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28 Cards in this Set
- Front
- Back
What are the causes of an S3?
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1. Physiological
2. Dilated cardiomyopathy 3. AR 4. MR |
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What are the causes of an S4?
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1. AS
2. HOCM 3. Systemic hypertension |
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What are ways of differentiating between a JVP and carotid pulse?
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- non pulsatile
- double flicker - moves with respiration (falls with inspiration) - moves with position - accentuates with hepatojugular reflex - fills from above |
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What are the signs of graves disease?
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Signs of hyperthyroidism:
- increased sweating, warm skin - tremor - thyroid acropachy, softening of nails, onycholysis - anemia - vitiligo - tachycardia - hypertension - high output cardiomyopathy - proximal myopathy - crush fractures - alopecia - Neuropsychiatric: insomnia, psychosis, emotional lability, - lid lag, lid retraction, thyroid stare - goitre +/- compressive Sx - low BMI - hyper-reflexia - high serum oestradiol (oligomenorrhoea, infertility, erectile dysfunction, gynaecomastia, reduced libido Signs specific for Graves: - diffusely enlarged vascular goitre with bruits and thrills - thyroid eye disease: proptosis, exopthalmos, chemosis, periorbital oedema, conjunctival injection, complex orbitopathy, corneal/conjunctival ulcerations, reduced visual acuity with optic neuropathy - myxoedema: infiltrative dermatopathy - raised, hyperpigmented, violaceous, orange-peel textured papules most commonly overlying the shins |
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What are the signs of thyroid eye disease?
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- hyperthryoidism: lid lag, lid retraction
- Grave's related: exopthalmus, proptosis, periorbital oedema, chemosis, complex orbitopathy, diplopia, corneal/conjunctival ulceration, optic neuropathy |
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What are the clinical findings of COPD?
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1. Inspection:
- cachexia - increased work of breathing - accessory muscle use - hoover's sign (subcostal tug) - tracheal tug - CO2 narcosis: metabolic flap, bounding pulse, encephalopathic - nicotine staining - cyanosis - polycythemia (palmar erythema) - barrel chested (increased AP diameter) 2.hyperexpansion 3. hyper-resonant percussion 4. auscultation: prolonged expiratory phase, expiratory wheeze, quiet breath sounds 5. cor pulmonale |
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What are the causes of peripheral neuropathy?
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Painless:
Painful: - toxins: heavy metals - drugs: chemotherapy (bortezomib, thalidomide, taxanes, vinca alkaloids), amioarone, HAART, antibiotics (isoniazid, metronidazole), colchicine - B1, 6, 12 deficiency - diabetic - alcoholic - inherited - paraneoplastic - |
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What are the features and causes of horners syndrome?
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Clinical findings:
1. anhydrosis 2. partial ptosis 3. meiosis Causes: 1. central: brainstem infarct/haemorrhage, lateral medullary syndrome, syringobulbia, tumour 2. cervical myelopathy, syringomyelia 3. pancoast tumour 4. carotid aneurysm, dissection 5. cavernous sinus infilatration/compression |
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What are the clinical findings of COPD?
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1. Inspection:
- cachexia - increased work of breathing - accessory muscle use - hoover's sign (subcostal tug) - tracheal tug - CO2 narcosis: metabolic flap, bounding pulse, encephalopathic - nicotine staining - cyanosis - polycythemia (palmar erythema) - barrel chested (increased AP diameter) 2.hyperexpansion 3. hyper-resonant percussion 4. auscultation: prolonged expiratory phase, expiratory wheeze, quiet breath sounds 5. cor pulmonale |
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What are the causes of peripheral neuropathy?
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Painless:
Painful: - toxins: heavy metals - drugs: chemotherapy (bortezomib, thalidomide, taxanes, vinca alkaloids), amioarone, HAART, antibiotics (isoniazid, metronidazole), colchicine - B1, 6, 12 deficiency - diabetic - alcoholic - inherited - paraneoplastic - |
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What are the features and causes of horners syndrome?
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Clinical findings:
1. anhydrosis 2. partial ptosis 3. meiosis Causes: 1. central: brainstem infarct/haemorrhage, lateral medullary syndrome, syringobulbia, tumour 2. cervical myelopathy, syringomyelia 3. pancoast tumour 4. carotid aneurysm, dissection 5. cavernous sinus infilatration/compression |
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What are the findings in Cushing's Syndrome?
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- Thin skin, easy bruising
- hypertension - proximal myopathy - alopecia - moon facies - altered mental state, psychosis - cataracts - hirsutism - acne - oral thrush - dorsocervical fat patds - vertebral crush fractures - central obesity - abdominal striae - hypogonadism (small testicular size) - urinalysis: glycosuria Look for causes: - visual fields - respiratory exam - abdominal adrenal masses |
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What are the causes of clubbing?
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1. cardiac: cyanotic congenital heart disease, subacute infective endocarditis, atrial myxoma
2. Resp: suppurative lung disease (abscess, bronchiectasis), ILD, NSCLC 3. GIT: celiacs, CLD, IBD 4. Others: pregnancy, idiopathic, thyroid acropachy |
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What are the signs of aortic stenosis?
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- slow rising, plateau, small volume pulse
- small pulse pressure difference - pressure loaded non displaced apex beat - aortic thrill - soft S2 - S4 - ESM - signs of LVF |
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What are the clinical signs of severity for aortic stenosis?
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1. small volume pulse
2. aortic thrill 3. S4 4. late peaking ESM 5. paradoxical splitting S2 6. LVF |
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What are the causes of hepato-splenomegaly?
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CHIICAT
1. CLD 2. Hematological disease: myeloproliferative, lymphoma, leukemia, pernicious anemia 3. Infiltration: amyloid, sarcoid 4. Infections 5. CTD - SLE 6. Acromegaly 7. Thyrotoxicosis |
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What are the features of Chronic Liver Disease?
alcoholic liver disease? |
- palmar erythema
- dupetreyns contracture (alcohol) - clubbing - metabolic flap - anemia - bruising - cachexia - proximal myopathy - encephalopathy - jaundice, icteric - hepatic fetor - spider nevi - gynaecomastia - spider nevi - caput medusa - splenomegaly - ascites - peripheral oedema Alcohol: - parotidomegaly - palmar erythema - dupetryen's contracture - AST > ALT |
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What are the causes of pulmonary fibrosis?
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- Idiopathic
- Non organic dusts: silicosis, coal miner's lung, asbestosis - Organic dusts (hypersensitivity pneumonitis): bird fancier's lung, mushroom workers lung, farmer's lung, chemical worker's lung - CTD: RA, scleroderma, Ank spond - Sarcoid - Iatrogenic: Drugs (amiodarone, methotrexate, bleomycin, nitrofurantoin), Radiation pneumonitis Upper lobs: SCART - Silicosis, Sarcoid - Coal miners - Ank Spond, ABPA - Radiation - TB Lower Zones: RASIO - RA - Asbestosis - Scleroderma - Idiopathic - Other drugs |
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What are the clinical features of acromegaly?
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- thick greasy skin
- sweating - spade like hands, enlarged feet - carpal tunnel, compressive neuropathy - proximal myopathy - hypertension - skin tags in axilla - acanthosis nigricans - frontal bossing - hirsutism, acne - macroglossia - gum hypertrophy with splaying of the teeth - prognathia - hoarse, deep voice - goitre - cardiomyopathy - organomegaly in abdomen - osteoarthritis, pseudogout - foot drop (compressive neuropathy) - heel pad thickening - urinalysis - glycosuria - BSL - PR - colonic polyps, evidence of fe def anemia - fundi for complications of diabetes or hypertension, or optic neuropathy Also look for signs of a pituitary adenoma - bitemporal hemianopia - hypogonadism - hypothyroidism - hypoadrenalism Signs of activity/untreated: - skin tag number - excessive sweating - presence of glycosuria, - increasing visual field loss, cranial nerve palsies 3, 4, 6, 7 - enlarging goitre - hypertension - symptoms: headache, increasing size of shoes, rings, dentures Complications: - diabetes - hypertension - atherosclerosis - thyroid - colonic malignancy, bleed - peripheral mononeuropathies |
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Causes of myopathy?
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- Hereditary muscular dystrophy
- Congenital myopathies - rare - Acquired: PACE, PODS ----polymyositis, dermatomyositis ---alcohol ---Carcinoma ---Endocrine (hypothyroid, hyperthyroid, Cushings, Acromegaly, hypopituitarism) ---Periodic paralysis ---Osteomalacia ---Drugs (chloroquine, steroids, statins, fibrates) ---Sarcoid ---Myasthenia Gravis |
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Causes of renal masses/enlargement?
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- benign cysts, APCKD
- malignant - RCC, mets - infiltrates - sarcoid, myeloma - infection - pyelonephritis, abscess - hydronephrosis - diabetic - HIV |
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What are the features of idiopathic parkinsons disease
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Idiopathic parkinsons disease:
- asymmetrical onset - tremor - bradykinesia - abnormal gait: hesistancy, freezing, stooped, festinating, shuffling, reduced arm swing, wide arc turns - rigidity - postural intability, retropulsion, propulsion - mask like facies - siallorhoea - soft monotous voice - anosmia - micrographia - dementia - frontal release signs: Palmar grasp, palmomental reflex, rooting reflex, sucking reflex, snout reflex, glabellar reflex |
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What are the signs of aortic regurgitation?
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- Pulse: Collapsing pulse / waterhammer pulse
Wide pulse pressure - Palpation: Displaced apex beat, hyperkinetic Diastolic thrill on expiration and sitting forward - Auscultation: Soft A2 High pitched decrescendo diastolic murmur immediately after 2nd HS (AV closure) Loudest at 3rd / 4th intercostal space Austin flint murmur: mid-diastolic rumble at apex due to shudder of anterior MV leaflet from regurgitant jet ESM often also present (AS without the signs – due to torrential flow across normal diameter valve as ventricular volume large) |
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What are the clinical signs of severity for aortic regurgitation?
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- Collapsing pulse
- Wide pulse pressure - Long decrescendo murmur - S3 - Soft A2 (AV closure) - Austin flint - Signs of LVF |
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What are the signs of Mitral Stenosis?
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- General: Tachypnoea, mitral facies, peripheral cyanosis
- Pulse: Normal or reduced volume AF may be present - JVP: Normal or prominent A wave Loss of a wave with AF - Palpation: Tapping apex beat Right parasternal heave Palpable P2 if PHT Diastolic thrill (rare) in left lateral position - Auscultation: Low pitched, rumbling diastolic murmur Best with bell with patient in left lateral position Loud S1 (cusps widely apart at onset of systole) Loud P2 if PHT Opening snap |
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What are the clinical signs of severity for Mitral Stenosis?
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- Small pulse pressure
- Soft S1 - Early opening snap (increased pressure) - Long diastolic murmur - Diastolic thrill - Signs of pulmonary HT: prominent a wave, RV heave, loud P2, pulm regurg, TR |
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What are the signs of Mitral Regurgitation?
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- Pulse:
Normal or sharp upstroke AF common May be a compensatory tachycardia (decrease time for regurgitation) - JVP: Normal unless RVF A wave lost in AF - Palpation: Apex beat displaced, Diffuse, hyperdynamic pansystolic thrill at apex Right parasternal heave - Auscultation: Soft/absent S1 Apical pansystolic murmur radiating to the axilla S3 |
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What are the clinical signs of severity for Mitral Regurgitation?
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- Small pulse pressure
- Soft S1 - Early opening snap (increased pressure) - Long diastolic murmur - Diastolic thrill - Signs of pulmonary HT: prominent a wave, RV heave, loud P2, pulm regurg, TR |