L1: Cardiac Examination

Question 1

Weight & height affection

• Lt to Rt Shunt “Large VSD”

Answer 1

• Weight loss > Height loss

“D2 ⭣⭣ caloric intake + ⭡⭡ requirements”

Question 2

Weight & height affection

• Cyanosis “Chronic Hypoxemia Like TOF”

Answer 2

Weight loss = Height loss

Question 3

Weight & height affection

• Obstructive Lesions “As AS”

Answer 3

Normal growth pattern

Question 4

Weight & height affection

• HF

Answer 4

Acute weight gain “D2 edema”

Question 5

Width & Length of BP Cuff

Answer 5

• The width of the bladder of the cuff should be 40-50% of the circumference of the limb.
• The length of the cuff should cover nearly the whole limb.

Question 6

• Pulsus alternans in ……
• Pulsus paradoxus in …….

Answer 6

• severe CHF
• pericardial effusion with tamponade

Question 7

Most comfortable Position

• Sitting Up

Answer 7

Severe HF – Tamponade - Pulmonary edema

Question 8

Most comfortable Position

• Squatting

Answer 8

TOF

Question 9

General Appearence

• Ill or Toxic

Answer 9

• inflammatory process as RF
• infection as endocarditis

Question 10

Down Syndrome & CHD

Answer 10

40% CHD:

◈ AVSD ⇢ 60%
◈ VSD, ASD ⇢ 20-30%
◈ TOF ⇢ 5-10%

Question 11

Noonan Syndrome & CHD

Answer 11

50% CHD:

◈ Valvular Pulmonary Stenosis

Question 12

Turner Syndrome & CHD

Answer 12

35% CHD:

◈ Bicuspid Aortic Valve
◈ Coarctation of aorta

Question 13

Marfan Syndrome & CHD

Answer 13

CHD:

◈ Mitral prolapse
◈ Aortic insufficiency
◈ Dissecting aortic aneurysm

Question 14

Nut. Status

• Loss of SC Fat

Answer 14

Reflecting severe FTT in severe CHF

Question 15

General Examination

• Splinter Hemorrhages

Answer 15

• Linear black lines under fingernails resembling splinter 2ry to small infarcts.
• Occur in Infective Endocarditis

Question 16

General Examination

• Janeway Lesions

Answer 16

• Erythematous, macula, non-tender.
• Occur in Infective Endocarditis

Question 17

General Examination

• Osler’s Nodes

Answer 17

Question 18

General Examination

• SC Nodules
• Erythema Marginatum
• Arthritis of Large Joints

Answer 18

Rheumatic fever

Question 19

General Examination

• Gum infection and decayed teeth

Answer 19

Infective endocarditis

Question 20

General Examination

• Chronic adenoid or tonsillar enlargement

Answer 20

Pulmonary Hypertension

Question 21

Precordial Bulge in ……

Answer 21

Long standing cardiomegaly (congenital or acquired)

Question 22

Precordial Activity in …….

Answer 22

• Quite precordium e.g., TOF.
• Active precordium only with volume overload ⇢ VSD, PDA, MR or AR.

Question 23

Normal Site of Apex

Answer 23

Question 24

Causes of Absent Apex

Answer 24

Question 25

Causes of **Shifted Apex**

Answer 25

Question 26

Extent of **Apex** - LVH

Answer 26

Localized

Question 27

Extent of **Apex** - RVH

Answer 27

Diffuse

Question 28

Character of **Apex** - Hyperdynamic

Answer 28

◈ Forcible & non-sustained ◈ In volume overload e.g., MR, AR, and VSD

Question 29

Character of **Apex** - Heaving

Answer 29

◈ Forcible & sustained ◈ In pressure overload e.g., AS, HTN

Question 30

Character of **Apex** - Slapping

Answer 30

◈ Not Forcible, not sustained ◈ In mitral stenosis

Question 31

Pulsations of **Apex** - Suprasternal Pulsations

Answer 31

Hyperdynamic circulation

Question 32

Pulsations of **Apex** - Pulsations in 2nd Right space

Answer 32

Aortic dilatation

Question 33

Pulsations of **Apex** - Pulsations in 2nd Left Space

Answer 33

Pulmonary HTN “PA Dilatation”

Question 34

Pulsations of **Apex** - Parasternal Pulsations

Answer 34

RVH

Question 35

Pulsations of **Apex** - Apical Pulsations

Answer 35

Normal

Question 36

Pulsations of **Apex** - Epigastric pulsations

Answer 36

RVH, Aorta, Pulsating liver

Question 37

General Examination - Scars

Answer 37

Question 38

Dullness outside the apex

Answer 38

Pericardial Effusion

Question 39

Auscultatory Areas

Answer 39

Question 40

Normal Variable Splitting of S2

Answer 40

Question 41

Heart Sounds in - ASD

Answer 41

Question 42

Heart Sounds in - Pulmonary HTN in VSD

Answer 42

Question 43

Heart Sounds in - Pulmonary Stenosis

Answer 43

Question 44

Heart Sounds in - TOF

Answer 44

Question 45

Heart Sounds in - Severe AS

Answer 45

Question 46

Abnormalities of S1 - MS

Answer 46

Question 47

Abnormalities of S1 - MR

Answer 47

Question 48

**Volume Overload** - Causes - Ventricular Response - Apex Character

Answer 48

Question 49

**Pressure Overload** - Causes - Ventricular Response - Apex Character

Answer 49

Question 50

Causes of **Opening Snap**

Answer 50

- In MS ⇢ it is best heard inside the apex - In TS ⇢ it is best heard over the tricuspid area

Question 51

Causes of **Ejection Click**

Answer 51

- In AS (valvular type) ⇢ it is heard in the aortic area (A1) - PS (valvular type) ⇢ it is heard in the pulmonary area (P).

Question 52

Causes of **Friction Rub**

Answer 52

Heard with dry pericardial effusion ------> Disappear with stopping breathing

Question 53

Types of **Murmur**

Answer 53

Question 54

MR - Max Intensity - Propagation

Answer 54

Question 55

MS - Max Intensity - Propagation

Answer 55

Question 56

VSD - Max Intensity - Propagation

Answer 56

Question 57

Rt Heart Murmurs increase with .......

Answer 57

inspiration

Question 58

Lt Heart Murmurs increase with .......

Answer 58

expiration

Question 59

Aortic Murmurs increase with .......

Answer 59

leaning forward

Question 60

Mitral Murmurs increase with .......

Answer 60

lt lateral position

Question 61

Types of **Systolic Murmurs**

Answer 61

Question 62

Murmur in - Mild PS - Mild AS

Answer 62

Question 63

Murmur in - Severe PS - Severe AS

Answer 63

Question 64

Murmur in - More Severe PS

Answer 64

Question 65

Murmur in - MR - TR - Large VSD

Answer 65

Question 66

Murmur in - Small VSD

Answer 66

Question 67

Diastolic Murmurs

Answer 67

Question 68

Murmur in - AR - PR

Answer 68

Question 69

Murmur in - MS - TS

Answer 69

Question 70

Murmur in - PDA

Answer 70