Cardiovascular

Question 1

80yo male with past history of heart disease (AMI, aortic stenosis) presents with leg oedema, increased SOB on exertion and orthopnoea

Answer 1

Congestive cardiac failure

Causes: ischaemia, valvular disease, hypertension, congenital, cardiomyopathy, right heart disease

Question 2

60yo male with CVD risk factors has chest discomfort and SOB brought on after 10-15 minutes of exertion that is relieved with rest. Occurs frequently, same every time

Answer 2

Stable angina

Question 3

60yo male with CVD risk factors that has worsening chest discomfort and SOB brought on with exertion. Less exertion required over time to bring on pain. Relieved with rest

Answer 3

Unstable angina

Question 4

60yo male with CVD risk factors presents with 10/10 chest pain radiating to the shoulder and jaw. Associated nausea, sweating and SOB

Answer 4

AMI

Question 5

Apex beat felt in the anterior axillary line, what has happened to the LV?

Answer 5

Left ventricular hypertrophy

Question 6

80yo male presents with a systolic crescendo-decrescendo murmur in the aortic region

Answer 6

Aortic stenosis

Causes: degenerative calcific valve, congenital bicuspid valve, congenital AS, rheumatic fever

Question 7

75yo male with long-standing HTN presents with an early diastolic decrescendo murmur in the aortic region and a widened PP

Answer 7

Aortic regurgitation

Causes:

• Acute: infective endocarditis, Marfan’s syndrome, dissecting aneurysm of aortic root
• Chronic: rheumatic, congenital, long-standing HTN, aortic root dilation (eg/ Marfan’s)

Question 8

50yo female with past history of rheumatic fever presents with a mid-late diastolic murmur over the apex associated with increasing orthopnoea and leg oedema

Answer 8

Mitral stenosis

Causes: rheumatic fever, congenital parachute valve

Question 9

A patient with a history of heart disease presents with a pan-systolic murmur in the apex region and tachypnoea

Answer 9

Mitral regurgitation

Causes:

• Acute: MI, infective endocarditis, trauma/surgery, spontaneous rupture of myxomatous cord
• Chronic: mitral valve prolapse, degenerative, rheumatic fever, papillary muscle dysfunction, cardiomyopathy, connective tissue disease, congenital

Question 10

77yo male with left heart failure presents with a new onset pansystolic murmur in the left lower sternal edge. Associated with this is a pulsatile liver and raised JVP

Answer 10

Tricuspid regurgitation

Causes: RVF, rheumatic, IE, valve prolapse, papillary muscle infarction, trauma, congenital

Question 11

11yo female from a developed country presents with a fever, arthralgia affecting large joints and a rash following a sore throat. On examination a murmur is heard

Answer 11

Acute rheumatic fever

Question 12

40yo male presents with increasing dyspnoea and episodes of syncope. On examination, the LV is enlarged, he has a murmur consistent with mitral regurgitation and an audible S4

Answer 12

Hypertrophic cardiomyopathy

Question 13

35yo presents with signs of left ventricular failure as well as mitral and tricuspid regurgitation

Answer 13

Dilated cardiomyopathy

Question 14

66yo presents with intermittent palpitations, these are described as fast and irregular. On ECG, no p waves are seen

Answer 14

AF

Question 15

Patient presents with occasional palpitations. These are sudden onset, occur at rest, regular and fast. Palpitations either resolve suddenly or by vasovagal maneouvres

Answer 15

SVT

Question 16

55yo male with a family history of sudden cardiac death presents acutely unwell with hypertension, tachycardia and chest discomfort. ECG shows wide complex tachycardia

Answer 16

VT

Question 17

ECG shows fixed prolongation of PR interval (>0.2s) with no failure of AV conduction

Answer 17

1st degree conduction block

Question 18

ECG shows progressive prolongation of PR interval with eventual loss of AV conduction for 1 beat

Answer 18

Second degree (I) conduction block

Question 19

ECG shows fixed, unchanging PR intervals with occasional loss of AV conduction for 1 beat

Answer 19

Second degree (II) conduction block

Question 20

ECG shows complete, persistent loss of conduction from the atria to the ventricles

Answer 20

Third degree conduction block

Question 21

33yo male presents with vague symptoms including chest pain, fatigue and dyspnoea following a viral infection 3 weeks previously

Answer 21

Viral myocarditis

Other causes: other infection, sarcoidosis, giant cell myocarditis, acute rheumatic fever, toxic (diphtheria), drugs, transplant rejection

Question 22

An obese 45yo lady presents to the doctor for a check up, she is well and routine bloods are ordered. What are they likely to show?

Answer 22

Dyslipidaemia

Question 23

Middle-aged male presents with hypotension, distant heart sounds and an elevated JVP

Answer 23

Pericardial tamponade

Question 24

25yo male presents with sharp chest pain that is relieved by sitting forward. ECG shows generalised ST depression

Answer 24

Acute pericarditis

Causes: viral infection, idiopathic, post-MI, after pericardiotomy, uraemia, neoplasia, connective tissue disease, hypothyroidism, other infection, acute rheumatic fever

Question 25

An overweight individual with T2DM presents with worsening eye symptoms

Answer 25

Hypertension

Question 26

An elderly male individual presents with unstable angina. What disease is affecting the coronary vessel?

Answer 26

Atherosclerosis

Question 27

65yo patient presents with a temporal headache, painless vision loss in one eye and a fever. On questioning, they also reveal a recent history of jaw claudication

Answer 27

Giant cell arteritis

Question 28

55yo woman presents with acute onset stiffness in the pelvic and shoulder girdles. Associated with this is a low grade fever and some weight loss. On further questioning she has some features of giant cell arteritis

Answer 28

Polymyalgia rheumatica

Question 29

40yo woman presents with digit discolouration, described pallor, cyanosis and rubor when it is cold

Answer 29

Raynaud’s disease

Question 30

80yo male with a smoking history presents with sudden onset abdominal pain associated with pre-syncope and a pulsatile abdominal mass

Answer 30

Ruptured AAA

Question 31

60yo male with long-standing hypertension presents with acute onset severe chest pain radiating to the back. He describes the pain as tearing. On examination the BP in the arms is different

Answer 31

Aortic dissection

Question 32

55yo female presents with ankle pain associated with pitting oedema, lipodermatosclerosis, venous eczema and varicose veins

Answer 32

Chronic venous disease

Question 33

A patient presents with a large ulcer with irregular edges and a shallow base in the gaiter area

Answer 33

Venous ulceration

Question 34

A patient presents with an ulcer over a pressure area that is small and deep with punched out edges

Answer 34

Arterial ulceration

Question 35

A patient with diabetes mellitus presents with an ulcer over a pressure point. This is associated with hypoaesthesia

Answer 35

Neuropathic ulceration

Question 36

Following a long flight, a 55yo female complains of unilateral calf pain and swelling

Answer 36

DVT

Other causes: active cancer, recent surgery, pregnancy, obesity, clotting disorders, cardiac failure

Question 37

Following a lymph node dissection, a patient complains of unilateral painless limb swelling that is non-pitting in nature

Answer 37

Lymphoedema

Other causes: primary (eg/ hypoplastic lymphatic development), radiation therapy, neoplastic infiltration, parasitic nematodes, penetrating trauma

Question 38

A 55yo male with CVD risk factors presents with leg pain that is brought on after 100m and is relieved by rest. At night he complains of pain in the same leg that is relieved by hanging it off the edge of the bed

Answer 38

PVD

Question 39

65yo male with long-standing, poorly controlled hypertension. He presents with left ventricular hypertrophy and a diastolic murmur in the aortic region. What is the most likely diagnosis?

Answer 39

Hypertensive heart disease

Question 40

32yo IVDU presents with fever and chills. On examination a systolic murmur loudest in the mitral region. A set of blood cultures are taken

Answer 40

Infective endocarditis

Common causes: Staphylococci and Streptococci