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FRACP short case > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Differentials for an ejection systolic murmur?

A 
Aortic stenosis
Pulmonary stenosis
Hypertrophic cardiomyopathy
Atrial septal defect
Hyperdynamic states:
- Normal = pregnancy and athletes
- Abnormal = Hyperthyroid and anaemia
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2
Q

How to differentiate aortic stenosis?

A

Aortic area
Radiates to carotids
Increases on expiration

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3
Q

How to differentiate HoCM?

A

Aortic area
Nil radiation
Increases on Valsalva

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4
Q

Differentials of a pansystolic murmur?

A

Mitral regurgitation
Tricupsid regurgitation
Ventricular septal defect

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5
Q

How to differentiate MR?

A

Mitral area
Radiates to axilla
Increases on expiration
SOFT S1

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6
Q

Differentials of a late systolic murmur?

A

Mitral prolapse - mid systolic click

Tricuspid prolapse

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7
Q

Differentials of an early diastolic murmur?

A

Aortic regurgitation

Pulmonary regurgitation

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8
Q

How to differentiate aortic regurgitation?

A 
Aortic area --> left sternal edge on leaning forward
Increased on expiration
Collapsing pulse
Wide pulse pressure
Nailbed pulsations
Head bobbing
Soft S2
Severe --> austin flint murmur - mid-diastolic rumble
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9
Q

Differentials of a mid-diastolic murmur?

A

Mitral stenosis - load S1

Tricuspid stenosis

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10
Q

Differentials of a continuous murmur?

A

Patent ductus arteriosus

Mammary souffle

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11
Q

Causes of a wide S2?

A

RBBB
Pulm HTN - load S2 in pulm area
Pulm stenosis

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12
Q

Causes of a fixed split S2?

A

Atrial septal defect

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13
Q

Causes of a paradoxically split S2?

A

Atrial septal defect
LBBB
HoCM

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14
Q

Cause of 3rd heart sound?

A 
LVF
AR
MR
VSD
PDA
RVF
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15
Q

Causes of a 4th heart sound?

A 
AS
MR
HTN
IHD
HoCM
Pulm HTN
Pulm Stenosis
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16
Q

Causes of MS?

A

Rheumatic
Severe mitral annular calcification
Congenital

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17
Q

Clinical signs of MS

A 
Small pulse pressure
Early-opening snap
Long mid-diastolic rumble
Presence of pulmonary HTN
Tapping apex beat
Load S1
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18
Q

Signs of Pulmonary HTN?

A 
Prominent a wavw in JVP
Right ventricular impulse
Load P2
Palpable P2
Pulmonary regurgitation
Tricuspid regurgitation
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19
Q

Results of investigations for MS?

A

ECG: AF, P mitrale, RV systolic overload, right axis deviation
CXR: large L atrium, mitral valve calcification, signs of Pulm HTN

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20
Q

Chronic causes of MR?

A

Degenerative disease
Mitral valve prolapse
Rheumatic
Papillary muscle dysfunction - LVF and IHD
Connective tissue disease - RA, Ank. spond.
Congenital

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21
Q

Acute causes of MR?

A

Infective endocarditis
MI
Surgery
Trauma

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22
Q

Signs of MR?

A 
Enlarged left ventricle
Pulm HTN
Third heart sound
Early diastolic rumble
Soft 1st heart sound
Small volume pulse
LVF
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23
Q

Results of Ix of MR?

A

ECG: P mitrale, AF, LVH, right axis deviation
CXR: Large left atrium and LVH, mitral annular calcification

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24
Q

Valvular causes of AR?

A

Rheumatic
Congenital
Seronegative Arthropathy - ank. spond

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25
Aortic root causes of AR?
``` Marfan's syndrome Aortitis HTN Dissecting aneurysm Old age ```
26
Signs of Aortic regurgitation?
``` Collapsing pulse Wide pulse pressure Length of the decrescendo diastolic murmur Third heart sound Soft A2 Austin flint murmur LVF ```
27
Results of investigations for AR?
ECG - LVH | CXR - LVH, valve calcification
28
Indications for surgery for MR?
Class 3 or 4 HF | LV dysfunction
29
What kind of surgery for MR?
Usually repair | Replacement = mechanical
30
Indications for surgery for AR?
SOB on exertion Worsening LVF Progressive LV dilatation
31
Causes of AS?
Degenerative disease Rheumatic Calcific bicuspid valve
32
Clinical signs of AS?
``` Plateau pulse Aortic thrill Long harsh systolic murmur 4th heart sound Paradoxical splitting of the 2nd heart sound LVF ```
33
Results of investigation for AS?
ECG - LVH CXR - LVH, valve calcification TTE - valve gradient, LV dysfunction
34
Indications for surgery for AS?
SOB Syncope Angina Critical obstruction
35
What kind of surgery for as?
Valve replacement or TAVI | Mechanical or tissue
36
Signs of TR?
``` Large V waves on JVP RV heave Pansystolic murmur increases on inspiration Pulsatile enlarged tender liver Ascites and oedema ```
37
Causes of TR?
``` Function secondary to cor pulmonale Rheumatic Infective endocarditis in IDU Congenital - ebsteins RV infarct --> papillary muscle dysfunction Trauma ```
38
Results of Ix for TR?
``` CXR = RV enlargement CXR = Box heart and narrow cardiac pedicle if ebsteins abnormality TTE = jet volume ```
39
Signs of Pulmonary stenosis?
``` Peripheral cyanosis Giant A waves on JVP Right ventricular heave Harsh ejection systolic murmur loader on inspiration with preceding click S4 may be present Signs of RV failure ```
40
Signs of chronic constrictive pericarditis?
``` Cachexia and ascites present Low BP Pulsus paradoxus Raised JVP Distant heart sounds Hepatosplenomegaly, ascites and oedema ```
41
Signs of HoCM?
``` Sharp jerky pulse Prominent A wave on JVP Double or triple impulse apex beat Late systolic ejection murmur at left sternal edge louder with valsalva and decreased with handgrip Pansystolic murmur of MR 4th heart sound ```
42
Investigation findings of HoCM?
ECG: LVH, lateral ST and T wave changes CXR: LVH, hump on left heart border TTE: Hypertrophy of the LV septal wall, MR
43
Signs of ASD ostium secundum?
Fixed splitting of 2nd heart sound Pulmonary ESM increasing on inspiration Pulmonary HTN
44
Investigation finding of ASD - ostium secondum?
ECG: Right axis deviation, RBBB and RVH CXR: Increased pulmonary vasculature, enlarged RA and RV TTE: RV dilation, Shunt on bubble studies
45
Signs of ASD - ostium primum?
``` Fixed splitting of 2nd heart sound Pulmonary ESM increasing on inspiration Pulmonary HTN MR TR VSD signs ```
46
Investigation findings of ASD - Ostium secondum?
Left axis deviation and RBBB on ECG
47
Signs of VSD?
Thrill Harsh pan-systolic murmur at left sternal edge MR Associated with Down's Syndrome
48
Results of investigations for VSD?
ECG: LVH CXR: LVH, increased pulm vasculature and enlarged RV TTE: VSD and shunt
49
When to close ASD/VSD?
Presence of Right to left shunt
50
Signs of PDA?
Continuous murmur | If shunt reversed --> pulmonary artery to aorta = cyanosis and toe clubbing
51
Investigation findings of PDA?
ECG: LVH CXR: increased pulm vasculature, calcification of duct, LV enlargement TTE = presence of shunt
52
Signs of CoA?
``` Developed upper body Radiofemoral delay HTN in arms only Chest collateral vessels Midsystolic murmur in the precordium and back ```
53
Investigation findings in CoA?
ECG: LVH CXR: Enlarged LV, Dilated ascending aorta, aortic indentation, rib notching
54
Signs of Eisenmergers Syndrome?
``` Older adults Cyanosis Clubbing Signs of polycythaemia JVP = dominant a wave RV heave Palpable P2 Loud split P2 4th heart sound Pulmonary ejection click, PR and TR ```
55
Investigation findings of Eisenmenger syndrome?
ECG: RVH, p pulmonale CXR: RV and RA enlargement, pulmonary artery prominence, increased hilar markings but attenuated peripheral vessels
56
Signs of ToF?
VSD RVoT obstruction Overriding aorta RVH ``` --> Clubbing Cyanosis Polycythaemia RV heave Thrill at left sternal edge ```
57
Investigation findings of ToF?
ECH: RVH, right axis deviation CXR: Boot shaped heart, RV enlargement, decreased vascularity of the lungs, right sided aortic knob and arch
58
Secondary causes of HTN?
``` Renal artery atherosclerosis Fibromuscular disease Diffuse renal disease Conn's syndrome Cushing's syndrome CAH - 17 and 11 beta hydroxylase defects Acromegaly Myoedema OCP Co-arctation of the aorta Polycythaemia Uraemia Neurogenic OSA EtOH ```
59
Fundoscopy grades in HTN?
``` I = silver wiring II = + AV nipping III = + haemorrhages and exudates IV = + papilloedema ```
60
Signs of Marfan's Syndrome?
``` Arachnodactyly Joint hypermobility Long thin limbs Long and narrow face Blue sclera High-arched palate Pectus carination or excavatum AR and MV prolapse CoA AAA Kyphoscoliosis Arm span greater than height ```
61
Causes of Oedema?
``` Drugs - CCB Cardiac - CCF, cor pulmonale, constrictive pericarditis Renal - nephrotic syndrome Liver cirrhosis Malabsorption or starvation Protein-losing enteropathy Myxoedema Cyclical oedema ```
62
Causes of SVC obstruction?
``` Lung carcinoma Retrosternal tumours - lymphoma, thymona, dermoid Retrosternal goitre Massive mediastinal lymphadenopathy Aortic aneurysm ```

FRACP short case (11 decks)

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