Cardiovascular system

Question 1

With a history of syncope, what condition would you suspect if the ECG showed right bundle branch block and ST elevation in leads V1-V3?

Answer 1

Brugada syndrome

Question 2

Name 4 conditions that are often found alongside HOCM

Answer 2

1. AF
2. Mitral valve prolapse
3. Freiderich’s ataxia
4. Myotonic dystrophy

Question 3

What is the inheritance pattern of HOCM?

Answer 3

Autosomal dominant or de novo mutations

Question 4

Characterise the murmur of aortic regurgitation

Answer 4

Early diastolic murmur heard best in the lower left sternal edge in expiration

Question 5

Define Durozier’s sign

Answer 5

Systolic murmur heard over the femorals with proximal compressions and a diastolic murmur heard with distal compression - clinical sign of aortic regurgitation

Question 6

Define Traube’s sign

Answer 6

Pistol shot femorals with systolic and diastolic sounds

Question 7

Give 4 connective tissues disorders that have an association with aortic regurgitation

Answer 7

1. Marfan’s syndrome
2. Ehler’s Danlos
3. Pseudoxanthoma elasticum
4. Osteogenesis imperfecta

Question 8

Give 4 clinical characteristics associated with Marfan’s syndrome

Answer 8

1. Tall
2. Arachnodactyly
3. Hypermobility
4. High arched palate

Question 9

Give 3 clinical characteristics associated with Ehler’s Danlos syndrome

Answer 9

1. Hypermobility
2. Hyperextensible skin
3. Fish mouth scars

Question 10

What 3 further ‘investigations’ would you suggest to the examiner if you suspected ankylosing spondylitis?

Answer 10

1. Enquiry about inflammatory joint pain and uveitis
2. Auscultate the lung bases for fibrosis
3. Dipstick the urine for proteinuria of amyloidosis

Question 11

What are the clinical findings of an Argyll-Robertson pupil?

Answer 11

1. Small irregular pupil
2. Depigmentation of the iris
3. Accommodates but does not react to light

Question 12

Suggest differentials for a new acute aortic regurgitation murmur

Answer 12

1. Aortic dissection
2. Infective endocarditis
3. Prosthetic valve failure

Question 13

Recall the 3 components of a trifascicular block

Answer 13

1. RBBB
2. Left axis deviation
3. First degree heart block

Question 14

Recall the typical findings on ECG in WPW patients

Answer 14

1. Broad QRS complexes
2. Short PR interval
3. Delta waves
4. Abnormal R wave progression

Question 15

Outline shockable and non shockable cardiac arrest rhythms

Answer 15

Shockable - Ventricular fibrillation and Ventricular tachycardia
Non-Shockable - Pulseless electrical activity and asystole

Question 16

Give 4 endocrine causes of secondary hypertension

Answer 16

1. Cushing’s syndrome
2. Conn’s syndrome
3. Phaeochromocytoma
4. Thyroid disease

Question 17

Give 3 renal causes of secondary hypertension

Answer 17

1. Renal artery stenosis
2. Glomerulonephritis
3. Chronic kidney disease

Question 18

Suggest an ‘anatomical’ cause of secondary hypertension

Answer 18

Coarctation of the aorta

Question 19

Suggest 3 iatrogenic causes of secondary hypertension

Answer 19

1. NSAIDS
2. Steroids
3. Sympathomimetics

Question 20

Recall the NYHA classification for heart failure

Answer 20

Class 1 - No limitations or symptoms with normal activity
Class 2 - Comfortable at rest/ with mild activity; little limitation
Class 3 - Comfortable at rest but symptoms are limiting activity
Class 4 - Symptoms on any activity and can occur at rest

Question 21

When are ACE inhibitors indicated in the treatment of chronic heart failure?

Answer 21

When there is evidence of left ventricular systolic dysfunction

Question 22

Which immunisations are required for patients with chronic heart failure?

Answer 22

1. Pneumococcal (once)

2. Influenza (annually)

Question 23

Recall the components of the CHADS2 scoring system to evaluate the need to anticoagulant a patient

Answer 23

C - Chronic cardiac failure 
H - Hypertension
A - Age (>75 years old)
D - Diabetes mellitus 
S - Stroke or TIA previously ( 2 points if present)

Question 24

Which organisms may cause acute rheumatic fever?

Answer 24

Group A Beta-haemolytic streptococcus

Question 25

Name the diagnostic criteria used for rheumatic fever

Answer 25

Modified Duckett Jones criteria

Question 26

Recall the grading of a murmurs prominence from 1 -6

Answer 26

1. Audible only with special effort in quiet surroundings 2. Quiet, may require special effort 3. Easily audible 4. Loud 5. Associated with a weak thrill (systolic murmurs only) 6. Associated with a strong thrill (systolic murmurs only)

Question 27

How does a D-Dimer test work?

Answer 27

Identifies cross linked fibrin degradation products in patients with thrombosis/ embolism

Question 28

When would standard unfractionated heparin be favoured over LMWH in the treatment of DVT?

Answer 28

If the patient is at a high risk of bleeding, unfractionated heparin is preferred as its effects can be rapidly terminated by stopping the infusion.