Week 1 Flashcards
myocardial ischaemia is classically felt in the ___________ radiating to the _______
Pain from a hollow organ is classically __________ (such as biliary or renal colic).
centre of the chest
left arm
colicky
The pain of a subarachnoid haemorrhage is classically very ____________, ‘like a __________ to the head’.
sudden
hammer blow
peptic ulcer pain is classically worse when _______ and better ___________ ).
hungry
after food
a headache accompanied by ______________ suggests migraine
preceding flashing lights
The UK Government now recommends that to minimize alcohol-related health effects, both men and women should keep to less than ________ of alcohol per week.
14 units
The units of alcohol can be determined by __________________ by its _________________ and ______________.
multiplying the volume of the drink (in ml)
% alcohol by volume (abv)
dividing this by 1000
The CAGE assessment for alcohol dependency
■ C – Have you ever felt the need to ___________________ ?
■ A – Have you ever felt ___________________?
■ G – Do you ever feel ___________________ ?
■ E – Do you ever drink in the ___________________?
—————— positive answers could indicate a problem of dependency.
Cut down your alcohol consumption
Angry at others criticizing your drinking
Guilty about excess drinking
mornings (Eye-opener)
Two or more
Pneumaturia: almost always due to a _____________
Fortification spectra: if associated with ___________, strongly suggests classical migraine
colovesical fistula
unilateral headache
Rigors: strongly suggests _________,_______, or __________
A bitten tongue: if associated with a seizure, strongly suggests a __________
bacteraemia, viraemia or malaria
grand mal fit
The examination should be conducted in a warm, private, quiet area. Daylight is preferable to artificial light, which may make the recognition of —————————————— difficult
subtle changes in skin colour (e.g. mild jaundice)
For most patients, start the examination on the right of the bed/couch with the patient __________ (approximately ______).
semi- recumbent
45°
Patients with left heart failure typically find that lying ___________ worsens their sense of ___________(______)
horizontally
breathlessness (orthopnoea
A persistent fever is one that ___________________________________
; a remittent fever ______________________ ; and an intermittent or spiking fever is present for only ___________ at a time before returning to normal. None has great sensitivity or specificity for any particular diagnosis, but changes may provide useful information about the course of a disease.
does not fluctuate by more than 1°C during 24 hours
oscillates by 2°C during the course of a day
several hours
fine tremor of _______ or recent _____________ therapy
rhythmical ‘pill rolling’ tremor of ____________
coarse jerky tremor of ___________ or __________
intention tremor of _______________.
thyro- toxicosis; beta-adrenergic
Parkinsonism
hepatic or uraemic failure
cerebellar disease
Feel for Dupuytren’s contracture in both hands, the first sign of which is usually a ___________ of tissue over the _________ of the __________ at the level of the ____________.
thickening
flexor tendon
ring finger
distal palmar crease.
____________ angle refers to the angulation between the nail plate and the skin below the nail, when viewed laterally.
Lovibond’s
Lovibond’s angle refers to the angulation between the _________ and ___________, when viewed laterally.
nail plate and the skin below the nail
Lovibond’s angle
Normally it is ______________. When clubbing is present, the angle is at least _______________________
less than 180°
180°, or more.
Raynaud’s syndrome, in which __________ of the __________ causes the fingers to become __________ and __________, followed by __________ __________ and then __________ due to __________ and __________
vasospasm; digital arterioles
white and numb
blue/purple cyanosis
redness; arteriolar dilatation
reactive hyperaemia
In koilonychia the nails are (soft or hard?), (thin or thick?) and _______ and the normal _______ity replaced by a _________-shaped _______ity .
It is a rare feature of longstanding ____________.
soft, thin and brittle
convex ; spoon
concav; iron-deficiency
Leuconychia ( __________ nails) may occur in _________ disease and other conditions associated with __________ , but are not particularly useful for making a clinical diagnosis of chronic liver disease.
opaque white
chronic liver
hypoalbuminaemia
The odour of diabetic ketoacidosis resembles __________
The odour of hepatic failure and uraemia have been described as ‘ __________ ’ or ‘ ________’, respectively, but such terms are rather subjec- tive and their use is limited.
Halitosis (bad breath) is common in patients with __________ diseases and those with gingivitis due to poor dental hygiene.
acetone
ammonia-like; mousy
suppurative lung
Causes of secondary HT???
Alcohol
Obesity
Pregnancy
RENAL
Endocrine
• - NEUROGENIC
Vascular
Aortic coarctation
Systemic hypertension is defined as persistently elevated systolic and diastolic blood pressure above _________ mmHg
140/90
Hypertension can only be diagnosed when elevated BP levels are measured on ______________ occasions
Two different
Optimal BP =
Normal BP=
High normal BP=
<120/80
120-129/80-84
130-139/85-89
You can rule out white coat hypertension by using _______ and ________ BP readings
Home
Ambulatory
Target organ damages in hypertension
BLOOD VESSELS:
_________ of the arterial wall
Widespread _________ ,causing _____,____, etc, especially if there’s a positive history of smoking, DM, or Hyperlipidemia
Aortic _________ and aortic __________
Thickening
Atheroma; CAD;CVD
Aneurysm; dissection
Target organ damages in hypertension
CNS:
________,________ atheroma, ________,________
Stroke; carotid; transient ischemic attack; subarachnoid Haemorrhage; hypertensive encephalopathy
hypertensive encephalopathy = _______+ _________ such as _____,____,______
High BP
Neurological symptoms
Speech and vision disturbance
Paresthesia
Papilloedema
Target organ damages in hypertension
RETINA:
GRADE1: arterial walls are ________, and ________ and there’s ______ phenomenon
Grade 2:grade 1+ _________
Grade 3: grade 2+ ___________
Grade 4: grade 3+ ____________
Thickening ; tortuous; silver wiring
Arteriovenous nipping
Evidence of retina ischemia
Papilloedema
silver wiring : increased __________ of the retinal vessels
Evidence of retina ischemia : eg _______ Haemorrhage and ________ exudates
Reflectiveness
Flame /blot
Cotton wool/soft
What grades of hypertensive Retinopathy are diagnostic of malignant hypertension
3 and 4
Target organ damages in hypertension
HEART:
________
__________
_____________
Coronary artery disease
Left ventricular hypertrophy
Atrial fibrillation
Heart failure
Target organ damages in hypertension
KIDNEY:
_________,__________
Proteinemia
Progressive renal failure
Malignant hypertension
A (common or rare?) complication of hypertension characterized by ________ and rapidly progressive ___________
Rare; raised BP
End organ damage
Pulsating abdominal mass= ???
Aortic aneurysm
Chest pain on exertion suggests ______________
angina pectoris
Severe prolonged cardiac chest pain may be due to ____________ or to __________ – known collectively as ______________
acute myocardial infarction
unstable angina
acute coronary syndrome.
Acute coronary syndrome is suggested by a previous history of ___________ but an episode of __________________________ can also be the first presentation of coronary artery disease.
stable angina
acute severe chest pain at rest
The term ‘syncope’ refers to _______________ due to _______________.
loss of consciousness
reduced cerebral perfusion
Cardiac arrest describes the sudden and complete _____________ due to ______, ventricular ___________ or ventricular ___________
loss of cardiac output
asystole; tachycardia
fibrillation
Acute coronary syndrome includes ———-,———,————
Unstable angina
NSTEMI
STEMI
Polyuria + cardiac arres
This is usually a symptom of ???
Supraventricular tachycardia
Additional heart sounds and murmurs demonstrate a consistent relationship to the ____________, whereas extracardiac sounds, such as a pleural rub or venous hum, do not.
cardiac cycle
Pathological sounds and murmurs are the product of _________ or _________ due to abnormal loading conditions.
turbulent blood flow
rapid ventricular filling
Some added heart sounds are physiological but may also occur in pathological conditions; for example, a third sound is common in ______ people and in _________ but is also a feature of __________.
young; pregnancy
Heart failure
Similarly, a systolic murmur due to turbulence across the right ventricular outflow tract may occur in hyperdynamic states such as _______ or __________, but may also be due to pulmonary stenosis or an intracardial heart lead
anaemia or pregnancy
Heart sounds: Timing
First heart sound : ________
Second heart sound : ___________
Third heart sound: __________
Fourth heart sound: ___________
Onset of systole
End of systole
Early in diastole, just after S2
End of diastole, just before S1
Heart sounds: Mechanisms
First heart sound : ________
Second heart sound : ___________
Third heart sound: __________
Fourth heart sound: ___________
Closure of mitral and tricuspid valves
Closure of aortic and pulmonary valves
From ventricular wall due to rapid cessation of filling
From ventricular origin related to atrial filling
Features of a benign or innocent heart murmur
(Soft or hard?)
Occurs at __________
No __________
No __________
Soft
Mid-systole
Radiation
Other cardiac abnormalities
Heart failure describes the clinical syndrome that develops when the heart cannot ___________, or can do so only at the expense of __________________.
maintain adequate output
elevated ventricular filling pressure
In mild to moderate forms of heart failure, symptoms occur only when the ___________________ increases during _______ or some other form of ________.
metabolic demand
exercise
stress
______________ is the commonest cause of angina and acute coronary syndrome and the leading cause of death worldwide.
Coronary artery disease (CAD)
Stable angina : ________ due to ___________ of one or more coronary arteries
Ischaemia ; fixed atheromatous stenosis
Unstable angina: _________ caused by _______ complete or partial _______ of a coronary artery due to ________ or ______ with superimposed ___________
Ischaemia ; dynamic
obstruction ; plaque rupture
erosion ;thrombosis
Myocardial infarction (type 1): ________ caused by _________ of a coronary artery due to plaque rupture or erosion with superimposed thrombosis
Myocardial infarction (type 2): ______________ where blood flow cannot meet the needs of the myocardium.
Myocardial necrosis; acute occlusion
Supply demand imbalance
Heart failure: ____________ due to ________ or _______
Myocardial dysfunction
infarction or ischaemia
Arrhythmia : __________ due to ischaemia or infarction
Altered conduction
Sudden death
Can be caused by : Ventricular __________ , _________ or ____________
arrhythmia
asystole
massive myocardial infarction
________ is the most impor- tant modiable risk factor for CAD
Smoking
Diabetes mellitus
This is a potent risk factor for all forms of atherosclerosis, especially type ______ diabetes mellitus.
2
Classification of angina pectoris and chestpain
Three characteristic features of angina
1. Constricting discomfort in the _________, or in the ______, ________, _______ or _______
2. Precipitated by _______________
3. Relieved by _______ (or GTN) within _________
centre of the chest
neck; shoulders
jaw or arms
physical exertion
rest; 5 minutes
coronary artery spasm may rarely occur as an isolated phenomenon in patients with normal coronary arteries on angiography. This is sometimes known as ________ angina; when it is accompanied by ___________ on the ECG, it is termed _______ angina.
variant
transient ST elevation
Prinzmetal’s
Some patients find the discomfort comes when they start walking and that later it does not return despite greater effort (‘ _______ angina’).
warm-up
The term acute myocardial infarction (MI) should be used when there is ______________ with clinical evidence of __________________ and with detection of a rise and/or fall of cardiac troponin values with at least one value above the 99th centile upper reference li
acute myocardial injury
acute myocardial ischaemia
For the diagnosis of type 2 MI, there needs to be clinical evidence of ischaemia, such as __________ or __________ .
ECG changes or symptoms of chest pain
Buerger’s disease or __________________ is an inflammatory disease of the arteries that is distinct from atherosclerosis and usually presents in (young or old?) ( ________ years) _______________.
thromboangiitis obliterans
Young 20–30 years male smokers
Buerger’s disease
_______ and _______ pulses are absent but _______ and ______ pulses are present.
It may also affect the veins, giving rise to superficial ___________. It often remits if the patient stops smoking.
Wrist and ankle
brachial and popliteal
thrombophlebitis
Buerger’s disease
____________ is the most frequent outcome if patients continue to smoke.
Major limb amputation
Raynaud’s syndrome
This common disorder affects 5%–10% of ___________ aged ______ years in temperate climates. It does not progress to ________ or ________, and _________ is unusual.
young women; 15–30
ulceration or infarction
significant pain
Raynaud’s syndrome
The patient should be reassured and advised to avoid __________. Usually, no other treatment is required, although vasodilators such as nifedipine can may be helpful if symptoms are trou- blesome. More severe Raynaud’s syndrome can also occur in association with digital ulceration in patients with connective tissue disease.
exposure to cold
a BP check is advisable every _______ in adults over 40 years of age to pick up occult hypertension.
5 years
Signs in hypertension
radio-femoral delay can be found in patients with ________________
enlarged kidneys in patients with ____________ disease
coarctation of the aorta
polycystic kidney
Dilated Cardiomyopathy is characterised by ________ and impaired ________ of the LV and often the RV.
dilatation; contraction
In DCM
Left ventricular _____ is increased but ___________ is normal or reduced .
mass; wall thickness
In DCM
__________ may be an important cause in some patients.
At least 25% of cases are inherited as an ______________ trait and a variety of single-gene mutations have been identified
Alcohol; autosomal dominant
Spondylosis
A general term for _____-related __________ of the _______
age
wear and tear
spinal discs
Brachial plexus
It begins in the _____________, passes through the _______, and runs through the entire ____________.
root of the neck
axilla
upper extremity
The brachial plexus is formed by the anterior rami (divisions) of cervical spinal nerves _______________ and the ___________
C5, C6, C7 and C8,
first thoracic spinal nerve, T1.
The brachial plexus is divided into five parts; ______,________,________,_______, and _________
roots, trunks, divisions, cords and branches
Branches of brachial plexus
________ Nerve
___________ nerve
________ nerve
________ Ulnar
________ nerve
Musculocutaneous
Axillary
Radial
Median
Ulnar
When dissecting the upper limb, it can be difficult to recognise what part of the brachial plexus you are at – it can just look like a mass of nerves.
The important structure to look for is an ‘ ____ ’ shape. This is formed by the _________,________, and _______ nerves, usually superficial to the axillary artery.
This shape is usually consistent between cadavers. It can help you get your bearings, and you can work backwards to identify the cords, divisions and branches
M
musculocutaneous, median, and ulnar
Erb’s palsy refers to an injury to the ___________ of the brachial plexus (typically ______). It most commonly occurs as a result of a ______ injury during a difficult __________-.
upper roots; C5-6
stretching
vaginal delivery.
Klumpke’s palsy is an injury of the ________ of the brachial plexus (_______). It is also most commonly associated with a ____________ but has a much (lower or higher?) incidence than Erb’s palsy.
lower roots
C8-T1
difficult vaginal delivery
Lower
In the neck, the internal jugular vein descends within the ___________ , (superficial or deep?) to the ___________ and (medial or lateral?) to the common carotid artery.
At the base of the neck, posteriorly to the ___________________ , the IJV combines with the ________ to form the _________ vein.
carotid sheath; deep
sternocleidomastoid muscle
lateral
sternal end of the clavicle
subclavian vein; brachiocephalic
The external jugular vein courses (superficial or deep?) to and obliquely across the _____________ in the ______ fascia. Part of its descent in the neck is also along the ________ border of the sternocleidomastoid muscle in its lower third.
superficial
sternocleidomastoid muscle
Superficial
posterior
The external jugular vein most commonly drains into the __________ vein near the _______ third of the _______.
subclavian
middle
clavicle
Kussmaul’s sign is a paradoxical ___________________ on inspiration, or a failure in the appropriate _________ with inspiration. It can be seen in some forms of heart disease and is usually indicative of __________________________ due to _________
rise in jugular venous pressure (JVP)
fall of the JVP
limited right ventricular filling
right heart dysfunction.
Most women experience menopause between the ages of ______ and ______ years as a natural part of biological ageing.
45 and 55
CRANIAL NERVES
____________ nerve (CN I)
____________ nerve (CN II)
____________ nerve (CN III)
____________ nerve (CN IV)
____________ nerve (CN V)
____________ nerve (CN VI)
____________ nerve (CN VII)
____________ nerve (CN VIII)
____________ nerve (CN IX)
____________ nerve (CN X)
____________ nerve (CN XI)
____________ nerve (CN XII).
Olfactory nerve (CN I)
optic nerve (CN II)
oculomotor nerve (CN III)
trochlear nerve (CN IV)
trigeminal nerve (CN V)
abducens nerve (CN VI)
facial nerve (CN VII)
vestibulocochlear nerve (CN VIII)
glossopharyngeal nerve (CN IX)
vagus nerve (CN X)
accessory nerve (CN XI)
hypoglossal nerve (CN XII).
Locomotor brachii is a prominent __________ of ——————- usually seen in patients with severe _________________ and elderly patients with ______________
pulsation of tortuous brachial artery
aortic regurgitation
arteriosclerosis
How to different between pulsation from the jugular vein and pulsation from the carotid artery
IJV’s is more of a wave like motion
Palpate the right subcoastal region deeply, If the pulsation gets more prominent, then it’s IJV
Echocardiography, also known as ________________, is the use of ultrasound to examine the heart, ____________. It is a type of medical imaging, using __________ or ___________ .
cardiac ultrasound
Non-invasively
An echocardiogram can also give physicians other estimates of heart function, such as a calculation of the _________,________, and _______
cardiac output, ejection fraction, and diastolic function
Uses of echocardiogram
_________ of Heart Conditions:
______________ of Heart Function:
____________________
Detection of _______________
It has. _________ , as well as ________ value
Diagnosis
Assessment
Monitoring Treatment Effectiveness
Blood Flow Irregularities
Prognostic; therapeutic
The Mercedes-Benz sign can be seen in aortic __________ on ______ 1. It is seen as _______________ that have a ________ configuration similar to the Mercedes-Benz logo
dissection ; CT
three distinct intimal flaps
triradiate
Reverse mercedenz Benz sign
Two of the three lumens outlined by these intimal flaps belong to the ________________
false lumen of aortic dissection.
Tissue Doppler echocardiography (TDE) is a medical ultrasound technology, specifically a form of echocardiography that measures the _________________ through the phases of one or more heartbeats by the Doppler effect ( _____________ ) of the reflected ultrasound.
velocity of the heart muscle (myocardium)
frequency shift
Doppler echocardiography
It is based on the Doppler principle that _______________________ from moving objects, such as _________, undergo a _____________.
sound waves reflected
red blood cells
frequency shift
The aorta can be divided into four sections:???
the ascending aorta, the aortic arch, the thoracic (descending) aorta and the abdominal aorta.
Aorta terminates at the level of _____ by bifurcating into the _______________________ arteries.
L4
left and right common iliac
Ascending Aorta: Branches
They give rise to the ____________________ arteries
left and right coronary
There are three major branches arising from the aortic arch. Proximal to distal:
List them
Brachiocephalic trunk
Left common carotid artery
Left subclavian artery
Coarctation of the aorta refers to _________ of the vessel, usually at the ___________________ (former ___________). It is a congenital condition.
narrowing
insertion of the ligamentum arteriosum
ductus arteriosus
Coarctation of aorta
The narrow vessel has an increased ————-1 to blood flow, which increases the _______ for the left ventricle – leading to _______________
resistance
after-load
left ventricular hypertrophy.
Branches of thoracic aorta
In descending order:
List them!
Bronchial arteries
Mediastinal arteries
Oesophageal arteries
Pericardial arteries
Superior phrenic arteries
Intercostal and subcostal arteries:
Aortic dissection
A ——— in the __________ of the aorta
It’s most common in (men or women?) in their ______ and ______
tear; inner layer
Men; 60s and 70s.
ABCDE of chest X-ray features of heart failure ??
A
B
C
D
E
Alveolar edema
Kerley B lines
Cardiomegaly
Dilated prominent upper lobe vessels
Pleural effusion
Kerley B lines are ???
Interstitial edema
Causes of heart failure?
List 8
High blood pressure
Valvular diseases
Cardiomyopathy
Congenital heart disease
Arrythmia
Diabetes
Coronary heart disease
Alcohol
Obesity
Precipitants of heart failure
List 8
Infections
Anaemia
Unaccustomed exercise
Electrolyte derangement
Endocrine dysfunction
Poor medical adherence
Renal failure
MI
Peripartum cardiomyopathy is a rare disorder in which a pregnant woman’s heart becomes _________ and ________ .
It develops during the _______________, or within __________________________.
weakened and enlarged
last month of pregnancy
5 months after the baby is born
Gallop rhythm is a mechanical event associated with a relatively _____ rate of _____________ and characterized by a ventricular ______ and a __________ sound
rapid
ventricular filling
bulge; low-frequency
A _________ rhythm in diastole is called a gallop and results from the presence of a ____________[__.
triple
S3, S4 or both
Gallop rhythm
Both sounds are _____ frequency and thus best heard with the _____ of the stethoscope.
Low
bell
A gallop rhythm contains another sound, called S3 or S4, dependent upon where in the cycle this added sound comes. It can also contain _______________ forming a ________ gallop, and in situations of very fast heart rate can produce a summation gallop where __________________.
both of these sounds ; quadruple
S3 and S4 occur so close as to be indistinguishable
Known as the “four pillars” of heart failure therapy, these medications are ____________,____________________ , ___________________ and __________________.
beta blockers
angiotensin receptor-neprilysin inhibitors (ARNIs)
mineralcorticoid receptor antagonists (MRAs)
sodium-glucose co-transporter 2 Inhibitors (SGLT2i)
Heart failure based on ejection fraction
??
Preserved: 50% and above of the ejection fraction
Mildly reduced: 40-40%
Reduced: less than 40%
Symptoms of left sided heart failure
Mention 7
Dyspnea
Orthopnea
Cough
Cyanosis
Fatigue
Tachycardia
Paroxysmal nocturnal dyspnea
Symptoms of right sided heart failure
List 7
Ascites
Pedal edema
Hepatomegaly
Distended jugular veins
Splenomegaly
Wright gain
Anorexia and GI distress
