Beside Questions Flashcards
Features of long standing hypertension
• Thickened arterial wall
• Locomotor brachialis
• BP elevated or normal
• elevated JVP
• distended neck vein
• Heaving apex beat
• S4 present
• Loud A2
Heart sounds names
- S1: closure of tricuspid and mitral valve
Systole: gap between S1 and S2
Diastole: gap between S2 and S1 - S2: Closure of pulmonary and aortic valve
- S3: Occurs just after S2, rapid filling of ventricles during diastole , commonly heard in children and young adults <30, but also cardiomyopathy, aortic and mitral regurgitation and constructive pericarditis ‘Ken-tucky ’ aka ventricular gallop
- S4:Occurs just before S1 in late diastole, atrial gallop ‘Tenne-ssee’ caused by blood flow into stiff ventricles (do not relax normally) eg. in hypertrophic cardiomyopathy and systemic hypertension
Heart murmur; signs of a problem with the valves
* Systolic murmurs (more common)
* Diastolic murmur
Leading cause of unilateral leg swelling
Cellulitis
Causes of tachycardia
Physiological
* Exercise
* Anxiety
* Stress
* pain
* fever
* pregnancy
Pathological
Cardiac causes
* HF
* arrhythmias
* MI
* Pericarditis and myocarditis
Non cardiac
* hypovolemia
* hyperthyroidism
* hypoxia
* sepsis
* drug induced (caffeine, cocaine, B-agonist, amophetamines)
Causes of bradycardia
Physiological:
Athletes heart
Sleep
Pathological:
- Sick Sinus Syndrome (SSS)
- Sinus Bradycardia (Pathological)
- First-Degree AV Block
- Second-Degree AV Block (Mobitz Type I & II)
- Third-Degree (Complete) AV Block
- Myocardial Infarction (especially Inferior MI)
- Hypothyroidism
- Hypothermia
- Hyperkalemia
- Increased Intracranial Pressure (Cushing’s Reflex)
- Vasovagal Syncope
- Beta-Blocker Toxicity
- Calcium Channel Blocker Toxicity (Verapamil, Diltiazem)
- Digoxin Toxicity
- Lyme Disease (causing AV Block)
Causes of Hyperdynamic states
Hyperdynamic states occur when the body increases cardiac output (CO), heart rate (HR), and contractility due to various physiological or pathological conditions.
- High Metabolic Demand
• Sepsis (early phase)
• Fever & infections
• Hyperthyroidism
• Pregnancy - Cardiovascular Conditions
• Anemia
• Arteriovenous (AV) fistula
• Paget’s disease of bone
• Beriberi (Thiamine deficiency) - Endocrine & Systemic Causes
• Hypercapnia (high CO₂)
• Liver cirrhosis
• Obesity
Cushings triad
Virchows triad
Beck’s triad
Cushings triad (signs that indicate raise ICP):
* hypertension
* bradycardia
* irregular respirations
Virchows triad (factors that contribute to thrombosis):
- endothelial injury
- hypercoagulability
- stasis of blood flow
Beck triad (CT):
* distended neck vein
* muffled hear sound
* hypotension
Cause of polyuria
DM
Diabetes insipidus
Psychogenic polydipsia
Hypercalcemia
Hypokalemia
Early stages of CKD
AKI
Alcohol or caffeine consumption
Post obstructive diuresis
Signs and symptoms of atrial fibrillation
Common Symptoms
• Palpitations (irregular, fast, or pounding heartbeat)
• Fatigue or weakness
• Dizziness or lightheadedness
• Shortness of breath (dyspnea)
• Chest discomfort or pain
• Reduced exercise tolerance
Signs on Physical Examination
• Irregularly irregular pulse
• Tachycardia (rapid heart rate)
• Variable pulse volume
• Hypotension (in severe cases)
Signs on ECG (Electrocardiogram)
• Irregular R-R intervals (irregular ventricular response)
• Absent P waves
• Fibrillatory waves (f-waves)
• Narrow QRS complexes (unless there is a conduction abnormality)
Elevated T wave is seen in
Hyperthyroidism
Precautions when taking BP
Wait 10-15 minutes of rest
No smoking at least 4 hours before
No caffeine 30 minutes prior to
No talking
Use toilet if needed
Back and arms should be well rested
Feet on floor
No alcohol
Appropriate cuff size (60-80% of the arm)
Taken at arm length
Causes of pitting and non-pitting edema
Pitting:
Heart failure
Liver cirrhosis
Pregnant
Non-pitting:
Elephantitis
Causes of radio-radial and radio-femoral delay
Radio-radial:
AV fistula
Radio-femoral:
Signs of CKD on USS
Loss of cortiocomedullary differentiation
Echogenicity
Shrunken kidneys
Components of RFT
EUCr
BUN
Differentials of malaria
- Pneumonia (productive cough, pleuritic chest pain, breathlessness
- Meningitis (neck stiffness, neck pain, phonophobia, photophobia, no travel hx to
- Tb
- HIV
- UTI (dysuria, urgency, frequency, hematuria, loin pain (if upper UTI), suprapubic pan (in lower UTI)
- Typhoid (constipation, diarrhea and abdominal pain, patronage of local food vendors)
- Lassa Fever (rashes, hx of bleeding of orifices or contact of persons bleeding from orifices)
- IE: Osler nodes, splinter hemorrhage, generalized body swelling, rashes
- URTI: cough, catarrh, sore throat
- Otitis media: ear pain, ringing in ears (tinnitus)
- SLE: malar rash
- Gastroenteritis: abdominal pain, Hx
of contaminated food/water, Ask also about; passage of watery/bloody stools
Joint pain symptoms;
13. SCD:
14. Juvenile artritis
15. Fibromyalgia
Associated symptoms
Joint pain
Myalgia
Risk factors for malaria
Swampy environment
Lack of use of insecticide treated mosquito net
Stagnant water
Blood genotype
Endemic region
Complications of Malaria
Cerebral malaria (LOC 30mins, confusions)
AKI (reduced urinary output)
Severe anemia
Hypoglycemia
Hyper reactive immune splenomegaly syndrome (HIMSS used to be TSS)
hyperpyrexia
Black water fever (caused by p.malariae)
DIC
ARDS
Agid malaria (shock)
Metabolic acidosis
Dehydration
Hyperparasitemia
Electrolyte derangement
CGN
Hemoglobinuria
• PREGNANCY RELATED COMPLICATIONS
• PULMONARY OEDEMA
What do patients with hypoglycemia present with?
Rule out hypoglycemia
Fever and LOC
rule out:
Confusion
Palpitation
Dizziness
Sweating
Headaches
