Cardiology

Question 1

If new onset BP >= 180/120 mmHg in GP setting, whats the next step in management?

Answer 1

Admit for specialist assessment

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Also if:

+ new-onset confusion, chest pain, signs of heart failure, or acute kidney injury then admit for specialist assessment

Question 2

Sore throat, reduced appetite, malaise, weight loss, Nil vomitting, nil bowel change, nil Urinary symptoms, SOB on exertion. O/e, Apical systolic murmer, non tender subcutaneous nodules on the knees and elbows. Most likely diagnosis?

Answer 2

Rheumatic fever

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Also Rule out:

Infective endocarditis

Viral pericarditis

SLE

Rheumatoid Arthritis

Lyme disese

Question 3

Sore throat, reduced appetite, malaise, weight loss, Nil vomitting, nil bowel change, nil Urinary symptoms, SOB on exertion. O/e, Apical systolic murmer, non tender subcutaneous nodules on the knees and elbows. How would you manage?

Answer 3

Urine: Cultures and sensitivity

Bloods: Blood cultures, CRP, ASO titres

Bedside, other: ECG

Imaging: CXR, TTE

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(Rheumatic fever)

Question 4

Sore throat, reduced appetite, malaise, weight loss, Nil vomitting, nil bowel change, nil Urinary symptoms, SOB on exertion. O/e, Apical systolic murmer, non tender subcutaneous nodules on the knees and elbows. How would you manage?

Answer 4

Short term:

Admit and observe

Aspirin

Benzylpenicillin, IM

Long term:

Oral penicillin, 10 days

If severe, consider surgery

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(Rheumatic Fever)

Question 6

Sudden central ‘tearing’ pain, may radiate to the back (may mimic an MI). Most likely diagnosis?

Answer 6

Aortic dissection