Cardiovascular

Question 1

Why does peripheral oedema develop

Answer 1

When rate of cap filtration > rate drainage
(inc cap refill in ven press, hypoalb, inflammation)
(dec drainage in lymph obstruction)

Question 2

Acute & chronic causes of peripheral oedema

Answer 2

Acute - DVT, arthritis, cellulitis, haematoma, fracture, acute arterial ischaemia, dermatitis
Chronic - gravitational, HF, nephrotic, chronic ven insuff, lymphoedema

Question 3

Causes of pulmonary oedema

Answer 3

Cardiac - LHF, MS, MI, HTN, Pul ven obst, IVF o/l
Lung - pneumonia, PE, inhalation pneumonitis
Misc - altitude, RF, nephrotic, cirrhosis, lymp obst

Question 4

Define central cyanosis & give some causes

Answer 4

Cyanosis of mucus membranes.

1) lung disease -> inadequate O2 transfer (COPD, PE, pleural effusion, severe LRTI)
2) shunting from pul circ to systemic (tet fallot, PDA, TGA)
3) inadequate O2 uptake (haemoglobinaemia)

Question 5

Define peripheral cyanosis & give some causes

Answer 5

Cyanosis of fingers.
Causes:
1) severe central cyanosis
2) physiological (cold, hypovolaemia)
3) local arterial disease (Raynaud's)

Question 6

Patient presents to GP with clubbing. Urgent investigation?

Answer 6

CXR

Question 7

Define raised JVP

Answer 7

> 4cm

Question 8

Causes of raised JVP

Answer 8

Fluid o/l
RHF/CCF
SVC obstruction
Tricuspid/pul valve disease
pHTN
AF (and other arrhythmias)
Inc intrathorax pressure (PE, pneumo)

Question 9

Define Kussmaul’s sign. What does it suggest?

Answer 9

When JVP inc on inspiration (usually drops as intrathoracic pressure drops)
Therefore caused by raised intrathoracic pressure or constrictive pericarditis.

Question 10

Signs of IE

Answer 10

Infective - fever, w/l, clubbing, splenomegaly, anaemia
Cardiac - (new) murmur, HF
Embolic - neuro deficit
Vasculitic - micro haematuria, splinter haemorrhage, conjunctival haemorrhage, Roth’s spots, Osler nodes, Janeway lesions

Question 11

What are Osler node & Janeway lesions?

Answer 11

Osler - painful lesions on finger pulp

Janeway - palmar macules

Question 12

Causes of ejection systolic murmur

Answer 12

AS, PS, HOCM

Flow murmurs - children, pregnancy, exercise

Question 13

Causes of pansystolic murmur

Answer 13

MV regurg/prolapse
Tricuspid regurg
VSD
ASD

Question 14

Causes of early diastolic murmur

Answer 14

AR, PR, TS

Question 15

Causes of mid diastolic murmur

Answer 15

MS, AR