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FRACP > A Clinical > Flashcards

A Clinical Flashcards

1
Q

Signs of severity of AS

A

Plateau pulse
Aortic Thrill
Late peaking ESM
LVF

rSplit S2
S4

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2
Q

Findings consistent with aortic stenosis

A

BP- small pulse pressure
Pulse - small vol, slow up rise, plateau

Apex - pressure loaded
Murmur - ESM, rad to carotids, soft on valsalva

RSplitting S2
S3
S4

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3
Q

Causes of AS

A

Bicuspid valve

Degenerative calcification

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4
Q

Signs of severity of MR

A

Small vol pulse
LV dilatation / displaced apex
LVF
Pulmonary HTN

Early diastolic rumble

S3s:
Soft S1
Split S2
S3

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5
Q

Findings consistent with MR

A

Apex - volume loaded, displaced
Murmur - pansystolic, to axilla

Valsalva - move put ur closer to S1
Isometric- increase intensity by increasing afterload

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6
Q

Indications for MVR

A

Acute MR
NYHA III/IV
LV dysfunction with EF >30%

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7
Q

Findings consistent with HOCM

A

Pulse- jerky
Apex- double impulse
Murmur- ESM, late, max LSE - PSM of MR at apex
S4

Valsalva- louder
Hand grip - softer

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8
Q

Signs of severity of HOCM

A

ECG- AF, LVH, lat ST changes, deep q waves, conduction blocks

TTE - asymmetrical hypertrophy with septal hypertrophy and SAM (systolic anterior motion) mitral valve

LVOT gradient correlated with symptoms and prognosis

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9
Q

Findings consistent with MVP

A

Murmur- mid or late diastolic click

Late crescendo-decrecendo at apex

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10
Q

Findings consistent with VSD

A

Thrill
Murmur- pansystolic loudest at LSE (loud=small)
S3
S4

Valsalva - softer

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11
Q

Signs of severity of VSD

A

Pulmonary HTN - shunt reversal

Cyanosis - shunt reversal

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12
Q

Indications for closure of VSD

A

Mid to large shunt
Complications:

CCF
RVOT
AR
IE
Eisenmongers
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13
Q

Findings consistent with ASD

A

Murmur- Midsystolic pulmonary ejection murmur
Fixed splitting S2
Mid diastolic rumbling LSE (incr flow through TV)

Inspiration - louder

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14
Q

Signs of severity of ASD

A

Pulmonary HTN

significant L:R shunt 2:1 (pulmonary to systemic)

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15
Q

Signs consistent with TR

A 
JVP- prominent v waves, rapid y decent 
Apex - RV heave 
PHT - loud P2
Murmur - harsh midsystolic murmur, LSE
Abdo - pulsatile liver

Louder on inspiration

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16
Q

Causes of TR

A

IE
2’ to RV dilation
(Causes of pulm HTN, ebsteins anomaly, large VSD)

17
Q

Findings consistent with pulmonary artery stenosis

A

JVP - prominent a wave
Apex -RVH
Murmur - harsh midsystolic pulm area
S2 widely split with soft P2

18
Q

Signs consistent with MS

A

Pulse - small pressure AF
Face - malar flush
JVP -prominent A wave

RVH heave
Apex - tapping, palp S1
Opening snap (S1), mid diastolic rumble

Roll to left

19
Q

Signs of severity of MS

A 
Small pulse pressure 
OS close to S2
Long diastolic murmur
Pulmonary HTN
Apical diastolic thrill

Indications for surgery
VA <1
CCF
PHTN

LA -> AF
Pulmonary HTN -> TR, RHF

20
Q

Signs consistent with AR

A 
Water hammer / collapsing pulse 
Femoral arterial pistol shot
Widened PP
Apex - displaced, heave 
Diastolic thrill
S3
S4
Decrecendo diastolic murmur 
Austin flint murmur (mid diastolic against MV)
21
Q

Causes of AR

A

Rheumatic
Endocarditis
Congenital (assoc with VSD)
Aortic root - dissection, marfans, ank spond, syphilis

22
Q

Signs of severity of AR

A 
Wide pulse pressure 
Collapsing pulse 
Long decrecendo diastolic murmur 
S3
Soft A2
Austin flint murmur 
LVF
23
Q

Signs consistent with pulmonary regurgitation

A

Decrecendo diastolic
Increases on inspiration

Causes
Pulmonary HTN
Post ToF repair
Absent pulmonary valve

24
Q

Patent ductus arteriosis

A

Continuous machinery murmur, radiates to the back

25
Q

Coarctation of the aorta

A

Radio-femoral delay
Different BP UL/LL
Continue murmur, loudest below left scapula
Systolic - left intraclavicular
Diastolic - over chest wall due to blood flow through collaterals

26
Q

Differentials of systolic murmur over the aortic region

A

AS - rad to carotids, soft on valsalva, slow rising pulse, narrow PP, pressure loaded apex, old

A sclerosis - does not radiate to carotids

HOCM - louder on valsalva, jerky pulse and double apex, young

27
Q

Differentials for Systolic Mumur in the mitral region

A

Mitral regurgitation - loud on expiration, volume loaded apex

MVP - mid, late systolic click, late crescendo-decrecendo murmur at apex

28
Q

Differentials for systolic murmur at the LSE

A

VSD- PSM, thrill, pulm HTN

TR - PSM, JVP V waves, RV heave, pulsatile liver, pulm HTN

Coarctation of aorta - continuous systolic murmur over the left infraclavicular region, radio/dem delay, differential in BP

29
Q

Differentials of a systolic murmur in the pulmonary region

A 
ASD
  mid systolic ejection murmur 
  Mid diastolic rumble 
  Fixed splitting S2
  Aw pulm HTN 
PAS 
  Harsh midsystolic 2nd ICS 
  Widely split S 2 with soft P2
  JVP a waves 
  RV heave

Carcinoid/young

30
Q

Differentials of Diastolic murmur in mitral region

A

MS

  • opening snap
  • mid diastolic rumble that is not audible

Clues:
Small PP, malar flush, a wave JVP, tapping apex,pulm HTN

AR
- Austin flint (low pitched mid diastolic or presystolic murmur)

Clues:
Wide PP, water hammer, volume loaded apex, diastolic thrill

31
Q

Differentials of diastolic murmur LSE

A

AR
-water hammer, wide PP, volume loaded apex, diastolic thrill

PR

  • pulm HTN
  • scar, repair of ToF

FRACP (12 decks)

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