Cardiology

Question 1

JVP vs carotid pulse

Answer 1

JVP

• has 2 peaks
• lower and lateral
• not palpable
• can be obliterated
• inspiration –> more visible( carotid no change)
• positive hepatojugular reflex
• posture dependent (decrease with upright posture)

Question 2

AR signs

Answer 2

• Marfanoid features
• peripheral stigmata of IE
• Collapsing Pulse
• head nodding
• marked capillary pulsation
• wide pulse pressure >60 mmhg (systolic okay but diastolic blood rushes back)
• displaced apex
• early diastolic murmur, loudest during expiration in sit-up and lean -forward position
• Austin Flint murmur

Question 3

AR murmur

Answer 3

early diastolic murmur loudest during expiration in sit-up and lean-forward position

Question 4

AR causes

Answer 4

• rheumatic
• congenital bicuspid aortic valve
• degenerative
• syphilis
• causes of a dilated aortic root/aortic aneurysm eg Marfan Syndrome, aortic dissection
• seronegative arthritis (ankylosing spondylitis, Reiter’s syndrome, colitis, psoriatic arthropathy)

Question 5

AR Ix

Answer 5

• Blood test for VDRL and IE blood culture
• CXR for dilated aortic arch and cardiomegaly
• Echo for LV size and function, aortic root size, degenerative or bicuspid valve, severity of AR

Question 6

AR vs PR

Answer 6

PR

• no collapsing pulse
• no LVH

Question 7

AR vs MS

Answer 7

MS

- no austin flint murmur, instead has loud S1 and opening snap

Question 8

AS signs

Answer 8

• small volume and slow-rising pulse
• sustained and thrusting, not or slightly displaced apex
• systolic thrill in aortic area
• soft s2 at aortic area if calcified and severely stenotic
• ejection systolic murmur at aortic area radiating to neck

Question 9

small volume and slow rising pulse

Answer 9

AS

Question 10

collapsing pulse

Answer 10

AR or PDA

Question 11

AS murmur

Answer 11

ejection systolic murmur at aortic area radiating to neck

Question 12

AS causes

Answer 12

• rheumatic
• degenerative calcification
• congenital bicuspid aortic valve

Question 13

AS vs aortic sclerosis

Answer 13

aortic sclerosis

• normal volume pulse
• normal or wide pulse pressure
• intact s2
• no LVH

Question 14

AS vs hypertrophic cardiomyopathy

Answer 14

hypertrophic cardiomyopathy

• jerky pusle
• normal s2
• murmur louder on standing

Question 15

AS vs MR

Answer 15

MR pansystolic murmur at apex radiating to axilla

Question 16

AS Ix

Answer 16

• ECG for LVH
• CXR for cardiomegaly and aortic valve calcification
• Echo for LVH, pressure gradient across aortic valve and aortic valvular area

Question 17

ASD signs

Answer 17

• if HF then raised JVP
• parasternal heave
• fixed wide splitting of S2
• loud P2
• ejection systolic murmur at pulmonic area
• mid-diastolic murmur at tricuspid area

Question 18

ASD murmurs

Answer 18

• ejection systolic murmur at pulmonic area

- mid-diastolic murmur at tricuspid area

Question 19

ASD vs PS

Answer 19

PS soft S2

Question 20

ASD vs PHT

Answer 20

PHT loud S2 without fixed splitting

Question 21

ASD Ix

Answer 21

ECG for RBBB
CXR for plethoric lung fileds with RV enlargement
Echo for dilated RV, PHT, assess size of defect