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72 Cards in this Set
- Front
- Back
10 causes of Atrial fibrillation |
Myocardial Ischaemia Myocarditis Mitral valve disease Sick Sinus syndrome Hypertension Pulmonary Embolism Thyrotoxicosis Stimulant Drugs - cocaine/coffee Aortic regurgitation Congenital AtrialSeptal defects |
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Velcro crepitations causes |
Post inflammatory Medication Connective Tissue Diseases Silicosis Farmer's lung Sarcoidosis Malignancy Idiopathic |
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Fine crepitation causes |
1. Alveolar inflammation 2. Alveolar congestion 3. Alveolar fibrosis |
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Dyspnea NYH classification |
1. disease present, no dyspnea 2. dyspnea during ordinary activity 3. dyspnea during less than ordinary activity 4. dyspnea at rest |
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Chest pain - DIfferential diagnosis |
1. Cardiac : stable angina / unstable angina (MI) coronary spasm 2. Chest wall: chostochondritis rib fracture 3. Serositis: pleura/ pericardium 4. Respiratory: Pulmonary Embolism 5. GIT causes: reflux oesophageal spasm referred pain |
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3 main complaints of respiratory origin |
1. Cough 2. Dyspnea 3. Chest pain |
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Cough What important questions should be raised? |
1.Productive/non? dry --> ILD, Ace inhibitors 2. When? morning indicates chronic bronchitis at night --> PND, Orthophnea, asthma 3. Haemoptysis? Bronchus Ca, TB, PE with infarct 4. How much? bronchiectasis, Lung abscess 5. Appearance of sputum - haemoptysis rusty brown : S pneumoniae coin sized blobs: K. pneumonia Yellow puss: Staphyloccocal |
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Define Cor Pulmonale and show it's progression |
COr Pulmonale is right ventricular heart disease due to a chronic lung disease or chest wall deformity. Pulmonary HT --> RV hypertrophy --> R heart failure |
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Causes for Right Heart Failure |
1. Left heart failure 2. Cor Pulmonale i.e. PHT 3.Atrial septal defect 4. Tricuspid regurgitation 5. Pulmonary stenosis 6. Myocardial infarction 7. Cardiomyopathy 4. Teratology of Fallot |
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Signs of Right Heart Failure |
Symptoms: ankle/sacral/abdominal swelling anorexia/nausea Signs: peripheral cyanosis low volume pulse Raised JVP & + Kussmaul sign & large V waves R ventricular heave Right ventricular S3 Pansystolic murmur of tricuspid regurg Tender hepatomegaly PULSATILE LIVER FLUID: pitting, ascites, pleural effusion |
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Symptoms of left heart failure |
1. Dyspnea 2. Orthopnea 3. PND 4. Fatigue |
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Signs of Left heart failure |
1.Tachycardia 2. Cheyne-Stokes breathing 3. Hypotension 4. Cardiac cachexia 5. cyanosis = peripheral and central 6. Tachycardia & Pulse alternans 7. Apex beat displaced & dyskinetic & palpable gallop 8. Left ventricular S3 9. Functional Mitral regurg 10. Pulm congestion crackles (fine) 11. Valsalva abnormal 12. +- RV failure |
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Causes of L heart failure |
1. Myocardial ischaemia 2. Cardiomyopathy 3. Aortic regurg 4. Mitral regurg 5. Patent Ductus Arteriousus 6. Hypertension 7. Aortic stenosis |
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Signs of a precipitating cause of Left heart failure |
1. Atrial fibrillation 2. Thyrotoxicosis 3. Anaemia |
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Myocardial infarction general signs |
1. Severe, pressing central chest pain radiating to left arm or jaw 2. Sweating 3. Anxiety |
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Myocardial infarction Physical findings |
1. Tachycardia & hypotension or bradycardia & hypotension 2. other arrhythmias :AFIB, VFIB, Heart block 3. Increased JVP & Kussmaul 4. Apex dyskinetic beat 5. S3, S4 6. POST MI mitral regurg, pericadial rub |
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Complications of a MI |
1. Arrythmias 2. Heart failure 3. Cardiogenic shock 4. rupture of a pappilary muscle 5. Ventricular aneurysm 6. Thromboembolism 7. Cardiac rupture 8. Death |
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Pulmonary Embolism suspicious history clues |
1. Sudden onset dyspnea 2. Severe chest pain 3. DVT 4. Resting tachycardia & hypotension 5. Cyanosis |
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Acute Aortic Dissection |
1. Severe chest pain 2. radiating to the back, tearing quality 3. with maximal intensity at onset |
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Aortic Dissection Family Hx |
1. Marfan syndrome 2. Ehlers Danos syndrome 3. SLE? RA? Sarcoidosis? |
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Infective Endocarditis SIGNS |
1. Splinter haemorrhages 2. Clubbing 2. Janeway Lesions 3. Osler nodes 4. Roth spots 5. Splenomegaly 6. In the heart: LEFT HEART VALVULOPATHY! MR,MS, AS, AR Prosthetic valves Patent Ductus Arteriousus, VSD, coarct of aorta |
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Infective endocarditis Criteria |
DUKES CRITERIA BE JOANOFARC Major B - blood culture positive E - echo evidence of vegitation Minor J- janeway lesion O- oslers node A- aneurysm(mycotic); abuse(idu) N- nephritis O- other predisposing heart condition F-fever A- arterial emboli R-roth's spot; rheumatoid factor C- culture positive not meeting major criteria |
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Pericarditis Signs |
1. Fever 2. Dyspnea 3. Pleuritic chest pain (localised) 4. Pericardial friction rub |
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Causes of acute pericarditis |
Viral Post MI pericardiotomy uraemia neoplasm CT diseases hypothyroidism acute rheumatic fever |
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Causes for hypertension |
1. Essential 2. Secondary - CKDisease - endocrine disorders (cushings, conns, phaeochromocytoma, thyrotoxicosis) - coarctation of aorta - other : COC, pregnant |
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Complications of hypertension |
1. MI 2. Stroke 3. Aneurysms 4. Left heart failure 5. Renal failure 6. Blindness |
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Pulmonary Hypertension Causes |
1. Idiopathic 2. Pulmonary emboli 3. Lung disease - COPD 4. LV failure 5. Congenital heart disease L-R shunt - atrial septal defect - ventricular septal defect - PDA 6. Severe kyphoscoliosis |
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Pulmonary Hypertension signs |
1. Tachypnea 2. Periph cyanosis 3. Hoarseness 4. Small volume pulse 5. JVP prominent A waves 6. Apex beat : R ventricular heave 7. Palpable P2 8. Auscul: systolic ejection click, Loud P2 S4 Pulm regurg 9. Cor pulmonale |
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Innocent murmurs |
1. Always systolic 2. Soft 3. Ejection systolic 4. Radiate to neck |
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Mitral stenosis Causes |
1. RHEUMATIC FEVER 2. Congenital parachute valve |
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Mitral stenosis Symptoms |
1. PND, orthopnea, dyspnea 2. May experience palpiations 3. haemoptysis 4. ascites, oedema, fatigue |
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Mitral stenosis signs |
1. Tachypnea 2. MITRAL FACIES 3. Peripheral cyanosis 4. Pulse might be irregular irregular (Afib) & normal or reduced volume 5. JVP prominent a wave if PHT, loss of a wave if AFIB 6. Palpation: TAPPING APEX BEAT Right ventricular heave Palpable P2 7. Auscultate: Opening snap diastolic murmur |
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SEVERE MITRAL STENOSIS |
1. Small pulse pressure 2. Soft S1 3. early opening snap 4. long diastolic murmur |
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Describing a murmur |
1. Location 2. Systolic/diastolic 3. Grading (sys6, dias4) 4. Character (crescendo...) 5. Radiate 6. Maneuvres |
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Mitral regurgitation Symptoms |
1. Dyspnea 2. Fatigue |
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Mitral regurg signs |
1. Tachypnea 2. Pulse might be irregular irregular (afib) or normal, volume normal or sharp upstroke 3. Palpate: apex beat displaced, diffuse and hyperdynamic 4. Pansystolic thrill present at apex beat 5. Auscultation: Soft S1 Left ventricular S3 Pansystolic murmur radiating to axilla |
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Mitral regurg causes |
1. Rheumatic fever 2. Mitral valve prolapse 3. Degenerative - ageing 4. LV failure / ischaemia 5. Cardiomyopathy (enlargement) 6. CT diseases 7. congenital |
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Aortic stenosis TRIAD OF SYMPTOMS |
1. exertional dyspnea 2. syncope 3. exertional chest pain |
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Aortic stenosis Signs |
1. Pulse: anacrotic/plateau, tardus parvus 2. Hyperdynamic apex beat 3. Systolic thrill at apex 4. Auscultation: diamond shape midsystolic murmur narrow split/ reverse A2 |
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Causes of aortic stenosis |
1. Rheumatic fever 2. Degenerative calcific aortic stenosis 3. Calcific bicuspid valve 4. Aortic sclerosis |
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Aortic regurgitation Signs |
1. Dyspnea 2. Fatigue 3. Palpitations 4. Exertional angina |
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Syndromes associated with aortic regurg |
1. Marfan 2. Ankylosing Spondilitis 3. SLE |
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Signs of aortic regurg |
1. quinke sign 2. pulse: Waterhammer pulse present, also bisferiense pulse WIDE PULSE PRESSURE 3. Corrigan sign in neck 4. Muller / De Musset 5. TRAUBE sign - over chest 6. Duroziez sign - pistol shots 7. Rosenbach sign - liver Palpate 8. Apex beat dispaced, hyperkinetic Diastolic thrill parasternally 9. Auscultate Decrescendo diastolic murmur over aortic area, grading, radiate downward, AUSTIN FLINT MURMUR AT APEX |
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Causes of aortic regurg |
1. rheumatic fever Infective endocarditis 2. dilation of aortic root: Marfan, aortitis, RA, syphilis 3. dissecting aneurysm 4. Ankylosing Spondilitis |
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quinke sign |
Cappilary pulsation in nail beds A.R. |
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Corrigan sign |
Carotid pulsations in neck despite radial compression A.R. |
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De Musset sign |
Head nodding in time with heartbeat A.R. |
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Tricuspid regurg |
1. Large V waves increased JVP 2. R ventricular heave 3. pansystolic murmur maximal on inspiration 4. Pulsatile liver 5. Ascites, edema, pleural eff |
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Cause of tricuspid regurg |
1. PHT 2. right ventricular failure 3. infective endocarditis - IV drug user 4. Pulm embolism 5. right ventricle infarct 6. tricuspid prolapse 7. trauma |
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Pleural effusion causes |
1. Transudate : LVHF, lymphatic obstruction 2. Exudate: TB, lobar pneumonia, PE & infarct, Rhumatoid Arthritis 3. Chylothorax: thoracic duct carcinoma, trauma 4. Empyema: lung abscess, metastatic infection, lobar pneumonia, trauma 5. Haemothorax: trauma, cancer 6. Mesothelioma |
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Resp failure signs |
Tachycardia Tachypnea Pulsus paradoxus Dyspnea Use of accesory muscles Chest indrawing Pursed lips Wheeze Cyanosis Silent lung fields |
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Resp failure signs |
Tachycardia Tachypnea Pulsus paradoxus Dyspnea Use of accesory muscles Chest indrawing Pursed lips Wheeze Cyanosis Silent lung fields |
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Causes of respiratory failure |
1. Lung: COPD, asthma, lobar pneumonia, pulmonary embolus, pleural effusion, pneumothorax, pulm oedema 2. Airway: trauma to face and neck, epiglottitis, angioedema, aspiration, foreign object 3. Other: anxiety, ketocidosis, anaemia |
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Coarse crackle causes |
1. Exudate in bronchial tree 2. Bronchiectasis 3. Broncho pneumonia |
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Coarse crackle causes |
1. Exudate in bronchial tree 2. Bronchiectasis 3. Broncho pneumonia |
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Ankylosing spondilitis |
SCHOBER SIGN
Bamboo spine...
1. Pleural effusion 2. Aortic aneurysm 3. Aortic regurg 4. Mitral regurg 5. Linea alba ventral hernia 6. Lense displacement, iritis, retinal detachment 7. Pericardial effusion |
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Rheumatoid arthritis features |
Swan neck Z formation Cannot grip- adductor weakness Mallet finger Ulnar deviation of phalanges Vasculitic infarcts Spindling sign Fluctuating of prox phalangeal joint early clubbing Pianokey movements Uveitis Rheumatoid nodules |
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Causes of pneumonia |
1. community acquired 2. Hospita acquired 3.immunocompromised 4. Post damage : aspiration etc |
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Causes of pneumonia |
1. community acquired 2. Hospita acquired 3.immunocompromised 4. Post damage : aspiration etc |
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Atelectasis ( lung collapse)
Causes |
1. Extramural: aortic aneurysm, lymphadenopathy
2. Intramural: bronchus carcinoma
3. Intraluminal: mucus, foreign object, aspiration |
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Causes of pneumonia |
1. community acquired 2. Hospita acquired 3.immunocompromised 4. Post damage : aspiration etc |
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Atelectasis ( lung collapse)
Causes |
1. Extramural: aortic aneurysm, lymphadenopathy
2. Intramural: bronchus carcinoma
3. Intraluminal: mucus, foreign object, aspiration |
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Causes of pneumothorax |
1. Spontaneous 2. Trauma 3. COPD - emphysema |
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Causes of pneumonia |
1. community acquired 2. Hospita acquired 3.immunocompromised 4. Post damage : aspiration etc |
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Atelectasis ( lung collapse)
Causes |
1. Extramural: aortic aneurysm, lymphadenopathy
2. Intramural: bronchus carcinoma
3. Intraluminal: mucus, foreign object, aspiration |
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Causes of pneumothorax |
1. Spontaneous 2. Trauma 3. COPD - emphysema |
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Clubbing |
1. Congenital 2. Occupational 3. Cardiac: infective endocarditis, cong cyanotic heart disease 4. Lung: lung abscess, bronchiectasis, COPD, lung cancer 5. Chronic liver failure 6. Crohns 7. Ulcerative colitis |
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COPD diagnostic criteria |
1. Smoking >40 py 2. Dyspnea 3. Previous diagnosis of COPD emphysema |
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Causes of distended abdomen |
Fat Flatus Faeces Foetus Fluid F-malignancy |
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Causes of distended abdomen |
Fat Flatus Faeces Foetus Fluid F-malignancy |
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Ascites |
1. Transudate: R heart failure, hypoalbuminaemia, nephrotic syndrome, TB 2. Exudate: Portal HT, hepatitis, schistosomiasis, cancer, Budd-Chiari 3. Chylothorax: thoracic duct ca 4. Haemothorax: trauma, malignacy 5. Empyema: subphrenic abscess, perforation 6. SPONTANEOUS BACTERIAL PERITONITIS |
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Causes for a waterhammer pulse |
Aortic regurg Pregnacy Anaemia Thyrotoxicosis |