Cardio/Resp/Gastro exam Flashcards
what is kussmaul’s sign
paradoxical increase in JVP with inspiration
occurs when right ventricular filling is restricted
usual position of the apex beat
5th ICS MCL
reasons for impalpable apex beat
Hyperexpanded lungs: obstructive lung disease (e.g. COPD)
Reduced impulse: tamponade or restrictive pericarditis
Obesity
Dextrocardia
reasons for seeing this scar in a cardio exam
emergency
previous valve surgery
coronary artery by-pass graft
what should you do if you see this scar in paces
check the lower limbs for calf scars -> if present then implies CABG over valve surgery
what does this scar indicate
lateral thoracotomy scar -> previous thoracic surgery
indications for this scar
inferior clavicle scar (and implant) -> cardiac pacemaker or defibrillator
how do you describe murmurs in a cardio exam
timing (systolic vs diastolic)
site of greatest intensity
character
loudness
radiation
what are the only grades of murmurs we should say it is
grade 2: heard by a non-expert in optimum conditions
grade 3: easily heard, no thrill
grade 4: loud murmur, palpable thrill
causes of a third heart sound
caused by passive filling of the ventricles during systole
happens in any condition where the atrium is more full than it should be:
-> volume overload
-> mitral regurgitation
-> aortic regurgitation
causes of a fourth heart sound
atrial contraction against a stiff left ventricle
causes include:
-> fibrosis (e.g. post MI)
-> Hypertension
-> aortic stenosis
-> HOCM
cardiac causes of clubbing
infective endocarditis
congenital cyanotic heart disease
atrial myxoma
causes of mitral regurg
acute: MI (papillary muscle rupture), endocarditis
chronic: rheumatic heart disease / dilated cardiomyopathy / mitral prolapse
causes of aortic stenosis
calcific valve disease (most common in elderly)
congenital bicuspid valve (younger)
rheumatic fever
how is aortic stenosis severity graded
echocardiography to look at mean gradient across the valve and the surface area of the valve area
indications for a pacemaker
persisting symptomatic bradycardia
heart block (complete or mobitz type 2)
suppression of resistant tachyarrhythmias
what do pacemaker letters and codes mean
most pacemakers have 3 letters only
letter 1: the chamber that is PACED
letter 2: the chamber that is SENSED
letter 3: the pacemaker’s RESPONSE to a sensed event (T = triggered, I = inhibited, D = dual, I/R = reverse)
what drugs improve the prognosis in left ventricular failure?
Rampiril
Bisoprolol
Spironolactone
Aspirin
Statin
what are the respiratory causes for clubbing?
any fibrotic lung disease
chronic suppurative lung disease (e.g. bronchiectasis)
lung cancer (all except small cell)
why doesn’t small cell lung cancer cause clubbing?
progresses too fast to induce clubbing
causes of decreased chest expansion
- fibrosis
- effusion
- collapse
- pneumothorax
common causes of wheeze
obstructive lung diseases, particularly COPD or asthma
what is stridor and what does it indicate?
high-pitched monophonic breath sound (usually inspiratory)
indicates obstruction at the upper airway level
what are the causes for dullness to percussion on respiratory examination?
- effusion
- consolidation
- lobectomy or pneumonectomy
- raised hemidiaphragm
- pleural thickening
