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4th year OSCE > Cardiovascular and Resp > Flashcards

Cardiovascular and Resp Flashcards

1
Q

CVS causes of clubbing?

A

IE, cyanotic congenital heart disease

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2
Q

Types of pansystolic murmurs

A

MR, TR, VSD, aortopulmonary shunt

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3
Q

What type of murmurs are common in children and high output states?

A

Ejection systolic

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4
Q

Name two high output states

A

Pregnancy, tachy

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5
Q

What heart sound is caused by calcified aortic valve or aortic regurg

A

Softer second heart sound

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6
Q

In systemic hypertension what happens to S2?

A

Louder

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7
Q

Causes of postural hypotension (HANDI)

A

hypovolaemia (dehydration), hypopituitarism, addisons, neuropathy (autonomic eg diabetes), drugs, idiopathic

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8
Q

Drugs that cause postural hypotension

A

anti-hypertensives, anti-psychotics, tricyclics, diuretics, vasodilators

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9
Q

How does jaundice occur as CVS sign?

A

Severe CCF backing in to liver–>congestion

A rare cause is prosthetic valves causing RBC haemolysis

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10
Q

Radiofemoral delay=

A

Coarctation of aorta (narrowing of aorta at ductus arteriosus joins descending aorta)

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11
Q

Radio-radio delay causes

A

Subclavian narrowing by atherosclerosis, aneurysm, subclavian steel, dissection

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12
Q

Bounding pulse is characteristic of what?

A

Aortic regurgitation

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13
Q

Pulsus alternans is characteristic of what?

A

LV failure

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14
Q

Clubbing is defined as…

A

loss of hyponichial angle (depth of DPD>IPD)

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15
Q

Causes of pulsus paradoxus

A

Pericarditis, pericardial effusion, asthma

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16
Q

Mitral facies are caused by…

A

pulmonary hypertension + low cardiac output usually from mitral stenosis (rare now)

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17
Q

Slow rising pulse =

A

aortic stenosis

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18
Q

Describe kussumals sign

A

Rise of JVP on inspiration (usually a fall due to increased RV filling) due to restricted RV filling that can be caused by cardiac tamponade, constrictive pericarditis or RV infarction)

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19
Q

How high can JVP be above sternal angle?

A

3cm

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20
Q

5 things to Distinguish JVP from carotid…

A
  1. change with breathing/posture
  2. adominojugular reflex
  3. fills from above
  4. double wave form
  5. not palpable
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21
Q

common cause of canon a wave

A

complete heart block (atria contacts against closed tricuspid- everything out of whack)

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22
Q

Signs of LV failure

A

exertional dyspnoea, orthopnoea, PND, central and peripheral cyanosis
Tachycardia, low pulse pressure, pulsus alternans
Displaced apex beat
S3, mitral regurg
Basal inspiratory crackles

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23
Q

Central cyanosis=

A

pulmonary oedema

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24
Q

Peripheral cyanosis=

A

low cardiac output

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25
Q

Cheyne stoke breathing is…

A

periods of hyperventilation progressing followed by period of apnoea (this is cyclical). caused by loss of control of respiratory system negative feedback

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26
Q

Causes of LV failure

A

Ischaemic Heart Disease, Cardiomyopathy, Valvular disease (MR/AR), Hypertension

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27
Q

Precipitating causes of LV failure

A

Anaemia, Thyrotoxicosis, AF

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28
Q

3 ejection systolic murmurs

A

AS, PS, HOCM

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29
Q

How does HOCM cause double impulse in ejection systolic murmur?

A

anterior movement of mitral valve in early systole causes blockage and results in double pulsation

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30
Q

What is HOCM and why dangerous?

A

Congenital defect in sarcomeres causing hypertrophy and myocardial disarray. Can cause sudden cardiac death

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31
Q

HOCM symptoms

A

similar to CCF, but treatment vastly different (diuretics make it worse!)

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32
Q

How HOCM differs from concentric hypertrophy from hypertension

A

HOCM is usually assymetric (just septal)

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33
Q

Causes of cardiomyopathy?

A

IHD, valvular, alcohol, idiopathic, drugs, pregnancy, BP, thyroid, haemochromatosis, viral, diabetes

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34
Q

Describe murmur of MVP?

A

Late systolic + midsystolic click

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35
Q

Early diastolic murmurs

A

Aortic/pulmonary regurg

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36
Q

Mid-diastolic murmurs

A

mitral stenosis

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37
Q

Why do fundoscopy for CVS exam?

A

Hypertension/diabetes, roth spots in IE

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38
Q

Other examination for CVS exam

A

temp, urine, lying/standing BP

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39
Q

Ankylosing spondylitis is linked with which murmur?

A

Aortic regurg

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40
Q

What type of murmurs are louder on inspiration?

A

right sided

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41
Q

What murmur is louder with valsava? all else decreased

A

HOCM

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42
Q

What murmur is louder with handgrip?

A

MR

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43
Q

Which murmurs get louder with forward lean?

A

Aortic regurgitation, pericardial rub

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44
Q

What is a 4th heart sound?

A

atrial contraction against stiff ventricle

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45
Q

Symptoms of RV failure

A 
ankle, sacral oedema, abdo distension
peripheral cyanosis
large v wave
right ventricular heave
pansystolic mrumur-->tricuspid regurg
pulsatile liver
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46
Q

Causes of RV failure?

A

pulm HTN, LV fail, MI, cardiomyopathy, valvular

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47
Q

Symptoms of Aortic stenosis

A

exertional chest pain, exertional dyspnoea, exertional syncope, small volume pulse

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48
Q

Murmur of aortic stenosis

A

Ejection systolic, loudest over aortic area with radiation to carotids. Often associated aortic regurgitation

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49
Q

What is austin flint murmur?

A

strong aortic regurg causing mitral regurg

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50
Q

things to look for on general inspection

A

cyanosis, dyspnoea (obvious distress), scars, deformities

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51
Q

murmurs to suspect with severe sudden onset chest pain

A

MR (papillary muscle rupture), VSD from an MI

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52
Q

Indications for defibrillator implantation

A

Heart failure patients with LVEF <30, NYHA I. Post VF

Brugada, long QT, sustained VT, HOCM

53
Q

Describe NYHA heart failure criteria

A

I. No symptoms
II. Mild symptoms with ordinary activity
III. 100m makes breathless
IV. At rest

54
Q

Pacemaker indications

A

Arrythmias (AV block, long QT), Post MI, Vasovagal syncope, HOCM

55
Q

What is cardiac resynchronisation therapy?

A

Resynchronisation of dyssonchronous ventricular action in patients with heart failure. Can be done with or without ICD

56
Q

Signs on CXR of COPD/cor pulmonale

A

Overinflated lungs, prominent pulmonary arteries, flat diaphragms

57
Q

Globular heart on CXR=

A

pericardial effusion

58
Q

Hallmark of bronchiecstasis/CF on CXR

A

thickened bronchial walls

59
Q

Important extra components in resp history?

A

job, travel, pets

60
Q

DDx pleuritic chest pain

A

rib fracture, pneumonia, PE, pneumothorax, pericarditis

61
Q

Hypertrophic osteoarthropathy is associated with which respiratory condition?

A

Carcinoma of lung

62
Q

Volume loaded apex beat murmur

A

MR

63
Q

Pressure loaded apex beat murmur

A

AS

64
Q

Distinguish between AS and MR

A

Ejection vs Pan, Radiation, Pressure vs Volume loaded

65
Q

What is the valsava manouvre used to assess?

A

Left heart failure- changes in blood pressure

66
Q

which murmurs increase on inspiration?

A

right sided

67
Q

which murmurs increase on lean forward and expiration?

A

aortic regurg

68
Q

which murmurs increase on hand grip?

A

mitral regurg

69
Q

describe a murmur…

A

grade, type, duration, loudest where, radiation

70
Q

grading for murmurs…

A

grade II- soft, no thrill, III- moderate, IV- loud + just palpable thrill, V- loud and easily palpable thrill, VI- no steth

71
Q

valsava increases which murmurs?

A

HOCM

72
Q

causes of aortic stenosis?

A

degenerative calcification, rheumatic fever, congenital bicuspid valve, hypertension (DM risk factor)

73
Q

causes of aortic regurg?

A

rheumatic, congenital bicuspid, ankylosing spondylitis, marfans

74
Q

Symptoms of MR?

A

Dyspnoea, fatigue

75
Q

Common pulse of MR

A

AF

76
Q

On auscultation for MR

A

S1 soft, S3, pansystolic at apex–>axillae

77
Q

Causes of MR

A

MVP, degenerative change, rheumatic, papillary muscle dysfunction, cardiomyopathy, marfans, RA, ankylosing spond

78
Q

Signs of tricuspid regurg

A

Large v wave, RV heave, increase inspiration, pulsatile abdomen, oedema

79
Q

Causes of tricuspid regurg

A

RF, IE, prolapse, papillary muscle

80
Q

Common signs right heart fail

A

oedema, pulsatile liver, raised JVP, peripheral cyanosis

81
Q

Common signs left hear fail

A

orthop, PND, exertional dyspnoea, fatigue, central cyanosis, basal creps, displaced apex beat, S3 on auscultation

82
Q

Autoimmune cases clubbing

A

SLE, RA, antophospholipid, TRAUMA

83
Q

Oslers nodes are…

A

painful red raised nodules on hands

84
Q

janeway lesions are

A

flat painless lesions

85
Q

Causes of atrial fib

A

MI, valvular disease, hypertension, thyrotoxicosis

86
Q

JVP normally how high above sternal angle

A

5cm

87
Q

Kussumauls sign caused when…

A

RV filling limited eg constrictive peri, tamponade, RV infarct

88
Q

Causes high JVP

A

RV fail, tricuspid stenosis/regurg, constrictive peri, SVC obstruction, fluid overload

89
Q

Causes loud S1

A

mitral stenosis

90
Q

causes soft S1

A

heart block, LBBB, MR

91
Q

Causes loud S2

A

pulm hypertension, AS, hypertension

92
Q

Causes soft S2

A

aortic regurg, aortic valve calcification

93
Q

Dull percusion note Ddx

A

Consolidation, collapse, effusion, fibrosis, pleural thickening

94
Q

Hyper-resonant percussion note DDx

A

pneumothorax, COPD

95
Q

Bronchial breathing DDx

A

Consolidation, above pleural effusion, next to pericardial effusion, localized fibrosis

96
Q

Silent chest=

A

life threatening asthma

97
Q

Wheeze is caused by… and has DDx

A

air expired through narrow airway

COPD, asthma, tumour, pulmonary oedema (LVF)

98
Q

Stridor is an… caused by…

A

high pitched inspiratory wheeze

tracheal obstruction

99
Q

Crackles are caused by…

A

opening of blocked airway

100
Q

Early crackles are caused by…

A

COPD (small airways)

101
Q

Late or pan-inspiratory crackles are caused by

A

Pulmonary fibrosis (fine crackles), alveolar oedema (medium crackles), bronchiecstasis (coarse crackles)

102
Q

Vocal resonance is increased in.. decreased …

A

consolidation, effusion

103
Q

Wheezes are… crackles are…

A

continuous, interrupted

104
Q

Pleural rub causes

A

adjacent pneumonia, pulmonary infarct

105
Q

Extra examinations to do in resp…

A

O2 sats, temp, Peak flow, forced expiratory time, spirometry, CXR

106
Q

Yellow/green sputum=

A

infected- pneumonia/bronchiecstasis

107
Q

Pink+smelly sputum=

A

pulmonary oedema

108
Q

DDx haemoptysis

A

malignancy, TB, infarct, PE, trauma

109
Q

Bronchiecstasis is…

A

dilation of bronchi resulting in impaired clearance of mucous and chronic infection

110
Q

Signs of bronchiecstasis

A

Fever, clubbing, large amount purulent sputum
Coarse pan inspiratory crackles
Can cause cor-pulmonale

111
Q

Causes bronchiectasis

A

cystic fibrosis, primary cilliary dyskinesia

childhood infection, TB, bronchial adenoma

112
Q

Emphysema signs

A

barrel chest, pursed lip breathing, use of accesory muscles, reduced chest expansion, hyperresonant percussion, decreased breath sounds, early inspiratory crackles

113
Q

Causes emphysema

A

smoking, alpha-1 anti-trypsin

114
Q

Indication for pneumonectomy

A

Cancer, TB

115
Q

Signs of pneumonectomy

A

Dyspnoea, tracheal/mediastinal deviation away from side of surgery, decreased expansion, hyperresonant percussion, breath sounds harsher over side of pneumonectomy

116
Q

Pneumoectomy vs lobectomy signs

A

trachea still central in lobectomy

117
Q

Flapping hands sign of…

A

CO2 retention–>COPD

118
Q

Pulmonary fibrosis results in…

A

impaired gas exchange and causes VQ mismatch

119
Q

Causes of fibrosis in upper lobe

A

SCHART (silicosis, sarcoid, coal worker, histiocytosis, ankylosing spondylitis, radiation, TB)

120
Q

Causes of fibrosis lower lobe

A

RASCO (RA, asbestosis, scleroderma, cryptogenic firbosing alveolitis, other (eg drugs)

121
Q

Signs of fibrosis

A

dyspnoea, clubbing, cyanosis, reduced expansion, dull percussion, fine late inspiratory crackles
signs of associated CT disease eg RA, SLE, scleroderma

122
Q

Horner’s syndrome cause and symptoms

A

apical lung tumour

constricted pupils, partial ptosis, loss of sweating

123
Q

CURB-65=

A

confusion, urea, respiratory rate, BP

124
Q

Mx Bronchiectasis

A

Postural drainage, Abx, bronchodilators, corticosteroids

125
Q

COPD vs Restrictive on spirometry

A

FEV1/FVC decreased in obstructive but not restrictive

126
Q

Tracheal deviation toward lesion DDx

A

Collapse, fibrosis

127
Q

Tracheal deviation away DDx

A

Consolidation, penumothorax, effusion

128
Q

Exudative pleural effusion DDx

A

pneumo, neoplasm, TB, RA, SLE, drugs

129
Q

Transudative effusion DDx

A

CCF, hypoalbulanaemia, hypothyroid

4th year OSCE (7 decks)

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