UNDF - Cardiovascular

Question 1

What are the possible presenting symptoms of pericarditis?

• a. Chest pain worse on exertion
• b. Crushing chest pain worse on inspiration
• c. Pleuritic chest pain worse on lying flat
• d. Pleuritic chest pain worse on leaning forward
• e. Pleuritic chest pain worse on movement

Answer 1

What are the possible presenting symptoms of pericarditis?

• a. Chest pain worse on exertion
• b. Crushing chest pain worse on inspiration
• c. Pleuritic chest pain worse on lying flat
• d. Pleuritic chest pain worse on leaning forward
• e. Pleuritic chest pain worse on movement

Question 2

An 80 year old man with long standing diabetes and systemic hypertension dies of congestive heart failure. The luminal surface of that abdominal aorta is shown:

Which pathological change would be expected to be seen on microscopic examination?

• a. Acute inflammation of the vessel wall
• b. Bacterial colonies in the vessel wall
• c. Cystic medial necrosis
• d. Lipid deposition and smooth muscle hyperplasia
• e. Obliterative end arteritis of the vasa vasorum

Answer 2

= d. Lipid deposition and smooth muscle hyperplasia

Question 3

What is the highest risk factor for developing infective endocarditis (IE)?

• a. Intravenous drug use
• b. Mitral valve prolapse with regurgitation
• c. Prosthetic heart valve
• d. Recent dental procedure
• e. Rheumatic fever without valvular defects

Answer 3

What is the highest risk factor for developing infective endocarditis (IE)?

• a. Intravenous drug use
• b. Mitral valve prolapse with regurgitation
• c. Prosthetic heart valve
• d. Recent dental procedure
• e. Rheumatic fever without valvular defects

Question 4

A 50 year old male presents with fever, malaise and polyarthralgia. He had rheumatic fever as a child and subsequently developed rheumatic heart disease. A few weeks ago he had a dental procedure. What is the most likely organism involved?

Answer 4

= E. Viridans streptococi

Question 5

A patient presents with fever, pleuritic chest pain and painful swollen joints. He is noted to have a cardiac murmur and uncontrolled spontaneous movements of his limbs. What is the most likely diagnosis?

• a. Acute rheumatic fever
• b. Atypical pneumonia
• c. Infective endocarditis
• d. Rheumatic heart disease
• e. Rheumatoid arthritis

Answer 5

A patient presents with fever, pleuritic chest pain and painful swollen joints. He is noted to have a cardiac murmur and uncontrolled spontaneous movements of his limbs. What is the most likely diagnosis?

• a. Acute rheumatic fever
• b. Atypical pneumonia
• c. Infective endocarditis
• d. Rheumatic heart disease
• e. Rheumatoid arthritis

Question 6

• a. Enterococcus fecalis
• b. Pseudomona aeruginosa
• c. Staphylococcus aureus
• d. Staphylococcus epidermidis
• e. Viridans streptococci

Answer 6

= c. Staphylococcus aureus

Question 7

• a. Buerger disease
• b. Churg-Strauss disease
• c. Kawasaki disease
• d. Polyarteritis nodosa
• e. Takayasu arteritis

Answer 7

= a. Buerger disease

Question 8

A 68-year-old female with a history of diabetes mellitus expires suddenly of cardiac arrest. The patient suffered a massive anterior myocardial infarction one year earlier. the heart autopsy is shown:

What is the most likely cause of this condition?

• a. Aortic stenosis
• b. Coronary artery aneurysm
• c. Hypertrophic cardiomyopathy
• d. Pulmonary embolism
• e. Stroke

Answer 8

= E. Stroke

Question 9

What is the approximate heart rate as indicated by the ECG trace (25mm/s) shown?

• a. 60 bpm
• b. 70 bpm
• c. 90 bpm
• d. 120 bpm
• e. 140 bpm

Answer 9

= e. 140 bpm

Question 10

A 78 year old male with a history of recurrent syncope undergoes surgery for aortic valve disease. A hard, markedly deformed valve is shown:

What is the most likely diagnosis?

• a. Bacterial endocarditis
• b. Bicuspid aortic valve
• c. Calcified aortic stenosis
• d. Marantic endocarditis
• e. Syphillitic aortitis

Answer 10

= c. Calcified aortic stenosis

Question 11

What rhythm is displayed on the ECG shown?

• a. Atrial flutter
• b. Atrial fibrillation
• c. Sinus tachycardia
• d. Ventricular fibrillation
• e. Ventricular tachycardia

Answer 11

= b. Atrial fibrillation

Question 12

What rhythm is displayed on the ECG shown?

• a. Atrial flutter
• b. Atrial fibrillation
• c. Sinus tachycardia
• d. Ventricular fibrillation
• e. Ventricular tachycardia

Answer 12

= a. Atrial flutter

(sawtooth appearance)

Question 13

Answer 13

= E. Ventricular tachycardia

Question 14

What rhythm is displayed on the ECG shown?

• a. Atrial flutter
• b. Atrial fibrillation
• c. Sinus tachycardia
• d. Ventricular fibrillation
• e. Ventricular tachycardia

Answer 14

= c. Sinus tachycardia

Question 15

Answer 15

Question 16

What is the most common source of Group A Streptococcus (GAS) infection leading to rheumatic fever in Australia?

Answer 16

= Pyoderma (GAS skin infection) (PPH 1 mark)

Question 17

What would be the effect of sensitivity and specificity of the Jones criteria as a diagnostic test for ARF if the number of major manifestations required to make a diagnosis is increased?

(1 mark)

Answer 17

Sensitivity would decrease, and Specifitiy would increase.

(PPH Total 1 mark)

Question 18

List two populations in which the positive predictive value of the Jones criteria is higher than in the general Australian population.

(2 marks)

Answer 18

1. Australian Aboriginal people
2. Indigenous people in New Zealand and Pacific Islands people
3. People who have had a previous diagnosis of ARF
4. People living in over-crowded conditions
5. People from countries where ARF is common ie. low and middle-income countries in Asia, Africa, South America

(1 mark each to a maximum of 2 marks, PPH Total 2 marks)

Question 19

Which intervention is most affective in preventing children who have had ARF from developing rheumatic heart disease?

Answer 19

Monthly long-acting penicillin (or benzathine penicillin) prophylaxis.

(PPH 1 mark)

Question 20

What would be the best study type to establish what proportion of children who need this intervention are actually receiving it?

Answer 20

Case series

(PPH 0.5 marks)

Question 21

What would be the best study type to establish the reasons why children who need this intervention are or are not receiving it?

Answer 21

A qualitative study

(PPH 0.5 marks)

Question 22

A middle aged man with hypercholesterolaemia, and who has smoked all of his life presents to the emergency department with crushing retrosternal chest pain. His ECG is shown:

What is the diagnosis? Which part of the heart has been compromised? Which artery is most likely to have been occluded?

Answer 22

Question 23

He is treated with the tissue plasminogen activator (tPA).

Describe the mechanism of action of this agent and how it might assist this patient. List two contraindications to prescribing tPA.

Answer 23

Question 24

On the diagram, identify the structures labelled a through C.

List the contents of A.

List the contents of B.

Answer 24

• A - Fibrous cap - Contents:
  
  1. Collagen
  2. Elastin
  3. (Macrophages, smooth muscle cells, foam cells, lymphocytes)
• B - Necrotic/lipid centre/core - Contents:
  
  1. Foam cells
  2. Macrophages
  3. Debris
  4. Cholesterol
• C - Tunica media

(0.5 marks for each to max 1.5 marks BCS)

Question 25

Answer 25

Question 26

In what ways does challenging patient behaviour influence medical care approach? (4 marks)

Answer 26

* Modern medicine has recognised and highlighted the challenges and worked on communication skills (1 mark) through more structured approaches and developed tools and processes (0.5 marks) to give us insight and better set of skills to handle doctor/patient relationship in a positive way for better outcomes. (Max 1.5 marks) * Examples of new advancements: 1. Use of Motivational interviewing skills 2. Being empathetic 3. Non-judgemental approach without stigmatising patient's behaviour and attitudes. 4. Avoid stereotyping patients 5. Be mindful of own reactions to patients emotions 6. Avoid threatening or manipulating patient's behaviours 7. Doctor's awareness that frustration can affect decision making (0.5 marks each up to 2.5 marks, PPD total 4 marks)

Question 27

In simple terms, what are the key ingredients of a ‘claim of negligence’? (4 marks)

Answer 27

* There must be a breach of duty of care by the defendant / tortfeasor owed to another person the plaintiff (1 mark). * Breach of duty of care causes harm or injury to the plaintiff (1 mark). * Behaviour of the defendant fell below the standard of card (1 mark). * The harm was not too remote from the breach (0.5 mark). * There are no legal excuses (defenses) to excuse the defendant's behaviour (0.5 marks).