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Meded Flashcards 2020 > from oxford handbook > Flashcards

from oxford handbook Flashcards

1
Q

What does a Bounding pulse mean? In what pathology?

A

CO2 retention, liver failure, and sepsis

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2
Q

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

A

aortic stenosis, shock, and pericardial eff usion

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3
Q

What does a Collapsing pulse mean? In what pathology?

A

aortic incompetence, AV malformations, and a patent ductus arteriosus

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4
Q

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

A

aortic stenosis

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5
Q

What does a Bisferiens pulse mean? In what pathology?

A

aortic stenosis and regurgitation

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6
Q

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

A

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

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7
Q

What does a Jerky pulses mean? In what pathology?

A

H(O)CM

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8
Q

What does a Pulsus paradoxus mean?

A

severe asthma, pericardial constriction, or cardiac tamponade

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9
Q

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

A

: Fluid overload, right heart failure

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10
Q

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

A

SVC obstruction

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11
Q

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

A

Pulmonary hypertension, pulmonary stenosis

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12
Q

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

A

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

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13
Q

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

A

Atrial fibrillation

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14
Q

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

A

Tricuspid regurgitation—look for earlobe movement.

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15
Q

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

A

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

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16
Q

What pathologies are these JVP abnormalities linked with? Absent JVP

A

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.

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17
Q

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

A
  • Innocent in children and high-output states (eg tachycardia, pregnancy). - aortic stenosis -pulmonary stenosis -HOCM
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18
Q

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

A
  • mitral or tricuspid regurgitation - ventricular septal defect - late systolic murmur ± midsystolic click
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19
Q

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

A

pulmonary regurgitation

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20
Q

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

A

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

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21
Q

What murmur radiates to the carotids?

A

aortic stenosis

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22
Q

What murmur radiates to the axilla?

A

mitral regurgitation

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23
Q

what is a graham steel murmur

A

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

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24
Q

What are the eponymous signs of aortic regurgitation

A
  • 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.
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25
Q

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

A

pressure on the trachea, eg by a tumour.

26
Q

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

A

recurrent laryngeal nerve pals

27
Q

What pathology is associated with this cough? Barking coughs

A

in croup

28
Q

What pathology is associated with this cough? Chronic cough

A
  • pertussis - TB - foreign body - asthma (eg nocturnal)
29
Q

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

A
  • acid irritation of the lungs in oesophageal reflux - side-eff ect of ACE inhibitors.
30
Q
A
31
Q

WHat are causes of Dyspnea?

A
32
Q

What pathology does this type of breathing indicate?

Bronchial breathing

A

Consolidation, localized fi brosis, above pleural/percardial effusion

Harsh with gap between inspiration and expiration. Increased vocal resonance and whispering pectoriloquy

33
Q

What pathology does this type of breathing indicate?

Diminished breath sounds

A

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

34
Q

What pathology does this type of breathing indicate?

Silent chest

A

Life-threatening asthma

35
Q

What pathology does this type of breathing indicate?

Wheeze (rhonchi)

A

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)
36
Q

What pathology does this type of breathing indicate?

Crackles (crepitations) - fine and late inspiratory

A

Pulmonary oedema

37
Q

What pathology does this type of breathing indicate?

Crackles (crepitations)- • Coarse and mid inspiratory

A

Bronchiectasis

38
Q

What pathology does this type of breathing indicate?

Crackles (crepitations)- • Early inspiratory

A

• Small airway disease

39
Q

What pathology does this type of breathing indicate?

Crackles (crepitations) • Late/pan inspiratory

A

• Alveolar disease

40
Q

What pathology does this type of breathing indicate?

Crackles (crepitations) • Disappear post cough

A

• Insignificant

41
Q

What pathology does this type of breathing indicate?

Pleural rub

A

• Pneumonia

Pulmonary infarction

42
Q

What pathology does this type of breathing indicate?

Pneumothorax click

A

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

43
Q

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)

A

PLEURAL EFFUSION

44
Q

what condition is this lung presentation characteristic of?

Expansion decreased

Percussion note increased

Breath sounds decreased

Trachea + mediastinum shift towards the affected side

A

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

45
Q

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

A

CONSOLIDATION

46
Q

what condition is this lung presentation characteristic of?

Expansion decreased

Percussion noteincreased

Breath sounds decreased

Trachea + mediastinum shift away from the affected side

A

TENSION PNEUMOTHORAX

47
Q

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

A

FIBROSIS

48
Q

what are causes of vomitting

A
49
Q

What conditions could cause Epigastric pain?

A

Pancreatitis,

gastritis/duodenitis,

peptic ulcer,

gallbladder disease,

aortic aneurysm.

50
Q

What conditions could cause Left upper quadrant pain?

A

Peptic ulcer,

gastric or colonic (splenic fl exure) cancer,

splenic rupture,

subphrenic or perinephric abscess,

renal (colic, pyelonephritis)

51
Q

What conditions could cause Right upper quadrant: pain?

A

Cholecystitis,

biliary colic,

hepatitis,

peptic ulcer,

colonic cancer (hepatic fl exure),

renal (colic, pyelonephritis), s

ubphrenic/perinephric abscess.

52
Q

What conditions could cause Loin pain?

A

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

53
Q

What conditions could cause Left iliac fossa pain?

A

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

54
Q

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

A

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.

55
Q

What conditions could cause Pelvic:pain?

A

Urological:

UTI,

retention,

stones.

Gynae:

menstruation,

pregnancy,

endometriosis ,

salpingitis,

endometritis

ovarian cyst torsion.

56
Q

What conditions could cause • Generalized: abdominal pain?

A

Gastroenteritis,

irritable bowel syndrome,

peritonitis,

constipation

57
Q

What conditions could cause central abdominal pain?

A

Mesenteric ischaemia,

abdominal aneurysm,

pancreatitis

58
Q

Faecal incontinence:

1. causes

2. Assesment

A

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

59
Q

What can cause Flatulence?

What is the main cause?

A
  1. Air swallowing - main gas nitrogen
  2. caeliac- methan, H2, Co2
60
Q

What are common causes for tenesmus?

A
  • common in IBS
  • caused by tumours
61
Q

What are common causes for steatorrhoea?

A

Ileal disease (eg Crohn’s or ileal resection),

pancreatic disease

obstructive jaundice (due to decreased excretion of bile salts from the gallbladder).

Meded Flashcards 2020 (36 decks)

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