General Clinical

Question 1

Asbestos body

Answer 1

These are non-ferrous fibres but they are surrounded by macrophages. Take up iron so best visualised with iron stain

Question 2

How can malignancy cause pleural effusion?

Answer 2

By blocking the lymphatic drainage from the pleura, but then also causes increased secretion of fluid

Question 3

What is the most common cause of death in pregnancy?

Answer 3

Pulmonary embolism

Question 4

What are you thinking of with unilateral calf swelling with pain and haemoptysus?

Answer 4

PE

Question 5

Why do you get haemorrhage with PE?

Answer 5

Lungs have a dual blood supply, so that if you occlude the pulmonary system you still get circulation. However, bronchial doesn’t penetrate the parenchyme of the lung, so if pulmonary circulation is blocked then you still get blood supply to the lung but it is going to tissue that is dying so causes excessive bleeding instesad

Question 6

What is the immediate treatment for PE?

Answer 6

Heparin to anti-coagulate and ventilation to improve oxygen and CO.

Question 7

What causes sudden cardiac death following MI?

Answer 7

Cardiac arrhythmias leading to ventricular tachycardia

Question 8

How do you differentiate ICDs from pacemakers in CXR?

Answer 8

ICDs have a wire coming from it, pacemakers do not

Question 9

Which x-ray technique is used to visualise the coronary arteries?

Answer 9

Coronary angiogram

Question 10

Which murmurs are the manoeuvres in precordial examination for?

Answer 10

Diastolic (mitral stenosis and aortic regurgitation)

Question 11

When does S3 occur?

Answer 11

Immediately after S2

Question 12

When does S4 occur?

Answer 12

Immediately before S1

Question 13

What does distended veins in the neck indicate?

Answer 13

SVC obstruction

Question 14

What are the causes of raised JVP?

Answer 14

Right heart failure and tricuspid regurgitation

Question 15

What are the causes of lowered JVP?

Answer 15

Haemorrhage, or anything that reduces blood volume

Question 16

How do you find the brachial pulse?

Answer 16

Tense biceps and find tendon, then feel under tendon when relaxed

Question 17

True or False: Everyones pulse is always regular

Answer 17

False, it changes on breathing

Question 18

What are some of the causes of a bounding pulse?

Answer 18

hypertrophy or CO2 retention (or can be normal)

Question 19

What are some causes of a weak pulse?

Answer 19

Shock or aortic stenosis

Question 20

What does collapsing pulse indicate?

Answer 20

Aortic regurg

Question 21

Which groups of people is aortic regurgitation common in?

Answer 21

Marfan’s, IVDU or ancholysing spondylitis

Question 22

What classes ventricular ectopic beats as ventricular tachycardia?

Answer 22

> 7 in a row

Question 23

How do you recognise AF on ECG?

Answer 23

No p waves and narrow QRS, and irregular

Question 24

What does tall tented T waves indicate?

Answer 24

Hyperkalaemia

Question 25

Where would the MI be located if pathology in leads II, III and aVF?

Answer 25

Inferior (right coronary a.)

Question 26

Where would the MI be located if pathology in leads II, III, aVF, V5 and V6?

Answer 26

Inferolateral

Question 27

Where would the MI be located if pathology in leads I, III and aVL?

Answer 27

Anterolateral (Circumflex)

Question 28

What causes the heaves on examination?

Answer 28

Right ventricular hypertrophy

Question 29

Where is the apex beat found?

Answer 29

Left 5th intercostal space midclavicular line

Question 30

Which intercostal space is at the level of the clavicle and sternal angle?

Answer 30

Clavicle - 1st intercostal | Sternal angle - 2nd intercostal

Question 31

What tests should you do with an MI?

Answer 31

- Cardio exam - ECG - Troponins

Question 32

What are causes of AF?

Answer 32

Hypertension (most common) Hyperkalaemia Ischaemia

Question 33

What is a side effect of lisinopril?

Answer 33

Hyperkalaemia

Question 34

What is a normal ankle brachial pressure index?

Answer 34

0.9

Question 35

What investigations would you do for peripheral vascular disease?

Answer 35

Ankle/brachial pressure Doppler ultrasound Peripheral angiogram

Question 36

When is splitting of S2 normal and why?

Answer 36

On inspiration in the pulmonary area due to change in intrathoracic pressure

Question 37

When is splitting of S2 not normal?

Answer 37

If it doesnt change on breathing and is in the mitral area - S3

Question 38

What causes S4?

Answer 38

Occurs during atrial contraction (active filling) due to stiff or less compliant ventricles. Heard in the mitral area - like S3

Question 39

What signals the start of systole and diastole?

Answer 39

S1 signals systole and S2 signals diastole

Question 40

What causes S1?

Answer 40

Closure of the atrioventricular valves (mitral and tricuspid)

Question 41

What causes S2?

Answer 41

Closure of the semilunar valves (aortic and pulmonary)

Question 42

Which murmurs are felt in time with the carotid pulse?

Answer 42

Systolic

Question 43

What are the 5 red flags of cardio?

Answer 43

Chest pain, SOB, palpitations, dizziness or ankle swelling

Question 44

Which part of the stethoscope do you use for mitral stenosis manoeuvre?

Answer 44

Bell

Question 45

Which part of the stethoscope do you use for aortic regurgitation manoeuvre?

Answer 45

Diaphragm