Reduced compliance of left ventricle eg in conditions causing ventricular hypertrophy (sign of diastolic heart failure). Conditions include: - Long standing HTN - Severe aortic stenosis - Hypertrophic cardiomyopathy - Restrictive cardiomyopathy - Post-MI fibrosis

Examination findings Flashcards by M M

Coarse crackles

Cystic fibrosis

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Elevated JVP

Fluid overload
Right sided heart failure
Pulmonary HTN

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Pan-systolic murmur heard loudest at apex

Mitral regurgitation

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Ejection systolic murmur heard loudest at right sternum

Aortic stenosis

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Third heart sound

indicates rapid ventricular filling

dilated cardiomyopathy eg HF
constrictive pericarditis

severe mitral or tricuspid regurgitation

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Fourth heart sound

Reduced compliance of left ventricle eg in conditions causing ventricular hypertrophy (sign of diastolic heart failure). Conditions include:

Long standing HTN
Severe aortic stenosis
Hypertrophic cardiomyopathy
Restrictive cardiomyopathy
Post-MI fibrosis

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Opening snap

Mitral stenosis

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Slow rising pulse

Aortic stenosis

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Bounding pulse

Aortic stenosis or CO2 retention

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Collapsing pulse

= water hammer or corrigans = aortic regurgitation

associated with widened pulse pressure

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Loud S1

AF (due to delayed closure of AV valves, so can also occur in tachycardia)

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Tapping apex

= palpable S1 = mitral stenosis

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Cannon A waves in JVP

Occur when right atria contracts against closed tricuspid valve. Seen in

AVNRT
Complete heart block
VT

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Low pitched rumbling mid-diastolic murmur

= Austin Flint Murmur = severe aortic regurgitation

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Mid-systolic click

Mitral valve prolapse

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Postural flapping tremor

Acute CO2 retention

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Hyperexpanded chest

COPD

Chronic asthma

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Stony dull percussion

Pleural effusion

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Fine crepitations

Pulmonary oedema

Pulmonary fibrosis

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Pleuritic chest pain

PE
Pneumonia
Pneumothorax

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Stridor

Upper airway obstruction eg foreign body or croup

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Coarse crackles

Aspiration
Pulmonary oedema
Chronic bronchitis
Pneumonia

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Pleural rub

Pleurisy
Pleural effusion
Pneumothorax

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Erythema nodosum

Sarcoidosis 
Drugs: sulphonamides, COCP, Dapsone
Streptococcal infection 
IBD
BCG vaccination
Leptospirosis 
Mycobacterium eg TB, leprosy 
Yersinia, other viruses, fungi

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ECG finding for PE

S1Q3T3 (S waves in lead 1, q waves in 3, T wave inversion in lead 3)

Findings for HOCM O/E

jerky pulse, double apex beat

Tapping apex

Mitral stenosis

Canon a waves in neck

3rd degree heart block

Early diastolic murmur at left sternal edge

Aortic regurgitation

Cause of 3rd heart sound

Rapid ventricular filling, eg may be seen in - dilated cardiomyopathy - Constrictive pericarditis - mitral regurgitation

Cause of 4th heart sound

Atria contracting against stiffened left ventricle (usually secondary to HTN, aortic stenosis or HOCM)

Low pitched rumbling mid-diastolic murmur

Mitral stenosis

Austin flint murmur

Pseudo mitral stenosis murmur | = Aortic regurgitation makes mitral valve leaflet close

Graham steell murmur

High pitched early diastolic murmur due to pulmonary regurgitation -> loudest on inspiration

Opening snap on auscultation

Mitral stenosis

Loud S1 heart sound

Mitral stenosis

Soft pan-systolic murmur

Tricuspid regurgitation

Expiratory wheezing

Acute severe asthma

Coarse crackles + purulent sputum

Bronchiectasis

Fine crepitations at lung bases

Pulmonary oedema | Pulmonary fibrosis

Pericardial rub

Acute pericarditis | Dressler's syndrome

Stridor indicates?

Upper respiratory tract obstruction eg trachea, epiglottis or larynx = just in inspiratory phase If biphasic then indicates glottis or sub glottis problem

What is a wheeze and what can cause it?

Indicates lower respiratory tract obstruction Inspiratory wheeze = extrathoracic cause. Wheezing in inspiratory phase = sign of stenosis/tumour/foreign body Expiratory wheeze = intrathroracic cause, eg asthma or anaphylaxis

Fine crepitations at lung bases suggests?

Pulmonary oedema | Pulmonary fibrosis

Causes of intention tremor

Cerebellar disease or lesion

Darkened red reflex on fundoscopy may suggest?

Cataracts Corneal abrasion Vitreous haemorrhage

White eye with no red reflex in child on fundoscopy?

Retinoblastoma

Features of CNIII palsy and causes

Down and out eye, fixed dilated pupil, ptosis Medical: DM, MS, infarction Surgical: PCA aneurysm, cavernous sinus thrombosis

Features of CNIV palsy and causes

Diplopia going downstairs Central causes: MS, SOL, Vascular Peripheral: DM, Trauma, Compression

Features of CNVI palsy

Diplopia horizontally Central causes: MS, SOL, Vascular Peripheral: DM, Trauma, Compression

Causes of floaters in eye

Retinal dettachement Vitreous haemorrhage DM/HTN retinopathy

Causes of haloes in eye

Acute glaucoma (if + pain) Cataract Corneal oedema

Green-brown rings in the periphery of the iris - name and cause?

Kaiser-Fleisher rings | Wilson's disease

A CT scan was performed which shows a biconvex mass after a head injury - diagnosis?

Extradural haemorrhage

A CT scan was performed which shows a crescent shaped mass after a head injury - diagnosis?

Subdural haemorrhage

ECG changes..., position and vessel? V1-V4

Anteroseptal LAD

ECG changes..., position and vessel? I, aVL, V5/V6

Lateral Left circumflex

ECG changes..., position and vessel? II, III, aVF

Inferior RCA

ECG changes..., position and vessel? V4-V6, I, aVL

Anterolateral LAD or LCA

ECG changes..., position and vessel? V1-V3 ST depression or upright T waves

Posterior? LCA or RCA

Subungal fibromas O/E - what condition?

Tuberous sclerosis

Patient presents with - raised JVP - pulsus paraxodus - diminished heart sounds what's cause?

cardiac tampondade eg could be post MI

Dull percussion, absent vocal resonance, reduced expansion - diagnosis?

Empyema

Dull percussion, increased vocal resonance, reduced expansion - diagnosis?

Consolidation

Soft S1

Prolonged PR interval Severe Mitral stenosis Mitral regurgitation

Inability to flex the 1st, 2nd and 3rd digits of the hand - name of sign and nerve damaged?

Benediction sign | - Median nerve

Inability to extend the 4th and 5th digits of the hand - name of sign and nerve damaged?

Ulnar claw hand

Loss of sensation on the dorsum of the hand over the thumb and index finger - nerve damaged?

Radial nerve

Signs of fluid overload

Tachypnoea Ascites Pulmonary oedema Raised JVP

Signs of fluid underload

Tachycardia Hypotension Oliguria Sunken eyes and reduced skin turgor

Fine end inspiratory crepitations on auscultation - cause?

Pulmonary fibrosis

Causes of pulmonary fibrosis

``` Upper: BREAST Berrylosis Radiotherapy EAA Ank Spondylosis Sarcoidosis TB ``` Zone: CARDS Cryptogenic fibrosing alveolitis (idiopathic) Asbestos RA and other CTDs Drugs : B-DAMN (bleomycin, Da agonists, amiodarome, methotrexate, nitrofurantoin) Scleroderma

Examination findings Flashcards

(72 cards)