Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

clinical skills > cardio exam theory > Flashcards

cardio exam theory Flashcards

1
Q

What are some important cardiovascular medical histories?

A

IHD: MI, coronary artery bypasses

Rheumatic fever

Sexually transmitted disease

Drug use

Past medical examination revealing cardiac disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some important social histories for cardiovascular health?

A

Tobacco, alcohol or drug use

Occupation

Lifestyle (exercise, diet)

Stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some important family medical histories for cardiovascular health?

A

IHD

Cardiomyopathy

Congenital heart disease

Marfan’s syndrome

Diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some coronary artery risk factors?

A

Previous coronary disease

Smoking

HTN and hyperlipidaemia

Relevant family history

Diabetes, obesity, physical inactivity

Male sex and advanced age

Raised homocysteine levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is a cardiac cause of chest pain, and how does it present?

A

Central, tight and/or heavy

May radiate to the jaw or left arm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are two vascular causes of chest pain and how do they present?

A

Aortic dissection

Aortic aneurysm

Very sudden onset, and radiate usually to the back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are pleuropericardial causes of chest pain?

A

Pericarditis +/- myocarditis

Infective pleurisy

Pneumothorax

Pneumonia

Autoimmune disease

metastatic tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What pleuropericardial causes of chest pain cause pleuritic pain?

A

Pericarditis +/- myocarditis

Infective pleurisy

Pneumonia (with fever and dyspnoea)

Autoimmune disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which pleuropericardial causes of chest pain cause a severe and constant pain?

A

Mesothelioma

Metastatic tumour (localised)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Does pain from pericarditis get worse when standing or lying down?

A

Lying down

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Both pneumothorax and pneumonia cause pleuropericardial chest pain and dyspnoea: what are their differences in symptoms?

A

Pneumothorax has a very sudden onset and is sharp

Pneumonia has an insidious onset and is also associated with fever and sputum production with cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some causes of chest pain resulting directly from the chest wall?

A

Persistent cough and other muscular strains

Intercostal myositis

Rib fracture or tumour (primary or metastatic)

Thoracic zoster

Coxsackie B virus infection

Thoracic nerve compression or infiltration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the three chest wall causes of chest pain that are worse with movement?

A

Persistent cough

Muscular strains

Intercostal myositis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which chest wall causes of chest pain follows nerve root distribution?

A

Thoracic zoster (precedes rash)

Thoracic nerve compression or infiltration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What gastrointestinal conditions can lead to chest pain?

A

Reflux (worse with lying down, not related to exertion)

Diffuse oesophageal spasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which GIT condition, associated with chest pain, is also associated with dysphagia?

A

Diffuse oesophageal spasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are some causes of chest pain that occur in the airways?

A

Tracheitis

Central bronchial carcinoma

Inhaled foreign body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is at least one circumstance in which it is not best to ask a patient about ‘pain’, but rather about ‘discomfort’ with relation to chest pain?

A

With angina, the symptoms may be felt as a dull ache rather than something that the patient would consider pain, thus they may not report it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Do patients always think of typical angina as a cardiac symptom? If not, why not?

A

Sometimes not

The ache usually is central rather than left sided, so many patients don’t consider it to be related to the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Where does angina pain radiate?

A

Jaw or arms

Very rarely travels below the umbilicus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the classic catalyst for the development of anginal pain?

A

Exertion (in low grade angina)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the classic thing that a patient will say stops their anginal pain?

A

Cessation of exertion (in low grade angina)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

In high grade angina, how does the presentation of the patient differ?

A

Becomes brought on by less and less exertion with higher grades

Highest grade is when it occurs at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Should a change in the pattern of onset of angina be taken seriously?

A

Yes

This represents a change from stable angina to unstable angina, which could mean the patient’s status is deteriorating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Is the efficacy of sublingual nitrates necessarily specific to the patient having angina?

A

No

They can also relieve oesophageal spasm, another cause of chest pain

They also can have a substantial placebo effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How long do sublingual nitrates typically take to bring about cessation of anginal pain?

A

A few minutes

27
Q

How does the pain associated with acute coronary syndrome (MI or unstable angina) differ from typical stable angina?

A

Occurs at rest

More severe and painful

Lasts longer

Less liable to be reduced in intensity by sublingual nitrates

28
Q

If chest pain is present for multiple days, is it likely to be acute coronary syndrome (MI or unstable angina) or stable angina?

A

Neither!

29
Q

If chest pain is present for more than half an hour, is it more likely to be acute coronary syndrome or stable angina?

A

Acute coronary syndrome

30
Q

What are some associated symptoms of MI?

A

Dyspnoea

Diaphoresis

Anxiety

Nausea

Faintess

31
Q

What is the name of chest pain made worse by inspiration?

A

Pleuritic pain

32
Q

How can pleuritic pain be relieved with a movement?

A

By the patient sitting up and leaning forwards

33
Q

What is the cause of pleuritic pain?

A

Inflamed pleural or pericardial surfaces moving on one another

34
Q

What usually makes chest wall pain worse?

A

Respiration

Or movement of the shoulders rather than with exertion

35
Q

What usually characterises the pain of arterial dissection?

A

Very severe pain, greatest at moment of onset

Pain described as ‘tearing’

Pain radiating to the back

36
Q

How does an arterial dissection involving the ascending aorta present differently to one involving the descending aorta?

A

Involving the ascending usually radiates to the anterior chest

Involving the descending aorta usually radiates to the back, between the scapulae

37
Q

What are some risk factors for arterial dissection?

A

History of HTN

Connective tissue disorders such as Marfan’s or Ehlers-Danlos syndrome

38
Q

How do patients usually describe the pain of pulmonary embolism?

A

Very sudden onset

Rentrosternal

39
Q

What are some associated symptoms of PE?

A

Collapse

Dyspnoea

Cyanosis

40
Q

In what cases can the pain of PE be identical to angina?

A

If associated with right ventricular ischaemia

41
Q

What is the pain of spontaneous pneumothorax like?

A

Sharp

Localised to one part of the chest

42
Q

What signs associated with chest pain would make you favour an MI diagnosis?

A

Onset at rest

Sweating

Anxiety

No relief with nitrates

Nausea and vomiting

43
Q

What signs associated with chest pain would make you favour an angina diagnosis?

A

Onset with exertion

Less severe

No sweating

Mild or no anxiety

Rapid relief with nitrates

44
Q

What signs associated with chest pain would make you favour an arterial dissection diagnosis?

A

Very severe pain radiating to the back

Instantaneous onset

Risk factors

45
Q

What signs associated with chest pain would favour a chest wall pain diagnosis?

A

Positional and localised

Often worse at rest

Tenderness on the chest wall

46
Q

What is the pathogenesis of cardiac dyspnoea on exertion?

A

Failure of LV to increase output

Increase in LVEDP

Raised pulmonary venous pressure

Interstitial fluid leakage

Reduced lung compliance and capacity

47
Q

What does the absence of orthopnoea suggest about a patient’s dyspnoea?

A

That LV failure is likely not the cause

48
Q

What are more uncommon causes of orthopnoea?

A

Large pleural effusion

Severe pneumonia

Massive ascites

Bilateral diaphragmatic paralysis

49
Q

What is the pathogenesis of paroxysmal nocturnal dyspnoea (PND)?

A

Sudden failure of LV output

Acute rise of pulmonary venous and capillary pressures

Transudation of fluid into interstitial tissues

Increases WOB

50
Q

What cardiac disease can cause lower limb oedema?

A

Right ventricle or biventricle failure

51
Q

Is ankle oedema caused by RV failure symmetrical or asymmetrical? And worse at night or morning?

A

Symmetrical

Worse at night

52
Q

What medical history is relevant for a patient with ankle oedema, especially if they have other cardiac conditions?

A

Whether they are on vasodilatory medications, eg calcium channel blockers

53
Q

What can cause oedema of the face rather than the ankles?

A

Nephrotic syndrome

54
Q

What associated features questions should you ask of a patient that complains of palpitations?

A

Faintness

Pain

dyspnoea

55
Q

Awareness of rapid palpitations followed by syncope suggests what?

A

Ventricular tachycardia

56
Q

Is ectopic beats or ventricular tachycardia the more likely cause of palpitations at rest?

A

Ectopic beats

57
Q

Do early and mid-inspiratory crackles favour heart failure or lung disease as a cause of dyspnoea?

A

Heart failure

Lung disease would be suggested by fine, end-inspiratory crackles

58
Q

What would make you think syncope was vasovagal?

A

Young

LOC short duration, no after-effects

Associated with emotional distress

59
Q

What would make you think syncope was due to orthostatic hypotension?

A

Onset when getting up quickly

Known low systolic BP, with or without use of antihypertensive medication

Brief duration

More common when fasted or dehydrated

60
Q

What would make you think syncope was due to ‘situational syncope’?

A

Occurs during micturition

Occurs with prolonged coughing

61
Q

What would make you think syncope was due to left ventricular outflow obstruction (AS, HCM)?

A

Occurs during exertion

62
Q

What would make you think syncope was due to cardiac arrhythmia?

A

History of rapid palpitations

No warning (heart block – Stokes-Adams attack)

History of cardiac disease (ventricular arrhythmias)

Anti-arrhythmic medication

63
Q

What would make you think syncope was due to epilepsy?

A

Prodrome with an aura

Tongue biting

Classical witness reports of jerking and head turns

Post-ictal state, + muscle pain

clinical skills (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions