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%\usepackage{opensans}          % Can't make this work so far. Shame. Would be lovely.
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% Document Info
\author{hjsdhaj}
\pdfinfo{
  /Title (cvs-examination.pdf)
  /Creator (Cheatography)
  /Author (hjsdhaj)
  /Subject (CVS Examination Cheat Sheet)
}

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\fancyhead[L]{
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
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    \vspace{-7pt}
    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\columnbreak
\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{CVS Examination Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{hjsdhaj} via \textcolor{DarkBackground}{\uline{cheatography.com/201639/cs/42712/}}}
\end{tabulary}
\end{multicols}}

\fancyfoot[L]{ \footnotesize
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{LL}
  \SetRowColor{FootBackground}
  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}hjsdhaj \\
  \uline{cheatography.com/hjsdhaj} \\
  \end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 16th March, 2024.\\
   Page {\thepage} of \pageref{LastPage}.
\end{tabulary}
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  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\end{multicols}}




\begin{document}
\raggedright
\raggedcolumns

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% from this page to resize cheat sheet text:
% www.emerson.emory.edu/services/latex/latex_169.html
\footnotesize % Small font.

\begin{multicols*}{2}

\begin{tabularx}{8.4cm}{p{0.88 cm} x{7.12 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Preperation:}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{W}} & Wash Hands \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
{\bf{I}} & Introduce Yourself + Patient's Identity \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
{\bf{P}} & Permission \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
{\bf{P}} & Patient Position + Pain \tn 
% Row Count 8 (+ 2)
% Row 4
\SetRowColor{LightBackground}
{\bf{E}} & Explaination \tn 
% Row Count 10 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Patient must be placed at 45°}}\{\{ac\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{General Inspection:}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{{\bf{Check visually from the end of the bed:}} \newline % Row Count 1 (+ 1)
 • Discomfort at rest \newline % Row Count 2 (+ 1)
 • Tachypnoea \newline % Row Count 3 (+ 1)
 • Pallor \newline % Row Count 4 (+ 1)
 • Cyanosis \newline % Row Count 5 (+ 1)
 • Surgical Scars \newline % Row Count 6 (+ 1)
 • Medical paraphernalia (e.g. IV infusions) \newline % Row Count 7 (+ 1)
 • Consciousness% Row Count 8 (+ 1)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{2.432 cm} x{2.584 cm} x{2.584 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Examination of Hands:}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Clubbing:}} & Place 2 fingernails together and look for Schamroth's sign & Chronic low blood-oxygen levels \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
\mymulticolumn{3}{x{8.4cm}}{{\bf{Pale Creases}}} \tn 
% Row Count 6 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{3}{x{8.4cm}}{{\bf{Peripheral Cyanosis}}} \tn 
% Row Count 7 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{3}{x{8.4cm}}{{\bf{Nicotine Staining}}} \tn 
% Row Count 8 (+ 1)
% Row 4
\SetRowColor{LightBackground}
{\bf{Splinter haemorrhages:}}\{\{nobreak\}\} & Small red lines on fingernails that look like a splinter & Tiny clots that damage small capillaries under the nails \tn 
% Row Count 13 (+ 5)
% Row 5
\SetRowColor{white}
{\bf{Lesions on fingers:}} & Tender -\textgreater{} Osler's Lesion\{\{nl\}\}(O for ouch))\{\{nl\}\}\{\{nl\}\}Not tender -\textgreater{} Janeway's Lesion & Endocarditis \tn 
% Row Count 20 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{,}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{} \tn 
% Row Count 0 (+ 0)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{1.596 cm} x{2.964 cm} x{3.04 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Vitals:}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Capillary Refill:}} & N\textless{}2secs &  \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
{\bf{Radial Pulse:}} & Identify {\bf{rate and rhythm}}\{\{nl\}\}{\emph{Allow for at least 15 sec}} &  \tn 
% Row Count 8 (+ 5)
% Row 2
\SetRowColor{LightBackground}
 & Compare both radial pulses for evidence of radial delay. & Mention checking for radial-femoral delay. \tn 
% Row Count 12 (+ 4)
% Row 3
\SetRowColor{white}
 & Examine for collapsing pulse & Quickly raise patient's arm above their head while measuring their pulse. \tn 
% Row Count 17 (+ 5)
% Row 4
\SetRowColor{LightBackground}
{\bf{Brachial pulse:}} & Both arms &  \tn 
% Row Count 20 (+ 3)
% Row 5
\SetRowColor{white}
{\bf{Femoral pulse:}} & Indicated if difficulty finding \seqsplit{radial/brachial} pulse &  \tn 
% Row Count 24 (+ 4)
% Row 6
\SetRowColor{LightBackground}
{\bf{Breathing Rate:}} & Should be examined immedately after taking radial pulse without informing the patient &  \tn 
% Row Count 30 (+ 6)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{x{1.596 cm} x{2.964 cm} x{3.04 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Vitals: (cont)}}  \tn
% Row 7
\SetRowColor{LightBackground}
{\bf{Blood Pressure:}} & Should be measured in both the right and left arms, standing and supine. & For DEM2 you only need to offer to check BP. \tn 
% Row Count 5 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{1.292 cm} x{3.116 cm} x{3.192 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Examination of the Face:}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Malar Flush:}} & Plum-red discolouration of the high cheeks & Associated with {\emph{mitral valve stenosis}} due to the resulting CO2 retention and its vasodilatory effects \tn 
% Row Count 7 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Examination of Eyes:}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Anaemia:}} & Pale conjunctiva \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
{\bf{Corneal Arcus:}} & Lipid deposits that appear as rings on the outer region of the cornea \tn 
% Row Count 5 (+ 4)
% Row 2
\SetRowColor{LightBackground}
{\bf{Xanthelasma of hypercholesterolaemia:}}\{\{nobreak\}\} & Pale yellow lump near eyelid \tn 
% Row Count 8 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{{\emph{Examination using fundoscopy should be done in patients with a history of diabetes, hypertension, or endocarditis}}}}\{\{ac\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{2.72 cm} x{5.28 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Examination of the Mouth:}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Dental Hygiene:}} & Possible cause of bacterial endocarditis \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
{\bf{Central Cyanosis:}} & Examine for blue tongue \tn 
% Row Count 4 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{1.824 cm} x{2.888 cm} x{2.888 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Pulses:}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Jugular venous pulse:}} & Located between the 2 heads of the SCM. Measured as cm of water above the sternal angle.\{\{nl\}\}Must remember to add 5cm to measured distance above sternal angle.\{\{nl\}\}\{\{nl\}\}Difficult to see, may require the use of a torch, \seqsplit{abdomino-jugulo} reflux can exaggerate the JVP in right sided heart failure. & {\bf{{\emph{Patient must be placed at 45°}}}} \tn 
% Row Count 20 (+ 20)
% Row 1
\SetRowColor{white}
{\bf{Carotid pulse:}} & Examine both, however only one at a time to avoid the patient feeling faint.\{\{nl\}\}\{\{nl\}\}{\bf{Comment on character and volume}} & {\emph{In patients over 50 you should listen for carotid bruits first.}} \tn 
% Row Count 29 (+ 9)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{3.84 cm} x{4.16 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Chest Inspection:}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Surgical scars, lift any fat/breast to check under} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Check for any pacemaker, etc.} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Visible apical pulsation} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Audible prosthetic heart valve} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
Physically feel for the heart at apex & Normally 5th intercostal space, left midclavicular line \tn 
% Row Count 7 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Palpate for heaves (using heel of hand) and thrills (finger pads)} \tn 
% Row Count 9 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{2.56 cm} x{5.44 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Chest Auscultation:}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\emph{Begin at the apex (Mitral Area) and proceed towards the base of the heart.\{\{nl\}\}\{\{nl\}\}{\bf{Must be repeated with both diaphragm and bell.}}}}\{\{ac\}\}} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
{\bf{S\textasciicircum{}1\textasciicircum{}}} & Caused by the closing of the atrioventricular valves after blood has been pumped into the ventricles. \tn 
% Row Count 7 (+ 4)
% Row 2
\SetRowColor{LightBackground}
{\bf{S\textasciicircum{}2\textasciicircum{}}} & Caused by the closing of the aortic and pulmonary valves after the ventricles have contracted. \tn 
% Row Count 11 (+ 4)
% Row 3
\SetRowColor{white}
{\bf{S\textasciicircum{}3\textasciicircum{}, S\textasciicircum{}4\textasciicircum{}}} & Third heart sound can be {\bf{{\emph{normal}} (in a younger patient)}}\{\{nl\}\}\{\{nl\}\}Fourth heart sound is {\bf{{\emph{always abnormal}}}} \tn 
% Row Count 16 (+ 5)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Check for radiation to carotid or axilla.}}\{\{ac\}\}} \tn 
% Row Count 18 (+ 2)
% Row 5
\SetRowColor{white}
{\bf{Carotid bruits:}} & Whooshing sound in the carotid, caused by non-laminar blood flow. \tn 
% Row Count 21 (+ 3)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Patient should be manouvered to accentuate murmurs:}}\{\{ac\}\}\{\{nl\}\}\{\{nl\}\}{\bf{Forward in expiration }}for aortic regurgitation.\{\{nl\}\}\{\{nl\}\}{\bf{Left lateral position}} in expiration for mitral murmurs.} \tn 
% Row Count 25 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Heart sounds should be timed by palpating pulse while auscultating.}} \newline  \newline The interval between S\textasciicircum{}1\textasciicircum{} and S\textasciicircum{}2\textasciicircum{} is systole. \newline  \newline The interval between S\textasciicircum{}2\textasciicircum{} and the next S\textasciicircum{}1\textasciicircum{} is when the ventricles relax and are filled with blood, i.e. diastole.}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{5.6 cm} x{2.4 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Back of Chest:}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Inspect chest wall for deformities/incisions} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Palpate for sacral oedema} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
Auscultate lung bases for crepitations & Pulmonary Oedema \tn 
% Row Count 4 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Examination of Feet:}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Popliteal Pulses on both legs}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Dorsalis Pedis Pulses in both feet}}} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Posterior Tibial Pulses in both feet}}} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
{\bf{Inspect for Peripheral Oedema:}}\{\{nobreak\}\} & Press for 5sec behind the medial malleolus and feel for any indentation afterwards \tn 
% Row Count 8 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Conclusion:}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{{\bf{Thank patient and explain that the examination is finished}} \newline % Row Count 2 (+ 2)
{\bf{{\emph{Sanitise Hands}}}}\{\{ac\}\}% Row Count 3 (+ 1)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}