from oxford handbook

Question 1

What does a Bounding pulse mean? In what pathology?

Answer 1

CO2 retention, liver failure, and sepsis

Question 2

What does a Small volume pulse mean? In what pathology?

Answer 2

aortic stenosis, shock, and pericardial eff usion

Question 3

What does a Collapsing pulse mean? In what pathology?

Answer 3

aortic incompetence, AV malformations, and a patent ductus arteriosus

Question 4

What does a Anacrotic (slow-rising) pulse mean? In what pathology?

Answer 4

aortic stenosis

Question 5

What does a Bisferiens pulse mean? In what pathology?

Answer 5

aortic stenosis and regurgitation

Question 6

What does a • Pulsus alternans mean?In what pathology?

Answer 6

(alternating strong and weak beats) suggests LVF, cardiomyopathy, or aortic stenosis

Question 7

What does a Jerky pulses mean? In what pathology?

Answer 7

H(O)CM

Question 8

What does a Pulsus paradoxus mean?

Answer 8

severe asthma, pericardial constriction, or cardiac tamponade

Question 9

What pathologies are these JVP abnormalities linked with? Raised JVP with normal waveform

Answer 9

: Fluid overload, right heart failure

Question 10

What pathologies are these JVP abnormalities linked with? Fixed raised JVP with absent pulsation

Answer 10

SVC obstruction

Question 11

What pathologies are these JVP abnormalities linked with? Large a wave

Answer 11

Pulmonary hypertension, pulmonary stenosis

Question 12

What pathologies are these JVP abnormalities linked with? Cannon a wave:

Answer 12

When the right atrium contracts against a closed tricuspid valve, large ‘cannon’ a waves result. Causes—complete heart block, single chamber ventricular pacing, ventricular arrhythmias/ectopics

Question 13

What pathologies are these JVP abnormalities linked with? Absent a wave

Answer 13

Atrial fibrillation

Question 14

What pathologies are these JVP abnormalities linked with? Large v waves

Answer 14

Tricuspid regurgitation—look for earlobe movement.

Question 15

What pathologies are these JVP abnormalities linked with? Constrictive pericarditis:

Answer 15

High plateau of JVP (which rises on inspiration—Kussmaul’s sign) with deep x and y descents

Question 16

What pathologies are these JVP abnormalities linked with? Absent JVP

Answer 16

When lying fl at, the jugular vein should be fi lled. If there is reduced circulatory volume (eg dehydration, haemorrhage) the JVP may be absent.

Question 17

What cardiac murmur pathology is associated with this murmur? An ejection-systolic murmur

Answer 17

• Innocent in children and high-output states (eg tachycardia, pregnancy). - aortic stenosis -pulmonary stenosis -HOCM

Question 18

What cardiac murmur pathology is associated with this murmur? A pansystolic murmur

Answer 18

• mitral or tricuspid regurgitation - ventricular septal defect - late systolic murmur ± midsystolic click

Question 19

What cardiac murmur pathology is associated with this murmur? Early diastolic murmurs

Answer 19

pulmonary regurgitation

Question 20

What cardiac murmur pathology is associated with this murmur? Mid-diastolic murmurs

Answer 20

mitral stenosis (accentuated presystolically if heart still in sinus rhythm), rheumatic fever

Question 21

What murmur radiates to the carotids?

Answer 21

aortic stenosis

Question 22

What murmur radiates to the axilla?

Answer 22

mitral regurgitation

Question 23

what is a graham steel murmur

Answer 23

Early diastolic murmur + pulmonary regurgitation is secondary to pulmonary hypertension resulting from mitral stenosis

Question 24

What are the eponymous signs of aortic regurgitation

Answer 24

• Musset’s sign—head nodding in time with the pulse.
• Müller’s sign—systolic pulsations of the uvula.
• Corrigan’s sign—visible carotid pulsations. •
• Quincke’s sign—capillary nailbed pulsation in the fi ngers.
• Traube’s sign—‘pistol shot’ femorals, a booming sound heard over the femorals.
• Duroziez’s sign—to and fro diastolic murmur heard when compressing the femorals proximally with the stethoscope.

Question 25

What pathology is associated with this cough? Loud, brassy coughing

Answer 25

pressure on the trachea, eg by a tumour.

Question 26

What pathology is associated with this cough? Hollow, ‘bovine’ coughing

Answer 26

recurrent laryngeal nerve pals

Question 27

What pathology is associated with this cough? Barking coughs

Answer 27

in croup

Question 28

What pathology is associated with this cough? Chronic cough

Answer 28

- pertussis - TB - foreign body - asthma (eg nocturnal)

Question 29

What pathology is associated with this cough? Dry, chronic coughing

Answer 29

- acid irritation of the lungs in oesophageal reflux - side-eff ect of ACE inhibitors.

Question 30

Answer 30

Question 31

WHat are causes of Dyspnea?

Answer 31

Question 32

What pathology does this type of breathing indicate? Bronchial breathing

Answer 32

Consolidation, localized fi brosis, above pleural/percardial effusion Harsh with gap between inspiration and expiration. Increased vocal resonance and whispering pectoriloquy

Question 33

What pathology does this type of breathing indicate? Diminished breath sounds

Answer 33

Pleural eff usion, pleural thickening, pneumothorax, bronchial obstruction, asthma, or COPD

Question 34

What pathology does this type of breathing indicate? Silent chest

Answer 34

Life-threatening asthma

Question 35

What pathology does this type of breathing indicate? Wheeze (rhonchi)

Answer 35

Air expired through narrow airways * Monophonic (single note, partial obstruction one airway) - Tumour occluding airway * Polyphonic (multiple notes, widespread airway narrowing)- • Asthma, cardiac wheeze (LVF)

Question 36

What pathology does this type of breathing indicate? Crackles (crepitations) - fine and late inspiratory

Answer 36

Pulmonary oedema

Question 37

What pathology does this type of breathing indicate? Crackles (crepitations)- • Coarse and mid inspiratory

Answer 37

Bronchiectasis

Question 38

What pathology does this type of breathing indicate? Crackles (crepitations)- • Early inspiratory

Answer 38

• Small airway disease

Question 39

What pathology does this type of breathing indicate? Crackles (crepitations) • Late/pan inspiratory

Answer 39

• Alveolar disease

Question 40

What pathology does this type of breathing indicate? Crackles (crepitations) • Disappear post cough

Answer 40

• Insignificant

Question 41

What pathology does this type of breathing indicate? Pleural rub

Answer 41

• Pneumonia Pulmonary infarction

Question 42

What pathology does this type of breathing indicate? Pneumothorax click

Answer 42

Shallow left pneumo thorax between layers of parietal pleura overlying heart, heard during cardiac systole

Question 43

what condition is this lung presentation characteristic of? (There may be bronchial breathing at the top of ) decreased Expansion: Percussion:(stony dull) Air entry: decreased Vocal resonance: decreased Trachea + mediastinum central (shift away from affected side only with massive effusions ≥ 1000mL)

Answer 43

PLEURAL EFFUSION

Question 44

what condition is this lung presentation characteristic of? Expansion decreased Percussion note increased Breath sounds decreased Trachea + mediastinum shift towards the affected side

Answer 44

SPONTANEOUS PNEUMOTHORAX/ EXTENSIVE COLLAPSE ( LOBECTOMY/ PNEUMONECTOMY)

Question 45

what condition is this lung presentation characteristic of? Expansion decreased Percussion note decreased Vocal resonance increased Bronchial breathing ± coarse crackles (with whispering pectoriloquy) Trachea + mediastinum centra

Answer 45

CONSOLIDATION

Question 46

what condition is this lung presentation characteristic of? Expansion decreased Percussion noteincreased Breath sounds decreased Trachea + mediastinum shift away from the affected side

Answer 46

TENSION PNEUMOTHORAX

Question 47

what condition is this lung presentation characteristic of? Expansion decreased Percussion note decreased Breath sounds bronchial ± crackles Trachea + mediastinum central or pulled towards the area of fibrosis

Answer 47

FIBROSIS

Question 48

what are causes of vomitting

Answer 48

Question 49

What conditions could cause Epigastric pain?

Answer 49

Pancreatitis, gastritis/duodenitis, peptic ulcer, gallbladder disease, aortic aneurysm.

Question 50

What conditions could cause Left upper quadrant pain?

Answer 50

Peptic ulcer, gastric or colonic (splenic fl exure) cancer, splenic rupture, subphrenic or perinephric abscess, renal (colic, pyelonephritis)

Question 51

What conditions could cause Right upper quadrant: pain?

Answer 51

Cholecystitis, biliary colic, hepatitis, peptic ulcer, colonic cancer (hepatic fl exure), renal (colic, pyelonephritis), s ubphrenic/perinephric abscess.

Question 52

What conditions could cause Loin pain?

Answer 52

Renal colic, pyelonephritis, renal tumour, perinephric abscess, pain referred from vertebral column

Question 53

What conditions could cause Left iliac fossa pain?

Answer 53

Diverticulitis, volvulus, colon cancer, pelvic abscess infl am m atory bowel disease, hip pathology, renal colic, urinary tract infection (UTI) , cancer in undescended testis; zoster—wait for the rash! (p454). **Gynae**: torsion of ovarian cyst, salpingitis, ectopic pregnancy

Question 54

What conditions could cause • Right iliac fossa pain:pain?

Answer 54

appendicitis Crohn’s ileitis, Diverticulitis, volvulus, colon cancer, pelvic abscess, infl am m atory bowel disease, hip pathology, renal colic, urinary tract infection (UTI), cancer in undescended testis; zoster—wait for the rash! (p454). **Gynae:** torsion of ovarian cyst, salpingitis, ectopic pregnancy.

Question 55

What conditions could cause Pelvic:pain?

Answer 55

**Urologica**l: UTI, retention, stones. **Gynae**: menstruation, pregnancy, endometriosis , salpingitis, endometritis ovarian cyst torsion.

Question 56

What conditions could cause • Generalized: abdominal pain?

Answer 56

Gastroenteritis, irritable bowel syndrome, peritonitis, constipation

Question 57

What conditions could cause central abdominal pain?

Answer 57

Mesenteric ischaemia, abdominal aneurysm, pancreatitis

Question 58

**Faecal incontinence:** **1. causes** **2. Assesment**

Answer 58

Causes: **Sphincter dysfunction:** * Vaginal delivery is the commonest cause due to sphincter tears or pudendal nerve damage. * Surgical trauma, eg following procedures for fi stulas, haemorrhoids, fi ssures. **Impaired sensation** * diabetes, MS, dementia, any spinal cord lesions (consider cord compression if acute faecal incontinence). **Faecal impaction** * overflow diarrhoea, extremely common, especially in the elderly, and very easily treated. **Idiopathic** * elderly women, this is usually multifactorial, including a combination of poor sphincter tone and pudendal damage leading to poor sensation. Assesment: DRE- asses tone neurology of legs - check for sensation

Question 59

What can cause Flatulence? What is the main cause?

Answer 59

1. Air swallowing - main gas nitrogen 2. caeliac- methan, H2, Co2

Question 60

What are common causes for tenesmus?

Answer 60

- common in IBS - caused by tumours

Question 61

What are common causes for steatorrhoea?

Answer 61

Ileal disease (eg Crohn’s or ileal resection), pancreatic disease obstructive jaundice (due to decreased excretion of bile salts from the gallbladder).