Cardio OSCE Flashcards Preview

Medicine > Cardio OSCE > Flashcards

Flashcards in Cardio OSCE Deck (22)
Loading flashcards...
1
Q

Ddx of an irregularly irregular pulse?

A
  • AF
  • Ventricular ectopic beats
  • Complete HB + variable ventricular escape
2
Q

How do you differentiate between AF and VEB without using a 12 lead ecg?

A

Without a 12 lead ECG excercise the patient and this should abolish VEB’s but AF will remain.

3
Q

Causes of central cyanosis?

A

1) Hypoxic lung disease
2) Right to left cardiac shunt
- cyanotic congenital heart disease
- Eisenmenger’s Syndrome
3) Methaemoglobinaemia (drug or toxin induced eg drugs like: sulfer drugs / local anaesthetics)

4
Q

What are causes of peripheral cyanosis?

A
  • Peripheral vascular disease
  • Raynaud’s syndrome
  • Heart failure
  • Shock
  • Severe central cyanosis
5
Q

Important causes of AF.

A
  • Ischaemic heart disease
  • Rheumatic heart disease
  • Thyrotoxicosis
  • Pnemonia / PE / Alcohol
6
Q

What is the most common Valvular abnormality in RA?

A
  • Mitral stenosis
7
Q

What are the causes of a non palpable apex beat?

A

1) Something between your fingers and the apex

  • Adipose tissue
    - in obese patients
  • Air
    - in COPD and a pneumothorax
  • Fluid
    - in pleural effusion,
    - Haemothorax,
    - Pericardial infusion
    2) The apex is not in its normal position
  • Displaced (In left ventricular failure)
  • Dextrocardia
8
Q

Causes of heart failure

A

1) Pump Failure
- IHD
- Cardiomyopathy
- Constrictive Pericarditis
- Arrhythmias (e.g AF, Complete Heart Block)
- Negative inotroped and / Chronotropes
2) Excessive preload
- Regurgitant valve disease (MR/AR)
- Fluid excess (renal failure, IV fluids)
3) Excessive afterload
- AS
- Hypertension
4) Isolated RHF
- Cor pulmonale (2nd to chronic lung disease)
- pulmonary hypertension (Primary or due to MS)
5) High output cardiac failure
- Anaemia
- Pregnancy
- Metabolic (hyperthyroidism, Paget’s)

9
Q

Ddx for LVH / Heaving apex.

A

1) Aortic stenosis
2) Hypertension
3) HOCM
4) Coarctation of the aorta

10
Q

What are causes for 3rd heart sound (volume overload)?

A
It is normal if < 30 years old
Due to volume overload which can be caused by  
   - CCF
   - MI
   - Hypertension
  • Aortic regurgitation
  • Mitral regurgitation
  • Constrictive percarditis
11
Q

What are the causes of a 4th heart sound (pressure overload)?

A
  • always abnormal
  • CCF / MI / hypertension / Cardiomyopathy
  • cannot be diagnosed in the context of AF
12
Q

What are chest x-ray features of LHF?

A
  • Alveolar oedema
  • Kerley B lines
  • Cardiomegaly
  • Upper lobe diversion (cephasalization)
  • Pleural Effusion
13
Q

Causes of pericarditis?

A
  • Viral (Coxsackie)
  • Bacterial fungal infection
  • immediately post MI
  • Dresslers syndrome (2 - 10 weeks post MI)
  • SLE / RA / scleroderma
  • Uraemia
  • Malignancy
14
Q

Causes of an absent arteriol pulse?

A
  • congenital usually bilateral
  • Previous arterial line
  • Previous cardiac catherterisation
  • Atheromatous disease (usually subclavian)
  • Arterial embolism (e.g. AF)
  • Surgical ligation
15
Q

What are the stigmata of infective endocarditis?

A

1) - Changing heart murmur
2) - Finger clubbing
3) - Splinter Haemorrhages
4) - Mild splenomegaly
5) - Microscopic haematuria
6) - Eponymous signs
- oslers node on finger pulps
- Janeway lesions on palms and sole
- Roth spots on the retina

16
Q

What are the complications of prosthetic valves?

A
  • Paravalvular leak (more common than the structural failure of the valve)
  • Structural valve failure
  • infective endocarditis
  • intravascular haemolysis
  • Thrombosis and obstruction
  • Warafarin related complications.
17
Q

What are some clinical features of aortic sclerosis?

A
  • Asymptomatic
  • Does not radiate to carotids
  • No slow rising pulse
  • Normal pulse pressure
  • second heart sound normal or loud (not quiet as in aortic stenosis)
18
Q

Signs of AR.

A
  • very obvious carotid pulsation
  • Nailbed pulsation
  • Head nodding
  • Systolic femoral murmur
  • Pistal shot femorals
19
Q

Indications for bioprosthetic valves? (lasts 10 years)

A

1) elderly (valve will outlast patient)

2) Contraindication to warfarin (woman of child bearing age)

20
Q

Ddx for Mitral stenosis murmur.

A
  • Austin Flint (associated with AR)
  • TS (usually rheumatic)
  • Atrial myxoma
21
Q

Ddx for mitral regurgitation murmur

A

1)- VSD (important post- MI)

2) - TR
- Pulsatile hepatomegaly
- Giant V waves in the JVP

22
Q

Ddx forAortic stenosis murmur

A
  • Aortic sclerosis
  • HOCM
  • Pulmonary stenosis (usually congenital)