Examination

Front 1

Causes of clubbing?

Back 1

Cardiac: chronic hypoxia, congenital cyanotic heart disease, SBE, atrial myoxma
Respiratory: Non small cell lung cancer, interstitial lung disease, TB, suppurative lung disease, mesothelioma, cystic fibrosis
GIT: malabsorption, IBD, cirrhosis
Other: Grave's disease
Other:

Front 2

Pulsus alternans?

Back 2

Alternate strong and weak pulses in a basically regular pulse
Sign of severely impaired LV function

Front 3

Characteristics of JVP?

Back 3

Double impulse
Falls with inspiration, rises with expiration
Not palpable
Can be occluded by gentle finger pressure
Varies with lifting up or lying down
Increases with hepatojugular reflux

Front 4

Causes of an elevated JVP?

Back 4

RHF
Right ventricular infarction
Pulmonary HTN
Hypervolaemia
SVC compression
tricuspid stenosis
Tricuspid regurgitation
Reduced RV compliance
Repicardial constriction/tamponade

Front 5

Kussmaul's sign?

Back 5

JVP elevates with inspiration:
- constrictive pericarditis
- right ventricular infarction

Front 6

Components of JVP?

Back 6

a wave: atrial contraction
x descent: atrial relaxation and RV systole
c wave: transmitted carotid pulsation
v wave: passive filling of atrium
y descent: opening of tricuspid valve

Front 7

S3?

Back 7

Can be normal
Dilated LV with reduced compliance or when there is filling of the LV, such as in severe mitral regurgitation

Front 8

S4?

Back 8

Powerful atrial contraction secondary to ventricular dysfunction or hypertrophy

Front 9

Murmur of mitral stenosis?

Back 9

Low-pitched rumbling diastolic murmur accentuated by exercise

Front 10

Murmur or mitral regurgitation?

Back 10

Pansystolic murmur maximal at the apex and radiating towards the axilla

Front 11

Aortic stenosis murmur?

Back 11

Harsh mid-systolic ejection murmur maximal over aortic area and radiating to carotids.
Loudest with patient sitting up and in full expiration

Front 12

Aortic regurg murmur?

Back 12

Decrescendo high-pitched diastolic murmur

Front 13

Symptoms of mitral stenosis?

Back 13

Dyspnoea, orthopnoea, PND, haemoptysis, ascites, oedema, fatigue