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30
DISEASES OF THE CARDIOVASCULAR SYSTEM
38
The following are recognised
complications of heart failure
hyponatraemia
O hypoalbuminaemia
© impaired liver function tests
© anaemia
^sudden death
39
With regard to angiotensin-converting
enzyme (ACE) inhibitors
0 ACE inhibitors reduce the conversion of
angiotensinogen to angiotensin I
G enalapril is a pro-drug
© cough is a less common side-effect of
ACE inhibitors than angiotensin II
antagonists
© first dose hypotension occurs less
commonly in patients pretreated with
diuretics
concurrent use of non-steroidal anti­
inflammatory therapy increases the
likelihood of severe renal dysfunction
40
In chronic biventricular cardiac failure
/0?angiotensin II contributes to renal salt
and water retention
O excess ADH is the major cause of
oedema
© hyponatraemia usualy indicates total
body sodium depletion
© cardiac sympathetic neural activity is
markedly diminished
© atrial natriuretic peptide is released
3 Fl
41
In the management of chronic heart
failure
O ACE inhibitor therapy reduces
subsequent hospitalisation rates
O coagulation is irnpairec and
thromboembolic risk therefore dedines
© drug suppression of ventricular
arrhythmia improves prognosis
© B-adrenoreceptor antagonists (B-
blockers) should always be avoided
© digoxin is only of benefit if atrial
fibrillation coexists
42
The diagnosis of rheumatic fever in a
patient with an elevated ASO
(antistreptolysin O) titre is confirmed by
O fever with an elevated erythrocyte
sedimentation rate
O arthralgia and a previous history of
rheumatic fever
chorea and a prolonged PR interval on
ECG
erythema nodosum and arthritis
rheumatic nodules and pancarditis
43
In patients with significant mitral
the mitral valve orifice is reduced from
5 cm2 to about 1 cm2
O a history of rheumatic lever or chorea is
elicited in over 90% of patients
© left atrial enlargement cannot be detected
on the chest X-ray
© the risk of systemic emboli is trivial in
p. sinus rhythm
©ynitral balloon valvuloplasty is not
' advisable if there is also significant mitral
regurgitation
28
DISEASES OF THE CARDIOVASCULAR SYSTEM
26
Digoxin
0 shortens the refraclory period of
conducting tissue
0 usually converts atrial flutter to sinus
rhythm
acts primarily on cell membrane ionic
pumps
0 effects are potentiated by hyperkalaemia
©is a recognised cause of ventricular
^arrhythmias
27
The cardiac drugs listed below are
associated with the following adverse
effects
0 digoxin—acute confusional state
0 verapamil—constipation
0;, amiodarone—photosensitivity
© propafenone—comeal microdeposits
©lignocaine—convulsions
28
In the classification of anti-arrhythmic
drugs, the following statements are true
di class I agents inhibit the fast sodium
(channel
0 'class II agents are 6-adrenoreceptor
antagonists
<g class III agents prolong the action
potential
® class IV agents inhibit the slow calcium
. channel
(a many antiarrhythmic agents have actions
I in more than one class
3 CT
29
In echocardiography
O endocarditis can be reliably excluded by
transthoracic echocardiography (TTE)
0 transoesophageal echocardiography
(TOE) is used to evaluate prosthetic
mitral valve dysfunction
0 normal Doppler-derived intracardiac flow
velocities are around 1 cm/sec
0 intracardiac clot cannot be distinguished
k from normal endocardial tissue
0 the pressure gradient between two
cardiac chambers approximates to four
times the square of blood flow velocity
between the chambers squared (P =
4 x V2)
30
Amiodarone therapy
O prolongs the plateau phase of the action
, potential
0 potentiates the effect of warfarin
0 is useful in the prevention of ventricular
but not supraventricular tachycardia
© should be withdrawn if comeal deposits
occur
0 has a significant negative inotropic action
31
The following statements about
atrioventricular block are true
O first degree block produces a soft first
' heart sound
0 the PR interval is fixed in Mobitz type I
second-degree block
0 decreasing PR intervals suggests
Wenckebach's phenomenon
© irregular cannon waves in the jugular
venous pressure suggest complete heart
block
0 the QRS complex in complete heart block
is always broad and bizarre
29
 DISEASES OF THE CARDIOVASCULAR SYSTEM
65
The following statements about the
prognosis of acute myocardial Infarction
are true
occur within the first 24
©' stress and social isolation adversely
; affect the prognosis
0 the 5-year survival is 75% for those who
. leave hospital
©Mate mortality is determined by the extent
L/of myocardial damage
0 survivors of ventricular fibrillation (VF)
have a worse prognosis if VF occurs
within the first 6-12 hours after the onset
of symptoms rather than 6-12 days later
66
The following statements about systemic
hypertension are true
O Casual blood pressure (BP) recordings
correlate poorly with life expectancy
O Systolic hypertension alone is of little
prognostic value
0 Most patients have a normal plasma
renin concentration
/'©/15% of the adult UK population have
essential hypertension
O 15% of hypertensives have hypertension
secondary to other d sorders
67 -
Recognised causes of secondary
hypertension include
O persistent ductus artenosus
O primary hyperaldosteronism
0 acromegaly
© oestrogen-contaming oral contraceptives
0 thyrotoxicosis
41 of 288
DISEASES OF THE CARDIOVASCULAR SYSTEM
68
In a patient with systemic hypertension,
the findings listed below suggest the
following diagnoses
O symmetrical small joint polyarthritis—
hyperparathyroidism
o radio-femoral delay in lhe pulses—
renovascular disease
0 left ventricular failure—
phaeochromocytoma
© epigastric bruit—coarctation of the aorta
0 palpably enlarged kidneys—renovascular
disease
69
Complications of systemic hypertension
include
O retinal microaneurysms
O dissecting aneurysm ol lhe ascending
y aorta
© renal artery stenosis
© lacunar strokes of the internal capsule
0 subdural haemorrhage
70
In the investigation of systemic
hypertension
O hyperkalaemic metabolic acidosis
indicates hyperaldosteronism
O excretion urography is useful in the
diagnosis of renal artery stenosis
0 normal urinary 5-HIAA excretion makes
the diagnosis of phaeochromocytoma
unlikely
© urine analysis for blood, protein and
glucose is essential
0 the commonest cause of electrolyte
abnormalities is diuretic treatment
71
Accelerated phase or malignant
hypertension is suggested by
hypertension and
O a loud second heart sound "
O a heaving apex beat
©headache
© retinal soft exudates or haemorrhages
0 * renal or cardiac failure
35
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39

DISEASES OF THE RESPIRATORY

4 SYSTEM
ANSWERS PAGE 184

5
Finger clubbing is a typical finding In In the normal adult
O chronic bronchitis O the transverse fissure separates the right
O bronchiectasis middle lobe from the right lower lobe
0 primary biliary cirrhosis 0 the left main bronchus is more vertical
C cryptogenic fibrosing alveolitis than the right
0 ventricular septal defect 0, the left upper lobe lies anterior to the left
lower lobe
2 ©the oblique fissure extends from the
Typical chest findings in a large right thoracic vertebral level T3
pleural effusion include 0 pulmonary surfactant is secreted by type
O normal chest expansion I pneumocytes
0 dull percussion note
0 absent breath sounds 6
(? vocal resonance decreased An increase In ventilatory rate is
0 pleural friction rub associated with
ft lactic acidosis
3 0 respiratory alkalosis
Typical chest findings In right lower lobe 0 exercise
consolidation Include fever
<J decreased chest expansion 0 decrease in arterial PaCO2
dull percussion note
0 decreased breath sounds 7
<|))increased vocal resonance In the normal resting adult
0 rhonchi and crepitations O pulmonary ventilation is 10 litres per
minute
4 C alveolar ventilation is 5 litres per minute
Typical chest findings in right lower lobe 0 pulmonary Wood flow is 10 litres per
collapse include minute
<3 decreased chest expansion © the PaO2 is 11-13 kPa and PaCO2 is
0 stony dull percussion note 4.8-6.0 kPa
0 bronchial breath sounds 0 pulmonary blood flow is higher at the
© decreased vocal resonance lung base
0 crepitations

46. of 288
40
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DISEASES OF THE RESPIRATORY SYSTEM 4 EB

73
Occupational exposure to the following In a patient with a symptomatic pleural
substances produces an extrinsic effusion
allergic alveolitis O physical signs in the chest are invariably
O cotton dust—bagassosis present
G mouldy hay—farmer’s lung O pleural biopsy should be avoided given a
0 tin dioxide—siderosis protein content of 50 g/L
© avian protein—bird fancier's lung © tuberculosis can be excluded If the chest
O mouldy barley—byslnncsis X-ray is otherwise normal
© lymphocytosis in the pleural fluid is
74 pathognomonic of pleural tuberculosis
The following statement! about 0 milky pleural fluid suggests thoracic duct
sarcoidosis are true obstruction
O pulmonary lesions typically cavitate
O the tuberculin tine test is usually positive 78
© erythema marginatum is a characteristic Typical features of an empyema thoracis
finding include
© spontaneous resolution is unusual O bilateral effusions on chest X-ray
0 hypercalcaemia suggests skeletal 9/a fluid level on chest X-ray suggests a
involvement bronchopleural fistula
© persistent pyrexia despite antibiotic
75 y therapy
Typical features of subacute sarcoidosis recent abdominal surgery
Include bacteriological culture of the organism
& hilar lymphadenopathy on chest X-ray despite antibiotic therapy
O cranial neuropathies
9 conjunctivitis 79
© erosive polyarthritis The following statements about
0 swollen parotid glands spontaneous pneumothorax are true
O breathlessness and pleuritic chest pain
76 are usually present
A pleural effusion with a protein content O bronchial breathing is audible over the
of 50 g/L would be compatible with affected hemithorax
O congestive cardiac failure (CCF) © absent peripheral lung markings on chest
pulmonary infarction X-ray suggests tension
9 subphremc abscess O surgical referral is required if there is a
© pneumonia bronchopleural fistula
0 nephrotic syndrome G pleurodesis should be considered for
recurrent pneumothoraces

80
The following are causes ol an elevated
hemidiaphragm
O recurrent laryngeal nerve paralysis
©surgical lobectomy
0 ibphremc abscess
© severe pleuritic pain
0 chronic severe asthma

49

55 of 288

4 DISEASES OF THE RESPIRATORY SYSTEM


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15
The following statements about oxygen
therapy are true
O at sea level, the pressure of oxygen in
\ ' inspired air is 20 kPa
Q chronic domiciliary oxygen therapy is
indicated only when PaO2 is < 6 kPa
0 dissolved oxygen contributes to tissue
Z’oxygenation in anaemia
0 oxygen toxicity in adults can produce
retrolental fibroplasia
central cyanosis unresponsive to 100%
oxygen indicates right-to-left shunting of
>20%
16
In the treatment of chronic bronchitis
associated with type II respiratory failure
O oxygen should be given so that the
inspired oxygen content should be at
least 40%
0 nebulised doxapram improves small
airways obstruction
© cough disturbing sleep should be treated
with pholcodine
0 corticosteroid therapy is usually
contraindicated
0 respiratory support should be considered
pH falls below 7.26
The following respiratory disorders are
indications for heart-lung transplantation
O bronchial adenocarcinoma
O cystic fibrosis
0 cryptogenic pulmona'y fibrosis
yp primary pulmonary hypertension
0 hepatopulmonary syndrome
18
The respiratory disorders listed below
are commonly due to the following viral
infections
0 laryngotracheobronchitis (croup)—
Coxsackie A virus
O epiglottitis—rhinoviruses
0 j bronchiolitis—respiratory syncytial virus
© viral pneumonia—enteroviruses
0 pharyngoconjunctival fever—echoviruses
42
DISEASES OF THE RESPIRATORY SYSTEM
24
Tvnical features of klebsiella nneumonia
a fit D 62% a 5:23 AM
R 71
19
Typical clinical features of acute
tracheobronchitis include
O an irntating unproductive cough at onset
0 supennfection with Staphylococcus
aureus
0 retrosternal chest pain
' pyrexia and neutrophi leucocytosis
crepitations rather than rhonchi on
auscultation
Characteristic features of pneumococcal
pneumonia include
O sudden onset of rigors and pleuritic pain
0 peak frequency in childhood and old age
0 lobar collapse and diminished breath
sounds
0: bacteraemia and neutrophil leucocytosis
0 herpes labialis
21
Recognised complications of
pneumococcal pneumonia include
O bronchial carcinoma
pericarditis
penpheral circulatory failure
pleural effusion and empyema
0 subph rente abscess
22
The following features suggest a poor
prognosis in pneumonia
G diastolic blood pressure of 50 mmHg
(^confusion
0 respiratory rate of 20 breaths per minute
,/■© blood urea of 9 mmoLI
O white cell count of 3000 x 10*/L
23
Typical features of staphylococcal
pneumonia include
an illness clinically indistinguishable from
pneumococcal pneumonia
© multiple lung abscesses appearing as
thin-walled cysts
association with influenza A infection
© staphylococcal sepsis elsewhere in the
body
penicillin resistance
4 Fl
28
Pneumonia In the immunocomoromised

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40
8 11
In the central control of breathing
O fever reduces the sensitivity of the
respiratory centre
O only central chemoreceptors are sensitive
to arterial RCO?
0 peripheral chemoreceptors are sensitive
only to artenal PO2
© chronic alveolar hypoventilation
decreases sensitivity to arterial PCO2
© chest wall and pulmonary stretch
receptors stimulate ventilation during
exercise
9 12
Alveolar hypoventilation is typically
associated with
O pulmonary embolism
severe chest wall deformity
salicylate intoxication
© pulmonary fibrosis
O severe chronic bronchitis
10
The following statements about
pulmonary function tests are true
O over 80% of vital capacity can normally
be expelled in 1 second
O the transfer factor is measured using
inspired oxygen
bronchitis and emphysema
© the forced expiratory volume
(FEVyiorced vital capacity (FVC) ratio is
usually normal in ankylosing spondylitis
O peak expiratory flow rates accurately
reflect the seventy of restrictive lung
disorders
47 of 288
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DISEASES OF THE RESPIRATORY SYSTEM 4 EB
In a patient with severe acute
breathlessness:
O a normal artenal PaO? invariably
suggests psychogenic hyperventilation
O pulsus paradoxus is pathognomic of
acute asthma
0 a normal chest X-ray excludes pulmonary
embolism
the extremities are typically cool and
sweaty in left ventricular failure
O left bundle branch block is strongly
suggestive of pulmonary embolism
The following are recognised causes of
haemoptysis
^tuberculosis
O chronic obstructive pulmonary disease
© bronchiectasis
© Goodpasture's syndrome
© mitral stenosis
13
The following disorders characteristically
produce type I respiratory failure
O kyphoscoliosis
O Guillain-BarrO polyneuropathy
© adult (acute) respiratory distress
syndrome (ARDS)
©, extrinsic allergic alveolitis
O inhaled foreign body in a major airway
The following disorders characteristically
produce type II respiratory failure
heroin overdose
0 pulmonary embolism
© cryptogenic fibrosing alveolitis
O bronchial asthma
41
 DISEASES OF THE
CARDIOVASCULAR SYSTEM
ANSWERS PAGE 172

1
The pain of myocardial ischaemia In the normal human heart
0 is typically induced by exerase and O the atnoventricular (AV) node is usually
' relieved by rest supplied by the left circumflex coronary
O radiates to the neck and jaw but not the z. artery
teeth Oi Bi-adrenoreceptors mediate chronotropic
O rarely lasts longer than 10 seconds after responses
resting & pulmonary artery systolic pressure
© is easily distinguished from oesophageal normally varies between 90 and 140
pain mmHg
6 invariably worsens as exerase continues © the annulus fibrosus aids conduction of
impulses from the atria to the ventricles
2 0 cardiac output is the product of heart rate
Syncope and ventricular end-diastolic volume
0 followed by faaal flushing suggests a
tachyarrhythmia 5
O without warning suggests a vaso vagal In the normal electrocardiogram
episode 0 the PR interval is measured from the end
© on exercise is a typical feature of mitral of the P wave to the beginning of the R
regurgitation , wave
© is the commonest cause of falls among O each small square represents 40
. elderly patients milliseconds at a standard paper speed
/©Its a recognised presenting feature of of 25 mm/sec
pulmonary embolism (? the heart rate is 75 per minute if the R-R
interval measures 4 cm
3 © R waves become progressively larger
Recognised features of severe cardiac C/ from leads V,-V6
ilure include O the P wave represents sinoatrial node
tiredness depolarisation
o weight loss
epigastric pain 6
© noctuna The pulse characteristics listed below are
nocturnal cough typical features of the following disorders
0 pulsus bisfenens—combined mitral
stenosis and regurgitation
O pulsus paradoxus—aortic regurgitation
© collapsing pulse—severe anaemia
© pulsus alternans—extrasystoles every
alternate beat
© slow rising pulse—mitral stenosis

25

Q3 DISEASES OF THE CARDIOVASCULAR SYSTEM


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n 3 DISEASES OF THE CARDIOVASCULAR SYSTEM
58
Unstable angina is
O invariably preceded by a history of effort
. angina
O associated with progression to
myocardial infarction in 15% of cases
© due to plaque rupture, thrombosis or
Cz coronary artery spasm
© an indication for immediate exercise
testing to assess prognosis
© best managed by emergency coronary
artery bypass surgery
59
The clinical features of acute myocardial
infarction include
Z® nausea and vomiting
O breathlessness and angor animi
© hypotension and peripheral cyanosis
© sinus tachycardia or sinus bradycardia
G absence of any symptoms or physical
\J signs
60
Findings consistent with an acute
anterior myocardial infarction include
© hypertension and raised jugular venous
pressure
O rumbling low-pitched diastolic murmur at
the cardiac apex
© ST elevation > 2 mm in leads II. Ill and
AVFonECG
(• gallop rhythm and soft first heart sound
© an increased serum gamma-glutamyl
transferase activity > 300 i.uJL
61
Drug therapies which improve the long-
£ term prognosis after myocardial
infarction include
Q aspirin
6 nitrates
© calcium antagonists
© ACE inhibitors
I OjB-blockers
40
S fi uillS 74% B 9:11 PM
* 71
62
Coronary artery thrombolysis with
streptokinase therapy is
O of no proven benefit to patients over the
age of 75 years
O more beneficial in patients with ST
depression than ST elevation
© relatively contraindicated in patients with
uncontrolled hypertension
© best avoided in patients with chest pain
without elevation of serum creatine
kinase activity
© more likely to cause anaphylactic shock
than therapy with tissue plasminogen
activator
63
In the treatment of acute mydcardial
infarction
©aspirin given within 6 hours of onset
. reduces the mortality
O streptokinase therapy reduces infarct size
and mortality by > 25%
©/diamorphine is better given intravenously
than by any other route
© immediate calcium channel blocker
therapy reduces the early mortality rate
© mobilisation should be deferred until
cardiac enzymes normalise
64
In the treatment of arrhythmias following
acute myocardial infarction
© atropine should be given for all sinus
bradycardias
O frequent ventricular ectopics usually
require lignocaine therapy
© complete head block in inferior infarcts
usually requires endocardial pacing
© lignocaine therapy should be given before
cardioversion for ventricular fibrillation
©Jcardioversion is indicated for all
Z tachyarrhythmias inducing acute
circulatory collapse
288

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[I 3 DISEASES OF THE CARDIOVASCULAR SYSTEM
72
In the emergency treatment of
accelerated hypertension
O the aim is to lower the systolic blood
pressure to normal within 60 minutes
0 intravenous sodium nitroprusside is
usually necessary to control the severe
hypertension
© parenteral therapy is preferable to oral
therapy
© vasodilator therapy to reduce the
afterload should be used
G ACE inhibitors are indicated if renal
artery stenosis is suspected
73
In the treatment of mild to moderate
systemic hypertension
treatment has more effect on the nsk of
7 stroke than the risk of coronary heart
disease
O weight reduction is more important to
prognosis than stopping smoking
© treatment is less likely to be of benefit if
cardiac or renal disease are present
© there are no proven benefits of therapy in
, patients aged over 70 years
G moderation of alcohol consumption is
likely to improve blood pressure control
74
Important explanations for hypertension
refractory to medical therapy include
3 poor compliance with drug therapy
O inadequate drug therapy
© phaeochromocytoma
© primary hyperaldosteronism
Q renal artery stenosis
75
In the drug treatment of hypertension
O thiazides exert their maximal effect after
1 week of treatment
Q lipid-soluble B-blockers are less likely to
cause neuropsychiatric complications
© ACE inhibitors may cause hyperkalaemia
© thiazides may cause hypouncaemia
G B-blockers may increase plasma
^-^cholesterol
36
DISEASES OF THE CARDIOVASCULAR SYSTEM
79
S © D ,dllH 62% a 5:22 AM
K 7
$ kf ^1
76
The murmurs listed below are typical
features of the following valvular heart
disorders
O low-pitched pansystolic murmur loudest
at the right sternal edge—tricuspid
regurgitation
O appeal late systolic murmur—mitral valve
prolapse
© mid-diastolic murmur at left sternal
edge—pulmonary regurgitation
© ■nid-diastolic murmur at the apex—mitral
(W systolic and diastolic murmur at left
y sternal edge—patent ductus arteriosus
77
With regard to ischaemic (coronary)
heart disease
3
25% of the male population of the UK die
from this disease
© the primary event in unstable angina is
coronary artery spasm
©70% of cases of sudden death are
attributable to this disease
© 70% of occluded vessels undergo
spontaneous revascularisation
0 50% of all deaths occur in patients over
the age of 75 years
78
With regard to anti-anginal drugs
ZO nitrates dilate the venous and arterial
vessels
O non-selective B-adrenoreceptor
antagonists cause coronary
vasodilatation
© nifedipine is likely to cause a bradycardia
© the usefulness of potassium channel­
blockers is limited by tolerance
G long acting nitrates have been proven to
be the most effective first line therapy
3 El
I 82

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DISEASES OF THE CARDIOVASCULAR SYSTEM
14
In the investigation of patients with
suspected heart disease
O the normal upper limit for the
cardiothoracic ratio (CTR) on chest X-ray
is 0 75
0 a negative exercise ECG excludes the
diagnosis of ischaemic heart disease
© a 'step-up' in oxygen saturation at cardiac
catheterisation suggests an intracardiac
9 shunt
Doppler echocardiography reliably
assesses pressure gradients between
cardiac chambers
©/radionuclide blood pocl scanning
accurately quantifies left ventricular
function
15
The following statements about cardiac
rhythms are true
O Cardiac rate falls with inspiration in
autonomic neuropathy
O)Re-entry tachyarrhythmias arise from
anomalous atrioventncular conduction
'©) Sinus bradycardia < 60/min is a normal
occurrence during sleep
0 Sinus arrest is defined on ECG by P
. waves which do not elicit QRS complexes
© Episodes of both bradycardias and
) tachycardias suggest the sick sinus
syndrome
(16>
Tn a patient with a recurrent AV nodal re­
entry tachycardia
0 adenosine is the prophylactic therapy of
first choice
0 the cardiac rate is often 160-220 beats
.z per minute
/(^polyuria after a prolonged episode is
^characteristic
© symptoms are invariably present dunng
episodes
© transient bundle branch block on ECG
indicates coexistent myocardial
ischaemia
SO 74% B 9:10 PM
M 71
3 EB
Typical features of the
Wolff-Parkinson-White (WPW) syndrome
include
O tachyarrhythmias resulting from re-entry
phenomenon
O ventricular pre-excitation via an
accessory AV pathway
®\ atrial fibrillation with a ventricular
response of > 160/min
© ECG between bouts showing prolonged
PR interval with narrow QRS complexes
© useful therapeutic response to verapamil
or digoxin
18
Atrial tachycardia with AV block is
typically associated with
O an irregularly irregular pulse
O slowing of the atrial rate on carotid sinus
massage
© presence of P waves identical to those
found during sinus rhythm
© digoxin toxicity and intracellular
potassium depletion
© bizarre broad QRS complexes on ECG
Atrial fibrillation (AF) is
0 present in 10% of the elderly population
over the age of 75 years
0 usually readily converted to permanent
sinus rhythm using DC cardioversion
© associated with an annual stroke risk of
5% if structural heart disease is present
common presenting feature of the sick
x sinus syndrome
© usually associated with a ventricular rate
(/ < 100 /min even before therapy is
introduced
27
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49

□4 DISEASES OF THE RESPIRATORY SYSTEM

81
Clinical features characteristic of
massive pulmonary embolism include
C central and peripheral cyanosis
U pleuritic chest pain and haemoptysis
0 breathlessness and syncope
© tachycardia and elevated jugular venous
pressure
0 Q waves in leads I, II and AVL on ECG
82
Recognised features of pulmonary
Infarction Include
y O peripheral blood leucocytosis and fever
** pleuropericardial friction rub
bloodstained pleural effusion
0 development of a lung abscess
ipsilateral elevation of the hemidiaphragm
83
In the treatment of acute pulmonary
thromboembolism
O streptokinase therapy should be given
immediately
O 24% oxygen therapy should correct
hypoxaemia
0 diamorphine therapy should be avoided if
the patient is severely hypoxic
© hepann infusion should be given until
warfann therapy has become effective
0 warfarin therapy should be continued for
4 weeks

50 56 of 288
Q 3 DISEASES OF THE CARDIOVASCULAR SYSTEM
32
Absolute indications lor permanent
endocardial pacing include
O asymptomatic congenital complete heart
block
0 asymptomatic Mobitz type I second-
degree heart block
© Adams-Stokes attacks in the elderly
© complete heart block due to rheumatic
mitral valve disease
G symptomatic second degree heart block
following acute inferior myocardial
infarction
33
The following statements about bundle
branch block (BBB) are true
0 Right BBB is most often the result of left
ventricular hypertrophy
O Right BBB produces nght axis deviation
with a QRS > 0.12 sec on ECG
0 Right BBB produces fixed splitting of the
second heart sound
© Left BBB produces reversed splitting of
the second heart sound
G Left posterior hemiblock produces left
axis deviation on ECG
34
In a patient with central chest pain at rest
6 intrascapular radiation suggests the
possibility of aortic dissection
/€ postural variation in pain suggests the
possibility of pencaraitis
© chest wall tenderness is a typical feature
of Tietze s syndrome
© relief of pain by nitrates excludes an
oesophageal cause
G features of autonomic disturbance are
specific to cardiac pain
36 of 288
35
In pericardial tamponade
0 electrical alternans is a recognised E
_ feature
© the systemic arterial pressure falls
dramatically on inspiration
0 the jugular venous pulse falls
dramatically on inspiration
© an effusion > 250 ml must be present
before detrimental haemodynamic effects
ensue
0 the chest X-ray is invariably abnormal
36
In a patient with cardiogenic shock due
to acute myocardial infarction
0 the absence of pulmonary oedema
suggests right ventricular infarction
O the central venous pressure is the best
s index of left ventricular filling pressure
©^dopamine in low dose increases renal
blood flow
© high flow, high concentration oxygen is
""indicated
G colloid infusion is indicated if oliguria and
pulmonary oedema develop
37
In the treatment of cardiac failure
associated with acute pulmonary oedema
O controlled oxygen therapy should be
restricted to 28% oxygen in patients who
ammi and
0 frusemide therapy given intravenously
reduces preload and afterload
© nitrates should be avoided if the systolic
blood pressure <140 mmHg
G ACE inhibitors decrease the afterioad but
increase the preload
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DISEASES OF THE CARDIOVASCULAR SYSTEM
79
In unstable angina
O nitrates should only be used
intravenously
O heparin should only be given
intravenously
an increased serum troponin T
concentration suggests an acute
myocardial infarction
© left main stem disease should not be
. ) managed by percutaneous balloon
angioplasty
0 if beta-blockers are contraindicated,
nifedipine is tne calcium antagonist of
choice
80
Dilated (congestive) cardiomyopathy is
O usually idiopathic
O associated with pathognomic ECG
changes
© a recognised complication of cytotoxic
' piemotherapy
© associated with chronic alcohol abuse
O caused by Coxsackie A infection
81
The clinical features of restrictive
(obliterative) cardiomyopathy include
/©) a presentation which mimics that of
constrictive pericarditis
primarily characterised by impaired
' diastolic function
0 association with primary or secondary
z amyloidosis
© complication of conditions inducing a
marked peripheral blood eosinophilia
0 gross cardiomegaly on chest X-ray
43 of 288
I] 3 DISEASES OF THE CARDIOVASCULAR SY
86
*
*
3 El
82
Clinical features compatible with
idiopathic dilated cardiomyopathy
include
O absence of a previous history of angina
or myocardial mfarctior
O deep Q waves in anteror ECG leads
&: biventricular dilatation with an ejection
J fraction < 20%
© dyskinetic segment of left ventricle on
echocardiography
0 functional mitral regurgitation
83
Clinical features compatible with
hypertrophic cardiomyopathy include
0 family history of sudden death
O angina pectoris and exertional syncope
0 jerky pulse and heaving apex beat
© murmurs suggesting both aortic stenosis
and mitral regurgitation
0 soft or absent second heart sound
84
Typical features of acute pericarditis
include
O chest pain identical to that of myocardial
infarction
O a friction rub that is best heard in the
axilla in mid-expiration
©ST elevation on the ECG with upward
■' concavity
© elevation of the serum creatine kinase
0 ECG changes that are only seen in the
chest leads
85
In a 20-year-old woman with acute
pericarditis, the following disorders
should be excluded
□ Hodgkin's disease
©/systemic lupus erythematosus
0 Coxsackie A virus infection
©acute rheumatic fever
0 rubella virus infection
37
I 90
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Q4 DISEASES OF THE RESPIRATORY SYSTEM

65 X 69
Bronchial carcinoma is * \ Typical features of cryptogenic fibrosing
O surgically resectable in approximately alveolitis Include
40% of cases O hypercapnic respiratory failure
O reliably excluded by the finding of a O positive antinuclear and rheumatoid
normal chest X-ray factors
0 associated with a 50% 5-year survival ©finger clubbing
after surgical resection © recurrent wheeze and haemoptysis
© only reliably diagnosable by © increased neutrophil and eosinophil count
bronchoscopy in bronchial washings
© usually small-cell in origin if associated
with finger clubbing 70
In coal worker's pneumoconiosis
66 O the disease usually progresses despite
Non-metastatic manifestations of avoidance of coal dust
bronchial carcinoma include 0 certification lor compensation depends
O c erebellar degeneration upon the clinical features
0 nyasthema © upper lobe opacities suggest progressive
© gynaecomastia massive fibrosis
© polyneuropathy © accompanying chronic bronchitis is not
0 dermatomyositis due to coal dust exposure
© confirmatory physical findings are often
67 present
Typical presentations of small-cell
bronchial carcinoma include 71
5 nephrotic syndrome Typical findings in silicosis include
O inappropnate antidiuretic hormone (ADH) 0,chest X-ray abnormalities similar to those
secretion found in coal workers
(j ectopic adrenocorticotropic hormone O ‘egg-shell’ calcification of the hilar lymph
(ACTH) secretion nodes
© ectopic parathyroid hormone secretion © progression of the disease arrested when
Q hypertrophic pulmonary osteoarthropathy dust exposure ceases
© fibrotic peripheral nodules in patients with
68 rheumatoid disease
The following are contraindications to © occupational history of coal, tin and
surgical resection in bronchial carcinoma mineral mining
O distant metastases
0 malignant pleural effusion 72
BJfEV, < 0 8 litres The following statements about
© ipsilateral mediastinal lymphadenopathy asbestos-related disease are true
© oesophageal involvement O pleural plaques usually progress to
become mesotheliomas
O benign pleural effusions are not blood­
stained
© finger clubbing and basal crepitations
suggest pulmonary asbestosis
© the FEV,/FVC ratio is typically decreased
O mesothelioma can only be reliably
diagnosed at thoracotomy

48

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DISEASES OF THE RESPIRATORY SYSTEM 4H
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Z

46

DISEASES OF THE RESPIRATORY SYSTEM 4 EB

56
Typical findings In severe chronic
obstructive pulmonary disease during
inspiration include
© elevation of the jugular venous pressure
during inspiration
/©■tracheal descent
0 ^drawing of the intercostal muscles
P contraction of the scalene muscles
0 widespread rhonchi
57
Typical chest X-ray findings In chronic
obstructive pulmonary disease Include
(V prominent pulmonary arteries at the hila
4 low flat diaphragms
0 prominent peripheral vascular markings
© upper lobe pulmonary venous congestion
(3 Kerley B lines and cardiomegaly
58
Recognised causes of bronchiectasis
include
© pnmary hypogammaglobulinaemia
O an inhaled foreign body
0 cystic fibrosis
© asthmatic pulmonary eosinophilia
G sarcoidosis
59
Typical clinical features of bronchiectasis
include
O chronic cough with scanty sputum
volumes
O recurrent pleurisy
0 haemoptysis
© empyema thoracis
G crepitations on auscdtation
60
Cystic fibrosis is associated with
6, an incidence of 1 in 2500 live births
U a decreased sweat sodium concentration
female infertility
© abnormal lung function at birth
G recumng pneumococcal pulmonary
infections
61
In the treatment of bronchiectasis
©postural drainage is best undertaken
twice daily
O failure of medical therapy is a dear
indication for surgery
0 antibiotic therapy is indicated if sputum
,... purulence persists
© thoracic CT is advisable before surgery is
undertaken
Chpulmonary emphysema is a
“^contraindication to surgery
62
The following statements about bronchial
obstruction are true
O lobar emphysema develops in the lung
-- distal to a partial obstruction
0 mediastinal displacement is invanably
towards the affected side
0 infection is inevitable especially in partial
obstruction
© a collapsed right middle lobe is best
detected radiologically
0 inhaled foreign bodies usually lodge in
the left main bronchus
63
Typical features of bronchial adenoma
include
© occurrence in elderly females
SYarcinoid syndrome if liver metastases
/are present
0 recurrent haemoptysis
© lobar emphysema
G recurrent pneumonia
64
Bronchial carcinoma
O accounts for 10% of ali male deaths from
cancer
O typically presents with massive
haemoptysis
0 histology reveals adenocarcinoma in 50%
of patients
©I is associated with asbestos exposure
G)is 40 times more common in smokers
'-s' than in non-smokers

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El 4 DISEASES OF THE RESPIRATORY SYSTEM

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Q3 DISEASES OF THE CARDIOVASCULAR SYSTEM

44 48
Expected findings in a patient with Disorders associated with aortic
significant mitral stenosis Include regurgitation include
O a soft early diastolic murmur 3, ankylosing spondylitis
O a quiet first sound and absence of an O Marfan’s syndrome
. opening snap syphilitic aortitis
0 left parasternal heave suggesting © persistent ductus arteriosus
/pulmonary hypertension (O Takayasu's disease
© a displaced apex beat
0 the opening snap occurring just before 49
the second heart sound In a patient with aortic regurgitation in
normal sinus rhythm
45 O a mid-diastolic murmur is usually due to
Recognised features of chronic mitral concomitant mitral stenosis
regurgitation include O a systolic murmur is often due Io
O soft first heart sound and loud third heart coexistent aortic stenosis
sound 0 a left parasternal heave and displaced
(Q presentation with signs of right ventricular apex beat are expected findings
failure © systemic diastolic arterial pressure is
0 the severity of regurg tation is increased usually low
by afterload reduction 0 a short early diastolic murmur suggests
© a pansystolic murmur and hyperdynamic mild regurgitation
displaced apex beat
G atrial fibrillation requiring anticoagulation 50
The following statements about tricuspid
46 valve disease are true
Disorders typically producing the sudden O Murmurs are best heard in mid-sternum
onset of symptomatic mitral regurgitation at the end of expiration
include O Ascites occurs with tricuspid regurgitation
O Marfan s syndrome • but not stenosis
0 acute myocardial infarction 0 Tricuspid stenosis produces cannon
0 acute rheumatic fever waves in the jugular venous pressure
© infective endocarditis © Both stenosis and regurgitation produce
0 diphtheria systolic hepatic pulsation
0 Endocarditis suggests the possibility of
47 ' intravenous drug abuse
Clinical features suggesting severe aortic
stenosis include 51
O late systolic ejection click The typical features of congenital
0 pulsus bisferiens pulmonary stenosis Include
0 heaving, displaced apex beat O breathlessness and central cyanosis
© syncope associated with angina giant a waves in the jugular venous
O loud second heart sound pressure
0 loud second heart sound preceded by an
ejection systolic click
© left parasternal heave and systolic thrill
G enlargement of the pulmonary artery
visible on chest X-ray

on
32
DISEASES OF THE CARDIOVASCULAR SYSTEM
52
In infective endocarditis
©streptococci and staphylococci account
tor over 80% of cases
© left heart valves are more frequently
involved than right heart valves
O normal cardiac valves are nut affected
© glomerulonephritis usually occurs due to
immune complex disease
© a normal echocardiogram excludes the
diagnosis
53
In the management of Infective
endocarditis
0 blood cultures are best obtained when
the fever peaks
O antibiotic therapy should be delayed
pending bacteriological confirmation
O parenteral antibiotic therapy should be
continued tor at least 4 months
© persistent fever suggests the possibility of
an allergy to antibiotic therapy
O cardiac surgery should be considered if
' ~/ cardiac failure develops
54
The risks of developing clinical evidence
of coronary artery disease are
0 increased by exogenous oestrogen use
in postmenopausal females
O diminished by stopping smoking
© reduced by the moderate consumption of
alcohol
© increased in hyperfibnnogenaemia
© increased by hypercholesterolemia but
not hypertnglyceridaemia
39 of 288
3Q
55
In the investigation of suspected angina
pectoris
O the resting ECG is usually abnormal
O exerctse-induced elevation in blood
pressure indicates significant ischaemia
© a normal ECG during exercise excludes
angina pectoris
© coronary angiography is only indicated if
an exercise tolerance test (ETT) is
abnormal
0 physical examination is of no clinical
value
56
In the treatment of patients with angina
pectoris
O aspirin reduces the frequency of anginal
attacks
O glyceryl trinitrate is equally effective when
swallowed as when taken sublingually
© calcium antagonists may cause
peripheral oedema
© tissue levels of nitrates must be
consistently high for maximum
therapeutic effect
© B-blockers are more effective than other
anti-anginal agents
57
In the management of angina pectoris
O coronary angioplasty improves symptoms
and subsequent mortality
O coronary angioplasty should not be
performed on stenotic coronary grafts
© 90% of patients undergoing coronary
artery grafting are pain free 5 years post­
operation
coronary artery grafts improve prognosis
in patients with stenosis of the left main
coronary artery
© the natural history of coronary artery
disease is of progressively severe pain
33
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43

]4 DISEASES OF THE RESPIRATORY SYSTEM

32 36
Typical features of primary tuberculosis The following statements about
include tuberculin tine testing are true
0 a sustained pyrexial illness 0 False positives are common in
©caseation within the regional lymph sarcoidosis and acute exanthemata
nodes © the skin reaction is best assessed 3 days
© bilateral hilar lymphadenopathy on chest - J after inoculation
© tuberculin-positive family contacts do not
©erythema nodosum ” rA/^iiiro
require BCG vaccination
0 pleural effusion with a negative tuberculin © grade 3 and 4 reactions are
skin test characterised by four discrete papules
□ tuberculin-positive children are immune
33 to tuberculosis
Recognised features of miliary
tuberculosis include 37
re systemic upset with fever in In the treatment of post-primary
childhood pulmonary tuberculosis
blood dyscrasias and '0 j combination drug therapy is always
hepatosplenomegaly indicated
© chest X-ray and negative O sputum remains infectious for at least 4
rculin test weeks after the onset of therapy
physical signs in the chest © at least 12 months daily therapy is
characteristic granulomata on liver and required for 100% effectiveness
bone biopsy © isoniazid and pyrazinamide do not cross
the blood-brain barrier
34 0 treatment failure is invariably due to
Typical features of posl-prlmary multiple drug resistance
tuberculosis include
0 purulent sputum negative for tuberculosis 38
on microscopy Recognised adverse reactions to anti­
G bilateral upper lobe opacities on chest X- tuberculous drugs include
>!ray 0 streptomycin—renal failure
© conspicuous physical signs in the chest O isomaz.d—hypothyroidism
© haematogenous dissemination in most © nfampicin—optic neuritis
cases © pyrazinamide—hepatitis
0 cavitation of pulmonary lesions © ethambutol—vestibular neuronitis

35 39
Recognised complications of post­ Prophylactic antituberculosls drug
primary tuberculosis include therapy Is Indicated in the following
/*0 aspergilloma tuberculin-positive subjects
O amyloidosis 0 insulin-dependent diabetics
© miliary tuberculosis tients receiving long-term
© bronchiectasis ppressant drug
O paraplegia HIV antibody-positive subjects
©children aged < 3 years who have not
had BCG immunisation
© iadults who have recently become
tuberculin-positive

44
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DISEASES OF THE RESPIRATORY SYSTEM 4U


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Fl 4 DISEASES OF THE RESPIRATORY SYSTEM
48
The sleep apnoea syndrome is
associated with
obesity
Q an increased risk of road traffic accidents
0 nocturnal restlessness apparent to the
patient
© a good response to inhaled
bronchodilator therapy administered at
\ bedtime
0 acromegaly
49
The typical features of asthmatic
pulmonary eosinophilia include
C immediate hypersensitivity and immune
complex reactions
O positive skin and serum tests for
Aspergillus fumigatus
0 isolation of Aspergillus clavatus in the
^sputum
© recurrent upper lobe collapse
O''chronic asthma and bronchiectasis
50
Mediastinal opacification on the chest
X-ray is a typical feature of
/0\thymoma
O retrosternal goitre
0 Pancoast tumour
X0) hiatus hernia
) 0 neurofibroma
51
In a patient with hoarseness
O a bovine cough suggests a functional
cause
<Ujpstndor suggests bilateral cord paralysis
0 inhaled corticosteroids are often
beneficial
0 the finding of a left hilar mass is likely to
explain the symptom
( 0/Teflon injection of the paralysed vocal
cord aids functional improvement
46
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Characteristic features of pulmonary
eosinophilia include
0 in association with ascariasis and
^microfilariasis
0 eosinophilic pneumonia without
peripheral blood eosinophilia
0 prominent asthmatic features
"©/induction by exposure to sulphonamide
■’ drugs
©'.opacities on chest X-ray
53
Clinical features compatible with a
diagnosis of extrinsic allergic alveolitis
include
O expiratory rhonchi and sputum
eosinophilia
0 dry cough, dyspnoea and pyrexia
'^Tend-inspiratory crepitations
© FEVj/FVC ratio of 50%
0 oositive serum precipitin tests
54
In chronic obstructive pulmonary disease
rtS\FEVi declines by 50 ml per year in
Sr patients who continue to smoke
<?■ FEV, is typically < 80% of the predicted
value
0 FEVi/FVC ratio is typically < 50% of the
r predicted value
© significant reversibility is defined as at
least a 200 ml or 15% increase in FEV,
0 total lung capacity (TLC) and residual
volume (RV) are typically reduced
55
In the management of chronic
obstructive pulmonary disease
O influenza immunisation should only be
offered once
O long-term antibiotic treatment decreases
the frequency of exacerbations
© inhaled steroids are of no value
© supplemental oxygen during air travel is
necessary if the resting PaO? < 9 kPa
0 long term controlled oxygen therapy
improves symptoms but not the
prognosis
DISEASES OF THE RESPIRATORY SYSTEM 4 EB

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DISEASES OF THE RESPIRATORY SYSTEM
Typical features of klebsielia pneumonia
include
upper lobe collapse on chest X-ray
severe systemic disturbance and high
mortality
copious chocolate-coloured sputum
organisms resistant Io chloramphenicol
and gentamicin
0 occurrence in previously healthy
individuals
25
Recognised features of mycoplasmal
pneumonia include
^institutional outbreaks in young adults
O haemolytic anaemia and cold agglutinins
0 complication
n the serum
0 fever and malaise preceding respiratory
> symptoms by several days
lfO inconspicuous physical signs in the chest
0 response Io tetracycline or erythromycin
therapy
26
Typical features of legionella pneumonia
include
O oro-faecal spread of infection
0 vomiting and diarrhoea
0 hyponatraemia and confusion
© inconspicuous physical signs in the chest
0 response to rifampicin and/or
erythromycin therapy
27
A non-pneumococcal pneumonia should
be suspected if the clinical features
include
O respiratory symptoms preceding systemic
upset by several days
0 chest signs less dramatic than the chest
—•'X-ray appearances
0 the development of a pleural effusion
w the absence of a neutrophil leucocytosis
© palpable splenomegaly and proteinuria
fl 4 DISEASES OF THE RESPIRATORY SYSTEM
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4 El
Pneumonia in the immunocompromised
is best treated with the following drug
Imes
Pneumocystis cannii—co-trimoxazole
Pseudomonas aeruginosa—azlocillin or
ciprofloxacin
0 cytomegalovirus—ganciclovir
© herpes simplex—acyclovir
0 /respiratory syncytial virus—(ribavirin
The following statements about
aspiration pneumonias are true
bronchiectasis is a recognised
0 chest X-ray abnormalities are typically
bilateral
0 tobar collapse predisposes to the
development of lung abscess
© systemic upset is usually marked
0 adult respiratory distress syndrome may
be a complication
30
The clinical features of suppurative
pneumonia and lung abscess include
<3 prior pulmonary infarction
O the presence of an inhaled'foreign body
© rigors and pleuritic chest pain
O bronchial breathing if there is an
underlying bronchial carcinoma
0 radiological features of cavitation
31
Post-primary tuberculosis in the UK is
associated with
O occurrence in childhood rather than old
age
0 an increased prevalence in diabetic
patients
0i human rather than bovine strains of
mycobacteria
© alcohol abuse and malnutrition
0 airborne reinfection rather than
reactivation of infection
43

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DISEASES OF THE RESPIRATORY SYSTEM
40
Pulmonary infection with Aspergillus
fumigatus ia a recognised cause of the
following
O bullous emphysema
0'mycetoma
0 necrotising pneumonits
© bronchopulmonary eosinophilia
0 extrinsic allergic alveolitis
41
Typical features of oarly-onset bronchial
asthma include
individuals are usually atopic
O a single allergen is often identifiable
3 paroxysmal expiratory wheeze and
dyspnoea
a strong family history of allergic
disorders
0 Aspergillus fumigatus is usually present
in the sputum
42
Typical features of late-onset bronchial
asthma include
O invariable history of cigarette smoking
O multiple allergens are often identifiable
0 exposure to aspirin and certain chemicals
induce attacks
0 asthma is more often chronic than
episodic
0 serum IgE concentrations are often
normal
43
Features indicative of severe acute
asthma include
0 pulse rate = 120 per minute
O peak expiratory flow rate (PEFR) »
< 70% of expected
0 pulsus paradoxus = 30 mmHg
0 arterial PaO2 ■ 10 kPa
0 arterial PaCO2 ■ 6 kPa
-------------------------------- '
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n4 DISEASES OF THE RESPIRATORY SYSTEM
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44
The initial management of severe acute
asthma should include
O 24% oxygen delivered by a controlled
flow mask
Oz salbutamol 5 mg by inhalation
0 ampicillin 500 mg orally and
cromoglycate 10 mg by inhalation
© hydrocortisone 200 mg i.v. and
prednisolone 40 mg orally
O arterial blood gas analyss and chest
V X-ray
45
Typical features of asthma include
0 ^eosinophilic bronchial inf Itrate
O ncreased airway macrophages
0 goblet cell hyperplasia
0 epithelial shedding
0 subendothelial fibrosis
46
In the diagnosis of asthma
O only increases in FEV, of > 15%
following bronchodilators are likely to be
significant
O a peripheral blood eosinophilia is
diagnostic
0 if doubt exists the methachohne bronchial
provocation test should be carried out
©the chest X-ray is usually unhelpful
between attacks
G arterial blood gas analysis is usually
z unhelpful between attacks
47
In the management of chronic persistent
asthma
inhaled f^-agomst use more than once
per day is an indication for inhaled
steroid therapy
O cromoglycate therapy is often useful as
an alternative to inhaled steroids in adults
0 patients taking high doses of inhaled
steroids should use a spacer device
0 leucotnene antagonists are valuable
substitutes for inhaled steroids
O anticholinergic agents should be avoided

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7 11
The following statements about the
jugular venous pressure (JVP) are true
O the external jugular vein is a reliable
guide to right atrial pressure
O the JVP is conventionally measured from
the suprasternal notch
© the normal JVP. unlike the blood
pressure, does not nse with anxiety
© the normal JVP does not nse on
abdominal compression
© the normal JVP falls during inspiration
The abnormalities of the jugular venous
pulse listed below are associated with
the following disorders
O cannon waves—pulmonary hypertension
CP giant a waves—tricuspid stenosis
© v waves—tricuspid regurgitation
© inspiratory rise in jugular venous
z pressure—pericardial tamponade
© absent a waves—atrioventricular
dissociation
9 © the AVR lead = right arm positive with
With regard to cardiovascular physiology
O cardiac output is the product of heart rate
and stroke volume
O coronary blood vessels are innervated
only by the parasympathetic nerves
p intracoronary acetylcholine provokes
vasoconstriction if atheroma is present
© an atheromatous coronary lesion restricts
blood flow during exercise if greater than
... 40%
© bradykinin is an endogenous vasodilator
10
The auscultatory findings listed below
are associated with the following
phenomena
0 third heart sound—opening of mitral
valve
O varying intensity of first heart sound-
atrioventricular dissociation
9 soft first heart sound—mitral stenosis
(9 reversed splitting of second heart
sound—left bundle branch block
© fourth heart sound—atrial fibrillation
26
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Z 'J
The following statements about the
measurement of the blood pressure (BP)
are true
O An arm cuff smaller than recommended
x lowers BP recordings
O Appearance of the first Korotkov sound
7 denotes systolic pressure
9 Muffling of the sound denotes phase V
diastolic pressure
© Inter-observer variation is less with phase
IV than with phase V
© Resting BP should be recorded as
random BP recordings do not correlate
with morbidity
12
In the normal electrocardiogram (ECG)
O depolarisation proceeds from epicardium
to endocardium
O depolarisation away from the positive
electrode produces a positive deflection
© depolarisation of the interventricular
y septum is recorded by the Q wave in V5 ♦
respect to the other limb leads
© voltage amplitudes vary with the
- thickness of cardiac muscle
©
Features that suggest a ventricular rather
than supraventricular tachycardia include
0 a ventricular rate > 160/minute
O termination of the arrhythmia with carotid
sinus pressure
©variable intensity of the first heart sound
© the presence of cardiac failure
© QRS complexes <0.14 sec in duration
on ECG

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Q3 DISEASES OF THE CARDIOVASCULAR SYSTEM
86
The typical features of constrictive
pericarditis include
O severe breathlessness
a normal chest X-ray
© a previous history of tuberculosis
tachycardia and a loud third heart sound
0 marked elevation of the jugular venous
7 pressure with a steep x and y descent
87
Central cyanosis in Infancy is an
expected finding in the following
congenital heart diseases
O persistent ductus arteriosus
transposition of the great arteries
© coarctation of the aorta
© Fallot's tetralogy
0 atrial septal defect
88
The following statements about
persistent ductus arteriosus are true
O Blood usually passes from the pulmonary
artery to the aorta
O The onset of heart fa lure usually occurs
in early infancy
© A systolic murmur around the scapulae is
typical
Shunt reversal is indicated by cyanosis of
the lower limbs
Prophylactic antibiotic therapy to prevent
endocarditis is indicated
89
Typical clinical features of coarctation of
the aorta include
*©\an association with a bicuspid aortic
valve
O cardiac failure developing in male
adolescents
© palpable collateral arteries around the
I scapulae
© nb notching on chest X-ray associated
with weak femoral pulses
0 ECG showing right ventricular
hypertrophy
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In atrial septal defect
O)the lesion is usually of secundum type
0 the initial shunt is right to left
0 splitting of the second heart sound
increases in expiration
© the ECG typically shows right bundle
/ branch block
© surgery should be deferred until shunt
reversal occurs
91
In small ventricular septal defects
© the murmur is confined to late systole
© the heart is usually enlarged
■;<£j'here is a risk of infective endocarditis
© surgical repair before adolesence is
usually indicated
^O'jmost patients are asymptomatic
92
In right-to-lett shunt reversals of
congenital heart disease (Eisenmenger's
syndrome)
G pulmonary arterial hypertension is
< usually present
© closure of the underlying lesion produces
symptomatic relief
© the chest X-ray is typically normal
central cyanosis and finger clubbing are
often present
0 physical signs of the underlying lesion
persist unchanged
93
In Fallot's tetralogy
O pulmonary and aortic stenosis are
combined with a ventricular septal defect
© both finger clubbing and central cyanosis
are present at birth
© the second heart sound is loud and
widely split on inspiration
© the chest X-ray and ECG are typically
normal
0 cyanotic spells occur due to episodes of
dysrhythmia

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3 DISEASES OF THE CARDIOVASCULAR SYSTEM
In patients with atrial fibrillation (AF)
O aspirin therapy alone does not reduce the
risk of stroke
O the radial pulse is typically irregularly
7 irregular
© the response in cardiac output to
_ ./exercise is reduced due to the absence
of atrial systole
© elective direct current (DC) cardioversion
is contraindicated during anticoagulant
therapy
alcohol abuse should be considered as a
likely cause
2i
Ventricular ectopic beats
^.produce a clinically detectable reduction
in stroke volume
O which are symptomatic usually indicate
underlying heart disease
© secondary to cardiac disease typically
disappear on exercise
©are likely to be escape beats when there
is underlying bradycardia
0 following acute myocardial infarction
indicate the need for antiarrhythmic
treatment
Tn ventricular tachycardia (VT)
underlying cardiac disease is usually
present
O amiodarone is useful n the prevention of
recurrent episodes
© a shortened QT interval on ECG
predisposes to recurrent episodes
© carotid sinus massage usually slows the
cardiac rate transiently
0 complicated by acute cardiac failure,
cardioversion should be avoided
28
0© .,illS 74% 8 9:10 PM
In ventricular fibrillation
O the radial pulse is extremely rapid and
thready
O; which is unresponsive to treatment.
y profound hypokalaemia should be
suspected
© ECG confirmation is vital before DC
shock is administered
© cardioversion should be synchronised
with the R wave on ECG
© immediate lignocaine therapy avoids the
need tor cardioversion
24
In cardiopulmonary resuscitation
0 a sharp blow to the praecordium helps
restore sinus rhythm
O asystole is the commonest finding on
V EGG
© a normal ECG suggests profound
hypovolaemia
© if cardioversion fails, intracardiac
adrenaline should be given
Gf; the compression to ventilation ratio
should be 5:1
25
In the management of cardiac
arrhythmias
J moderation of alcohol consumption
should be advised
O symptoms are a reliable guide to the
.efficacy of drug treatment
for refractory paroxysmal tachycardias
© combination drug therapy is often better
than monotherapy
O treatment of the causative disease is of
no proven benefit
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1000 MCQaDDs for.Jne ( PDFDrive ).pdf - Read-only

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DISEASES OF THE CARDIOVASCULAR SYSTEM 3 El

94 97
Cardiovascular changes in normal In Intermittent claudication due to
pregnancy Include atherosclerosis
O an increase in cardiac output of 150% by O pain is typically relieved by rest and
12 weeks elevation of the leg
O tachycardia, elevated jugular venous © secondary ischaemic ulcers are usually
pressure and third heart sound painless
0 reduction in systemic diastolic pressure © pedal pulses are often still palpable
© pulmonary systolic murmur © exercise which causes pain should be
0 increased blood coagulability avoided
© the risk of progression is lessened by
95 warfarin
After a myocardial infarction (Ml)
O car driving should not resume for at least
12 weeks Recognised causes of Raynaud's
0 a total plasma cholesterol of 5.8 mmol/L phenomenon Include
does not require drug treatment O 3-biocker therapy
© dietary treatment of ©? cryoglobulmaemia
hypercholesterolemia is effective in G progressive systemic sclerosis
, .most patients G vibration trauma
© exercise testing can usually be © giant cell arteritis
/undertaken safely 4 weeks post-MI
G- ACE inhibitors confe' a prognostic benefit 99
z in patients with symptomatic heart failure The risk of dissecting aortic aneurysm is
increased in
96 □ Marfan s syndrome
The following features suggest that O coarctation of the aorta
mitral valvuloplasty rather than mitral © pregnancy
valve replacement would be the preferred © calcific aortic stenosis
treatment option in patients with mitral © syphilitic aortitis
stenosis
Ol a loud first heart sound and opening too
/ snap Characteristic features of dissecting
© moderate mitral regurgitation aortic aneurysm include
© pulmonary hypertension ehhaemopericardium
© left atrial thrombus © acute paraparesis
0 severe inoperable coronary artery ©. interscapular back pain
disease © early diastolic murmur
© pleural effusion

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