Short Case

Question 1

Splenomegaly

Answer 1

Infective endocarditis
Glandular fever
Haemolytic anaemia - spherocytosis
Felty

Question 2

Massive splenomegaly

Answer 2

MPNs- CML, Myelofibrosis
Infection - rarely

Question 3

Hepatomegaly

Answer 3

Three CS
Cancer- met or primary
Cardiac
Cirrhosis

Others
PC disease
Infiltrative - amyloid
Infective - abscess

Question 4

MR severity

Answer 4

Displaced apex
Thrill and heave
Failure, S3
Pulmonary hypertension
Soft S1

Question 5

MR intervention
When low EF

Answer 5

When primary such as due to rheumatic heart disease or connective tissue disease or congenital pathology

Question 6

Mitral stenosis severity

Answer 6

Early opening snap
Pulmonary hypertension
Length of murmur
Cardiac failure
Narrow pulse pressure

Question 7

Mitral stenosis intervention

Answer 7

Exertional dyspnea or pulmonary hypertension

Question 8

Aortic stenosis severity

Answer 8

Slow rising pulse
Long and late murmur
Soft s2
Thrill

Question 9

Indication for AS surgery

Answer 9

Symptoms
Associated CAD
LVH

Question 10

Aortic regurgitation

Answer 10

Wide pulse pressure
Collapsing pulse
Prolonged diastolic component of murmur
Austin flint diastolic in mitral area

Question 11

Indication for AVR

Answer 11

Symptomatic
Cardiac dysfunction
LvEnd systolic dimension>5.5cm

Question 12

Aortic stenosis causes

Answer 12

Bicuspid
Degenerative
Rheumatic

Question 13

Mitral stenosis

Answer 13

Rheumatic
Calcific
Rare congenital

Question 14

Upper lobe fibrosis

Answer 14

Silicosis/sarcoidosis
Coal workers lung
Histiocytosis x
Ankylosing spondylitis
Radiotherapy
Tb

Question 15

Resp opening statement

Question 16

Lower lobe fibrosis

Answer 16

Rheumatoid arthritis
Asbestosis
Idiopathic
O

Question 17

Middle aged murmur
No scar on entry
Wideish pulse pressure
Corrigans
Diastolic on end expiration
Systolic without radiation
What is it?
What ix and results do you expect?

Question 18

Obese lady with bibasal crackles and left sided upper lobe scar
Clubbing
What is the cause of Jane’s dyspnea and what l investigations

Answer 18

Most likely ipf
Other ddx for ll
Hrct looking for uip
Pft for rld
Fbe uec and lft to look for complications

Question 19

Abdominal exam
Young Talia Pw fullness
Bilateral masses with features of vascular access today
No scars and no veins bilateral fullness and no hernias
Macronodular non tender non pulsatile mass
22cm in size
Left sided nodular mass that I can’t get above descends on inspiration with resonant traubes space
And no shifting dullness or bruit on auscultation

Answer 19

Young lady

Question 20

Abdominal exam
Young Talia Pw fullness
Bilateral masses with features of vascular access today
No scars and no veins bilateral fullness and no hernias
Macronodular non tender non pulsatile mass
22cm in size
Left sided nodular mass that I can’t get above descends on inspiration with resonant traubes space
And no shifting dullness or bruit on auscultation

Answer 20

Young lady

Question 21

Diastolic murmur without wide pulse pressure loudest in the aortic area

Question 22

Cranial nerve examination
Right Facial weakness with preserved wrinkling
reduced visual acuity left eye normal fields
Pupils reactive no ptosis
No parotid enlargement
Had I the vials Would like to examine anterior third of tongue for taste

Question 23

Tumara is short of breath
Malnourished with active arteriovenous fistula and ics recession portsvatch and left sternal scar

No clubbing or thickened skin
Proximal myopathy
Trachea not deviated
Reduced percussion resonance to both bases left more than right
Auscultation fine end inspiration crackles today
Anteriorly percussion and Ajax
Jvp raised
Rv Heaves apparent or thrills
Auscultation of p2
Abdomen
No pedal oedema

Answer 23

Young cachectic with bilateral ant thoracotomy scars with associated end organ complications
My findings
To summarize she’s dyspneic with clam shell
Thoractomy maybe due to lung transplant with issues of rejection and esrf
Ddx
Brochiectasis such as cf
Other ddx could include idiopathic pf
Daiiii
Spirometry
6mwt
Hrct

Question 24

Abdominal examination
Young man Peter has presented with abdominal pain
Bronzed but skin tan lotion skin, missed some bits
No clubbing
? Dupuytren

Asterexis
Bruising apparent
Nil peripheral oedema or raised Jvp

Question 25

Increased ul tone
Weak finger abductors
Median nerve weakness
Normal reflexes
Myotonic reflexes negative
Bilateral

Answer 25

Bilateral weakness and pain
Ddx muscular myositis
Myasthenia
Nerve root compression disc herniation or oa which would be unusual
Ddx brachial plexopathy due to some infiltrative
Paraneoplastic processes but again unlikely
Id be interested in the nerve conduction study looking for demywlination with reduced velocity
Aconal reduces amplitude
Demyelinating lmn pathology

Question 26

Mark older presents with abdominal pain
On examination my most salient findings were that of a midline laparotomy scar and hepatomegaly in the context of obesity
My findings in detail

Answer 26

To summarize marks abdominal pain may be due to the abdominal mass or the significant ventral herniation
He has chronic liver disease without features of decompensation today
With regards to his isolated hepatomegaly my differentials would include . 1.alcoholic or metabolic fatty liver disease
2. Cancer whether this be hepatocellular or malignant
3. Myeloproliferative disease
4. Right heart failure
To investigate id like to begin with the liver function, synthetic dysfunction with low albumin and coagulopathy. I’d also like to see if there is any renal dysfunction
I’d like to look at the ultrasound for features especially of cirrhosis and portal hypertension with reversal of flow and ensure patent portal vein
And confirm ddx with fibroscan

Question 27

Rodney who has presented with upper limb stiffness

Question 28

Searle has difficulty walking
Please examine his upper limbs
Flat affect and look of surprise

Question 29

Gerard has shortness of breath
Please examine the respiratory system

Answer 29

Etiologies of bronchiectasis I would consider would include