13. Dept of Internal Medicine Overview p102 (TC 6th edition) Michels, M. E. J., Evans, D. E., & Blok, G. A. (2012). What is a clinical skill? Searching for order in chaos through a modified Delphi process.

  14. Dept of Internal Medicine Overview Evans-Brown Model to learn clinical skills Taken from: Evans, D. E., & Brown, J. (2009). How to succeed at medical school : an essential guide to learning (p. ix, 179 p.). Oxford: Wiley-Blackwell.

  15. Many thanks!!! Dept of Internal Medicine Cardio exam

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