handbook difficult Flashcards
_____________, with or without cardiac dilatation, is seen in conditions such as congestive heart failure (for example, due to ischaemic heart disease), right heart failure (for example, cor pulmonale), right ventricular myocardial infarction, volume overload (such as in renal failure), mitral stenosis, pericardial constriction and effusion
A raised JVP
A physiological state in which the JVP can be seen is ___________________
pregnancy, reflecting volume expansion
A raised and nonpulsatile JVP is a manifestation of __________________
superior vena cava obstruction
The _____________ is usually seen rather than felt
JVP
The pulsation is abolished by ________________ at the root of the neck with the transverse application of a finger across the medial sternomastoid
gentle compression
In the setting of ______________________, the JVP may even be palpable, and it requires more pressure to abolish the pulsation
severe tricuspid incompetence
The JVP normally has two characteristic peaks, an ___________ wave corresponding to atrial contraction and a smaller ___________ wave corresponding to right ventricular contraction
‘a’
‘v’
The carotid pulse may transmit a __________ wave but this wave is less easily identified at the bedside
‘c’
There are two descents that are described.________________. These are more difficult to appreciate than the peaks.
‘X’ and ‘y’.
The ________ wave is also increased in pulmonary hypertension (for example, secondary to mitral stenosis, or in primary pulmonary hypertension) and in the rarely seen tricuspid stenosis.
‘a’
The _________ wave is prominent in tricuspid regurgitation. Sometimes the _________ wave may extend up behind the ears and the top of the JVP may be missed
‘V
‘V
It is an important part of clinical examination to sit the patient up at ____________ to try to see the top of the JVP as part of routine examination when this is not defined at ________________
90 degrees
45 degrees
The JVP moves with respiration, falling on ________
inspiration
This is not seen in the presence of a significant pericardial effusion or constrictive pericarditis, the ‘Kussmaul sign’.
The JVP moves with respiration, falling on inspiration
The *x’ and ‘y descents are exaggerated in ___________ and ______________ respectively, The external jugular vein is often mistaken for the internal jugular vein
pulmonary hypertension and constrictive pericarditis
It is more readily seen as it is superficial and courses across the sternomastoid muscle
The external jugular vein
The ________ jugular vein can be held up at the root of the neck where the vein traverses the fascia to join the deeper vein
external
This is often mistaken for a raised JVP. A clue is that the vein may be no longer apparent after movement of the head.
The external jugular vein is often mistaken for the internal jugular vein
Buttock and thigh muscle ischaemic claudication pain on walking relieved by rest is due to obstruction of the _____________ artery by plaque or thrombus
common or external iliac
The typical symptom of occlusion of the superficial femoral artery is ______________ on walking and would not involve the buttock or thigh musculature
calf claudication
____________ muscle pain becomes progressively severe with increasing effort, and thus the onset may consistently relate to a given distance walked
ischaemic
______________ due to disc or facet joint encroachment usually affects the mid or lower lumbar spinal canal, and can cause nerve root impingement symptoms
Spinal canal stenosis
with pain aggravated by walking and requiring recumbency for relief
nerve root impingement symptoms
Pain distribution is related to ____________________ rather than to ischaemic muscle groups
lower lumbar dermatome segments