the cardiac examination Flashcards

1
Q

cardiac muscle is supplied by

A

three coronary arteries

  • left anterior descending artery
  • circumflex artery
  • right coronary artery
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2
Q

causes of cachexia

A

malignant disease

secere cardiac failure (cardiac cachexia)

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3
Q

marfan syndrome

A

tall stature, thoracic kyphosis, pactus excavatum, arachnodactyly (spider fingers), long limbs, aortic regurgitation and a high arched palate

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4
Q

osler’s nodes

A

rare manifestation of endocarditis
red, raised, tender palapable nodules on the pulps of the fingers or toes
or on thenar or hypothenar eminences

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5
Q

janeway lesions

A

non tender erythematous maculopapular lesions containing bacteria, which occur very rarely on the palms or pulps of the fingers in patients with infective endocarditis

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6
Q

tendon xanthomata

A

yellow orange deposits of lipid in the tendons that occur in type 2 hyperlipidaemia
can be seen over the tendons of the hand or arm

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7
Q

palmar xanthomata

A

xanthomata over the elbows

indicative of type 3 hyperlipidaemia

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8
Q

tuberuptive xanthomata

A

xanthomata of the knee in type 3 hyperlipidaemia

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9
Q

type 2 hyperlipidaemia

A

elevated LDL or elevated VLDL

choleserol alone or both cholesterol and tryglycderides are elevated

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10
Q

regullar rhythm bradycardia

A

physiological eg. ahletes
drugs eg. beta blockers, digoxin, amiodarone
hypothyroidism eg. decreassed sympathetic actvitiy
hypothermia
raissed ICP
third degree atrioventricular (AV) block or third degree AV block
MI
vasovagal syncope
jaundice - in severe cases

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11
Q

irrugularly irregular rhythm bradycardia

A

AF
alcohol, post thoracotomy, idiopethic
mitral valve disease or any cause of left atrial enlargemnt

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12
Q

regularly irregular rhythm

A

sinus arrythmia

second degree AV block

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13
Q

regular rhythm tachycardia

A
hyperdynamic circulation due to exercise, emotion, fever, pregnancy, thyrotoxicosis, anaemia, arteriovenous fistula, ber-beri
congestive heart failure
costrictuve pericarditis 
drugs 
normal variant denervated heart eg. diabetes 
hypovolaemic shock 
supraventricular tachycardia 
atrial flutter 
ventricular tachycardia 

sinus tachycardia due to thyrotoxicosis, pulmonary empbolism, myocarditis, mycardia ischamia, fever, acute hypoxia or hypercapnia,

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14
Q

cause of atrial fibrullation

A

bombardment of the atrioventricular node with impulses, some of which are conducted to the ventricles because the AV node is unable to conduct at such high rates
ventricles beat irregularly at rates of 150-180 per minute

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15
Q

bigeminy

A

every second beat is an ectopic one

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16
Q

trigeminy

A

every third beat is an ectopic one

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17
Q

radial radial delay usually due to

A

large arterial occlusion by an atherosclerotic plaque or anuerysm or to subclavian artery stenosis on one side

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18
Q

pulsus alternans

A

alternating strong and weak pulse

19
Q

grade 1 hypertension

A

mild

140-159/90-99

20
Q

grade 2 hypertension

A

moderate

160-179/100-109

21
Q

grade 3 hypertension

A

severe

>180/>110

22
Q

after measuring BP in both arms

A

use the arm with the highest blood pressure

23
Q

arcus senilis

A

half or complete grey circle seen around the outer perimeter of the pupil and is probably associated with some increase in cardiovascular risk

24
Q

marfan syndrome

A

aortic root dilatation causing aortic regurg

mitral valve prolapse causing mitral regurgitation

25
height of the JVP
if the JVP is more than 3cm above the sternal angle then the right heart filling pressure is increased
26
abdominojugular reflux test
if there is right ventricular failure or left ventricular failure the JVP will remian elevated after 10 seconds of abdominal pressure
27
funnel chest
pectus excavatum
28
hunchback
hyphoscoliosis
29
the apex beat is located
at the 5th intercostal space medial to te midclavicular line
30
if the apex beat is displaced laterally or inferiorly
enlargement
31
pressure loaded apex beat
heaving forceful aortic stenosis or hypertension
32
volume loaded
displaced, diffuse, non sustained | advanced mitral regurgitation or dilated cardiomyopathy
33
dyskinetic apex
uncoordinated impulse felt over a larger area due to left ventricular dysfunction
34
double impulse apex beat
two distinct impulses are felt with each systole | characteristic of hypertrophic cardiomyopathy
35
tapping apex beat
``` felt when the first heart sound is palpable mitral or (rarely) tricuspid regurgitation ```
36
parasternal impulse
in cases of right ventricular enlargement or severe left atrial enlargement right ventricle becomes pushed anteriorly impulse is felt by the heel of the hand being lifted of the chest with each systole
37
presence of a thrill indicates
severe valve lesion
38
pansystolic murmur may be
mitral regurgitation tricuspid regurgitation ventricular septal defect aotropulmonary shunts
39
midsystolic murmur may be
aortic stenosis or sclerosis pulmonary stenosis hypertrophic cardiomyopathy pulmonary flow murmur of aan atrial septal defect
40
late systolic murmur may be
mitral valve prolapse | papillary muscle dysfunction (due usually to ischaemia of hypertrophic cardiomyopathy)
41
early diastolic murmur may be
aortic regurgitation | pulmonary regurgitation
42
mid diastolic murmur may be
mitral stenosis tricuspid stenosis atrial myxoma austin flint murmur of aortic regurgitation carey coombs murmur of acute rheumatic fever
43
pre systolic murmur may be
mitral stenosis tricuspid stenosis atrial myxoma
44
continuous murmur may be
patent ductus arteriosus arteriovenous fistula (coronary artery, pulmonary, systemic, haemodialysis fistula) aortopulmonary connection venous hum rupture of sinus of valsalva into right ventricle or atrium mammary souffle