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CMP- Flashcards > The Chest: Chest Wall, Pulmonary, and Cardiovascular Systems; The Breasts > Flashcards

The Chest: Chest Wall, Pulmonary, and Cardiovascular Systems; The Breasts Flashcards

1
Q

What is pulsus paradox ?

A

A drop in SBP of > 10 mmHg during inspiration is called Pulsus pardox.

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2
Q

What is the mechanism of pulsus paradox?

A

Increase in RV filling causing bulging of the septum to the left ventricle during inspiration + reduction in left ventricular filling reduces SV of the left ventricle during inspiration leading to Pulsus paradox.

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3
Q

What are the causes of pulsus paradox?

A
  • COPD and Asthma attacks
  • moderate to severe cardiac tamponade
  • Constrictive pericarditis.
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4
Q

Cardiac tamponade occurs in what % of patients with neoplastic, tubercular or purulent pericarditis ?

A

61 %

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5
Q

What are the elements of Beck’s triad in cardiac tamponade?

A
  • Low BP
  • Distended Juglar veins
  • Muffled heart sounds.
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6
Q

When is pericardial rub heard in cardiac tamponade ?

A

When it occurs due to inflammatory pericarditis.

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7
Q

What type of aortic dissection causes cardiac tamponade ?

A

stanford Type A or dissection of the ascending aorta.

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8
Q

What is Kusmul’s sign ?

A

It is the paradoxical raise in JVP during inspiration and is classically seen in constrictive pericarditis.

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9
Q

What is the mechanism of Kusmul’s sign ?

A

It develops due to impaired filling of the right ventricle due to fluid in the pericardial space or poor compliance of myocardium or pericardium.

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10
Q

What causes S2 heart sound ?

A

It is caused by tensing and reverberation of the aortic and pulmonic valves and the great vessels heard during

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11
Q

What are the components of the S2 ?

A

A2 of aortic valve closure and P2 which is the delayed closure of pulmonic valve due to right ventricular filling during inspiration causing a longer ejection time.

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12
Q

What is the difference in the second heart sound during inspiration and expiration ?

A

During inspiration it is split and during expiration it is single under physiologic conditions.

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13
Q

What is the best location to hear the physiologically split second heart sound ?

A

Pulmonic area

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14
Q

What is the cause of a P2 louder than A2 in pulmonic area ?

A

Pulmonary HTN most commonly due to ASD

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15
Q

What causes wide splitting of S2 ?

A

prolonged RV ejection time or shortened LV ejection time.

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16
Q

What are the causes of prolonged RV ejection time ?

A
  • Pulmonic stenosis or HTN causing increased resistance to ejection.
  • Increased R ventricular SV as in ASD.
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17
Q

What are the causes of lower intensity A2 of S2 heart sound ?

A
  • Mitral or aortic regurgitation
  • Low DBP
  • Relatively immobile aortic valve
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18
Q

What are the causes of fixed splitting of S2 ?

A
  • The most common cause is ASD.
  • Any condition that causes severe RVF can cause fixed splitting RV outflow obstruction, pulmonary HTN, and primary RV dysfunction.
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19
Q

What is the character of the murmur of mitral stenosis ?

A

Low pitched diastolic rumble best heard at the mitral area during inspiration.

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20
Q

What is the character of the murmur of aortic regurgitation ?

A

An early diastolic decrescendo murmur

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21
Q

What is the cause of wider pulse pressure in AR ?

A

It is caused by the combined effect of rapid decrease in arterial pressure due to regurgitation of ejected blood into the LV and the rapid increase in SV due to ventricular overload. It is the cause of Watson’s collapsing pulse and Corrigan’s collapsing pulse.

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22
Q

What is De Musset’s sign ?

A

head bobbing seen in AR

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23
Q

What is Landlfi’s sign ?

A

alternating systolic constriction and diastolic dilatation of pupils seen in AR.

24
Q

Gerhard’s sign ?

A

Systolic pulsation of the spleen.

25
Q

What is Muller’s sign ?

A

Systolic pulsation of the Uvula

26
Q

What is Rosenbach’s sign ?

A

Systolic pulsation of the liver.

27
Q

What is paradoxical splitting of S2 ?

A

It is the splitting of S2 occuring during expiration rather than inspiration.

28
Q

reverse or paradoxical splitting of S2 suggests ___ ?

A

HCOM and normal splitting favours VSD or Mitral regurgitation.

29
Q

What is the difference between S3, S4 and S1 and S2?

A

S1 and S2 have similar intensity and high pitched than S3 and S4

30
Q

What causes S3 ?

A

It is heard during early diastolic rapid filling and is created by blood slapping on to an overly complaint ventricle as in HFpEF

31
Q

What causes S4?

A

It is a late diastolic sound which occurs due to blood thrashing on to a non-complaint ventricle as in HFrEF due to concentric LVH. It is always pathologic.

32
Q

What is the best position to hear left ventricular S3 and S4 ?

A

Left lateral decubitus position at the apex

33
Q

What is the best position to hear right ventricular S3 and S4 ?

A

along the lower left sternal border.

34
Q

What S3 and S4 increases in intensity during inspiration ?

A

RV, the LV S3 and S4 are not affected by inspiration.

35
Q

What is the quality of the murmur of aortic stenosis heard at the aortic area ?

A

Crescendo -decresendo

36
Q

what is Parvus and tardus ?

A

It is the weak and slowly raising nature of the carotid pulse due to aortic stenosis.

37
Q

What are the two causes of acute holosystolic murmurs ?

A
  • Post MI inter ventricular septum rupture that occurs 3 to 5 days after MI.
  • MI causing dysfunction of papilary muscle or corde tendeni can cause it.
38
Q

What is the relationship of VSD location relative to crista and the pan-systolic murmur location?

A

VSD below the crista = Murmur best heard at 3rd or 4th ICS.
VSD above the crista = murmur best heard at second ICS.

39
Q

what is Bifed pulse of HCOM ?

A

It is best felt on the carotid arteries due to the presence of an initial sharp upstroke of systolic ejection which is followed by a second upstroke leading to the bifed pulse.

40
Q

What are the characteristics of the murmur of mitral regurgitation ?

A

It is a pansystolic murmur that starts at the beginning of S1 and continues to S2. It is not altered with respiratory cycle, but can increase due to increased venous return, squatting / clenching the fist which increase after load.

41
Q

What are the auscultatory features of mitral regurgitation other than the pan systolic murmur ?

A
  • S1 is diminished.
  • A left parasternal hive can occur due to systolic expansion of the left atrium.
  • Wide splitting of S2 and S3 can sometimes be heard.
42
Q

What is the cause of wide split S1 ?

A

It is split when mitral and tricuspid valve closes asynchronously as in RBBB, pulmonic stenosis or ASD causing RV overload.

43
Q

What is Brut Di Cannon ?

A

It is the variable and intermittently very loud S1 due to atrial fibriliation, flutter with varying block, PVC and VTAC that cause asynchronous closing of mitral and tricuspid valve.

44
Q

What is the phenomenological difference between JVP and carotid pulse?

A

The JVP has double peaks ( a AND v Waves) and a dominant inward collapsing movement ( X descent). While the carotid pulse is more medially and submandibularly visible with a sharp ascend and descend.

45
Q

Bilateral elevation of the eman JVP without venous pulsation indicates ____?

A

SVCO syndrome.

46
Q

What are the causes of EJVP without right atrial pressure elevation ?

A

Tricuspid valve obstruction or stenosis or SVCO syndrome.

47
Q

What are the signs of SVCO other than non pulsating EJVP?

A

Distended veins in the arms and the upper troso due to lateral thoracic veins draining caudally.

48
Q

Why is right JVP is used to measure in clinical setting ?

A

There is better transmission of the right atrial pulse and pressure into the right JV because the right internal JV and innominate veins are in line with the Superior venacava.

49
Q

What is the cause of the ‘a’ wave of JVP ?

A

It is caused by the right atrial systoly.

50
Q

What cause X decent of JVP ?

A

It is the right atrial relaxation and downward movement of tricuspid valves following right atrial systole.

51
Q

What causes an elevated ‘a’ Wave of JVP ?

A

resistance to right atrial emptying due to pulmonary HTN, tricuspid valve stenosis, right atrial mass or thrombus gives raise to a prominent a wave of the JVP?

52
Q

What causes Cannon ‘a’ Wave of the JVP ?

A

It is a large ‘ a’ wave that occurs when atrium contracts against a closed tricuspid valve as in AV dissociation due to complete AV block, VTACH, or premature ventricular, junctional or atrial contractions.

53
Q

What causes absent ‘ a’ Waves ?

A

This occurs when atrium is not contracting.

54
Q

What causes ‘v’ Wave of the JVP ?

A

It is the right atrial filling when the tricusped valve is closed.

55
Q

What causes elevated ‘ v’ wave of JVP or Lancisi’s sign ?

A

It occurs due to tricuspid regurgitation jet.

56
Q

What is Frederick’s sign ?

A

It is the exaggerated collapse of the neck veins seen in constrictive pericarditis.

CMP- Flashcards (1 decks)

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