Examinations

Question 1

Left heart failure

Answer 1

Pulsus Alternans
Potentially hypotensive
Displaced, dilated apex
S3
Bi-basal crackles

Question 2

Hypertensive Heart disease

Answer 2

Heaving apex
S4

Question 3

Signs of secondary causes for Hpt

Answer 3

Renal artery bruits
Cushings
Coarctation
Acromegaly

Question 4

Complications of Hypertension

Answer 4

Stroke
Peripheral vascular disease

Question 5

Right heart failure (Signs)

Answer 5

Oedema
Raised JVP
Hepatomegaly
Ascites

Question 6

Cor Pulmonale

Answer 6

Signs of significant lung disease
Except if the reason for PHT is due to thrombo-embolic disease

Question 7

signs of PHT

Answer 7

Prominent A-wave of JVP
Parasternal heave
Loud P2
S3 over pulmonary area

Question 8

Ischemic Heart Disease

Answer 8

Dx from typical history: Mostly pt with risk factors
As well as potential family history
Central to left sided chest pain
Intermittent, exercise induced, relieved by rest
Except with unstable angina or infarct, when pain is spontaneous and prolonged.
Referring to jaw or left arm

There is no specific signs.
Peripheral vascular disease
Previous CVA

Question 9

Aortic Regurg

Answer 9

Decrescendo murmur
Best heard sitting forward in exhalation
Soft S2, potentially S3
Dilated displaced apex
Waterhammer pulse / Corrigan / Derozier’

Question 10

Aortic Stenosis

Answer 10

Ejection systolic
Radiating up carotid
Loud S2, potentially S4
Heaving Apex
Plateau pulse

Question 11

Mitral stenosis

Answer 11

Diastolic rumble, pre-systolic accentuation
Best heard when turned on Lt lateral side
Loud S1, potentially a opening snap
Tapping apex (apex spared, but PHT)
Signs of PHT

Question 12

Mitral regurg

Answer 12

Pansystolic
Radiating to axilla
Soft S1, potentially S3
Dilated displaced apex

Question 13

Infective Endocarditis (Features)

Answer 13

Anemia
Clubbing
Splinter hemorrhage
Janeway lesions / Roth spots
Splenomegaly
Hematuria
Digital gangrene or other emboli if severe

Question 14

Infective Endocarditis (Signs)

Answer 14

Potentially dilated, displaced apex
S3
Most like AR or MR
TR in IV drug users

Question 15

Atrial fibrillation

Answer 15

Irregular, irregular pulse
Pulse deficit

Question 16

Atrial fibrillation (causes)

Answer 16

Hpt
IHD
Valvular heart disease with dilation
Hyperthyroidism

Question 17

Pericardial effusion

Answer 17

Absent apex beat
Despite not feeling apex, with percussion there is an enlarge cardiac dullness
Muffled heart sound

Question 18

Signs of Tamponade

Answer 18

Distended neck veins
Tachycardia
Drop in BP
Pulsus Paradoxis

Question 19

Liver on exam

Answer 19

Can’t get above it
Moves early with respiration
Can’t ballot it
Enlarged inferiorly

Question 20

Liver size

Answer 20

Depends on height and gender
Upper border – 6th intercostal
Lower border – at rib border
About 10cm in male / 7.5cm in woman

Question 21

spleen on exam

Answer 21

Has a notch
Can’t get above it
Moves early on inspiration
Can’t ballot it
Enlarge towards umbilicus

Question 22

Shifting Dullness

Answer 22

Percuss and find the edge of the dullness
Then turn patient on side so that area which was dull is now on top
Wait 10 seconds for fluid to shift
Repeat percussion
If dull area is now resonant – then there is shifting dullness.

Question 23

Nausea and Vomiting (Intra-Abdominal)

Answer 23

Obstructive lesions

Inflammatory
Cholecystitis
Pancreatitis

Infective
Gastro-enteritis

Functional
Gastroparesis

Question 24

Nausea and Vomiting (Intra-cranial)

Answer 24

Raised ICP
Cancer
Hydrocephalus
Bleeds
Meningitis
Labyrinthine disease
Motion sickness
Labyrintitis

Question 25

Nausea and Vomiting (Drugs)

Answer 25

Morphine
Chemotherapy
Digoxin

Miscellaneous
Pregnancy
Uremia

Question 26

Weight loss

Answer 26

Abdominal
Malabsorption
Chronic diarrhea

Inflammatory
Chronic infection
HIV
TB
CTD / Vasculitis

Endocrine
Thyroid
Type 1 DM
Adison’s

Malignancy