History And Pe

Question 1

NYHA

Answer 1

functional capacity /exercise tolerance
I - asymptomatic
II - comfortable at rest, slight limitation in ordinary physical activity
III - comfortable at rest, but with marked limitation with less than ordinary activities
IV - symptomatic at rest

Question 2

CCS

Answer 2

I - ordinary physical activity such as walking and climbing stairs, doesn’t cause angina
Angina with strenous work or rapid prolonged exertion

II - slight limitation of activity, walkijg or climbing stairs rapidly, walking uphill, walking or stair climbing after meals, in cold, wind or emotional stress,
Walking more than 2 blocks on normal level and climbing more than one flight of stairs under normal conditions

III - marked limitation of ordinary physical activity
Walking 1-2 blocks on normal level and climbing 1 flight of stairs under normal conditions

IV - Inability to carry on any physical activity without discomfort. Anginal syndrome may be present at rest

Question 3

Emaciation

Answer 3

Chronic heart failure
Malignancy
Infection

Question 4

Patients with palpitations, HR less than 60

Answer 4

Significant arrhythmia

LR 3

Question 5

Cheyne Stokes, OSA suggests

Answer 5

Severe systolic heart failure

Question 6

Central cyanosis

Answer 6

Hereditary methemoglobenemia

Question 7

Peripheral Cyanosis / acrocyanosis

Answer 7

Small vessel constriction in severe HF or peripheral vascular disease

Question 8

Describe Cyanosis in PDA and PUlmonary hypertension with RL shunting

Answer 8

Differential cyanosis - affecting lower but not upper extremities

Question 9

Findings on Osler Weber Rendu Syndrome

Answer 9

Hereditary telangiectasias onnlipsnmouth tounge and mucosa resembles spiders

At lungs, may cause right to left shunting and central cyanosis

Question 10

Telangiectasias can also be seen in

Answer 10

Scleroderma with or without pulmonary hpn

Question 11

Describe findings in iron overload /hemochromatosis

Answer 11

Tanned or bronze discoloration

Question 12

Ecchymoses -
Petechiae -
Purpura -

Answer 12

• anticoagulant or antiplatelet use
• thrombocytopenia
• IE or leukoclastic vasculitis

Question 13

Xanthomas at palmar creases are specific for

Answer 13

Type III hyperlipoprotenemia

Question 14

Describe pseudoxanthoma elasticum

Answer 14

Leathery, cobblestobe, pluced chicken appearance

Question 15

Extensive lentiginoses with multiple CV syndromes - myxoma, asd, hcom, valvular stenoses

Answer 15

Dev delay associated cardiovascular symptoms - LAMB, CARNEY, LEOPARD

Question 16

In pxs wjth Lupus pernio, erythema nofosum or granula annulare with heartnfaioure and syncope, what will you suspect

Answer 16

Cardiovascular sarcoid

Question 17

High arched palate -
Large protruding tongue -
Bifid uvula -
Orange tonsils -

Answer 17

Marfan
Amyloidosis
Loeys-Dietz
Tangier disease

Question 18

Describe pxs with possible congenital heart disease with Noonan, Turner and Down syndromes

Answer 18

Hypertelorism, lowset ears, microagnathia, webbed neck

Question 19

Valvular heart disease associated with Osteogenesis imperfecta

Answer 19

MR, AR

Question 20

Lacrimal gland hyperplasia

Answer 20

Sarcoidosis

Question 21

Mitral facies

Answer 21

Pink purple patches with telengiactasias over malar eminences
Can also be seen in dses with low cardiac output and PUlmonary hypertension

Question 22

Unopposable “fingerized” thumb

Answer 22

Holt oram syndrome

Question 23

Arachnodactyly

Answer 23

Marfan

Question 24

Janeway lesions

Answer 24

Non tender, slightly raised areas of hemorrhage om palms and soles

Question 25

Osler nodes

Answer 25

Tender, raised nodules on pads of fingers and toes

Question 26

Splinter hemorrhages

Answer 26

Linear petechiae in nailbeds

Question 27

Normal jvp, with signs of venous disease

Answer 27

Chronic venous insufficiency

Question 28

Lower extremity or presacral edema with elevated jvp

Answer 28

Heart failure

Volume overload

Question 29

Homans sign

Answer 29

Calf pain on dorsiflexion of foot - neither specific nor sensitive with dvt

Question 30

Lipodystrophy

Answer 30

Redistribution of fat from extremities to central or abdominal stores

Question 31

Normal us clubbed nail : phalangeal depth ratio

Answer 31

Normal- DPD < IPD

Clubbed - DPD >IPD

Question 32

Normal us clubbed nail : phalangeal depth ratio

Answer 32

Normal- DPD < IPD

Clubbed - DPD >IPD

Question 33

Schamroth sign

Answer 33

IF no clubbing, nail to nail opposition creates a diamond shaped window ; in clubbing there
is obliteration of this space

Question 34

Cardiac aburmalities to be expected in AnkyIosing spondylitis with severe kyphosis

Answer 34

AR , lst degree Av block

Question 35

Straight back syndrome

Answer 35

MVP

Question 36

Thrill over well developed Intercostal artery collateralS suggests

Answer 36

Aortic coarctation

Question 37

Enlarged liver and tender in HF, systolic pulsations signifies

Answer 37

Tricuspid Regurgitation