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3a > Clinical knowledge > Flashcards

Clinical knowledge Flashcards

1
Q

How many anterior ribs should be visible on a CXR?

A

5

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2
Q

What is the best type of projection used for CXRs?

A

PA (posterior to anterior)

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3
Q

Why are AP projections used for CXRs?

A

If the patient is too unwell to tolerate standing or leaving the bed

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4
Q

What is the issue with AP projections?

A

The quality is bad and they make the heart appear larger than it is

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5
Q

What is a pneumonic to assess the quality of CXRs?

A

RIPE
Rotation = clavicles equidistant from spinous processes? spinous processes vertically orientated against vertebral bodies?
Inspiration = are 5-6 ribs, costophrenic angles and lateral rib edges visible?
Projection = AP or PA?
Exposure = vertebrae visible behind the heart?

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6
Q

What is the ABCDE approach to CXRs?

A 
Airways 
Breathing 
Cardiac
Diaphragm 
Everything else
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7
Q

Why should you inspect the trachea in CXRs?

A

For evidence of deviation eg in pneumothorax or pleural effusion

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8
Q

What is the criteria for cardiomegaly in CXRs?

A

If the heart occupies more than 50% of the thoracic width on a PA CXR

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9
Q

What is pneumoperitoneum and state some possible causes of it

A

When free gas accumulates under the diaphragm causing it to lift
Bowel obstruction, appendicitis and diverticulitis are examples of causes

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10
Q

What is chilaiditi syndrome?

A

Abnormal positioning of the colon between the liver and diaphragm and can give false impression of pneumoperitoneum

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11
Q

Where is the PR interval between?

A

The start of the p wave to the beginning of the q wave

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12
Q

Where is the ST segment between?

A

The end of the S wave and the beginning of the T wave

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13
Q

Where is the QT interval between?

A

The start of the QRS complex and the end of the T wave

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14
Q

What does the T wave represent?

A

Ventricle repolarisation

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15
Q

What does each small square and each large square on ECG paper represent?

A

Small square = 0.04 secs

Large square = 0.2 secs

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16
Q

How can you calculate the rate of ECGs with regular rhythms?

A

Divide 300 by the number of large squares between each R-R interval

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17
Q

How can you calculate the rate of ECGs with irregular rhythms?

A

Number of R waves (on rhythm strip) x 6

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18
Q

Which leads give an inferior view of the heart?

A

Leads II, III and aVR

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19
Q

Which leads give an anterior view of the heart?

A

Leads V3 and V4

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20
Q

Which leads give a septal view of the heart?

A

Leads V1 and V2

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21
Q

Which leads give a lateral view of the heart?

A

Leads I, aVL, V5 and V6

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22
Q

Where is the normal cardiac axis between?

A

-30 and +90

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23
Q

What causes positive deflections on ECGs?

A

When direction of electrical activity moves towards a lead

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24
Q

On an ECG with a normal cardiac axis which leads would you expect to have the most positive and most negative deflection?

A

Lead II = most positive

Lead aVR = most negative

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25
Q

On an ECG with a normal cardiac axis what deflections would you expect in Leads I and aVF?

A

Lead I = positive

Lead aVF = positive

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26
Q

Using the quadrant approach (looking at QRS in leads I and aVF) what would you expect to see in RAD?

A

Lead I = negative

Lead aVF = positive

27
Q

Using the quadrant approach (looking at QRS in leads I and aVF) what would you expect to see in LAD?

A

Lead I = positive

Lead aVF = negative

28
Q

What is P mitrale and what causes it?

A

Bifid p waves caused by left atrial enlargement eg mitral stenosis

29
Q

What is P pulmonale and what causes it?

A

Tall, peaked p waves caused by right atrial enlargement usually due to pulmonary hypertension

30
Q

What is the criteria for a broad QRS complex?

A

> 120ms

31
Q

What is the general trend for QRS complexes across chest leads in a normal ECG?

A

Becomes more positive

32
Q

Describe what is seen on an ECG in atrial fibrillation

A

Tachycardia, irregularly irregular rhythm, no p waves

33
Q

Describe what is seen on an ECG in atrial flutter

A

Regular fast atrial activity (around 300bpm)

Saw tooth pattern of p waves

34
Q

What changes on an ECG can be seen from a STEMI?

A

Hyperacute t waves
ST elevation
T wave inversion
Pathological Q waves

35
Q

What ECG changes do NSTEMIs cause?

A

ST depression and t wave flattening or inversion

36
Q

What are the three different categories of supraventricular tachycardia?

A

Regular atrial = sinus tachycardia, atrial tachycardia and atrial flutter
Regular atrioventricular = AVRT or AVNRT
Irregular atrial = AF or atrial flutter (variable block)

37
Q

Describe why AV nodal re entrant tachycardia occurs (AVNRT)

A

There is no accessory pathway
The AVN has one fast and one slow pathway and a premature atrial contraction whilst the fast pathway is in its refractory period means that it goes down the slow pathway
This causes a continuous re entrant circuit causing increased stimulation of the ventricles

38
Q

What can be seen on an ECG in AVNRT?

A

Tachycardia, QRS narrow <120ms, no p waves as buried in QRS

39
Q

What is AV re entrant tachycardia?

A

Tachycardia due to an accessory pathway

40
Q

Give an example of AVRT and the ECG changes that it causes

A

Wolf parkinson white

Short PR interval <120, wide QRS>110 and slurred delta wave at the start of the QRS complex

41
Q

What does ventricular tachycardia look like on an ECG?

A

Regular, broad complex tachycardia with uniform QRS complexes within each lead

42
Q

What does ventricular fibrillation look like on an ECG?

A

Chaotic irregular deflections

No identifiable p waves, QRS complexes or t waves

43
Q

What are two causes of RBBB?

A

PE and IHD

44
Q

What ECG changes does RBBB cause?

A

Broad QRS>120ms
M shaped QRS in V1-3
Widened slurred S wave in V6
(MaRRoW)

45
Q

What ECG changes does LBBB cause?

A

Broad QRS>120ms
Dominant S wave in V1 “W”
Broad R wave in V6 “M”
(WiLLiaM)

46
Q

What is first degree AV block?

A

PR interval >200ms

47
Q

What is mobitz 1 second degree AV block?

A

Progressive prolongation of PR interval until a non conducted p wave

48
Q

What is mobitz II second degree AV block?

A

Intermittent non conducted p wave without prolongation of PR interval

49
Q

What is third degree AV block?

A

Complete heart block
Severe bradycardia
No link between p waves and QRS complexes

50
Q

What ECG changes do hyper and hypokalaemia cause?

A 
Hyperkalaemia = flattened p waves, wide QRS and tall, tented t waves 
Hypokalaemia = flattening of t waves and QT prolongation
51
Q

What ECG changes do hyper and hypocalcaemia cause?

A 
Hypercalcaemia = QT shortening 
Hypocalcaemia = QT prolongation
52
Q

What is a normal QT interval?

A

0.33-0.44 secs

53
Q

What ECG changes can hypothermia cause?

A

J waves, prolonged QRS and PR and ventricular ectopics

54
Q

What ECG changes does pericarditis cause?

A

Widespread diffuse saddle shaped ST elevation

55
Q

How can you tell between the JVP and carotid pulse?

A

JVP = a double waveform eg two pulses but the carotid artery has one for each cardiac cycle
JVP isnt easy to palpate but the carotid is

56
Q

Where is the JVP located

A

Between the two heads of the sternocleidomastoid (sternal and clavicular heads)

57
Q

How do you measure the JVP and where should it be located?

A

Assess the vertical distance between the sternal angle and the top of the pulsation point (shouldnt be >3cm)

58
Q

What causes raised JVP?

A

Venous hypertension due to right sided heart failure, tricuspid regurg or constrictive pericarditis

59
Q

What causes the first and second heart sounds?

A 
First = closure of mitral and tricuspid valves 
Second = closure of aortic and pulmonary valves
60
Q

Describe aortic stenosis

A

Ejection systolic crescendo decrescendo
Narrow pulse pressure
Radiates to carotids
Louder on expiration and when the patient is sat forwards

61
Q

Describe aortic regurgitation

A

Early diastolic
Collapsing pulse
May have corrigans sign = visibly exaggerated pulsing carotids due to hyperdynamic circulation

62
Q

Describe mitral stenosis

A

Mid diastolic
Loudest at apex
Low pitched rumbling

63
Q

Describe mitral regurgitation

A

Pan systolic

Loudest in mitral area and when patient is in left lateral position

64
Q

Where do you auscultate each of the 4 valves?

A

Aortic valve = 2nd right IC space right sternal border
Pulmonary valve = 2nd left IC space left sternal border
Tricuspid valve = 4th IC space left sternal border
Mitral valve = 5th IC space left mid clavicular line

3a (3 decks)

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