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MEDICINE FOR FINALS

Comprehensive guide covering cardiovascular examination techniques, findings, and diagnoses for medical students preparing for final exams. Includes detailed descriptions of inspection, palpation, auscultation, and interpretation of various cardiovascular conditions.

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MEDICINE FOR FINALS

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  1. MEDICINE FOR FINALS DR INDER MAINIE MAY 2002

  2. CARDIOVASCULAR • INTRODUCTION • MAY I EXAMINE YOU? • 45 DEGREES • INSPECTION (SOB, SCARS, MALAR FLUSH, ANKLE OEDEMA) • ALWAYS LOOK AROUND THE BED, INHALERS, OXYGEN, DIET DRINKS ETC

  3. EXAMINATION • LOOK AT THE HANDS • FINGER CLUBBING • CYANOSIS • SPLINTER HAEMORRAGES • PALE

  4. PULSE • RATE • RHYTMN • CHARACTER BRACHIAL/CAROTID • VOLUME • COLLAPSING PULSE

  5. CAUSES OF IRREGULAR IRREGULAR PULSE • ATRIAL FIBRILLATION, VE’S, ATRIAL FLUTTER WITH VAR BLOCK, CHB • CAUSES OF AF • ISCHAMIC HEART DISEASE • RHEUMATIC HEART DISEASE • THYROID • NO CAUSE • CARDIOMYOPATHY • WPW • INFECTION • ASD

  6. COLLAPSING PULSE • AORTIC REGURG LOOK FOR CORRIGAN’S SIGN • PDA • PAGETS • PREGNANCY • RUPTURED ANEURYSM OF AORTIC SINUS • FEVER • ANAEMIA

  7. RADIO-FEMORAL DELAY • COARCTATION OF THE AORTA • ASK WHILE EXAMINING THE PULSE CAN YOU CHECK FOR THIS

  8. BLOOD PRESSURE • ALWAYS REMEMBER TO ASK IF YOU CAN CHECK THE BLOOD PRESSURE

  9. JVP • INTERNAL JUGULAR • BETWEEN THE TWO HEADS • EQUAL TO PRESSURES IN THE RIGHT ATRIUM • a WAVE = ATRAL CONTRACTION • v WAVE= ATRIAL FILLING DURING VENTRICLAR SYSTOLE,TRICUSPID VALVE IS CLOSED

  10. CAUSES OF A RAISED JVP • HEART FAILURE –ELEVATION, SUSTAINED HJR • PE – ELEVATED • PERICARDIAL EFFUSION-ELEVATED, PROMINENT Y DESCENT • CONSTRICTIVE PERICARDITIS-ELEVATED KUSSMAULS, PARADOXICAL RISE ON INSPIRATION • AF NO a WAVES • TRICUSPID STENOSIS- GIANT a WAVES • TRICUSPID REGURG- GIANT v WAVES • COMPLETE HEART BLOCK- CANNON WAVES

  11. APEX BEAT • LOOK FOR STERNOTOMY SCARS • LOOK FOR THORACOTOMY SCARS • POSITION AND CHARACTER • CHECK FOR HEAVES OR THRILLS

  12. HEART SOUNDS • PALPATE THE CAROTID SIMULTANEOUSLY • COMMENT ON I AND II OR ADDITIONAL • MURMURS

  13. MURMURS STENOSIS- APEX LEFT LATERAL USE THE BELL • REMEMBER CHANGES IN BREATHING • INSPIRATION RIGHT HEART MURMURS GET LOUDER • EXPIRATION LEFT SIDE MURMURS GET LOUDER • PANSYSTOLIC MURMUR APEX, AXILLA • EARLY DIASTOLIC AORTIC REGURG 3RD ICS SIT FORWARD ON EXP

  14. GRADING OF MURMURS • 1. FAINT • 2. FAINT BUT EASILY DETECTED • 3. POMINENT BUT NOT LOUD • 4. LOUD THRILL • 5. VERY LOUD • 6. LOUD WITHOUT CONTACT

  15. REMEMBER • LUNG BASES • SACRAL OEDEMA • HEPATOSPLENOMEGALY FAILURE • PERIPHERAL PULSES

  16. MITRAL STENOSIS • MALAR FLUSH • PULSE- IRREGULR IRREGULAR • RAISED JVP • TAPPING APEX NOT DISPLACED • LEFT PARASTERNAL HEAVE(RIGHT VENTRICULAR ENLARGEMENT) • LOUD 1ST HS • OPENING SNAP

  17. MITRAL STENOSIS • CAUSES- RHD • TAPPING APEX BEAT -DUE TO ACCENTUATED 1ST HS • OPENING SNAP OPENING OF A STENOSED VALVE – PLIABLE, ABSENT IN DIFFUSELY CALCIFIED VALVE • LOUD 1ST – VALVES ARE MOBILE • PRESYSTOLIC ACCENTUATION- SINUS RHYTMN DUE TO THE ATRIAL SYSTOLE WHICH INCREASES FLOW ACROSS A STENOTIC VALVE

  18. COMLICATIONS • LEFT ATRIAL ENLARGEMENT • AF • PULMONARY HTN • TR • RHF

  19. SEVERITY • NARROWER DISTANCE BETWEEN 2ND HS AND OS • LONGER THE DIASTOLIC MURMUR

  20. MITRAL REGURG • PERIPHERAL PULSES- NORMAL JERKY DUE TO REDUCED SYSTOLIC EJECTION TIME SECONDARY TO A LARGE VOLUME OF BLOOD REGURG INTO LEFT ATRIUM • APEX BEAT- DISPLACED • 1ST HS SOFT • 3RD HS • PSM -> AXILLA LOUDER ON EXP

  21. CAUSES OF MR • MITRAL VALVE PROLAPSE • RHD • LEFT VENTRICLAR DILATATION • CORONARY DISEASE • ANNULAR CALCIFICATION • ENDOCARDITIS • PAPILLARY MUSCLE RUPTURE • CARDIOMYOPATHY • CONNECTIVE TISSUE DISORDER • TRAUMA • MYXOMATOUS DEGENERATION

  22. CAUSES OF PSM • MR • TR • VSD • HOCM

  23. AORTIC REGURG • PULSE- LARGE VOLUME, COLLAPSING • CORRIGAN’S • APEX DISPLACED OUTWARDS, FORCEFUL • EDM- LSE SIT FORWARD EXPIRATION

  24. Aortic Regurgitation • WIDE PULSE PRESSURE • FEMORALS- PISTOL SHOTS(TRAUBE’S) • TO AND FRO MURMUR (DUROZIEZ’S) • CORRIGANS – CAROTID PULSATION • QUINCKE’S • UVULA PULSATIONS (MULLER’S) • ARGYLL ROBERTSON PUPIL • MARFANS • ANK SPOND, RA

  25. Causes Of Aortic Regurgitation • RF • HTN • ATHEROSCLEROSIS • ENDOCARDITIS • SYPHILIS • MARFANS • RA • ANK SPOND • TRAUMA • AORTIC DISSECTION

  26. SEVERITY • WIDE PULSE PRESSURE • SOFT 2ND HS • 3RD HS • AUSTIN FLINT MURMUR • LVF • LONGER + LOUDER

  27. AORTIC STENOSIS • LOW VOLUME SLOW RISING • APEX- HEAVING, NOT DISPLACED • SOFT 2ND • EJECTION CLICK • S4 MAY BE HEARD • ESM • NARROW PULSE PRESSURE • REVERSE SPLITTING

  28. CAUSES OF AORTIC STENOSIS • RHEUMATIC • DEGENERATIVE CALCIFICATION OF A BICUSPID VALVE

  29. OTHER CAUSES OF ESM • PULM STENOSIS • HOCM • SUPRAVALVULAR STENOSIS

  30. SYMPTOMS • FATIGUE • ANGINA • DYSPNOEA • SYNCOPE • DEATH

  31. INVESTIGATIONS • ECG • CXR • ECHO • CATH • EST BE CAREFUL IF SYMPTOMATIC

  32. TRICUSPID REGURGITATION • CAUSES • FUNCTIONAL • PULMONARY HTN • CCF • RHD • ENDOCARDITIS – DRUG ADDICTS

  33. VSD • PSM AT LSE • LOUD P2 OF PULM HTN • MAY HAVE CCF • LOUDNESS DOES NOT MEAN SEVERE

  34. CAUSES OF VSD • CONGENITAL • RUPTURE AFTER MI • 50% MAY CLOSE SPONTANEOUSLY • COMPLICATIONS ARE • CCF • AORTIC REGURG • SBE • PULM HTN

  35. INFECTIVE ENDOCARDITIS • ANAEMIA • CLUBBING • SPLINTER HAEMORRAGES- EMBOLISM • OSLER NODES- INFLAMMATION OF EMBOLI • JANEWAY LESIONS • PETECHIAE • ROTH SPOTS • SPLENOMEGALY • HAEMATURIA • DENTAL • FBP- NORMOCYTIC NORMOCHROMIC • ESR • BLOOD CULTURES • ECHO/ TOE

  36. COMLICATIONS OF SBE • CARDIAC FAILURE • RENAL PAIN • CEREBRAL ANEURYSMS • MYCOTIC ANEURYSMS • VALVE ABSCESS

  37. HOCM • PULSE JERKY • DOUBLE APICAL- LEFT VENTRICULAR HEAVE WITH PROM PRESYSTOLIC PULSE • PSM- SOFTER ON SQUATTING • 4TH HS • FAMILY HISTORY

  38. RESPIRATORY • INTRO • SITTING POSITION • SPUTUM CUP • BREATHLESS • WASTING • ASYMMETRICAL BREATHING • COUNT RESP

  39. HANDS • CLUBBING • CYANOSIS • TAR • BOUNDING PULSE • ASTERIXIS • TONGUE – CYANOSIS • EYES- PALLOR, HORNERS

  40. EXAMINATION • LOOK FOR NECK VEINS • CERVICAL LYMPH • TRACHEA DEVIATION • PALPATE • MOVEMENTS OF BOTH SIDES • VOCAL FREMITUS • PERCUSSION • AUSCULTATION

  41. PLEURAL EFFUSION • LOOK FOR DECREASED MOVEMENT • TRACHEAL DEVIATION • ASPIRATION MARKS • STONY DULL • DECREASED VOCAL RESONANCE • FIND THE UPPER LEVEL • BRONCIAL BREATHING • SIGNS OF RA, TAR, LYMPH NODES, RADIATION BURNS, MASTECTOMY

  42. CAUSES OF DULLNESS • PLEURAL EFFUSION • PLEURAL THICKENING • CONSOLODATION • COLLAPSE • RAISED HEMIDIAPHRAGM

  43. INVESTIGATIONS • CXR • TAP • SEND FOR PROTEIN, LDH, GLUCOSE, BACTERIOLOGY, CYTOLOGY • PH IF EMPYEMA • AMYLASE IN NG, PANCREATITIS, OESOPHAGEAL RUPTURE • RHEUMATOID FACTOR

  44. TRANSUDATE • NEPHROTIC SYNDROME • CARDIAC FAILURE • LIVER FAILURE • HYPOTHYROID • CONSTRICTIVE PERICARDITIS • MEIGS

  45. EXUDATE • CA • SECONDARIES • PNEUMONIA • PE • TB • RA • SLE • LYMPHOMA • MESOTHELIOMA

  46. PROGNOSIS • POOR IN NG PEURAL FLUID • LOW GLUCOSE • LOW pH

  47. HAEMORRAGIC FLUID • PE • NG • TB

  48. REMEMBER OCCUPATION EG SHIP BUILDING

  49. BRONCHIECTASIS • LOOK FOR SPUTUM CUP • FINGER CLUBBING • BILATERAL COARSE CREPS • LATE INSP CREPS

  50. BRONCHIECTASIS • DEF - CHRONIC NECROTIZING INFECTION OF THE BRONCHI AND BRONCHIOLES LEADING TO ABNORMAL, PERMANENT DILATATION OF THE AIRWAYS

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