Cardiology Flashcards
How do you grade heart murmurs?
1 = softest murmur only heard in a quiet room in certain positions
2 = the softest murmur heard in all positions in the OPD/ward
3 = loud, not accompanied by a palpable thrill
4 = loud, accompanied by a palpable thrill
5 = heard with the stethoscope barely touching the chest
6 = audible without stethoscope touching the chest
What is the normal liver span in children?
4.5-5cm at 1 week of age
6-7cm by mid-childhood
How do you differentiate the left kidney and the spleen on palpation?
The left kidney moves in late inspiration and the upper pole can be defined (unlike the spleen)
How can one describe alterations of consciousness objectively?
AVPU
A = alert
V = responds to verbal stimuli
P = responds to painful stimuli
U = unresponsive
How do you describe abnormal tone? (Terminology)
Spasticity (increased and higher velocity) = UMNL
Hypotonia
Hypertonic
Dystonia = abnormally increased tone with altered posture and positions of limbs in relation to one another.
Floppiness
Clonus
Babinski sign
Where do you expect to find the apex beat in a child?
<4yrs = 4th left ICS MCL
>4yrs = 5th left ICS MCL
What signs on cardiac exam indicate pulmonary hypertension?
Palpable P2
Loud S2
Left parasternal heave (RV enlargement)
Epigastric heave
What does a suprasternal thrill indicate?
Aortic stenosis
What signs would you find on a patient with aortic stenosis?
Left ventricular hypertrophic (displaced apex beat)
Suprasternal thrill
How do you describe your findings of a large liver?
Upper border
Lower border
Liver span
Pulsation
Consistency
Tender
What heart condition would give you splenomegaly?
Infective endocarditis
What are the common causes of joint pain in children?
Growing pains
Hyper mobility syndrome (lax ligaments)
Septic arthritis
Osteomyelitis
Infection eg TB
Trauma
Rheumatic fever
Malignancy eg leukaemia
Reactive arthritis
Juvenile idiopathic arthritis
Haemarthritis (haemophilia)
Avascular necrosis
Slipped femoral epiphysis
Define clubbing
Bulbous uniform swelling of the soft tissue of the terminal phalanx of a digit with subsequent loss of the normal angle between the nail and the nail bed.
What are the causes of clubbing?
PRIMARY
>idiopathic
>inherited
SECONDARY
>pulmonary
-malignancies
-chronic lung disease eg Bronchiectasis
-suppurative eg empyema, lung abscess
-other eg pulm hypertension
> cardiac
-R->L shunting
-pulm HT
-critical congenital heart disease
-infective endocarditis
> GIT
-inflammatory eg UC, Crohns
-malabsorption, achalasia
> MALIGNANCY
-thyroid CA
-thymus CA
-Hodgkin lymphoma
> SKIN
-hyperkeratosis
How does clubbing develop?
1) fluctuation and softening of nail bed
2) loss of normal <165 angle between nailbed and fold
3) increased convexity of nail fold
4) thickening of whole distal finger
5) shiny aspect and striata on of nail and skin
