Cardiovascular and Resp Flashcards
1
Q
CVS causes of clubbing?
A
IE, cyanotic congenital heart disease
2
Q
Types of pansystolic murmurs
A
MR, TR, VSD, aortopulmonary shunt
3
Q
What type of murmurs are common in children and high output states?
A
Ejection systolic
4
Q
Name two high output states
A
Pregnancy, tachy
5
Q
What heart sound is caused by calcified aortic valve or aortic regurg
A
Softer second heart sound
6
Q
In systemic hypertension what happens to S2?
A
Louder
7
Q
Causes of postural hypotension (HANDI)
A
hypovolaemia (dehydration), hypopituitarism, addisons, neuropathy (autonomic eg diabetes), drugs, idiopathic
8
Q
Drugs that cause postural hypotension
A
anti-hypertensives, anti-psychotics, tricyclics, diuretics, vasodilators
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
10
Q
Radiofemoral delay=
A
Coarctation of aorta (narrowing of aorta at ductus arteriosus joins descending aorta)
11
Q
Radio-radio delay causes
A
Subclavian narrowing by atherosclerosis, aneurysm, subclavian steel, dissection
12
Q
Bounding pulse is characteristic of what?
A
Aortic regurgitation
13
Q
Pulsus alternans is characteristic of what?
A
LV failure
14
Q
Clubbing is defined as…
A
loss of hyponichial angle (depth of DPD>IPD)
15
Q
Causes of pulsus paradoxus
A
Pericarditis, pericardial effusion, asthma
16
Q
Mitral facies are caused by…
A
pulmonary hypertension + low cardiac output usually from mitral stenosis (rare now)
17
Q
Slow rising pulse =
A
aortic stenosis
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)
19
Q
How high can JVP be above sternal angle?
A
3cm
20
Q
5 things to Distinguish JVP from carotid…
A
- change with breathing/posture
- adominojugular reflex
- fills from above
- double wave form
- not palpable
21
Q
common cause of canon a wave
A
complete heart block (atria contacts against closed tricuspid- everything out of whack)
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
23
Q
Central cyanosis=
A
pulmonary oedema
24
Q
Peripheral cyanosis=
A
low cardiac output
25
Cheyne stoke breathing is...
periods of hyperventilation progressing followed by period of apnoea (this is cyclical). caused by loss of control of respiratory system negative feedback
26
Causes of LV failure
Ischaemic Heart Disease, Cardiomyopathy, Valvular disease (MR/AR), Hypertension
27
Precipitating causes of LV failure
Anaemia, Thyrotoxicosis, AF
28
3 ejection systolic murmurs
AS, PS, HOCM
29
How does HOCM cause double impulse in ejection systolic murmur?
anterior movement of mitral valve in early systole causes blockage and results in double pulsation
30
What is HOCM and why dangerous?
Congenital defect in sarcomeres causing hypertrophy and myocardial disarray. Can cause sudden cardiac death
31
HOCM symptoms
similar to CCF, but treatment vastly different (diuretics make it worse!)
32
How HOCM differs from concentric hypertrophy from hypertension
HOCM is usually assymetric (just septal)
33
Causes of cardiomyopathy?
IHD, valvular, alcohol, idiopathic, drugs, pregnancy, BP, thyroid, haemochromatosis, viral, diabetes
34
Describe murmur of MVP?
Late systolic + midsystolic click
35
Early diastolic murmurs
Aortic/pulmonary regurg
36
Mid-diastolic murmurs
mitral stenosis
37
Why do fundoscopy for CVS exam?
Hypertension/diabetes, roth spots in IE
38
Other examination for CVS exam
temp, urine, lying/standing BP
39
Ankylosing spondylitis is linked with which murmur?
Aortic regurg
40
What type of murmurs are louder on inspiration?
right sided
41
What murmur is louder with valsava? all else decreased
HOCM
42
What murmur is louder with handgrip?
MR
43
Which murmurs get louder with forward lean?
Aortic regurgitation, pericardial rub
44
What is a 4th heart sound?
atrial contraction against stiff ventricle
45
Symptoms of RV failure
```
ankle, sacral oedema, abdo distension
peripheral cyanosis
large v wave
right ventricular heave
pansystolic mrumur-->tricuspid regurg
pulsatile liver
```
46
Causes of RV failure?
pulm HTN, LV fail, MI, cardiomyopathy, valvular
47
Symptoms of Aortic stenosis
exertional chest pain, exertional dyspnoea, exertional syncope, small volume pulse
48
Murmur of aortic stenosis
Ejection systolic, loudest over aortic area with radiation to carotids. Often associated aortic regurgitation
49
What is austin flint murmur?
strong aortic regurg causing mitral regurg
50
things to look for on general inspection
cyanosis, dyspnoea (obvious distress), scars, deformities
51
murmurs to suspect with severe sudden onset chest pain
MR (papillary muscle rupture), VSD from an MI
52
Indications for defibrillator implantation
Heart failure patients with LVEF <30, NYHA I. Post VF
| Brugada, long QT, sustained VT, HOCM
53
Describe NYHA heart failure criteria
I. No symptoms
II. Mild symptoms with ordinary activity
III. 100m makes breathless
IV. At rest
54
Pacemaker indications
Arrythmias (AV block, long QT), Post MI, Vasovagal syncope, HOCM
55
What is cardiac resynchronisation therapy?
Resynchronisation of dyssonchronous ventricular action in patients with heart failure. Can be done with or without ICD
56
Signs on CXR of COPD/cor pulmonale
Overinflated lungs, prominent pulmonary arteries, flat diaphragms
57
Globular heart on CXR=
pericardial effusion
58
Hallmark of bronchiecstasis/CF on CXR
thickened bronchial walls
59
Important extra components in resp history?
job, travel, pets
60
DDx pleuritic chest pain
rib fracture, pneumonia, PE, pneumothorax, pericarditis
61
Hypertrophic osteoarthropathy is associated with which respiratory condition?
Carcinoma of lung
62
Volume loaded apex beat murmur
MR
63
Pressure loaded apex beat murmur
AS
64
Distinguish between AS and MR
Ejection vs Pan, Radiation, Pressure vs Volume loaded
65
What is the valsava manouvre used to assess?
Left heart failure- changes in blood pressure
66
which murmurs increase on inspiration?
right sided
67
which murmurs increase on lean forward and expiration?
aortic regurg
68
which murmurs increase on hand grip?
mitral regurg
69
describe a murmur...
grade, type, duration, loudest where, radiation
70
grading for murmurs...
grade II- soft, no thrill, III- moderate, IV- loud + just palpable thrill, V- loud and easily palpable thrill, VI- no steth
71
valsava increases which murmurs?
HOCM
72
causes of aortic stenosis?
degenerative calcification, rheumatic fever, congenital bicuspid valve, hypertension (DM risk factor)
73
causes of aortic regurg?
rheumatic, congenital bicuspid, ankylosing spondylitis, marfans
74
Symptoms of MR?
Dyspnoea, fatigue
75
Common pulse of MR
AF
76
On auscultation for MR
S1 soft, S3, pansystolic at apex-->axillae
77
Causes of MR
MVP, degenerative change, rheumatic, papillary muscle dysfunction, cardiomyopathy, marfans, RA, ankylosing spond
78
Signs of tricuspid regurg
Large v wave, RV heave, increase inspiration, pulsatile abdomen, oedema
79
Causes of tricuspid regurg
RF, IE, prolapse, papillary muscle
80
Common signs right heart fail
oedema, pulsatile liver, raised JVP, peripheral cyanosis
81
Common signs left hear fail
orthop, PND, exertional dyspnoea, fatigue, central cyanosis, basal creps, displaced apex beat, S3 on auscultation
82
Autoimmune cases clubbing
SLE, RA, antophospholipid, TRAUMA
83
Oslers nodes are...
painful red raised nodules on hands
84
janeway lesions are
flat painless lesions
85
Causes of atrial fib
MI, valvular disease, hypertension, thyrotoxicosis
86
JVP normally how high above sternal angle
5cm
87
Kussumauls sign caused when...
RV filling limited eg constrictive peri, tamponade, RV infarct
88
Causes high JVP
RV fail, tricuspid stenosis/regurg, constrictive peri, SVC obstruction, fluid overload
89
Causes loud S1
mitral stenosis
90
causes soft S1
heart block, LBBB, MR
91
Causes loud S2
pulm hypertension, AS, hypertension
92
Causes soft S2
aortic regurg, aortic valve calcification
93
Dull percusion note Ddx
Consolidation, collapse, effusion, fibrosis, pleural thickening
94
Hyper-resonant percussion note DDx
pneumothorax, COPD
95
Bronchial breathing DDx
Consolidation, above pleural effusion, next to pericardial effusion, localized fibrosis
96
Silent chest=
life threatening asthma
97
Wheeze is caused by... and has DDx
air expired through narrow airway
| COPD, asthma, tumour, pulmonary oedema (LVF)
98
Stridor is an... caused by...
high pitched inspiratory wheeze
| tracheal obstruction
99
Crackles are caused by...
opening of blocked airway
100
Early crackles are caused by...
COPD (small airways)
101
Late or pan-inspiratory crackles are caused by
Pulmonary fibrosis (fine crackles), alveolar oedema (medium crackles), bronchiecstasis (coarse crackles)
102
Vocal resonance is increased in.. decreased ...
consolidation, effusion
103
Wheezes are... crackles are...
continuous, interrupted
104
Pleural rub causes
adjacent pneumonia, pulmonary infarct
105
Extra examinations to do in resp...
O2 sats, temp, Peak flow, forced expiratory time, spirometry, CXR
106
Yellow/green sputum=
infected- pneumonia/bronchiecstasis
107
Pink+smelly sputum=
pulmonary oedema
108
DDx haemoptysis
malignancy, TB, infarct, PE, trauma
109
Bronchiecstasis is...
dilation of bronchi resulting in impaired clearance of mucous and chronic infection
110
Signs of bronchiecstasis
Fever, clubbing, large amount purulent sputum
Coarse pan inspiratory crackles
Can cause cor-pulmonale
111
Causes bronchiectasis
cystic fibrosis, primary cilliary dyskinesia
| childhood infection, TB, bronchial adenoma
112
Emphysema signs
barrel chest, pursed lip breathing, use of accesory muscles, reduced chest expansion, hyperresonant percussion, decreased breath sounds, early inspiratory crackles
113
Causes emphysema
smoking, alpha-1 anti-trypsin
114
Indication for pneumonectomy
Cancer, TB
115
Signs of pneumonectomy
Dyspnoea, tracheal/mediastinal deviation away from side of surgery, decreased expansion, hyperresonant percussion, breath sounds harsher over side of pneumonectomy
116
Pneumoectomy vs lobectomy signs
trachea still central in lobectomy
117
Flapping hands sign of...
CO2 retention-->COPD
118
Pulmonary fibrosis results in...
impaired gas exchange and causes VQ mismatch
119
Causes of fibrosis in upper lobe
SCHART (silicosis, sarcoid, coal worker, histiocytosis, ankylosing spondylitis, radiation, TB)
120
Causes of fibrosis lower lobe
RASCO (RA, asbestosis, scleroderma, cryptogenic firbosing alveolitis, other (eg drugs)
121
Signs of fibrosis
dyspnoea, clubbing, cyanosis, reduced expansion, dull percussion, fine late inspiratory crackles
signs of associated CT disease eg RA, SLE, scleroderma
122
Horner's syndrome cause and symptoms
apical lung tumour
| constricted pupils, partial ptosis, loss of sweating
123
CURB-65=
confusion, urea, respiratory rate, BP
124
Mx Bronchiectasis
Postural drainage, Abx, bronchodilators, corticosteroids
125
COPD vs Restrictive on spirometry
FEV1/FVC decreased in obstructive but not restrictive
126
Tracheal deviation toward lesion DDx
Collapse, fibrosis
127
Tracheal deviation away DDx
Consolidation, penumothorax, effusion
128
Exudative pleural effusion DDx
pneumo, neoplasm, TB, RA, SLE, drugs
129
Transudative effusion DDx
CCF, hypoalbulanaemia, hypothyroid
