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The Ultimate Guide To Passing Clinical Medical Finals > Cardiovascular > Flashcards

Cardiovascular Flashcards

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USMLE® Step 1 flashcards
1
Q

What is Malar Flush seen in?

A

Mitral Stenosis AND Pulmonary hypertension

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2
Q

Cardiovascular disease associated with Downs Syndrome

A

Ventricular Septal Defect

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3
Q

Cardiovascular disease associated with Turners Syndrome

A

Aortic Stenosis
Coarctation of the aorta
Bicuspid Aortic Valve

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4
Q

Cardiovascular disease associated with Noonan’s Syndrome

A

Pulmonary Stenosis

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5
Q

PICTURE

A

Janeway Lesions

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6
Q

PICTURE

A

Oslers Nodes

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7
Q

PICTURE

A

Splinter Haemorrhages

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8
Q

PICTURE

A

Xanthoma

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9
Q

Cause of Regularly Irregular pulse

A

Heart Block

Ectopics

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10
Q

DDx of radial-radial delay

A

Atherosclerosis

Aortic Dissection

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11
Q

DDx of radial-femoral delay

A

Coarctation of the aorta

Acute dissection

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12
Q

DDx of collapsing pulse

A

Aortic regurgitation

Persistant Ductus Arteriosus

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13
Q

Why do you check blood pressure in both arms?

A

To check for thoracic aortic dissection.

This is indicated by a significant discrepancy (>30mmHg) between arms.

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14
Q

Narrow Pulse Pressure

A

Aortic Stenosis

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15
Q

Wide Pulse Pressure

A

Aortic Regurgitation

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16
Q

Diagnose that sign: Blue Sclera

A

Marfans

Ehlers-Danlos

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17
Q

PICTURE

A

Marfans

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18
Q

Picture

A

Ehlers-Danlos

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19
Q

What should you look at in the eyes and face for CV Exam

A 
Anaemia
Sclera
Corneal Arcus
Xanthelasma
Cushingoid Appearance
Cynosis
FUNDOSCOPY
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20
Q

What vein do you use to assess the JVP?

A

Internal Jugular Vein

It is valveless unlike the external jugular

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21
Q

Why assess the JVP?

A

The internal jugular vein reflects the pressure and function of the right side of the heart and thoracic cavity.
It gives information on circulatory volume and right ventricular function.

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22
Q

Causes of a raised JVP

A 
Overfilled Right Atrium
..Fluid Overload
..Right Ventricular Failure
..Pregnancy
Right Ventricular Compression
..Cardiac Tamponade
..Constrictive pericarditis
Increased intrathoractic pressure leading to right heart failure
..Pulmonary HTN
..Pulmonary Oedema
..Tension Pneumothorax
Tricuspid Valve Disease
..Stenosis
..Regurgitation
..Cardiac Myxoma
Superior Vena Cava Obstruction
..Lung Tumour
..Mediastinal Masses
..Large Thyroid Goitre
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23
Q

Diagnose that sign: Large Pulse Volume

A

Suggests a Hyperdynamic Circulation e.g Sepsis, Anaemia, CO2 Retention, Aortic Regurgitation.

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24
Q

Diagnose that sign: Low Pulse Volume

A

Low cardiac output states: CCF, Hypovolaemia

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25
Q

Diagnose that sign: Slow Rising Pulse

A

Aortic Stenosis

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26
Q

Diagnose that sign: Collapsing Pulse

A

Aortic Regurgitation

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27
Q

Diagnose that sign: Pulsus Paradoxus

A

Seen in conditions where venous return is restricted such as severe acute asthma and cardiac tamponade

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28
Q

What is Pulsus Paradoxus

A

fall in pulse pressure >10mmHg on inspiration

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29
Q

Diagnose that sign: Pulsus Alternans

A

Aortic Stenosis

Severe Left Ventricular Failure

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30
Q

What is Pulsus Alternans?

A

Alternating small and large volume beats

31
Q

Diagnose that sign: Thoracotomy Scar

A

Mitral Valvotomy

32
Q

Diagnose that sign: Midline Stenotomy Scar

A

CABG, Valve Replacement.

33
Q

Diagnose that sign: Heave

A

Hand Vertical on Left Sternal Edge
Forceful impulse lifts hand off chest

Right Ventricular Hypertrophy
Left Atrial Hypertrophy

34
Q

Diagnose that sign: Thrill

A

Hand Horizonal across manubrium
Vibration

Palpable Murmurs

35
Q

Definition of Apex Beat

A

Most inferior point where the cardiac impulse is still palpable

36
Q

Angle of Louis: anatomical landmark for….

A

2nd costal cartilage

37
Q

Diagnose that sign: Tapping Apex BEat

A

Palpable first heart sound
Mitral Stenosis
Tricuspid stenosis

38
Q

What is the First Heart Sound (S1)?

A

Closure of Mitral and Tricuspid Valves

39
Q

Diagnose that sign: Loud First Heart Sound

A

Tachycardia

Mitral Stenosis

40
Q

Diagnose that sign: Quiet First Heart Sound

A

Bradycardia

Heart Block

41
Q

What is the Second Heart Sound?

A

Closure of the Aortic (followed by Pulmonary) Valve

42
Q

What is the Third Heart Sound?

A

Sometimes called Gallop Rhythm.
Due to rapid LV filling in diastole.

Can be normal in young healthy athletic adults.
Also seen in heart failure and mitral regurgitation

43
Q

What is the forth heart sound?

A

Always pathological.
Amyloidosis, Aortic Stenosis, Hypertension.
Due to forceful atrial contraction against stiff left ventricle

44
Q

Grading System for Murmurs

A

PAGE 45

45
Q

Ejection systolic murmur of AS heard best in Mitral Region

A

Galavardin Phenomena

46
Q

Characteristic Murmur of Mitral Regurgitation

A

Pansystolic murmur heard best in the mitral region. Radiating to the axilla.

47
Q

Characteristic Murmur of Mitral Stenosis

A

Mid diastolic murmur. No radiation. Heard best in left lateral position in the mitral region.

48
Q

Characteristic Murmur of Aortic Regurgitation

A

Early Diastolic Murmur. Heard best sitting forward in tricuspid region.
May radiate to apex.

49
Q

Characteristic Murmur of Tricuspid Regurgitation

A

Pansystolic Murmur heard best in tricuspid region

50
Q

Characteristic Murmur of Ventricular Septal Defect

A

Ejection Systolic Murmur heard best in the tricuspid region

51
Q

Characteristic Murmur of Pulmonary Stenosis

A

Ejection Systolic Murmur. Loudest in Pulmonary area on inspiration.

52
Q

Characteristic Murmur of Aortic Stenosis

A

Ejection Systolic Murmur. Loudest on right sternal edge. May radiate to carotids.

53
Q

Characteristic Murmur of Aortic Sclerosis

A

Ejection Systolic Murmur. Loudest on right sternal edge. Doesn’t radiate to carotids.

54
Q

Cardiovascular Disease associated with Ankylosing Spondylitis

A

Aortic Regurgitation

55
Q

Name that CV sign: Pulsatile Liver

A

Tricuspid Regurgitation

56
Q

Name that CV sign: Splenomegaly

A

Infective Endocarditis

57
Q

To complete my cardiovascular examination…

A

To complete my cardiovascular examination I would like to do a brie examinaiton of the abdomen specifically looking for hepatomegaly, Pulsitlie liver and splenomegaly.
I would also like to perform a peripheral vascular examination and perform fundoscopy to assess for signs of infective endocarditis, hypertensive and diabetic retinopathy.
I would also like to examine any observation charts available for pulse, blood pressure and temperature and do a urine dip.
Finally I would like to do a 12 lead echocardiogram and order a chest X Ray with a posterior anterior view.

58
Q

Name that CV sign: Hepatosplenomegaly

A

Right Heart Failure

59
Q

How do you distinguish the JVP from the Carotid Pulse

A

The JVP, unlike the carotid pulse:

  1. Has a double pulsation (the ‘a’ and ‘v’ wave)
  2. Is impalpable
  3. Can be obliterated by light pressure applied at the root of the neck
  4. JVP rises momenterily with the hepatojugular reflex
  5. The JVP height varies with respiration (falls with inspiration)
60
Q

What are the two main waveforms of the JVP?

A

The a wave: represents arterial contraction

The v wave: represents venous return during tricuspid valve closure.

61
Q

What is Kussmaul’s sign and when is it seen?

A

Kussmauls sign is the paradoxical rise of the JVP during inspiration.
Normally JVP falls during inspiration becuase the intrathoracic pressure becomes increasingly negative increasing the blood flow back to the heart, however, when the right atrium fails to accommodate the increased venous return the JVP rises.
It is seen in Cardiac Tamponade, constrictive pericarditis and severe asthma.

62
Q

DDx that sign: Loss of ‘a’ wave in JVP

A

Atrial fibrillation- wave lost due to ineffective atrial contraction.

63
Q

DDx that sign: Cannon Waves

A

These are giant ‘a’ waves seen in the JVP during complete heart block.

64
Q

Name that scar:

PICTURE

A

Median Sternotomy Scar

Used in CABG, Aortic and mitral valve replacements

65
Q

Name that scar:

PICTURE

A

Left Thorocotomy scar

Used for mitral valvotomy for mitral stenosis

66
Q

Name that scar:

PICTURE

A

Right Parasternal Scar

Used in aortic and mitral valve procedures

67
Q

Name that scar:

PICTURE

A

Upper Hemisternotomy

Used in aortic and mitral valve procedures

68
Q

Name that scar:

PICTURE

A

Infraclavicular

Used for inserting a permanent pacemaker

69
Q

Causes of commonly heard murmurs

A

PAGE 49

70
Q

What is reverse splitting of the Second Heart Sound (S2)?

A

A phenomenon where there is significant delay in left ventricular emptying such that the aortic valve closes after the pulmonary valve.
It is detected when splitting is heard on expiration but come together on inspiration.

Associated with LBBB, Hypertrophic Cardiomyopathy and right ventricular pacing

71
Q

What are some indications for Pacemakers?

A

Pacemakers are most often due to atriventricular block such as third degree heart block with bradycardia or long periods of asystole, sick sinus syndrome with symptomatic bradycardia and symptomatic second degree heart block.

Symptoms include pre-syncope, syncope (Stokes-Adams) Confusion and seizures; related to the bradycardia.

72
Q

What would you look for on a CXR of a patient with a recently inserted pacemaker?

A

Rarely, patients may have had an iatrogenic pneumothorax.

Other complications of pacemakers include: pacemaker failure, infection and electromagnetic interference.

73
Q

Complications of pacemakers

A

Iatrogenic pneumothorax, pacemaker failure, infection and electromagnetic interference.

Pacemakers are an absolute CI to MRI

The Ultimate Guide To Passing Clinical Medical Finals (4 decks)

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