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BPT Clinical Exam > Clinical Exam > Flashcards

Clinical Exam Flashcards

1
Q

Signs of severe AS

A

PP AT LP 4 PS2 LVF

1 Plateau pulse (slow upstroke).
2 Aortic thrill (very important sign of severe stenosis).
3 Lateness of the peak of the systolic murmur.
4 Fourth heart sound (S4).
5 Paradoxical splitting of S2 (delayed left ventricular ejection and aortic valve closure).
6 Left ventricular failure (a late sign).

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2
Q

Signs of severe MR?

A

SPELL 123

Small-volume pulse 
Pulmonary HTN 
Early diastolic rumble
LV enlargement
LV failure
Soft S1
Early A2
S3
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3
Q

Causes of apical predominant fine crepitations?

A 
S = silicosis, sarcoidosis
H = histiocytosis X
A  = ankylosing spondylitis, allergic bronchopulmonary aspergillosis 
T = tuberculosis
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4
Q

Causes of basal predominant fine crepitations?

A 
RAMIS
R = RA
A = asbestosis
M = Meds (busulfan, bleomycin, nitrofurantoin, hydralazine, methotrexate, amiodarone)
I = IPF
S = Scleroderma, SLE
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5
Q

Causes of clubbing

A
  1. Cardiovascular
    • Cyanotic congenital heart disease
    • Infective endocarditis
2.	Respiratory
•	Lung carcinoma
•	Chronic supportive lung disease: bronchiectasis, abscess, empyema
•	Idiopathic pulmonary fibrosis
•	Cystic fibrosis
•	Asbestosis 
•	Pleural mesothelioma
  1. Gastrointestinal
    • Cirrhosis
    • Inflammatory bowel disease
    • Coeliac disease
  2. Thyrotoxicosis
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6
Q

Signs of pulmonary hypertension

A
  1. Pulse: Low volume pulse
  2. JVP: prominent a wave
  3. Praecordium: right ventricular heave, palpable P2
  4. Auscultation: ejection systolic click, loud P2, S4
  5. Signs of right ventricular failure
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7
Q

Vocal resonance over consolidation is normal or increased or decreased?

A

Increased

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8
Q

Vocal resonance over pleural effusion is normal or increased or decreased?

A

Decreased

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9
Q

Causes of massive hepatomegally

A

HAMR M

  • Hepatocellular carcinoma
  • Alcoholic liver disease with fatty infiltration
  • Myeloproliferative disease
  • Right heart failure
  • Metastases
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10
Q

Causes of moderate hepatomegally

A

FACH
Fatty liver disease
Amyloid
CML
Haemochromatosis

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11
Q

Causes of mild hepatomegally

A

a. Hepatitis
b. Biliary obstruction
c. Hydatid disease
d. HIV infection

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12
Q

Causes of hepatosplenomegally

A

CHICIE
• CLD with portal hypertension
• Haem: e.g. myeloproliferative, lymphoma, leukaemia, thalassaemia, sickle cell
• Infection, e.g. acute viral hepatitis, EBV, CMV
• Connective tissue , e.g. SLE
• Infiltration, e.g. amyloid, sarcoid
• Endo: eg Acromegaly, Thyrotoxicosis

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13
Q

Signs of portal hypertension

A
  • Splenomegaly
  • Collateral veins
  • Ascites
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14
Q

Causes of massive splenomegally

A

Primary MMM

  • Chronic myeloid leukaemia
  • Myelofibrosis
  • Malaria
  • Primary lymphoma of the spleen
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15
Q

Causes of moderate splenomegally

A

PLLTS

  • Portal hypertension
  • Leukaemia (acute or chronic)
  • Thalassaemia, sickle cell anaemia
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16
Q

Causes of mild splenomegally

A

ICHI
• Infection: EBV, hepatitis, infective endocarditis
• CTD: RA, SLE, PAN
• Haemolytic anaemia
• Infiltrations: e.g. amyloid, sarcoid

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17
Q

Lateral medullary syndrome signs

A

Ipsilateral (I HAN 5,9,10)
* Horner’s syndrome
* Ataxia
* Nystagmus (to the side of the lesion)
* Cranial nerve V (pain and temperature), IX and X

Contralateral
* Pain and temperature loss over trunk and limbs

Non-lateralised
Vertigo
Dysarthria
Dysphagia
Dysphonia

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18
Q

Causes of motor-predominant peripheral neuropathy

A
  • Diabetes mellitus
  • Guillain-Barre syndrome and CIDP
  • Hereditary motor and sensory neuropathy (Charcot-Marie-Tooth)
  • Acute intermittent porphyria
  • Lead poisoning
  • Multifocal motor neuropathy
19
Q

Causes of sensory-predominant peripheral neuropathy

A
  • Diabetes mellitus
  • B12 deficiency
  • Paraproteinaemia
  • Carcinoma (e.g. lung, ovary, breast)
  • Sjogren’s syndrome
  • Vitamin B6 intoxication
  • Syphilis
20
Q

Signs of subacute combined degeneration of the cord

A 
• Symmetrical dorsal column loss (vibration and position sense) 
- Sensory ataxic gait
• Symmetrical UMN signs in lower limbs 
- absent ankle reflexes
• Peripheral sensory neuropathy
• Optic atrophy (occasionally)
• Dementia (occasionally)
21
Q

Scleroderma antibodies

A

Limited = anti-centromere = pHTN (T in limited, centromere, pHTN) Centromere = CRESTomere

Diffuse = anti-scl70 = ILD (DILS)

22
Q

Causes of a tender liver?

A
  • Hepatitis
  • Rapid liver enlargement – right heart failure, Budd–Chiari syndrome
  • Hepatocellular carcinoma
23
Q

Causes of a firm and irregular liver?

A
  • Cirrhosis
  • Metastatic disease
  • Lipoidoses
  • Amyloid
  • Granuloma
  • Hydatid cyst
24
Q

Causes of a pulsatile liver?

A
  • Tricuspid regurgitation
  • Hepatocellular carcinoma
  • Vascular abnormalities
25
Q

Cavernous sinus syndrome?

A

CN 3/4/6 (motility)
V1, V2 (sensation)
Horner’s

26
Q

Secondary causes of hypertension?

A

RECOM
• Renal: renal artery stenosis, diffuse renal disease
• Endocrine: Cushing’s, Acromegally, Conn’s, Phaeochromycytoma
• Co-arctation of the aorta
• OSA
• Meds/drugs/pharm: methamphetamine, cocaine, pseudoephidrine,

27
Q

Arthropathy of the hands predominantly affecting PIP. Top differentials?

A

RA and SLE

28
Q

Arthropathy of the hands predominantly affecting DIP. Top differentials?

A

OA. Psoriatic arthritis. Gout

29
Q

Examination findings of malnourishment

A

Loss of subcutaneous fat in the triceps and biceps

Muscle wasting with hollowing of the temples and marked prominence of the clavicle

30
Q

Signs of internuclear ophthalmoplegia

A

On contralateral gaze:
- Ipsilateral eye fails to adduct
- Contralateral eye has nystagmus

But convergence is intact

31
Q

ECG features of MR

A

P mitrale (broad, bifid P waves in lead II)
AF
Right axis deviation

32
Q

ECG features of AS

A

LVH voltage criteria (7 large squares V1 + V5/V6 or R in aVL > 11 mm)
LBBB
Left axis deviation

33
Q

Apex beat in AS

A

Pressure loaded (forceful and sustained)

34
Q

Apex beat in MR

A

Volume loaded (forceful NOT sustained)

35
Q

Causes of a pan systolic murmur?

A

MR
MVP
TR
VSD

36
Q

Causes of an ejection systolic murmur?

A

AS
Aortic sclerosis
HOCM
ASD
PS

37
Q

Defining features of decompensated cirrhosis?

A

Jaundice
Hepatic encephalopathy
Ascites
Variceal bleeding

38
Q

TTE features of severe AS?

A

Valve area <1 cm2
Peak velocity >4 m/s
Mean gradient >40 mm

39
Q

Lights criteria

A

Exudate is defined by any of the following:

Pleural fluid protein to Serum protein ratio >/= 0.5
Pleural LDH to serum LDH ratio >/= 0.6
Pleural LDH >/= 2/3 ULN for serum

40
Q

Signs of activity in acromegaly?

A

SHE DIG
- Skin tag number
- Hypertension. Headache
- Excessive sweating. Enlarging goitre
- Development of cranial nerve palsies III, IV, V, or VI
- Increasing visual field loss or increasing ring size, shoe size or dentures
- Glycosuria

41
Q

UIP features

A

Basal
Honeycombing
Sub-pleural reticular opacities
Traction bronchiectasis

42
Q

NSIP features

A

GG opacities
Sub-pleural sparing reticular opacities
Traction bronchiectasis

43
Q

Mnemonic for social history in long case

A

H FAMS AS EILSH 1/2/5
Home
Family
ADLs
Mobility
Supports
Alcohol
Smoking
Education
Income
Legal
Sexual
Hobbies
Where do you see yourself in 1/2/5 years?

44
Q

Mnemonic for ROS in long case

A

4Fs, CC, SET
Falls
Fractures
Food
Feelings
Cognition
Continence
Sleep
Exercise Tolerance

BPT Clinical Exam (1 decks)

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