Alfred short tutorial (non neurology)

Question 1

What is a wide pulse pressure

Answer 1

>60

Question 2

Apex beat in mitral regurg

Answer 2

Displaced

Question 3

How to describe the character of the apex beat

Answer 3

• Pressure loaded - suggests hypertrophied
• Volume loaded/dyskinetic
• Tapping apex beat - mitral stenosis (indicating a palpable first heart sound)

Question 4

What does a palpable heave suggest

Answer 4

Right ventricular hypertrophy

Question 5

Where do you hear the first heart sound

Answer 5

Apex

Mitral regurg = soft

Mitral stenosis = loud

Question 6

Where is best to auscultate for tricuspid regurg

Answer 6

Left lower sternal edge

Question 7

Where do you best hear aortic regurg

Answer 7

Left sternal edge

Question 8

When does the first heart sound occur

Answer 8

End of diastole

Question 9

What does a loud S1 indicate

Answer 9

Reduced diastolic filling

Question 10

What happens to the first heart sound in severe MR?

Answer 10

Soft S1 (a sign of severity)

Question 11

What condition causes a variable first heart sound

Answer 11

Atrial fibrillation - due to variatoini in duration of diastole

Question 12

What causes a fixed split of the 2nd heart sound

Answer 12

ASD

Question 13

What causes of wide split in the 2nd heart sound that varies with inspiration

Answer 13

Pulmon stenosis/RBBB

Question 14

Most common cause of a variable wide split of 2nd heart sound

Answer 14

Right bundle branch block

Question 15

How do u differentiation reversed splitting with normal splitting

Answer 15

In expiration not inspiration

Question 16

When does the S3 occur

Answer 16

During diastole (S2 is the end of systole)

Question 17

When is S3 pathological

Answer 17

Pt >40

Question 18

When does the 4th heart sound occur?

Answer 18

IN diastole

Question 19

What does the 4th heart sound indicate

Answer 19

Stiff ventricle - generated from atrial contraction (so cannot hear during atrial fibrillation)

Question 20

Where is diastolic is the AR murmur

Answer 20

Early decrescendo diastolic

Question 21

Where is the AS murmur heart

Answer 21

Trick question - can be heard all over precordium - characterise it based on harsh/musical

Question 22

What does valsalva do in differntiating murmurs

Answer 22

Differentiate AS and HOCM - HOCM will get louder

Question 23

What dynamic maneuvour increases the volume of mitral stenosis

Answer 23

Hand grip

Question 24

Aetiology of primary mitral regurgitation

Answer 24

Degenerative (myxomatous degeneration, mitral valve prolapse, partial flail, flail leaflet

IE

Rheumatic disease

Question 25

What is the normal mitral valve size

Answer 25

4-6cm

Question 26

What mitral valve size would indicate severe MS

Answer 26

\<1cm

Question 27

What is the most common aetiology of AS

Answer 27

Degenerative bicuspid aortic valve

Question 28

Why do you get chest pain in AS? (4 reasons)

Answer 28

Coexistent coronary artery disease Turbulant flow in the coornary arteries that come off the aortic root Raise ventricular end diastolic pressure to get blood out of valve which impedes coronary flow in diastole Cardiac muscle becomes thick which may suffer from hypoxia

Question 29

Most common cause of AR

Answer 29

Rheumatic heart disease

Question 30

When might you hear both a decrescendo diastolic murmur and also an ejection systolic murmur

Answer 30

In severe AR due to high blood flow and does not necessarily mean AS

Question 31

What is an austin flint murmur

Answer 31

Mid-diastolic murmur which is an indication of severity in aortic stenosis

Question 32

What is the most common cause of TR

Answer 32

Functional dilataion of the RV

Question 33

What is a common cause of TR in patients with heart transplants

Answer 33

Frequent trans-jugular cardiac biopsies

Question 34

What are the peripheral signs of TR

Answer 34

JVP w prominent V wave and rapid Y descent Pulsatile liver Often RV heave PHT, loud P2 Pansystolic murmur, Left LSE, louder on inspiration

Question 35

What is the most common non genetic cause of HOCM

Answer 35

Long term hypertension

Question 36

When do you get an apex double impulse

Answer 36

HOCM

Question 37

Causes of large R wave in V1

Answer 37

R) ventricular hypertrophy Posterior infarct RBBB WPW w RBB configuration

Question 38

what causes a S3 heart sound

Answer 38

turbulent flow

Question 39

what does a S4 mean

Answer 39

stiff ventricle (elderly)