Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Finals Knowledge FW (copied Akash) > Medicine 1 > Flashcards

Medicine 1 Flashcards

(50 cards)

Start Studying
1
Q

List the cardiac causes of clubbing.

A

Infective endocarditis
Congenital cyanotic heart disease
Atrial myxoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What causes the four heart sounds?

A

S1: mitral valve closure
S2: aortic valve closure
S3: rapid ventricular filling of dilated left ventricle (Kentucky, Most commonly caused by HFrEF, reduced EF means more blood left i.e. greater end diastolic volume and so after contraction blood from atria rushes into an already full LV)
S4: atrial contraction against stiff ventricle (Tenesse, chronic htn leads to LVH and atria contracting against a stiff hypertrophied LV causes this sound just before S1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What murmur is caused by aortic stenosis?

A

Ejection systolic murmur loudest in the right 2nd ICS heart best when sitting forward and in end expiration
Radiates to the carotids
Soft S2 and presence of S4 indicates severity. (tennesse) S4 is caused by atria contracting against stiff ventricle (due to hypertrophy from contracting against a higher afterload)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How does aortic sclerosis differ from aortic stenosis on examination?

A

No radiation to the carotids
Normal pulse character

NOTE: HOCM is another differential for an ejection systolic murmur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

List some causes of aortic stenosis.

A

Senile calcification
Bicuspid aortic valve (2% of population)
Rheumatic heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the main symptoms of severe aortic stenosis?

A

Syncope
Angina
Dyspnoea (this carries worst prognosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

List the echocardiogram features of severe aortic stenosis.

A

Pressure gradient > 40 mm Hg
Valve area < 1 cm^2
Jet velocity > 4 m/s (speed of blood flow across valve)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Outline the management of aortic stenosis.

A

General: MDT, optimise cardiovascular risk, monitor with regular follow-up/echos, treat angina (BB) and heart failure (ACEi + BB)
Surgical valve replacement
TAVI (effective in older/frail patients who are not fit for open repair)
Balloon valvuloplasty is an alternative to TAVI (NOTE: effect reduces after 1 year)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the benefits of TAVI compared to open repair?

A

Heart does not need to be stopped and heart-lung bypass is not necessary
Avoids large thoracotomy scar
Less strain on body (so better for frail patients)

NOTE: it is associated with a higher risk of stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What murmur is caused by mitral regurgitation?

A

Pansystolic murmur heard loudest at the apex in the left lateral position at end-expiration
Radiates to the axilla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some clinical signs of mitral regurgitation?

A 
Displaced apex  (due to LVH)
Apical thrill 
Quiet S1
Pansystolic murmur radiating to the axilla 
S3 (rapid ventricular filling) 
Look for valvulotomy scar
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

List some causes of mitral regurgitation.

A

Mitral valve prolapse (most common)
LV dilatation (e.g. hypertension, connective tissue disorders)
Annular calcification
Rheumatic heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some echocardiogram features of severe mitral regurgitation?

A

Regurgitant volume > 60 mL

Systolic pulmonary flow reversal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Outline the management of mitral regurgitation.

A

General: MDT, risk factor modification
AF - rate control and anticoagulation
Reduce afterload (ACEi, BB, diuretics)
Valve replacement (if symptomatic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What murmur is caused by aortic regurgitation?

A

High-pitched early diastolic murmur loudest at the lower left sternal edge (erb’s point) when sitting forward in end-expiration

NOTE: can cause Austin-Flint murmur (rumbling mid-diastolic murmur due to regurgitant blood hitting the mitral valve)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

List some causes of aortic regurgitation.

A 
Bicuspid aortic valve 
Rheumatic heart disease 
Ankylosing spondylitis 
Rheumatoid arthritis 
Connective tissue disease (Marfan's, Ehlers-Danlos) 
Infective endocarditis 
Type A aortic dissection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Outline the management of aortic regurgitation.

A 
General: MDT, risk factor modification
Reduce afterload (ACEi, BB, diuretics) 
Surgical valve replacement (if symptomatic or LV dysfunction)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What murmur does mitral stenosis cause?

A 
Loud S1 (opening snap) and rumbling mid-diastolic murmur heard loudest at the apex in the left lateral position in end-expiration with the bell
Radiates to the axilla
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are some signs of mitral stenosis?

A

Malar flush (severe)
AF
Tapping apex beat (palpable first heart sound)
NON-displaced apex beat
Right ventricular heave
Blowing mid-diastolic murmur with presystolic accentuation (if not in AF)

NOTE: tends to be middle-aged women who had rheumatic fever in childhood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

List some causes of mitral stenosis.

A

Rheumatic heart disease (MOST COMMON)
Senile degeneration
Endocarditis
Congenital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Outline the management of mitral stenosis.

Study These Flashcards
A

Consider rheumatic fever prophylaxis (pen V)
AF rate control and anticoagulation
Surgical: percutaneous balloon valvotomy (FIRST LINE provided valve mobile and not calcified)
Alternative: replacement

NOTE a TOE to check for a left atrial mural thrombus should be performed before intervention

22
Q

What is the Duckett-Jones criteria for rheumatic heart disease?

Study These Flashcards
A 
MAJOR 
- joints (arthritis)
- carditis 
- nodules subcutaneous 
- erythema marginatum 
- Sydenham's chorea 
MINOR
- Fever 
- High ESR or CRP 
- Arthalgia
- Prolonged PR interval 
- Previous rheumatic fever

Diagnostic criteria:
1.evidence of recent strep infection (antibodies, throat swab or positive rapid GAS test) AND
2. 2 major or 1 major + 2 minor

23
Q

Outline the management of rheumatic fever.

Study These Flashcards
A

Bed rest
Penicillin V
Analgesia for carditis/arthritis: NSAIDs are first line

24
Q

Outline the secondary prevention of rheumatic fever.

Study These Flashcards
A

penicillin V often used after acute infection to prevent recurrence. Given for years and years..

25
What is the difference between acute and subacute endocarditis?
Acute: previously normal valves --> rapid deterioration caused by S. aureus and S. epidermidis --> RF: IVDU, skin wounds, immunosuppression Subacute, more insidious onset: affects damaged valves --> caused by less virulent organisms e.g. S. viridans, S. bovis, HACEK --> RF: prosthetic valves, damages valves
26
List some clinical features of infective endocarditis.
``` Petechiae (common) Splenomegaly (common) Clubbing Splinter haemorrhages Janeway lesions Osler's nodes Fever Roth spots Haematuria ```
27
Which murmurs are most commonly associated with infective endocarditis?
Mitral regurgitation | Aortic regurgitation
28
Outline the Duke criteria for infective endocarditis.
MAJOR - blood cultures: 2x cultures on separate occasions positive for typical IE organisms eg staph aureus, strep viridans) - echo evidence: vegitation or new murmur MINOR - predisposition (cardiac lesion, IVDU) - fever - Vascular phenomena - septic emboli, Janeway lesions, splinter haemorrhages, roth spots - immune phenomena: osler - +ve blood culture not meeting major criteria e.g. contains organisms that are not typical for IE For diagnosis: 2 major OR 1 major + 3 minor OR 5 minor
29
Outline the management of infective endocarditis of the **native** valve
initial blind therapy: IV amoxicillin but if confirmed staph - fluclox if confirmed strep viridans - benzyl pencillin if penicillin allergic for all 3 above scenarios = vancomycin
30
What might you see on general inspection of a patient with a valve replacement?
``` Audible valve click Bruising (anticoagulation) Warfarin alert bracelet Anaemia Midline sternotomy (CABG, open valve replacement) +/- saphenous vein sampling Neck scars from line insertion Femoral/radial scars from angiography ```
31
Name three different types of prosthetic valve.
Starr-Edwards - 3 artificial sounds Tilting disc (Bjork-Shiley) or bileaflet (St. Jude) - 1 artificial sound Bioprosthetic - normal heart sounds NOTE: bileaflet valves are most commonly used
32
How might mitral valve replacements sound different from aortic valve replacements?
Aortic: Lub-Click (systolic flow murmur) Mitral: Click-Dub (diastolic flow murmur)
33
What might a lateral thoracotomy scar be due to?
Mitral valve replacement Mitral valvotomy Coarctation repair Blalock-Taussig shunt
34
What might leave a subclavicular scar in cardiology?
Pacemaker | ICD
35
What is a scar in the antecubital fossa of a cardiology patient suggestive of?
Angoigraphy
36
Which cardiothoracic procedures may be done through a midline sternotomy?
CABG Aortic valve replacement Mitral valve replacement
37
Outline the factors considered when deciding on a type of valve replacement.
METAL: durable, needs lifelong warfarin, better for young patients or patients who are already on warfarin (e.g. for AF) PORCINE: less durable (10 years), no need for warfarin, better for elderly/at risk of haemorrhage NOTE: porcine also known as Carpentier-Edwards valves
38
List some complications of valve replacement.
Thromboembolus Bleeding (due to warfarin) Bioprosthetic dysfunction and LVF (usually within 10 years but can be treated percutaneously by valve in valve) Haemolysis Infective endocarditis (S. viridans, S. epidermidis) Atrial fibrillation (particularly mitral valve replacement)
39
How can any murmur be made louder in a patient?
Make them exercise
40
List some causes of atrial fibrillation.
``` Ischaemic heart disease Valvular pathology (mainly mitral) Rheumatic heart disease Thyrotoxicosis Pneumonia PE Post-op Electrolytes (e.g. hypokalaemia) Alcohol ```
41
Which investigations are useful for identifying a cause of AF?
``` FBC (infection) U&E (K+) TFTs (hyperthyroid) Troponin D-dimer CXR (pulmonary oedema, pneumonia, calcified mitral valve) Echo (valve pathology, LV function) ``` NOTE: important differential is multiple ventricular ectopics
42
How can ventricular ectopics be clinically distinguished from AF?
Exercise the patient AF: pulse remains irregularly irregular VE: as heart rate increases, pulse becomes regular (closes the window for ventricular ectopics)
43
What is the difference between paroxysmal, persistent and permanent AF?
Paroxysmal: < 7 days and self-terminates Persistent: > 7 days and can be terminated with pharmacological or electrical cardioversion Permanent: > 1 year i.e. AF that is continuous and cannot be converted back to normal sinus rhythm, or the decision is made to not attempt to restore sinus rhythm. e.g. long term AF who are rate controlled only but not rhythm controlled
44
What CHADS-Vasc score requires warfarinisation?
2 or more (consider if scores 1)
45
How should a patient with acute AF presenting < 48 hours of onset be managed?
1st line: rhythm control (DC cardioversion or chemical cardioversion (flecainide or amiodarone)) Start LMWH Rate control (BB, CCB, digoxin) NOTE: rhythm control is first line in younger patients, first episode AF and when there is an obvious precipitant to the AF
46
Which medications should be used in the management of paroxysmal AF?
Prevention: bisoprolol or sotalol | Pill in the pocket: flecainide or amiodarone
47
How should patients presenting more than 48 hours after the onset of AF be managed?
3 weeks of DOAC (warfarin if DOAC contraindicated) and rate control before elective cardioversion | Can be done earlier if a TOE excludes a mural thrombus
48
List some contraindications of warfarin.
``` Bleeding tendency Compliance issues (dosing/monitoring) Risk of falls Peptic ulcer disease Pregnancy ```
49
List some complications of warfarin.
Bleeding | Osteoporosis
50
List some indications for permanent pacing.
``` Anything from Mobitz Type 2 and above needs pacing (i.e. mobitz 2 and complete AV block. This is because mobitz 2 can progress to complete block) Symptomatic bradycardia Drug-resistant tachyarrhythmias Biventricular pacing in chronic heart failure (HFrEF patients have ventricular dyssynchrony and dont beat efficiently, this improves efficiency of beating and make them coordinate together) ```

Finals Knowledge FW (copied Akash) (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions