Talley's short's

Question 1

Turner’s syndrome appearance

Answer 1

Short stature
Wide spaced nipples
Short and webbed neck

Question 2

Turner’s syndrome manifestations

Answer 2

Cardiac abnormalities
Ovarian failure
HTN

Question 3

What might malar flush indication (in CVS exam)

Answer 3

Mitral stenosis

Pulmonary stenosis

Question 4

Mitral stenosis murmuir

Answer 4

mid-diastolic rumbling murmur

Question 5

Mitral stenosis severity (clinical signs)

Answer 5

small pulse pressure
early-opening snap
long murmur
signs of pulmonary hypertension

Question 6

Non ECHO investigation findings in mitral stenosis

Answer 6

p mitrale
AF
R ventricular systolic overload
r axis deviation

CXR:

• mitral valve calcification
• big left atrium
• signs of pulmonary hypertension
• signs of heart failure

Question 7

Indications for surgery in mitral stenosis

Answer 7

exertional dyspnoea and falling valve area <1cmsq with signs of increasing right heart pressures

Question 8

mitral stenosis signs

Answer 8

malar flush
tapping apex beat
narrow pulse pressure (severity)
mid diastolic rumbling murmur

Question 9

aetiology of mitral regurgitation

Answer 9

chronic:
degenerative
prolapse
rheumatic
papillary muscle dysfunction
connective tissue (RA, ank spond)
congenital

acute:
infective endocarditis
myocardial infarct
surgery
trauma

Question 10

clinical signs of severity in mitral regurg

Answer 10

enlarged LV
pulmonary HTN
third  heart sound
early diastoli rumble
soft first heart sound
aortic component of 2nd heart sound is earlier
small volume pulse
LV failure

Question 11

indications for surgery in mitral regurg

Answer 11

dyspnoea III/IV
progressive LV dysfunction
acute MR w haemodynamic compromise

Question 12

hypertension exam

Answer 12

general inspection
- Cushing’s, acromegaly, polycythemia, uraemia (modify exam if present)

confirm blood pressure

• both arms
• lying standing
• measure in legs

pulse

• radial radial
• radial femoral

hands
- vasculitis changes

face
- polycythemia

fundi
- hypertensive changes

CVS

• LVH, coarctation of the aorta
• 4th heart sound

Abdo

• renal masses
• abdo aneurysm
• renal bruits

Urinalysis

Question 13

hypertensive retinopathy grades

Answer 13

grade I
- vascular attenuation (silver wiring)

grade 2
- grade 1 + AV nicking

grade 3
- grade 2+ retinal oedema, cotton wool spots, flame haemorrhages, copper wiring

grade 4
- grade 3 + optic disc oedema/silver wiring

Question 14

Marfan’s syndrome examination

Answer 14

Normal CVS exam

+

Hands/arms: arachnodactyly (spider fingers), joint hypermobility as well as long thin limbs
arm span (exceed height)

Face:- long/narrow face, lens dislocation, blue sclerae; high arch palate

Chest: - pectus carinatum (protrudes out)/excavatum

Heart:

• AR, mitral valve prolapse
• coarctation of the aorta

Back:

• kyphoscoliosis
• hypermobility

Question 15

examination for oedema (lower limb pitting)

Answer 15

general inspection - generalised or localised oedema

nutrition

myxoedema

pitting lower limb oedema:

• define extent
• look for DVT
• varicose veins
• inguinal nodes
• abdo - wall oedema, wall veins, ascites, abdo masses, liver disease
• JVP
• signs of constrictive pericarditis (pulsus paradoxus, absent apex beat, rapid x/y JV descent)
• feel all nodal groups
• delayed ankle jerks (hypothyroidism)

Question 16

superior vena caval obstruction examination

Answer 16

general appearance - cushingoid, exophtalos, conjunctival injection, hoarseness

pupils - horner’s

fundi - venous dilation

neck - enlarged, JVP, thyroid

Pemberton’s

Supraclavicular lymphadenopathy, listenover trachea for inspiratory stridor

chest - distended venous collaterals

oedema in arms

peripheral manifestations of lung carcinoma (bony tenderness, neurological exam, horners)