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Cvs Combanium Flashcards

1
Q

Mechanism of PND

A

Slow resorption of fluid from interstitium
Elevation of diaphragm
Decreased sympathetic drive of heart
Nocturnal depression of resp centre

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2
Q

Mech of orthopnea

A

On lying down,fluid returns to vascular compartment
Increased venous return to heart
Increased pulm venous pressure
Pulm interstitial edema

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3
Q

Causes of orthopnea

A

Acute left heart failure
Marked CCF
Massive ascitis

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4
Q

Causes of platypnea

A

Left atrial thromus
Left atrial tumour
Pulm av fistula

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5
Q

Causes of angina

A

Cad
As
Ar
Hcom
Systemic hypertension

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6
Q

Levine test

A

Relief of anginal pain by carotid sinus massage

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7
Q

What is syncope

A

Transient loss of consciousness due to inadequate cerebral blood flow secondary to abrupt decrease in cardiac output

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8
Q

Causes of syncope

A

Cardiac
Heart block
Extreme bradycardia
Tachyarrythmia
As
Hocm
Pulm stenosis
Drugs
Antihypertensive
Beta blockers
Vasodilator
Hypoglycemia
Reflexes
Vasovagal syncope
Orthostatic hypotension
Hypersensitive carotid sinus
Cough syncope-
Micturition syncope

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9
Q

Palpitation and causes

A

Unpleasant awareness of forceful rapid beating of one’s own heart

Cardiac
Tachyarrythmia
Extrasystoles- atrial,ventricular
Endocrine
Phaeochromocytoma
Thryotoxicosis
Hypoglycemia
High output states
Anemia
Beri beri
Pyrexia
Ar
Drugs
Atropine
Adrenaline
Aminophylline
Thyroid e
Psychogenic
Anxiety

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10
Q

Ortners syndrome

A

Compression of left recurrent laryngeal nerve be enlarged left atrium causing hoarseness of voice usually seen in ms

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11
Q

Marfans syndrome

A

Hyperextensibility of joints
High arched palate
Dislocation of lens
Tall thin person with long slender fingers

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12
Q

Left parasternla pulsations seen in

A

Right ventricular enlargement
Left atrial enlargement
Aortic aneurysm

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13
Q

Epigastric pulsation seen in

A

Right vent hypertrophy
Aortic aneurysm
Liver pulsation
Mass over aorta

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14
Q

Second left ICS pulsations seen in

A

Dilated pulm artery
Hyperkinetic state
Aortic aneurysm

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15
Q

Uprasternal pulsation seen in

A

Ar
Coarctation of aorta
Hyperkinetic state
Aortic aneurysm
Abnorm thyroidae ima artery

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16
Q

Pulsation in right side of chest seen in

A

Dextrocardia
Right atrial enlargement

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17
Q

Pulsations in back seen in

A

Suzmans sign- coarctation of the aorta
Pulm artery venous fistula

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18
Q

Neck pulsations seen in

A

Hyperkinetic state
Ar
Carotid artery aneurysm
Exophthalmos goitre
Subclavian artery aneurysm

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19
Q

Tapping Apex beat

A

Ms

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20
Q

Diffuse apex beat

A

Left vent aneurysm
Left vent dysfunction

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21
Q

Double apical impulse

A

Hocm
Left vent aneurysm
As with ar
Left bundle branch block

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22
Q

Triple or quadruple apical impulse

A

Hocm

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23
Q

Hyperdynamic apex impulse

A

Ar
Mr
High output state
Vsd
Pda

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24
Q

Heaving Apex beat

A

As
Systemic hypertension
Coarctation of aorta

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25
Absent apical impulse
Dextrocardia Obesity Under rib Emphysema Pericardial eff
26
Types of apical impulse
Tapping Diffuse apex Double Triple or quadruple Hyperdynamic Heaving
27
Diff between heaving and hyperdynamic apical impulse
Heaving. Hyperdynamic Normal location. Out and down Pressure overload. Volume Left vent hypertrophy. LV dilatation
28
Grading of parasternla heave
Grade 1- visible but not palpable 2- visible and palpable but obliterable 3- visible and palpable but not obliterable
29
Causes of parasternla heave
Rvh Left atrial enlargement
30
Soft S1 heard in
Mr Tr Calcified ms Calcified ts Left ventricular dysfunction
31
Loud S1 heard in
Ms Ts High output states Asd Vsd Pda Atrial myxoma
32
Variable S1 heard in
A fib Extra systoles Complete heart block
33
Soft S2 heard in
Soft a2 - calcified as Soft p2- calcified pulm stenosis
34
Loud S2 heard in
Loud a2- systemic hypertension Atherosclerosis Aortic aneurysm Loud P2 Pulm artery hypertension Pulm artery dilatation
35
Single S2 heard in
Absent a2- as,aortic atresia Absent p2- pulm stenosis,pulm atresia
36
Split S2 heard in
Early a2- Mr,vsd, constrictive pericarditis Late p2- lv ectopics,lv pacemaker,right bundle branch block
37
Wide fixed split S2 heard in
Asd Right vent failure Massive acute pulm embolism
38
Reverse splitting of s2
Severe as Hocm Systemic hypertension Pda RV pacemaker Ov ectopics
39
Physiological S3
Children Athletes Pregnancy
40
Pathological s3
High output states Congenital -asd,vsd,pda Ar,Mr,tr CCF Constrictive pericarditis Ischemic heart disease
41
Pathological s4
Hypertrophic cardiomyopathy Systemic hypertension As Cad
42
How are murmurs produced
Due to turbulent flow of blood through a constricted or irregular orifice or due to increased flow
43
Grading of murmurs
Levine and Freeman's grading Grade 1- very soft 2- faint murmur but clearly audible 3- moderately loud but no thrill 4- loud with thrill 5- louder with thrill and can be heard away from involved site 6- murmur with thrill heard even when steth is lifted off chest wall
44
Why are systolic murmurs graded
Can be physiological
45
Why are diastolic murmurs usually not graded
Always pathological
46
Ejection systolic murmur
Aortic area As Coarctation of aorta Aortic aneurysm Functional murmur in ar Pulmonary area Pulm stenosis Tof Pah Asd
47
Pan systolic murmur
Mr Vsd Tr
48
Early diastolic murmur
Ar PR
49
Graham steeles murmur
High pitched decreacendo diastolic blowing murmur along the left sternal border resembling ar murmur due to pulm regurg seen in pulm htn
50
Mid diastolic murmur
Ms Ts Carey coombs murmur Austin flint murmur Flow murmur of asd,vsd,pda,Mr,tr
51
Continuous murmur
Pda Aortopulm window Coarctation of aorta Venous hum Mammary souffle
52
Venous hum
Low pitched soft continuous murmur due to flow of blood through jugular veins best heard in lower border of right sternocleidomastoid muscle Obliterated by compression of neck veins or valsalva manouvre Accelerated by exercise
53
Mammary souffle
Continuos murmurs heard in third oartumof pregnancy best heard in mammary area Obliterated by firm digital pressure applied laterally Accentuated during systole
54
Opening snap
High pitched loud snapping or clicking due to sudden tensing of cusps of mitral and tricuspid valve Seen in ms and ts Absent in mild ms,calcified mitral valve,ms with mr
55
Causes of pericardial rub
Viral pericarditis Pyogenic pericarditis Tb pericarditis Dresslers syndrome Sle Rheumatoid arthritis Acute mi
56
Diff between pericardial rub and murmurs
Rub. Murmur No coincide with sys or diastole. Coincides No conduction. Present Superficial. Deep Pressure steth alters. No alter
57
Pericardial knock
Loud high frequency diastolic sound heard in constrictive pericarditis due to abrupt halt to early diastolic filling
58
Cause of mid diastolic clicks
Mitral valve prolapse syndrome Tricuspid valve prolapse syndrome Ebsteins anomaly Severe ar
59
Causes of ms
Rheumatic heart disease Congenital-parachute mitral valve Hunters syndrome Hurlers syndrome Lutembachers syndrome Carcinoid syndrome Amyloidosis Drugs- methysergide
60
Normal mitral valve orifice
4-6 cm sq
61
Orifice size in ms
Mild-1.5-2 cm sq Moderate:1-1.5 Critical:<1
62
Signs in ms
Small volume pulse Left parasternla heave Tapping Apex Palpable S2 Diastolic thrill at apex Loud S1 Opening snap Mid diastolic murmur
63
Ms murmur soft in
Obesity Emphysema Large rv Coincidental asd Low flow(severe pah, cardiomyopathy)
64
Hemoptysis in ms reason
Rupture of thin walled dilated bronchopulm veins due to sudden rise in left atrial pressure Pulm congestion Pulm edema Recurrent bronchitis Bronchiectasis Pulm infarction
65
Complications of ms
Due to back pressure( pulm edema,pah,rvf,tr) Arrythmias( af,atrial flutter) Infection(ie,bronchopulm infection) Embolism(pulm,angina,renal htn,leriches syndrome) Pressure effects(ortners syndrome, dysphagia,left lung collapse) Hemoptysis
66
Chronic Mr causes
Rhd Cardiomyopathy Sle Ankylosingnspondilitis Marfans syndrome Ehler danlos syndrome Amyloidosis Sarcoidosis Htn Ihd
67
Acute Mr causes
Ie Acute rf Mi Trauma Ruptured chorda tendinae Prosthetic valve endocarditis Left atrial myxoma
68
Signs of mr
Low volume collapsing pulse Hyperdynamic apex beat Apex down and out Parasternla heave Soft S1 S3 Systolic thrill over mitral area Palpable S2 Loud p2
69
Diff between mr and vsd
Mr. Vsd Rhd. Palp and dizziness Systolic thrill at apex. Left sternal edge Soft S1. Norm Left atrium enlarged. Norm
70
Complications of mr
Af Ie Thromboembolism Lvf Rvf
71
Indications for mitral valve replacement
Acute symptomatic Mr Symptomatic with normal lv function or mild to severe lv dysfunction Asymp with mild to severe lv dysfunction Asymp with norm lv function but with af and pah
72
Causes of as
Rhd Atherosclerosis Congenital Degeneration
73
Signs of as
Slow rising pulse(pulses parvus et tardus) Low systolic BP Bernheim phenomenon-prominent a waves in jvp Heaving Apex beat Carotid thrill Soft S2 Esm at aortic area
74
Compl of as
Lvf Arrythmias Complete heart block Ie Sudden death
75
Chronic ar causes
Congenital bicuspid valve Congenital disproportionate cusps Rhd Syphillis Rheumatoid arthritis Ankylosingnspondilitis Marfans Ehler danlos Systemic htn
76
Acute ar causes
Aortic dissection Trauma Ie Prosthetic valve dysfunction
77
Signs of ar
Lighthouse sign(alternate flushing and blanching of forehead) Landolf sign Beckers sign Demusset sign Muller sign Quinke sign Collapsing pulse Pulsus bisferens Traubes sign Durozlez murmur Durozlez sign Rosenbach sign Gerhardt sign Hyperdynamic apical imp S3 Esm at aortic Austin flint murmur
78
Lighthouse sign
Alternate flushing and blanching of forehead
79
Landolf sign
Change in pupillary size according to cardiac cycle
80
Beckers sign
Retinal artery pulsations
81
Demussets sign
Head bobbing with each heart beat
82
Myers sign
Systolic pulsations of uvula
83
Quinke sign
Nail bed capillary pulsations
84
Durozlaz sign
Systolic murmur heard over femoral artery when compressed distally with diaphragm
85
Rosenbach sign
Pulsation of liver
86
Gerhardt sign
Pulsation of spleen
87
Oliver cardavell sign
Pulsation of larynx
88
Dennisons sign
Pulsation of cervix
89
Hills sign
Popliteal cuff systolic pressure exceeds brachial cuff pressure more than 60 mm hg
90
Austin flint murmur
Mid diastolic murmur over mitral area Due to regurgitant stream directed towards anterior mitral leaflet which produces the murmur
91
DD of rheumatic fever
Ie Lyme disease Malignancy
92
Types of heart failure
Acute and chronic Left right and bivent Forward and backward Diastolic and systolic High and low output
93
Causes of lhf
Ihd Systemic htn Aortic and mitr disease Cardiomyopathy
94
Causes of rhf
Left heart failure Chr lung disease(cor pulmonale) Pulm EMB Pulm htn Asd vsd
95
Signs of lvf
Tachypnea Pallor Pulsus alterans Cardiomegaly with sustained apex Functional Mr Basal crepitations
96
Signs of rvf
Peripheral edema and cyanosis Raised jvp and hepatojugular reflex Tender hepatomegaly Ascitis and pleural eff
97
Framingham criteria for diagnosis of chf
Major Ond Neck vein distension Rales Cardiomegaly Acute pulm edema S3 gallop Inc venous pressure Positive hepatojugular reflex Minor Extremity edema Night cough Dyspnea on exertion Hepatomegaly Pleural eff Tachycardia

General Med (10 decks)

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