BMJ one examination - clinical

Question 1

Post-birth when can you fly

Answer 1

2-3 days

Question 2

MI + thrombolysis when can they fly

Answer 2

7-10 days

Question 3

Fasting cholesterol concentration

Answer 3

<4mmol for total cholesterol
<2mmol for LDL

Question 4

fasting blood glucose indicative of diabetes

Answer 4

> 7mmol (risk factor for ischaemic heart disease)

Question 5

cholesterol level to be at risk of ischaemic heart disease

Answer 5

> 6mmol

Question 6

reduce wave amplitude
ST segment depression
increased U wave amplitude
shortened QT interval

Answer 6

digoxin effect

Question 7

72Y M five episodes of brief LOC, CT head and EEG normal, what investigation next?

Answer 7

24 hour ECG recording

Question 8

56y smoker 1 hour episode of slurred speech yesterday (already had CT scan yesterday), what investigation now?

Answer 8

Lipid profile

Question 9

16y F collapses after long time standing, investigations

Answer 9

No more - most likely vasovagal

Question 10

pleural rub indicates what condition?

Answer 10

PE

Question 11

70y M SOB over last 2 months, made worse when lies down, aortic murmur and basal crackles

Answer 11

Left ventricular failure

Question 12

58y M admitted unconscious, BP 230/190, papilloedema and LV hypertrophy. Diagnosis?

Answer 12

Hepatic encephalopathy (as unconscious)

Question 13

65y M chronic bronchitis, raised JVP, hepatomegaly, ankle and sacral oedema. Which side heart failure?

Answer 13

Right ventricular failure

Question 14

55y M carcinoid syndrome, diarrhoea, rash, memory problems. Diagnosis?

Answer 14

Pellagra

Question 15

72y F background of IBD and poor healing wounds. Diagnosis?

Answer 15

Zinc deficiency
common in Crohn’s disease

Question 16

62y F primary hypothyroidism, fatigue and breathlessness. Jaundice and pale conjunctivae. Diagnosis?

Answer 16

Pernicious anaemia

Question 17

54y M alcoholic weight loss, right hypochondriac discomfort and deteriorating ascites. Best test?

Answer 17

AFP - hepatocellular carcinoma

Question 18

72y M weight loss and back pain. Osteoslerotic lesions. Best test?

Answer 18

PSA

Question 19

83y M discomfort in left leg. Widening of left tibia with curvature. Best test?

Answer 19

ALP. - pagets disease

Question 20

Avoid in the treatment of patients with recurrent hypoglycaemia?

Answer 20

Atenolol - mask awareness of hypoglycaemia

Question 21

An agent that reduces cardiovascular risk in patients with high HDL-C levels?

Answer 21

Gemfibrozil

Question 22

65y M hx of peptic ulceration and strong family history of ischaemic heart disease. Corneal arcus. Best medication?

Answer 22

clopidogrel

Question 23

apex beat in sixth intercostal space lateral to mid clavicular line, forceful in nature and associated with a triple apex beat

Answer 23

HOCM

Question 24

apex beat in with intercostal space, mid clavicular line, associated with thrill over fourth intercostal space to left of sternum

Answer 24

VSD

Question 25

57y F pain and paraesthesia of right lower limb. AF no claudication. Pale and cold limb, no sponanteous movement and pulses are absent.

Answer 25

Femoral embolus

Question 26

84yM severe calf pain limiting mobility to 10 yards. Areas of skin breakdown over tips of first and second toes and over heels.

Answer 26

Critical ischaemia (persistent rest pain for a minimum of two weeks, alteration and gangrene)

Question 27

65y F 6 weeks post MI with deteriorating SOB and relatively recent onset. O/e first soft heart sound followed by mid systolic murmur which is loudest at apex and in expiration.

Answer 27

Mitral regurgitation

Question 28

55y M 6 weeks post MI, fatigue and fever. Soft systolic sound over left fourth intercostal space louder on leaning forward.

Answer 28

Pericardial rub - Dressler's syndrome

Question 29

72y M severe SOB orthopnoea and Paroxysmal nocturnal dyspnoea. Most likely pulse?

Answer 29

pulses alternans

Question 30

33y F severe asthma. Most likely pulse?

Answer 30

Pulsus paradoxus

Question 31

Early diastolic murmur louder in expiration

Answer 31

collapsing pulse

Question 32

5 y F with ejection systolic murmur radiating between scapulae and radio femoral delay has unusual facial appearance.

Answer 32

Turner's syndrome

Question 33

72y F breathless post hip replacement, fourth heart sound and raised JVP?

Answer 33

Acute PE

Question 34

7y M HR 90, 2/6 ejection systolic murmur, URTI

Answer 34

normal heart

Question 35

25y F obese 3 month hx of SOB on exertion, central cyanosis, parasternal lift and loud pulmonary second sound, no cardiac murmurs

Answer 35

Primary pulmonary hypertension

Question 36

51 M abdominal pain, flushing and diarrhoea. Elevated venous pressure, prominent pulsation, enlarged liver with edge 6cm below costal margin of right mid-clavicular line, soft systolic murmur

Answer 36

Tricuspid regurgitation - flushing an diarrhoea suggest carcinoid syndrome

Question 37

72y F deteriorating SOV, loud first heart sound and rumbling diastolic murmur

Answer 37

Mitral stenosis

Question 38

36y F high fever, SOB, cough and rusty sputum

Answer 38

Pneumonia

Question 39

54y smoker central chest pain and heavy perspiration

Answer 39

MI

Question 40

44y F chest discomfort when lying down and stooping, overweight

Answer 40

hiatus hernia

Question 41

soft first heart sound - most likely murmur

Answer 41

mitral regurgitation

Question 42

loud first heart sound and opening snap in diastole, most likely murmur

Answer 42

Mitral stenosis

Question 43

17y M recurrent LOC and rpepsyncope, ejection systolic murmur loudest at left lower sternal edge, pathological Q waves in anterior chest leads

Answer 43

HOCM

Question 44

45y F unwell for 1 year. Weakness in left arm now resolved. Fainted while gardening. Finer clubbing, normal pulse, mid diastolic murmur.

Answer 44

Mitral regurgitation

Question 45

77y F triple vessel CAD with poor left ventricular function, aneurysm complicating recent anterior MI. Admitted after blackout.

Answer 45

VT

Question 46

Which diabetes drug is contraindicated in heart failure

Answer 46

Pioglitazone

Question 47

75y M AF after attending round tine medical. ECG shows AF, best medication to give?

Answer 47

warfarin

Question 48

69y M with known angina, chest pain two minutes duration during golf. what medication?

Answer 48

GTN spray

Question 49

55y insulin diabetic with blood pressure high. Blood pressure consistently high. Best medication?

Answer 49

lisinopril - ace inhibitor always in diabetics

Question 50

50y M with asthma and hypertension 180/120. What to give?

Answer 50

lisinopril

Question 51

66y M on atenolol continues to have high blood pressure. Also takes allopurinol. What to give?

Answer 51

Amlodipine (avoid thiazide diuretics) ACE and beta-blocker not recommended together due to non-synergy for hypertension

Question 52

60y M severe headaches, BP 220/140mmHg, papilloedema. What medication?

Answer 52

Sodium nitroprusside

Question 53

41y D CAD sharp pain under right breast followed by chest tightness. Dizziness. Sinus tachycardia. Most likely diagnosis?

Answer 53

hyperventilation

Question 54

64y M sudden pain in between shoulder blades, overweight, sweaty and distressed, TOE shows LVH. Diagnosis?

Answer 54

aortic dissection - severe pain through back, hypertension

Question 55

58y F with 3 week history of central chest pain, T wave inversion in leads, AVL and V3-V6. Cause?

Answer 55

Unstable angina

Question 56

37y M with fever and malaise. Last 12 hours severe left sided chest pain exacerbated by movement on respiration. T wave inversion aVR Cause?

Answer 56

Pleurisy - five day history go malaise, t wave inversion in aVR (non-specific)

Question 57

60y F stroke three years ago increasing SOB, AF, Chest X-ray straight boarder on cardiac silhouette.

Answer 57

Rheumatic mitral stenosis

Question 58

75y F mitral valve replacement 13 years ago recurrent breathlessness, pulsation in her neck, abdominal pain and ankle swelling

Answer 58

Tricuspid regurgitations (JVP, giant V waves, oedema and hepatic congestion)