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Year 3 Cardio > OSCE > Flashcards

OSCE Flashcards

1
Q

Name three investigations (bedside and imaging) which may be useful in the context of a suspected ventricular septal defect (VSD)

A

Pulse oximetry
Echocardiogram
Chest X-ray
ECG

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2
Q

What would pulse oximetry show if there is a ventricular septal defect?

A

VSD causes reduced oxygen saturation from the mixing of blood or from decreased cardiac output secondary to pulmonary hypertension

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3
Q

What might be seen on a CXR with a VSD?

A

: may reveal cardiomegaly and pulmonary oedema

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4
Q

What would an ECG show in VSD?

A

May show LV hypertrophy in moderate or large VSDs. Pulmonary hypertension may also cause increased RV pressure and RV hypertrophy.

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5
Q

What murmur is seen in VSD?

A

Pansystollic

Loudest at the lower-left sternal border

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6
Q

What is clubbing?

A

uniform soft tissue swelling of the terminal phalanx of a digit with subsequent loss of the normal angle between the nail and the nail bed.

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7
Q

What are the cardiac causes of clubbing?

A 
Congenital cyanotic heart disease
Infective endocarditis
Atrial myxoma (very rare)
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8
Q

What is the test for clubbing called?

A

Shamroth’s Window test

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9
Q

What is a clamshell incision?

A

urvilinear ‘W’ shape that extends across the anterior chest from the mid-axillary line on either side and is located in the sub-mammary fold

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10
Q

What does a clamshell incision indicate?

A

provides complete exposure to the thoracic cavity

used procedures requiring bilateral access

e.g. malignancy, bilateral transplant

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11
Q

Describe the clinical relevance of jugular venous pressure

A

Jugular venous pressure provides an indirect measure of central venous pressure.

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12
Q

What are the cardiac causes of a raised JVP?

A

Right-sided heart failure
Tricuspid regurgitation
Constrictive pericarditis

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13
Q

What are some causes of right-sided HF?

A

left-sided HF

pulmonary hypertension

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14
Q

What are some causes of pulmonary hypertension?

A

COPD

Interstitial lung disease

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15
Q

What are some causes of constrictive pericarditis?

A

Idiopathic
Rheumatoid Arthritis
TB

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16
Q

Define aortic stenosis

A

Aortic stenosis is one of the most common and serious valve disease problems. It is a narrowing of the aortic valve opening and restricts the blood flow from the left ventricle to the aorta.

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17
Q

What murmur is heard with aortic stenosis?

A

Cresendo-decrescendo midsystolic ejection murmur

Radiates to the carotids

Louder on expiration and leaning forwards

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18
Q

What is a thrill?

A

Palpable vibration caused by turbulent blood flow through a heart valve

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19
Q

What are some causes of aortic stenosis?

A

Calcification of aortic valves

Congenital bicuspid aortic valve

Rheumatic heart disease

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20
Q

When does mitral regurgitation occur?

A

Back flow of blood from left ventricle to left atria during ventricular systole

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21
Q

What murmur is heard with mitral regurgitation?

A

Pan-systolic murmur
Loudest on expiration and when patient is leaned to the LHS and using the bell
Radiates to axilla

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22
Q

What are some causes of mitral regurgitation?

A 
Infective endocarditis
Acute myocardial infarction with rupture of papillary muscles
Rheumatic heart disease
Congenital defects of the mitral valve
Cardiomyopathy
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23
Q

What is aortic regurgitation?

A

Backflow of blood from the aorta into the left ventricle during ventricular diastole.

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24
Q

What murmur is heard with aortic regurgitation?

A

Decressendo Early diastolic murmur

Loudest at the left sternal edge

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25
Q

What are the two main causes of aortic regurgitation?

A

Valvular disease

Aortic root dilatation

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26
Q

What are some valvular diseases?

A

Congenital bicuspid aortic valve
Rheumatic heart disease
Infective endocarditis

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27
Q

What are some causes of aortic root dilatation?

A

Aortic dissection
Connective tissue disease e.g. Marfans
Aortitis

28
Q

What is mitral stenosis?

A

narrowing of the mitral valve, which results in decreased filling of the left ventricle during systole and increased left atrial pressure (due to incomplete left atrial emptying)

29
Q

What murmur is heard with mitral stenosis?

A

low-pitched, rumbling, mid-diastolic murmur

loudest over apex when manoeuvred to left

30
Q

What is the most common cause of mitral stenosis?

A

Rheumatic heart disease

31
Q

What are some clinical features of mitral stenosis?

A

Low-volume pulse, could be irregularly irregular (AF is common)

Loud S1 with tapping apex beat

Malar flush

32
Q

When does mitral valve proplase occur?

A

mitral valve leaflets prolapse into the left atrium during systole

most common valvular abnormality

33
Q

What are the clinical features of a mitral valve prolapse?

A

Mid-systolic click (prolapse of the mitral valve into left atrium)
Followed by a mid or late-systolic murmur
Heard loudest at the apex
Loudest in expiration

34
Q

What is tricuspid regurgitation?

A

Backflow of blood from the right ventricle into the right atrium during ventricular systole

35
Q

What murmur is heard in tricuspid regurgitation?

A

Pansystolic murmur heard loudest over the tricuspid region

36
Q

What are some causes of tricuspid regurgitation?

A

RV dilatation secondary to pulmonary stenosis or pulmonary HTN

Rheumatic fever

Infective endocarditis

Carcinoid syndrome

Congenital

37
Q

What are some signs of right-sided heart failure?

A

Right ventricular heave
Peripheral oedema
Hepatomegaly
Ascites

38
Q

What is pulmonary stenosis?

A

Narrowing of the pulmonary valve

39
Q

What are some causes of pulmonary stenosis?

A

Turner’s
Rheumatic fever
Carcinoid syndrome

40
Q

What murmur is heard in pulmonary stenosis?

A

Ejection systolic murmur loudest on inspiration

Radiates to left shoulder/infraclavicular region

41
Q

What is pulmonary regurgitation?

A

Backflow of blood from the pulmonary artery into the right ventricle during ventricular diastole

V rare

42
Q

What are some causes of pulmonary regurgitation?

A

Pulmonary hypertension
Infective endocarditis
Congenital valvular heart disease

43
Q

What is tricuspid stenosis?

A

Narrowing of the tricuspid valve

44
Q

What murmur is heard in tricuspid stenosis?

A

Narrowing of the tricuspid valve

45
Q

When do you get radio-femoral delay?

A

Coarctation of aorta

46
Q

What is the management for an uncomplicated descending aorta dissection?

A

Medically - beta blockade and analgesia

47
Q

How are aortic dissection’s classified?

A

Stanford classification
type A - ascending aorta, 2/3 of cases
type B - descending aorta, distal to left subclavian origin, 1/3 of cases

48
Q

What investigations are done for aortic dissection?

A

Unstable patient - Transoesophageal echocardiography

Stable patient - CT angiography

49
Q

For how long can you not drive post MI no angioplasty?

A

4 weeks

50
Q

For how long can you not drive post MI with angioplasty?

A

1 week

51
Q

For how long can you not drive following pacemaker insertion?

A

1 week

52
Q

For how long can you not drive following CABG?

A

4 weeks

53
Q

How is symptomatic bradycardia treated?

A

IV atropine

54
Q

What is treatment for newly diagnose hypertension?

A

CCB first line for non-diabetics

55
Q

Give an example of a CCB

A

Amplodipine

56
Q

When is a ACEi first line HTN treatment?

A

In diabetes

57
Q

Give an example of a ACEi

A

Ramipirl

58
Q

What is the management for narrow tachycardia?

A

If no shock:
Vasovagal manoeuvre
Adenosine or Verapamil if asthmatic

If signs of shock:
DC cardioversion

59
Q

What is the first line treatment for regular broad complex tachycardias without adverse features?

A

IV amiodarone

60
Q

What is first-line treatment for SVT with narrow complexed tachycardia?S

A

IV adenosine

61
Q

When are J waves seen?

A

Hypothermia

62
Q

When are delta waves seen?

A

WPW

63
Q

When are U-waves seen?

A

Hypokalaemia

64
Q

What might be seen on CXR in aortic dissection?

A

Widened mediastinum

65
Q

What is the treatment for torsades des pointes?

A

IV Mg

Year 3 Cardio (12 decks)

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