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Year 3 - Clinical Communication Skills > CVS Examination and History > Flashcards

Flashcards in CVS Examination and History Deck (10)
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1

Describe questions to ask in a CVS history

History of presenting compliant
- What have you come to see us with today?
- Do you have any other symptoms?
- How are you feeling at the moment
- How long has it gone on for
- Has this happened before and when did it start
- What does it (pain) feel like
- Do it start suddenly or a gradual onset
- Where speficially is the pain and does it spread
- What is the character of the pain
– does anything make it better or worse
- How are you generally – are you fit and well

Then go into more specific questions about symptoms:
– have you had any shortness of breath
- What were you doing when the pain happens
- does the pain spread anywhere else
- is there anything you can do to lessen the pain/ or make it easier to breath
- have you taken anything for the pain
- does the pain start suddenly


Ideas Concerns Expectations
- Do you have any idea of what might be going on
- Is there anything that is worrying you specifically
- What were you hoping id be able to do for you today


Past Medical history
- Do you have any medical conditions
- Have you seen anyone for this before
Specific questions
- Have you had contact with those that are unwell recently
- how's your blood pressure


Drug history and allergies
- What prescribed medication do you take
- What over the counter medication do you take
- Have you taken any illicit substances?
- Do you have any allergies?

Social history
- What do you do for a living
- Do you smoke – how long have you smoked, how many cigarettes do you smoke a day
- Do you drink
- Where do you currently live
- Do you have a support network that helps you
- Do you require any assistane in day to day life
- How much exercise do you do – how often and what type


Family History
- Has your family had any significant illness
- Are they well and still alive


Systematic review
Now just before we finish I just have some quick general questions to ask
- Have you had a fever
- Any weight changes
- Do you fill fatigued
- Have you had a cough?
- Do you get any stomach pain or nausea and vomiting
- Are you going to the toilet as usually?
- Have you had a headache, any visual changes, or motor and sensory disturbances
- Any chest wall pain, or trauma
- Do you have any rashes or other skin problems

Before I examine you is there anything else that you would like to add or think that I have missed

2

Describe CVS clinical skills examination

WIPER
- wash hands
- introduce yourself
- permissions and pain
- expose the patient
- reposition the patient lying down at a 45 degree angle

Inspection from the end o the bed
- breathlessness
-distress
- scars
- surrounding environment - oxygen, fluid restriction signs, GTN

peripheral inspection
- start with the hands - look for peripheral cyanosis, clubbing, splinter haemorrhages, Osler nodes, janeway lesions
- feel the hands for warmth, sweating and clamminess
- test capillary refill time - should be less than 2 seconds

pulses
- look for rate, rhythm and character
- radial
- brachial
- then do collapsing radial pulse - while doing the pulse in the radius raise it above the heart and note changes in volume and character

- measure the blood pressure

eyes
- corenal arcus
- and periorbital region xanthelasma
- conjuctiva for palor

Mouth and tongue
- central cyanosis

- jugular venous pressure height
- measure ether level of the jugular venous pressure with reference to the height above the sternal angle

- carotid pulse - assess volume and character on both sides

- insect the chest wall for previous scars, pacemakers, abnormal pulsations and an apex beat

Palpate for
- apex beat
- heaves
- thrills

Ascultate
- listen with both bell and diaphragm at the apex base, aortic and pulmonary regions
- when listening to the heart sounds they should be timed against the carotid pulse

- roll the patient onto the left side and listen to murmur - should be timed with the carotid pulse

- to listen for an early diastolic murmur which means there is aortic problem - ask the patient to sit forwards take a deep breath breath out and hold there breath

- listen over the carotid pulses for bruits

- listen over the lung bases for creptations which result from pulmonary oedema

- check sacral oedema
- move to the lower limbs
- check for ankle oedema - check both legs
- check the peripheral pulses on both legs - the femoral pulse, asculatate for bruits
- popliteal pulse
- the posterior tibial pulse - dorsals pedis pulse

3

What should you look for in the hands and what should you test for in a CVS examination

Look for:
- peripheral cyanosis,
- clubbing
- splinter haemorrhages,
- Osler nodes
- janeway lesions - endocarditis
- tar stains

Feel for:
- warmth
- sweating
- clamminess

- test for capillary refill time - should be less for two seconds

4

What should you check the eyes for

- corenal arcus
- and periorbital region xanthelasma
- conjuctiva for palor

5

What do you palpate for

- apex beat
- heaves
- thrills

6

Where do you listen with the bell and diaphragm

- listen with both bell and diaphragm at the apex base, aortic and pulmonary

7

name where the
- aortic
- pulmonary
- mitral
- tricuspid
areas are

- aortic - 2nd intercostal space right sternal edge
- pulmonary - 2nd intercostal space left sternal edge
- mitral - 4th intercostal space left sternal edge
- tricuspid - 5th intercostal space - mid clavicular line

8

What makes COVID unlikely

- wet cough
- COVID is a dry cough

9

what is bronchial breathing

- when the expiration is longer than the inspiration

10

What do you ask when they say they are coughing up blood

- fresh blood, clotted blood
- frequency
- when did it start - what do you think caused it to start
- what is the amount of blood
- is it mixed with phelgm, is there no phlegm or just phlegm sometimes