Week 2 Flashcards by Iseoluwa Ojo

Rheumatic fever in childhood is important because of its association with _______________ disease

diabetes and dyslipidaemias because of their association with ____________ disease.

Smoking is a major risk factor for _________ disease.

Alcohol abuse predisposes to _________ and ________.

valvular heart ; coronary artery

coronary artery; cardiac arrhyth- mias and cardiomyopathy

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____________,___________,___________, and ____________ are the most common causes of acute, severe chest pain.

Chronic, recurrent chest pain is usually caused by __________,_________,________,___________.

Myocardial ischaemia, pericarditis, aortic dissection and pulmonary embolism

angina, oesophageal reflux or musculoskeletal pain

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Risk factors for cardiovascular disease
■

____________
_____________
_____________
________________
___________________

Smoking

hypertension

hypercholesterolaemia

diabetes

family history of premature vascular disease

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Xanthomas are _______________________.

Xanthelasma are __________________________

lesions on the skin containing cholesterol and fats

a type of xanthoma appearing on the eyelids.

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Causes of angina
Impaired myocardial oxygen supply
■ Coronary artery disease:
–_____________
– ________ in connective tissue disorders –_________________
■ Coronary artery ———-
■ Congenital coronary artery disease:
– _____________
– anomalous origin from pulmonary artery
■ Severe _________ or _________

atherosclerosis; arteritis; diabetes mellitus

spasm; arteriovenousfistula

anaemia or hypoxia

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Causes of angina

Increased myocardial oxygen demand
■ __________________________ : caused by ______________,________,_____________

■ _______________________

Left ventricular hypertrophy

hypertension, aortic valve disease, hypertrophic cardiomyopathy

Tachyarrhythmias

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Occasionally angina is provoked only by the first significant activity of the day, a phenomenon known as the ‘_______________’ due to myocardial _____________.

warm-up effect

preconditioning

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Pericarditis causes _______ chest pain, which is _______ in character and aggravated by _________,____________ or postural changes.

central

Sharp

deep inspiration

cough

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What differentiates STEMI from NSTEMI?

Presence of cardiac bio markers in STEMI

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Aortic dissection produces severe _______ pain in either the ___________ of the chest.

tearing

front or the back

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Aortic dissection
Typical patient
■ Middle-aged or elderly patient with a history of _________ or ___________
■ Occasionally younger patient with _________ disease (e.g. _________ )

hypertension or arteriosclerotic disease

aortic root

Marfan syndrome

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Peripheral pulmonary embolism causes _______-onset sharp, ____________pain, ______________ and __________.

sudden

pleuritic chest

breathlessness

haemoptysis

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Major, central pulmonary embolism presents with ________ and _______ pain that can be indistinguishable from ______________ pains and syncope

breathlessness

chest

ischaemic chest

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Dyspnoea is an ___________________ occurring either at ___________ or __________________ .

abnormal awareness of breathing

rest or at an unexpectedly low level of exertion

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Acute left ventricular failure

Major symptoms
■ Severe _________, _________, ___________, _________,_________

Major symptoms
■ Severe dyspnoea, orthopnoea, frothy sputum, cough, PND

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NYHA classification

I
II
III
IV

Asymptomatic

Symptoms on normal exertion, e.g. walking up a flight of stairs

Symptoms on minimal exertion, e.g. getting dressed

Symptoms at rest

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Exertional fatigue is an important symptom of heart failure and is particularly troublesome towards the __________

end of the day

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Cardiovascular disorders produce dizziness and syncope by _____________, resulting in abrupt _____________.

transient hypotension

cerebral hypoperfusion

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Recovery from cardiovascular syncope is usually ______, unlike with other common causes of syncope (e.g. stroke, epilepsy, overdose)

rapid

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In _______________ heart disease, clubbing is not present at birth but develops during infancy and may become very marked. ______________ is the only other cardiac cause of clubbing

congenital cyanotic

Infective endocarditis

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Cardiac causes of cyanosis ?

Heart failure
Pulmonary edema
Congenital heart disease

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Subcutaneous oedema that pits on digital pressure is a cardinal feature of _______________, a cardiac condition .

congestive heart failure

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pericardial effusion (_______________)

thickened pericardium ( _______________ )

cardiac tamponade

pericardial constriction

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A reduced or absent pulse indicates an obstruction more _________ally in the arterial tree, usually caused by _________________ or ______________ and less commonly by ______________ .

proxim

atherosclerosis or thromboembolism

aortic dissection

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_________________ causes symmetrical reduction and delay of the femoral pulses compared with the radial pulses (‘radiofemoral delay’), a sign that should be looked for in younger patients with hypertension. Bruits from collateral vessels may also be heard over the back of such patients.

Coarctation of the aorta

In _____________, and less commonly in ______________, inspiration produces a paradoxical rise in the JVP (Kussmaul’s sign) because the ____________________________________

constrictive pericarditis tamponade increased venous return that occurs during inspiration cannot be accommodated within the constrained right side of the heart

A thrill is a ____________ whereas a heave can be a sign of ___________________.

palpable murmur right ventricular hypertrophy

A thrill feels like a __________ and a heave feels like an abnormally _________________

vibration large beating of the heart.

The diaphragm and bell of the stethoscope permit appreciation of _____- and _____-pitched auscultatory events, respectively.

high low

Auscultation at the mitral valve diaphragm (mitral ______________) and then bell (mitral _________)

regurgitation stenosis

Auscultation at the tricuspid valve with diaphragm for _________,_________,____________

tricuspid regurgitation, tricuspid stenosis, ventricular septal defect

Auscultation at the pulmonary valve with diaphragm for ___________,________,__________

pulmonary stenosis, pulmonary regurgitation, patent ductus arterioles

Auscultation at the aortic valve with diaphragm for ___________,___________ Then tell patient to _____________ and Auscultate with diaphragm at ____________ in ___________ to check for ______________

aortic stenosis, hypertrophic cardiomyopathy Sit forward. lower left sternal edge; held expiration aortic regurgitation

Major signs of Acute LVF ____-output state (________,__________, cold periphery), __________,________,____________

Low hypotension, oliguria, tachycardia, S3, sweating, crackles at lung base

Major symptoms of acute LVF List 4

Severe dyspnoea, orthopnoea, frothy sputum, cough

Infective endocarditis is invariably associated with pyrexia, which may be _______ grade or ‘ _________ ’ in nature if paravalvular abscess develops. Pyrexia also occurs for the first ____ days after _______________.

low; swinging 3; myocardial infarction

Breathe sounds List 4

Bronchial Vesicular Broncho vesicular Tracheal

The bronchial breath sounds over the ________ has a _______ pitch, (softer or louder?), inspiration and expiration are _________ and there is a _______________. The vesicular breathing is heard over the _________, ______ pitched and (softer or harder?) than bronchial breathing.

trachea; higher; louder equal; pause between inspiration and expiration thorax; lower; softer

Duration of breath sounds Vesicular Broncho-vesicular Bronchial Tracheal

Inspiration last longer than expiratory Inspiration last equal time as expiration, with no pause inbetween Expiration last longer than inspiration, with pause in between Equal time, with pause inbetween

Location of breath sounds Vesicular Broncho-vesicular Bronchial Tracheal

Thorax Between the scapula Manubrium Trachea

Blunting of a costophrenic angle is the classic sign for ____________. It is important to note that minor blunting may be caused by ________ or ____________.

pleural effusion scarring or chronic atelectasis

The cardiothoracic ratio is defined as the ratio of the ___________________________ to the ____________________ measured to the inner surface of the ribs on the PA radiograph

greatest transverse dimension of the heart greatest transverse dimension of the chest cavity

normal cardio thoracic ratio measurement is ____-_______

0.42-0.50

Sacubitril/valsartan, sold under the brand name Entresto, is a fixed-dose combination medication for use in ___________. It consists of the ______________, sacubitril and the _______________ valsartan.

heart failure neprilysin inhibitor angiotensin receptor blocker

In a lung collapse, trachea moves to _______ side In pleural effusion, trachea moves to _______ side

Collapsed side Opposite

The term unfolded aorta refers to the ____________ and _________ of the aortic arch on a frontal chest radiograph giving an ' ___________ ' appearance. It is one of the more common causes of apparent mediastinal widening and is seen with ______________, usually associated with _______________.

widened and decreased curvature opened up increasing age aortic calcification

Pulmonary edema- ______ mucus Bronchial cancer -______ mucus

Pink Rusty Brown

Colour-flow mapping has been a major technological advance. Instead of the unidirectional ultrasound beam used in ___________ and _________ Doppler imaging, the beam is ________________.

Continuous wave ; pulsed rotated through an arc

Colour flow mapping Frequency sampling throughout the arc permits the construction of a colour-coded map, red indicating flow _______ and blue _________ the transducer.

towards away from

Colour-flow data can be superimposed on the standard ______ echocar- diogram to identify precisely the ______________________________ of the heart.

2D patterns of flow within the four chambers

dyspnoea Its mechanisms are complex and not fully understood. It is not due simply to a _____________________ (hypoxia) or to a _______________________(hypercapnia), although these may play a significant part.

lowered blood oxygen tension raised blood carbon dioxide tension

Variable airways obstruction due to asthma is very often worse at _________ and __________ . By contrast, people with predominantly irreversible airways obstruction due to _________________ will often say that as long as they are sitting in bed, they feel quite normal; it is exercise that troubles them

night and in the early morning chronic obstruc- tive pulmonary disease (COPD)

cough acute (lasting less than _________ ) chronic (lasting more than __________)

3 weeks; 8 weeks

Acute cough is most commonly caused by _______________________ ; however, any cough that is associated with ______________________ should be a cause for concern, prompt approprate assessment and a baseline ___________ at the very least.

recent infection, either viral or bacterial haemoptysis chest X-ray (CXR)

Any patient with a chronic cough, i.e. one that lasts more than 8 weeks, should be sent for a ______ and _________ as baseline investigations

CXR and spirometry

Severe coughing, whatever its cause, may be followed by __________

vomiting

5 causes of acute dyspnea

Myocardial infarction Pulmonary embolus Pulmonary edema Airway obstruction Anaphylaxis

Five most common causes of chronic cough with a normal CXR ■ ______________________ ■ _____________ ■ _________ ■_____________(________) ■ _________________

Post viral upper respiratory tract infection (URTI) Smoking Asthma Post nasal drip (hay fever) Gastro-oesophageal reflux disease (GORD)p

Pleuritic pain is _________ and _______ and is made worse by __________ or _________ . It occurs when the pleura is inflamed, most commonly by infection in the underlying lung. More constant pain, unrelated to breathing, may be caused by ____________________________________

sharp and stabbing deep breathing or coughing local invasion of the chest wall by a lung or pleural tumour.

A spontaneous pneumothorax causes pain which is worse on breathing but which may have more of an _____________ character than the ___________ pain of pleurisy.

aching stabbing

A change in the voice may indicate involvement of the left recur- rent laryngeal nerve by a _______________. Sometimes patients using ________________ for asthma develop oropharyngeal candidiasis or even hoarseness or weakness of the voice, which improves on changing the treatment. Do not ascribe hoarseness to this cause in older patients, as ________________________ can also be present with hoarseness or a change in the quality of the voice.

carcinoma of the lung inhaled corticosteroids carcinoma of the vocal cords

________________ procedure is always indicated if hoarseness persists for more than 4 weeks.

Laryngoscopy

Damage from inhalation of asbestos may take decades to become manifest, most seriously as __________________ .

malignant mesothelioma

In middle-aged individuals who present with a _____________, often the first sign of a mesothelioma, always ask about possible asbestos exposure in jobs

pleural effusion

__________ sputum is characteristic in patients with chronic bronchitis when there is no active infection.

Mucoid

Occasionally asthmatics have a ________ tinge to the sputum, owing to the presence of many _________. People with asthma may also produce a particularly ________ form of ________ sputum, and sometimes they cough up _____ of the bronchial tree, particularly after an attack.

yellow; eosinophils tenacious; mucoid; casts

Patients with bronchopulmonary aspergillosis may bring up ______ sputum or sputum with black parts in it

black

When sputum is particularly foul smelling, the presence of __________ should be suspected.

anaerobic organisms

Very ill patients with pulmonary oedema may bring up __________________ sputum.

pink or white frothy

Rusty-coloured sputum is characteristic of ___________________________ .

pneumococcal lobar pneumonia

Blood may be coughed up alone or bloodstained sputum produced in _________________ , pulmonary ___________, pulmonary ___________, bronchiectasis or pulmonary ___________ (e.g. with __________) being possible causes.

bronchogenic carcinoma tuberculosis; embolism hypertension; mitral stenosis

Spirometry This test measures ___________________, as well as how _________________________.

how much air you can breathe in and out of your lungs easily and fast you can the blow the air out of your lungs

____________ is the most common type of pulmonary function or breathing test.

Spirometry

The standard chest X-ray is a __________________ view taken with the __________ against the front of the patient’s chest and the _____________, 2 m behind the patient

posteroanterior (PA) film X-ray source

Points to note when assessing the chest X-ray ■ __________ of patient and date (and time) of X-ray ■ Bony skeleton ■ ________ of the patient ■ _______________ ■ Outline of _______ ■ Outline of ____________ ■ _____________ ■ ___________

Name Position; Position of the trachea heart; mediastinum Diaphragm; Lung fields

Closest differential diagnosis of angina is???

Oesophageal spasm