dyspnoea, ankle swelling, palpitations

Question 1

orthopnoea occurs because

Answer 1

in an upright position the patients interstitial oedema is redistributed, the lower zones of the lungs become worse and the upper zones get better
allows improved overall blood oxygenation

Question 2

patient complaints with orthopnoea

Answer 2

may spend the night sitting up in a chair or propped up with pillows

Question 3

absense of orthopnoea implies

Answer 3

left ventircular failure is unlikely

Question 4

paroxysmal nocturnal dyspnoea is caused by

Answer 4

sudden failure of left ventricular output with an acute rise in pulmonary venous and capillary pressures
causes transudation of fluid into the interstitial tissues, which increases the work of breathing
may be precipitated by resorption of peripheral oedema at night while supine

Question 5

presence of orthopnoea and paroxysmal noctural dyspnoea is siggestive of

Answer 5

cardiac failure over lung disease

Question 6

oedema due to heart disease

Answer 6

not painful or red
weight ggain of 3kg or more
symmetrical and worse in the evenings, improvement during the night

Question 7

oedema may be due to

Answer 7

biventricular failure or right ventricular failure secondary to a number of possible aetiologies

Question 8

drugs in oedema

Answer 8

calcium channel blockers can cause peripheral oedema (vasodilator)

Question 9

heart misses or thumps that are worse at rest could be

Answer 9

ectopic beats

Question 10

very fast, regular

instantaneous onset could be

Answer 10

supraventriculaar tachycardia or (ventricular tachycardia)

Question 11

if they are offset with vagal monouvres

Answer 11

SVT

Question 12

fast and irregular heart beats

Answer 12

AF

Question 13

forceful and regular

Answer 13

awareness of sinus rhythm (anxiety)

Question 14

patient describes severe dizziness or syncope, pre-existing heart failure

Answer 14

ventricular tachycardia

Question 15

if the episodes start and stop suddenly and are improved by deep breathing or holding breath

Answer 15

SVT

Question 16

if they have lost conasciousness during an episode

Answer 16

ventricular arythmias

Question 17

syncope

Answer 17

transient loss of consciousness resulting from cerebral anoxia, usually due to inadequate blood flow

Question 18

presyncope

Answer 18

transient sensation of being about to blakc out without loss of consciousness

Question 19

favours vasovagal syncope

Answer 19

onset in teens or 20s
occurs in response to emotional distress
associated with nausea or claminess
injury common
unconscious brief, no neurological signs on walking

Question 20

favours orthostatic hypotension

Answer 20

breif 
injury uncommon 
onset when getting out of bed or standing 
morre common when fasted or dehydrated 
known low systolic blood pressure 
use of antihypertensive medications

Question 21

favours situational syncope

Answer 21

occurs during micturation

occurs with prolonged coughing

Question 22

favours syncope due to left ventricular outflow obstruction

Answer 22

occurs during exertion - indicates aortic stenosis or hypertrophic cardiomyopathy

Question 23

favours syncope due to cardiac arrythmia

Answer 23

family history of sudden death
antiarrythmic medication - prolonged QT
history of cardiac disease - ventricular arrythmias
history of rpid palpitations
no warning - heart blocks, stroke, adams attack

Question 24

favours vertigo

Answer 24

no loss of consciousness
worse when turning head
head or room seems to spin
may occur when patient turns over in bed

Question 25

favours syncope due to seizure

Answer 25

prodrome - aura 
tongue bitten 
jerking movements during episode 
head turns during episode 
cyanosis during episode 
sleepiness afterward 
muscle pain afterward 
follows emotional stress

Question 26

favours metabolic cause of syncope (coma)

Answer 26

hypoglycaemia agents, low blood suger, episode prolonges rather than transient

Question 27

syncope while urinating

Answer 27

micturation syncope

Question 28

cause of vagal stimulus

Answer 28

affferent stimulus causes an increase in vagal tone leading to brady cardia and hypotension
vagal stimulus can also lead to nausea, sweating, headache, a feeling of warmth or clamminess and abdominal discomfort

Question 29

drug influence in postural hypotension

Answer 29

antihypertensive and antianginal drugs

Question 30

arrythmia related syncope

Answer 30

sudden loss of consciousness regardless of the patient’s posture
chest pain may precede the syncopal episode if the patient has sichaemic heart disease or aortic stenosis
recovery is quick

Question 31

sudden slowing of pulse

Answer 31

usually complete heart block