Cardiology FRACGP -AKT Dr Sam 1-50

A 45-year-old lady has 10 months history of shortness of breath. She is found to have

irregularly irregular pulse and loud P2 with fixed splitting and ejection systolic murmur in left 2nd ICS. What is the probable diagnosis?

A 64-year-old man has recently suffered from an MI and is on aspirin, atorvastatin and Ramipril. He has been having trouble sleeping and has been losing weight for the past 4 months. He doesn’t feel like doing anything he used to enjoy and has stopped socializing. He says he gets tired easily and can’t concentrate on anything. What is the most appropriate treatment?

A 75-year-old man collapsed while walking in his garden. He recovered fully within 30 minutes with BP 110/80 mmHg and regular pulse of 70bpm. He has a systolic murmur on examination. His activities have been reduced lately which he attributes to old age. What is the definitive diagnostic investigation that will assist you with his condition?

A 65-year-old man with hypertension presents with lower abdominal pain and back pain. An expansive abdominal mass is palpated lateral and superior to the umbilicus. What is the single most discriminating investigation?

A 54-year-old man has recently been diagnosed with moderate depression. He has history of MI and is suffering from insomnia. What is the drug of choice for him?

Which finding, on clinical examination of the pulse, suggests a diagnosis of hypertrophic

obstructive cardiomyopathy (HOCM)?

A man with prosthetic heart valve underwent hemicolectomy and after some days complains of left hypochondriac pain, fever and has a systolic murmur. What is the next investigation to ascertain the cause of HF?

A 45-year-old lady has 10m history of SOB (shortness of breath). She is found to have irregularly irregular pulse and loud P2 with fixed splitting and ejection systolic murmur in left 2nd ICS. What is the probable diagnosis?

A 72yo man has been advised to have antibiotic prophylaxis for some years now before dental treatment. He has never experienced chest pain. Three weeks ago, he noticed breathlessness on exertion and for one week he had orthopnoea. His pulse is normal. What is the most probable diagnosis?

A 67-year-old man presents with palpitations. ECG shows an irregular rhythm and HR=140bpm. He is otherwise stable, BP=124/80mmHg. What is the most appropriate management?

A 67-year-old man had successful thrombolysis for an inferior MI 1 month ago and was

discharged after 5days. He is now readmitted with pulmonary oedema. What is the most

probable diagnosis?

A 60-year-old lady who had stroke 3 years ago now reports having increased dyspnoea on

exertion and atrial fibrillation. CXR: straight left border on the cardiac silhouette. What is the most probable diagnosis?

A 60-year-old diabetic complains of pain in thigh and gluteal region on walking up the stairs for the last 6 months. She is a heavy smoker and has ischemic heart disease. What is the most appropriate diagnosis?

A 50-year-old man has a stab wound to his left anterior chest pain at the level of the 4th ICS. He has a BP 80mmHg, pulse=130bpm. His neck veins are dilated and his heart sounds are faint. His trachea is central. What is the most appropriate diagnosis?

A 28-year-old man with complains of headache and nose bleeds also has pain in the lower limbs on exertion. Exam: radio-femoral delay, cold legs with weak pulse and mild systolic murmur with normal S1S2. What is the most probable diagnosis?

A 75-year-old lady who had mitral valve replacement 13 yrs ago has developed recurrent

breathlessness. Her husband has noticed prominent pulsation in her neck. She complains of

abdominal pain and ankle swelling. What is the most probable diagnosis?

A 40-year-old man collapsed at home and died. The GPs report says he suffered from T2DM and BMI=35. What is the most likely cause of death?

An 18-year-old man complains of fatigue and dyspnoea. He has left parasternal heave and systolic thrill with a harsh pan-systolic murmur at left parasternal edge. What is the most probable diagnosis?

An MI patient who is already on aspirin no longer smokes and his cholesterol, ECG, echo and BP are normal. What medications will you commence Choose the best option for him

In 85% of the population this artery is dominant. What is the single most appropriate option?

A 60-year-old patient who has had a MI a week back presents with dyspnoea and pericardial rub. ECG shows ST elevation. CXR: loss of margin at costo-vertebral angle. What is the single most likely cause?

A 57-year-old woman who is suffering from hypertension, presented to the hospital with

complaints of recurrent falls when trying to get out of bed or getting up from sitting. She is on some anti-hypertensive therapy with no other medical problems. What is the cause of her fall?

A 47-year-old man with history of IHD complains of chest pain with SOB on exertion over the past few days. ECG normal, Echo= increased EF (ejection fraction) and decreased septal wall thickness. What is the most likely diagnosis?

A 66-year-old man present with palpitations. ECG is given below. What is the most appropriate next step in management

65-year-old presents with palpitations. ECG is given below. What is the most probable diagnosis?

A 54-year-old patient 7 days after a total hip replacement presents with acute onset

breathlessness and raised JVP. Which of the following investigation will be most helpful in?

leading to a diagnosis?

A 61-year-old man has been referred to the emergency department with frequent episodes of breathlessness and chest pain along with palpitations. He has a regular pulse rate 60bpm. ECG sinus rhythm. What is the most appropriate investigation to be done?

A woman had an MI. She was breathless and is put on oxygen mask and GTN, her chest pain has improved. Her HR 40bpm. ECG shows ST elevation in leads I, II, III. What is your next step?

A 45-year-old man who is diabetic and hypertensive but poorly compliant has chronic SOB (shortness Of Breath), develops severe SOB and chest pain. Pain is sharp, increased by breathing and relieved by sitting forward. What is the single most appropriate diagnosis?

A 50-year-old lady presents to emergency department with sudden severe chest pain radiating to both shoulder and accompanying SOB (shortness of breath). Examination: cold peripheries and paraparesis. What is the single most appropriate diagnosis?

A 28-year-old man presents with rapid pounding in the chest. He is completely conscious

throughout. The ECG was taken which is given below. What is the medication used to manage this condition?

A 72-year-old man collapsed in the medical ward. ECG done by the nurse is given below. What is the most likely diagnosis?

A 65-year-old male presents with dyspnoea and palpitations. Examination: pulse 170bpm, BP120/80mmHg. ECG shows supraventricular tachycardia. Carotid massage has been done as first instance. What is the next step of the management?

A 55-year-old woman was found collapsed at home, paramedics revived her but in the

ambulance she had a cardiac arrest and couldn’t be saved. The paramedic’s report tells that the woman was immobile lately due to hip pain and that they found ulcers on the medial side of ankle. She had DM and was on anti-diabetics. What is the likely cause of her death?

An ECG of an elderly lady who collapsed in the emergency department shows rapid ventricular rate of 220bpm, QRS 140ms. ECG is given below. What is the most probable diagnosis?

A 58-year-old type 1 diabetic on anti-hypertensive therapy for 13 years developed central chest pain for 45 minutes while driving along with cold sweating and dyspnoea. What is the single most appropriate diagnosis?

A 45-year-old manual worker presented with a 2hour history of chest pain radiating to his left arm. His ECG is normal. What is the single most appropriate investigation?

A 50-year-old man with DM suddenly develops persistent crushing central chest pain radiating to the neck. He is pale and sweaty on examination. His BP in 90/60 mmHg, Pulse 130b/min and sats 97 %.What is the single most appropriate diagnosis?

A 50-year-old woman returned by air to the UK from Australia. 3days later she presented with sharp chest pain and breathlessness. Her CXR and ECG are normal. What is the single most appropriate investigation you would request?

A 48-year-old presents with severe chest pain since the last 40mins. In the ED he is given

oxygen, GTN, morphine. ECG=ST elevation. Bloods- increased troponin levels. What is the next step of management?

A 65-year-old man with hypertension He is on coversyl 5 mg daily, nifedipine and bisoprolol 2.5 mg daily. He develops gingival hyperplasia. What is the single most likely cause?

A 53yo had a dental extraction after which he recently had a mitral valve prolapse. He presents with high temp of 39C, cardiac failure and new cardiac murmur. What is the single most likely diagnosis?

A 46-year-old African-Caribbean man is found to have BP 160/90mmHg on 3 separate occasions. What is the best initial treatment?

A 45-year-old man had recently started taking anti-hypertensive therapy. 6 months later his RBS is 14mmol/l. Which single drug is most likely to have caused this?

A 43-year-old lady is admitted with pyrexia, arthropathic, breathlessness and syncope. She was recently diagnosed with pulmonary emboli. There is an early diastolic sound and a mid-diastolic rumble. Her JVP is elevated with prominent a-waves. What is the most likely cause?

A 60-year-old lady has severe chest pain. ECG shows changes of inferior wall MI. ECG also shows progressive prolongation of PR interval until a QRS complex is dropped. What is the most probable diagnosis?

A 56-year-old man was recently put on anti-hypertensive medications and recent biochemistry on 2 occasions showed: Na+ 129, K+ 4.6, Urea 11.3, Creatinine 112. Which of the following drugs is responsible for this result?

A 63-year-old man continues to experience chest pain and has a temperature of 37.8˚C 2 days after an acute MI. His ECG is given below. What is the single most likely explanation for the abnormal investigation?

 

A 55-year-old man returns for routine follow up 6 weeks after an MI. He gets breathless when walking uphill. His ECG shows ST elevation in leads V1, V2, V3 and V4. What is the single most likely explanation for the abnormal investigation?