Questions and Answers asked in the Exam of the Medical Rounds

1. 112
Questions and Answers asked in the Exam of the Medical Rounds
- Manifestations of R. heart failure
Congested neck veins
Enlarged tender liver
Lower limb edema
R. ventricular gallop
- Manifestations of L. heart failure
Basal crepitations
L. ventricular gallop
Orthopnea
Paroxysmal nocturnal dyspnea
Neck Veins:
Systolic pulsations in tricuspid
incompetence and atrial fibrillation.
Giant prominent ‘a’ wave in tricuspid
stenosis and RV hypertrophy as in
pulmonary stenosis and pulmonary
hypertension. Canon ‘a’ wave in
complete heart block.
- Clubbing causes
Cardiac causes
Cyanotic heart diseases
Infective endocarditis
Respiratory
Supportive lung disease (bronchiectasis,
lung abscess)
Bronchogenic carcinoma
BUT (bronchial asthma, TB) never cause
clubbing
Blue clubbing: congenital heart disease
Pale clubbing: Infective endocarditis
- Myocardial infarction
Chest pain compressing
Severe radiation to the arm and back
Syncope, sweating
Auscultation S4 or nothing
- Congested non pulsating neck veins:
SVC obstruction
Causes : wide fixed splitting of S2: ASD
- Signs of DVT:
1- one calf larger than the other
2- tender calf muscles
3- Human's sign: pain in dorsiflexion of
ankle
- Kussmaul sign in
1- constrictive pericarditis
2- restrictive cardiomyopathy
3- severe Rt, side heart failure
4- pericardial effusion with tamponade
- Causes of atrial fibrillation
Mitral valve disease
coronary heart disease
Hypertension
hyperthyroidism
Constrictive pericarditis
ASD
- Complications of atrial fibrillation
Thromboembolic (embolus)
Decreased cardiac performance
- Diagnosis of Infective endocarditis
Blood culture
vegetations by ECHO
- Aortic dissection
Severe lancinating chest pain
Unequal blood pressure in both arms
(due to closure of LT subclavian artery)
- Valvular heart disease
- Mitral stenosis:
Signs:- Snappy S1, mid diastolic
rumbling murmur, diastolic thrill, O.S.
- Aortic regurgitation
Soft blowing early diastolic murmur
propagated to the apex
- Aortic stenosis
Harsh ejection systolic murmur
Systolic thrill
Absent A2
Sustained apex
Plateau pulse
- Tricuspid regurgitation
Pansystolic murmur increases in
inspiration
Systolic pulse in the liver
Systolic neck veins

2. 113
- Rheumatic fever
John’s criteria major and minor
A-Major criteria
- Myocarditis (L. heart failure- gallop-
arrhythmia)
- Endocarditis (mitral regurgitation –
aortic regurgitation)
- Pericarditis. (How to diagnose
pericarditis by ECHO: by presence of
pericardial effusion)
B-Minor criteria
- Clinical (fever, arthralgia, history of
previous tonsillitis 1-3 wks, presence of
Rh. valve lesion)
- Lab. (Increased CRP, ESR, prolonged
PR)
- 60 year male patient with hypertension
presented with BP 200/100 mmHg,
severe chest pain, unequal pulse:
Most probable diagnosis is dissecting
aortic aneurysm
- Pulsus alternans occurs in heart
failure.
- Paradoxical pulse occurs in pericardial
tamponade, constrictive pericarditis.
MCQs
- Accentuated first heart sound in all
except:
a- Short P-R interval
b- Increase cardiac output
c- Mitral stenosis
Myocarditis-d
- Eisenmenger syndrome occurs in all
except:
a- Large VSD
b- Large ASD
c- PDA
d- Fallot`s tetralogy
- Epigastric pulsations in all except:
a-portal hypertension
b- aortic aneurysm
c-congestive heart failure
d- Rt ventricular enlargement
- In AF all is present except:
a. absent a wave
b. S4
c. S1 of variable intensity
d. Systolic neck venous pulsation
e. Irregular irregularity in the pulse
- In pulmonary hypertension all is present
except:
a. systolic thrill on the pulmonary area
b. S2 close (narrow) splitting
c. Diastolic shock
d. Ejection systolic murmur
- AF is caused by all except:
a. Ischemic heart disease
b. Thyrotoxicosis
c. Mitral valve disease
d. Cor pulmonale
- Edema in congestive heart failure occur
in all except:
a- Peri-orbital
b- Ankle
c- Sacrum
d- External Genitalia