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FRACP clinicals > Alfred short tutorial (non neurology) > Flashcards

Alfred short tutorial (non neurology) Flashcards

1
Q

What is a wide pulse pressure

A

>60

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2
Q

Apex beat in mitral regurg

A

Displaced

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3
Q

How to describe the character of the apex beat

A
  • Pressure loaded - suggests hypertrophied
  • Volume loaded/dyskinetic
  • Tapping apex beat - mitral stenosis (indicating a palpable first heart sound)
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4
Q

What does a palpable heave suggest

A

Right ventricular hypertrophy

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5
Q

Where do you hear the first heart sound

A

Apex

Mitral regurg = soft

Mitral stenosis = loud

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6
Q

Where is best to auscultate for tricuspid regurg

A

Left lower sternal edge

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7
Q

Where do you best hear aortic regurg

A

Left sternal edge

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8
Q

When does the first heart sound occur

A

End of diastole

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9
Q

What does a loud S1 indicate

A

Reduced diastolic filling

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10
Q

What happens to the first heart sound in severe MR?

A

Soft S1 (a sign of severity)

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11
Q

What condition causes a variable first heart sound

A

Atrial fibrillation - due to variatoini in duration of diastole

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12
Q

What causes a fixed split of the 2nd heart sound

A

ASD

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13
Q

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

A

Pulmon stenosis/RBBB

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14
Q

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

A

Right bundle branch block

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15
Q

How do u differentiation reversed splitting with normal splitting

A

In expiration not inspiration

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16
Q

When does the S3 occur

A

During diastole (S2 is the end of systole)

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17
Q

When is S3 pathological

A

Pt >40

18
Q

When does the 4th heart sound occur?

A

IN diastole

19
Q

What does the 4th heart sound indicate

A

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

20
Q

Where is diastolic is the AR murmur

A

Early decrescendo diastolic

21
Q

Where is the AS murmur heart

A

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

22
Q

What does valsalva do in differntiating murmurs

A

Differentiate AS and HOCM - HOCM will get louder

23
Q

What dynamic maneuvour increases the volume of mitral stenosis

A

Hand grip

24
Q

Aetiology of primary mitral regurgitation

A

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

IE

Rheumatic disease

25
Q

What is the normal mitral valve size

A

4-6cm

26
Q

What mitral valve size would indicate severe MS

A

<1cm

27
Q

What is the most common aetiology of AS

A

Degenerative bicuspid aortic valve

28
Q

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

A

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

29
Q

Most common cause of AR

A

Rheumatic heart disease

30
Q

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

A

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

31
Q

What is an austin flint murmur

A

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

32
Q

What is the most common cause of TR

A

Functional dilataion of the RV

33
Q

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

A

Frequent trans-jugular cardiac biopsies

34
Q

What are the peripheral signs of TR

A

JVP w prominent V wave and rapid Y descent

Pulsatile liver

Often RV heave

PHT, loud P2

Pansystolic murmur, Left LSE, louder on inspiration

35
Q

What is the most common non genetic cause of HOCM

A

Long term hypertension

36
Q

When do you get an apex double impulse

A

HOCM

37
Q

Causes of large R wave in V1

A

R) ventricular hypertrophy

Posterior infarct

RBBB

WPW w RBB configuration

38
Q

what causes a S3 heart sound

A

turbulent flow

39
Q

what does a S4 mean

A

stiff ventricle (elderly)

40
Q
A

FRACP clinicals (24 decks)

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