Cardiology

Question 1

AF on auscultation

Answer 1

Variable S1

Question 2

When to check for R-F delay

Answer 2

Young patient with hypertension to check for coarctation as secondary cause

Question 3

Wide pulse pressure (>60mmHg)

Answer 3

Collapsing pulse suggesting AR

Question 4

Anaemia in metallic valves

Answer 4

Haemolysis

Question 5

Malar flush murmur

Answer 5

MS

Pulmonary hypertension

Question 6

Pulsatile ear

Answer 6

Pulsatile V wave in keeping with TR

Question 7

Slow rising pulse
Slow volume
Plateau

Answer 7

AS

Question 8

Bisferiens carotid pulse

Answer 8

Mild aortic stenosis plus reflux

Question 9

Collapsing carotid pulse

Answer 9

AR

Question 10

Jerky pulse

Answer 10

HOCM

Question 11

Most downward lateral beat

Answer 11

Apex beat

Question 12

Heaving/pressure loaded apex beat

Answer 12

LVH

AS

Question 13

Apex beat mitral stenosis

Answer 13

Tapping

Question 14

MI apex beat

Answer 14

Dyskinetic

Question 15

Volume loaded apex beat

Answer 15

Mitral regurgitation

Question 16

Loud S1

Answer 16

MS

Question 17

Soft S2

Answer 17

MR

Question 18

Loud P2

Answer 18

Pulmonary HTN

Question 19

Soft A2

Answer 19

AR

Question 20

S3

Answer 20

Dilated LV

MR

Question 21

S4

Answer 21

Hypertrophic LC
HTN
AS
HOCM

Question 22

Hand grip

Answer 22

MS

Question 23

ASD murmur

Answer 23

Soft ESM and fixed splitting of s2

Question 24

Aetiology of PRIMARY MR

Answer 24

Degenerative - myxomatosis degeneration, MV prolapse
IE
Rheumatic disease
Congenital

Question 25

Aetiology secondary MR

Answer 25

Papillary muscle ischaemia

Functional 2ry to LV dilatation

Question 26

Signs of MR severity

Answer 26

Soft S1 
Split s2
Pulmonary HTN 
LVF
Small pulse volume 
Early diastolic rumble

Question 27

MR Apex beat

Answer 27

Displaced and dyskinetic

Question 28

Indications for MR surgery

Answer 28

Symptomatic NYHA III/IV with primary severe MR and LV >30%

Asymptomatic with primary severe MR and LV 30-60 or LVESD >40

Limited evidence for valve replacement for secondary MR

Transcatheter repair for bad surgical candidates

Question 29

Mitral valve prolapse exam

Answer 29

Mid or late Systolic click murmur

Heard at apex

Question 30

Mitral stenosis aetiology

Answer 30

Rheumatic

Congenital (rare)

Question 31

MS valve areas

Answer 31

Normal 4-6
MS - 2cm
Severe - 1.5

Question 32

MS exam

Answer 32

AF
malar flush 
Prominent A wave of JVP
Tapping apex beat
Palpable s1
RVH
accentuated/snapping s1
Mid diastolic rumbling murmur

Question 33

MS signs of severity

Answer 33

Small pulse pressure
Long diastolic murmur
Apical diastolic thrill

Question 34

Indication for MS surgery

Answer 34

Balloon - severe MS MVA <1.5cm and symptomatic and favourable anatomy

Surgery- failed balloon

Question 35

AS signs of severity

Answer 35

Small volume plateau pulse 
Aortic thrill 
Length and lateness of the murmur 
Loudness grade 4
S4 
LVF 
Pressure loaded apex beat

Question 36

AS severe criteria

Answer 36

Gradient >40mmhg
VMax >4m/a
Valve area <1cm

Question 37

Aetiology AS

Answer 37

Degenerative
Bicuspid
Rheumatic

Question 38

Indication for AS intervention

Answer 38

Severe high gradient with symptoms on hx or exercise

Asymptomatic with severe AS and LVEF <50%

Severe AS undergoing cardiac surgery

TAVI for poor surgical candidates

Question 39

AR aetiology

Answer 39

Valve disease

• rheumatic
• congenital with VSD
• endocarditis

Aortic root

• dissection
• Ank spond
• marfans
• syphilis

Question 40

AR exam severe

Answer 40

Water hammer pulse 
Wide pulse pressure 
S3
Decrescendo diastolic murmur 
Austin flint 
LVF 

Femoral artery pistol shot murmur
Displaced apex beat

Question 41

AVR indications

Answer 41

Symptomatic severe AR regardless LVEF

Asymptomatic severe AR EF <50%