Physical examination findings

Question 1

What is the changes in JVP seen during inspiration in a healthy person? Give the reason.

Answer 1

The JVP normally falls with inspiration due to decreased intrathoracic pressure

Question 2

What is Kussmaul’s sign?

Answer 2

It is a paradoxical rise in JVP on inspiration, or failure in the appropriate fall of JVP with inspiration.

Question 3

What are the waves seen in a jugular pulse tracing?

Answer 3

a wave, v wave and occasionally c wave

Question 4

When do the waves in a jugular pulse tracing occur in?

Answer 4

a wave is from right atrial contraction.
v wave is from right atrium filling when the tricuspid valve is closed.
c wave is seen when the tricuspid valve closes.

Question 5

How is pain caused by venous insufficiency relieved?

Answer 5

Pain caused by venous insufficiency is often relieved by walking or by elevating the legs. Compression stockings usually ameliorate the pain.

Question 6

What is pectus excavatum?

Answer 6

Funnel chest: It is a posterior displacement of the lower sternum

Question 7

What is pectus carinatum?

Answer 7

Pigeon chest: It is a deformity of the chest characterised by a protrusion of the sternum and ribs.

Question 8

What is the temperature of the skin of the affected region in Peripheral Arterial Disease and in Peripheral Venous Disease?

Answer 8

In Peripheral Arterial disease, the temperature is normal or cool.
In Peripheral Venous disease, the temperature is normal or increased.

Question 9

Name 6 ischaemic signs of lower limb PAD

Answer 9

absence of hair, thin skin and brittle nails
Cold and pallor
Pulse may be diminished or absent

Question 10

What are the 6 signs of acute limb ischaemia?

Answer 10

The 6 P’s:
Pulseless
Paralysis
Paraesthesia (loss of light touch sensation over the forefoot/dorsum of hand)
Pain on squeezing muscle (indicative of impending muscle infarction)
Perishing cold
Pallor

There may also be absence of hair, thin skin and brittle nails

Question 11

Name the alternative diagnosis for chest pain: cardiovascular.

Answer 11

Pericarditis, Aortic dissection, Aortic stenosis, Myocarditis

Question 12

What are the alternative diagnosis for chest pain: respiratory

Answer 12

Pulmonary embolism, Pneumothorax, Lung cancer, Pleurisy

Question 13

What are the alternative diagnosis for chest pain: Musculoskeletal

Answer 13

fractured/bruised rib, Tietze’s syndrome (Costochrondritis), Muscle strain/tear

Question 14

What are the differential diagnosis for chest pain: GI

Answer 14

Gastro-oesophageal reflux, Oesophageal spasm, Peptic ulcer disease, Pancreatitis, Cholecystitis

Question 15

What is suspected if chest pain is relieved within minutes by rest or glyceryl trinitrate?

Answer 15

Suspect angina.

Question 16

What is the difference in the effect of GTN on angina and oesophageal spasm?

Answer 16

GTN can relieve chest pain from angina within minutes, but it will take longer for oesophageal spasm.

Question 17

Describe the chest pain experienced in aortic dissection.

Answer 17

In aortic dissection, chest pain is classically instantaneous, tearing and interscapular. It may also be retrosternal.

Question 18

What features make cardiac chest pain unlikely?

Answer 18

1. Stabbing shooting pain
2. Pain lasting for <30secs, however severe
3. well-localised, left sub-mammary pain
4. pain of continually varying position
5. Youth

Question 19

What is pleurisy? What are the signs and symptoms of Pleurisy?

Answer 19

Pleurisy is inflammation of the pleura.
It presents with pleuritic chest pain (sharp pain) that is worsened on breathing, coughing or sneezing. Patients tend to breath shallowly to minimise pain

Question 20

What are the signs of accelerated phase hypertension?

Answer 20

In accelerated phase hypertension, there is a rapid increase in BP, resulting in severe hypertension (systolic >200mmHg, diastolic >130mmHg) + bilateral retinal haemorrhages and exudates.
Papilloedema may or may not be present.
Headache and visual disturbances.

Question 21

Squatting down can accentuate which heart murmur sound?

Answer 21

Ejection systolic murmur - aortic stenosis - as it increases venous return.

Question 22

How is the sound of the murmur in mitral stenosis accentuated?

Answer 22

Asking the patient to lean to the left

Question 23

Valsalva manoeuvre increases the heart sounds in which heart conditions? How is Valsalva manoeuvre done?

Answer 23

Valsalva manoeuvre accentuates heart sounds in mitral valve prolapse and hypertrophic obstructive cardiomyopathy.
Ask patient to breathe out as if he is straining.