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Question 1
Correct
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A 16-year-old boy is discovered following a street brawl with a stab wound on the left side of his chest to the 5th intercostal space, mid-clavicular line. He has muffled heart sounds, distended neck veins, and a systolic blood pressure of 70 mmHg. What is the most accurate description of his condition?
Your Answer: Beck’s triad
Explanation:Medical Triads and Laws
There are several medical triads and laws that are used to diagnose certain conditions. One of these is Beck’s triad, which consists of muffled or distant heart sounds, low systolic blood pressure, and distended neck veins. This triad is associated with cardiac tamponade.
Another law is Courvoisier’s law, which states that if a patient has a palpable gallbladder that is non-tender and is associated with painless jaundice, the cause is unlikely to be gallstones.
Meigs syndrome is a triad of ascites, pleural effusion, and a benign ovarian tumor.
Cushing’s syndrome is a set of signs and symptoms that occur due to prolonged use of corticosteroids, including hypertension and central obesity. However, this is not relevant to the patient in the question as there is no information about steroid use and the blood pressure is low.
Finally, Charcot’s triad is used in ascending cholangitis and consists of right upper quadrant pain, jaundice, and fever.
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This question is part of the following fields:
- Cardiology
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Question 2
Correct
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You are called to see a 62-year-old man who has suddenly deteriorated after pacemaker insertion. He has sudden-onset shortness of breath and is cold and clammy. On examination, his blood pressure is 90/50 mmHg, pulse 100 bpm and regular. His jugular venous pressure (JVP) is markedly elevated and his heart sounds are muffled. You give him oxygen and plasma volume expanders intravenously (iv).
Which of the following is the next most appropriate intervention?Your Answer: Prepare for pericardiocentesis
Explanation:Management of Cardiac Tamponade
Cardiac tamponade is a medical emergency that requires urgent intervention. The condition is characterized by a large amount of fluid in the pericardial sac, which can lead to compression of the heart and subsequent haemodynamic instability.
The first step in managing cardiac tamponade is to perform pericardiocentesis, which involves draining the fluid from the pericardial sac. Delaying this procedure can result in cardiac arrest and death.
While echocardiography can aid in diagnosis, it should not delay the initiation of pericardiocentesis. Similarly, a chest X-ray is not necessary for management. Swann-Ganz catheter insertion and inotropic support are also not recommended as they do not address the underlying cause of the condition.
In summary, prompt recognition and treatment of cardiac tamponade is crucial for patient survival.
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This question is part of the following fields:
- Cardiology
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Question 3
Correct
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A 38-year-old man comes for his 6-week post-myocardial infarction (MI) follow-up. He was discharged without medication. His total cholesterol is 9 mmol/l, with triglycerides of 1.2 mmol/l. He is a non-smoker with a blood pressure of 145/75. His father passed away from an MI at the age of 43.
What is the most suitable initial treatment for this patient?Your Answer: High-dose atorvastatin
Explanation:Treatment Options for a Patient with Hypercholesterolemia and Recent MI
When treating a patient with hypercholesterolemia and a recent myocardial infarction (MI), it is important to choose the most appropriate treatment option. In this case, high-dose atorvastatin is the best choice due to the patient’s high cholesterol levels and family history. It is crucial to note that medication should have been prescribed before the patient’s discharge.
While dietary advice can be helpful, it is not the most urgent treatment option. Ezetimibe would only be prescribed if a statin were contraindicated. In this high-risk patient, low-dose atorvastatin is not sufficient, and high-dose atorvastatin is required, provided it is tolerated. If cholesterol control does not improve with high-dose atorvastatin, ezetimibe can be added at a later check-up. Overall, the priority is to control the patient’s high cholesterol levels with medication.
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This question is part of the following fields:
- Cardiology
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Question 4
Correct
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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?
Your Answer: Start her on digoxin
Explanation:Treatment Options for Atrial Fibrillation in a Patient with Heart Failure
When treating a patient with atrial fibrillation (AF) and heart failure, the aim should be rate control. While bisoprolol is a good choice for medication, it may not be suitable for a patient with chronic low blood pressure. In this case, digoxin would be the treatment of choice. Anticoagulation with either a novel oral anticoagulant or warfarin is also necessary. Electrical cardioversion is not appropriate for this patient. Increasing the dose of bisoprolol may be reasonable, but considering the patient’s clinical presentation and past medical history, it may not be the best option. Amlodipine will not have an effect on rate control in AF, and calcium-channel blockers should not be used in heart failure. Amiodarone should not be first-line treatment in this patient due to her heart failure. Overall, the best treatment option for AF in a patient with heart failure should be carefully considered based on the individual’s medical history and current condition.
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This question is part of the following fields:
- Cardiology
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Question 5
Correct
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A 68-year-old man presents to the Emergency Department with chest pain that began 2 hours ago. He reports that he first noticed the pain while lying down. The pain is rated at 7/10 in intensity and worsens with deep inspiration but improves when he leans forward. The patient has a medical history of long-standing diabetes mellitus and had a myocardial infarction 6 weeks ago, for which he underwent coronary artery bypass grafting. The surgery was uncomplicated, and he recovered without any issues. He smokes 1.5 packs of cigarettes per day and does not consume alcohol. Upon auscultation of the chest, a friction rub is heard. Serum inflammatory markers are elevated, while serial troponins remain stable. What is the most likely diagnosis?
Your Answer: Dressler syndrome
Explanation:Complications of Myocardial Infarction
Myocardial infarction can lead to various complications, including Dressler syndrome, papillary muscle rupture, ventricular aneurysm, reinfarction, and pericardial tamponade. Dressler syndrome is a delayed complication that occurs weeks after the initial infarction and is caused by autoantibodies against cardiac antigens released from necrotic myocytes. Symptoms include mild fever, pleuritic chest pain, and a friction rub. Papillary muscle rupture occurs early after a myocardial infarction and presents with acute congestive heart failure and a new murmur of mitral regurgitation. Ventricular aneurysm is characterized by paradoxical wall motion of the left ventricle and can lead to stasis and embolism. Reinfarction is less likely in a patient with atypical symptoms and no rising troponin. Pericardial tamponade is a rare complication of Dressler syndrome and would present with raised JVP and muffled heart sounds.
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This question is part of the following fields:
- Cardiology
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Question 6
Correct
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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?Your Answer: At the apex beat
Explanation:Surface Locations for Cardiac Auscultation
Cardiac auscultation is a crucial part of a physical examination to assess the heart’s function. The surface locations for cardiac auscultation are essential to identify the specific valve sounds. Here are the surface locations for cardiac auscultation:
1. Apex Beat: The mitral valve is best heard over the palpated apex beat. If it cannot be felt, then it should be assumed to be in the fifth intercostal space, mid-clavicular line.
2. Fifth Intercostal Space, Mid-Axillary Line: This location is too lateral to hear a mitral valve lesion in a non-dilated ventricle.
3. Second Intercostal Space, Left of the Sternum: The pulmonary valve is located in the second intercostal space, left of the sternum.
4. Fourth Intercostal Space, Left of the Sternum: The tricuspid valve is located in the fourth intercostal space, left of the sternum.
5. Xiphisternum: The xiphisternum is not used as a marker for cardiac auscultation, though it is used to guide echocardiography for certain standard views.
Knowing the surface locations for cardiac auscultation is crucial to identify the specific valve sounds and assess the heart’s function accurately.
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This question is part of the following fields:
- Cardiology
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Question 7
Correct
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A 63-year-old diabetic woman presents with general malaise and epigastric pain of 2 hours’ duration. She is hypotensive (blood pressure 90/55) and has jugular venous distension. Cardiac workup reveals ST elevation in leads I, aVL, V5 and V6. A diagnosis of high lateral myocardial infarction is made, and the patient is prepared for percutaneous coronary intervention (PCI).
Blockage of which of the following arteries is most likely to lead to this type of infarction?Your Answer: Left (obtuse) marginal artery
Explanation:Coronary Arteries and their Associated ECG Changes
The heart is supplied with blood by the coronary arteries, and blockages in these arteries can lead to myocardial infarction (heart attack). Different coronary arteries supply blood to different parts of the heart, and the location of the blockage can be identified by changes in the electrocardiogram (ECG) readings.
Left (obtuse) Marginal Artery: This artery supplies the lateral wall of the left ventricle. Blockages in this artery can cause changes in ECG leads I, aVL, V2, V5, and V6, with reciprocal changes in the inferior leads.
Anterior Interventricular (Left Anterior Descending) Artery: This artery supplies the anterior walls of both ventricles and the anterior part of the interventricular septum. Blockages in this artery can cause changes in ECG leads V2-V4, sometimes extending to V1 and V5.
Posterior Interventricular Artery: This artery is a branch of the right coronary artery and supplies the posterior walls of both ventricles. ECG changes associated with blockages in this artery are not specific.
Right (Acute) Marginal Artery: This artery supplies the right ventricle. Blockages in this artery can cause changes in ECG leads II, III, aVF, and sometimes V1.
Right Mainstem Coronary Artery: Inferior myocardial infarction is most commonly associated with blockages in this artery (80% of cases) or the left circumflex artery (20% of cases). ECG changes in this type of infarct are seen in leads II, III, and aVF.
Understanding Coronary Arteries and ECG Changes in Myocardial Infarction
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This question is part of the following fields:
- Cardiology
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Question 8
Incorrect
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A 56-year-old Caucasian man presents to his General Practitioner (GP) for routine health screening. He has a background history of obesity (BMI 31 kg/m2), impaired glucose tolerance and he used to smoke. His blood pressure is 162/100 mmHg. It is the same in both arms. There is no renal bruit and he does not appear cushingoid. He does not take regular exercise. At his previous appointment his blood pressure was 168/98 mm/Hg and he has been testing his BP at home. Average readings are 155/95 mmHg. He does not drink alcohol. His father had a heart attack at age 58. Blood results are listed below:
Investigation Result Normal value
HbA1C 46 mmol/l < 53 mmol/mol (<7.0%)
Potassium 4.1 mmol/l 3.5–5 mmol/l
Urea 7 mmol/l 2.5–6.5 mmol/l
Creatinine 84 µmol/l 50–120 µmol/l
Total cholesterol 5.2 mmol/l < 5.2 mmol/l
High-density lipoprotein (HDL) 1.1 mmol/l > 1.0 mmol/l
Low density-lipoprotein (LDL) 3 mmol/l < 3.5 mmol/l
Triglycerides 1.1 mmol/l 0–1.5 mmol/l
Thyroid Stimulating Hormone (TSH) 2 µU/l 0.17–3.2 µU/l
Free T4 16 pmol/l 11–22 pmol/l
What is the most appropriate next step in management of this patient?Your Answer: Lifestyle advice alone
Correct Answer: Commence ACE inhibitor
Explanation:Treatment for Stage 2 Hypertension: Commencing ACE Inhibitor
Stage 2 hypertension is a serious condition that requires prompt treatment to reduce the risk of a cardiac event. According to NICE guidelines, ACE inhibitors or ARBs are the first-line treatment for hypertension. This man, who has multiple risk factors for hypertension, including age, obesity, and physical inactivity, should commence pharmacological treatment. Lifestyle advice alone is not sufficient in this case.
It is important to note that beta blockers are not considered first-line treatment due to their side-effect profile. Spironolactone is used as fourth-line treatment in resistant hypertension or in the setting of hyperaldosteronism. If cholesterol-lowering treatment were commenced, a statin would be first line. However, in this case, the patient’s cholesterol is normal, so a fibrate is not indicated.
In summary, commencing an ACE inhibitor is the appropriate course of action for this patient with stage 2 hypertension.
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This question is part of the following fields:
- Cardiology
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Question 9
Incorrect
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A 27-year-old Asian woman complains of palpitations, shortness of breath on moderate exertion and a painful and tender knee. During auscultation, a mid-diastolic murmur with a loud S1 is heard. Echocardiography reveals valvular heart disease with a normal left ventricular ejection fraction.
What is the most probable valvular disease?Your Answer: Aortic regurgitation
Correct Answer: Mitral stenosis
Explanation:Differentiating Heart Murmurs: Causes and Characteristics
Heart murmurs are abnormal sounds heard during a heartbeat and can indicate underlying heart conditions. Here are some common causes and characteristics of heart murmurs:
Mitral Stenosis: This condition is most commonly caused by rheumatic fever in childhood and is rare in developed countries. Patients with mitral stenosis will have a loud S1 with an associated opening snap. However, if the mitral valve is calcified or there is severe stenosis, the opening snap may be absent and S1 soft.
Mitral Regurgitation and Ventricular Septal Defect: These conditions cause a pan-systolic murmur, which is not the correct option for differentiating heart murmurs.
Aortic Regurgitation: This condition leads to an early diastolic murmur.
Aortic Stenosis: Aortic stenosis causes an ejection systolic murmur.
Ventricular Septal Defect: As discussed, a ventricular septal defect will cause a pan-systolic murmur.
By understanding the causes and characteristics of different heart murmurs, healthcare professionals can better diagnose and treat underlying heart conditions.
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This question is part of the following fields:
- Cardiology
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Question 10
Correct
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A 65 year old man with a BMI of 29 was diagnosed with borderline hypertension during a routine check-up with his doctor. He is hesitant to take any medications. What dietary recommendations should be given to help lower his blood pressure?
Your Answer: Consume a diet rich in fruits and vegetables
Explanation:Tips for a Hypertension-Friendly Diet
Maintaining a healthy diet is crucial for managing hypertension. Here are some tips to help you make the right food choices:
1. Load up on fruits and vegetables: Consuming a diet rich in fruits and vegetables can reduce blood pressure by 2-8 mmHg in hypertensive patients. It can also aid in weight loss, which further lowers the risk of hypertension.
2. Limit cholesterol intake: A reduction in cholesterol is essential for patients with ischaemic heart disease, and eating foods that are low in fat and cholesterol can reduce blood pressure.
3. Moderate alcohol consumption: Men should have no more than two alcoholic drinks daily to lower their risk of hypertension.
4. Eat oily fish twice a week: Eating more fish can help lower blood pressure, but having oily fish twice weekly is advised for patients with ischaemic heart disease, not hypertension alone.
5. Watch your sodium intake: Restricting dietary sodium is recommended and can lower blood pressure. A low sodium diet contains less than 2 g of sodium daily. Aim for a maximum of 7 g of dietary sodium daily.
By following these tips, you can maintain a hypertension-friendly diet and reduce your risk of complications.
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This question is part of the following fields:
- Cardiology
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Question 11
Incorrect
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A 61-year-old man comes to his General Practitioner complaining of increasing exertional dyspnoea accompanied by bilateral peripheral oedema. He reports feeling extremely fatigued lately. During the physical examination, his lungs are clear, but he has ascites. On auscultation of his heart sounds, you detect a holosystolic murmur with a high pitch at the left sternal edge, extending to the right sternal edge. What is the probable reason for this patient's symptoms?
Your Answer: Pulmonary stenosis
Correct Answer: Tricuspid regurgitation
Explanation:Differentiating Heart Murmurs and Symptoms
Tricuspid regurgitation is characterized by signs of right heart failure, such as dyspnea and peripheral edema, and a classical murmur. The backflow of blood to the right atrium leads to right heart dilation, weakness, and eventually failure, resulting in ascites and poor ejection fraction causing edema.
Mitral regurgitation has a similar murmur to tricuspid regurgitation but is heard best at the apex.
Aortic regurgitation is identified by an early diastolic decrescendo murmur at the left sternal edge.
Aortic stenosis does not typically result in ascites, and its murmur is ejection systolic.
Pulmonary stenosis is characterized by a mid-systolic crescendo-decrescendo murmur best heard over the pulmonary post and not a holosystolic murmur at the left sternal edge.
Understanding Heart Murmurs and Symptoms
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This question is part of the following fields:
- Cardiology
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Question 12
Incorrect
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A 68-year-old woman is admitted to the Cardiology Ward with acute left ventricular failure. The patient is severely short of breath.
What would be the most appropriate initial step in managing her condition?Your Answer: Administer oxygen and secure venous access
Correct Answer: Sit her up and administer high flow oxygen
Explanation:Managing Acute Shortness of Breath: Prioritizing ABCDE Approach
When dealing with acutely unwell patients experiencing shortness of breath, it is crucial to follow the ABCDE approach. The first step is to address Airway and Breathing by sitting the patient up and administering high flow oxygen to maintain normal saturations. Only then should Circulation be considered, which may involve cannulation and administering IV furosemide.
According to the latest NICE guidelines, non-invasive ventilation should be considered as part of non-pharmacological management if simple measures do not improve symptoms.
It is important to prioritize the ABCDE approach and not jump straight to administering medication or inserting a urinary catheter. Establishing venous access and administering medication should only be done after ensuring the patient’s airway and breathing are stable.
If the patient has an adequate systolic blood pressure, iv nitrates such as glyceryl trinitrate (GTN) infusion could be considered to reduce preload on the heart. However, most patients can be treated with iv diuretics, such as furosemide.
In cases of acute pulmonary edema, close monitoring of urine output is recommended, and the easiest and most accurate method is through catheterization with hourly urine measurements. Oxygen should be given urgently if the patient is short of breath.
In summary, managing acute shortness of breath requires a systematic approach that prioritizes Airway and Breathing before moving on to Circulation and other interventions.
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This question is part of the following fields:
- Cardiology
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Question 13
Incorrect
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A 65-year-old man presents to the Emergency Department with sudden onset epigastric discomfort. He has a significant past medical history of hypercholesterolaemia and type II diabetes mellitus, and he is a heavy smoker. On examination, his pulse is 30 bpm; he is hypotensive and has distended neck veins. The chest is clear to auscultation. Initial blood tests reveal an elevated troponin level, and an electrocardiogram (ECG) shows hyperacute T-waves in leads II, III and aVF.
What is the most likely diagnosis?Your Answer: Acute pulmonary embolism (PE)
Correct Answer: Right/inferior MI
Explanation:Understanding the Different Types of Myocardial Infarction: A Guide to ECG Changes and Symptoms
Myocardial infarction (MI) can occur in different areas of the heart, depending on which artery is occluded. Right/inferior MIs, which account for up to 40-50% of cases, are caused by occlusion of the RCA or, less commonly, a dominant left circumflex artery. Symptoms include bradycardia, hypotension, and a clear chest on auscultation. Conduction disturbances, particularly type II and III heart blocks, are also common. ECG changes include ST-segment elevation in leads II, III, and aVF, and reciprocal ST-segment depression in aVL (± lead I).
Anterolateral MIs are possible, but less likely to present with bradycardia, hypotension, and a clear chest. An anterior MI, caused by occlusion of the LAD, is associated with tachycardia rather than bradycardia.
Other conditions, such as acute pulmonary edema and pulmonary embolism, may present with similar symptoms but have different ECG changes and additional features. Understanding the ECG changes and symptoms associated with different types of MI can help with accurate diagnosis and appropriate treatment.
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This question is part of the following fields:
- Cardiology
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Question 14
Incorrect
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Various cardiac diseases necessitate the use of pacemakers to maintain regular heartbeats and sustain the patient's life. The following are three types of pacemakers, labeled 1-3: AAI, VVI, and DDD. Can you correctly match each pacemaker to the condition it is typically used to treat?
Your Answer: AAI – second-degree heart block; VVI – AF; DDD – long QT syndrome
Correct Answer: AAI – sinus node dysfunction; VVI – AF; DDD – second-degree heart block
Explanation:Understanding Pacemaker Coding and Indications
Pacemakers are electronic devices that are implanted in the chest to regulate the heartbeat. They are used to treat a variety of heart conditions, including sinus node dysfunction, atrial fibrillation (AF), and heart block. Pacemakers are coded based on the chambers they pace, sense, and respond to, as well as their ability to modulate heart rate and provide multisite pacing.
AAI pacemakers are used to pace the atria in patients with sinus node dysfunction and intact AV conduction. VVI pacemakers are used in patients with chronic atrial impairment, such as AF. DDD pacemakers are used to pace both the atria and ventricles in patients with second-degree heart block.
It is important to note that AAI pacemakers would not be effective in treating ventricular systolic dysfunction, and DDD pacemakers cannot be used in the treatment of long QT syndrome. However, pacemakers can be used in long QT syndrome if clinically necessary, and DDD pacing may be appropriate for some patients with first-degree heart block.
In summary, understanding pacemaker coding and indications is crucial for selecting the appropriate device for each patient’s unique heart condition.
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This question is part of the following fields:
- Cardiology
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Question 15
Correct
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A 20-year-old female patient visited her doctor complaining of general malaise, lethargy, and fatigue. She couldn't pinpoint when the symptoms started but felt that they had been gradually developing for a few months. During the physical examination, the doctor detected a murmur and referred her to a cardiologist based on the findings. The cardiac catheterization results are as follows:
Anatomical site Oxygen saturation (%) Pressure (mmHg)
End systolic/End diastolic
Superior vena cava 77 -
Right atrium (mean) 79 7
Right ventricle 78 -
Pulmonary artery 87 52/17
Pulmonary capillary wedge pressure - 16
Left ventricle 96 120/11
Aorta 97 120/60
What is the most accurate description of the murmur heard during the chest auscultation of this 20-year-old woman?Your Answer: A continuous 'machinery' murmur at the left upper sternal edge with late systolic accentuation
Explanation:Characteristics of Patent Ductus Arteriosus
Patent ductus arteriosus is a condition that is characterized by an unusual increase in oxygen saturation between the right ventricle and pulmonary artery. This is often accompanied by elevated pulmonary artery pressures and a high wedge pressure. These data are typical of this condition and can be used to diagnose it. It is important to note that patent ductus arteriosus can lead to serious complications if left untreated, including heart failure and pulmonary hypertension. Therefore, early detection and treatment are crucial for improving outcomes and preventing long-term complications.
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This question is part of the following fields:
- Cardiology
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Question 16
Correct
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What term describes a lack of pulses but regular coordinated electrical activity on an ECG?
Your Answer: Pulseless electrical activity (PEA)
Explanation:Causes of Pulseless Electrical Activity
Pulseless Electrical Activity (PEA) occurs when there is a lack of pulse despite normal electrical activity on the ECG. This can be caused by poor intrinsic myocardial contractility or a variety of remediable factors. These factors include hypoxemia, hypovolemia, severe acidosis, tension pneumothorax, pericardial tamponade, hyperkalemia, hypocalcemia, poisoning with a calcium channel blocker, or hypothermia. Additionally, PEA may be caused by a massive pulmonary embolism. It is important to identify and address the underlying cause of PEA in order to improve patient outcomes.
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This question is part of the following fields:
- Cardiology
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Question 17
Correct
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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?Your Answer: Wolff–Parkinson–White syndrome
Explanation:Understanding Wolff-Parkinson-White Syndrome: An Abnormal Congenital Accessory Pathway with Tachyarrhythmia Episodes
Wolff-Parkinson-White (WPW) syndrome is a rare condition with an incidence of about 1.5 per 1000. It is characterized by the presence of an abnormal congenital accessory pathway that bypasses the atrioventricular node, known as the Bundle of Kent, and episodes of tachyarrhythmia. While the condition may be asymptomatic or subtle, it can increase the risk of sudden cardiac death.
The presence of a pre-excitation pathway in WPW results in specific ECG changes, including shortening of the PR interval, a Delta wave, and QRS prolongation. The ST segment and T wave may also be discordant to the major component of the QRS complex. These features may be more pronounced with increased vagal tone.
Upon diagnosis of WPW, risk stratification is performed based on a combination of history, ECG, and invasive cardiac electrophysiology studies. Treatment is only offered to those who are considered to have significant risk of sudden cardiac death. Definitive treatment involves the destruction of the abnormal electrical pathway by radiofrequency catheter ablation, which has a high success rate but is not without complication. Patients who experience regular tachyarrhythmias may be offered pharmacological treatment based on the specific arrhythmia.
Other conditions, such as first-degree heart block, pulmonary embolism, hyperthyroidism, and Wenckebach syndrome, have different ECG findings and are not associated with WPW. Understanding the specific features of WPW can aid in accurate diagnosis and appropriate management.
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This question is part of the following fields:
- Cardiology
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Question 18
Correct
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A 70-year-old male presents with abdominal pain.
He has a past medical history of stroke and myocardial infarction. During examination, there was noticeable distension of the abdomen and the stools were maroon in color. The lactate level was found to be 5 mmol/L, which is above the normal range of <2.2 mmol/L.
What is the most probable diagnosis for this patient?Your Answer: Acute mesenteric ischaemia
Explanation:Acute Mesenteric Ischaemia
Acute mesenteric ischaemia is a condition that occurs when there is a disruption in blood flow to the small intestine or right colon. This can be caused by arterial or venous disease, with arterial disease further classified as non-occlusive or occlusive. The classic triad of symptoms associated with acute mesenteric ischaemia includes gastrointestinal emptying, abdominal pain, and underlying cardiac disease.
The hallmark symptom of mesenteric ischaemia is severe abdominal pain, which may be accompanied by other symptoms such as nausea, vomiting, abdominal distention, ileus, peritonitis, blood in the stool, and shock. Advanced ischaemia is characterized by the presence of these symptoms.
There are several risk factors associated with acute mesenteric ischaemia, including congestive heart failure, cardiac arrhythmias (especially atrial fibrillation), recent myocardial infarction, atherosclerosis, hypercoagulable states, and hypovolaemia. It is important to be aware of these risk factors and to seek medical attention promptly if any symptoms of acute mesenteric ischaemia are present.
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This question is part of the following fields:
- Cardiology
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Question 19
Incorrect
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A 59-year-old man, a bus driver, with a history of angina, is admitted to hospital with chest pain. He is diagnosed and successfully treated for a STEMI, and discharged one week later.
Which of the following activities is permitted during the first month of his recovery?Your Answer: Sexual intercourse
Correct Answer: Drinking alcohol (up to 14 units)
Explanation:Post-Myocardial Infarction (MI) Precautions: Guidelines for Alcohol, Machinery, Driving, Sex, and Exercise
After experiencing a myocardial infarction (MI), also known as a heart attack, it is crucial to take precautions to prevent further complications. Here are some guidelines to follow:
Alcohol Consumption: Patients should be advised to keep their alcohol consumption within recommended limits, which is now 14 units per week for both men and women.
Operating Heavy Machinery: Patients should avoid operating heavy machinery for four weeks post MI.
Bus Driving: Patients should refrain from driving a bus or lorry for six weeks post MI. If the patient had angioplasty, driving is not allowed for one week if successful and four weeks if unsuccessful or not performed.
Sexual Intercourse: Patients should avoid sexual intercourse for four weeks post MI.
Vigorous Exercise: Patients should refrain from vigorous exercise for four weeks post MI.
Following these guidelines can help prevent further complications and aid in the recovery process after a myocardial infarction.
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This question is part of the following fields:
- Cardiology
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Question 20
Correct
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A 70-year-old man with a history of chronic cardiac failure with reduced ventricular systolic function presents with recent onset of increasing breathlessness, and worsening peripheral oedema and lethargy. He is currently taking ramipril and bisoprolol alongside occasional paracetamol.
What is the most appropriate long-term management?Your Answer: Addition of spironolactone
Explanation:For the management of heart failure, first line options include ACE inhibitors, beta-blockers, and aldosterone antagonists. In this case, the patient was already on a beta-blocker and an ACE inhibitor which had been effective. The addition of an aldosterone antagonist such as spironolactone would be the best option as it prevents fluid retention and reduces pressure on the heart. Ivabradine is a specialist intervention that should only be considered after trying all other recommended options. Addition of furosemide would only provide symptomatic relief. Insertion of an implantable cardiac defibrillator device is a late-stage intervention. Encouraging regular exercise and a healthy diet is important but does not directly address the patient’s clinical deterioration.
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This question is part of the following fields:
- Cardiology
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