Pulses

Question 1

Slow rising pulse
Narrow pulse pressure
Heaving apex beat
Fourth heart sound

Answer 1

Aortic stenosis

Question 2

Collapsing pulse
Wide pulse pressure
“pistol shot” over femoral arteries

Answer 2

Aortic regurgitation

Question 3

Radiofemoral delay in a patient with hypertension

Answer 3

Coarction of the aorta

Question 4

45XO

Answer 4

Turner’s syndrome (associated with coarctin of the aorta)

Question 5

Puslsus paradoxicus
JVP rises on inspiration
Heart sounds muffled

Answer 5

Cardiac tamponade

this is Beck’s triad!!

Question 6

Bounding pulse in a patient who is short of breath

Answer 6

Acute CO2 retention

Question 7

Pulse in severe left ventricular failure

Answer 7

Alterans (regular rhythm but strong beat then weak beat)

Question 8

Slow rising pulse

Answer 8

Aortic stenosis

Question 9

Narrow pulse pressure

Answer 9

Aortic stenosis

Question 10

Opening snap

Answer 10

Mitral stenosis

Question 11

Wide splitting of the second heart sound

Answer 11

Right bundle branch block

Question 12

Mid systolic click followed by a late systolic murmur

Answer 12

Mitral valve prolapse

Question 13

Ejection systolic murmur

Answer 13

Pulmonary stenosis

Question 14

Low volume pulse, slow rising

Answer 14

Aortic stenosis

Question 15

Forceful apex

Answer 15

Aortic stenosis

Question 16

Ejection systolic murmur maximal in aortic area and radiating to carotids?

Answer 16

Aortic stenosis

Question 17

Aortic stenosis on ECG?

Answer 17

LVH

Question 18

If you can’t give surgery for aortic stenosis (i.e. too high risk) what would you do?

Answer 18

Transcatheter aortic valve implantation

Question 19

Displaced apex beat

Answer 19

Mitral regurgitation

Question 20

Pansystolic murmur

• maximal at apex
• radiating to axilla

Answer 20

Mitral regurgitation

Question 21

Where is mitral regurgitation murmur best heard?

Answer 21

Maximal at apex

Radiating to axilla

Question 22

Drug treatment for mitral regurgitation? (DADW)

Answer 22

Diuretics
ACEi
Digoxin
Warfarin

Question 23

Tapping apex

Answer 23

Mitral stenosis

Question 24

Mid diastolic murmur localised to apex

Answer 24

Mitral stenosis

Question 25

Malar flush
Tapping apex beat
Mid Diastolic murmur localised to apex
Later stages: Rt heart failure, cardiac cachexia

Answer 25

Mitral stenosis

Question 26

Mitral stenosis on CXR?

Answer 26

Straight left heart border

Question 27

Drug treatment for mitral stenosis?

Answer 27

DBDW

diuretics, beta-blockers, digoxin, warfarin

Question 28

Causes of aortic regurgitation?

Answer 28

Infective endocarditis
Rheumatic heart disease
Marfan’s syndrome
Acute aortic dissection

Question 29

High volume collapsing pulse, displaced apex

Answer 29

Aortic regurgitation

Question 30

When and where is aortic regurgitation murmur best heard?

Answer 30

Early diastolic murmur at lower left sternal edge

Question 31

Drug treatment for aortic regurgitation?

Answer 31

AAD

ACEi, ARB, diuretics

Question 32

Straight left heard border on CXR

Answer 32

Mitral stenosis

Question 33

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 33

VSD

Question 34

There is a soft late systolic murmur at the apex radiating to the axilla

Answer 34

Mitral valve prolapse
-there may be a mid systolic click

(mitral incompetence usually second to proplapse)

Question 35

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 35

This is a classical description of hypertrophic cardiomyopathy