Cardioresp

Question 1

Describe the kind of murmur heard in aortic stenosis

Answer 1

Crescendo decrescendo (diamond)
Systolic murmur

Question 2

Describe the murmur heard in aortic regurgitation and where best to auscultate for this

Answer 2

Diastolic murmur

Left seternal border

Question 3

Describe the diagnostic findings of tension pneumothorax on CT and X-ray

Answer 3

Visceral pleural line visible

Question 4

Describe the system used to assess need for hospitalisation in CAP

Answer 4

CRB-65

New mental confusion
Respiratory rate >30
Blood pressure <90 systolic
Age >65

Question 5

Likely diagnoses of a patient presenting with central chest pain, fever, high pitched squeaky ‘rub’ heard at the left sternal edge and ST segment changes on ECG

Answer 5

• Pericarditis (upward conceived ST segment elevation with PR depression)
• STEMI

Question 6

Discuss the components of dual anti-platelet therapy and use in ACS

Answer 6

• Aspirin 300mg and clopidogrel or ticagrelor or prasugrel

- NSTEMI

Question 7

Which genetic disorder should be tested for in a younger patient presenting with signs and investigations positive for COPD

Answer 7

Alpha-1 Antitrypsin deficiency

Question 8

How to differentiate a pleural effusion from pulmonary oedema

Answer 8

Effusion —>
Stony dull to percussion
Reduced tactile vocal fremetus
Reduced breath sounds on auscultation

Question 9

What is Wolff Parkinson white syndrome

Answer 9

Supraventricular tachycardia caused by an accessory pathway

Question 10

Possible causes of an ejection systolic murmur

Answer 10

• Aortic stenosis
• Pulmonary stenosis
• Atrial septal defect, tetralogy of Fallot

Question 11

Management of acute supravebtricular tachycardia

Answer 11

If patient is compromised DC cardioversion

Otherwise

1) Vagal manoeuvres
2) IV adenosine

Question 12

Management of acute AF

Answer 12

If patient is showing adverse signs (shock, myocardial Ischaemia chest pain or ECG changes syncope and heart failure) DC cardioversion and amiodarone if unsuccessful

Question 13

Occlusion of the right coronary artery causing an inferior MI may lead to bradycardia, true or false

Answer 13

True

As the right coronary artery supplies the SAN node

Question 14

What is the standard therapy for treating active TB

Answer 14

Initial phase

• Rifampicin
• Isoniazid
• Pyrazinamide
• Ethambutol

continuation
- Rifampicin
Isoniazid

Question 15

Most common cause of community acquired pneumonia?

Answer 15

Strep. pneumoniae

Question 16

Which organism is likely responsible for a pneumonia with haemolytic anaemia and erythema multiform

Answer 16

Mycoplasma pneumoniae

Question 17

Suggest a suitable mask to administer oxygen for a critically ill patient in shock who is hypoxic

Answer 17

15 L/min reservoir mask

Target stats of 94-98%

Question 18

Likely diagnosis for patient with chest pain and a raised JVP on inspiration

Answer 18

constrictive pericarditis

Kussmaul’s sign

Question 19

Discuss diagnostic values of spirometry for asthma

Answer 19

FEV1/FVC <80% (20% drop in FEV1)

and

12% and 200mL reversibility of FEV1 following bronchodilator

Question 20

What is the 3rd stage in the management of inadequate asthma control

Answer 20

Addition of LABA e.g salmetrol (BTS)

Addition of LTRA (NICE)

Question 21

Pathophysiological process of pulmonary hypertension in COPD

Answer 21

Hypoxic pulmonary vasoconstriction –> narrowing of pulmonary vasculature and fibrosis –> right sided heart failure

Question 22

What happens to the DLCO/TLCO in interstitial lung disease

Answer 22

decreased transfer factor

Question 23

Common causative agent of hospital acquired pneumonia

Answer 23

gram negative
S. Aureus
S. pneumonia
anaerobes

Question 24

Definition of hospital acquired pneumonia

Answer 24

24hrs after hospital admission, or within 7 days of discharge

Question 25

Typical causative pathogen of cavitating multifocal consolidation pneumonia

Answer 25

S. Aureus

Question 26

Common causative agent of pneumonia in COPD patients

Answer 26

Haemophilius Influenzae

Question 27

Pneumonia associated with haemolytic anaemia and erythema multiform

Answer 27

Mycoplasma Pneumoniae

Question 28

Risk factors for TB

Answer 28

HIV/AIDS Poverty and overcrowding immunosuppression Heavy alcohol consumption

Question 29

Suggest possible causes for a pleural effusion with raised LDH and protein levels

Answer 29

Infective Inflammatory causes - RA/SLE, pancreatitis Dressler's syndrome Neoplasm

Question 30

Discuss cause of bifid P waves on ECG

Answer 30

P mitrale caused by left atrial enlargement due to mitral valve disease

Question 31

Features of mitral stenosis

Answer 31

``` Hx of rheumatic heart disease AF Malar Flush Mid-diastolic murmur (low pitched) Features of pulmonary hypertension ```

Question 32

Examination findings of the patient with aortic stenosis

Answer 32

- Ejection systolic murmur, crescendo decrescendo which radiates to carotids - Slow rising pulse - Heaving apex beat - Systolic thrill

Question 33

Commonly seen pathogen in bronchiectasis infective flare

Answer 33

pseudomonas aerginosa

Question 34

Common causative pathogen in atypical pneumonia, spread by domesticated and exotic birds

Answer 34

Chlamydia psttaci

Question 35

Causes of preserved ejection fraction HF (diastolic)

Answer 35

Chronic hypertension leading to —> Ventricular Hypertrophy Stiffened muscle -fibrotic scar tissue Aortic stenosis Cardiomyopathies, hypertrophic and restrictive

Question 36

In a patient with pneumonia, dry cough and atypical chest signs, hyponatraemia and lymphopenia is most associated with which organism?

Answer 36

Legionella pneumoniae

Question 37

In a patient with pneumonia, high fever, rapid onset and herpes labialis is most associated with which organism?

Answer 37

Strep. p

Question 38

State the paraneoplastic features associated with small cell lung cancer

Answer 38

ADH ACTH - Cushing's Lambert-Eaton syndrome

Question 39

State the paraneoplastic features of squamous cell lung cancer

Answer 39

- PTH-rp causing hypercalacaemia - Hypertrophic pulmonary osteoarthropathy - Hyperthyroidism due to ectopic TSH

Question 40

A 70-year-old woman is found to have a pan-systolic murmur after presenting with dyspnoea. A soft S1 and split S2 is also noted

Answer 40

mitral regurgitation

Question 41

Progressive prolongation of the PR interval until a dropped beat occurs -

Answer 41

second degree heart block (Mobitz type I or Wenkebach)

Question 42

Which valvular heart disease results in an S4 heart sound

Answer 42

Aortic stenosis

Question 43

Causes of transudative pleural effusions

Answer 43

``` Congestive Heart Failure (CHF) Hepatic cirrhosis Hypoproteinemia Nephrotic syndrome Acute atelectasis Myxedema Peritoneal dialysis Meig's syndrome Obstructive uropathy ```

Question 44

Which valvular heart disease may be associated with polycystic kidney disease

Answer 44

Mitral valve prolapse

Question 45

Post MI complication associated with acute onset HF and pan systolic murmur

Answer 45

Ventricular septal defect