Cardiovascular Medicine EMQs 1

Question 1

A 63 year old man with a history of high blood pressure presents in A&E with sudden onset tearing chest pain radiating to the back.

Answer 1

Aortic Dissection

Question 2

A 40 year old woman develops sudden onset dyspnea at rest following hip replacement surgery. On examination she is tachycardic and her ECG shows right axis deviation.

Answer 2

Pulmonary Embolus

Question 3

A 60 year old businessman complains of central crushing chest pain radiating to both arms after running to catch a bus. Pain was releived by rest and his ECG 1 hr later was unremarkable.

Answer 3

Angina

Question 4

A 21 year old high-jumper presents with acute-onset dyspnoea and right-sided pleuritic chest pain. Examination reveals increased vocal resonance and reduced expansion on the right side.

Answer 4

Pneumothorax

Question 5

A 23 year old woman presents with localised left sided chest pain that is exacerbated by coughing and is particularly painful on light pressure to that area. Pain is relieved by aspirin. ECG unremarkable.

Answer 5

Costochondritis

Question 6

Slow rising pulse, narrow pulse pressure, heavy apex beat and fourth heart sound.

Answer 6

Aortic Stenosis

Question 7

Collapsing pulse, wide pulse pressure, pistol short sound herd over femoral arteries.

Answer 7

Aortic regurgitation

Question 8

Radio femoral delay in a patient with hypertension.

Answer 8

coarctation of aorta

Question 9

Pulsus paradoxus, jugular venous pressure rises on inspiration, heart sounds muffled.

Answer 9

Cardiac Tamponade

Question 10

Bounding pulse in a patient who is short of breath

Answer 10

Acute CO2 retention

Question 11

Tapping apex beat, loud S1, mid-diastolic mumur loudest at the apex in expiration lying on the left side.

Answer 11

Mitral Stenosis - Rheumatic heart disease

Question 12

Heaving undisplaced apex beat, absent A2 with ejection systolic murmur radiating to the carotids.

Answer 12

Aortic Stenosis

Question 13

Pansystolic murmur heard best at lower left sternal edge during inspiration in a patient with pulsatile hepatomegaly.

Answer 13

Tricuspid regurgitation - Infective endocarditis in IV drug users. Giant systolic V waves in the JVP.

Question 14

Displaced, volume-overloaded apex. Soft S1, pansystolic murmur at apex radiating to axilia.

Answer 14

Mitral Regurgitation - Rheumatic heart disease.

Question 15

Left parasternal heave and harsh pansystolic murmur at lower left sternal edge that is also audible at apex.

Answer 15

Ventricular septal defect.