cardiovascular

Question 1

left side congestive heart failure symptoms and clinical findings

Answer 1

Symptoms:
paroxysmal nocturnal dyspnea, Elevated pulmonary capillary wedge pressure, restlessness, confusion, orthopnea, tachycardia, exertional dyspnea, fatigue, cyanosis, pulmonary congestion (cough, crackle, wheezes, blood-tinged sputum, tachypnea)
Clinical: Tachypnoea, S3 gallop, cardiac murmurs, paradoxial splitting of S2

Question 2

Right sided congestive heart failure symptoms

Answer 2

Symptoms: fatigue, elevated peripheral venous pressure, ascites, enlarged liver and spleen, my be secondary to chronic pulmonary problems, distended jugular veins, anorexia and complaints of GI distress, weight gain, dependent edema
Clinical:
Jugular venous distension, peripheral edema, perioral and peripheral cyanosis, congestive hepatomegaly, ascites (portal hypertension signs)

Question 3

Abdominal aortic aneurism symptoms and clinical findings

Answer 3

Asymptomatic until they rupture
expanding: Sudden, severe, constant Low Back Pain / flank pain, abdominal pain or groin pain.
Abdominal Px radiating to the back, flank and groin
May have Syncope
Palpable abdominal mass (but this may only be in 50% of cases)
Nausea and vomiting d/t bowel compression/pain
Venous thrombosis

Question 4

Dissecting Abdominal Aortic Aneurysm (AAA) symptoms and clinical signs

Answer 4

Shock
Cyanosis
Mottling
Altered mental state
Tachycardia
Hypotension

Sudden, severe chest Px (peak at onset) sharp, tearing or ripping
Minimal radiations
18-50% aortic regurgitation in proximal dissection (early diastolic murmur)
Ischemia (Myocardial or cerebral)

Question 5

Angina Pectoris

Answer 5

Substernal Pain
Dyspnoea
Pain may refer to neck, jaw and shoulder
stable = only pain with exercise that quickly subsides
unstable = pain at rest increasing in severity and frequency

Question 6

Atrial Fibrillation symptoms

Answer 6

If mild, can be asymptomatic
Palpitations (M/C)
Fatigue, light-headedness due to low cardiac output
Irregularly irregular rhythm

Question 7

Haemorrhoids
symptoms

Answer 7

Painless bleeding
Perianal irritation (made worse if frequent bouts of defaecation)
Acute external: more painful on sitting, standing or defecating often thrombosed (bunch of grapes)
Prolapse
Constipation

Question 8

Hypercholesterolemia symptoms

Answer 8

Xanthoma (tendons) (fatty build up)
Xanthelasma (eyelids) (fatty build up)
Corneal arcus (a white, blue or gray crescent shape (arc) made of lipid (fatty) deposits that curves around the outer edges of the cornea of the eye)
CAD ( coranary artery disease)
Cerebrovascular disease
Peripheral arterial disease

Question 9

Heat Exhaustion and Heat Stroke symptoms

Answer 9

Generalised malaise, weakness, headache, muscle cramps, nausea, vomiting, hypotension and tachycardia
Rectal temperature usually normal
Sweating may/may not be present (often not with older patients)
Neurological manifestations (seizure, tremor, hemiplegia, coma, psychosis)
Evidence of dehydration
Tachycardia, hyperventilation
Skin is red, hot and flushed
Sweating is often absent – particularly in older patients

Question 10

Mitral Regurgitation symptoms

Answer 10

Fatigue, dyspnoea, orthopnoea
Haemoptysis d/t pulmonary hypertension
Possible systemic emboli
Hyper dynamic apex, usually with palpable left ventricular lift and apical thrill
Pansystolic murmur

Question 11

Mitral Valve Prolapse symptoms

Answer 11

Usually female with narrow AP chest diameter
A mid-systolic click then a late systolic murmur
Most patients are asymptomatic
(If present) chest Px and palpitation
(Rare) anxiety, fatigue, dyspnoea

Question 12

Mitral Stenosis symptoms

Answer 12

Exertional dyspnoea
Acute pulmonary oedema
Systemic emboli
Facial flushing
Haemoptysis
Opening snap in early diastole
Apical mid-diastolic or presystolic murmur
Accentuated S1

Question 13

Myocardial Infarction symptoms

Answer 13

Crushing substernal chest Px
Unrelieved by nitroglycerin
Radiations to the left or right arm, neck, jaw, back, shoulders
Dyspnoea, nausea, vomiting
20% no Px
Patients are often sweaty and pale
Rales may be present at lung base due to LVF
Physical examination may be normal

Question 14

Peripheral arterial disease symptoms

Answer 14

50% asymptomatic
One third describe intermittent claudication, brought on by exercise and relieved by rest
Px at rest, particularly when supine
Diminished pulses
Cool skin, peripheral cyanosis, atrophy, hair loss, ulcers, gangrene

Dorsalis pedis pulses often occlude first
Vascular claudication often made worse with exercise vs neurological not so much
Reduced leg BP

Question 15

Stroke symptoms

Answer 15

Motor and/or sensory and/or cognitive deficits
Depends on the area involved
M/C manifestations are
Contralateral weakness or sensory loss
Left sided: language difficulty, aphasia
Right sided: visuospatial changes
Onset is usually sudden

Question 16

Subdural Haemotoma symptoms

Answer 16

Vague headache, often worse in the morning
Apathy, confusion and clouding of consciousness
Frank coma
Dementia-type presentation
Neurological symptoms simulate TIA
ANY sign of cortical dysfunction (having trouble with:
Reading, spelling or math, Driving, Getting dressed, Telling the difference between objects that are moving and those that are still, Judging how far away objects are, Using everyday objects or tools, Identifying left from right.)
New onset of seizures

Question 17

Syncope symptoms

Answer 17

Blood pressure:
Low BP (orthostatic hypotension).
Drop in BP but no change in heart rate can be caused by beta blockers
Pulse:
Tachycardia, bradycardia or irregular rhythm, consider arrhythmia
Heart:
If murmurs are suggestive of sub-aortic or aortic stenosis, consider L ventricle outflow obstruction.
JVD and distal heart sounds, consider cardiac tamponade

Question 18

Thrombophlebitis (superficial) symptoms

Answer 18

Palpable and tender vein, with erythema and oedema of the overlying skin and subcutaneous tissue.
Redness and tenderness along the course of the vein – useful to DDx from cellulitis, erythema nodosum.
No significant swelling of the limb
No or Low-grade fever only

Question 19

Infective Endocarditis symptoms

Answer 19

fever, Fatigue and weakness, New onset or worsening of heart failure symptoms: IE can cause heart valves to malfunction, leading to symptoms such as shortness of breath, swelling in the legs or abdomen, and fatigue, Heart murmur, joint pain, swelling, and stiffness, Small, painless, red or purple spots (petechiae) on the skin, or painful, raised lesions (nodules) on the fingertips or toes, may be seen in some cases of IE, Neurological symptoms confusion, seizures, and stroke.