2019 Flashcards
(54 cards)
Patient is post MI with pansystolic murmur and bibasal crackles - cause?
Papillary muscle rupture and acute MR
Patient is 4 weeks post inferior MI with chest pain and fever.
On examiation - systolic murmur, temp 37.5, ECG shows Q waves and ST depression in II, III, aVF.
Diagnosis?
Pericarditis (likely Dressler’s syndrome)
Patient has a pansystolic murmur, that is loudest at the apex and radiated to the axilla. JVP is raised at 8cm.
Diagnosis?
Mitral regurgitation
The murmur here strongly suggestive of MR, JVP being raised likely a red herring, but could be due to left–>right failure
Patient with early diastolic murmur and mid-diastolic murmur. JVP 8cm.
Diagnosis?
Mid-diastolic murmur –> mitral stenosis
Early diastolic murmur –> pulmonary insufficiency
This is a Graham-Steel murmur caused by pulmonary hypertension
Therefore pulmonary regurgitation is the diagnosis.
Patient with hyperkalaemia, raised urea, ECG shows bradycardia with 2:1 block
Many features here for digoxin toxicity
Young person collapsed, but is now fine, after genetic testing diagnosed with Long QT syndrome. What is the most common cause of death in these patients?
Ventricular tachycardia
Person has syncope, chest pain, and faints. Which investigation best to identify cause?
Echo, ECG, carotid doppler
This question largely depends on age..
Elderly –> ECHO (?aortic stenosis)
Younger –> ECG (?arrhythmia)
ST elevation in II, III, aVF - what artery is affected?
Right coronary artery
More specifically, the posterior interventricular branch
You are called to see a 75yo patient who is unresponsive. Nurses saw her choking. You cannot detect a pulse and there is no respiratory effort, with nothing visible in the mouth. What do you do?
5 back blows, 5 abdominal thrusts, start CPR, inspect using laryngoscope
Start CPR (+ get help)
62yo man with Hx EtOH, weight loss, cachectic, jaundice, ascites. What tumour marker?
alpha-fetoprotein (for HCC)
Patient with ?ank spond. Most diagnostic investigation?
HLA-B27, MRI sacroiliac joints, lumbar XR, CT
MRI sacroiliac joints
HLA-B27 90% specific and only in Caucasians
MRI > xray + CT
What investigation for polymyositis?
Anti-Jo antibodies
Patient with flexural surface rash and anaemia. What investigation would be diagnostic?
Flexural rash –> dermatitis herpetiformis –> coeliac disease
Therefore, answer = faecal calprotectin
Patient being treated for exacerbation of asthma. Responding well, then suddenly deteriorates with no air entry on left. Diagnosis?
PTX, PE, increased severity of asthma, anaphylaxis
Increased severity of asthma
Patient with cancer and metastasis with nausea and vomiting, not on chemo or radiotherapy. Which antiemetic to give?
Cyclizine
Which of the following can cause cholestasis?
Bendroflumethiazide, benzos, carbamazepine
Benzodiazepine
30yo gentleman with intermittent swallowing + difficults for solid that is relieved with drinking large amounts of water. Bad smelling breath. Diagnosis?
pharyngeal pouch
Rapidly growing parotid gland swelling (2 -> 5 cm)
Diagnosis?
Largely depends on other details, my guess would be lymphadenopathy
Gentleman with AF and stroke, Hx of intracerebral bleed 6 years ago. What medication should be added?
Inpatient –> clopidogrel
Long-term –> needs anticoagulation
Patient with fever, reduced air entry on left, stony dullness, etc etc
Most useful next investigation?
Pleural fluid aspiration
Tension PTX - tracheal deviation, deteriorating clinical picture
Management?
Needle decompression
ECG suggestive of SVT, what drug would you give?
Adenosine IV (after failed vagal maouevres)
Gentleman with deficits related to cranial nerves III to VI - where is the lesion?
Cavernous sinus
Elderly man sitting in a chair, just goes unconscious for 5 mins, but is then fine. ECG shows prolonged PR, LAD, RBBB = incomplete trifascicular block.
Cause of syncope?
Complete heart block (complete trifascicular block)
