Medical Student Finals Archive - Page 662 of 685

MSFinals-0222

A 20-year-old man, who recently immigrated to the United Kingdom from Eastern Europe, presents to his general practitioner with a history of intermittent dizzy spells. He reports having limited exercise capacity since childhood, but this has not been investigated before. Upon examination, the patient appears slight, has a dusky blue discoloration to his lips and tongue, and has finger clubbing. A murmur is also heard. The GP refers him to a cardiologist.

The results of a cardiac catheter study are as follows:

Anatomical site Oxygen saturation (%) Pressure (mmHg)
End systolic/End diastolic
Superior vena cava 58 –
Inferior vena cava 52 –
Right atrium (mean) 56 10
Right ventricle 55 105/9
Pulmonary artery – 16/8
Pulmonary capillary wedge pressure – 9
Left atrium 97 –
Left ventricle 84 108/10
Aorta 74 110/80

What is the most likely diagnosis?

MSFinals-0223

A 60-year-old woman undergoes cardiac catheterisation. A catheter is inserted in her right femoral vein in the femoral triangle and advanced through the iliac veins and inferior vena cava to the right side of the heart so that right chamber pressures can be recorded.
What two other structures pass within the femoral triangle?

MSFinals-0224

A 30-year-old woman with rheumatic fever has ongoing shortness of breath following her infection. You suspect she may have mitral stenosis.
What is the most suitable surface anatomical landmark to listen for this murmur?

MSFinals-0225

A 16-year-old girl is referred to cardiology outpatients with intermittent palpitations. She describes occasional spontaneous episodes of being abnormally aware of her heart. She says her heart rate is markedly increased during episodes. She has no significant medical or family history. She is on the oral contraceptive pill. ECG is performed. She is in sinus rhythm at 80 beats per min. PR interval is 108 ms. A slurring slow rise of the initial portion of the QRS complex is noted; QRS duration is 125 ms.
What is the correct diagnosis?

MSFinals-0226

A 25-year-old with cystic fibrosis was evaluated for cor pulmonale to determine eligibility for a deceased donor double-lung transplant.
What is the surface landmark used to identify right ventricular hypertrophy?

MSFinals-0227

A 48-year-old woman comes to you for a follow-up appointment after a recent fall. She has a medical history of type 2 diabetes mellitus, bilateral knee replacements, chronic hypotension, and heart failure, which limits her mobility. Her weight is 118 kg. During her last visit, her ECG showed atrial fibrillation (AF) with a heart rate of 180 bpm, and she was started on bisoprolol. She underwent a 48-hour ECG monitoring, which revealed non-paroxysmal AF. What is the most appropriate course of action for her management?

MSFinals-0228

A 48-year-old woman comes to you for consultation after being seen two days ago for a fall. She has a medical history of type 2 diabetes mellitus, bilateral knee replacements, chronic hypotension, and heart failure, which limits her mobility. Her weight is 120 kg. During her previous visit, her ECG showed that she had AF with a heart rate of 180 bpm. She was prescribed bisoprolol and advised to undergo a 48-hour ECG monitoring. Upon her return, it was discovered that she has non-paroxysmal AF.
What is the most appropriate course of action?

MSFinals-0229

A 42-year-old man is admitted with a 30-min history of severe central ‘crushing’ chest pain radiating down the left arm. He is profusely sweating and looks ‘grey’. The electrocardiogram (ECG) shows sinus tachycardia and 3-mm ST elevation in V3–V6.
Which of the following is the most appropriate treatment?

MSFinals-0230

A 42-year-old man presents to the Emergency Department with severe central chest pain that worsens when lying down, but improves when sitting forward. The pain radiates to his left shoulder. He has a history of prostate cancer and has recently completed two cycles of radiotherapy. On examination, his blood pressure is 96/52 mmHg (normal <120/80 mmHg), his JVP is elevated, and his pulse is 98 bpm, which appears to fade on inspiration. Heart sounds are faint. The ECG shows low-voltage QRS complexes. What is the most appropriate initial management for this patient?

MSFinals-0231

A 42-year-old man presents to the Emergency Department with severe central chest pain that worsens when lying down, is relieved by sitting forward, and radiates to his left shoulder. He has a history of prostate cancer and has recently completed two cycles of radiotherapy. On examination, his blood pressure is 96/52 mmHg (normal <120/80 mmHg), his JVP is elevated, and his pulse is 98 bpm with a decrease in amplitude during inspiration. Heart sounds are faint. The ECG shows low-voltage QRS complexes. What is the most appropriate initial management for this patient?