Presentations

Question 1

Chest pain - Differentials

Hint: think systems

Answer 1

Myocardial Infarction, Angina, Pericarditis, Mitral valve prolapse, Aortic dissection, Cardiac tamponade

Pulmonary embolism, Pneumonia, Pneumothorax, Lung cancer

GORD, Oesophageal tear, Peptic ulcer, Biliary disease

Cervical nerve root compression, Costochondritis, Fractured rib

Herpes Zoster

Question 2

Chest pain - Examination/Investigations

Answer 2

Pulses and BP, JVP
Apex beat and listen to heart sounds
Chest expansion and listen to lungs

Bloods: Troponin, FBC, U/E, ABGs, LFTs
ECG
Chest CT
Echocardiogram
CTPA
MRI
V/Q scan
Exercise tolerance test

Question 3

Dyspnoea - Differentials

Answer 3

Cardiac Failure, Coronary artery disease, valvular heart disease, arrhythmias
PE, airway obstruction (COPD, Asthma), Pneumothorax,
Pneumonia, fibrosis, lung cancer (any Interstitial lung disease)
Pleural effusion
Chest wall limitations (myopathy, neuropathy, fracture, kyphoscoliosis, obesity)
Anaemia
Psychogenic hyperventilation
Acidosis (aspirin overdose, diabetic)

Question 4

Dyspnoea - History for diagnosis

Answer 4

Acute or chronic
Continuous or intermittent
Exacerbating and relieving factors (cold, breathing, exertion, lying flat)
Associated symptoms (pain, cough, palpitations)

Question 5

Syncope - Differentials

Answer 5

Tachyarrhythmia (supraventricular, ventricular), Bradyarrhythmia (sinus, heart bloc, sinus arrest)
Strokes-Adams attack (transient asystole)
LV outflow obstruction (A stenosis, HOCM), RV outflow obstruction (P stenosis)
Pulmonary hypertension
Postural hypotension
PE
Septic shock
Stroke, TIA, Vertebrobasilar attack
Epilepsy
Hypoglycaemia
Alcohol withdrawl

Question 6

Syncope - Important questions

Answer 6

Collateral history
Aura
Injuries, Incontinence, tongue biting
Do they remember the event
Previous instances
Pre-existing conditions (arrhythmias, epilepsy, diabetes, hypertension)

Question 7

Syncope - Examinations/Investigations

Answer 7

Pulses, JVP, BP (postural difference), Apex beat, Murmurs/bruits
Complete Neuro exam

Bloods: FBC, U/E, Calcium, Troponin, Blood glucose ABGs
ECG (maybe Holter monitor)
Tilt test
Chest CT
Echo
Doppler carotid
Head CT

Question 8

Peripheral Oedema - Causes

Answer 8

Cardiac Failure: Congestive (MI, hypertensive, myocarditis, valve diseases), Right sided 2dary to pl hypertension (chronic lung disease, primary pul hypertension)

Hypoalbuminaemia: Protein loss (nephrotic syndrome, burns, enteropathy), reduced protein production (liver failure)

Renal impairment: low function: sodium retention means water retention ( hypertension, DM, autoimmune, infection)

Hepatic Cirrhosis: reduced albumin production, peripheral vasodilation, renin-angiotensin activation (increase Na and H2O retention)
(Hep A, B, C, Autoimmune, Alcohol, biliary cirrhosis, Wilson’s, haemochromatosis, drugs)

Drugs: Corticosteroids, CCBs (nifedipine)

Cushing’s

Question 9

Localised Oedema - Causes

Answer 9

Venous thrombosis or compression
Cellulitis
Trauma
Lymphoedema 2daryto obstruction (e.g. malignancy)