General diagnosis - Cardiovascular exam

Question 1

Aneurysm of the arch of the aorta

Answer 1

vascular surgeon referral

• bovine cough and tracheal tug
• dilation of the arch of the aorta
• associated with: atherosclerosis, HTN, Marfan’s syndrome, tertiary syphilis
• chest xray: widening of the S. mediastinum
• CT confirms aneurysm

Question 2

Aortic imcompetence

Answer 2

cardiologist referral

• titubation, diastolic murmur (2nd right intercostal space near sternum)
• valvular heart disease
• associated w/: rheumatic fever,marfan’s syndrome, syphilitic aortitis
• ECHOcardiography confirms Dx

Question 3

Aortic stenosis

Answer 3

cardiologist referral

• angina, systolic murmur (2nd right intercostal space parasternally)
• valvular heart disease often caused rheumatic fever
• ECHOcardiography confirms Dx

Question 4

Bacterial endocardidtis

Answer 4

hospital referral

• fatigue, fever, harsh murmur (tricuspid valve MC affected)
• valvular heart disease seen with intravenous drug users (staphylococcus aureus)
• blood cultures grow offending organism

Question 5

Cardiac tamponade

Answer 5

hospital referral
Beck’s triad: distant heart sounds, high jugular venous pressure, hypotension
- compression of the heart by fluid/blood w/in pericardial sac (infection or traumatic)
- ECHOcardiography confirms Dx

Question 6

Coarctation of the aorta

Answer 6

vascular surgeon referral

• HTN in upper limbs and delayed radiofemoral pulse
• congenital narrowing of the aorta beyond left subclavian aa.
• CT confirms Dx

Question 7

Fallot’s tetralogy

Answer 7

pediatric cardiologist referral

• failure to thrive d/t poor feeding, cyanosis, clubbing of the fingers and loud pansystolic murmur herd (3rd left intercostal space parasternally)
• MC cyanotic congenital heart disease (pulmonary stenosis, right ventricular hypertrophy, overriding aorta, ventricular septal defect)
• chest xray: boot-shaped heart

Question 8

Hyperthyroidism

Answer 8

Co-manage with enocrinologyist

• goiter, tachycardia, diarrhea, BL exophthalmos (in graves disease), unblinking stare, fine physiological tremor of outstretched hands — older pts present with atrial fibrillation-irregularly irregular pulse.
• overactive thyroid gland with excess production of thyroxin
• elevated T3 and T4 with a low TSH in primary hyerthyroidism

Question 9

Mitral incompetence

Answer 9

cardiologist referral

• pansystolic murmur (5th left intercostal space, midclavicular line)
• valvular heart disease often caused by rheumatic fever
• ECHOcardiography confirms Dx

Question 10

Mitral stenosis

Answer 10

cardiologist referral

• malar flush, diastolic murmur with an opening snap (5th left intercostal space, midclavicular line)
• valvular heart disease often caused by rheumatic fever

Question 11

Mitral valve prolapse

Answer 11

cardiologist referral

• atypical chest pain, mid-systolic click (5th left intercostal space, midclavicular line)
• valvular heart disease (idiopathic), associated w/ marfan’s syndrome
• echography confirms Dx and severity of prolapse

Question 12

Pulmonary embolism

Answer 12

911
sudden onset of dyspnea, pleuritic chest pain, hemoptysis
- breakaway clot from DVT causing obstruction of pulmonary aa. or branch
- positive d-dimer
- lung perfusion scan or spiral CT of chest is diagnostic

Question 13

Subacute bacterial endocarditis

Answer 13

hospital referral

• fatigue, low grade fever, anemia, splinter hemorrhages, clubbing of the fingers and splenomegaly
• disease caused by infection of previously damaged heart valves by streptocccus viridans
• blood cultures grow causative organism associated with dental caries

Question 14

Subclavian steal syndrome

Answer 14

cardiologist referral

• syncope, especially with upper body exercise and radio-radial delay (>10 mm diff b/w BP in both arms)
• congenital occlusion of subclavian aa w/ shunting of blood via vertebral aa
• MRA confirms Dx

Question 15

S. vena cava obstruction

Answer 15

cardiothoracic surgeon referral

• edema of the face and distended neck and upper limb veins
• obstruction fo the SVC by large mass in the S. mediastinum
• seen in lymphoma
• chest xray: widening of the S. mediastinum
• CT scan will show the mass

Question 16

Absence of Schamroths space or nail bed angle

Answer 16

clubbing of the fingers

Question 17

Beau’s lines (transverse grooves in nails)

Answer 17

recent serious disease

Question 18

carotid bruit (whooshing sound)

Answer 18

significantly narrowed artery

Question 19

clubbing of fingers

Answer 19

bacterial endocarditis, Fallot’s tetralogy

Question 20

cyanosis-central (blue lips, fingers, toes)

Answer 20

sever respiratory distress, Fallot’s tetralogy

Question 21

cyanosis-peripheral (blue finger, toes)

Answer 21

cold temperature, raynaud’s disease

Question 22

diagonal earlobe creases

Answer 22

increased risk of heart attack

Question 23

dilated chest and arm veins

Answer 23

superior vena cava obstruction

Question 24

diastolic murmur in 2nd RICS

Answer 24

aortic regurgitation

Question 25

elevated jugular venous pressure

Answer 25

CHF, cardiac temponade

Question 26

diastolic murmur 5th LICS

Answer 26

mitral stenosis

Question 27

displaced apex beat outside of 5th LICS

Answer 27

left ventricular hypertrophy

Question 28

distended jugular veins

Answer 28

congestive heart failure

Question 29

erythema marginatum, cardiac murmur, joint pain

Answer 29

rheumatic fever

Question 30

hepatojugular reflex (increased JVP with RUQ pressure)

Answer 30

congestive heart failure

Question 31

koilonychia (spoon shaped nails)

Answer 31

severe iron deficiency anemia

Question 32

left parasternal heave

Answer 32

right ventricular hyperophy

Question 33

loss of hair on the dorsum of the foot and toes

Answer 33

peripheral vascular disease

Question 34

malar flush (red flushed cheeks)

Answer 34

mitral stenosis, carcinoid tumors

Question 35

midsystolic click in 5th LICS

Answer 35

mitral valve prolapse

Question 36

pale nail beds, mucosa or tongue

Answer 36

anemia

Question 37

pansystolic murmur in 5th LICS

Answer 37

mitral regurgitation

Question 38

peripheral edema BL

Answer 38

CHF, chronic bronchitis, cirrhosis, renal failure

Question 39

peripheral edema unilateral

Answer 39

DVT, cellulitis

Question 40

precodial thrill (palpable murmur)

Answer 40

pathological murmur

Question 41

pulses alternans (strong followed by weak)

Answer 41

left ventricular failure

Question 42

pulses bigeminus (double beats)

Answer 42

hypertrophic obstructive cardiomyopathy

Question 43

pules magnus (bounding pulse)

Answer 43

fever, anemia, hyperthyroidism

Question 44

pulses paradoxus (pule decreases in inspiration)

Answer 44

>10 mm Hg : asthma, cardiac tamponade

Question 45

pulses parvus (low volume pulse0

Answer 45

shock, aortic stenosis

Question 46

Radio-femoral delay

Answer 46

coarctation of the aorta

Question 47

S3 heart sound

Answer 47

normal in healthy young adults, CHF

Question 48

S4 heart sound

Answer 48

HTN, cardiomyopahty

Question 49

split 1st heart sound varies with breathing

Answer 49

normal in health yound 30yo adults

Question 50

split 1st heart sound-fixed (no variation)

Answer 50

ASD or right bundle branch block

Question 51

Splinter hemorrhage

Answer 51

subacute bacterial endocarditis

Question 52

systolic murmur in 2nd RICS

Answer 52

aortic stenosis

Question 53

systolic murmur in the 5th LICS midclavicular line

Answer 53

mitral regurgitation (incompetence)

Question 54

titubation (nodding of head with heart beat)

Answer 54

aortic regurgitation (incompetence)

Question 55

tracheal tug (downward pull on trachea)

Answer 55

aneurysm of the arch of the aorta

Question 56

xanthelasma (yellow eyelid deposits)

Answer 56

hyperlipidemia (50% pts)

Question 57

water hammer pulse (bounding pulse)

Answer 57

fever, anemia, hyperthyroidism)