Week 1 Flashcards by Iseoluwa Ojo

myocardial ischaemia is classically felt in the ___________ radiating to the _______

Pain from a hollow organ is classically __________ (such as biliary or renal colic).

centre of the chest

left arm

colicky

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The pain of a subarachnoid haemorrhage is classically very ____________, ‘like a __________ to the head’.

sudden

hammer blow

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peptic ulcer pain is classically worse when _______ and better ___________ ).

hungry

after food

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a headache accompanied by ______________ suggests migraine

preceding flashing lights

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The UK Government now recommends that to minimize alcohol-related health effects, both men and women should keep to less than ________ of alcohol per week.

14 units

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The units of alcohol can be determined by __________________ by its _________________ and ______________.

multiplying the volume of the drink (in ml)

% alcohol by volume (abv)

dividing this by 1000

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The CAGE assessment for alcohol dependency
■ C – Have you ever felt the need to ___________________ ?
■ A – Have you ever felt ___________________?
■ G – Do you ever feel ___________________ ?
■ E – Do you ever drink in the ___________________?

—————— positive answers could indicate a problem of dependency.

Cut down your alcohol consumption

Angry at others criticizing your drinking

Guilty about excess drinking

mornings (Eye-opener)

Two or more

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Pneumaturia: almost always due to a _____________

Fortification spectra: if associated with ___________, strongly suggests classical migraine

colovesical fistula

unilateral headache

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Rigors: strongly suggests _________,_______, or __________

A bitten tongue: if associated with a seizure, strongly suggests a __________

bacteraemia, viraemia or malaria

grand mal fit

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The examination should be conducted in a warm, private, quiet area. Daylight is preferable to artificial light, which may make the recognition of —————————————— difficult

subtle changes in skin colour (e.g. mild jaundice)

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For most patients, start the examination on the right of the bed/couch with the patient __________ (approximately ______).

semi- recumbent

45°

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Patients with left heart failure typically find that lying ___________ worsens their sense of ___________(______)

horizontally

breathlessness (orthopnoea

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A persistent fever is one that ___________________________________

; a remittent fever ______________________ ; and an intermittent or spiking fever is present for only ___________ at a time before returning to normal. None has great sensitivity or specificity for any particular diagnosis, but changes may provide useful information about the course of a disease.

does not fluctuate by more than 1°C during 24 hours

oscillates by 2°C during the course of a day

several hours

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fine tremor of _______ or recent _____________ therapy

rhythmical ‘pill rolling’ tremor of ____________

coarse jerky tremor of ___________ or __________

intention tremor of _______________.

thyro- toxicosis; beta-adrenergic

Parkinsonism

hepatic or uraemic failure

cerebellar disease

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Feel for Dupuytren’s contracture in both hands, the first sign of which is usually a ___________ of tissue over the _________ of the __________ at the level of the ____________.

thickening

flexor tendon

ring finger

distal palmar crease.

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____________ angle refers to the angulation between the nail plate and the skin below the nail, when viewed laterally.

Lovibond’s

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Lovibond’s angle refers to the angulation between the _________ and ___________, when viewed laterally.

nail plate and the skin below the nail

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Lovibond’s angle

Normally it is ______________. When clubbing is present, the angle is at least _______________________

less than 180°

180°, or more.

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Raynaud’s syndrome, in which __________ of the __________ causes the fingers to become __________ and __________, followed by __________ __________ and then __________ due to __________ and __________

vasospasm; digital arterioles

white and numb

blue/purple cyanosis

redness; arteriolar dilatation

reactive hyperaemia

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In koilonychia the nails are (soft or hard?), (thin or thick?) and _______ and the normal _______ity replaced by a _________-shaped _______ity .

It is a rare feature of longstanding ____________.

soft, thin and brittle

convex ; spoon

concav; iron-deficiency

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Leuconychia ( __________ nails) may occur in _________ disease and other conditions associated with __________ , but are not particularly useful for making a clinical diagnosis of chronic liver disease.

opaque white

chronic liver

hypoalbuminaemia

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The odour of diabetic ketoacidosis resembles __________

The odour of hepatic failure and uraemia have been described as ‘ __________ ’ or ‘ ________’, respectively, but such terms are rather subjec- tive and their use is limited.

Halitosis (bad breath) is common in patients with __________ diseases and those with gingivitis due to poor dental hygiene.

acetone

ammonia-like; mousy

suppurative lung

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Causes of secondary HT???

Alcohol
Obesity
Pregnancy
RENAL
Endocrine
• - NEUROGENIC
Vascular
Aortic coarctation

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Systemic hypertension is defined as persistently elevated systolic and diastolic blood pressure above _________ mmHg

140/90

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Hypertension can only be diagnosed when elevated BP levels are measured on ______________ occasions

Two different

Optimal BP = Normal BP= High normal BP=

<120/80 120-129/80-84 130-139/85-89

You can rule out white coat hypertension by using _______ and ________ BP readings

Home Ambulatory

Target organ damages in hypertension BLOOD VESSELS: _________ of the arterial wall Widespread _________ ,causing _____,____, etc, especially if there’s a positive history of smoking, DM, or Hyperlipidemia Aortic _________ and aortic __________

Thickening Atheroma; CAD;CVD Aneurysm; dissection

Target organ damages in hypertension CNS: ________,________ atheroma, ________,________

Stroke; carotid; transient ischemic attack; subarachnoid Haemorrhage; hypertensive encephalopathy

hypertensive encephalopathy = _______+ _________ such as _____,____,______

High BP Neurological symptoms Speech and vision disturbance Paresthesia Papilloedema

Target organ damages in hypertension RETINA: GRADE1: arterial walls are ________, and ________ and there’s ______ phenomenon Grade 2:grade 1+ _________ Grade 3: grade 2+ ___________ Grade 4: grade 3+ ____________

Thickening ; tortuous; silver wiring Arteriovenous nipping Evidence of retina ischemia Papilloedema

silver wiring : increased __________ of the retinal vessels Evidence of retina ischemia : eg _______ Haemorrhage and ________ exudates

Reflectiveness Flame /blot Cotton wool/soft

What grades of hypertensive Retinopathy are diagnostic of malignant hypertension

3 and 4

Target organ damages in hypertension HEART: ________ __________ _____________

Coronary artery disease Left ventricular hypertrophy Atrial fibrillation Heart failure

Target organ damages in hypertension KIDNEY: _________,__________

Proteinemia Progressive renal failure

Malignant hypertension A (common or rare?) complication of hypertension characterized by ________ and rapidly progressive ___________

Rare; raised BP End organ damage

Pulsating abdominal mass= ???

Aortic aneurysm

Chest pain on exertion suggests ______________

angina pectoris

Severe prolonged cardiac chest pain may be due to ____________ or to __________ – known collectively as ______________

acute myocardial infarction unstable angina acute coronary syndrome.

Acute coronary syndrome is suggested by a previous history of ___________ but an episode of __________________________ can also be the first presentation of coronary artery disease.

stable angina acute severe chest pain at rest

The term ‘syncope’ refers to _______________ due to _______________.

loss of consciousness reduced cerebral perfusion

Cardiac arrest describes the sudden and complete _____________ due to ______, ventricular ___________ or ventricular ___________

loss of cardiac output asystole; tachycardia fibrillation

Acute coronary syndrome includes ———-,———,————

Unstable angina NSTEMI STEMI

Polyuria + cardiac arres This is usually a symptom of ???

Supraventricular tachycardia

Additional heart sounds and murmurs demonstrate a consistent relationship to the ____________, whereas extracardiac sounds, such as a pleural rub or venous hum, do not.

cardiac cycle

Pathological sounds and murmurs are the product of _________ or _________ due to abnormal loading conditions.

turbulent blood flow rapid ventricular filling

Some added heart sounds are physiological but may also occur in pathological conditions; for example, a third sound is common in ______ people and in _________ but is also a feature of __________.

young; pregnancy Heart failure

Similarly, a systolic murmur due to turbulence across the right ventricular outflow tract may occur in hyperdynamic states such as _______ or __________, but may also be due to pulmonary stenosis or an intracardial heart lead

anaemia or pregnancy

Heart sounds: Timing First heart sound : ________ Second heart sound : ___________ Third heart sound: __________ Fourth heart sound: ___________

Onset of systole End of systole Early in diastole, just after S2 End of diastole, just before S1

Heart sounds: Mechanisms First heart sound : ________ Second heart sound : ___________ Third heart sound: __________ Fourth heart sound: ___________

Closure of mitral and tricuspid valves Closure of aortic and pulmonary valves From ventricular wall due to rapid cessation of filling From ventricular origin related to atrial filling

Features of a benign or innocent heart murmur (Soft or hard?) Occurs at __________ No __________ No __________

Soft Mid-systole Radiation Other cardiac abnormalities

Heart failure describes the clinical syndrome that develops when the heart cannot ___________, or can do so only at the expense of __________________.

maintain adequate output elevated ventricular filling pressure

In mild to moderate forms of heart failure, symptoms occur only when the ___________________ increases during _______ or some other form of ________.

metabolic demand exercise stress

______________ is the commonest cause of angina and acute coronary syndrome and the leading cause of death worldwide.

Coronary artery disease (CAD)

Stable angina : ________ due to ___________ of one or more coronary arteries

Ischaemia ; fixed atheromatous stenosis

Unstable angina: _________ caused by _______ complete or partial _______ of a coronary artery due to ________ or ______ with superimposed ___________

Ischaemia ; dynamic obstruction ; plaque rupture erosion ;thrombosis

Myocardial infarction (type 1): ________ caused by _________ of a coronary artery due to plaque rupture or erosion with superimposed thrombosis Myocardial infarction (type 2): ______________ where blood flow cannot meet the needs of the myocardium.

Myocardial necrosis; acute occlusion Supply demand imbalance

Heart failure: ____________ due to ________ or _______

Myocardial dysfunction infarction or ischaemia

Arrhythmia : __________ due to ischaemia or infarction

Altered conduction

Sudden death Can be caused by : Ventricular __________ , _________ or ____________

arrhythmia asystole massive myocardial infarction

________ is the most impor- tant modiable risk factor for CAD

Smoking

Diabetes mellitus This is a potent risk factor for all forms of atherosclerosis, especially type ______ diabetes mellitus.

Classification of angina pectoris and chestpain Three characteristic features of angina 1. Constricting discomfort in the _________, or in the ______, ________, _______ or _______ 2. Precipitated by _______________ 3. Relieved by _______ (or GTN) within _________

centre of the chest neck; shoulders jaw or arms physical exertion rest; 5 minutes

coronary artery spasm may rarely occur as an isolated phenomenon in patients with normal coronary arteries on angiography. This is sometimes known as ________ angina; when it is accompanied by ___________ on the ECG, it is termed _______ angina.

variant transient ST elevation Prinzmetal’s

Some patients find the discomfort comes when they start walking and that later it does not return despite greater effort (‘ _______ angina’).

warm-up

The term acute myocardial infarction (MI) should be used when there is ______________ with clinical evidence of __________________ and with detection of a rise and/or fall of cardiac troponin values with at least one value above the 99th centile upper reference li

acute myocardial injury acute myocardial ischaemia

For the diagnosis of type 2 MI, there needs to be clinical evidence of ischaemia, such as __________ or __________ .

ECG changes or symptoms of chest pain

Buerger’s disease or __________________ is an inflammatory disease of the arteries that is distinct from atherosclerosis and usually presents in (young or old?) ( ________ years) _______________.

thromboangiitis obliterans Young 20–30 years male smokers

Buerger’s disease _______ and _______ pulses are absent but _______ and ______ pulses are present. It may also affect the veins, giving rise to superficial ___________. It often remits if the patient stops smoking.

Wrist and ankle brachial and popliteal thrombophlebitis

Buerger’s disease ____________ is the most frequent outcome if patients continue to smoke.

Major limb amputation

Raynaud’s syndrome This common disorder affects 5%–10% of ___________ aged ______ years in temperate climates. It does not progress to ________ or ________, and _________ is unusual.

young women; 15–30 ulceration or infarction significant pain

Raynaud’s syndrome The patient should be reassured and advised to avoid __________. Usually, no other treatment is required, although vasodilators such as nifedipine can may be helpful if symptoms are trou- blesome. More severe Raynaud’s syndrome can also occur in association with digital ulceration in patients with connective tissue disease.

exposure to cold

a BP check is advisable every _______ in adults over 40 years of age to pick up occult hypertension.

5 years

Signs in hypertension radio-femoral delay can be found in patients with ________________ enlarged kidneys in patients with ____________ disease

coarctation of the aorta polycystic kidney

Dilated Cardiomyopathy is characterised by ________ and impaired ________ of the LV and often the RV.

dilatation; contraction

In DCM Left ventricular _____ is increased but ___________ is normal or reduced .

mass; wall thickness

In DCM __________ may be an important cause in some patients. At least 25% of cases are inherited as an ______________ trait and a variety of single-gene mutations have been identified

Alcohol; autosomal dominant

Spondylosis A general term for _____-related __________ of the _______

age wear and tear spinal discs

Brachial plexus It begins in the _____________, passes through the _______, and runs through the entire ____________.

root of the neck axilla upper extremity

The brachial plexus is formed by the anterior rami (divisions) of cervical spinal nerves _______________ and the ___________

C5, C6, C7 and C8, first thoracic spinal nerve, T1.

The brachial plexus is divided into five parts; ______,________,________,_______, and _________

roots, trunks, divisions, cords and branches

Branches of brachial plexus ________ Nerve ___________ nerve ________ nerve ________ Ulnar ________ nerve

Musculocutaneous Axillary Radial Median Ulnar

When dissecting the upper limb, it can be difficult to recognise what part of the brachial plexus you are at – it can just look like a mass of nerves. The important structure to look for is an ‘ ____ ’ shape. This is formed by the _________,________, and _______ nerves, usually superficial to the axillary artery. This shape is usually consistent between cadavers. It can help you get your bearings, and you can work backwards to identify the cords, divisions and branches

M musculocutaneous, median, and ulnar

Erb’s palsy refers to an injury to the ___________ of the brachial plexus (typically ______). It most commonly occurs as a result of a ______ injury during a difficult __________-.

upper roots; C5-6 stretching vaginal delivery.

Klumpke’s palsy is an injury of the ________ of the brachial plexus (_______). It is also most commonly associated with a ____________ but has a much (lower or higher?) incidence than Erb’s palsy.

lower roots C8-T1 difficult vaginal delivery Lower

In the neck, the internal jugular vein descends within the ___________ , (superficial or deep?) to the ___________ and (medial or lateral?) to the common carotid artery. At the base of the neck, posteriorly to the ___________________ , the IJV combines with the ________ to form the _________ vein.

carotid sheath; deep sternocleidomastoid muscle lateral sternal end of the clavicle subclavian vein; brachiocephalic

The external jugular vein courses (superficial or deep?) to and obliquely across the _____________ in the ______ fascia. Part of its descent in the neck is also along the ________ border of the sternocleidomastoid muscle in its lower third.

superficial sternocleidomastoid muscle Superficial posterior

The external jugular vein most commonly drains into the __________ vein near the _______ third of the _______.

subclavian middle clavicle

Kussmaul's sign is a paradoxical ___________________ on inspiration, or a failure in the appropriate _________ with inspiration. It can be seen in some forms of heart disease and is usually indicative of __________________________ due to _________

rise in jugular venous pressure (JVP) fall of the JVP limited right ventricular filling right heart dysfunction.

Most women experience menopause between the ages of ______ and ______ years as a natural part of biological ageing.

45 and 55

CRANIAL NERVES ____________ nerve (CN I) ____________ nerve (CN II) ____________ nerve (CN III) ____________ nerve (CN IV) ____________ nerve (CN V) ____________ nerve (CN VI) ____________ nerve (CN VII) ____________ nerve (CN VIII) ____________ nerve (CN IX) ____________ nerve (CN X) ____________ nerve (CN XI) ____________ nerve (CN XII).

Olfactory nerve (CN I) optic nerve (CN II) oculomotor nerve (CN III) trochlear nerve (CN IV) trigeminal nerve (CN V) abducens nerve (CN VI) facial nerve (CN VII) vestibulocochlear nerve (CN VIII) glossopharyngeal nerve (CN IX) vagus nerve (CN X) accessory nerve (CN XI) hypoglossal nerve (CN XII).

Locomotor brachii is a prominent __________ of ——————- usually seen in patients with severe _________________ and elderly patients with ______________

pulsation of tortuous brachial artery aortic regurgitation arteriosclerosis

How to different between pulsation from the jugular vein and pulsation from the carotid artery

IJV’s is more of a wave like motion Palpate the right subcoastal region deeply, If the pulsation gets more prominent, then it’s IJV

Echocardiography, also known as ________________, is the use of ultrasound to examine the heart, ____________. It is a type of medical imaging, using __________ or ___________ .

cardiac ultrasound Non-invasively

An echocardiogram can also give physicians other estimates of heart function, such as a calculation of the _________,________, and _______

cardiac output, ejection fraction, and diastolic function

Uses of echocardiogram _________ of Heart Conditions: ______________ of Heart Function: ____________________ Detection of _______________ It has. _________ , as well as ________ value

Diagnosis Assessment Monitoring Treatment Effectiveness Blood Flow Irregularities Prognostic; therapeutic

The Mercedes-Benz sign can be seen in aortic __________ on ______ 1. It is seen as _______________ that have a ________ configuration similar to the Mercedes-Benz logo

dissection ; CT three distinct intimal flaps triradiate

Reverse mercedenz Benz sign Two of the three lumens outlined by these intimal flaps belong to the ________________

false lumen of aortic dissection.

Tissue Doppler echocardiography (TDE) is a medical ultrasound technology, specifically a form of echocardiography that measures the _________________ through the phases of one or more heartbeats by the Doppler effect ( _____________ ) of the reflected ultrasound.

velocity of the heart muscle (myocardium) frequency shift

Doppler echocardiography It is based on the Doppler principle that _______________________ from moving objects, such as _________, undergo a _____________.

sound waves reflected red blood cells frequency shift

The aorta can be divided into four sections:???

the ascending aorta, the aortic arch, the thoracic (descending) aorta and the abdominal aorta.

Aorta terminates at the level of _____ by bifurcating into the _______________________ arteries.

L4 left and right common iliac

Ascending Aorta: Branches They give rise to the ____________________ arteries

left and right coronary

There are three major branches arising from the aortic arch. Proximal to distal: List them

Brachiocephalic trunk Left common carotid artery Left subclavian artery

Coarctation of the aorta refers to _________ of the vessel, usually at the ___________________ (former ___________). It is a congenital condition.

narrowing insertion of the ligamentum arteriosum ductus arteriosus

Coarctation of aorta The narrow vessel has an increased ————-1 to blood flow, which increases the _______ for the left ventricle – leading to _______________

resistance after-load left ventricular hypertrophy.

Branches of thoracic aorta In descending order: List them!

Bronchial arteries Mediastinal arteries Oesophageal arteries Pericardial arteries Superior phrenic arteries Intercostal and subcostal arteries:

Aortic dissection A ——— in the __________ of the aorta It's most common in (men or women?) in their ______ and ______

tear; inner layer Men; 60s and 70s.

ABCDE of chest X-ray features of heart failure ?? A B C D E

Alveolar edema Kerley B lines Cardiomegaly Dilated prominent upper lobe vessels Pleural effusion

Kerley B lines are ???

Interstitial edema

Causes of heart failure? List 8

High blood pressure Valvular diseases Cardiomyopathy Congenital heart disease Arrythmia Diabetes Coronary heart disease Alcohol Obesity

Precipitants of heart failure List 8

Infections Anaemia Unaccustomed exercise Electrolyte derangement Endocrine dysfunction Poor medical adherence Renal failure MI

Peripartum cardiomyopathy is a rare disorder in which a pregnant woman's heart becomes _________ and ________ . It develops during the _______________, or within __________________________.

weakened and enlarged last month of pregnancy 5 months after the baby is born

Gallop rhythm is a mechanical event associated with a relatively _____ rate of _____________ and characterized by a ventricular ______ and a __________ sound

rapid ventricular filling bulge; low-frequency

A _________ rhythm in diastole is called a gallop and results from the presence of a ____________[__.

triple S3, S4 or both

Gallop rhythm Both sounds are _____ frequency and thus best heard with the _____ of the stethoscope.

Low bell

A gallop rhythm contains another sound, called S3 or S4, dependent upon where in the cycle this added sound comes. It can also contain _______________ forming a ________ gallop, and in situations of very fast heart rate can produce a summation gallop where __________________.

both of these sounds ; quadruple S3 and S4 occur so close as to be indistinguishable

Known as the “four pillars” of heart failure therapy, these medications are ____________,____________________ , ___________________ and __________________.

beta blockers angiotensin receptor-neprilysin inhibitors (ARNIs) mineralcorticoid receptor antagonists (MRAs) sodium-glucose co-transporter 2 Inhibitors (SGLT2i)

Heart failure based on ejection fraction ??

Preserved: 50% and above of the ejection fraction Mildly reduced: 40-40% Reduced: less than 40%

Symptoms of left sided heart failure Mention 7

Dyspnea Orthopnea Cough Cyanosis Fatigue Tachycardia Paroxysmal nocturnal dyspnea

Symptoms of right sided heart failure List 7

Ascites Pedal edema Hepatomegaly Distended jugular veins Splenomegaly Wright gain Anorexia and GI distress