Cardiology

Question 1

how common is deep vein thrombosis?

Answer 1

25-50% of surgical patients

2/3 per 1,000

Question 2

where do they occur mostly?

Answer 2

65% below the knees

Question 3

List risk factors for the condition

Answer 3

age
pregnancy
immobility - bed bound, travelling long distances 
synthetic oestrogen 
thrombophilia 
surgery
cancer
previous DVT

Question 4

signs on examination

Answer 4

tenderness 
swelling
warmth of calves
erythema 
mild fevr
odema
homans sign

Question 5

what is homans sign?

Answer 5

discomfort/ increase resistance behind the knee on forced dorsiflexion of the foot

Question 6

what is a test for it?

Answer 6

D dimer

Question 7

issues with this test?

Answer 7

sensitive but not specific

elevated in cancer, pregnancy, , infection and post op

Question 8

what are other diagnostic options?

Answer 8

compression US

thrombophilia test before anti-cogulation

Question 9

prevention methods

Answer 9

avoid immobility
avoid the pil
heparin
compression stockings

Question 10

a medication which can prevent it ?

what does it act in

Answer 10

Fondaparinux

Xa inhibitor

Question 11

what are the treatment options

Answer 11

heparin
warfarin
inferior vena cava filters
post phlebitis changes

Question 12

what can be used to assess if this is DVT or not?

Answer 12

wells scores

Question 13

what does it compromise of?

Answer 13

cancer - active or palliation with 6 months
bedridden recently >3 days
major surgery within last month
calf swelling >3cm compared to other leg- measure below tibial tuberosity
collateral superficial veins
pitting odema

Question 14

differentials include…

Answer 14

cellulitis
bakers cyst
chronic venous insufficiency
lymphedema

Question 15

what is valvular disease ?

Answer 15

Disease or damage to any of the four heart valves that can affect blood flow through the heart- 2 main types of valve prob;

Question 16

differentiating between stenosis and regurgitation

Answer 16

valve stenosis (doesn’t open fully in diastole- blood flow restriction) 
valve regurgitation (or leaky valve, doesn’t close properly in systole- blood backflow through valve)

Question 17

signs

Answer 17

radio-radio delay - coarctation of the aorta
collapsing pulse- aortic regurgitation
slow rising- aortic stenosis
forward and tilt left- mitral murmur
lean forward, hold breath and listen in aortic area- regurgitation

Question 18

mitral valve disease

Answer 18

mitral regurg and mitral stenosis
so this can present with :

stenosis:

rergurg:
most common reason is itral proploase, post MI damaging papillary muscle attached to chordea tenaiae
leaky valve when unable to close properly allowing blood to flow back
mid-systolic clic and pansystolic murmur
can delay when squatting down as it increases venous return and click sooner when standing due to decreased venous return
can cause LHF when hypertrophy of left ventricle

Question 19

stenosis mitral

Answer 19

mid-diastolic urmur -increased sound when left hand side expiration using bell
rheumatic fever
pulmonary odema
narrowing from 4-6cm to 2cm of the valve therefore reduced blood flow
RHF
increased AF risk
swallowing difficulities with compression of atrium onto osephgeagus

Question 20

aortic regurg and stenosis

Answer 20

regurg
, syncope, orthopnea, CCF
causes - anuseum, infective endocarditis, syphilis
collapsing pulse, listening whilst learning forward
carotid pulsation (quinicke sign)
displaced apex beat
diastolicmurmur increased systolic pressure and decrease diastolic pressure

stenosis
sudden death 
syncope angina 
ejection systolc murmur 
thrill, heave, pulse radiate to carotid