History And Pe Flashcards
NYHA
functional capacity /exercise tolerance
I - asymptomatic
II - comfortable at rest, slight limitation in ordinary physical activity
III - comfortable at rest, but with marked limitation with less than ordinary activities
IV - symptomatic at rest
CCS
I - ordinary physical activity such as walking and climbing stairs, doesn’t cause angina
Angina with strenous work or rapid prolonged exertion
II - slight limitation of activity, walkijg or climbing stairs rapidly, walking uphill, walking or stair climbing after meals, in cold, wind or emotional stress,
Walking more than 2 blocks on normal level and climbing more than one flight of stairs under normal conditions
III - marked limitation of ordinary physical activity
Walking 1-2 blocks on normal level and climbing 1 flight of stairs under normal conditions
IV - Inability to carry on any physical activity without discomfort. Anginal syndrome may be present at rest
Emaciation
Chronic heart failure
Malignancy
Infection
Patients with palpitations, HR less than 60
Significant arrhythmia
LR 3
Cheyne Stokes, OSA suggests
Severe systolic heart failure
Central cyanosis
Hereditary methemoglobenemia
Peripheral Cyanosis / acrocyanosis
Small vessel constriction in severe HF or peripheral vascular disease
Describe Cyanosis in PDA and PUlmonary hypertension with RL shunting
Differential cyanosis - affecting lower but not upper extremities
Findings on Osler Weber Rendu Syndrome
Hereditary telangiectasias onnlipsnmouth tounge and mucosa resembles spiders
At lungs, may cause right to left shunting and central cyanosis
Telangiectasias can also be seen in
Scleroderma with or without pulmonary hpn
Describe findings in iron overload /hemochromatosis
Tanned or bronze discoloration
Ecchymoses -
Petechiae -
Purpura -
- anticoagulant or antiplatelet use
- thrombocytopenia
- IE or leukoclastic vasculitis
Xanthomas at palmar creases are specific for
Type III hyperlipoprotenemia
Describe pseudoxanthoma elasticum
Leathery, cobblestobe, pluced chicken appearance
Extensive lentiginoses with multiple CV syndromes - myxoma, asd, hcom, valvular stenoses
Dev delay associated cardiovascular symptoms - LAMB, CARNEY, LEOPARD
In pxs wjth Lupus pernio, erythema nofosum or granula annulare with heartnfaioure and syncope, what will you suspect
Cardiovascular sarcoid
High arched palate -
Large protruding tongue -
Bifid uvula -
Orange tonsils -
Marfan
Amyloidosis
Loeys-Dietz
Tangier disease
Describe pxs with possible congenital heart disease with Noonan, Turner and Down syndromes
Hypertelorism, lowset ears, microagnathia, webbed neck
Valvular heart disease associated with Osteogenesis imperfecta
MR, AR
Lacrimal gland hyperplasia
Sarcoidosis
Mitral facies
Pink purple patches with telengiactasias over malar eminences
Can also be seen in dses with low cardiac output and PUlmonary hypertension
Unopposable “fingerized” thumb
Holt oram syndrome
Arachnodactyly
Marfan
Janeway lesions
Non tender, slightly raised areas of hemorrhage om palms and soles
Osler nodes
Tender, raised nodules on pads of fingers and toes
Splinter hemorrhages
Linear petechiae in nailbeds
Normal jvp, with signs of venous disease
Chronic venous insufficiency
Lower extremity or presacral edema with elevated jvp
Heart failure
Volume overload
Homans sign
Calf pain on dorsiflexion of foot - neither specific nor sensitive with dvt
Lipodystrophy
Redistribution of fat from extremities to central or abdominal stores
Normal us clubbed nail : phalangeal depth ratio
Normal- DPD < IPD
Clubbed - DPD >IPD
Normal us clubbed nail : phalangeal depth ratio
Normal- DPD < IPD
Clubbed - DPD >IPD
Schamroth sign
IF no clubbing, nail to nail opposition creates a diamond shaped window ; in clubbing there
is obliteration of this space
Cardiac aburmalities to be expected in AnkyIosing spondylitis with severe kyphosis
AR , lst degree Av block
Straight back syndrome
MVP
Thrill over well developed Intercostal artery collateralS suggests
Aortic coarctation
Enlarged liver and tender in HF, systolic pulsations signifies
Tricuspid Regurgitation
