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BPT Clinical Exam > Examination for the Long Case > Flashcards

Examination for the Long Case Flashcards

1
Q

Cause of Clubbing

A

-Cyanotic heart disease
-Lung disease
Abscess
Bronchiectasis
Cystic Fibrosis
Dont say COPD
Empyema
Fibrosis
-Ulcerative Collitis + Inflammatory Bowel Disease(Crohn’s Disease)
-Biliary cirrhosis
-Birth Defects
-Infective Endocarditis
-Neoplasm(eg. Lung cancer or mesothelioma)
-Gastrointestinal malabsorption syndrome(Coeliac disease)

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2
Q

Lung expansion: Symmatrical but reduced

A

Chronic obstructive lung disease.

Interstitial lung disease.

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3
Q

Lung expansion: Asymmetrical and abormal

A

In unilateral lung disease, lung resection or pneumonectomy (paradoxical expansion may occur).

Unilateral lung transplantation with normal expansion of the transplanted lung and reduced expansion of the native lung.

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4
Q

Dull percussion

A

Lung consolidation/collapse.

Pleural effusion (stony dull).

Mesothelioma.

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5
Q

Differentiating lung collapse/consolidation from pleural effusion

A
  • Increased vocal resonance

- Bronchial breath sounds

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6
Q

PHTN Findings

A
  • Palpable thrill over Pulmonary area
  • RV parasternal heave
  • Loud P2, may be split
  • TR
  • Features of RVF: elevated JVP, lung crackles, hepatomegaly, peripheral oedema
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7
Q

TR Findings

A
  • elevated JVP with prominent V wave and Y descent
  • Pulsatile liver
  • RV heave
  • Features of pulmonary HTN
  • PSM loudest at left lower sternal edge, loudest on inspiration

Commonly associated with MR and PHTN

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8
Q

Causes of AS

A

Degneration of bicuspid valve
Calcification
RHD

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9
Q

Moderate heptomegaly

A

15-20 cm

  • As per massive DDx
  • Haemachromatosis
  • CML
  • Lymphoma
  • NAFLD
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10
Q

Mild Splenomegaly

A

1-2 cm

  • PRV
  • ET
  • Haemolytic anaemia
  • ITP
  • CTD
  • Sarcoid
  • Amyloid
  • Portal HTN
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11
Q

Gallavardin phenomenon

A

AS murmur heard at apex

In this phenomenon, the harsh murmur of aortic valvular stenosis may change in quality and become musical at the apex.

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12
Q

Causes of AR

A

Valve pathology

  • RHD
  • Congenital w/ or w/o VSD
  • Cx of IE

Aortic root pathology

  • Aortic root dissection
  • Ank Spond
  • Syphilitic aortitis
  • Cx of Marfan’s
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13
Q

DDx hepatosplenomegaly

A

-CLD w/ Portal HTN (although liver usually small)

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14
Q

DDx massive hepatosplenomegaly

A

Myelofibrosis
Myelodysplasia
CML/CMML

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15
Q

DDx moderate hepatosplenomegaly

A 
Myelofibrosis
Myelodysplasia
CML/CMML
CLL
Lymphoma
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16
Q

Indicators for decompensated cirrhosis

A
  • Variceal bleed
  • Hepatic encephalopathy
  • Ascites
  • SBP
  • HC
  • Hepatorenal or hepatopulmonary syndromes
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17
Q

Differentiating spleen from renal mass

A
  • Spleen moves down and medially with respiration
  • Spleen has a notch on upper margin
  • Spleen not ballotable
  • Cannot get above a spleen
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18
Q

TR

A
  • elevated JVP with prominent V wave and Y descent
  • Pulsatile liver
  • RV heave
  • Features of pulmonary HTN
  • PSM loudest at left lower sternal edge, loudest on inspiration

Commonly associated with MR and PHTN

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19
Q

DDx for wide based gait

A
  • Cerebellar ataxia
  • Sensory ataxia
  • Vestibular ataxia
  • Frontal ataxic gait
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20
Q

AR signs of severity

A
  • Wide pulse pressure with collapsing pulse
  • S3
  • Soft A2
  • Austin Flint murmur
  • LV enlargement
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21
Q

AS signs of severity

A
  • A small volume, slow rising, plateau carotid pulse.
  • The presence of an aortic thrill.
  • A long late peaking ejection systolic murmur.
  • The presence of an S4, indicating reduced compliance of the left ventricle.
  • Paradoxical splitting of S2.
  • The presence of left ventricular failure.
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22
Q

Gallavardin phenomenon

A

AS murmur heard at apex

In this phenomenon, the harsh murmur of aortic valvular stenosis may change in quality and become musical at the apex.

23
Q

Causes of positive Rombergs test

A

(Steady with eyes open, not steady with eyes closed)

  • Posterior column lesion
  • PN
  • Vestibular dysfunction
24
Q

Findings in Diabetic neuropathy

A
  • Gait: Sensory ataxia
  • Romberg’s positive
  • Sensory loss in glove and stocking
  • In severe cases motor weakness or loss of ankle jerk
25
Q

Findings in CIDP

A

Symmetric, sensorimotor neuropathy, with predominant motor neuropathy, resulting in both proximal and distal muscle weakness

  • Ataxic gait
  • Positive Rombergs
  • Glove and stocking distribution of sensory loss
  • Reflexes generally absent or reduced
  • Muscle atrophy/weakness

Less common:
-Asymmetric and/or sensory predominant forms

26
Q

MS findings

A

UMN findings:

  • Hyperreflexia
  • Spacitity
  • Up going plantar
  • Occasionally reflexes are lost due to interruption of afferent motor reflex
  • Cerebellar and sensory findings may be present
27
Q

Pulsus bisferiens

A

Commonly due to:

  • mod-severe AR
  • Mixed AR and AS
  • HOCM
28
Q

Mitral Valve prolapse signs

A

Mid systolic click +/- mid systolic murmur of MR

29
Q

DDx PArkinsonian like gait

A

-Parkinson like syndrome e.g surapnuclear palsy, drug induced parkinsonism

Posture is often more upright

30
Q

DDx for wide based gait

A
  • Cerebellar ataxia
  • Sensory ataxia
  • Vestibular ataxia
  • Frontal ataxic gait
31
Q

DDX asymmetric gait

A
  • Unilateral spasticity e.g. motor stroke
  • Unilateral cerebellar lesions
  • Unilateral foot drop e.g. common peroneal nerve lesion, L5 lesion, unilateral stroke
32
Q

Standing on toes

A

Assesses S1

33
Q

Standing on heels

A

Tests L4/5

34
Q

Causes of positive Rombergs test

A

(Steady with eyes open, not steady with eyes closed)

  • Posterior column lesion
  • PN
  • Vestibular dysfunction
35
Q

Clasp knife/spasticity

A

UMN lesion

36
Q

Lead pipe/rigidity

Cogwheel rigidity

A

extra-pyramidal lesions

37
Q

Knee Jerk

A

L3,4

38
Q

Ankle jerk

A

S1,2

39
Q

Findings in proximal myopathy

A 
Muscle atrophy
No fasciculations
Normal Tone
Normal reflexes
Down going plantars
Weakness in prox muscles
40
Q

AR signs

A
  • Wide pulse pressure
  • Collapsing water hammer pulse
  • Quinke’s sign
  • Head bobbing
  • Pistol shot femoral artery sounds
  • Displaced apex beat
  • Diastolic thrill at left lower sternal edge
  • S3
  • Diastolic murmur loudest at the left lower sternal edge on expiration
41
Q

Austin flint murmur

A

mid diastolic murmur head at the apex in severe AR

42
Q

AR signs of severity

A
  • Wide pulse pressure with collapsing pulse
  • S3
  • Soft A2
  • Austin Flint murmur
  • LV enlargemen
43
Q

MR Signs

A
  • May have AF
  • Displaced, dyskinetic apex beat
  • PSM radiating to axilla
  • Soft S1
  • S3 due to turbulent LV blood flow
  • Apical thrill
44
Q

Causes of MR

A
  • Mitral valve degeneration
  • RHD
  • IE
  • Congenital heart disease
  • Ruptured chordae tendinae
  • Infarcted papillary muscles
  • LV dilatation
45
Q

MR signs of severity

A
  • LV dilatation
  • Soft S1
  • PHTN
  • Split S2
  • S3
  • Cx of LVF
  • Small pulse volume
46
Q

CAuses of MS

A
  1. RHD
    LEss common
    -Radiation
    -Congenital MS
47
Q

Signs of MS

A
  • Malar flush
  • JVP: prominant A wave
  • Tapping apex beat
  • Loud S1
  • Opening snap
  • Mid diastolic rumbling murmur
48
Q

MS signs of severity

A
  • Small pulse pressure
  • Short distance between opening snap and S2
  • Long diastolic murmur
  • Presence of PHTN
  • Apical diastolic thrill
49
Q

Pulsus bisferiens

A

Commonly due to:

  • mod-severe AR
  • Mixed AR and AS
  • HOCM
50
Q

Mitral Valve prolapse signs

A

Mid systolic click +/- mid systolic murmur of MR

51
Q

Signs of HOCM

A

-Jerky carotid pulse
-JVP possible prominent A wve
-Apex beat: double impulse
-Systolic thrill at left lower sternal edge
-ESM at left lower sternal edge, loudest on valsalva
-PSM of MR
-S4
-

52
Q

ASD signs

A
  • Fixed splittingof the 2nd HS

- ESM loudest in pulmonary area

53
Q

VSD signs

A

Small:

  • loud, high frequency systolic murmur, loudest at left lower sternal edge
  • palpable thrill in 3rd or 4th left intercostal space

Large:

  • Softer
  • Holosystolic

BPT Clinical Exam (11 decks)

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