General

Question 1

What causes a fourth heart sound?

Answer 1

Heart failure
Myocardial infarction
Cardiomyopathy
Hypertension (pressure overload)

Due to atrial contraction in a non compliant or hypertrophied ventricle

Question 2

What causes a third heart sound?

Answer 2

Heart failure, myocardial infarction, cardiomyopathy,hypertension (pressure overload )
PLUS
mitral and aortic regurgitation (volume overload) and constrictive pericarditis

Normal in children and young adults up to the age of 30
Due to blood rushing in during the rapid filling phase of diastole- stiff or dilated ventricle suddenly reaches its elastic limit and decelerates the incoming rush of blood
“Lub … de dub”

Question 3

What are 5 signs of endocarditis?

Answer 3

2 in the hands - clubbing and splinters
1 in the heart- changing murmurs
2 in the abdomen- splenomegaly, microscopic haematuria— glomerulonephritis will see red cell casts
Plus a few rarities- osler, roth, janeway

Question 4

Causes of splinter haemorrhages

Answer 4

Endocarditis
Trauma
Vasculitis- SLE

Question 5

What are the four stages of clubbing.

Answer 5

Increased fluctuated of nail bed
Loss of angle
Increased curvature of nail
Expansion of the terminal phalanx- drum stick appearance

Question 6

What are the causes of atrial fibrillation?

Answer 6

Ischaemic heart disease
Rheumatic heart disease
Mitral stenosis
Thyrotoxicosis
Pulmonary embolism
Alcoholic heart disease
Pneumonia