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CVS and GIT PRACTICALS Flashcards

1
Q

What are the cardinal symptoms of CVS?

A

Chest pain, palpitations, dyspnea, syncope and pedal edema

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2
Q

Causes of chest pain

A

•Cardiac ( cad,angina pectoralis, mvp)
•Vascular ( aortic dissection)
•Pulmonary ( pleuritis, pneumothorax, pneumonia)
•Neurogenic ( shingles)
•Musculoskeletal ( costochondritis, arthritis)

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3
Q

Difference between cardiac and non cardiac pain

A

C- diffuse and central , NC- localised, peripheral

Type of pain
C- tight , squeezing, dull , constricting
Nc- sharp , stabbing , catching

Precipitation
C- exertion and emotion
Nc- not related to exertion

Radiation
C- radiation to shoulder,jaw, neck
Nc- usually no radiation

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4
Q

What is vincent’s angina?

A

Fusospirochetal infection of pharynx and palatine causing ulceromembranous pharyngitis and tonsillitis

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5
Q

What is Ludwig angina?

A

It is characterized by rapid spreading cellulitis bilaterally affecting the submandibular, sublingual and submental spaces

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6
Q

Name a few Angina equivalents

A

Seen commonly in elderly and diabetics
Breathlessness, perspiration/ diaphoresis, syncope, gi - upper and pain n v , confusion and fatigue

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7
Q

Describe Palpitations

A

Uncomfortable increased awareness of one’s own heart beat

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8
Q

Causes of palpitations

A

Cardiac -
• cardiac arrhythmias- premature atrial and ventricular beats, svt
•structural- atrial myoma, valvular hd, mvp

High output states- anemia, beriberi, pregnancy, thyrotoxicosis

Drug induced - alcohol, atropine, amphetamine

Endocrine- hyperthyroidism,pheochromocytoma

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9
Q

Types of palpitations

A

Extra systolic palpitations - ectopic beats , missing or skipping beat

Tachycardiac palpitations - rapid fluctuations, regular in vt aflutter, irregular in afib

Anxiety related palpitations

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10
Q

What is syncope?

A

Syncope is defined as transient loss of consciousness due to decreased cerebral blood flow and postural tone.
Spontaneous return to baseline neurological functions without any resuscitation

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11
Q

Causes of true syncope

A

•Cardiac - cardiac arrhythmias : VT, SVT, long QT syndrome. Structural hd- AS,MS,PS, pericardial syncope, acute MI
• Neurogenic syncope (vasovagal)- carotid sinus, micturation
• Orthostatic hypotension - primary: parkinson, autonomic failure, secondary: Diabetic neuropathy

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12
Q

Causes of Psuedosyncope

A

Seizures, metabolic: HE, encephalitis, SAH

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13
Q

Define pedal edema

A

Fluid accumulation in third or interstitial space exceeds capacity of physiological lymphatic drainage

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14
Q

Signs of infective endocarditis

A

Fever, pallor, clubbing, splinter haemorrhage, mucosal petechiae, janeway lesions, osler nodes and Roth spots on fundus

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15
Q

Signs of Rheumatic hd

A

Carditis, arthritis, erythema marginatum, subcutaneous nodules and syndemham chorea

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16
Q

Features of Down syndrome

A

CHILD HAS MANY PROBLEMS
cataract, hypotonia, hypothyroidism, increased gap between 1st and 2nd toe (sandal gap), leukemia, duodenal atresia, hirschsprung disease, alzheimer’s disease , mental retardation and micrognathia, atlantoaxial subluxation, nystagmus, protruding tongue, poor hearing, round face and respiratory infection s , occiput is flat and oblique palpebral fissure, brushfield spots and brachycephaly, low nasal bridge, epicanthal fold, Mongolian slant and myoclonus

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17
Q

Marfan syndrome features

A

Aortic aneurysm, mvp, arachnodactyly, subluxation of lens ( upward) and other joints

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18
Q

William ‘s syndrome features

A

Supravalvular AS, PA stenosis, mental retardation and elfin facies, long philtrum

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19
Q

Congenital Rubella triad

A

Deafness (SNHL), PDA, Cataract

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20
Q

Palpation of CVS

A

Tips of fingers- localisation of pulsations
Metacarpal heads- appreciation of thrill
Heel- appreciation of heave

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21
Q

What does Precordial bulge indicate?

A

Right ventricular dilatation.
Stand at the foot end of the patient bed

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22
Q

Abnormal apical impulse

A
  1. Absent - pericardial effusion, dextrocardia, lft pleural effusion
  2. Tapping - Mitral stenosis
  3. Hyperdynamic (volume overload)-AR,MR,VSD,PDA
  4. Heaving ( pressure overload)- AS, HCM
  5. Double apical impulse- HOCM, LV aneurysm
  6. Triple impulse - HOCM
  7. Retractile - severe TR
  8. See saw- Lv aneurysm
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23
Q

Skoda’ s sign

A

In adhesive pericarditis- systolic retraction of apex following by diastolic expansion

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24
Q

How to check for parasternal heave?

A

Heel of hand with wrist cocked up in left 3,4or 5 ICS in left sternal margin
Caused by RV and LA

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25
Grades of parasternal heave
Grade 1- visible, not palpable Grade 2- visible, palpable and obliterable Grade 3- visible palpable and not obliterable Rv- synchronous with apex , systolic La - no synchronous with apex, diastolic
26
Causes of parasternal heave
Rv hypertrophy - pressure overload: pulmonary HTN, ps Volume overload: TR, ASD, VSD
27
What is a thrill?
A grade 4 palpable murmur , described as purring of a cat, best felt head of metacarpals
28
Rotch sign
With moderate to large pericardial effusion causing obliteration of cardiohepatic angle
29
Topographical areas of heart
Aortic - right 2nd ICS pulmonary - left 2nd ICS Mitral - corresponding to apex in left 5th ICS Tricuspid - lower left sternal angle to 5th ICS Neo - aortic area , 3rd left ICS
30
Gibbons areas
1st left ICS for PDA
31
Rogers area
4th left ICS for VSD
32
Duration of cardiac cycle
Systole - 0.3 s Diastole- 0.5 s Total 0.8s
33
Heart sounds
S1 - closing M and T S2- semilunar valves S3- rapid ventricular filling S4- filling of ventricle due to atrial contraction
34
Conditions in which loud, soft and variable S1 is heard
Loud- ( heard with same intensity as mitral region at pulmonary and aortic) MS , ASD, Hyperdynamic circulation Soft- MR, TR, AR , effusion and obesity Variable - Afib, ventricular tachycardia, complete heart block
35
Wide split S1 is heard ?
Ebstein's anomaly, RBBB, severe MS
36
Single S2 is heard in?
Severe AS, PS, Fallot' s tetralogy
37
Wide and fixed S2
ASD, Severe RV
38
Wide and variable S2 split
RBBB, MR, VSD
39
Paradoxical split of S2
Early P2- complete LBBB, Rv pacing Late A2- severe AS and HCM
40
Clicks vs snaps
High pitched systolic sounds - high pitched diastolic sounds Produced by aortic and pulmonary valve opening - mitral and tricuspid opening
41
Describe Pericardial rub
Triphasic- Mid-systolic ,mid-diastolic and pre systolic Leathery grating sound Heard with diaphragm of stethoscope
42
What are murmurs and how are they produced?
Turbulent blood flow due to increased velocity or decreased viscosity, valve is narrow or incompetent, diameter increased or decreased
43
Grading of systolic murmurs
Grade 1 - murmur so faint can only be heard with special effort Grade 2- faint but immediately audible Grade 3- murmur moderately loud Grade 4- very loud Grade 5- a murmur that is extremely loud and is heard even with one edge of the stethoscope touching the chest Grade 6- very loud and audible with a stethoscope just removed from contact
44
Name a few continuous murmurs
PDA, tricuspid atresia, truncus arteriosus
45
Variation of murmur with respiration
•Right sided murmurs increase on inspiration: TS , TR (Carvallo's sign), PR • Left sided murmurs increase on expiration: MS, MR, AS, AR
46
Innocent murmurs
Vibratory systolic murmur ( still 's) Pulmonary systolic murmur Mammary souffle Venous hum
47
Carey coombs murmur
Mid- diastolic murmur in Rheumatic fever
48
Austin flint murmur
Late diastolic murmur in aortic regurgitation
49
Graham Steel murmur
High pitched, diastolic in pulmonary regurgitation
50
Rytand's murmur
Mid diastolic atypical murmur in CHB
51
Mill wheel murmur
Due to air in Rv cavity following cardiac catheterization
52
Gibson 's murmur
Continuous machinary murmur (PDA)
53
How to auscultate for mitral stenosis
Patient in left lateral position Breath held in expiration Using bell of the stethoscope Time the murmur with carotid
54
How to auscultate for Tricuspid area?
Patient in supine position Breath held in expiration Using diaphragm of the stethoscope Murmur increase on hepatic compression
55
How to auscultate Aortic area?
Patient in sitting and leaning forward Breath held in expiration Using diaphragm of the stethoscope Time the murmur with carotid
56
Name a few changing murmurs
Carey coombs murmur, atrial myoma s or thrombus
57
Ortner's syndrome
Hoarseness of voice due to enlarged lA
58
What is Muller 's maneuver
It is the opposite of valsalva maneuver and includes forced expiration following attempted forceful inhalation with closed glottis
59
Define Diarrhea
Change in frequency and consistency of stools, passage of more than 200g/dl. Acute < 3 wks , persistent 2-4 wks, chronic >4wks
60
Psuedodiarrhoea
Frequent passage of small volumes of stool, associated with urgency, tenesmus or incomplete evacuation - ibd or proctitis
61
Constipation
Bowel movements that are infrequent or hard to pass
62
Obstipation
Intractable constipation that is refractory to cure or control, inability to pass any faeces or flatus
63
Dyspepsia
Postprandial fullness Early satiety Epigastric pain
64
Causes of dysphagia
1. Neuromuscular - ALS , MS , MG 2. Structural causes - cancer, infection of pharynx or neck 3. Motility - achalasia , nutcracker,chagas, scleroderma
65
Causes of odynophagia
Caustic injury, pill induced injury, infectious, severe reflux
66
Causes of rt upper quadrant pain
Biliary colic, acute cholecystitis, acute cholangitis, sphincter of oddi dysfunction, acute hepatitis, liver abscess,budd chiari syndrome
67
Peripheral signs of chronic liver disease
Skin,nail and hands : spider nevi, clubbing of hands, leukonychia, palmar erythema, dupuytren's contracture, scratch marks Endocrine - gynaecomastia, atrophy of testis, loss of axillary and pubic hair Parotid and lacrimal gland enlargement Fetor hepaticus Asterixis
68
Causes of psuedogynaecomastia
Obesity and cushing's syndrome
69
Dupuytren's contracture
Fibrosis of palmar aponeurosis due to local microvessel ischaemia Causes - Dm , RA
70
What is orthodeoxia- platypnea syndrome?
Clubbing and central cyanosis, due to development of pulmonary Av shunt
71
Name various nail changes
•Terry 's - chalky and brittle nails •Muerhrcke's nails- transverse white lines that disappear with pressure •Clubbing
72
Zieves syndrome
Alcohol induced hemolytic anemia and hypercholesterolemia
73
How are quadrants of abdomen divided?
Left and right midclavicular line, transtubercular plane and subcostal plane
74
Direction of visible peristalsis
L to R: pylorus R to L: distal small bowel
75
Bowel sounds
Normal : 7-35 Increased ( borborygmus) - intestinal obstruction, diarrhoea, laxatives Decreased: paralytic ileus and peritonitis
76
What is Cruveilheir- Baumgarten murmur?
Or venous hum, it is a continuous murmur due to opening of paraumbilical vein in the falciform ligament
77
Hackett's grading of splenomegaly
0- normal impalpable spleen 1- spleen palpable on deep inspiration 2- spleen palpable on midclavicular line halfway between umbilicus and coastal margin 3- spleen goes to the umbilicus 4- spleen goes past the umbilicus 5- spleen expands towards pubic symphysis
78
What are the percussion methods of spleen?
Castell's method Traube's space Nixon's methods
79
Boundaries of traube's space
Above 6th rib, below coastal margin, laterally midaxillary line
80
Obliteration of traube's space
Massive splenomegaly, left sided pleural effusion, pericardial effusion
81
Upward shift of traube's space
Left side diaphragmatic paralysis and left lower fibrosis
82
Causes of mild splenomegaly
Septic shock, IE, enteric fever, IM, Tb, Syphilis,SLE

Medicine Practicals (5 decks)

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