CVS

Question 1

Postural/orthostatic hypotension

Answer 1

> 20/10 mmHg

Supine vs. standing position

Question 2

Active precordium

Answer 2

Vascular heart disease
Ischemic heart disease
High output states

Question 3

Quiet precordium

Answer 3

Normal
Dilated cardiomyopathy
Restrictive cardiomyopathy
Constrictive pericarditis

Question 4

Bulging of chest

Answer 4

Chronic condition:
Hypertensive heart disease
Hypertrophic CM

Question 5

Diffuse PMI

Answer 5

> 2.5 cm

LV enlargement

Question 6

Tapping vs sustained PMI

Answer 6

Tapping: normal, dilated CM
Sustained:>2/3 systolic, LVH

Question 7

Shifted PMI

Answer 7

Hypertensive HD
Valvular HD
Dilated CM
Mediastinal shift (pleural effusion, tumor, pneumomediastinum)

Question 8

LV hypertrophy causes

Answer 8

Hypertension
Athletic
Valvular heart disease
Hypertrophic CM
Congenital heart disease

Question 9

Ischemic cardiomyopathy

Answer 9

Weakening of heart muscle due to blockage of coronary arteries. LV is enlarged, DILATED, and weak.

Question 10

Jones criteria

Answer 10

For Rheumatic fever

Joint 
Carditis
Nodules (subcutaneous, painless)
Erythema marginatum 
Sydenham chorea

Previous rheumatic fever
ECG with PR elevation 
Athralgias
CRP and ESR elevated
Elevated temperature

Question 11

Non-palpable PMI

Answer 11

Obesity
Muscular chest wall
Pericardial effusion
Dilated cardiomyopathy 
Dextrocardia

Question 12

Reversible non-palpable PMI

Answer 12

Pregnancy
Alcohol
Thyroid
Cocaine
Chronic uncontrolled tachycardia

Question 13

Beck’s triad

Answer 13

For cardiac tamponade

Raised JVP (distended neck veins)
Absent heart sound
Hypotension

Question 14

Most common cause of mitral stenosis

Answer 14

RHD

Question 15

RHD leads to (valves)

Answer 15

Mitral stenosis, aortic stenosis

Question 16

Most common cause of aortic regurgitation

Answer 16

Aortic root dilatation eg. syphilitic aneurysm

Question 17

There’s wide pulse pressure with (valvular disease)

Answer 17

Aortic regurgitation

Question 18

Hyper dynamic circulation???

Answer 18

Bounding pulse
Pulsating nail bed
Head bobbing

Question 19

Acute Rheumatic fever etiology

Answer 19

Step. pyogene

Group A, beta hemolytic (complete RBC lysis)

Question 20

Presence of thrill

Answer 20

Grade 4+

Question 21

S1 accentuation in

Answer 21

MS
High output states
Anemia 
Exercise
Hyperthyroidism

Question 22

S3 normal in

Answer 22

Children, adolescents and young adult

Question 23

S3 in older pts signifies

Answer 23

HF

Produced due to volume overload

Question 24

Characterization of murmur

Answer 24

Position 
Quality
Radiation
Timing (systole, diastole)
Pitch 
Grading (1-6)

Question 25

MR ddx

Answer 25

``` MV prolapse IE Papillary muscle rupture Trauma Chordal rupture Rheumatic fever Mitral annular calcification Dilated cardiomyopathy IHD ```

Question 26

MS ddx

Answer 26

``` Rheumatic fever Congenital Severe mitral annular calcification SLE (Libman Sacks endocarditis) RA ```

Question 27

AR ddx

Answer 27

``` Congenital (bicuspid) Endocarditis Rheumatic fever Prolapse Traumatic Syphilis Aortic dissection Aneurysm ```

Question 28

Bounding pulse ddx

Answer 28

``` AR Anemia Fever Thyrotoxicosis Pregnancy ```

Question 29

Wide pulse pressure ddx

Answer 29

``` AR Thyrotoxicosis Fever PDA Arteriovenous fistula ```

Question 30

AS ddx

Answer 30

Congenital (bicuspid, unicuspid) Degenerative calcific Rheuamtic fever

Question 31

Pulse pressure normal range

Answer 31

40-60mmHg

Question 32

Peripheral signs of aortic regurgitation

Answer 32

``` Demusste’s sign Traube’s sign Durozie’s sign Quincke’s pulses Mueller’s sign Becker’s sign Hill’s sign Mayne’s sign Rosenbach’s sign Gerhard’s sign Jarring of the entire body Corrigan’s/water hammer pulse ```

Question 33

Risk factors for CVD

Answer 33

``` Non modifiable: Age Sex Race Family history ``` ``` Modifiable: Weight (obesity) Physical activity Diet Salt intake Hypertension DM Dyslipidemia Alcohol Cigarettes ```

Question 34

Hypertension complications

Answer 34

Cerebrovascular accident (stroke) Coronary heart disease Intermittent Claudication (PAD) CKD

Question 35

Precipitating factors of CVD

Answer 35

HEART FAILS ``` Hypertension Infective Endocarditis Arrhythmia Rheumatic fever Thyrotoxicosis Fever (infection) Anemia Myocardial Infarction Pulmonary embolism (lung) Stress ```

Question 36

Intermittent claudication

Answer 36

Muscle pain on mild exertion, classically in the calf muscles, caused by PAD

Question 37

Hypertension definition

Answer 37

Pre-HTN: 120-139/80-89 mmHg Stage 1: 140-159/90-99 mmHg Stage 2: >=160/100 mmHg

Question 38

DM HTN definition

Answer 38

>130/80 mmHg

Question 39

Ambulatory HTN

Answer 39

Awake: >=135/85 Sleeping: >=120/75

Question 40

Ankle-brachial index

Answer 40

G

Question 41

Framingham criteria (heart failure)

Answer 41

Y

Question 42

DVT ddx

Answer 42

Ruptured Baker’s cyst Cellulitis Post phlebitic syndrome /venous insufficiency Lymphedema

Question 43

DVT symptoms

Answer 43

Pain Redness Superficial venous dilation

Question 44

Risk factors of DVT

Answer 44

``` Active cancer Paralysis/limb weakness Recent cast Bed ridden Hx of surgery Hx of trauma Cigarette smoking OCP Pregnancy COPD HTN Anti-phospholipid Ab syndrome Long-haul air travel Family history ```

Question 45

Complication of DVT

Answer 45

Pulmonary embolism Cerebrovascular accident Kidney ischemia Right sided HF

Question 46

Well’s criteria (DVT)

Answer 46

Active cancer Bedridden recently >3 days or major surgery within 12 weeks Calf swelling >3cm compared to the other leg Collateral (nonvaricose) superficial veins Entire leg swollen Localized tenderness Pitting edema Paralysis, paresis or recent plaster immobilization of the lower extremity Previously documented DVT Alternative diagnosis to DVT as likely or more likely (-2)

Question 47

DVT investigations

Answer 47

D dimer test (>500ng/ml) | Doppler ultrasound

Question 48

Cardiac causes of chest pain

Answer 48

``` Angina pectoris MI Pericarditis Aortic dissection HCM AS ```

Question 49

Cardiac causes of SOB

Answer 49

HF | Pericardial effusion

Question 50

Cardiac causes of clubbing

Answer 50

IE Cyanotic CHD PDA with reversal of shunt (in the toes)

Question 51

CXR findings of DVT (pulmonary embolism)

Answer 51

Wester Mark’s sign Hampton’s hump Palla’s sign

Question 52

Virchow’s triad

Answer 52

Hypercoaguability of blood Vessel wall injury (endothelial damage) Stasis of blood

Question 53

Rheumatic fever criteria mnemonic

Answer 53

JONES CAFE PAL ``` Major: Joints Heart Nodules Erythema marginatun Sydenham chorea ``` ``` Minor: CRP elevation Arthlagia Fever ESR elevation ``` Prolonged PR Anamesis Leukocytosis

Question 54

Normal platelet count

Answer 54

150,000 - 450,000 per mcl of blood

Question 55

Normal WBC count

Answer 55

4,500- 11,000 WBCs/mcl of blood

Question 56

Etiology for culture negative endocarditis (CNE)

Answer 56

- HACEK - Coxiella Burnetti - Bartonella species - Brucella species - Tropheryma whipple - Corynebacterium species and Propionbacterium acne - Legionella - Aspergillus species