EMQs Flashcards
A 55 year old man, who has been stable throughout his admission with an acute myocardial infarction develops sharp chest pains 4 days after admission. The pain is different to that on admission. A new clinical finding is of a high pitched sound, with both systolic and diastolic components heard over the heart
Dx?
Pericarditis
A 68 year old woman who is about to be discharged home after a myocardial infarction and collapses in the medical wards acutely breathless. She has no pain, remains conscious but is extremely distressed. She has a new, loud pan-systolic murmur
Dx?
papillary muscle rupture
A 50 year old man, discharged from hospital six weeks earlier after an uncomplicated MI, develops episodes of fever, non-exercise related chest pains and shortness of breath.
Dx?
Dressler’s syndrome
60 year old woman is recovering well at home three weeks post MI. She reports increasing shortness of breath, which is accompanied by episodes of cough and occasional haemoptysis
Dx?
thromboembolism
A 45 year old fitness fanatic is admitted to CCU with chest pains. His ECG and serial enzymes are normal and he acknowledges personal and work related stress. His awareness of his heart rate regularly slowing down and speeding up are confirmed by clinical examination
Dx?
sinus arrhythmia
A 55 year old lady with a ten year history of scleroderma with lung fibrosis attends your clinic for routine follow-up. Her blood pressure is 140/88, the apex beat is in the normal position, jugular venous pressure is not elevated but her second heart sound is loud in the third left intercostal space.
Dx?
pulmonary artery HTN
A 75 year old lady is found to have an irregularly irregular pulse. Her blood pressure is 150/85. The jugular venous pressure is not elevated, she has a pan systolic murmur, loudest at the apex beat radiating into the axilla. Chest X-ray shows pulmonary oedema
Dx?
mitral incompetence
A 25 year old man is found to have a systolic murmur at routine health screening. His blood pressure is 125/75, he has no elevation of jugular venous pressure or ankle swelling. The apex beat is in the 5th left intercostal space and he has no basal crepitations. The systolic murmur is loudest in the 2nd right intercostal space and radiates to the carotids.
Dx?
bicuspid aortic valve murmur
A 55 year old man presents with crescendo angina. His blood pressure is 110/90. His jugular venous pressure is not elevated and there is no ankle swelling. The apex beat is in the mid- clavicular line in the 6th intercostal space. He has no evidence of left ventricular cardiac failure. There is a systolic murmur loudest in the 2nd right intercostal space radiating to the carotids
aortic stenosis
A 45 year old lady with previous rheumatic fever presents with increasing shortness of breath. She has a collapsing pulse, blood pressure is 160/60 and, although there are no signs of right ventricular failure, she has bilateral basal crepitations in both bases posteriorly. There are no systolic murmurs to be heard but on sitting the patient forward you can hear a diastolic murmur in the 2nd right intercostal space and down the left sternal edge.
Dx?
aortic regurgitation
75 year old man with crushing central chest pain for 1 hour and ST elevation in the anterior leads of his ECG. He had a previous myocardial infarction 6 months ago.
Mx?
primary angioplasty
2 year old female who suffers a cardiac arrest whilst in the A&E Department. The monitor shows asystole.
Mx?
adrenaline 1mg IV
24 year old female who presents with wheeze and a rash following ingestion of shellfish.
Mx?
adrenalin 500mcg IM
6 year old male with crushing central chest pain, has a broad complex tachycardia. On examination he is clammy tachypnoeic and has a BP of 90/30.
Mx?
Synchronised DC conversion 150J
67 year old male who is brought into A&E after having an out of hospital cardiac arrest, the monitor shows ventricular fibrillation
Mx?
Defibrillation 200J
A 68-year old man is brought in by ambulance to A&E having collapsed while trying to move a chest of drawers. His severe tearing chest pain radiates to his back and his BP shows a blood pressure of 170/100 mmHg in the right arm, and 200/130 mmHg in the left arm.
Dx?
dissecting thoracic aortic aneurysm
45-year old female presents with a 16 hour history of pleuritic chest pain and haemoptysis. She ruptured her anterior cruciate about 10 weeks ago and consequently remained immobile for most of the recovery period. Since
leaving hospital, her leg has become red, warm and swollen.
Dx?
PE
A 60-year old smoker presents with several episodes of severe burning central chest pain. He says it is often precipitated by a heavy meal or on occasion when he bends over to tie his shoe- lace.
Dx?
oesophageal reflux
A 75-year old lady comes to the GP with a sharp stabbing pain in the left side of her chest, which has been there for 4 days. She also has a productive cough and feels very hot
Dx?
bronchopneumonia
A 43-year old man is brought in by ambulance to A&E having collapsed at home. His central chest pain, which radiates down his left arm, began about
an hour ago and has worsened gradually. He also complains of feeling sick and sweaty.
Dx?
MI
A 45-year old women presents with new chest pain occurring on exertion. It radiates to her jaw and left arm, and is relieved by rest. Her ECG is normal.
Dx?
stable angina pectoris
A 42-year old man presents with a history of chest pain radiating to the jaw and left arm often occurring at night. It is not relieved by GTN spray however there are no ECG changes.
Dx?
unstable angina pectoris
A 70-year old women collapses at home and when admitted describes a history of chest pain with increasing shortness of breath. On auscultation an ejection systolic murmur is heard that radiates to the carotids.
Dx?
AS
25-year old man presents with chest pain that radiates to his arms and shoulders. It worsens on lying down and on examination he is febrile with a pericardial rub. ECG shows ST elevation in all leads.
Dx?
acute pericarditis
A 24-year old women presents with chest pain, haemoptysis and shortness of breath. On examination she is tachypnoeic and tachycardic with a pleural rub. She has recently been commenced on the OCP.
Dx?
PE
A 52-year old man whose ECG shows prolonged PR intervals with two P waves to every QRS complex.
Dx?
Second degree AV block
A 12-year old girl attending her GP for annual check up who is noticed to have a faster heart rate on inspiration than on expiration.
Dx?
Sinus arrhythmia
A 62-year old lady with a heart rate of 152 bpm irregular saw-toothlike waves between QRST complexes. Not all these waves are followed by a QRS complex.
Dx?
atrial flutter
A 42-year old woman about to be started on thyroxine whose heart rate is 52 bpm.
Dx?
sinus bradycardia
A 55-year old man with a recent history of MI shows deep S waves in V1 and tall late R waves in leads I and V6 on ECG.
Dx?
LBBB
