Cardiology

Question 1

What end of bed signs may you see in a patient during a Cardiology examination?

Answer 1

Mallar flush (MR)
Pallor
Cyanosis
Oedema
Dyspnoea

Question 2

What hand signs may you see in a patient in CV exam?

Answer 2

Pallor
Cyanosis
Tar staining
Xanthomata
Arachnodactyly
Pigmentation

Question 3

Give 3 causes of clubbing.

Answer 3

Cyanotic heart disease
Cystic fibrosis
Lung cancer
Ulcerative colitis
Bronchiectasis
Benign mesothelioma
Infective endocarditic
Idiopathic pulmonary fibrosis
Neurogenic tumours
GI disease

Question 4

What nail signs may you see?

Answer 4

Splinter haemorrhages
Janeway lesions
Osler’s nodes

Question 5

What may cause a radio-radial delay?

Answer 5

Subclavian stenosis
Aortic dissection
Aortic coarctation

Question 6

What may cause a collapsing pulse?

Answer 6

Aortic regurgitation
PDA

High output states (anaemia, AV fistula, thyrotoxicosis)

Fever
Pregnancy

Question 7

What pulse characters are there?

Answer 7

Normal
Slow-rising (AS)
Bounding (AR and CO2 retention)
Thready (hypovolaemia)

Question 8

Which conditions may give a narrow pulse pressure?

Answer 8

SBP - DBP <25mmHg

Aortic stenosis
Cardiac tamponade
Congestive heart failure

Question 9

Which conditions may give a wide pulse pressure?

Answer 9

SBP - DBP >100mmHg

Aortic regurgitation
Aortic dissection

Question 10

What may cause a raised JVP?

Answer 10

Cardiac tamponade
Congestive heart failure
Restrictive cardiomyopathy
Constrictive pericarditis

Question 11

What is a positive result for a hepatojugular reflux?

Answer 11

sustained rise and >4cm rise

Question 12

What eye signs may be noted on CVS exam?

Answer 12

Xanthelasma
Corneal arcus
Conjunctival pallor
Kayser-Fleischer rings
Brushfield spots

Question 13

Which thoracic scars may you note in a CVS exam?

Answer 13

Median sternotomy scar (CABG)
Anterolateral thoracotomy scar (minimally-invasive cardiac surgery)
Infraclavicular scar (pacemaker)
Left mid-axillary scar (ICD)

Question 14

Which valves may be accentuated by expiration?

Answer 14

Aortic (lean forward and exhale)

Mitral (left lateral decubitus and exhale)

Question 15

Which values are accentuated by inspiration?

Answer 15

Tricuspid (exhale)

Pulmonary (exhale)

Question 16

What clinical signs of aortic regurgitation exist?

Answer 16

Aortic area, diastolic murmur, accentuated by leaning forward and breathing out

Collapsing pulse
Displaced apex beat
Wide pulse pressure

DeMusset’s sign (head bobbing)
Corrigan’s sign (distension and collapse of carotid arteries in the neck)
Quincke’s sign (nail bed pulsations)
Traube’s sign (pistol shot sounds over femoral artery)

Question 17

What are the clinical features of mitral stenosis?

Answer 17

Mitral area, diastolic murmur, accentuated by left lateral decubitus position and breathing out; radiates to axilla

Low volume pulse (character)
Malar flush

Question 18

What is the Ebstein anomaly?

Answer 18

Congenital tricuspid regurgitation due to valves displaced downwards into the right ventricle causing regurgitation

Question 19

What criteria is used to determine CTPA or D-Dimer in PE?

Answer 19

Well’s Score

DAMN BC

DVT likely
Another DDx less likely than PE

Mobility (>3 days or surgery in 4 weeks)
Medical history of PE
HR >100bpm

Blood in cough
Cancer Hx (last 6 months or palliative)

Question 20

How do you treat patients presenting with AF?

Answer 20

Stable

<48 hours = rhythm control
Bisoprolol; Amiodarone (if HF)
>48 hours = rate control

Unstable
DC Cardiovert

Question 21

What are the complications of DC cardioversion?

Answer 21

Stroke
Pulmonary vein stenosis
Cardiac tamponade