Internal Medicine

Myocardial Ischaemia

Myocarditis

Mitral valve disease

Sick Sinus syndrome

Hypertension

Pulmonary Embolism

Thyrotoxicosis

Stimulant Drugs - cocaine/coffee

Aortic regurgitation

Congenital AtrialSeptal defects

Post inflammatory

Medication

Connective Tissue Diseases

Silicosis

Farmer's lung

Sarcoidosis

Malignancy

Idiopathic

1. Alveolar inflammation

2. Alveolar congestion

3. Alveolar fibrosis

1. disease present, no dyspnea

2. dyspnea during ordinary activity

3. dyspnea during less than ordinary activity

4. dyspnea at rest

1. Cardiac : stable angina / unstable angina (MI)

coronary spasm

2. Chest wall: chostochondritis

rib fracture

3. Serositis: pleura/ pericardium

4. Respiratory: Pulmonary Embolism

5. GIT causes: reflux

oesophageal spasm

referred pain

1. Cough

2. Dyspnea

3. Chest pain

1.Productive/non? dry --> ILD, Ace inhibitors

2. When? morning indicates chronic bronchitis

at night --> PND, Orthophnea, asthma

3. Haemoptysis? Bronchus Ca, TB, PE with infarct

4. How much? bronchiectasis, Lung abscess

5. Appearance of sputum

- haemoptysis

rusty brown : S pneumoniae

coin sized blobs: K. pneumonia

Yellow puss: Staphyloccocal

COr Pulmonale is right ventricular heart disease due to a chronic lung disease or chest wall deformity.

Pulmonary HT --> RV hypertrophy --> R heart failure

1. Left heart failure

2. Cor Pulmonale i.e. PHT

3.Atrial septal defect

4. Tricuspid regurgitation

5. Pulmonary stenosis

6. Myocardial infarction

7. Cardiomyopathy

4. Teratology of Fallot

Symptoms:

ankle/sacral/abdominal swelling

anorexia/nausea

Signs:

peripheral cyanosis

low volume pulse

Raised JVP & + Kussmaul sign & large V waves

R ventricular heave

Right ventricular S3

Pansystolic murmur of tricuspid regurg

Tender hepatomegaly

PULSATILE LIVER

FLUID: pitting, ascites, pleural effusion

1. Dyspnea

2. Orthopnea

3. PND

4. Fatigue

1.Tachycardia

2. Cheyne-Stokes breathing

3. Hypotension

4. Cardiac cachexia

5. cyanosis = peripheral and central

6. Tachycardia & Pulse alternans

7. Apex beat displaced & dyskinetic & palpable gallop

8. Left ventricular S3

9. Functional Mitral regurg

10. Pulm congestion crackles (fine)

11. Valsalva abnormal

12. +- RV failure

1. Myocardial ischaemia

2. Cardiomyopathy

3. Aortic regurg

4. Mitral regurg

5. Patent Ductus Arteriousus

6. Hypertension

7. Aortic stenosis

1. Atrial fibrillation

2. Thyrotoxicosis

3. Anaemia

1. Severe, pressing central chest pain radiating to left arm or jaw

2. Sweating

3. Anxiety

1. Tachycardia & hypotension or bradycardia & hypotension

2. other arrhythmias :AFIB, VFIB, Heart block

3. Increased JVP & Kussmaul

4. Apex dyskinetic beat

5. S3, S4

6. POST MI mitral regurg, pericadial rub

1. Arrythmias

2. Heart failure

3. Cardiogenic shock

4. rupture of a pappilary muscle

5. Ventricular aneurysm

6. Thromboembolism

7. Cardiac rupture

8. Death

1. Sudden onset dyspnea

2. Severe chest pain

3. DVT

4. Resting tachycardia & hypotension

5. Cyanosis

1. Severe chest pain

2. radiating to the back, tearing quality

3. with maximal intensity at onset

1. Marfan syndrome

2. Ehlers Danos syndrome

3. SLE? RA? Sarcoidosis?

1. Splinter haemorrhages

2. Clubbing

2. Janeway Lesions

3. Osler nodes

4. Roth spots

5. Splenomegaly

6. In the heart:

LEFT HEART VALVULOPATHY! MR,MS, AS, AR

Prosthetic valves

Patent Ductus Arteriousus, VSD, coarct of aorta

DUKES CRITERIA

BE JOANOFARC

Major

B - blood culture positive

E - echo evidence of vegitation

Minor

J- janeway lesion

O- oslers node

A- aneurysm(mycotic); abuse(idu)

N- nephritis

O- other predisposing heart condition

F-fever

A- arterial emboli

R-roth's spot; rheumatoid factor

C- culture positive not meeting major criteria

1. Fever

2. Dyspnea

3. Pleuritic chest pain (localised)

4. Pericardial friction rub

Viral

Post MI

pericardiotomy

uraemia

neoplasm

CT diseases

hypothyroidism

acute rheumatic fever

1. Essential

2. Secondary

- CKDisease

- endocrine disorders (cushings, conns, phaeochromocytoma, thyrotoxicosis)

- coarctation of aorta

- other : COC, pregnant

1. MI

2. Stroke

3. Aneurysms

4. Left heart failure

5. Renal failure

6. Blindness

1. Idiopathic

2. Pulmonary emboli

3. Lung disease - COPD

4. LV failure

5. Congenital heart disease L-R shunt

- atrial septal defect

- ventricular septal defect

- PDA

6. Severe kyphoscoliosis

1. Tachypnea

2. Periph cyanosis

3. Hoarseness

4. Small volume pulse

5. JVP prominent A waves

6. Apex beat : R ventricular heave

7. Palpable P2

8. Auscul: systolic ejection click,

Loud P2

S4

Pulm regurg

9. Cor pulmonale

1. Always systolic

2. Soft

3. Ejection systolic

4. Radiate to neck

1. RHEUMATIC FEVER

2. Congenital parachute valve

1. PND, orthopnea, dyspnea

2. May experience palpiations

3. haemoptysis

4. ascites, oedema, fatigue

1. Tachypnea

2. MITRAL FACIES

3. Peripheral cyanosis

4. Pulse might be irregular irregular (Afib) & normal or reduced volume

5. JVP prominent a wave if PHT, loss of a wave if AFIB

6. Palpation: TAPPING APEX BEAT

Right ventricular heave

Palpable P2

7. Auscultate:

Opening snap

diastolic murmur

1. Small pulse pressure

2. Soft S1

3. early opening snap

4. long diastolic murmur

1. Location

2. Systolic/diastolic

3. Grading (sys6, dias4)

4. Character (crescendo...)

5. Radiate

6. Maneuvres

1. Dyspnea

2. Fatigue

1. Tachypnea

2. Pulse might be irregular irregular (afib) or normal, volume normal or sharp upstroke

3. Palpate: apex beat displaced, diffuse and hyperdynamic

4. Pansystolic thrill present at apex beat

5. Auscultation: Soft S1

Left ventricular S3

Pansystolic murmur radiating to axilla

1. Rheumatic fever

2. Mitral valve prolapse

3. Degenerative - ageing

4. LV failure / ischaemia

5. Cardiomyopathy (enlargement)

6. CT diseases

7. congenital

1. exertional dyspnea

2. syncope

3. exertional chest pain

1. Pulse: anacrotic/plateau, tardus parvus

2. Hyperdynamic apex beat

3. Systolic thrill at apex

4. Auscultation:

diamond shape midsystolic murmur

narrow split/ reverse A2

1. Rheumatic fever

2. Degenerative calcific aortic stenosis

3. Calcific bicuspid valve

4. Aortic sclerosis

1. Dyspnea

2. Fatigue

3. Palpitations

4. Exertional angina

1. Marfan

2. Ankylosing Spondilitis

3. SLE

1. quinke sign

2. pulse: Waterhammer pulse present, also bisferiense pulse

WIDE PULSE PRESSURE

3. Corrigan sign in neck

4. Muller / De Musset

5. TRAUBE sign - over chest

6. Duroziez sign - pistol shots

7. Rosenbach sign - liver

Palpate

8. Apex beat dispaced, hyperkinetic

Diastolic thrill parasternally

9. Auscultate

Decrescendo diastolic murmur over aortic area, grading, radiate downward,

AUSTIN FLINT MURMUR AT APEX

1. rheumatic fever

Infective endocarditis

2. dilation of aortic root: Marfan, aortitis, RA, syphilis

3. dissecting aneurysm

4. Ankylosing Spondilitis

Cappilary pulsation in nail beds

A.R.

Carotid pulsations in neck despite radial compression

A.R.

Head nodding in time with heartbeat

A.R.

1. Large V waves increased JVP

2. R ventricular heave

3. pansystolic murmur maximal on inspiration

4. Pulsatile liver

5. Ascites, edema, pleural eff

1. PHT

2. right ventricular failure

3. infective endocarditis - IV drug user

4. Pulm embolism

5. right ventricle infarct

6. tricuspid prolapse

7. trauma

1. Transudate : LVHF, lymphatic obstruction

2. Exudate: TB, lobar pneumonia, PE & infarct, Rhumatoid Arthritis

3. Chylothorax: thoracic duct carcinoma, trauma

4. Empyema: lung abscess, metastatic infection, lobar pneumonia, trauma

5. Haemothorax: trauma, cancer

6. Mesothelioma

Tachycardia

Tachypnea

Pulsus paradoxus

Dyspnea

Use of accesory muscles

Chest indrawing

Pursed lips

Wheeze

Cyanosis

Silent lung fields

Tachycardia

Tachypnea

Pulsus paradoxus

Dyspnea

Use of accesory muscles

Chest indrawing

Pursed lips

Wheeze

Cyanosis

Silent lung fields

1. Lung: COPD, asthma, lobar pneumonia, pulmonary embolus, pleural effusion, pneumothorax, pulm oedema

2. Airway: trauma to face and neck, epiglottitis, angioedema, aspiration, foreign object

3. Other: anxiety, ketocidosis, anaemia

1. Exudate in bronchial tree

2. Bronchiectasis

3. Broncho pneumonia

1. Exudate in bronchial tree

2. Bronchiectasis

3. Broncho pneumonia

SCHOBER SIGN

Bamboo spine...

1. Pleural effusion

2. Aortic aneurysm

3. Aortic regurg

4. Mitral regurg

5. Linea alba ventral hernia

6. Lense displacement, iritis, retinal detachment

7. Pericardial effusion

Swan neck

Z formation

Cannot grip- adductor weakness

Mallet finger

Ulnar deviation of phalanges

Vasculitic infarcts

Spindling sign

Fluctuating of prox phalangeal joint

early clubbing

Pianokey movements

Uveitis

Rheumatoid nodules

1. community acquired

2. Hospita acquired

3.immunocompromised

4. Post damage : aspiration etc

1. community acquired

2. Hospita acquired

3.immunocompromised

4. Post damage : aspiration etc

1. Extramural: aortic aneurysm, lymphadenopathy

2. Intramural: bronchus carcinoma

3. Intraluminal: mucus, foreign object, aspiration

1. community acquired

2. Hospita acquired

3.immunocompromised

4. Post damage : aspiration etc

1. Extramural: aortic aneurysm, lymphadenopathy

2. Intramural: bronchus carcinoma

3. Intraluminal: mucus, foreign object, aspiration

1. Spontaneous

2. Trauma

3. COPD - emphysema

1. community acquired

2. Hospita acquired

3.immunocompromised

4. Post damage : aspiration etc

1. Extramural: aortic aneurysm, lymphadenopathy

2. Intramural: bronchus carcinoma

3. Intraluminal: mucus, foreign object, aspiration

1. Spontaneous

2. Trauma

3. COPD - emphysema

1. Congenital

2. Occupational

3. Cardiac: infective endocarditis, cong cyanotic heart disease

4. Lung: lung abscess, bronchiectasis, COPD, lung cancer

5. Chronic liver failure

6. Crohns

7. Ulcerative colitis

1. Smoking >40 py

2. Dyspnea

3. Previous diagnosis of COPD emphysema

Fat

Flatus

Faeces

Foetus

Fluid

F-malignancy

Fat

Flatus

Faeces

Foetus

Fluid

F-malignancy

1. Transudate: R heart failure, hypoalbuminaemia, nephrotic syndrome, TB

2. Exudate: Portal HT, hepatitis, schistosomiasis, cancer, Budd-Chiari

3. Chylothorax: thoracic duct ca

4. Haemothorax: trauma, malignacy

5. Empyema: subphrenic abscess, perforation

6. SPONTANEOUS BACTERIAL PERITONITIS

Aortic regurg

Pregnacy

Anaemia

Thyrotoxicosis