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Flashcards in Diagnosis- CVS Deck (38)
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1
Q

A 35 year old male comes into GP surgery for his well man’s yearly check up. You perform a full review of the patient finding that all observations are normal apart from his blood pressure. His systolic is 141mmhg and his diastolic is 96mmgg. What stafe hypertension does this patient have?

A) Stage 1 Hypertension

B) Stage 2 Hypertension

C) Stage 3 Hypertension

D) Not Hypertensive

E) he needs further assessment via ABPM or HBPM

A

E- because he might have has white coat hypertension (nervous) so need to look into it further

2
Q

A 57 year old female from eNorway comes into your GP surgery. She is atype2 diabetic and has been newly diagnosed with essential hypertension. What pharmacologival treatmnet should she first be started on?

A) Thiazide Diuretic

B) ACE inhibitor

C) Loop Diuretic

D) Angiotensin II Receptor Blocker

E) Lifestyle advice only

A

B

3
Q

A 29 year old male comes into A&E with an acute onset central chest pain in the past 3 hours. The pain does not radiate. He reports recently feeling febrile over the past few days and is short of breath. You examine his fingers and notice arachnodactyly. You are then told by the nurse who took his obs that is bothe tachypnoeic and tachycardic. His chest pain is relieved slightly on sitting forward. His ECG show below what is the likely diagnosis?

A) Anterio MI

B) Cardiac Tamponade

C) Pulonary embolism

D) Pericarditis

E) Pneumothorax

A

D (sitting forward)

Differential is pancreatitis

saddle shaped ST elevation.

4
Q

A 54 year old male is brought int A&E due to a ‘tearing’ chest pain that radiates through to his back. He has previously been diagnosed with Mardan’s syndrome. On examination he has radifemoral delay, increased systolic blood pressure, a systolic murmur and cold feet. What is the diagnosis?

A) Aortic dissection

B) Pulmonary embolism

C) Myocardial infarction

D) Fractured Left 5th Rib

E) Cardiac tampnade

A

A

  • Marfans radiates to back all signs. Riodfemeral delay= aortic dissection. Hypertension is the most important risk factor.
5
Q

You are assessing a patient who is said to have a new murmur that has developed after being diagnosed with infective endocarditis. She is complaining of symptoms of dyspnoea and fatigue. On assessment, it is louder on expiration and radiates to the axilla. there is a soft S1 and split 2. Given the type fo valvular problem, which chamber of the heart is likely to have the largest % increase in size on CXR?

A) Left atrium
B) Right atrium
C) Left ventricle
D) Right ventricle
E) None of them would be any larger

A

C

6
Q

A 50 year old male comes into your clinic for a medication review as he is on beta blockers. His ECG is shown below, what is the diagnosis.

A) Mobitz I (wenckeback)
B) Mobitz II
C) 1st degree AV block
D) 3rd degree AV block
E) WPQ syndrome

A

A

7
Q

Which medical traid best describes the symtoms of cardiac tamponade?

A) Charcot’s Triad: RUQ pain, fever, jaundice
B) Beck’s traid: Raised JVP, hypotension, muffled heart sounds
C) Tachycardia, tachypnoea, tender heptaomegaly
D) Virchow’s traid: Stasis, hypercoagulopathy, vessel injury
E) Chest pain, heart failure syncope

A

B- Right answer

A- Ascending Cholangitis

C- Congestive Heart Failure

D- Decrease coagulation

C- Aortic stenosis - syncope is classic symptom

8
Q

A 2- month old baby boy is brough into your cardiology paediatric clinic due to his month complainig of the child not gainig weight and having sudden cyanotic spells after feeds. On CXR the heart looks boots shaped. What is the congenital deformity this child has?

A) Transposition of the great arteries
B) Tricuspid atresia
C) Tetralogy of Fallot- TOF
D) Patent foramen ovale- PFO
E) Eisenmenger syndrome

A

C- suddent cyanotic spells( child goes really blue). Heart looking like a boot shape. Often picked up in first two months of life

9
Q

A 26 year old man presents to his cardiologist for exercise intolerance and blue discolouration of the lips and fingernails. He aslo reports occasionally coughing up blood. He reports having being diagnosed with a congential heart defect when he was young but was lost to follow up after moving cities. A doppler echocardiagram shows a ventricular septal defect, right ventricular hypertrophy and elevated pulmonary vascular resistance. What is the diagnosis?

A) Tetraolgy of Fallot
B) Eisenmenger syndrome
C) Pulmonary valve stenosis
D) Transposition of the great arteries
E) Generalised atherosclerosis of the vessels causing increased PVR

A

B- congenital heart defect when he was younger, ventricular hypertrophy

10
Q

A 65 year old male presents with dyspnoea which worsens when falling asleep. He has a raised JVP, bibasal coarse crepitations, dull percussion notes and is tachycardic. On peripheral examination he has pitting oedema up to his knees and a capillary refill of 3 seconds. Given the diagnosis, which blood test is most likely to be raised?

A) Ferritin
B) Sodium (hypernatremia)
C) BNP>50pg/ml
D) BNP>100pg/ml
E) Troponin T

A

D- Greater than 100 suggest HF. Cap refill is raised. Worsens when falling asleep is orthopnoea (sleep with a few pillows)

11
Q

A 43 year old male presents to A&E feeling increasing short of breath and is experiencing both chest pain and palpitations, onset 6 hours ago. On cardiac auscultation you hear a quiet S1 and a normal S2. his pulse feels weak, so you decided to carry out an ECG which shpws a lack of Pwaves and an irregulrly irregular pulse, His other observations are all normal and he has no PMH of structural heart disease. Given the diagnosis, what is the best management?

A) 3 weeks anticogulation- then pharmocological cardioversion
B) Propanolol
C) Diltiazem
D) Digoxin
E) Flecainide

A

E

BCD are all rate control methods

12
Q

Shubhi is a 54 year old woman with a known history of HTN, hyperlipidemia, 25-pack year smoking history. She’s complaining of SOB, retrosternal chest pain that radiates to the neck, jaw and left arm. It is episodic and only comes on when riding her bike. It is relieved once she rests.

What is it?

A

STABLE ANGINA

13
Q

Swarna, cardiosoc sec, is a 120 yo woman, with a known history of HTN,DM, hyperlipidemia. She complains of central crushing chest pain radiating to the left arm with associated epigastric pain. She has been short of breath, sweaty and lightheaded for 30 mins. Her BP is 80/60 and HR is 45 bpm.

ECG reveals ST elevation in leads II,III, aVF

What is it? Where? Which artery?

A

STEMI, inferior, RCA

14
Q
A

B) v2 v3 v4

15
Q
A

Lateral MI

16
Q

Identify STEMI

A
17
Q

Investigation for ACS

A

MONA

Morphine. Oxygen, Aspirin, Nitrates

18
Q

Chronic management for ACS

A
19
Q

When do inpatients need coronary intervention ?

A
20
Q

Extended matching items: Which of the above events coincides with:

  • The opening of the AV VALVES
  • The third heart sounds
  • The second heart sounds
  • The PQ interval on the ECG
    a) Peak of flow from the ventricles t the main vessels
    b) Beginning of isometric relaxation
    c) Atrial contraction
    d) During Rapid ventricular filling
    e) End of Isometric Contraction
    f) End of isometric Relaxation
A

F, D, B, C

21
Q
A

Mitral

regurgitation

22
Q
A

Mitral stenosis

23
Q
  • A 59-year-old man presented to the emergency department with chest and back pain and syncope. A chest x-ray revealed a widened mediastinum, and a diagnosis of aortic dissection was confirmed
  • A scan of the heart showed dilation in the part of the aorta where the coronary arteries arose.
  • On auscultation an early diastolic murmur was heard that was getting progressively quieter. Murmur is louder on expiration.

1) What is the valve abnormality?
2) What abnormality would you find with the pulse?
3) Where would you ausculate to hear the murmur?

A
  1. Aortic regurgitation
  2. Water hammer, bounding pulse
  3. 2nd ICS, Right sternal border
24
Q
A

Mitral stenosis

25
Q

•A 57-year-old male is referred to the cardiology clinic with mild dyspnoea. He has a background medical history of hypertension, hypercholesterolemia, type two diabetes mellitus, and he has recently been diagnosed with a metastatic carcinoid tumour.

On examination, he has a harsh mid-ejection systolic murmur that is loudest on inspiration.

What is the most likely diagnosis?

Aortic regurgitation

  • Aortic stenosis
  • Mitral stenosis
  • Pulmonary stenosis
  • Tricuspid regurgitation
A

•Pulmonary stenosis

26
Q

•A 22-year-old intravenous drug user is found to have a femoral abscess. The nursing staff contact the on call doctor as the patient has a temperature of 39oC. He is found to have a pan systolic murmur loudest at the left sternal edge at the 4th intercostal space.

A

Tricuspid regurgitation

27
Q
  • Which of these could be an opening snap that becomes louder with inspiration?
  • 1) Mitral stenosis
  • 2)tricuspid stenosis
  • 3)aortic stenosis
  • 4)pulmonary stenosis
A

•2)tricuspid stenosis

28
Q
A

Aortic stenosis

29
Q

A patient with HF has been ordered to reduce her sodium intake in order to better control her condition. Which best explains why reduction in sodium intake affects symptoms of HF?

A.Increased Na intake damages the heart valve and affects circulation

B.Too much Na has been shown to cause sodium dysrhythmias

C.Increased dietary Na leads to greater risk of atherosclerosis

D.Too much sodium intake is associated with fluid retention

A

D.Too much sodium intake is associated with fluid retention

30
Q

One of the most common causes of Heart Failure?

A.Sinus bradycardia

B.Myocarditis

C.Prior Myocardial Infarction

D.Cardiomyopathy

A

C.Prior Myocardial Infarction

31
Q

Which type of cardiomyopathy is most likely to cause systolic HF?

A.Dilated Cardiomyopathy

B.Restrictive Cardiomyopathy

C.Hypertrophic Cardiomyopathy

D.Takasubo Cardiomyopathy

A

A.Dilated Cardiomyopathy

32
Q

What heart sound is usually heard in congestive heart failure?

A.S4

B.S3

C.Bifid Pulse

D.Delayed S1

E.Split S2

A

B.S3

33
Q

Which of the following is a sign of Right Sided HF?

A.PND

B.Cough and Dyspnea

C.Hepatomegaly

D.Anemia

A

C.Hepatomegaly

34
Q

Wolff-Parkinson White is associated with what Cardiomyopathy?

A.Dilated Cardiomyopathy

B.Restrictive Cardiomyopathy

C.Hypertrophic Cardiomyopathy

D.Takasubo Cardiomyopathy

A

C.Hypertrophic Cardiomyopathy

35
Q
  • A 72 year old male presents to the A&E with a 2 hour history of tearing chest pain radiating to the back. He has a history of hypertension. Observations show: (RR- 21 breaths/min, Pulse: 93bpm, Temp- 37.2, BP- 174/146mmHg, Oxygen sats- 96% on RA). Auscultation of the heart identifies a diastolic murmur , heard loudest over the 2nd intercostal space, right sternal border. Which of the following CT angiography findings would result from this patient’s likely diagnosis:
  • Ballooning of the aortic arch
  • Blurring of the posterior wall of the design aorta
  • False lumen of the ascending aorta
  • Total occlusion of the LAD
  • Thrombus in Right PA
A

•False lumen of the ascending aorta

36
Q
  • 28 year old male presenting to the A&E with severe, acute onset chest pain relieved by sitting up and worsened on inspiration. The patient had an MI 2 days ago and is on observations on the ward. Which one of the following ECG traces is most likely expected?
  • ST elevation in chest leads
  • Wide-spread ST depression
  • QT prolongation
  • U waves
  • PR depression and saddle shaped QRS
A

•PR depression and saddle shaped QRS

37
Q
  • Which of the following is not a criteria listed in the PE wells score?
  • Contraceptive use
  • Immobilisation for > 3 days
  • Unilateral leg swelling
  • Previous DVT/PE
  • Malignancy
A

•Contraceptive use

38
Q
A