Cardiovascular reviewCardiovascular review

Endocarditis

A 28 yrs old man is brought to ER because of fatigue A 28 yrs old man is brought to ER because of fatigue and fever of and fever of acute onsetacute onset. He has a history of I/V drug . He has a history of I/V drug use. Echo suggests endocarditis of the tricuspid valve. use. Echo suggests endocarditis of the tricuspid valve. He has He has nono past history of valvular heart disease. Blood past history of valvular heart disease. Blood cultures are likely to growcultures are likely to grow

Streptococcus viridansStreptococcus viridans Staph AureusStaph Aureus Treponema PallidumTreponema Pallidum Streptococcus PyogenesStreptococcus Pyogenes

A drug addict presents with two weeks history of fever A drug addict presents with two weeks history of fever and chest pain. On examination a and chest pain. On examination a new systolic murmurnew systolic murmur is heard at the apex. Echocardiogram shows an is heard at the apex. Echocardiogram shows an oscillating massoscillating mass attached to the mitral valve. What is the attached to the mitral valve. What is the diagnosis?diagnosis?

A Mitral stenosisA Mitral stenosis B Cardiac failureB Cardiac failure C Septicemia C Septicemia D Atrial myxomaD Atrial myxoma E Infective Endocarditis. E Infective Endocarditis. Subacute b/c of existing Subacute b/c of existing

lesion of valvelesion of valve

What nail/skin lesion is found in this conditionWhat nail/skin lesion is found in this condition

An i/v drug addict presents with fever and pleuritic chest pain of one weeks duration. You detect on examination a friction rub and a murmur at the left 5th interspace. most likely diagnosis is

Bacterial endocarditis Pericarditis Septicemia pneumonia

A 50 yrs old woman complains of recurrent transient A 50 yrs old woman complains of recurrent transient loss of consciousness and dizziness for 3 months. she loss of consciousness and dizziness for 3 months. she has fever, has fever, severe wt losssevere wt loss, fatigue and breathlessness at , fatigue and breathlessness at rest that is relieved in rest that is relieved in supine position and worse on supine position and worse on standingstanding. O/e febrile, pallor, and clubbing.S1 is delayed . O/e febrile, pallor, and clubbing.S1 is delayed and soft. low pitched sound and soft. low pitched sound (plop(plop) is heard in diastoli ) is heard in diastoli followed by a rumbling murmur and findings vary with followed by a rumbling murmur and findings vary with body position. Echo shows mass arising from atrial body position. Echo shows mass arising from atrial septum septum

Mitral IncompetenceMitral Incompetence Mitral StenosisMitral Stenosis Lt Atrial myxomaLt Atrial myxoma Mitral valve prolapseMitral valve prolapse

Hypertension/hypotension

A 45 yrs old man presents with attacks of light headedness and you detect a pulse of 88 and bp110/80 whilst sitting. As soon as he gets up his pulse is 120 and bp 90/70. most likely diagnosis is postural hypotension

Cardiac arrhythmia TIA Intravascular volume depletion Normal finding

A diabetic presents with light headedness when he gets A diabetic presents with light headedness when he gets up from lying down position. His bp is 120/80 when he up from lying down position. His bp is 120/80 when he is lying down and 90/60 when he stands up. He also is lying down and 90/60 when he stands up. He also has urinary incontinence and ED. The fall in bp is due has urinary incontinence and ED. The fall in bp is due to to

A HypovolemiaA Hypovolemia B AnemiaB Anemia C high blood glucose C high blood glucose D D Autonomic neuropathyAutonomic neuropathy E drug inducedE drug induced

A 60 yrs pt presents with high bp, cardiomegaly, A 60 yrs pt presents with high bp, cardiomegaly, oliguria and weakness. Management should oliguria and weakness. Management should include include

Reducing preloadReducing preload Reducing afterload Reducing afterload prop to BPprop to BP Increasing heart rateIncreasing heart rate Increasing myocardial contractility Increasing myocardial contractility

A 20 yrs old pt presents with headache and light A 20 yrs old pt presents with headache and light headedness. On examination his femoral pulse is weak headedness. On examination his femoral pulse is weak and delayed as compared to radial. Bp is 180/100 in the and delayed as compared to radial. Bp is 180/100 in the upper extremity and 100/60 in the lower and Xray upper extremity and 100/60 in the lower and Xray shows notching of the ribs. Most likely diagnosis is shows notching of the ribs. Most likely diagnosis is

A A Coarctation of aorta----TURNERSCoarctation of aorta----TURNERS B Patent Ductus ArteriosusB Patent Ductus Arteriosus C Congenital aortic stenosisC Congenital aortic stenosis D Conns syndromeD Conns syndrome E PhaeochromocytomaE PhaeochromocytomaWhat genetic disease is this often associated with?What genetic disease is this often associated with?

A 25 yrs old pt presents with A 25 yrs old pt presents with ParoxysmsParoxysms of of headache /palpitations/ hyperhydrosis/flushing Bp is headache /palpitations/ hyperhydrosis/flushing Bp is 200/110 and 2hrs later 140/90200/110 and 2hrs later 140/90

What is the diagnosis: What is the diagnosis: pheo?pheo?

How would you confirm--How would you confirm-- A 30 yrs pt presents with fatigue/weakness A 30 yrs pt presents with fatigue/weakness

/polyurea /muscle cramps. Bp is 180/100 se K 2.5 /polyurea /muscle cramps. Bp is 180/100 se K 2.5 prim hyperaldosteronism CONN’Sprim hyperaldosteronism CONN’S

A lady with SLE A lady with SLE on prednisone on prednisone for ten yrs presents for ten yrs presents with hypertension and impaired glucose tolerance and with hypertension and impaired glucose tolerance and you detect a compression fracture of T10 you detect a compression fracture of T10 CUSHINGCUSHING

During repair of an abdominal aortic aneurysm the During repair of an abdominal aortic aneurysm the anesthesiologist inserts a balloon tipped catheter and anesthesiologist inserts a balloon tipped catheter and feeds it through to the patient’s feeds it through to the patient’s pulmonary arterypulmonary artery. once . once in position, the balloon is inflated and the pressure is in position, the balloon is inflated and the pressure is read. What pressure is he attempting to determineread. What pressure is he attempting to determine

Left Atrial pressureLeft Atrial pressure Left ventricular end systolic pressureLeft ventricular end systolic pressure Pulmonary artery pressurePulmonary artery pressure Right atrial pressureRight atrial pressure

You have been a family physician of a couple You have been a family physician of a couple who have been trying to have a baby. The who have been trying to have a baby. The woman visits your clinic for woman visits your clinic for a pregnancy a pregnancy test and test and results are positive. What can you predict about results are positive. What can you predict about her blood pressure over the course of pregnancyher blood pressure over the course of pregnancy

It will decreaseIt will decrease It will decrease then come back to baselineIt will decrease then come back to baseline It will increaseIt will increase It will not changeIt will not change

A pt is at emerg complaining of severe A pt is at emerg complaining of severe headache. on exam his bp is 180/110 and it is headache. on exam his bp is 180/110 and it is noted that 4 previous clinic readings over 2 yrs noted that 4 previous clinic readings over 2 yrs have been around 130/90. an hr later it is have been around 130/90. an hr later it is 180/120.on exam you are likely to detect 180/120.on exam you are likely to detect sudden sudden raise of BPraise of BP

Radiofemoral delay in pulse Radiofemoral delay in pulse Assymetrical pulses Assymetrical pulses renal artery bruit—renal artery bruit—renal artery stenosisrenal artery stenosis Bounding pulseBounding pulse

anatomy

A young man presents to ER after being involved in a A young man presents to ER after being involved in a fight. on examination, a one inch fight. on examination, a one inch stabstab wound is noticed wound is noticed at the fourth intercostal space just left of the sternum. at the fourth intercostal space just left of the sternum. which chamber of the heart is most likely to have been which chamber of the heart is most likely to have been penetrated by the knife?penetrated by the knife?

Left atriumLeft atrium Left ventricleLeft ventricle Right atriumRight atrium Right ventricle ant most chamberRight ventricle ant most chamber

A patient presents with H/O hypertension for 10 yrs. A patient presents with H/O hypertension for 10 yrs. While palpating the precordium, a heave is identified at While palpating the precordium, a heave is identified at the apex which is located in the 6th intercostal space at the apex which is located in the 6th intercostal space at the ant axillary line. This finding indicates the ant axillary line. This finding indicates

Mitral regurgitationMitral regurgitation Aortic stenosisAortic stenosis Left ventricular hypertrophyLeft ventricular hypertrophy PericarditisPericarditis Rt ventricular hypertrophyRt ventricular hypertrophy

A 20 yrs lady comes to the clinic with severe shortness A 20 yrs lady comes to the clinic with severe shortness of breath on exertion for 3 months. She has a past of breath on exertion for 3 months. She has a past medical history of Chronic Obstructive Pulmonary medical history of Chronic Obstructive Pulmonary Disease. On examination she is found to have a Disease. On examination she is found to have a left left parasternal heaveparasternal heave, raised JVP, hepatomegaly and , raised JVP, hepatomegaly and peripheral edema. The most likely cause of this heave is:peripheral edema. The most likely cause of this heave is:

a) Left ventricular hypertrophya) Left ventricular hypertrophy b) b) Right ventricular hypertrophy---COR Right ventricular hypertrophy---COR

PULMONALEPULMONALE c) Cardiomegalyc) Cardiomegaly d) Hypertensiond) Hypertension e) Hyperdynamic circulatione) Hyperdynamic circulationMost likely diagnosis is ?Most likely diagnosis is ?

A 60 yrs old lady presents with 20 yrs history of A 60 yrs old lady presents with 20 yrs history of Hypertension. For the last 6 months has developed Hypertension. For the last 6 months has developed fatigue, dyspnea and ankle swelling. On examination fatigue, dyspnea and ankle swelling. On examination she has pulse of 120, Bp 160/90, raised JVP and faint she has pulse of 120, Bp 160/90, raised JVP and faint S3 gallop. what maneuver will augment S3S3 gallop. what maneuver will augment S3

ValsalvaValsalva Lying downLying down StandingStanding Sitting up leaning forwardSitting up leaning forward Hand grip Hand grip (isometric exercise) (isometric exercise)

A 30 yrs lady complains of chest pain for 3 days. A 30 yrs lady complains of chest pain for 3 days. you suspect costocondritis as cause of her chest you suspect costocondritis as cause of her chest pain. what examination technique will you use to pain. what examination technique will you use to confirmconfirm

InspectionInspection PalpationPalpation PercussionPercussion auscultationauscultation

A 30 yrs pregnant lady, chronic smoker develops A 30 yrs pregnant lady, chronic smoker develops dyspnoea and on ex has dyspnoea and on ex has loud P2,loud P2, rt ventricular rt ventricular heave (lt parasternal heave). She is likely to have heave (lt parasternal heave). She is likely to have

Mitral stenosisMitral stenosis Pulmonary hypertensionPulmonary hypertension Cardiac failureCardiac failure High cardiac outputHigh cardiac output

A 58 yrs old man with Marfans syndrome presents with A 58 yrs old man with Marfans syndrome presents with abrupt onset of “abrupt onset of “tearing” chest pain radiating to the tearing” chest pain radiating to the back, on examination: pallor, diaphoretic, BP is 70/20, back, on examination: pallor, diaphoretic, BP is 70/20, asymmetric pulse, declining mental status and CXRasymmetric pulse, declining mental status and CXR widened mediastinumwidened mediastinum. Most likely diagnosis is . Most likely diagnosis is

A Mediastinal tumourA Mediastinal tumour B Myocardial infarctionB Myocardial infarction C Acute DeliriumC Acute Delirium D Aortic dissectionD Aortic dissection E Pulmonary embolismE Pulmonary embolismPredisposing factors?Predisposing factors?

A 55 yrs old male complains of chest pain lasting 5 mts A 55 yrs old male complains of chest pain lasting 5 mts that he had every few months when he walked for 2 that he had every few months when he walked for 2 blocks. this pain went away when he stopped walking. blocks. this pain went away when he stopped walking. For the last 1 month this pain occurs even when he is For the last 1 month this pain occurs even when he is just sitting and has happened 5 times this week and just sitting and has happened 5 times this week and lasted 10mts.your diagnosis is lasted 10mts.your diagnosis is

AnginaAngina MIMI Unstable anginaUnstable angina Prinzmetal anginaPrinzmetal angina

A 35 yrs old lady has several attacks of chest of non exertional chest pain with palpitations. She rushes every time to a dr or ER where her ECG is done and is normal everytime. she suddenly got her attack yesterday in the bus and had to be rushed to hospital. she most likely is having

Angina MI Conversion disorder Panic attack

Arrhythmias

An 80 yrs old diabetic with hypertension and a history of An 80 yrs old diabetic with hypertension and a history of Rheumatic heart disease presents with left sided weakness. On Rheumatic heart disease presents with left sided weakness. On examination pulses are examination pulses are irregularly irregularirregularly irregular, Jugular veins show , Jugular veins show absent absent “a” waves“a” waves and ECG shows and ECG shows absence of “P” wavesabsence of “P” waves Most Most likely diagnosis islikely diagnosis is

A supra ventricular tachycardiaA supra ventricular tachycardia B Multiple Premature ventricular contractionsB Multiple Premature ventricular contractions C C Atrial FibrillationAtrial Fibrillation D Sinus arrythmiaD Sinus arrythmiaHis past med record shows presence of S3 and S4.what can you His past med record shows presence of S3 and S4.what can you

expect to find nowexpect to find nowAbsent S3Absent S3Absent S4Absent S4loud S3loud S3loud S4loud S4

A 40 yrs old lady presents with palpitations, light headed spells and breathlessness. you detect on her ECG short PR interval and slurred QRS upstrokes indicative of delta wave. She likely has

AV block Ventricular Tachycardia WPW syndrome (supraventricular tachycardia) MI AF

Cardiac failure & cardiomyopathy

65 yrs old man with chronic hypertension complains of 65 yrs old man with chronic hypertension complains of recurrent shortness of breath of 2 months. He is a recurrent shortness of breath of 2 months. He is a nonsmoker. examination of the precordium is normal nonsmoker. examination of the precordium is normal except for a prominent apical impulse. echo shows except for a prominent apical impulse. echo shows LVH. radionucleide ventriculography shows LVH. radionucleide ventriculography shows normal normal right and left ejection fractions(60%).right and left ejection fractions(60%). what has caused what has caused his symptomshis symptoms

Cor pulmonaleCor pulmonale Systolic heart dysfunctionSystolic heart dysfunction Diastolic dysfunction Diastolic dysfunction Reactive airway diseaseReactive airway disease

A 70 yrs old patient with history of coronary artery A 70 yrs old patient with history of coronary artery disease presents with worsening dyspnea on exertion, disease presents with worsening dyspnea on exertion, orthopnea and paroxysmal nocturnal dyspnea. On orthopnea and paroxysmal nocturnal dyspnea. On examination there is tachycardia, S3 gallop, bilateral examination there is tachycardia, S3 gallop, bilateral crackles. Cxray shows cardiomegaly and bilateral Kerley crackles. Cxray shows cardiomegaly and bilateral Kerley B lines. B lines. Ejection fraction is 20 %Ejection fraction is 20 %Hemodynamics Hemodynamics associated with this condition includesassociated with this condition includes

A increased Rt ventricular preloadA increased Rt ventricular preload B increased left ventricular preloadB increased left ventricular preload C decreased left ventricular preloadC decreased left ventricular preload D Increased rt ventricular afterloadD Increased rt ventricular afterload E increased left ventricular afterloadE increased left ventricular afterload

A 60 yrs old patient presents with shortness of breath, fatigue and swelling of his abdomen and feet for 5 months. He is a heavy smoker. on examination you detect raised JVP, hepatomegaly, ascites and paedeledema. Chest is clear. The cause of his edema is

LVF Increased plasma oncotic pressure Decreased plasma oncotic pressure in liver cirrhosis Corpulmonale Venous insufficiency

A 50 yrs hypertensive pt presents with edema and is diagnosed with CCF and put on Ramipril, atenolol, diuretic (frusemide), digoxin and slow k. His edema worsens so spironolactone is added. which drug should now be stopped.

Digoxin Frusemide Slow k atenolol

A 25 yrs A 25 yrs lady delivers lady delivers normally and develops breathlessness, normally and develops breathlessness, fatigue and swelling of her feet toward the end of the day 2 fatigue and swelling of her feet toward the end of the day 2 weeks after delivery. she has raised JVP, heaving apical impulse weeks after delivery. she has raised JVP, heaving apical impulse displaced laterally and systolic murmurs at apex and tricuspid displaced laterally and systolic murmurs at apex and tricuspid areas,S3,S4. she also has tender hepatomegaly, basal rhales and areas,S3,S4. she also has tender hepatomegaly, basal rhales and pedeledema. Cxray shows cardiomegaly, pulmonary edema and pedeledema. Cxray shows cardiomegaly, pulmonary edema and ejection fraction is 40%.She likely has ejection fraction is 40%.She likely has

Dilated cardiomyopathyDilated cardiomyopathy Hypertrophic Obstructive cardiomyopathyHypertrophic Obstructive cardiomyopathy Restrictive cardiomyopathyRestrictive cardiomyopathy Cardiac failureCardiac failureWhat type of cardiac dysfunction does she have? What type of cardiac dysfunction does she have? systolicsystolicWhat type of cardiomyopathy will alcoholics and pts with Thiamine What type of cardiomyopathy will alcoholics and pts with Thiamine

def havedef have

A young athlete presents for evaluation with low blood A young athlete presents for evaluation with low blood pressure, bradycardia, Resp rate 12 and a pressure, bradycardia, Resp rate 12 and a systolic systolic murmur along the left lower sternal border.murmur along the left lower sternal border. what what condition do you want to rule out before you allow him condition do you want to rule out before you allow him to participate in athletics ? to participate in athletics ?

HOCM HOCM Before valsalva Before valsalva Dilated cardiomyopathyDilated cardiomyopathy Restrictive cardiomyopathyRestrictive cardiomyopathy Normal finding in athlete after valsalva Normal finding in athlete after valsalva Aortic stenosisAortic stenosisValsalva and standing venous returnValsalva and standing venous returnInspiration and squatting venous returnInspiration and squatting venous returnExercise bp/cardiac output/gallopsExercise bp/cardiac output/gallops

AS

Examination of a patients carotid pulse reveals Examination of a patients carotid pulse reveals 22

impulses impulses in AR and MS in AR and MS or peaks in a patient during ventricularor peaks in a patient during ventricular

systole. Which of the following physical findings systole. Which of the following physical findings

probably will be associated with this pulse?probably will be associated with this pulse? A rumbling diastolic murmur beginning with an Opening snap A rumbling diastolic murmur beginning with an Opening snap

MSMS Decrease in systolic pressure during inspiration Decrease in systolic pressure during inspiration pulsus paradoxic, pulsus paradoxic,

cardiac temponadecardiac temponade Ejection Systolic murmur along lt sternal border in HCM---Ejection Systolic murmur along lt sternal border in HCM---

answeranswer Pan systolic murmur at apex Pan systolic murmur at apex MRMR Left sided S3 Left sided S3 cardiac failurecardiac failure

Split S2

A 26 yrs old lady, asymptomatic, comes for a A 26 yrs old lady, asymptomatic, comes for a physical exam and is found to have heart sounds physical exam and is found to have heart sounds as shown and a systolic murmur in the Pulmonic as shown and a systolic murmur in the Pulmonic area area

Expiration S1 A2 P2 inspiration S1 A2 P2Expiration S1 A2 P2 inspiration S1 A2 P2

Pulmonary StenosisPulmonary Stenosis LBBBLBBB Coarctation of aortaCoarctation of aorta Atrial Septal Defect---embryo: septum Atrial Septal Defect---embryo: septum

primum,secundum, sinus venosusprimum,secundum, sinus venosus Aortic stenosisAortic stenosis

A 6 yrs old child presents for routine examination at a A 6 yrs old child presents for routine examination at a clinic and is found to have a systolic murmur at the left clinic and is found to have a systolic murmur at the left second intercostal space near the sternum. His heart second intercostal space near the sternum. His heart sounds are as follows. What is the most likely sounds are as follows. What is the most likely diagnosis? insp S1 A2 P2 exp S1 A2 P2diagnosis? insp S1 A2 P2 exp S1 A2 P2

A Innocent murmurA Innocent murmur B ASDB ASD C Aortic stenosisC Aortic stenosis D Pulmonic Stenosis----RBBB—MR—MVP?D Pulmonic Stenosis----RBBB—MR—MVP? E Left bundle branch blockE Left bundle branch blockWhat other conditions can have this splitWhat other conditions can have this split

A 40 yrs old man complains of palpitation and A 40 yrs old man complains of palpitation and light headedness off and on for 3 weeks. He had light headedness off and on for 3 weeks. He had a myocardial infarction 2 months ago. On a myocardial infarction 2 months ago. On auscultation you hearauscultation you hear

Inspiration expirationInspiration expiration

S1 S2 S1 P2A2S1 S2 S1 P2A2

A child attends a well baby clinic and the dr A child attends a well baby clinic and the dr detects a soft systolic murmur at the left second detects a soft systolic murmur at the left second interspace.S2 has a split during inspiration interspace.S2 has a split during inspiration only. only. most likely diagnosis is most likely diagnosis is

ASDASD Pulmonic stenosisPulmonic stenosis Innocent murmurInnocent murmur RBBBRBBB

Valvular disease

A 20 yrs old man diagnosed with Marfans syndrome A 20 yrs old man diagnosed with Marfans syndrome complains of fatigue and shortness of breath. O/E you notice complains of fatigue and shortness of breath. O/E you notice his his head nodding, collapsing pulse, detect a wide pulsehead nodding, collapsing pulse, detect a wide pulse pressure Bp (120/40) and his phonocardiogram is as follows. pressure Bp (120/40) and his phonocardiogram is as follows. What is the most likely diagnosis?What is the most likely diagnosis?

A Mitral stenosisA Mitral stenosis B Tricuspid regurgitationB Tricuspid regurgitation C C Aortic IncompetenceAortic Incompetence D Innocent murmurD Innocent murmur E Patent Ductus ArteriosusE Patent Ductus ArteriosusWhere will you hear this murmurWhere will you hear this murmurWhat position will accentuate this murmur?What position will accentuate this murmur?What conditions predispose to this abnormalityWhat conditions predispose to this abnormality

A 70 yrs old diabetic with hypercholesterolemia A 70 yrs old diabetic with hypercholesterolemia presents with angina, syncope, dyspnoea on exertion. presents with angina, syncope, dyspnoea on exertion. On examination his carotid pulse is diminished, slowly On examination his carotid pulse is diminished, slowly rising and there is a crescendo-decrescendo systolic rising and there is a crescendo-decrescendo systolic murmur at second intercostal space at the right upper murmur at second intercostal space at the right upper sternal border, radiating to the neck phonocardiogram sternal border, radiating to the neck phonocardiogram is as shown Most likely diagnosis is is as shown Most likely diagnosis is

A Carotid atherosclerosisA Carotid atherosclerosis C Hypertrophic obstructive cardiomyopathyC Hypertrophic obstructive cardiomyopathy D Aortic StenosisD Aortic Stenosis E Pulmonic StenosisE Pulmonic Stenosis

An i/v drug user presents with chest pain and An i/v drug user presents with chest pain and shortness of breath. you detect raised JVP and shortness of breath. you detect raised JVP and large v waveslarge v waves as well as holosytolic murmur at as well as holosytolic murmur at left 4 ics, left 4 ics, pulsating liverpulsating liver and edema. diagnosis is and edema. diagnosis is

Tricuspid stenosisTricuspid stenosis Mitral stenosisMitral stenosis Tricuspid regurgitationTricuspid regurgitation Complete heart blockComplete heart block

A 32 yrs old teacher is referred to your clinic for A 32 yrs old teacher is referred to your clinic for evaluation of non exertional evaluation of non exertional chest painchest pain. She . She appears anxious and has occasional appears anxious and has occasional skipped skipped beatsbeats and and fatiguefatigue. Predict the findings you are . Predict the findings you are likely to detect On examination. likely to detect On examination.

A early diastolic murmur in the aortic areaA early diastolic murmur in the aortic area B midsystolic click, late systolic murmur B midsystolic click, late systolic murmur C signs of Cardiac failureC signs of Cardiac failure D S3 and S4D S3 and S4 E midsystolic murmur in the Aortic areaE midsystolic murmur in the Aortic area

A 30 yrs old female presents with shortness of breath A 30 yrs old female presents with shortness of breath after exertion of 6 months duration. She was diagnosed after exertion of 6 months duration. She was diagnosed with Rheumatic fever in childhood. you detect the with Rheumatic fever in childhood. you detect the following following rumbling diastolic murmur rumbling diastolic murmur on auscultationon auscultation

Most likely diagnosis is Most likely diagnosis is A ASDA ASD B Mitral IncompetenceB Mitral Incompetence C Tricuspid IncompetenceC Tricuspid Incompetence D Mitral StenosisD Mitral Stenosis

A 25 yrs old patient has cough, shortness of A 25 yrs old patient has cough, shortness of breath and fatigue for 6 months. Cardiac breath and fatigue for 6 months. Cardiac catheterization reveals a pressure of 16 mm in catheterization reveals a pressure of 16 mm in the left atrium and 4 mm end diastolic in left the left atrium and 4 mm end diastolic in left ventricle. This is most likely due to ventricle. This is most likely due to

Rheumatic heart diseaseRheumatic heart disease Ischemic heart diseaseIschemic heart disease Congenital heart diseaseCongenital heart disease cardiomyopathycardiomyopathy

Congenital heart disease

A 13 months old baby presents with paroxysms of dyspnea A 13 months old baby presents with paroxysms of dyspnea followed by loss of consciousness for 1-2 minutes. She is often followed by loss of consciousness for 1-2 minutes. She is often seen squatting after playing. O/E you detect clubbing, central seen squatting after playing. O/E you detect clubbing, central cyanosis, a lt parasternal heave and an ejection systolic murmur cyanosis, a lt parasternal heave and an ejection systolic murmur at left 2nd intercostal space Her chest xray shows a boot shaped at left 2nd intercostal space Her chest xray shows a boot shaped heart and heart and decreased pulmonary vascularitydecreased pulmonary vascularity. This is due to. This is due to

Septum secondum defSeptum secondum def Unequal division of Truncus Arteriosus by conotruncal septumUnequal division of Truncus Arteriosus by conotruncal septum Endocardial cushion defEndocardial cushion def Looping defectLooping defect spiraling defectspiraling defect

A 2 yrs old child, has severe stridor and dysphagia. A 2 yrs old child, has severe stridor and dysphagia. Assuming she has a vascular ring this is Assuming she has a vascular ring this is embryologicaly due toembryologicaly due to

Improper spiraling of the septumImproper spiraling of the septum Looping defectLooping defect Endocardial cushion defectEndocardial cushion defect Aortic arch defectAortic arch defect

A neonate (4kgs birth weight) born of diabetic mother A neonate (4kgs birth weight) born of diabetic mother is seen to have severe cyanosis and is diagnosed with is seen to have severe cyanosis and is diagnosed with cyanotic congenital heart disease. cyanotic congenital heart disease. prostaglandin Eprostaglandin E is is given as the baby is prepared for surgery. most likely given as the baby is prepared for surgery. most likely diagnosis isdiagnosis is

Fallots tetralogyFallots tetralogy Tricuspid AtresiaTricuspid Atresia Transposition of the great Arteries—SPIRLING defectTransposition of the great Arteries—SPIRLING defect Hypoplastic ventricleHypoplastic ventricleWhat embryological defect has caused thisWhat embryological defect has caused this

A 2 days old baby, born by ceasarean section is noted to have blue lips and tongue and on auscultation has a systolic murmur. cxray shows an enlarged heart. Most likely diagnosis is

PDA Coarctation of Aorta Bicuspid Aortic valve Transposition of the Great arteries

A five month old girl is breathless after feeds. She A five month old girl is breathless after feeds. She was born full term and is alert. Examination reveals a was born full term and is alert. Examination reveals a loud holosystolic murmur in left lower parasternal loud holosystolic murmur in left lower parasternal region, no cyanosis/clubbing. phonocardiogram is as region, no cyanosis/clubbing. phonocardiogram is as shown. Catheterization shows increased oxygen shown. Catheterization shows increased oxygen saturation in the rt ventricle Which is the most likely saturation in the rt ventricle Which is the most likely diagnosis?diagnosis?

ASDASD PDAPDA Patent Foramen OvalePatent Foramen Ovale Pulmonic stenosisPulmonic stenosis VSDVSD

A 2 yrs boy born premature presents with shortness of A 2 yrs boy born premature presents with shortness of breath after playing. On examination you detect dilated breath after playing. On examination you detect dilated pulsating neck vessels a pulsating neck vessels a pulse pressure of 80pulse pressure of 80 and a loud and a loud machinery murmur machinery murmur as shown at the left first to third as shown at the left first to third intercostal space. Most likely diagnosis is intercostal space. Most likely diagnosis is

A VSDA VSD B Fallots tetralogyB Fallots tetralogy C ASDC ASD D Patent ductus arteriosusD Patent ductus arteriosusWhat drug is tried before surgeryWhat drug is tried before surgeryWhat maternal condition is associated with thisWhat maternal condition is associated with this

A 10 yrs old girl diagnosed with Fallots tetralogy dies and autopsy is done. This is likely to reveal

ASD Decreased pulmonary vascularity Increased pulmonary vascularity Left Atrial hypertrophy Left ventricular hypertrophy

A child is born with craniofacial abnormalities, A child is born with craniofacial abnormalities, hypoplasia of thymus and hypoparathyroidism and hypoplasia of thymus and hypoparathyroidism and cyanotic congenital heart disease. maldevelopment of cyanotic congenital heart disease. maldevelopment of which structure results in this defect which structure results in this defect

Aortic archesAortic arches Endocardial cushionEndocardial cushion Neural crest cellsNeural crest cells Cardiac loopingCardiac looping

Which cardiac defect is associated with this syndrome Which cardiac defect is associated with this syndrome

Summary: Congenital Defects

ASD: septum primum/secundum/sinus venosus VSD: endocardial cushion defect Persistent Truncus Arteriosus: Bulbus cordis (absent

conotruncal(aortico-pulmonary septum) Transposition of GA: spiralling defect Dextrocardia &Corrected TGA: looping defect Fallots tetralogy: unequal division of Truncus

Arteriosus resulting in narrow PA and wide Aorta Vascular ring : Aortic arch defect

Pericardial disease

A 47 yrs old man had a myocardial infarction 3 days A 47 yrs old man had a myocardial infarction 3 days ago and was recovering. suddenly develops ago and was recovering. suddenly develops hypotension. O/E pulse is 120, weak and thready, hypotension. O/E pulse is 120, weak and thready, tachypnec, pale, cool sweaty skin, tachypnec, pale, cool sweaty skin, Bp 90/50 which is Bp 90/50 which is noted as 60/30 during inspiration,noted as 60/30 during inspiration, JVP is raised, chest JVP is raised, chest clear and heart sounds are muffled. Cxray shows clear and heart sounds are muffled. Cxray shows globular heart shadow. Most likely diagnosis isglobular heart shadow. Most likely diagnosis is

A Pulmonary edemaA Pulmonary edema B PericarditisB Pericarditis C Cardiac TamponadeC Cardiac Tamponade D LBBBD LBBB E HypovolemiaE Hypovolemia

A 27 yrs old man presents to the ER after experiencing A 27 yrs old man presents to the ER after experiencing substernal chest pain radiating to the arm. The pain is substernal chest pain radiating to the arm. The pain is worse on inspiration and relieved by leaning forwardsworse on inspiration and relieved by leaning forwards. . He says he recently recovered from an upper He says he recently recovered from an upper respiratory infection. O/E pulse is 120, Bp 120/70 respiratory infection. O/E pulse is 120, Bp 120/70 Cardiac exam reveals a Cardiac exam reveals a friction rubfriction rub and distant heart and distant heart sounds. ECG shows elevated ST segments across all sounds. ECG shows elevated ST segments across all the chest leads. Most likely diagnosis isthe chest leads. Most likely diagnosis is

A Acute myocardial infarctionA Acute myocardial infarction B PericarditisB Pericarditis C Cardiac TamponadeC Cardiac Tamponade D PleurisyD Pleurisy E Viral myocarditisE Viral myocarditisWhat is the causative organismWhat is the causative organism

A 70 year old woman presents to you with shortness A 70 year old woman presents to you with shortness of breath, fatigue, and abdominal distension.10 years of breath, fatigue, and abdominal distension.10 years ago she underwent a lumpectomy for left breast ago she underwent a lumpectomy for left breast carcinoma, followed by 6 weeks of local radiotherapy. carcinoma, followed by 6 weeks of local radiotherapy. O/E she has a raised JVP which increases O/E she has a raised JVP which increases with with inspiration (kussmauls sign)inspiration (kussmauls sign), BP 98/7O, , BP 98/7O, reduced reduced pulse pressurepulse pressure, a weak pulse. Her , a weak pulse. Her heart sounds are heart sounds are faintfaint and she has ascites, hepatomegaly and and she has ascites, hepatomegaly and paedeledema. what is the most likely diagnosis?paedeledema. what is the most likely diagnosis?

b) Tracheobronchial obstructionb) Tracheobronchial obstruction c) Overmedicated with her antihypertensivesc) Overmedicated with her antihypertensives d) Late onset asthmad) Late onset asthma e) Constrictive pericarditise) Constrictive pericarditis

A 60yrs old patient presents to ER with acute onset of shortness A 60yrs old patient presents to ER with acute onset of shortness of breath and severe stabbing chest pain.. He underwent a of breath and severe stabbing chest pain.. He underwent a prostatectomy 3 weeks ago and prostatectomy 3 weeks ago and was in bed for 2 weekswas in bed for 2 weeks as he as he developed surgical wound infection . O/E you find him in developed surgical wound infection . O/E you find him in severe respiratory distress with Bp 90/60 Heart rate 110/mt severe respiratory distress with Bp 90/60 Heart rate 110/mt respiratory rate 40/mt Oxygen saturation of 77% on room air. respiratory rate 40/mt Oxygen saturation of 77% on room air. He is cyanosed, JVP is raised, trachea is central and Breath He is cyanosed, JVP is raised, trachea is central and Breath sounds are reduced on the right side. EKG:S1Q3T3 Most likely sounds are reduced on the right side. EKG:S1Q3T3 Most likely diagnosis is diagnosis is

A Rt Pleural EffusionA Rt Pleural Effusion B Acute MI B Acute MI C PericarditisC Pericarditis D Rt Lobar PneumoniaD Rt Lobar Pneumonia E E Pulmonary EmbolismPulmonary Embolism

A 55 yrs old construction worker presents for A 55 yrs old construction worker presents for evaluation of painful legs. He smoked 2 pkts cigarettes evaluation of painful legs. He smoked 2 pkts cigarettes daily since age 15.He has noticed pain in both buttocks daily since age 15.He has noticed pain in both buttocks and legs when walking relieved with resting for 10 and legs when walking relieved with resting for 10 minutes. O/E dorsalis pedis, femoral pulses are absent minutes. O/E dorsalis pedis, femoral pulses are absent bilaterally but radial is present. His feet are cool, no bilaterally but radial is present. His feet are cool, no edema and less hair growth. Most likely diagnosis isedema and less hair growth. Most likely diagnosis is

A DVTA DVT B Aortoiliac bifurcation occlusionB Aortoiliac bifurcation occlusion C coarctation of AortaC coarctation of Aorta D Femoral artery obstructionD Femoral artery obstruction

A 30 yrs old pt sustains gunshot wound over the A 30 yrs old pt sustains gunshot wound over the femoral region and undergoes surgery.3 months femoral region and undergoes surgery.3 months later at follow up he is seen to have a bruit and later at follow up he is seen to have a bruit and thrill over the same region.thrill over the same region.

AneurysmAneurysm AV fistulaAV fistula OcclusionOcclusion Surgical scarSurgical scar

Trace the sequence of valvular events after the P Trace the sequence of valvular events after the P wave on the ECGwave on the ECG

A Closure of Mitral/tricuspid, followed by A Closure of Mitral/tricuspid, followed by opening of Aortic/pulmonic, closure of A/P opening of Aortic/pulmonic, closure of A/P finally opening of M/Tfinally opening of M/T

B closure of A/P foll by opening M/T then B closure of A/P foll by opening M/T then closure of M/T finaly opening A/Pclosure of M/T finaly opening A/P

C closure of M/T foll by op of M/T then clos C closure of M/T foll by op of M/T then clos of A/P foll by op of A/Pof A/P foll by op of A/P