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clinical Flashcards

1
Q 
these symptoms describe 
Breathlessness
haemoptysis 
chest pain
hoarseness
A

mitral stenosis

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2
Q 
what are these the symptoms of 
Breathless
fatigue
heart failure
palpitations
A

mitral regurgitation

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3
Q 
what are these the symptoms of? Chest pain precipitated exertion, cold weather, emotions, or a heavy meal. 
tight band of pressure
radiates to neck, jaw or arms
rapidly improves with rest
syncope
fatigue
A

stable angina

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4
Q 
what are the these symptoms of? Chest pain
angina
tight band 
radiates to neck and jaw
aggravating with stress
increasing frequency and severity
provoked even at rest
Look unwell
murmur
crackles
women, elderly and diabetics may show untypical signs
A

acute coronary syndromes/ myocardial infarcture

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5
Q

what are these symptoms of? severe breathlessness, autonomic activation, chest pain. Shock, pulmonary oedema, tachycardia, harsh systolic murmur, parasternal heave, palpable thrill, elevated JVP.

A

papillary muscle rupture from a myocardial infarcture

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6
Q 
what are these the symptoms of? Angina
syncope 
exertional pre-syncope
breathlessness
Heart failure
A

aortic stenosis

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7
Q

what are the signs of aortic regurgitation?

A

Increased LV systolic pressure
large volume and collapsing pulse
hyperdynamic/displaced apex beat

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8
Q

what are the signs of atheroma?

A 
Smoking, male, hypertension, diabetes, elderly, obese, sedentary, low birth weight and low economic status. 
family history
biochemistry LDL
corneal arcus
tendon xanthomata
Xanthelasmata
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9
Q

what are the signs of mitral stenosis

A 
Pulmonary odema
embolization
diastolic thrill 
right ventricular heave
prominent JVP a wave 
tapping apex beat
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10
Q

mitral regurgitation signs?

A 
Pulmonary oedema, cardiogenic shock
JVP prominent
brisk hyperdynamic apex beat
RV heave
reduced S1 sound
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11
Q

signs of stable angina?

A 
Atherosclerosis 
diabetes mellitus 
smoking
hypertension 
Hyperlipidaemia
age
family history
obesity
xanthalasma and corneal arcus 
abdominal aortic aneurysm, bruits or reduced peripheral pulse
retinopathy 
anaemia
tachycardia, aortic stenosis, mitral regurgitation, elevated JVP, peripheral oedema, basal crackles
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12
Q

signs of thrombosis and embolsim

A 
Hypercholesterolaemia 
cardiac failure, burns
malignancy
age
Contraception 
immobilisation 
obesirty
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13
Q

signs of aortic stenosis

A 
Increased LV systolic pressure
LV failure
small volume pulse and slow rising
JVP prominent
vigorous and sustained apex beat 
RV heave 
S2 sound less audible
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14
Q

signs of hypertension

A 
Stress 
age
renal disease
endocrine disease 
smoking
weight
race
alcohol 
genetic 
low birth weight
drugs
hypercholesterolaemia
pregnancy
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15
Q

stage 1 hypertension

A

Stage 1 –BP higher than 140/90 mm Hg clinically and daytime average of 135/85

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16
Q

stage 2 hypertension

A

stage 2-160/100 mm Hg DA – 150/95 mm Hg

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17
Q

severe hypertension

A

severe – 180 mmHg or diastolic higher than 110 mm Hg

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18
Q

investigations for aortic regurgitation

A 
ECG
CXR
cardiac catheterisation 
echocardiography
MRI
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19
Q

investigations for mitral stenosis

A 
ECG
catheritersation
CXR – LA enlargement
echocardiography
MRI
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20
Q

investigations for mitral regurgitation

A

ECG
CXR
cardiac catheterisation
echocardiography

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21
Q

investigations for stable angina

A 
Full blood count
lipid profile
fasting glucose
electrolytes
liver/thyroid tests 
CXR 
electrocardiogram (patho Q waves or later ST depression) 
exercise tolerance test
myocardial perfusion tests (tracer seen no after stress ischaemia, seen neither at rest or stress it’s infarction) 
CT
invasive angiography
cardiac catheterisation
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22
Q

investigations for acute coronary syndromes or MI

A

Serial ECG – ST elevation or
T wave inversion
cardiac biomarkers of cardiac troponin.

echo for size of wall abnormality, mitral regurgitation, mural thrombus

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23
Q

test for MI complications

A

ECHO

Cath left heart and right heart

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24
Q

investigation for aortic stenosis

A 
ECG
CXR 
Catheterisation
echocardiography
MRI
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25
Q

investigation for hypertension

A 
ECG
echocardiogram
renal ultrasound
renal function
screen for causes 
risk score
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26
Q

treatment for atheroma

A 
Smoking cessation
weight loss
blood pressure control
diet 
aspirin
surgery
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27
Q

treatment for mitral stenosis

A 
Diuretics
Na restriction
anti-coagulation 
valvotomy
MVR
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28
Q

treatment for mitral regurgitation

A

Preload/after load reduction from sodium nitroprusside, dobutamine

mitral valve repair or replacement

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29
Q

treatment for stable angina

A

Reduce risk factors
satins, ACE inhibitors, aspirin. Beta blockers, Calcium channel blockers, Ik channel blockers
percutaneous coronary intervention (stenting with aspirin and clopidogrel)
coronary artery bypass surgery with use of long saphenous vein

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30
Q

treatment for thrombosis and embolism

A

Prophylaxis for risk patients; heparin, TEDS

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31
Q

treatment for ventricular fibrillations and cardiac failure

A

CPR and defibrillation

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32
Q

treatment for left ventricular thrombus

A

warfarin

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33
Q

ST elevated MI

A 
prevention 
statins
angiotensin
aspirin
clopidogrel
general measures 
treatment
PCI within 120-150 minutes 
fibrinolytic therapy within 90 minutes 
thrombolysis if  <3hrs onset
thrombolytic agents
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34
Q

treatment for free wall tear

A

Pigtail catheter drainage, pericardiocentesis

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35
Q

treatment for papillary muscle rupture

A

PMR – balloon Pump nitrates >90mm hG, inotropes <90 mmhg mitral valve replaced or VSD repair

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36
Q

NON-STEMI treatment

A

Immediately – morphine, oxygen, nitro-glycerine, aspirin
treatment
Aspirin + ADP receptor blocker for 1 year. Anti-thrombotic therapy unfractionated herpain or low mol weight heparin
beta blockers
statins
ACE inhibitors
coronary angiography
revascularisation by PCI or CABG within 3-12 days

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37
Q

treatment for aortic stenosis

A

aortic valve replacement or repair

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38
Q

hypertension

A 
Aggressive treatment 
salt restriction 
remove source of stress
remove alcohol 
lose weight

young – ACE inhibitor or ARB
elderly calcium channel blocker and thiazide a diuretic

alpha-adrenoceptor
antagonists

methyldopa

beta blocker

only nifedipine, methyl dopa, atenolol, labetalol, thiazide diuretic or amlodipine for pregnant wome

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39
Q

treatment for aortic regurgitation

A

vasodilator, aortic valve repair or replacement

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40
Q

a subendocardial infarct refers to

A

non ST elevated myocardial infarct in that it is only limited to a partial, mainly the interior/innermost myocardial cells

41
Q

a transmural infarct refers to

A

A St elevated myocardial infarct, normally when a whole section of myocardium tissue is necrotic

42
Q 
Loss of power
loss of sensation
loss of vision
loss of coordination 
incontinence
headache, vomiting, neck stiffness
photophobia 
fit
A

stroke

43
Q

signs of a stroke

A 
Speech dysarthria/dysphasia
neglect
loss of vision
ataxia, vertigo, nystagmus (loss of eye control)
vertigo  
visual field defects
high blood pressure
atrial fibrillations
age 
race
Family history 
prior TIA  or stroke
44
Q

investigations for a stroke are

A 
Blood tests (full blood count, platelets, red cells, lipids) 
ECG (24hr)
CT (blood)
MRI (ischaemic) 
echocardiogram
carotid doppler (ultrasound)
45
Q

stroke treatment options are

A

Stroke unit
thrombolysis
clot retrieval using a catheter

 secondary prevention; 
clopidogrel or 
aspirin + dipyridamole 
statin 
blood pressure drugs
carotid endarterectomy
46
Q

Rheumatic fever signs

A

Relapsing illness
skin and joint manifestations
pancarditis
sydenham’s chorea/ St Vitu’s dance

47
Q

Impending; increasing back pain and tender
rupture; painful pulsatile mass, haemodynamic instability, hypoperfusion

unusually; distal embolization
aortocaval/aortoenteric fistula, ureteric occlusion, duodenal obstruction

A

aneurysm

48
Q

signs of aneurysm

A 
Degenerative disease
connective tissue disease
infection 
male
age
Smoking
hypertension
Family history
49
Q

tests for aneurysm

A

Screening – ultrasound <65

patient fitness 
blood
ECG
ECHO
PFTs
MPs 
CPEX 
patient preference 
USS 
CTA/MRA
50
Q

treatment for aneurysm

A

Size, candidate and suitability
has to be larger than >5.5cm
conservative
repair endovascular or open

emergency; transfusion, laparotomy

51
Q

symptoms of chronic heart failure

A

Dyspnoea, fatigue, oedema, reduced exercise capacity

52
Q

signs of chronic heart failure

A

Underlying causes; left ventricular dysfunction or severe aortic stenosis
age
hypertension
obesity
diabetes
tachycardia, raised JVP, 3rd heart sound, chest crepitation’s/effusions, displaced or abnormal apex beat

53
Q

investigations for chronic heart failure

A 
Responsiveness to diuretics, evidence of cardiac dysfunction required. 
ECHO
radionucleotide
left ventriculogram
cardiac MRI 
12 lead ECG 
BNP (low excludes heart failure) 
CXR  
found out LVSD; 
coronary angiogram, MRI, test autoantibodies, CT exclude renal failure etc. 
NYHA grading
54
Q

treatment for chronic heart failure

A 
Diuretics 
ace inhibitors 
betablockers
aldosterone receptor blockers 
ARNI’s
55
Q

symptoms of dilated myopathy

A

Dyspnoea, PND, oedema, weight gain, cough,

56
Q

signs of dilated myopathy

A 
JVP elevated
displaced Apex
s3/s4 noise
MR murmur 
pleural oedema 
pleural effusion 
hepatomegaly 
atrial fibrillations
Acites 
crepitations 
narrow pulse 
sacral oedema
oedema
57
Q

investigations for dilated myopathy

A 
ECHO
ECG
bloods
angiogam 
BNP 
CXR
biopsy
58
Q

treatment for dilated myopathy

A 
Treat anaemia 
remove exacerbating factors such as drugs or toxins
diet
ACEI 
AT2 blockers 
diuretic 
betablockers 
Spironolactone 
anticoagulantants
transplant
59
Q

pericarditis symptoms

A

Chest pain, pleuritic pain, postural leaning back hurt more, fever

60
Q

pericarditis signs

A

Pericardial rub, elevated JVP, effusion
low b.p.
breathing diminishes pulse
muffled heart sounds

61
Q

pericarditis investigation s

A

ECHO, ECG, troponin, PR segment depression, St changes

62
Q

pericarditis treatment

A

Limit use of NSAIDS
drain if necessary
anti-microbials

63
Q

restrictive cardiomyopathy signs

A

Diabetic, sarcoidosis, amyloid, sarcoid, haemochromatosis

64
Q

restrictive cardiomyopathy investigations

A

ECG, CXR, BNP, blood tests
auto-antibodies, amyloid biopsy, low plasma alpha galactose (fabry) ECHO
CMRI

65
Q

restrictive cardiomyopathy treatment

A

No diuretics or anticoagulants,

most likely have to cardiac transplant, ICD or treat iron deficiency, or underlying amyloid or Fabrys.

66
Q

Hypertrophic cardiomyopathy symptoms

A

Chest pain, dyspnoea, presyncope, syncope, exertional stress, arrhythmias, angina,

67
Q

Hypertrophic cardiomyopathy signs

A

Genetic, notched pulse pattern, double apex beat, thrills, murmurs which increase more with Valsalva and squatting, JVP raised, notched pulse pattern

68
Q

Hypertrophic cardiomyopathy investigations

A

ECG
ECHO, MRI
risk test for whether defibrillator is needed
family testing

69
Q

Hypertrophic cardiomyopathy treatment

A

Avoid exercise, avoid dehydration
remove negative drugs or stimuli
obstructive form surgical or alcohol septal ablation to restore flow.
use of beta blockers, Verapamil, or Disopyrimide to treat symptoms and anticoagulants for atrial fibrillations

70
Q

myocarditis signs/symptoms

A

Heart failure, shortness of breath, acute fever, heart block

71
Q

myocarditis investigations

A

ECG

Biomarkers elevated but not consistent with MI, ECHO, MRI, Viral DNA PCR, autoantibodies, Step antibodies, HIV

72
Q

myocarditis treatment

A

Treat heart failure and arrhythmia, use of immunotherapy or stop toxic exposure

73
Q

pericardial effusion symptoms

A

Fatigue, shortness of breath, dizzys with low BP, chest pain

74
Q

pericardial effusion signs

A

Pulsus paradoxus, JVP raised, low BP, pulmonary oedema,

75
Q

pericardial effusion investigations

A

ECHO
CXR
Sample fluid

76
Q

pericardial effusion treatment

A

Drainage

pericardial window if persistent

77
Q

Ventricular tachycardia symptoms

A

palpitations, dyspnoea, syncope, poor LV function

78
Q

tests for Ventricular Tachycardia

A

Bloods, ECHO, angiogram

79
Q

treatment for Ventricular tachycardia

A

Cardiac arrest protocol, DC cardioversion, treat underlying cause
ICD therapy

80
Q

bradycardia symptoms

A

syncope

81
Q

bradycardia signs

A 
Neuromuscular disease 
bifascicular/trifascicular block 
sinus node disease 
cartid sinus hypersensitivity 
vasovagal syncope
82
Q

bradycardia treatment

A

pacemaker

83
Q

coarctation signs

A

Turner’s syndrome
hypertension
cold legs, poor pulse
if before left subclavian right radial femoral delay, if after left subclavian then right and left radio-femoral delay

84
Q

coarctation symptoms

A

Heart failure, failure to thrive

hypertension

85
Q

chronic limb ischaemia symptoms

A 
Fontaine classification;
asymptomatic 
stage 2: claudication pain 
A – more than 200 m 
B – less than 200 m
stage 3 -  feet rest pain
stage 4 – necrosis, gangrene
86
Q

chronic limb ischaemia signs

A

Risk factors; male, age, smoking, hypercholesterolaemia, hypertension, diabetes
ulceration, pallor, hair loss, pulses, capillary refill time

87
Q

chronic limb ischaemia investigations

A 
Exercise tolerance
effect of incline
Change over time
bilateral
tissue loss and peripheral pulse/sensation 
ankle brachial pressure index 
0.95-0.5 = claudication
0.5-0.3 = rest pain
<0.2 gangrene/ulceration
buerger’s test 
slow to regain colour
hyperaemic sunset
88
Q

chronic limb ischaemia treatment

A 
Managed similar to coronary heart disease; 
antiplatelet therapy
statins 
BP control
smoking cessation
Exercise
diabetic control 
angioplasty, stent, endovascular reconstruction or bypass if critical 
bypass required an autologous conduit 
amputation if necessary
89
Q

acute limb ischaemia symptoms

A

Pain, pallor, perishing cold, paraesthesia (pins and needles) paralysis, pulseless

90
Q

Acute limb ischaemia signs

A

Recent trauma, dissection, aneurysm, thrombosis, embolism
chronic limb ischaemia
rapid onset
compartment syndrome; inflammation, oedema, obstruction, tense tenderness, rise in creatine kinase, risk of renal failure

91
Q

Acute limb ischaemia inv.

A

ECG
blood
nil by mouth?

92
Q

Acute limb ischaemia treatment

A 
Analgesia, anticoagulated
limb salvageable
amputate
embolectomy
Bypass
endovascular
thrombolysis 
palliate
93
Q

Diabetic foot disease symptoms

A

Ulceration, recent infection like symptoms, painless

94
Q

Diabetic foot disease inv.

A

Diabetes, check pressure check pressure points, plantar foot surface, tracking infection, investigate for gas gangrene, necrotising fasciitis, osteomyelitis

95
Q

Diabetic foot disease treatment

A

PREVENTION

Footcare, glycaemic control, wearing shoes, regular woundcare, systemic antibiotics
revascularisation, distal bypass, amputation

96
Q

Infective Endocarditis

A

Fever/chills

night sweats, malaise, fatigue, anorexia, weight loss, weakness, arthralgia, headache, SOB

97
Q

Infective Endocarditis signs

A

Cardiac murmur, janeway lesions, osler nodes, roth spot, meningeal signs, cutaneous infarcts, vasculitis rash, signs of heart failure , embolic events, history of IE, prosthetics

98
Q

Infective Endocarditis investigation

A 
Blood culture 3 sets 30 mins apart +/- 
renal function tests 
Urinalysis 
ECG (PR  prolonged)
CXR 
MRI, PET/CT, ECHO, SPECT
99
Q

Infective Endocarditis treatment

A

I.V. antibiotics

or antibiotic prophylaxis for prevention as well as good oral hygiene and aseptic measures

cardiovascular (6 decks)

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