Cardiology

Question 1

Collapsing pulse

Answer 1

Aortic regurgitation

Question 2

Pulse in cardiac tamponade

Answer 2

Paradoxical

(abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

ALSO occurs in left ventricular compression, constrictive pericarditis or severe asthma

Question 3

Alterans pulse

Answer 3

Severe left ventricular failure

• regular rhythm but with alternating beats which are weak and then strong
• It is found in patients with severe heart failure and suggests a poor prognosis

Question 4

Slow rising pulse

Answer 4

Aortic stenosis

Question 5

Absent pulse

Answer 5

Takayasu’s arteritis

-narrowing of major arteries such as the renal, carotid, subclavian etc

Question 6

A 42 year old man with central chest pain. Movement exacerbated the pain and the anterior chest wall is tender

Answer 6

Tietze’s disease
This is caused by inflammation around the costosternal junctions

It may be bilateral or unilateral and the chest wall is very tender over the affected area.

Question 7

A 67 year old man industrial worker with left sided chest pain and long term pleural plawues

Answer 7

Mesothelioma

Question 8

An obese 42 year old woman with central chest pain going through to her back, which is aggravated by sitting forward. The pain seems to be worse at night and after large meals

Answer 8

GORD

Question 9

P wave

Answer 9

Atrial depolarisation

Question 10

QRS complex

Answer 10

Ventricular depolarisation

Question 11

T wave

Answer 11

Ventricular repolarisation

Question 12

QT interval

Answer 12

Rough indication of the duration of ventricular systole

Question 13

First heart sound coincides with what on the ECG?

Answer 13

QRS complex

Question 14

When does the 2nd heart sound occur on the ECG?

Answer 14

At the same time as the T wave

Question 15

Causes of narrow pulse pressure (<30mmHg)

Answer 15

Tachycardia
Severe Aortic Stenosis
Constrictive Pericarditis
Pericardial Effusion
Ascites

Question 16

Causes of widened pulse pressure (>40mmHg)

Answer 16

Pathophysiology in Isolated Systolic Hypertension
Suggests reduced large artery vascular compliance
Best Blood Pressure marker for cardiovascular risk
Causes
Isolated Systolic Hypertension
Aortic Regurgitation
Thyrotoxicosis
Patent Ductus Arteriosus
Arteriovenous fistula
Beriberi heart
Aortic Coarctation
Anemia
Emotional state

Question 17

Ejection systolic murmurs

Answer 17

Associated with aortic stenosis and are usually harsh, radiating to the neck

Ejection systolic murmurs can occur in severe aortic regurgitation, due to the large stroke volume passing through the aortic valve with each systolic contraction of the left ventricle

Hypertrophic obstructive cardiomyopathy can also cause an ejection systolic murmur

Aortic sclerosis may produce an ejection systolic murmur

Pulmonary stenosis