Ed-10 page 525-544

1. A 41-year-old man is admitted with left-sided pleuritic chest pain. He has a dry cough and reports that the pain is relieved by sitting forward. For the past three days he has been experiencing flu-like symptoms. Given the likely diagnosis, what is the most likely finding on ECG?

2. A 15-year-old collapses and dies whilst playing football and school. He had no past medical history of note. Post-mortem examination reveals asymmetric concentric enlargement of the myocardial septum. What is the the likely diagnosis?

3. Which one of the following features would indicate cardiac tamponade rather than constrictive pericarditis?

4. Which one of the following is least likely to cause dilated cardiomyopathy?

5. You get bleeped in the middle of your night shift to talk to a worried father who's daughter has been admitted with cyanosis. He tells you that they were aware she has had a murmur since birth, but it has only been the last few days in which she has had symptoms. You believe that this is a case of Eisenmenger's syndrome. What is the medical definition of Eisenmenger's syndrome?

6. A 44-year-old gentleman presents to the emergency department with chest pain. As the acting cardiology registrar, you are asked to see him immediately as he ECG shows ST segment elevation in multiple leads. When you arrive, he is sitting in bed leaning forward to rest his arms on his knees. His past medical history includes hypertension, type 1 diabetes mellitus (diagnosed aged 11) and his father died from a myocardial infarction age 60. In addition to this, he tells you he has been well recently apart from a slight 'sore throat' 2 weeks ago that cleared up with no problems. He first noticed the chest pain 4 hours ago while still in bed this morning and he describes it as left sided chest pain with no radiation. He has taken 1g paracetamol with minimal improvement. Given the likely diagnosis, which of the following is the most specific ECG finding in this condition?

7. You are on the cardiac arrest team and are called to the emergency department for a 25-year-old male who has arrived in cardiac arrest. He collapsed while playing football. His brother is present: he reports that their father died suddenly in his 30s and they were later told he had hypertrophic obstructive cardiomyopathy (HOCM). Screening had been discussed with both his children but this had not happened yet. Assuming the diagnosis is the same, which of the following is likely to confer the poorest prognosis?

8. Following Components of tetralogy of Fallot:except

9 .most Common causes of pericardial effusion in BD

10. Acyanotic cong heart disease : except

11.Six weeks after having a prosthetic heart valve a patient develops infective endocarditis. What is the most likely causative organism?

12. A 58-year-old man is admitted to the cardiology ward after presenting with fever, malaise and a new murmur. An echocardiogram has shown a vegetation on the aortic valve. Blood cultures are reported as follows: Streptococcus sanguinis isolated What is the most appropriate follow-up given the blood culture results?

13.Which one of the following features is not part of the modified Duke criteria used in the diagnosis of infective endocarditis?

14. What is the most common cause of cyanosis of a 1.5 year child?

15. Which finding we get in long standing IE?

16. A 40-year-old woman who is being treated for refractory hypertension undergoes a coronary angiogram after developing non-specific chest pains. The cardiologist takes a number of measurements during the procedure: Pressure (mmHg) Right femoral artery 122/68 Left ventricle 202/104 Aorta 194/84 The blood pressure in her left arm taking during the procedure was 188/74 mmHg. What is the most likely underlying diagnosis?

17.A 74-year-old man with symptomatic aortic stenosis is reviewed in the cardiology clinic. He is otherwise fit and well and keen for intervention if possible. What type of intervention is he most likely to be offered?

18.Which of the following congenital heart defects may progress to Eisenmenger's syndrome?

9.Which of the following congenital heart defects is associated with a bicuspid aortic valve

20. A 67-year-old diabetic gentleman who recently underwent aortic valve replacement presented with a fever, raised inflammatory markers and deranged renal function. Which one of the following organisms contribute to the highest rate of mortality in patients with his condition?