Cardiovascular (medicine)

Question 1

clinical hx of patient with

• preceding sore throat
• malaise
• fever
• arthralgia
• subcutaneous nodules on extensors
• cardiac murmur
• raised CRP

likely diagnosis?

Answer 1

rheumatic fever

Question 2

likely causative organism of rheumatic fever:

Answer 2

group A beta-haemolytic streptococcus

Question 3

how would you manage a patient with rheumatic fever?

Answer 3

• IM dose of benzylpenicillin 1.2g stat

- followed by oral penicillin

Question 4

which heart valve is commonly involved in rheumatic fever?

Answer 4

mitral valve

Question 5

ECG: U waves are seen in…

Answer 5

hypokalaemia

Question 6

ECG: Delta waves are seen in….

Answer 6

Wolf-parkinson-White syndrome

Question 7

ECG: peaked P waves suggest…

Answer 7

right atrial enlargement

P pulmonale
- peaked P wave

Question 8

When looking at oxygen saturation between RA and RV, if there is an increase in oxygen - why does this occur?

Answer 8

abnormal connection between these two chambers

i.e. a VSD

confirmed by raised right ventricular pressures

Question 9

35 y/o female

PC: mild central chest pain, does not radiate, pleuritic in nature, relieved on sitting forward

HPC: viral episode a week ago, malaise, and fever

no breathlessness, non-smoker

OE

• afebrile
• t.cardic
• 100 bpm
• 120/80 mmHg
• RR 16/min

soft rub on auscultation
JVP not elevated, lungs clear, no peripheral oedema

what tests would you perform initially given diagnosis?

Answer 9

acute pericarditis

• Echocardiogram
• serial ECGs
• repeat troponin

Question 10

which ECG finding is classical of pericarditis?

Answer 10

ST segments elevated in many leads

‘saddle shaped’

Question 11

most appropriate choice of treatment for patients with acute pericarditis?

Answer 11

regular NSAIDs

Question 12

enlarged heart but in the absence of pulmonary vascular congestion indicates:

Answer 12

pericardial effusion more likely than congestive failure