Monday, March 29, 2010

Name the disease in which grotesque facial features are seen? Enumerate the cardiac conditions associtaed

  • HURLER'S SYNDROME
  • Grotesque facial features - prominent supraorbital ridge, depressed nasal bridge, thick lips, corneal clouding, peg shaped teeth
  • CARDIAC CONDITIONS ASSOCIATED ARE
  • CAD
  • AR
  • HOCM
  • Mitral annulus calcification (MR)

Saturday, March 27, 2010

What are Brushfield's spots?

  • Grayish white spots at the periphery of the iris
  • It is more clearly seen in dark pigmented iris
  • Seen in DOWN'S SYNDROME
 

Friday, March 26, 2010

What are the causes of thrombosis in situ in coronary artery?

  • TTP
  • Polycythemia vera
  • Sickle cell anemia
  • Primary thrombocytosis

Thursday, March 25, 2010

What are the causes of Precordial tenderness?

  • Tietze syndrome
  • Acute pericarditis
  • Acute myocarditis

Wednesday, March 24, 2010

Why is Internal Jugular Vein (IJV) preferred over External Jugular Vein (EJV)?

  • IJV is in direct continuation of right atrium
  • Right atrial pulsation is not transmitted well as there are prominent valves at the proximal EJV
  • Adjoining structures of neck and upper thorax can cause extrinsic compression of EJV
  • Increased sympathetic activity can cause vasoconstriction of EJV thus making its pulsation invisible

Tuesday, March 23, 2010

Why Right internal jugular vein is preferred to left internal jugular vein?

  • Right jugular vein and innominate vein extends in a straight line from superior vena cava and right atrium
  • Left innominate vein into which left internal jugular vein drains does not extend in a straight line from superior vena cava and right atrium
  • Left innominate vein may be kinked or compressed by dilated aorta or aneurysm or other surrounding structures

Friday, March 12, 2010

When does bruit suggest?

  • Bruit suggests partial obstruction of an artery or transmission of a cardiac murmur
  • Bruit is heard if the obstruction in an artery is equal to or more than 50%
  • If the obstruction is equal to 80%, a continuous bruit is heard
  • If obstruction is more than 80%, no bruit heard

Wednesday, March 10, 2010

How should we record the Blood pressure if the patient has Atrial Fibrillation?

  • 3-5 recordings are done. It is the mean of 3-5 recordings.
  • Systolic BP is recorded as the maximum audible sound at a particular level.If the difference between the two recording is less than or equal to 5mm, average of the two recordings are taken. 
  • Beat to beat variation can lead to underestimation of the blood pressure.
  • Blood pressure recorded after a long cycle can be falsely high.

Tuesday, March 9, 2010

What is Clindactyly?

  • Clindactyly means incurved fingers 
  • Claw like appearance of the hand
  • Seen in Down's syndrome
  • Ellis van Creveld syndrome
  • Hurler's syndrome

Monday, March 8, 2010

What are the techniques to record Blood pressure?

  • Palpatory method
  • Auscultatory method
  • Flush method
  • Ultrasound Doppler method
  • Arterial tonometry/ Oscillometric method
  • Ambulatory BP monitor(ABPM)

Sunday, March 7, 2010

Differential Diagnosis - Upper limb and Lower limb Blood pressure difference

  • Coarctation of aorta
  • Aortic dissection
  • Aortic arch syndrome
  • Subclavian steal syndrome
  • Severe chronic aortic regurgitation
  • Inaapropriate cuff size for thigh
Difference of more than 20 mmHg Blood pressure is considered significant.

 

Saturday, March 6, 2010

Differential Diagnosis - Upper limb Blood pressure difference

  • Aortic Arch Syndrome/ Coarctation of Aorta
  • Supravalvular aortic stenosis
  • Subclavian steal syndrome
  • Scalenus anticus syndrome/ Cervical rib syndrome
  • Aneurysm of subclavian or innominate artery
  • Thrombosis of innominate or subclavian artery
A Blood Pressure difference of more than 10 mmHg between the two arms is considered significant. 

Thursday, March 4, 2010

What is Mean Blood Pressure?

  • It is the average blood pressure during a single cardiac cycle.
  • It can be determined from the formula MAP = (CO X SVR) + CVP where CO is cardiac output, SVR is systemic vascular resistance and CVP is central venous pressure.
  • At nomal heart rate, it can be estimated as MBP = DBP+ 1/3 PP
(Mean blood pressure = Diastolic blood pressure + 1/3 Pulse pressure,
PP = SBP- DBP)
  • At higher heart rate, MAP is the arithmetic mean of systolic and diastolic blood pressure
  • The regional blood flow or the organ perfusion depends on MBP
  • Normal ranges between 95-100 mmHg.
  • MAP greater than 60 mmHg is enough to sustain the perfusion of organs

Wednesday, March 3, 2010

What are Korotkoff sounds? What are its five phases?

  • Korotkoff sound represents arterial oscillation resulting from distension of the arterial wall with each cardiac impulse due to partial occlusion of artery by the cuff. 
  •  Low pitch sound
  • Five phases are
  • PHASE 1 - CLEAR TAPPING SOUND   (SBP)
  • PHASE II - ONSET OF SWISHING SOUND OR SOFT MURMUR
  • PHASE III- LOUD SLAPPING SOUND
  • PHASE IV - SUDDEN MUFFLING OF SOUND
  • PHASE V - DISAPPEARANCE OF SOUND / PHASE OF SILENCE (DBP)
  • "Tap - Murmur - Slap - Muffle - Silence"
  • It was described by Nikolai Korotkoff, a Russian surgeon in 1905
 

Tuesday, March 2, 2010

What is the average Blood Pressure in children?

  • At 1 yr of age , average Systolic Blood Pressure(SBP) is 90mmHg
  • Every 3 yr , increases by 5 mmHg
  • At 12 yrs , reaches adult level
  • Diastolic Blood pressure remains average 60mmHg
  • Formula to calculate SBP in children 
SBP = 90+(AGE X 5)/3

Monday, March 1, 2010

What is Murmur? How does it differ from Heart Sounds?

  • Murmur is a latin word
  • It is defined as a prolonged series of audible signals/ vibrations of varying intensity, frequency, configuration and duration.
  • Heart sounds results from sudden deceleration of blood.
  • Murmurs are produced by turbulent blood flow.