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General Med > Cvs Combanium > Flashcards

Cvs Combanium Flashcards

1
Q

Mechanism of PND

A

Slow resorption of fluid from interstitium
Elevation of diaphragm
Decreased sympathetic drive of heart
Nocturnal depression of resp centre

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2
Q

Mech of orthopnea

A

On lying down,fluid returns to vascular compartment
Increased venous return to heart
Increased pulm venous pressure
Pulm interstitial edema

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3
Q

Causes of orthopnea

A

Acute left heart failure
Marked CCF
Massive ascitis

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4
Q

Causes of platypnea

A

Left atrial thromus
Left atrial tumour
Pulm av fistula

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5
Q

Causes of angina

A

Cad
As
Ar
Hcom
Systemic hypertension

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6
Q

Levine test

A

Relief of anginal pain by carotid sinus massage

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7
Q

What is syncope

A

Transient loss of consciousness due to inadequate cerebral blood flow secondary to abrupt decrease in cardiac output

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8
Q

Causes of syncope

A

Cardiac
Heart block
Extreme bradycardia
Tachyarrythmia
As
Hocm
Pulm stenosis
Drugs
Antihypertensive
Beta blockers
Vasodilator
Hypoglycemia
Reflexes
Vasovagal syncope
Orthostatic hypotension
Hypersensitive carotid sinus
Cough syncope-
Micturition syncope

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9
Q

Palpitation and causes

A

Unpleasant awareness of forceful rapid beating of one’s own heart

Cardiac
Tachyarrythmia
Extrasystoles- atrial,ventricular
Endocrine
Phaeochromocytoma
Thryotoxicosis
Hypoglycemia
High output states
Anemia
Beri beri
Pyrexia
Ar
Drugs
Atropine
Adrenaline
Aminophylline
Thyroid e
Psychogenic
Anxiety

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10
Q

Ortners syndrome

A

Compression of left recurrent laryngeal nerve be enlarged left atrium causing hoarseness of voice usually seen in ms

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11
Q

Marfans syndrome

A

Hyperextensibility of joints
High arched palate
Dislocation of lens
Tall thin person with long slender fingers

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12
Q

Left parasternla pulsations seen in

A

Right ventricular enlargement
Left atrial enlargement
Aortic aneurysm

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13
Q

Epigastric pulsation seen in

A

Right vent hypertrophy
Aortic aneurysm
Liver pulsation
Mass over aorta

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14
Q

Second left ICS pulsations seen in

A

Dilated pulm artery
Hyperkinetic state
Aortic aneurysm

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15
Q

Uprasternal pulsation seen in

A

Ar
Coarctation of aorta
Hyperkinetic state
Aortic aneurysm
Abnorm thyroidae ima artery

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16
Q

Pulsation in right side of chest seen in

A

Dextrocardia
Right atrial enlargement

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17
Q

Pulsations in back seen in

A

Suzmans sign- coarctation of the aorta
Pulm artery venous fistula

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18
Q

Neck pulsations seen in

A

Hyperkinetic state
Ar
Carotid artery aneurysm
Exophthalmos goitre
Subclavian artery aneurysm

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19
Q

Tapping Apex beat

A

Ms

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20
Q

Diffuse apex beat

A

Left vent aneurysm
Left vent dysfunction

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21
Q

Double apical impulse

A

Hocm
Left vent aneurysm
As with ar
Left bundle branch block

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22
Q

Triple or quadruple apical impulse

A

Hocm

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23
Q

Hyperdynamic apex impulse

A

Ar
Mr
High output state
Vsd
Pda

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24
Q

Heaving Apex beat

A

As
Systemic hypertension
Coarctation of aorta

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25
Q

Absent apical impulse

A

Dextrocardia
Obesity
Under rib
Emphysema
Pericardial eff

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26
Q

Types of apical impulse

A

Tapping
Diffuse apex
Double
Triple or quadruple
Hyperdynamic
Heaving

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27
Q

Diff between heaving and hyperdynamic apical impulse

A

Heaving. Hyperdynamic
Normal location. Out and down
Pressure overload. Volume
Left vent hypertrophy. LV dilatation

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28
Q

Grading of parasternla heave

A

Grade 1- visible but not palpable
2- visible and palpable but obliterable
3- visible and palpable but not obliterable

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29
Q

Causes of parasternla heave

A

Rvh
Left atrial enlargement

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30
Q

Soft S1 heard in

A

Mr
Tr
Calcified ms
Calcified ts
Left ventricular dysfunction

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31
Q

Loud S1 heard in

A

Ms
Ts
High output states
Asd
Vsd
Pda
Atrial myxoma

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32
Q

Variable S1 heard in

A

A fib
Extra systoles
Complete heart block

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33
Q

Soft S2 heard in

A

Soft a2 - calcified as
Soft p2- calcified pulm stenosis

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34
Q

Loud S2 heard in

A

Loud a2- systemic hypertension
Atherosclerosis
Aortic aneurysm
Loud P2
Pulm artery hypertension
Pulm artery dilatation

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35
Q

Single S2 heard in

A

Absent a2- as,aortic atresia
Absent p2- pulm stenosis,pulm atresia

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36
Q

Split S2 heard in

A

Early a2- Mr,vsd, constrictive pericarditis
Late p2- lv ectopics,lv pacemaker,right bundle branch block

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37
Q

Wide fixed split S2 heard in

A

Asd
Right vent failure
Massive acute pulm embolism

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38
Q

Reverse splitting of s2

A

Severe as
Hocm
Systemic hypertension
Pda
RV pacemaker
Ov ectopics

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39
Q

Physiological S3

A

Children
Athletes
Pregnancy

40
Q

Pathological s3

A

High output states
Congenital -asd,vsd,pda
Ar,Mr,tr
CCF
Constrictive pericarditis
Ischemic heart disease

41
Q

Pathological s4

A

Hypertrophic cardiomyopathy
Systemic hypertension
As
Cad

42
Q

How are murmurs produced

A

Due to turbulent flow of blood through a constricted or irregular orifice or due to increased flow

43
Q

Grading of murmurs

A

Levine and Freeman’s grading
Grade 1- very soft
2- faint murmur but clearly audible
3- moderately loud but no thrill
4- loud with thrill
5- louder with thrill and can be heard away from involved site
6- murmur with thrill heard even when steth is lifted off chest wall

44
Q

Why are systolic murmurs graded

A

Can be physiological

45
Q

Why are diastolic murmurs usually not graded

A

Always pathological

46
Q

Ejection systolic murmur

A

Aortic area
As
Coarctation of aorta
Aortic aneurysm
Functional murmur in ar
Pulmonary area
Pulm stenosis
Tof
Pah
Asd

47
Q

Pan systolic murmur

A

Mr
Vsd
Tr

48
Q

Early diastolic murmur

A

Ar
PR

49
Q

Graham steeles murmur

A

High pitched decreacendo diastolic blowing murmur along the left sternal border resembling ar murmur due to pulm regurg seen in pulm htn

50
Q

Mid diastolic murmur

A

Ms
Ts
Carey coombs murmur
Austin flint murmur
Flow murmur of asd,vsd,pda,Mr,tr

51
Q

Continuous murmur

A

Pda
Aortopulm window
Coarctation of aorta
Venous hum
Mammary souffle

52
Q

Venous hum

A

Low pitched soft continuous murmur due to flow of blood through jugular veins best heard in lower border of right sternocleidomastoid muscle
Obliterated by compression of neck veins or valsalva manouvre
Accelerated by exercise

53
Q

Mammary souffle

A

Continuos murmurs heard in third oartumof pregnancy best heard in mammary area
Obliterated by firm digital pressure applied laterally
Accentuated during systole

54
Q

Opening snap

A

High pitched loud snapping or clicking due to sudden tensing of cusps of mitral and tricuspid valve
Seen in ms and ts
Absent in mild ms,calcified mitral valve,ms with mr

55
Q

Causes of pericardial rub

A

Viral pericarditis
Pyogenic pericarditis
Tb pericarditis
Dresslers syndrome
Sle
Rheumatoid arthritis
Acute mi

56
Q

Diff between pericardial rub and murmurs

A

Rub. Murmur

No coincide with sys or diastole. Coincides
No conduction. Present
Superficial. Deep
Pressure steth alters. No alter

57
Q

Pericardial knock

A

Loud high frequency diastolic sound heard in constrictive pericarditis due to abrupt halt to early diastolic filling

58
Q

Cause of mid diastolic clicks

A

Mitral valve prolapse syndrome
Tricuspid valve prolapse syndrome
Ebsteins anomaly
Severe ar

59
Q

Causes of ms

A

Rheumatic heart disease
Congenital-parachute mitral valve
Hunters syndrome
Hurlers syndrome
Lutembachers syndrome
Carcinoid syndrome
Amyloidosis
Drugs- methysergide

60
Q

Normal mitral valve orifice

A

4-6 cm sq

61
Q

Orifice size in ms

A

Mild-1.5-2 cm sq
Moderate:1-1.5
Critical:<1

62
Q

Signs in ms

A

Small volume pulse
Left parasternla heave
Tapping Apex
Palpable S2
Diastolic thrill at apex
Loud S1
Opening snap
Mid diastolic murmur

63
Q

Ms murmur soft in

A

Obesity
Emphysema
Large rv
Coincidental asd
Low flow(severe pah, cardiomyopathy)

64
Q

Hemoptysis in ms reason

A

Rupture of thin walled dilated bronchopulm veins due to sudden rise in left atrial pressure
Pulm congestion
Pulm edema
Recurrent bronchitis
Bronchiectasis
Pulm infarction

65
Q

Complications of ms

A

Due to back pressure( pulm edema,pah,rvf,tr)
Arrythmias( af,atrial flutter)
Infection(ie,bronchopulm infection)
Embolism(pulm,angina,renal htn,leriches syndrome)
Pressure effects(ortners syndrome, dysphagia,left lung collapse)
Hemoptysis

66
Q

Chronic Mr causes

A

Rhd
Cardiomyopathy
Sle
Ankylosingnspondilitis
Marfans syndrome
Ehler danlos syndrome
Amyloidosis
Sarcoidosis
Htn
Ihd

67
Q

Acute Mr causes

A

Ie
Acute rf
Mi
Trauma
Ruptured chorda tendinae
Prosthetic valve endocarditis
Left atrial myxoma

68
Q

Signs of mr

A

Low volume collapsing pulse
Hyperdynamic apex beat
Apex down and out
Parasternla heave
Soft S1
S3
Systolic thrill over mitral area
Palpable S2
Loud p2

69
Q

Diff between mr and vsd

A

Mr. Vsd
Rhd. Palp and dizziness
Systolic thrill at apex. Left sternal edge
Soft S1. Norm
Left atrium enlarged. Norm

70
Q

Complications of mr

A

Af
Ie
Thromboembolism
Lvf
Rvf

71
Q

Indications for mitral valve replacement

A

Acute symptomatic Mr
Symptomatic with normal lv function or mild to severe lv dysfunction
Asymp with mild to severe lv dysfunction
Asymp with norm lv function but with af and pah

72
Q

Causes of as

A

Rhd
Atherosclerosis
Congenital
Degeneration

73
Q

Signs of as

A

Slow rising pulse(pulses parvus et tardus)
Low systolic BP
Bernheim phenomenon-prominent a waves in jvp
Heaving Apex beat
Carotid thrill
Soft S2
Esm at aortic area

74
Q

Compl of as

A

Lvf
Arrythmias
Complete heart block
Ie
Sudden death

75
Q

Chronic ar causes

A

Congenital bicuspid valve
Congenital disproportionate cusps
Rhd
Syphillis
Rheumatoid arthritis
Ankylosingnspondilitis
Marfans
Ehler danlos
Systemic htn

76
Q

Acute ar causes

A

Aortic dissection
Trauma
Ie
Prosthetic valve dysfunction

77
Q

Signs of ar

A

Lighthouse sign(alternate flushing and blanching of forehead)
Landolf sign
Beckers sign
Demusset sign
Muller sign
Quinke sign
Collapsing pulse
Pulsus bisferens
Traubes sign
Durozlez murmur
Durozlez sign
Rosenbach sign
Gerhardt sign
Hyperdynamic apical imp
S3
Esm at aortic
Austin flint murmur

78
Q

Lighthouse sign

A

Alternate flushing and blanching of forehead

79
Q

Landolf sign

A

Change in pupillary size according to cardiac cycle

80
Q

Beckers sign

A

Retinal artery pulsations

81
Q

Demussets sign

A

Head bobbing with each heart beat

82
Q

Myers sign

A

Systolic pulsations of uvula

83
Q

Quinke sign

A

Nail bed capillary pulsations

84
Q

Durozlaz sign

A

Systolic murmur heard over femoral artery when compressed distally with diaphragm

85
Q

Rosenbach sign

A

Pulsation of liver

86
Q

Gerhardt sign

A

Pulsation of spleen

87
Q

Oliver cardavell sign

A

Pulsation of larynx

88
Q

Dennisons sign

A

Pulsation of cervix

89
Q

Hills sign

A

Popliteal cuff systolic pressure exceeds brachial cuff pressure more than 60 mm hg

90
Q

Austin flint murmur

A

Mid diastolic murmur over mitral area
Due to regurgitant stream directed towards anterior mitral leaflet which produces the murmur

91
Q

DD of rheumatic fever

A

Ie
Lyme disease
Malignancy

92
Q

Types of heart failure

A

Acute and chronic
Left right and bivent
Forward and backward
Diastolic and systolic
High and low output

93
Q

Causes of lhf

A

Ihd
Systemic htn
Aortic and mitr disease
Cardiomyopathy

94
Q

Causes of rhf

A

Left heart failure
Chr lung disease(cor pulmonale)
Pulm EMB
Pulm htn
Asd vsd

95
Q

Signs of lvf

A

Tachypnea
Pallor
Pulsus alterans
Cardiomegaly with sustained apex
Functional Mr
Basal crepitations

96
Q

Signs of rvf

A

Peripheral edema and cyanosis
Raised jvp and hepatojugular reflex
Tender hepatomegaly
Ascitis and pleural eff

97
Q

Framingham criteria for diagnosis of chf

A

Major
Ond
Neck vein distension
Rales
Cardiomegaly
Acute pulm edema
S3 gallop
Inc venous pressure
Positive hepatojugular reflex
Minor
Extremity edema
Night cough
Dyspnea on exertion
Hepatomegaly
Pleural eff
Tachycardia

General Med (10 decks)

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