Passmedicine extras

Question 1

What heart sound may be heard in hypertrophic cardiomyopathy?

Answer 1

S4

think causes subvalvular aortic stenosis - this is seen in severe AS

Question 2

When would tricuspid valve murmurs be louder?

Answer 2

on inspiration

this is because intrathoracic pressure decreases causing increased venous return to right side of the heart

Question 3

What cardiac signs can be seen in diabetes

Answer 3

because of autonomic neuropathy may see:

• postural hypotension
• loss resp. arrhythmia I.e. HR doesn’t slow upon deep breathing

Question 4

Left ventricular aneurysm

1. What is the pathophysiology behind it?
2. What clinical features can be seen?

Answer 4

1. incomplete reperfusion of LV following MI causing scar formation and hence impaired conductivity and contractility

(hence can result in HF and arrhythmia)

2. • S3+4
   • persistent ST elevation (should normally resolve within 2 weeks post MI)
   • bibasal crackles caused by HF
   • thrombus could also form in aneurysm causing stroke

Question 5

What type of electrical activity is likely to be seen in the heart in a patient who is pulseless with a pneumothorax

Answer 5

pulseless electrical activity (a tracing which should produce a pulse but does not)

NOTE: this problem is outwith the heart (in this case specifically decreased venous return) so therefore not with the heart’s conducting system so you would have no reason to think there was a problem with the heart’s electrical activity until indicated otherwise

Question 6

How is the QT interval measured?

Answer 6

from start of QRS complex / Q wave to END of the T wave

Question 7

How would you differentiate between panic attack and PE if there is no pain present from a PE cause?

(both cause shortness of breath, tachypnoea, tachycardia)

Answer 7

O2 sats would not be decreased in panic attack likely very good due to increased breathing