Examination findings Flashcards
Coarse crackles
Cystic fibrosis
Elevated JVP
Fluid overload
Right sided heart failure
Pulmonary HTN
Pan-systolic murmur heard loudest at apex
Mitral regurgitation
Ejection systolic murmur heard loudest at right sternum
Aortic stenosis
Third heart sound
indicates rapid ventricular filling
dilated cardiomyopathy eg HF
constrictive pericarditis
severe mitral or tricuspid regurgitation
Fourth heart sound
Reduced compliance of left ventricle eg in conditions causing ventricular hypertrophy (sign of diastolic heart failure). Conditions include:
- Long standing HTN
- Severe aortic stenosis
- Hypertrophic cardiomyopathy
- Restrictive cardiomyopathy
- Post-MI fibrosis
Opening snap
Mitral stenosis
Slow rising pulse
Aortic stenosis
Bounding pulse
Aortic stenosis or CO2 retention
Collapsing pulse
= water hammer or corrigans = aortic regurgitation
associated with widened pulse pressure
Loud S1
AF (due to delayed closure of AV valves, so can also occur in tachycardia)
Tapping apex
= palpable S1 = mitral stenosis
Cannon A waves in JVP
Occur when right atria contracts against closed tricuspid valve. Seen in
- AVNRT
- Complete heart block
- VT
Low pitched rumbling mid-diastolic murmur
= Austin Flint Murmur = severe aortic regurgitation
Mid-systolic click
Mitral valve prolapse
Postural flapping tremor
Acute CO2 retention
Hyperexpanded chest
COPD
Chronic asthma
Stony dull percussion
Pleural effusion
Fine crepitations
Pulmonary oedema
Pulmonary fibrosis
Pleuritic chest pain
PE
Pneumonia
Pneumothorax
Stridor
Upper airway obstruction eg foreign body or croup
Coarse crackles
Aspiration
Pulmonary oedema
Chronic bronchitis
Pneumonia
Pleural rub
Pleurisy
Pleural effusion
Pneumothorax
Erythema nodosum
Sarcoidosis Drugs: sulphonamides, COCP, Dapsone Streptococcal infection IBD BCG vaccination Leptospirosis Mycobacterium eg TB, leprosy Yersinia, other viruses, fungi
ECG finding for PE
S1Q3T3 (S waves in lead 1, q waves in 3, T wave inversion in lead 3)
Findings for HOCM O/E
jerky pulse, double apex beat
Tapping apex
Mitral stenosis
Canon a waves in neck
3rd degree heart block
Early diastolic murmur at left sternal edge
Aortic regurgitation
Cause of 3rd heart sound
Rapid ventricular filling, eg may be seen in
- dilated cardiomyopathy
- Constrictive pericarditis
- mitral regurgitation
Cause of 4th heart sound
Atria contracting against stiffened left ventricle (usually secondary to HTN, aortic stenosis or HOCM)
Low pitched rumbling mid-diastolic murmur
Mitral stenosis
Austin flint murmur
Pseudo mitral stenosis murmur
= Aortic regurgitation makes mitral valve leaflet close
Graham steell murmur
High pitched early diastolic murmur due to pulmonary regurgitation -> loudest on inspiration
Opening snap on auscultation
Mitral stenosis
Loud S1 heart sound
Mitral stenosis
Soft pan-systolic murmur
Tricuspid regurgitation
Expiratory wheezing
Acute severe asthma
Coarse crackles + purulent sputum
Bronchiectasis
Fine crepitations at lung bases
Pulmonary oedema
Pulmonary fibrosis
Pericardial rub
Acute pericarditis
Dressler’s syndrome
Stridor indicates?
Upper respiratory tract obstruction eg trachea, epiglottis or larynx = just in inspiratory phase
If biphasic then indicates glottis or sub glottis problem
What is a wheeze and what can cause it?
Indicates lower respiratory tract obstruction
Inspiratory wheeze = extrathoracic cause. Wheezing in inspiratory phase = sign of stenosis/tumour/foreign body
Expiratory wheeze = intrathroracic cause, eg asthma or anaphylaxis
Fine crepitations at lung bases suggests?
Pulmonary oedema
Pulmonary fibrosis
Causes of intention tremor
Cerebellar disease or lesion
Darkened red reflex on fundoscopy may suggest?
Cataracts
Corneal abrasion
Vitreous haemorrhage
White eye with no red reflex in child on fundoscopy?
Retinoblastoma
Features of CNIII palsy and causes
Down and out eye, fixed dilated pupil, ptosis
Medical: DM, MS, infarction
Surgical: PCA aneurysm, cavernous sinus thrombosis
Features of CNIV palsy and causes
Diplopia going downstairs
Central causes: MS, SOL, Vascular
Peripheral: DM, Trauma, Compression
Features of CNVI palsy
Diplopia horizontally
Central causes: MS, SOL, Vascular
Peripheral: DM, Trauma, Compression
Causes of floaters in eye
Retinal dettachement
Vitreous haemorrhage
DM/HTN retinopathy
Causes of haloes in eye
Acute glaucoma (if + pain)
Cataract
Corneal oedema
Green-brown rings in the periphery of the iris - name and cause?
Kaiser-Fleisher rings
Wilson’s disease
A CT scan was performed which shows a biconvex mass after a head injury - diagnosis?
Extradural haemorrhage
A CT scan was performed which shows a crescent shaped mass after a head injury - diagnosis?
Subdural haemorrhage
ECG changes…, position and vessel?
V1-V4
Anteroseptal
LAD
ECG changes…, position and vessel?
I, aVL, V5/V6
Lateral
Left circumflex
ECG changes…, position and vessel?
II, III, aVF
Inferior
RCA
ECG changes…, position and vessel?
V4-V6, I, aVL
Anterolateral
LAD or LCA
ECG changes…, position and vessel?
V1-V3 ST depression or upright T waves
Posterior?
LCA or RCA
Subungal fibromas O/E - what condition?
Tuberous sclerosis
Patient presents with
- raised JVP
- pulsus paraxodus
- diminished heart sounds
what’s cause?
cardiac tampondade eg could be post MI
Dull percussion, absent vocal resonance, reduced expansion - diagnosis?
Empyema
Dull percussion, increased vocal resonance, reduced expansion - diagnosis?
Consolidation
Soft S1
Prolonged PR interval
Severe Mitral stenosis
Mitral regurgitation
Inability to flex the 1st, 2nd and 3rd digits of the hand - name of sign and nerve damaged?
Benediction sign
- Median nerve
Inability to extend the 4th and 5th digits of the hand - name of sign and nerve damaged?
Ulnar claw hand
Loss of sensation on the dorsum of the hand over the thumb and index finger - nerve damaged?
Radial nerve
Signs of fluid overload
Tachypnoea
Ascites
Pulmonary oedema
Raised JVP
Signs of fluid underload
Tachycardia
Hypotension
Oliguria
Sunken eyes and reduced skin turgor
Fine end inspiratory crepitations on auscultation - cause?
Pulmonary fibrosis
Causes of pulmonary fibrosis
Upper: BREAST Berrylosis Radiotherapy EAA Ank Spondylosis Sarcoidosis TB
Zone: CARDS
Cryptogenic fibrosing alveolitis (idiopathic)
Asbestos
RA and other CTDs
Drugs : B-DAMN (bleomycin, Da agonists, amiodarome, methotrexate, nitrofurantoin)
Scleroderma
