Cardio Exam

Question 1

Give 2 features of AF on ECG and why AF is dangerous

Answer 1

Irregularly irregular rhythm
No distinct p waves
Turbulent flow pattern increases clot risk

Question 2

Describe 2nd degree heart block mobitz I

Answer 2

Gradual prolongation of PR interval until a beat is skipped

Regularly irregular

Question 3

Describe 2nd degree heart block mobitz II

Answer 3

P waves regular, but only some followed by QRS
No PR prolongation
Regularly irregular

Question 4

Describe 3rd degree heart block

Answer 4

P waves regular, QRS regular, no relationship

Atria + ventricles beat asynchronously

Question 5

Describe ventricular fibrilation

Answer 5

Rate irregular + >250 bpm

Asynchronous ventricular contraction, no filling

Question 6

Describe ventricular tachycardia

Answer 6

Rate regular + fast

p waves hidden- dissociated atrial rhythm

Question 7

What characterises ST elevation? What is it caused by?

Answer 7

ST segment >2mm above isoelectric line

Infarction

Question 8

What characterises ST depression? What is it caused by?

Answer 8

ST segment >2mm below isoelectric line

Ischaemia

Question 9

What 4 features are seen in the hands of a patient with infective endocarditis?

Answer 9

Janeway lesions: haemorrhagic lesions on thenar eminence
Clubbing
Osler’s nodes: painful, raised lesions
Splinter haemorrhages

Question 10

List 4 defining features of clubbing

Answer 10

Loss of Lovibonds angle
Increased longitudinal curvature of nail
Boggy nail bed
Drumsticking of finger nails

Question 11

Give 4 CVS causes of clubbing

Answer 11

Congenital cyanotic heart disease e.g. teratology of fallot
Atrial myxoma
Infective endocarditis
Malignancy

Question 12

What stigmata may be present in the hands of a patient with hypercholesterolaemia?

Answer 12

Tendon xanthomata

Question 13

Name a condition that can cause radio-radial delay

Answer 13

Aortic dissection

Question 14

Name a condition that can cause a collapsing pulse. What other hyper kinetic states may this arise in?

Answer 14

Aortic regurgitation
Thyrotoxicosis
Fever
Anaemia

Question 15

What is Quincke’s pulse? What causes it?

Answer 15

Visible capillary pulsations on compression to fingernail bed
Aortic regurgitation

Question 16

What causes an irregularly irregular pulse?

Answer 16

Atrial fibrillation

Question 17

What causes a slow rising pulse?

Answer 17

Aortic stenosis

Question 18

What causes a bounding pulse?

Answer 18

CO2 retention

Question 19

Give 2 features of a CO2 retention flap. What causes this?

Answer 19

Bilateral
Symmetrically timed
Hypercapnia: COPD/ T2 respiratory failure

Question 20

Describe the abnormality of a collapsing pulse

Answer 20

On lifting their arm, pulse gets REALLY strong (like hammer hitting arm)

Question 21

State 2 causes of a collapsing pulse

Answer 21

Aortic regurgitation

Patent ductus arteriosis

Question 22

Give 3 causes of a narrow pulse pressure

Answer 22

HF
Blood loss
Aortic stenosis

Question 23

Give 3 causes of a wide pulse pressure

Answer 23

Aortic regurgitation
PDA
Aortic coarctation

Question 24

What is pulsus paradoxus? Give 2 causes

Answer 24

varied pulse strength with each inspiration + expiration
Sever asthma
Cardiac tamponade

Question 25

What is pulsus alternans? Name a cause

Answer 25

regular alterations in force of pulse (not varying with respiration) Severe LVF

Question 26

What is bisferiens pulse?

Answer 26

Double pulse- 2 systolic peaks First: pressure increase related to LV ejection Second: reflected wave from periphery due to an artery's recoil effect

Question 27

What are the most common causes of a bisferiens pulse?

Answer 27

Mixed aortic valve disease (AR + AS) HOCM

Question 28

When may a jerky pulse be felt?

Answer 28

HOCM

Question 29

Give 3 causes of a molar flush

Answer 29

Mitral stenosis (CO2 retention causes vasodilation) SLE Polycythaemia rubra vera

Question 30

What causes corneal arcus in under 50s?

Answer 30

Hypercholesteralaemia

Question 31

What causes xanthelasma?

Answer 31

Hypercholesteralaemia

Question 32

In which syndrome may you see a high arched palate?

Answer 32

Marfan's

Question 33

List 4 causes of raised JVP

Answer 33

Fluid overload Cardiac tamponade RHF + Cor pulmonale Constrictive pericarditis

Question 34

What should happen to the JVP on inspiration?

Answer 34

Fall due to reduced intrathoracic pressure

Question 35

What are cannon A waves in the JVP? What causes these?

Answer 35

Large A waves from simultaneous contraction of RA + RV | 3rd degree heart block

Question 36

What causes large V waves in the JVP?

Answer 36

Tricuspid regurgitation

Question 37

What is Kussmaul's sign? What causes this?

Answer 37

JVP rise on inspiration Impaired RV function Cardiac tamponade, constrictive pericarditis, restrictive cardiomyopathy

Question 38

What can cause displacement of the apex beat?

Answer 38

Left/ Right ventricular hypertrophy

Question 39

What causes a heaving apex beat?

Answer 39

Pressure overload in Aortic stenosis

Question 40

What causes a tapping apex beat?

Answer 40

Mitral stenosis

Question 41

What causes S4?

Answer 41

Atrial contraction against a stiff ventricle

Question 42

What causes S3?

Answer 42

Turbulent ventricular filling

Question 43

What manoeuvre is recommended for hearing aortic regurgitation? Where?

Answer 43

Lean forward | Left 3rd ICS parasternal

Question 44

What manoeuvre is recommended for hearing mitral stenosis? Where?

Answer 44

Roll onto left side | 5th ICS MCL with bell

Question 45

Which heart murmur radiates to the cartoids?

Answer 45

Aortic stenosis