Cardio

Question 1

Aortic Stenosis

Answer 1

ESM
Forceful Non-displaced Apex Beat

Quiet A2 (aortic valve sound in S2)
Narrow Pulse Pressure
S4 Tenessee
Decompensation - LVF

Question 2

Mitral Regurgitation

Answer 2

Pansystolic Murmur (apex left lateral position end expiration)
Displaced Apex - volume overload
Soft S1

Question 3

Aortic Regurgitation

Answer 3

Early Diastolic murmur

Apex displaced (volume overload)
Soft S2
Collapsing Pulse
Wide pulse pressure

Quincke’s: capillary pulsation in nail beds
Corrigan’s: visible vigorous carotid pulsation
De Musset’s: head nodding
Traube’s: pistol-shot sound over femorals

Question 4

Mitral Stenosis

Answer 4

Mid-diastolic murmur

Tapping Apex (palpable S1, non-displaced)
Loud S1
Early diastolic opening snap
Malar Flush - back pressure + vasoconstriction
LVF

Question 5

Rheumatic Fever Criteria

Answer 5

Jones Criteria

Major Criteria
 Pancarditis
 Arthritis
 Subcut nodules
 Erythema marginatum
 Sydenham’s chorea

Minor criteria
 Fever
 ↑ESR or ↑CRP
 Arthralgia
 not if arthritis is a major
 Prolonged PR interval
 not if carditis is a major
 Prev rheumatic fever

Question 6

Infective Endocarditis Criteria

Answer 6

Major
1. +ve Blood Culture
 Typical organism in 2 separate cultures, or
 Persistently +ve cultures, e.g. 3, >12h apart
2. Endocardial Involvement
 +ve echo: vegetation, abscess, dehiscence
or
 New valvular regurgitation

Minor

1. Predisposition: cardiac lesion, IVDU
2. Fever >38
3. Emboli: septic infarcts, splinters, Janeway lesions
4. Immune: GN, Osler nodes, Roth spots, RF
5. +ve blood culture not meeting major criteria

Question 7

Left sided Heart Failure

Answer 7

Causes
 1: IHD
 2: Idiopathic dilated cardiomyopathy
 3: Systemic HTN
 4: Mitral and aortic valve disease

Symptoms
 Fatigue
 Exertional dyspnoea
 Orthopnoea + PND
 Nocturnal cough (± pink, frothy sputum)
 Wt. loss and muscle wasting

Signs
 Cold peripheries ± cyanosis
 Often in AF
 Cardiomegaly c¯ displaced apex
 S3 + tachycardia = gallop rhythm
 Wheeze (cardiac asthma)
 Bibasal creps

Question 8

Right Sided Heart Failure

Answer 8

Causes
 LVF
 Cor pulmonale
 Tricuspid and pulmonary valve disease

Symptoms
 Anorexia and nausea

Signs
 ↑JVP + jugular venous distension
 Tender smooth hepatomegaly (may be pulsatile)
 Pitting oedema
 Ascites

Question 9

Inguinal canal

Answer 9

Inguinal ligament (floor) 
aponeurosis of external oblique (anterior wall)
transversalis fascia (posterior wall)
internal oblique (roof)

Question 10

Femoral Canal

Answer 10

lacuna ligament (medial border)
inguinal ligament (anterior border)
femoral vein (lateral border)
pectineal ligament (posterior border)

Contents

• lymphatics - draining deep inguinal nodes
• deep lymph node - lacunar node
• loose connective tissue