Clinical very good :) :)

Question 1

Harsh pan-systolic murmur, loudest at the lower left sternal edge and inaudible at the apex. The apex is not displaced. It does not intensify on inspiration

Answer 1

Ventricular septal defect

Question 2

Soft late systolic murmur at the apex, radiating to the axilla

Answer 2

Mitral valve prolapse

(late systolic murmurs resemble mitral incompetence)

There may also be a systolic click

Question 3

Possible reason for systolic click?

Answer 3

Mitral incompetence

Question 4

Slow-rising pulse and heaving apex (apex not displaced)

Ejection systolic murmur best hears at the right second interspace that does not radiate

Answer 4

Aortic stenosis

Question 5

The pulse is regular and jerky in character. The cardiac impulse is hyperdynamic and not displaced.
There is a mid-systolic murmur with no ejection click, loudest at the left sternal edge

Answer 5

Hypertrophic cardiomyopathy

Question 6

Constant “machinery-like” murmur throughout systole and diastole

Answer 6

Patent ductus arteriosus

Question 7

Tented T waves on ECG?

Answer 7

Hyperkaelemia

hyperkaelemia impairs cardiac conduction

Question 8

You can investigate arrhythmias with an electrophysiological study, what is this?

Answer 8

This is when you induce a clinical arrhythmia to study mechanism and map pathway

-Also gives the opportunity to treat the arrhythmia by radiofrequency ablation

Question 9

Why would you carry out an exercise ECG?

Answer 9

To assess for ischemia

Exercise induced arrhythmia

Question 10

How would you check for paroxysmal arrhythmia?

Answer 10

To assess for paroxysmal arrhythmia

Question 11

Side effects of statins?

Answer 11

Myalgias, myositis and deranged liver function tests

Question 12

Side effects of amiodarone?

Answer 12

Hepatic/pulmonary fibrosis
Hypo/hyperthyroidism
Blue-grey photosensitivity rash

Question 13

Side effects of GTN?

Answer 13

Headaches and hypotension

Question 14

Loud S1 with opening snap
Palpable S1
Rumbling low pitched diastolic murmur

Answer 14

Mitral stenosis

Question 15

A 72 year old woman with an acute ischaemic stroke has ST elevation on her electrocardiogram. There is a past medical history of MI

Answer 15

Left ventricular aneurysm

Question 16

Retinal haemorrhages that are usually caused by an immune complex vasculitis and are most commonly seen in bacterial endocarditis

Answer 16

Roth’s spots

Question 17

ECG yellow electrode

Answer 17

Left arm

Question 18

Which ECG electrode should be put on bony prominence on left side of abdomen or left leg?

Answer 18

Green

Question 19

Which ECG electrode should be placed on bony prominence on the right arm/shoulder?

Answer 19

Red

Question 20

Risks of RIPE aneurysm

Answer 20

Rupture
Infection (of thrombus)
Pressure effects on neighbouring structures
Emboli of thrombi to lower limb

Question 21

Cardiac abnormalities
Thymoma
Cleft palate
Hypocalcemia/hypoparathyroidism
22nd chromosome

Answer 21

DiGeorge syndrome

Question 22

Raised J waves

Answer 22

Hypothermia

Question 23

Loud P2

Answer 23

Pulmonary hypertension

Question 24

Congenital rubella syndrome is associated with

Answer 24

PDA
Atrial septal defect
Pulmonary stenosis

Question 25

Marfan syndrome is associated with

Answer 25

Aortic root dilaration (causing aortic regurgitation)
Mitral valve proplapse
Mitral regurgitation

Question 26

Turner syndrome is associated with

Answer 26

Coarction of the aorta

Question 27

When and how does Tetralogy of Fallot usually present?

Answer 27

Prevents with cyanotic episodes usually at 1-2 months

Question 28

Why should you not use rate-limiting Ca channel blockers and beta blockers together?

Answer 28

May cause severe AV block and hypotension

Question 29

Opens into the left posterior aortic sinus

Answer 29

Left coronary artery

Question 30

Opens into the right atrium

Answer 30

Coronary sinus

Question 31

Commonly associated with the atrioventricular groove

Answer 31

Right coronary artery

Question 32

Supplies the AV node

Answer 32

Posterior interventricular artery

Question 33

Supplies the apex of the heart

Answer 33

Anterior interventricular artery

Question 34

Most common cause of aortic stenosis

Answer 34

Calcification of congenital bicuspid valve