00
Correct
00
Incorrect
00 : 00 : 0 00
Session Time
00 : 00
Average Question Time ( Mins)
  • Question 1 - A 50-year-old woman is currently receiving antibiotics for bacterial endocarditis and is worried...

    Correct

    • A 50-year-old woman is currently receiving antibiotics for bacterial endocarditis and is worried about her future health. She asks about the common complications associated with her condition.

      Which of the following is a typical complication of bacterial endocarditis?

      Your Answer: Stroke

      Explanation:

      The risk of emboli is heightened by infective endocarditis. This is due to the formation of thrombus at the site of the lesion, which can result in the release of septic emboli. Other complications mentioned in the options are not typically associated with infective endocarditis.

      Aetiology of Infective Endocarditis

      Infective endocarditis is a condition that affects patients with previously normal valves, rheumatic valve disease, prosthetic valves, congenital heart defects, intravenous drug users, and those who have recently undergone piercings. The strongest risk factor for developing infective endocarditis is a previous episode of the condition. The mitral valve is the most commonly affected valve.

      The most common cause of infective endocarditis is Staphylococcus aureus, particularly in acute presentations and intravenous drug users. Historically, Streptococcus viridans was the most common cause, but this is no longer the case except in developing countries. Coagulase-negative Staphylococci such as Staphylococcus epidermidis are commonly found in indwelling lines and are the most common cause of endocarditis in patients following prosthetic valve surgery. Streptococcus bovis is associated with colorectal cancer, with the subtype Streptococcus gallolyticus being most linked to the condition.

      Culture negative causes of infective endocarditis include prior antibiotic therapy, Coxiella burnetii, Bartonella, Brucella, and HACEK organisms (Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella). It is important to note that systemic lupus erythematosus and malignancy, specifically marantic endocarditis, can also cause non-infective endocarditis.

    • This question is part of the following fields:

      • Cardiovascular System
      19.6
      Seconds
  • Question 2 - A 45-year-old woman has varicose veins originating from the short saphenous vein. During...

    Correct

    • A 45-year-old woman has varicose veins originating from the short saphenous vein. During mobilization of the vein near its origin, which structure is at the highest risk of injury?

      Your Answer: Sural nerve

      Explanation:

      Litigation often arises from damage to the sural nerve, which is closely associated with this structure. While the other structures may also sustain injuries, the likelihood of such occurrences is comparatively lower.

      Anatomy of the Popliteal Fossa

      The popliteal fossa is a diamond-shaped space located at the back of the knee joint. It is bound by various muscles and ligaments, including the biceps femoris, semimembranosus, semitendinosus, and gastrocnemius. The floor of the popliteal fossa is formed by the popliteal surface of the femur, posterior ligament of the knee joint, and popliteus muscle, while the roof is made up of superficial and deep fascia.

      The popliteal fossa contains several important structures, including the popliteal artery and vein, small saphenous vein, common peroneal nerve, tibial nerve, posterior cutaneous nerve of the thigh, genicular branch of the obturator nerve, and lymph nodes. These structures are crucial for the proper functioning of the lower leg and foot.

      Understanding the anatomy of the popliteal fossa is important for healthcare professionals, as it can help in the diagnosis and treatment of various conditions affecting the knee joint and surrounding structures.

    • This question is part of the following fields:

      • Cardiovascular System
      25.4
      Seconds
  • Question 3 - A 65-year-old male comes to the GP complaining of mild chest pain and...

    Correct

    • A 65-year-old male comes to the GP complaining of mild chest pain and dyspnoea. The patient has no significant medical history but has a family history of heart disease, with his father passing away following a heart attack last year. The GP suspects atrial flutter and decides to perform an ECG to confirm the diagnosis. What ECG findings would you anticipate given the diagnosis?

      Your Answer: Narrow complex tachycardia

      Explanation:

      Atrial flutter is characterized by a sawtooth pattern on ECG and typically presents as a narrow complex tachycardia. The regular atrial activity in atrial flutter is typically 300 bpm, and the ventricular rate is a fraction of this. For example, a 2:1 block would result in a ventricular rate of 150/min, a 3:1 block would result in a ventricular rate of 100/min, and a 4:1 block would result in a ventricular rate of 75/min.

      Atrial flutter is a type of supraventricular tachycardia that is characterized by a series of rapid atrial depolarization waves. This condition can be identified through ECG findings, which show a sawtooth appearance. The underlying atrial rate is typically around 300 beats per minute, which can affect the ventricular or heart rate depending on the degree of AV block. For instance, if there is a 2:1 block, the ventricular rate will be 150 beats per minute. Flutter waves may also be visible following carotid sinus massage or adenosine.

      Managing atrial flutter is similar to managing atrial fibrillation, although medication may be less effective. However, atrial flutter is more sensitive to cardioversion, so lower energy levels may be used. For most patients, radiofrequency ablation of the tricuspid valve isthmus is curative.

    • This question is part of the following fields:

      • Cardiovascular System
      62
      Seconds
  • Question 4 - You are a doctor working in the intensive care unit. A 35-year-old man...

    Incorrect

    • You are a doctor working in the intensive care unit. A 35-year-old man has been admitted to the ward due to suddenly vomiting large volumes of fresh blood. His blood pressure is 90/60 mmHg and his heart rate is 150bpm. He needs urgent intravenous fluids. Several attempts at intravenous cannulation have been made but to no avail. The on-call anaesthetist suggests performing a great saphenous vein cutdown.

      Where should the anaesthetist make the incision?

      Your Answer: Five centimetres below the inferior margin of the inguinal ligament

      Correct Answer: Anterior to the medial malleolus

      Explanation:

      The long saphenous vein is often used for venous cutdown and passes in front of the medial malleolus. Venous cutdown involves surgically exposing a vein for cannulation.

      On the other hand, the short saphenous vein is situated in front of the lateral malleolus and runs up the back of the thigh to drain into the popliteal vein at the popliteal fossa.

      The long saphenous vein originates from the point where the first dorsal digital vein, which drains the big toe, joins the dorsal venous arch of the foot. It then passes in front of the medial malleolus, ascends the medial aspect of the thigh, and drains into the femoral vein by passing through the saphenous opening.

      The femoral vein becomes the external iliac vein at the inferior margin of the inguinal ligament. It receives blood from the great saphenous and popliteal veins, and a deep vein thrombosis that blocks this vein can be life-threatening.

      During a vascular examination of the lower limb, the dorsalis pedis artery is often palpated. It runs alongside the extensor digitorum longus.

      Lastly, the posterior tibial vein is located at the back of the medial malleolus, together with other structures, within the tarsal tunnel.

      The Anatomy of Saphenous Veins

      The human body has two saphenous veins: the long saphenous vein and the short saphenous vein. The long saphenous vein is often used for bypass surgery or removed as a treatment for varicose veins. It originates at the first digit where the dorsal vein merges with the dorsal venous arch of the foot and runs up the medial side of the leg. At the knee, it runs over the posterior border of the medial epicondyle of the femur bone before passing laterally to lie on the anterior surface of the thigh. It then enters an opening in the fascia lata called the saphenous opening and joins with the femoral vein in the region of the femoral triangle at the saphenofemoral junction. The long saphenous vein has several tributaries, including the medial marginal, superficial epigastric, superficial iliac circumflex, and superficial external pudendal veins.

      On the other hand, the short saphenous vein originates at the fifth digit where the dorsal vein merges with the dorsal venous arch of the foot, which attaches to the great saphenous vein. It passes around the lateral aspect of the foot and runs along the posterior aspect of the leg with the sural nerve. It then passes between the heads of the gastrocnemius muscle and drains into the popliteal vein, approximately at or above the level of the knee joint.

      Understanding the anatomy of saphenous veins is crucial for medical professionals who perform surgeries or treatments involving these veins.

    • This question is part of the following fields:

      • Cardiovascular System
      68.6
      Seconds
  • Question 5 - A 45-year-old man undergoes a routine medical exam and his blood pressure is...

    Correct

    • A 45-year-old man undergoes a routine medical exam and his blood pressure is measured at 155/95 mmHg, which is unusual as it has been normal for the past five annual check-ups. What could be the reason for this sudden change?

      Your Answer: An undersized blood pressure cuff

      Explanation:

      Ensuring Accurate Blood Pressure Measurements

      Blood pressure is a crucial physiological measurement in medicine, and it is essential to ensure that the values obtained are accurate. Inaccurate readings can occur due to various reasons, such as using the wrong cuff size, incorrect arm positioning, and unsupported arms. For instance, using a bladder that is too small can lead to an overestimation of blood pressure, while using a bladder that is too large can result in an underestimation of blood pressure. Similarly, lowering the arm below heart level can lead to an overestimation of blood pressure, while elevating the arm above heart level can result in an underestimation of blood pressure.

      It is recommended to measure blood pressure in both arms when considering a diagnosis of hypertension. If there is a difference of more than 20 mmHg between the readings obtained from both arms, the measurements should be repeated. If the difference remains greater than 20 mmHg, subsequent blood pressures should be recorded from the arm with the higher reading. By following these guidelines, healthcare professionals can ensure that accurate blood pressure measurements are obtained, which is crucial for making informed medical decisions.

    • This question is part of the following fields:

      • Cardiovascular System
      43.1
      Seconds
  • Question 6 - A 45-year-old patient has a cardiac output of 6 L/min and a heart...

    Correct

    • A 45-year-old patient has a cardiac output of 6 L/min and a heart rate of 60/min. Her end-diastolic left ventricular volume is 200ml. What is her left ventricular ejection fraction (LVEF)?

      Your Answer: 50%

      Explanation:

      Cardiovascular physiology involves the study of the functions and processes of the heart and blood vessels. One important measure of heart function is the left ventricular ejection fraction, which is calculated by dividing the stroke volume (the amount of blood pumped out of the left ventricle with each heartbeat) by the end diastolic LV volume (the amount of blood in the left ventricle at the end of diastole) and multiplying by 100%. Another key measure is cardiac output, which is the amount of blood pumped by the heart per minute and is calculated by multiplying stroke volume by heart rate.

      Pulse pressure is another important measure of cardiovascular function, which is the difference between systolic pressure (the highest pressure in the arteries during a heartbeat) and diastolic pressure (the lowest pressure in the arteries between heartbeats). Factors that can increase pulse pressure include a less compliant aorta (which can occur with age) and increased stroke volume.

      Finally, systemic vascular resistance is a measure of the resistance to blood flow in the systemic circulation and is calculated by dividing mean arterial pressure (the average pressure in the arteries during a heartbeat) by cardiac output. Understanding these measures of cardiovascular function is important for diagnosing and treating cardiovascular diseases.

    • This question is part of the following fields:

      • Cardiovascular System
      45.6
      Seconds
  • Question 7 - A 32-year-old arrives at the emergency department with a stab wound to the...

    Incorrect

    • A 32-year-old arrives at the emergency department with a stab wound to the femoral artery. He has a history of intravenous drug use.

      Due to poor vein quality, peripheral cannulation under ultrasound guidance is not feasible. Intraosseous access has been established, but additional access is required to administer large volume transfusions.

      To obtain access to a vessel that runs anterior to the medial malleolus, the consultant has decided to perform a venous cutdown.

      Which vessel will be accessed through this procedure?

      Your Answer: Short saphenous vein

      Correct Answer: Long saphenous vein

      Explanation:

      The correct answer is the long saphenous vein, which passes in front of the medial malleolus and is commonly used for venous cutdown procedures. This vein is the largest vessel in the superficial venous system and is formed from the dorsal venous arch of the foot. During a venous cutdown, the skin is opened up to expose the vessel, allowing for cannulation under direct vision.

      The anterior tibial vein, fibular vein, and posterior tibial vein are all incorrect answers. The anterior tibial vein is part of the deep venous system and arises from the dorsal venous arch, while the fibular vein forms from the plantar veins of the foot and drains into the posterior tibial vein. The posterior tibial vein also arises from the plantar veins of the foot but ascends posterior to the medial malleolus.

      The Anatomy of Saphenous Veins

      The human body has two saphenous veins: the long saphenous vein and the short saphenous vein. The long saphenous vein is often used for bypass surgery or removed as a treatment for varicose veins. It originates at the first digit where the dorsal vein merges with the dorsal venous arch of the foot and runs up the medial side of the leg. At the knee, it runs over the posterior border of the medial epicondyle of the femur bone before passing laterally to lie on the anterior surface of the thigh. It then enters an opening in the fascia lata called the saphenous opening and joins with the femoral vein in the region of the femoral triangle at the saphenofemoral junction. The long saphenous vein has several tributaries, including the medial marginal, superficial epigastric, superficial iliac circumflex, and superficial external pudendal veins.

      On the other hand, the short saphenous vein originates at the fifth digit where the dorsal vein merges with the dorsal venous arch of the foot, which attaches to the great saphenous vein. It passes around the lateral aspect of the foot and runs along the posterior aspect of the leg with the sural nerve. It then passes between the heads of the gastrocnemius muscle and drains into the popliteal vein, approximately at or above the level of the knee joint.

      Understanding the anatomy of saphenous veins is crucial for medical professionals who perform surgeries or treatments involving these veins.

    • This question is part of the following fields:

      • Cardiovascular System
      46.8
      Seconds
  • Question 8 - A 79-year-old man is admitted to the hospital after experiencing severe dizziness, vertigo,...

    Incorrect

    • A 79-year-old man is admitted to the hospital after experiencing severe dizziness, vertigo, slurred speech, and nausea with vomiting. The diagnosis reveals a basilar artery stroke. Which blood vessels combine to form the affected artery?

      Your Answer: Posterior inferior cerebellar arteries

      Correct Answer: Vertebral arteries

      Explanation:

      The Circle of Willis is an anastomosis formed by the internal carotid arteries and vertebral arteries on the bottom surface of the brain. It is divided into two halves and is made up of various arteries, including the anterior communicating artery, anterior cerebral artery, internal carotid artery, posterior communicating artery, and posterior cerebral arteries. The circle and its branches supply blood to important areas of the brain, such as the corpus striatum, internal capsule, diencephalon, and midbrain.

      The vertebral arteries enter the cranial cavity through the foramen magnum and lie in the subarachnoid space. They then ascend on the anterior surface of the medulla oblongata and unite to form the basilar artery at the base of the pons. The basilar artery has several branches, including the anterior inferior cerebellar artery, labyrinthine artery, pontine arteries, superior cerebellar artery, and posterior cerebral artery.

      The internal carotid arteries also have several branches, such as the posterior communicating artery, anterior cerebral artery, middle cerebral artery, and anterior choroid artery. These arteries supply blood to different parts of the brain, including the frontal, temporal, and parietal lobes. Overall, the Circle of Willis and its branches play a crucial role in providing oxygen and nutrients to the brain.

    • This question is part of the following fields:

      • Cardiovascular System
      33.5
      Seconds
  • Question 9 - Which one of the following nerves is not found in the posterior triangle...

    Incorrect

    • Which one of the following nerves is not found in the posterior triangle of the neck?

      Your Answer: Phrenic nerve

      Correct Answer: Ansa cervicalis

      Explanation:

      The anterior triangle of the neck contains the ansa cervicalis.

      The posterior triangle of the neck is an area that is bound by the sternocleidomastoid and trapezius muscles, the occipital bone, and the middle third of the clavicle. Within this triangle, there are various nerves, vessels, muscles, and lymph nodes. The nerves present include the accessory nerve, phrenic nerve, and three trunks of the brachial plexus, as well as branches of the cervical plexus such as the supraclavicular nerve, transverse cervical nerve, great auricular nerve, and lesser occipital nerve. The vessels found in this area are the external jugular vein and subclavian artery. Additionally, there are muscles such as the inferior belly of omohyoid and scalene, as well as lymph nodes including the supraclavicular and occipital nodes.

    • This question is part of the following fields:

      • Cardiovascular System
      139.5
      Seconds
  • Question 10 - A 78-year-old male patient with AF, who is on appropriate medication for rate...

    Correct

    • A 78-year-old male patient with AF, who is on appropriate medication for rate control, is admitted with dig toxicity after receiving antibiotics for a UTI. What ECG finding is most probable?

      Your Answer: Reverse tick abnormality

      Explanation:

      Dig Toxicity and its Treatment

      Dig Toxicity can occur as a result of taking antibiotics that inhibit enzymes, especially if the prescribing physician does not take this into account. One of the most common signs of dig toxicity is the reverse tick abnormality, which can be detected through an electrocardiogram (ECG).

      To treat dig toxicity, it is important to first address any electrolyte imbalances that may be present. In more severe cases, a monoclonal antibody called digibind may be administered to help alleviate symptoms. Overall, it is important for healthcare providers to be aware of the potential for dig toxicity and to take appropriate measures to prevent and treat it.

    • This question is part of the following fields:

      • Cardiovascular System
      71.4
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular System (6/10) 60%
Passmed