Week 10 formative quiz Flashcards
The classic triad of the presentation of Aortic stenosis is syncope, angina and heart failure.
True - however this does not mean all patients will present this way. These are all features of SEVERE aortic stenosis.
Mitral regurgitation radiates to the carotids.
False - Mitral regurgitation is a pan systolic murmur heard best at the apex and radiates to the left axilla. Aortic stenosis radiates to the carotids.
The classic pulse of aortic regurgitation is collapsing.
True - a collapsing pulse reaches its peak volume quickly and then “falls away”, as blood refluxes back through an incompetent aortic valve.
Kussmaul’s sign may be seen in constrictive pericarditis.
True - JVP normally falls on inspiration. Kussmaul’s sign is a rise in JVP on inspiration. It may be seen in constrictive pericarditis.
The classic pulse of aortic stenosis is collapsing
False - The classic pulse of aortic stenosis is described as small volume and slow rising.
Fat emboli are associated with fractures of long bones.
True - Fat embolism syndrome is a complication which may present after a fracture of long bones.
Malignancy is a risk factor for thrombus formation.
True - Malignancy is an associated risk for thrombus formation and diagnosis of a thrombus may raise suspicion of underlying malignancy, especially if no other risk factors are present.
Williams syndrome is classically associated with aortic regurgitation.
False - It is classically associated with Supravalvular Aortic stenosis.
When investigating a suspected case of infective endocarditis, it is important to take multiple blood cultures all at the same time and site.
False - It is important to take multiple sets, typically 3 sets, all from different sites. They should be taken 6 or more hours apart. If the patient is very unwell, 2 sets from different sites should be taken within 1 hour.
Virchow’s triad consists of changes in the vessel wall, the blood components and the blood flow.
True - Above is Virchow’s triad. These are the risk factors which contribute to a thrombus forming.
A 60 year old patient with renal failure presents as an emergency with sharp chest pain which is eased by leaning forward. On auscultation a faint rub can be heard. The diagnosis is likely to be an acute myocardial infarction.
False - The diagnosis is likely to be acute pericarditis, possibly secondary to high urea levels seen in renal failure.
Aortic stenosis is an ejection systolic murmur.
True - Aortic stenosis is an ejection systolic murmur which is heard best in the second intercostal space on the right of the sternum and radiates to the carotids.
Long QT syndrome is a possible cause of nocturnal seizures
Particularly SCN5A – associated Long QT can present with nocturnal “seizures”. A 12 lead ECG is an essential part of the investigation of a first seizure. The “seizure” is associated with self-terminating ventricular tachycardia (Torsades de Pointes type). Patients with KCNQ1 and KCNH2 associated Long QT tend to have episodes of arrhythmia associated with exertion (including diving into cold water) or sudden fright (such as an alarm bell) respectively. Arrhythmia can be prevented by beta-blockers and other therapies. Certain antibiotics and antipsychotics drugs can cause acquired Long QT.
The aortic and pulmonary valves are the two most common valves operated on in adults.
False - The aortic and MITRAL valves are the most common two valves operated on in adults.
During a Coronary Artery Bypass Graft the patient is required to be placed on cardiopulmonary bypass.
Bypass is required to take over the function of the heart and lungs.
Hypertrophic cardiomyopathy is rare and usually fatal in young adults.
Hyerptrophic cardiomyopathy is a common disorder affecting 1/500 people, and in most cases is relatively mild becoming symptomatic in older people, although it is occasionally severe in younger adults. 4 genes for sarcomere proteins (MYBPC3, MYH7, TTNT2 and TNNI3) are commonly implicated in the disorder (although a number of other types have been described) and most patients will have a variant on one of these genes. The severely affected younger patients often have two variants, which may explain their severity.
A patient presents after a road traffic accident with a tachycardia, hypotension, raised JVP and muffled heart sounds. The likely cause of these signs is constrictive pericarditis.
False - The likely diagnosis is pericardial tamponade secondary to trauma. Becks triad is seen above, a collection of signs seen in acute pericardial tamponade. These are hypotension, raised JVP and muffled heart sounds.
In mitral valve disease, valve replacement is always required
False - Mitral valve repair is often used in mitral valve disease and can be effective. For example in mitral valvuloplasty, a small hallow tube is advanced via blood vessels to the heart. A balloon is inflated to stretch open the stenosed mitral valve.
Some people with mild mitral valve disease may not require any treatment at all.
Pericardial tamponade is a large collection of fluid in the pleural space.
False - This is a large collection of fluid in the pericardial space which causes cardiac compression and as a result leads to a reduction in cardiac output.
A sternotomy is required during a Coronary Artery Bypass Graft procedure.
True - Sternotomy (midline incision through the sternum) allows access to the heart to carry out the procedure.
Marfan syndrome is an autosomal recessive disorder of chromosome 15.
False - It is an Autosomal dominant disorder.
The pulse pressure in Aortic regurgitation is narrow.
False - The pulse pressure is the difference between systolic and diastolic pressure. In Aortic regurgitation the pulse pressure is wide.
Alcoholic heart disease is always irreversible.
False - In the early stages complete abstinence from alcohol can possibly reverse the effects.
Aortic surgery should be offered in Marfan syndrome if the Sinus of Valsalva exceeds 3cm.
False - Aortic surgery should be offered in Marfan syndrome if the Sinus of Valsalva exceeds 5.5cm or exceeds 5% growth per year.
