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PACES > Cardio/Resp/Gastro exam > Flashcards

Cardio/Resp/Gastro exam Flashcards

1
Q

what is kussmaul’s sign

A

paradoxical increase in JVP with inspiration

occurs when right ventricular filling is restricted

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2
Q

usual position of the apex beat

A

5th ICS MCL

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3
Q

reasons for impalpable apex beat

A

Hyperexpanded lungs: obstructive lung disease (e.g. COPD)

Reduced impulse: tamponade or restrictive pericarditis

Obesity

Dextrocardia

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4
Q

reasons for seeing this scar in a cardio exam

A

emergency
previous valve surgery
coronary artery by-pass graft

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5
Q

what should you do if you see this scar in paces

A

check the lower limbs for calf scars -> if present then implies CABG over valve surgery

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6
Q

what does this scar indicate

A

lateral thoracotomy scar -> previous thoracic surgery

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7
Q

indications for this scar

A

inferior clavicle scar (and implant) -> cardiac pacemaker or defibrillator

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8
Q

how do you describe murmurs in a cardio exam

A

timing (systolic vs diastolic)
site of greatest intensity
character
loudness
radiation

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9
Q

what are the only grades of murmurs we should say it is

A

grade 2: heard by a non-expert in optimum conditions
grade 3: easily heard, no thrill
grade 4: loud murmur, palpable thrill

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10
Q

causes of a third heart sound

A

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

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11
Q

causes of a fourth heart sound

A

atrial contraction against a stiff left ventricle

causes include:
-> fibrosis (e.g. post MI)
-> Hypertension
-> aortic stenosis
-> HOCM

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12
Q

cardiac causes of clubbing

A

infective endocarditis
congenital cyanotic heart disease
atrial myxoma

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13
Q

causes of mitral regurg

A

acute: MI (papillary muscle rupture), endocarditis

chronic: rheumatic heart disease / dilated cardiomyopathy / mitral prolapse

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14
Q

causes of aortic stenosis

A

calcific valve disease (most common in elderly)
congenital bicuspid valve (younger)
rheumatic fever

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15
Q

how is aortic stenosis severity graded

A

echocardiography to look at mean gradient across the valve and the surface area of the valve area

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16
Q

indications for a pacemaker

A

persisting symptomatic bradycardia
heart block (complete or mobitz type 2)
suppression of resistant tachyarrhythmias

17
Q

what do pacemaker letters and codes mean

A

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)

18
Q

what drugs improve the prognosis in left ventricular failure?

A

Rampiril
Bisoprolol
Spironolactone
Aspirin
Statin

19
Q

what are the respiratory causes for clubbing?

A

any fibrotic lung disease

chronic suppurative lung disease (e.g. bronchiectasis)

lung cancer (all except small cell)

20
Q

why doesn’t small cell lung cancer cause clubbing?

A

progresses too fast to induce clubbing

21
Q

causes of decreased chest expansion

A
  • fibrosis
  • effusion
  • collapse
  • pneumothorax
22
Q

common causes of wheeze

A

obstructive lung diseases, particularly COPD or asthma

23
Q

what is stridor and what does it indicate?

A

high-pitched monophonic breath sound (usually inspiratory)

indicates obstruction at the upper airway level

24
Q

what are the causes for dullness to percussion on respiratory examination?

A
  • effusion
  • consolidation
  • lobectomy or pneumonectomy
  • raised hemidiaphragm
  • pleural thickening
25
Q

how do you differentiate between consolidation and pleural effusion clinically?

A

both are dull to percussion

vocal resonance is decreased/absent in effusion

it is increased in consolidation

(solid conducts noise better than gas/liquid)

26
Q

how do you differentiate a transudative vs exudative pleural effusion

A

informmaly:
transudative = protein <30g/L, exudative = >30

formally = Light’s criteria

27
Q

What are the common causes of cirrhosis?

A

alcohol
viral (hepatitis)
fatty liver (NAFLD/NASH)
autoimmune
genetic (e.g. HH, Wilsons)
drugs (e.g. isoniazid, methotrexate)

28
Q

what are the complications of cirrhosis?

A

liver failure -> coagulopathy and encephalopathy

portal hypertension

ascites (varices and hypersplenism)

jaundice

HCC

29
Q

why do patients get oedema in liver disease?

A

low albumin

stimulation of RAAS leads to fluid retention

30
Q

what are clinical signs of alcohol dependence?

A

cachexia
cerebellar dysfunction
peripheral neuropathy
dupuytrens

31
Q

what are the causes of decompensation in liver disease

A

infection
SBP
GI bleeding
HCC

32
Q

Scoring system used for grading severity of liver disease?

A

Child-Pugh

33
Q

components of the child Pugh scoring system for liver disease

A

BR
PT
albumin
ascites
encephalopathy

PACES (10 decks)

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