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158 Cards in this Set
- Front
- Back
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OS stands for ??
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opening snap
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is OS high pitched or low-pitched ??
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high pitched--sharp
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how OS is produced ??
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by opening of the mitral valve
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is OS systolic or diastolic ??
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diastolic .. heard soon after S2
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where is OS heard with maximum intensity ??
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medial to the apex
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in which condition OS is heard ???
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MS
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due to opening of which valve, OS is produced ??
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mitral
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what does presence of OS signifies ??
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it means VALVE CUSPS ARE STENOSED BUT MOBILE
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types of systolic clicks ??
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1. Ejection
a. aortic b. pulmonary 2. Mid |
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ESC stands for ??
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ejection systolic click
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is ESC high pitched or low pitched ??
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high pitched--sharp
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is ESC systolic or diastolic ??
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systolic---heard soon after S1
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how are ESCs produced ??
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due 2 opening of
1. abnormal aortic valve (aortic click) 2. abnormal pulm valve(pulm click) |
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where are these sounds heard best ??
1. aortic click 2. pulm click 3. OS |
1. A1 area & apex
2. pulm area 3. medial to apex |
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what is the effect of respiration on
1. aortic click ? 2. pulm click ?? |
1. no change
2. increases in intensity during expiration |
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types of valvular stenosis acc to area involved ??
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valvular
supravalvular subvalvular |
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if signs of stenosis are present,, how to justify that the stenosis is valvular,supravalvular or subvalvular ??
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listen to ESC..if present..it means stenosis is valvular
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causes of dilatation of pulm artery ?
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1. idiopathic
2. pulm HTN |
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causes of aortic click ??
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1. AS
2. bicuspid aortic valve |
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causes of pulm click
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1. PS
2. dilatation of pulm artery |
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is ESC high pitched or low pitched ??
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high pitched--sharp
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is ESC systolic or diastolic ??
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systolic---heard soon after S1
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how are ESCs produced ??
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due 2 opening of
1. abnormal aortic valve (aortic click) 2. abnormal pulm valve(pulm click) |
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where are these sounds heard best ??
1. aortic click 2. pulm click 3. OS |
1. A1 area & apex
2. pulm area 3. medial to apex |
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what is the effect of respiration on
1. aortic click ? 2. pulm click ?? |
1. no change
2. increases in intensity during expiration |
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types of valvular stenosis acc to area involved ??
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valvular
supravalvular subvalvular |
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if signs of stenosis are present,, how to justify that the stenosis is valvular,supravalvular or subvalvular ??
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listen to ESC..if present..it means stenosis is valvular
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causes of dilatation of pulm artery ?
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1. idiopathic
2. pulm HTN |
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causes of aortic click ??
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1. AS
2. bicuspid aortic valve |
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causes of pulm click
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1. PS
2. dilatation of pulm artery |
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is ESC high pitched or low pitched ??
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high pitched--sharp
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is ESC systolic or diastolic ??
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systolic---heard soon after S1
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how are ESCs produced ??
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due 2 opening of
1. abnormal aortic valve (aortic click) 2. abnormal pulm valve(pulm click) |
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where are these sounds heard best ??
1. aortic click 2. pulm click 3. OS |
1. A1 area & apex
2. pulm area 3. medial to apex |
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what is the effect of respiration on
1. aortic click ? 2. pulm click ?? |
1. no change
2. increases in intensity during expiration |
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types of valvular stenosis acc to area involved ??
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valvular
supravalvular subvalvular |
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if signs of stenosis are present,, how to justify that the stenosis is valvular,supravalvular or subvalvular ??
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listen to ESC..if present..it means stenosis is valvular
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causes of dilatation of pulm artery ?
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1. idiopathic
2. pulm HTN |
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causes of aortic click ??
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1. AS
2. bicuspid aortic valve |
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causes of pulm click
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1. PS
2. dilatation of pulm artery |
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one sign on ausultation in C/O bicuapid aortic valve ??
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aortic click
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which ESC is not affected in intensity with respiration ??
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aortic click
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MSC stands for ??
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mid-systolic click
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cause of MSC ??
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MVP
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MVP stands for ?
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mitral valve prolapse
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is there any LATE SYSTOLIC MURMUR ??
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yes..may be heard after mid systolic click in MVP--bedside pg 77
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types of prosthetic valves ??
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mechanical
biological |
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do biological prosthetic valves produce sounds similar to the normal heart sounds ???
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yes---bcoz these are of animal tissue
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how many sounds are there in a pt with mechanical prosthetic valves ??
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4 instead of 2
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y are there 4 sounds instead fo 2 in a pt with mechanical prosthetic valves ??
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bcoz these valves produce sounds both at teh time of closure and opening
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characteristics of sounds of mechanical valves (vs normal valves)??
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four instead of 2
louder different character |
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causes of
1. OS ?? 2. aortic click ? 3. pulm click ?? 4. MSC ?? |
1. MS
2. aortic stenosis, bicuspid aortic valve 3. PS, dilated pulm artery 4. MVP |
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pericardial knock is heard in ??
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constrictive pericarditis
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OTHER SOUNDS of heart include ??
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OS
ESC MSC prosthetic valves sounds |
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which other sound is
1. early systolic ?? 2. mid systolic ?? 3. early diastolic ?? |
1. ESC
2. MSC 3. OS |
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systolic clicks are aka ??
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ejection clicks
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as all , OS , S3 and S4 are diastolic sounds....what is the sequence of their appearance in diastole ??
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OS = earliest diastole
S3 = early diastole S4 = late diastole |
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S4 is aka ??
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pre-systolic gallop
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pre-systolic gallop is aka ?
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S4
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we know that S3 is early diastolic..but which is called as DISTAL s3 ??
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pericardial knock
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what is the name of the heart valve which is the only one to have 2 cusps ??
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mitral valve
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site of maximum intensity of
1. S1 2. S2 |
1. apex
2. P2 = pulm area A2 = A1 area |
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parts of S1 ??
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M1
T1 |
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parts of S2 ??
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P2
A2 |
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site where P2 has minimum intensity ?
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pulm area
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to hear P2, which area should be ausultated ??
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pulmonary area
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is there any other site where P2 can be auscultated ??
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no
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A2 is best heard at A1 area,,where else can it be heard ??
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it can be heard anywhere on the precordium with amximum intensity at A1 area
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only murmur which is low-pitched ??
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murmur of MS
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only murmur which is best heard with bell ??
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murmur of MS
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causes of visible pulsations in
1. rt 2nd ICS ? 2. lt 2nd ICS ? 3. suprasternal notch ? 4. epigastrium ? 5. parasternal border ? |
1. aortic aneurysm
2. pulm artery dilatation 3. AR 4. thin lean person AAA RV hypertrophy TR (pulsatile liver) 5. RV hypertrophy |
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in RV hypertrophy, visible pulsation canbe seen in which areas ??
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1. epigastrium
2. parasternal border |
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pulsatile liver is seen in ??
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TR
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2 things of apex beat that should be noted when looking for it ??
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site
character |
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right ventricular heave is aka??
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left parasternal heave
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palpable murmur is called ??
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thrill
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define apex beat ??
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lowermost & outermost part of the precordium where a definite cardiac impulse is felt
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apex beat is normally formed by ??
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LV
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is normal apex beat tapping or heaving ??
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neither
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palpable S1 is actually a ??
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tapping apex beat
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is normal apex beat tapping or heaving ??
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neither
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palpable S1 is actually a ??
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tapping apex beat
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what is thrill ??
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loud murmur which is palpable
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in which position thrills are best appreciated ??
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(1) - when the patient leans forwards, holding his breath in expiration (except for thrill of MS)
(2) when teh patient is in left lateral position --for thrill of MS |
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when palpating the thrill, which step must nor be forget ??
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palapting the carotid pulsations simultaneously
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when is S1 palpable ??
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in MS ---tapping apex beat
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causes of
1. palpable P2 ? 2. palpable A2 ? |
1. pulm HTN
2. systemic HTN |
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Radio-femoral delay is seen in ??
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coarctation of aorta
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to maximally appreciate the character of the pulse, which pulse should be checked ??
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any vessel close to the heart...brachial, carotid,femoral
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name 7 characters of the pulses ??
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1. Slow-rising pulse(Pulsus Plateau)
2. Water-Hammer Pulse(Collapsing Pulse) 3. Pulsus isferiens 4. Jerky Pulse 5. Pulsus Paradoxus 6. Pulsus Alternans 7. Pulsus Bigeminus |
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Slow-Rising Pulse is aka ??
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Pulsus Plateau
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is pulsus plateau low-volume or high volume ???
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low volume
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cause of pulsus plateau ??
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AS
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in pulsus plateau, what happens to BP ???
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pulse pressure becomes narrow
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this term describes which character of pulse the best ;;;;
RISES SLOWLY, STAYS LONGER |
Pulsus Plateau
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Collapsing Pulse is aka ??
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water hammer pulse
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EKG findings in Pulmonary Embolism ???
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1. RV Strain
2. RAD 3. RBBB 4. S1Q3T3 5. S1,2,3 6. Sinus tachycardia |
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what does "S1Q3T3" signifies..??
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a large S wave in lead I
a large Q wave in lead III an inverted T wave in lead III |
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a normal CXR in a dyspneic patient suggests ??
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PE
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PE men CXR pe kia findings milti hain ??
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CXR is usually normal--- infact a normal CXR in a dyspneic patient suggests PE
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S1Q3T3 on ECG is a classical sign of ??
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PE
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Perfusion defects with normal CXR suggests ??
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PE
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Periodic Breathing is aka ??
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Cheyne-Stokes Breathing
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causes of Cheyne Stokes breathing ??
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left heart failure
brain stem lesions |
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psychogenic dyspnea k patient men tetany kion develop ho jati hai ??
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bcoz he hyperventilates---> respiratory alkalosis --> which decreases ionized calcium --> tetany
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a 30 years old male patient comes to you with a H/O sudden and severe breathlessness..he is anxious and is hyperventilating...his pattern of breathing is irregular. Rest of examination is normal...? what is the diagnosis?? what would you like to note in this patient further to confirm the diagnosis ??
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psychogenic acute dyspnea...
breathing during sleep..it will be normal |
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types of pneumothorax ??
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1. spontaneous
primary secondary 2. traumatic 3. tension |
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what is cardiac asthma??
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acute pulmonary edema due to cardiac causes ( LVF/MS)
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what is PCWP ??
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pulmonary capillary wedge pressure
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PCWP roughly reflects ???
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left atrial pressure ( actually it is a few mmHg higher than LA pressure)
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congenital heart diseases to kis tarah classify kia jata hai???
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Congenital heart diseases are classified into 2 groups depending upon that central cyanosis hai ke nahin...
1. cyanotic 2. acyanotic |
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name 4 acyanotic congenital heart diseases??
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vsd
asd pda coarctation of aorta |
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name 2 cyanotic congenital heart diseases??
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fallot's tetralogy
transposition of great arteries |
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cyanosis ki types ??
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peripheral
central |
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kin kin jagahon pe cyanosis check ki jati hai ???
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nails
tip of nose ear lobules inner surface of lip dorsum of tongue |
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blood mein reduced Hb kitni ho jaye to tab cyanosis develop hoti hai ??
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more than 5 gm%
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causes o bluish discoloration of skin and mucous membranes ??
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1.reduced hemoglobinemia ( if >5gm%)..this is called cyanosis
2.methemoglobinemia 3.sulfhemoglobinemia |
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how will you diferentiate between cyanosis and met/sulfhemoglobinemia ??
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1. pt is not breathless
2. oxygen saturation of Hb is normal |
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LUTEMBACHER'S SYNDROME ???
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combo of ASD(congenital) and MS (acquired)
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most important physical sign of ASD ???
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wide + fixed spliiting of S2
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define coarctation of aorta ??
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narrowing of the descending thoracic aorta
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CXR findings on coarctation of aorta ??
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notching of the undersurface of ribs
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child assumes a squatting position after exercise ---diagbosis ??
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tetralogy od fallot
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in which condition survival of a pt with TGA is possible ??
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when there is a large ASD or VSD..so that oxygenated blood flow from lt heart to rt heart and to aorta
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how the definite diagnosis of BRONCHIAL ASTHMA is established ???
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by demonstrating the reversibility of airway obstruction
THE REVERSIBILITY IS DEFINED AS 15% OR MORE INCREASE IN FEV1 FOLLOWING 2 PUFFS OF A BETA-AGONIST INHALER |
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how do you define REVERSIBILITY in C/O bronchial asthma??
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THE REVERSIBILITY IS DEFINED AS 15% OR MORE INCREASE IN FEV1 FOLLOWING 2 PUFFS OF A BETA-AGONIST INHALER
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jo catheter PCWP measure karne ke liye use hota hai, us ka kia naaam hai ??
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swan-ganz catheter
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pathophysiological hallmark of bronchial asthma is ??
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narrowing of the airways
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how narrowing of the airways occurs in bronchial asthma ??
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1. thick tenacious secretions
2. edema of the mucosa 3. spasm of the smooth muscles |
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BRONVHIAL ASTHMA ko define karo ??
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chronic inflammatory disease of the airways, characterized by hyperresponsiveness og the bronchial tree to multiple stimuli
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"episodes of dyspnea,cough n wheezing"..diagnosis ?/
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bronchial asthma
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in acute attack of bronchial asthma,patient presents with an attack of breathlessness of sudden onset....what is a hallmark of this breathless ness ??
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it is not related to exertion
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in acute attack of bronchial asthma, cough is dry initially, later thick tenacious sputum is produced which may be stringy taking the from of the casts of distal airways..what is this form of sputum called as ??
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curschmann's spirals
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in acute attack of bronchial asthma, kia sputum bahar cough out karne se breathlessness relieve ho jati hai ??
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nahin
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why nocturnal awakening occurs in a pt of bronchial asthma ??
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due to circadian variations in degree of airway obstruction in these patients which is most severe between 2am to 4am
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normal FET ??
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<4 sec
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how FET is calculated ???
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diaphragm of steth is placed on trachea, pt is asked to expire forcefully n fully following full inspiration...note the duration..normal less than 4sec..prolonged in br asthma
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normal PEFR ??
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400-600 L/min
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normal FEV1/FVC % ??
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65-80%
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2 most important features of severity of asthmatic attack are ??
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pulsus paradoxus
use of accessory muscles |
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PEFR is measured by ??
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peak flow meter
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what 2 features you will like to see in patient of asthma attack to label it as a severe case ???
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Pulsus Paradoxus
Use of Accessory Muscles |
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in asthma , sputum examination men kia milta hai ??
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1. eosinophils
2. charcot-leyden crystals |
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charcot-leyden crystals
(a) shape ? (b) location ? |
(a) double pyramid shaped
(b) normally found in cytoplasm of eosinophils |
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normal FET and PEFR and FEV1/FVC%??
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FET = less than 4 sec
PEFR = 400-600 L/min FEV1/FVC% = 65-80% |
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CXR findings in asthma ??
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1. normal
2. may show hyperinflation |
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instruments used to measure
(A) FET (B) PEFR (C) FEV1 (D) FVC |
(A) FET = stethoscope
(B) PEFR = peak flow meter (C) FEV1 = vitalography (D) FVC = vitalography |
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in which phase of the cardiac cycle, all the valves are open ??
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none
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in which phase of the cardiac cycle, all the valves are closed
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isovolumic ventricular contraction
isovolumic ventricular relaxation |
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heart sound produced by atrial systole ??
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s4
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70% blood from atria to ventricles flow spontaneously, 30% is pushed by atrial contraction(systole)..what is this called as ??
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atrial kick
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name 5 phases of cardiac cycle ??
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1. late diastole
2. atrial systole 3. isovoulmic ventr relaxation 4. ventricular ejection 5. Isovolumic ventricular relaxation |
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PMI ??
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point of maximum impulse (apex beat)
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literal meaning of spirometry ?
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measuring of breath
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most common PFT performed ??
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spirometry
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The spirometry test is performed using a device called ??
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spirometer
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graph of spirometry is called ??
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spirogram
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Can Functional residual capacity (FRC) be measured via spirometry??
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NO---but it can be measured with
1. plethysmograph or 2. dilution tests (for example, helium dilution test). |
