week 5 CVS

Question 1

Myocarditis is a degenerative disorder of heart muscle.

a. true
b. false

Answer 1

False - This is the term for an inflammatory process involving the heart muscle.

Question 2

Williams syndrome is classically associated with aortic regurgitation.

a. true
b. false

Answer 2

False - It is classically associated with Supravalvular Aortic stenosis.

Question 3

Williams Syndrome is associated with supravalvular aortic stenosis

a. true
b. false

Answer 3

a. true

Question 4

A 60 year old patient with renal failure presents as an emergency with sharp chest pain which is eased by leaning forward. On auscultation a faint rub can be heard. The diagnosis is likely to be an acute myocardial infarction.

a. true
b. false

Answer 4

False - The diagnosis is likely to be acute pericarditis, possibly secondary to high urea levels seen in renal failure.

Question 5

sharp chest pain which is eased by leaning forward might indicate?

Answer 5

acute pericarditis

Question 6

High ureal levels seen in renal failure can cause pericarditis

a. true
b. false

Answer 6

a. true

Question 7

High ureal levels seen in renal failure can cause pericarditis

a. true
b. false

Answer 7

a. true

Question 8

Infective endocarditis can affect the valves of the heart.

a. true
b. false

Answer 8

True - the cardiac valves are often affected in infective endocarditis. It can often present with a new murmur.

Question 9

Hypertrophic cardiomyopathy is rare and usually fatal in young adults.

a. true
b. false

Answer 9

Hyerptrophic cardiomyopathy is a common disorder affecting 1/500 people, and in most cases is relatively mild becoming symptomatic in older people, although it is occasionally severe in younger adults. 4 genes for sarcomere proteins (MYBPC3, MYH7, TTNT2 and TNNI3) are commonly implicated in the disorder (although a number of other types have been described) and most patients will have a variant on one of these genes. The severely affected younger patients often have two variants, which may explain their severity.

Question 10

Hyerptrophic cardiomyopathy is a common disorder affecting 1/500 people

a. true
b. false

Answer 10

a. true

relatively mild but can become severe in younger adults

Question 11

why might hypertrophic cardiomyopathy be more severe in younger adults?

Answer 11

Often have 2 variants (of genes commonly implicated) instead of one.

4 genes for sarcomere proteins (MYBPC3, MYH7, TTNT2 and TNNI3) - most paitents have vairant on one of these genes,

Question 12

Infective endocarditis could cause a stroke.

a. true
b. false

Answer 12

True - There is a risk of septic emboli arising from the vegetations which form in the heart. These can embolise to the systemic circulation and can therefore occlude arterial supply. One such complication is a stroke.

Question 13

Virchow’s triad consists of changes in the vessel wall, the blood components and the blood flow.

a. true
b. false

Answer 13

True - Above is Virchow’s triad. These are the risk factors which contribute to a thrombus forming.

Question 14

QT interval changes with the HR

a. true
b. false

Answer 14

a. true

Question 15

The aortic and pulmonary valves are the two most common valves operated on in adults.

a. true
b. false

Answer 15

False - The aortic and MITRAL valves are the most common two valves operated on in adults.

Question 16

The classic pulse of aortic regurgitation is collapsing.

a. true
b. false

Answer 16

True - a collapsing pulse reaches its peak volume quickly and then “falls away”, as blood refluxes back through an incompetent aortic valve.

Question 17

A collasping pulse is a feature of

Answer 17

Aortic Regurgitatin

• pulse reaches it peak volume quickly and then falls away as blood refluxes back thrpugh the incompetent aortic valve

Question 18

An indication for a Coronary Artery Bypass Graft is Left main stem disease.

a. true
b. false

Answer 18

True - this artery supplies a huge portion of the left ventricle, and so severe disease is an indication for CABG.

Question 19

Aortic regurgitation is a diastolic murmur.

a. true
b. false

Answer 19

True - Aortic regurgitation is an early diastolic murmur heard best in the lower left sternal edge while sitting forward on expiration.

Question 20

Describe the murmur heard in Aortic regurgitation

Answer 20

early diastolic murmur heard best in the lower left sternal edge while sitting forward on expiration

Question 21

The classic triad of the presentation of Aortic stenosis is syncope, angina and heart failure.

a. true
b. false

Answer 21

True - however this does not mean all patients will present this way. These are all features of SEVERE aortic stenosis.

Question 22

Mitral stenosis is a diastolic murmur.

a. true
b. false

Answer 22

True - Mitral stenosis is a mid-diastolic murmur.

Question 23

The pulse pressure in Aortic regurgitation is narrow.

a. true
b. false

Answer 23

False - The pulse pressure is the difference between systolic and diastolic pressure. In Aortic regurgitation the pulse pressure is wide.

Question 24

A post op patient complains of sudden onset chest pain, shortness of breath and haemoptysis. On examination the patient is tachycardic, and hypotensive. He has also been complaining of swelling of his leg for the past day. The most likely diagnosis is a pneumothorax.

a. true
b. false

Answer 24

False - The most likely diagnosis in this presentation is a pulmonary embolism.

Question 25

sudden onset chest pain, shortness of breath and haemoptysis. On examination the patient is tachycardic, and hypotensive. He has also been complaining of swelling of his leg for the past day. The most likely diagnosis is?

Answer 25

Pulmmonary embolism

Question 26

symptoms of pulmonary embolism?

Answer 26

* sudden onset of chest pain * SOB * haemoptysis * tachycardia * hypotensive * swelling in leg (caused by DVT)?

Question 27

Dilated cardiomyopathy is the end stage of many disease processes a. true b. false

Answer 27

Ischaemic heart disease, hypertension, some drugs, and some metabolic disorders can all cause dilated cardiomyopathy. However, when no other disease process is evident, a genetic cause can be found in about 20% of cases, and of these the most commonly affected gene is Titin. Interestingly, a proportion of patients with dilated cardiomyopathy attributed to alcohol excess or pregnancy also have a variant in TTN. Dilated cardiomyopathy may therefore have more than one cause even in a single individual.

Question 28

People with mutations in titan do not get hypertrophic cardiomyopathy a. true b. false

Answer 28

a. true they get DILATED cardiomyopathy

Question 29

cauases of dilated cardiomyopathy?

Answer 29

* mutation in Titan protein gene * alcohol excess * pregnancy * hypertension, IHD , drugs, metabolic disorders,

Question 30

Antibiotics should be routinely given for dental procedures for prophylaxis against infective endocarditis. a. true b. false

Answer 30

False - Guidelines advise against extensive use of antibiotic prophylaxis. Only in very specific cases where patients are at high risk.

Question 31

Pericardial tamponade is a large collection of fluid in the pleural space. a. true b. false

Answer 31

False - This is a large collection of fluid in the pericardial space which causes cardiac compression and as a result leads to a reduction in cardiac output.

Question 32

Pericardial tamponade

Answer 32

a large collection of fluid in the pericardial space which causes cardiac compression as a result leads to a reduction in cardiac output.

Question 33

Aortic stenosis is an ejection systolic murmur. a. True b. False

Answer 33

True - Aortic stenosis is an ejection systolic murmur which is heard best in the second intercostal space on the right of the sternum and radiates to the carotids.

Question 34

Ejection systolic murmur which is heard best in the second intercostal space on the right of the sternum and radiates to the carotids which valve is affected?

Answer 34

Aortic stenosis

Question 35

In mitral valve disease, valve replacement is always required a. true b. false

Answer 35

b. false Mitral valve repair is often used in mitral valve disease and can be effective. For example in mitral valvuloplasty, a small hallow tube is advanced via blood vessels to the heart. A balloon is inflated to stretch open the stenosed mitral valve. Some people with mild mitral valve disease may not require any treatment at all.

Question 36

Aortic surgery should be offered in Marfan syndrome if the Sinus of Valsalva exceeds 3cm. a. true b. false

Answer 36

False - Aortic surgery should be offered in Marfan syndrome if the Sinus of Valsalva exceeds 5.5cm or exceeds 5% growth per year.

Question 37

When should aortic valve surgery be offered in marfans syndrome

Answer 37

if the Sinus of Valsalva exceeds 5.5cm or exceeds 5% growth per year.

Question 38

Down's syndrome is associated with atrio-ventricular septal defects. a. true b. false

Answer 38

True. There are several cardiac manifestations of Down's Syndrome, including Atrio-Ventricular septal defects (most common), other septal defects, patent ductus arteriosus, and Tetralogy of Fallot.

Question 39

Defects associated with Down's syndrome

Answer 39

* atrio-septal defects * patent ductus arteriosus * duodenal atresia * Teralogy of fallot

Question 40

patent ductus arteriosus

Answer 40

is a blood vessel that connects the pulmonary artery to the aorta This connection is present in all babies in the womb, but should close shortly after birth.

Question 41

A sternotomy is required during a Coronary Artery Bypass Graft procedure. a. true b. false

Answer 41

True - Sternotomy (midline incision through the sternum) allows access to the heart to carry out the procedure.

Question 42

The combined oral contraceptive pill is a risk factor for a venous thrombus formation. a. true b. false

Answer 42

True - The OCP is a risk factor for venous thrombus formation as it contains oestrogen which can increase levels of clotting factors.

Question 43

Turner syndrome is a condition where a person with a male phenotype is missing an X chromosome (45,X) a. true b. false

Answer 43

False - It is a condition where a person with a FEMALE phenotype is missing an X chromosome (45,X)

Question 44

Turner syndrome is associated with coarctation of the aorta. a. true b. false

Answer 44

True - there are several congenital heart defects associated with Turner's Syndrome, including coarctation of the aorta and bicuspid aortic valve.

Question 45

A Roth spot is a sign which may be seen in infective endocarditis. They may be seen on the palms of hands and the soles of feet. a. true b. false

Answer 45

A Roth spot is a sign which may be seen in infective endocarditis. They may be seen on the palms of hands and the soles of feet.

Question 46

The classic pulse of aortic stenosis is collapsing a. true b.false

Answer 46

False - The classic pulse of aortic stenosis is described as small volume and slow rising.

Question 47

The classic pulse of aortic stenosis is described as small volume and slow rising. a. true b. false

Answer 47

a. true

Question 48

When investigating a suspected case of infective endocarditis, it is important to take multiple blood cultures all at the same time and site. a. true b. false

Answer 48

False - It is important to take multiple sets, typically 3 sets, all from different sites. They should be taken 6 or more hours apart. If the patient is very unwell, 2 sets from different sites should be taken within 1 hour.

Question 49

Prosthetic heart valves are a risk factor in Infective endocarditis. a. true b. false

Answer 49

True - Prosthetic heart valves are a risk factor in infective endocarditis as infection can adhere to the prosthetic material.

Question 50

Myocarditis can be caused by drugs. a. true b. false

Answer 50

True - For example certain chemotherapy and anti psychotic drugs can cause myocarditis.

Question 51

Myocarditis can be caused by drugs. a. true b. false

Answer 51

True - For example certain chemotherapy and anti psychotic drugs can cause myocarditis.

Question 52

Noonan syndrome is associated with pulmonary stenosis. a. true b. false

Answer 52

True - the classic cardiac associations of Noonan syndrome are pulmonary stenosis and hypertrophic cardiomyopathy.

Question 53

Classic cardiac features of noonan syndrome a. true b. false

Answer 53

pulmonary stenosis and hypertrophic cardiomyopathy.

Question 54

The murmur of Aortic stenosis radiates to the axilla. a. true b. false

Answer 54

False - Aortic stenosis is an ejection systolic murmur which is heard best in the second intercostal space on the right of the sternum and radiates to the CAROTIDS. Mitral regurgitation radiates to the axilla.

Question 55

Where is an Aortic stenosis is an ejection systolic murmur which is heard best ?

Answer 55

in the second intercostal space on the right of the sternum and radiates to the CAROTIDS.

Question 56

mitral regurigitation radiates to the ?

Answer 56

axilla

Question 57

Rheumatic fever can lead to valvular heart disease. It is related to staphylococcal infections. a. true b. false

Answer 57

False - Rheumatic fever is associated with streptococcal pyogenes infection.

Question 58

Rheumatic fever is associated with streptococcal pyogenes infection. a. true b. false

Answer 58

a. true

Question 59

During a Coronary Artery Bypass Graft the patient is required to be placed on cardiopulmonary bypass. a. true b. false

Answer 59

Bypass is required to take over the function of the heart and lungs.

Question 60

Clinical evaluation rather than genetic testing is helpful in the diagnosis of patients with possible Marfan syndrome. a. true b. false

Answer 60

b. false Because of age dependent penetrance of some features of Marfan syndrome (including aortic dilatation, some skin and skeletal features and ocular features), genetic testing is extremely useful in determining the need for follow-up and prophylactic treatment

Question 61

Marfan syndrome is an autosomal recessive disorder of chromosome 15. a. true b. false

Answer 61

False - It is an Autosomal dominant disorder.

Question 62

Pericarditis can be caused by high urea levels. a. true b. false

Answer 62

True - Uraemia, for example in renal failure, can be a cause of acute pericarditis.

Question 63

Uraemia, for example in renal failure, can be a cause of acute pericarditis a. true b. false

Answer 63

a. true

Question 64

The risk of a thrombus forming post operatively is not related to the degree of tissue damage during surgery. a. true b. false

Answer 64

False - Damage to tissue leads to tissue factor release, a step in the clotting cascade. In invasive operations or ones which involve a lot of damage to tissue (eg Orthopaedic operations) there would be higher concentrations of tissue factor released and therefore an increased risk of thrombus formation.

Question 65

Streptococcus Viridans is a common bacteria involved in infective endocarditis. a. true b. false

Answer 65

True - This is a common cause and is most abundant in the mouth. Poor dentition or dental procedures have the potential to introduce this bacteria into the blood stream and possibly lead to infective endocarditis. Other common bacteria include staph aureus and enterococcus.

Question 66

Osler nodes are a sign which may be seen in infective endocarditis. a. true b. false

Answer 66

True - These are painful, erythematous nodules found on the hands and soles of feet. They are associated with infective endocarditis as well as other conditions.

Question 67

Osler nodes are a sign which may be seen in

Answer 67

infective endocarditis.

Question 68

A post op patient complains of a tender, hot, swollen and erythematous calf. The most likely diagnosis is lymphoedema. a. true b. false

Answer 68

False - The most likely diagnosis in this presentation is a deep vein thrombosis.

Question 69

A post op patient complains of a tender, hot, swollen and erythematous calf. The most likely diagnosis is lymphoedema. a. true b. false

Answer 69

False - The most likely diagnosis in this presentation is a deep vein thrombosis.

Question 70

The incidence of infective endocarditis is higher in diabetic patients. a. true b. false

Answer 70

a. true

Question 71

Long QT syndrome is a possible cause of nocturnal seizures a. true b. false

Answer 71

a. true Particularly SCN5A – associated Long QT

Question 72

Arteries such as the internal mammary or the radial artery can be used as conduits in a CABG. a. true b. false

Answer 72

a. true

Question 73

Arteries such as the internal mammary or the radial artery can be used as conduits in a CABG. a. true b. false

Answer 73

a. true

Question 74

Outflow tract cardiac malformation and speech delay are the two most significant features of 22q11 deletion syndrome in childhood. a. true b. false

Answer 74

a. true Roughly 40% of 22q11 deletion patients will have outflow tract abnormality and 40% will have speech delay due to palatal dysfunction. Only some patients have an actual cleft palate – velopharyngeal insufficiency is more common. DiGeorge syndrome (thymic hypoplasia, hypoparathyroidism, and outflow tract cardiac malformation) is an uncommon presentation of 22q11 deletion syndrome.

Question 75

two significant features of 22q11 deletion syndrme

Answer 75

Roughly 40% of 22q11 deletion patients will have outflow tract abnormality and 40% will have speech delay due to palatal dysfunction. Only some patients have an actual cleft palate – velopharyngeal insufficiency is more common. DiGeorge syndrome (thymic hypoplasia, hypoparathyroidism, and outflow tract cardiac malformation) is an uncommon presentation of 22q11 deletion syndrome.

Question 76

Once a thrombus is formed in a vein it cannot move to a different site. a. true b. false

Answer 76

False - A thrombus can dislodge and embolise to a distal site. This can be seen when a clot from the deep veins in the legs, embolises to the lungs (Pulmonary embolism).

Question 77

Aortic stenosis can lead to left ventricular hypertrophy. a. true b. false

Answer 77

True - There is increased afterload on the left ventricle due to the back-pressure from the stenosed aortic valve. This means the ventricle has to work harder and can become hypertrophied.

Question 78

Myocarditis can cause heart failure. a. true b. falsee

Answer 78

True - extensive damage to the myocardium resulting from inflammation can lead to heart failure.

Question 79

Warfarin is required in patients with mechanical heart valves. a. true b. false

Answer 79

True - Warfarin is required for life as there is an increased risk of a thrombus forming. At the time of writing, this remains one of the few conditions where warfarin is still used in preference over newer oral anticoagulant drugs.

Question 80

An IV drug user is referred after his GP heard a murmur over the left lower sternal edge. He has been feeling “hot” for the last three weeks. The likely diagnosis is pericarditis. a. true b. false

Answer 80

False - The most likely diagnosis is infective endocarditis. The classic presentation in IV drug users is infective endocarditis most commonly affecting the tricuspid valve and caused by staph aureus. IV drug abuse is a risk factor as bacteria from the skin are introduced into the bloodstream through non-sterile needle use.

Question 81

Patients with Marfan syndrome should have an annual review with echocardiogram a. true b. false

Answer 81

True - this is to monitor the aortic root diameter.

Question 82

Echocardiogram is the imaging investigation of choice in infective endocarditis. a. true b. false

Answer 82

True - Echo allows visualisation of the heart structure and a view of the heart valves for signs of the infection such as septic vegetations. It can aid diagnosis and is a part of the Dukes criteria for diagnosing infective endocarditis.

Question 83

Heparin may be given to prevent a deep vein thrombosis in certain surgical patients at risk a. true b. false

Answer 83

True - Anticoagulants such as Heparin/LMWH or newer agents can be given to prevent thrombus forming

Question 84

A parasternal heave palpated on the left side of the sternum may be due to left ventricular hypertrophy a. true b. false

Answer 84

False - A parasternal heave is palpated when the heel of the hand is lifted upwards when placed on the chest. A parasternal heave on the left of the sternum may be caused by RIGHT ventricular hypertrophy as the right ventricle lies deep to this area.

Question 85

Down's syndrome is due to a deletion on chromosome 21. a. true b. false

Answer 85

False - Down's syndrome is Trisomy 21 - an extra chromosome.

Question 86

Kussmaul’s sign may be seen in constrictive pericarditis. a. true b. false

Answer 86

a. true True - JVP normally falls on inspiration. Kussmaul’s sign is a rise in JVP on inspiration. It may be seen in constrictive pericarditis.

Question 87

Kussmaul’s sign

Answer 87

is a rise in JVP on inspiration. It may be seen in constrictive pericarditis.

Question 88

The commonest cause of splinter haemorrhages is infective endocarditis. a. true b. false

Answer 88

False - This is a sign seen in infective endocarditis however there are a variety of causes, the commonest being trauma.

Question 89

A 60 year old patient with renal failure presents as an emergency with sharp chest pain which is eased by leaning forward. On auscultation a faint rub can be heard. The diagnosis is likely to be an acute myocardial infarction. a. true b. false

Answer 89

False - The diagnosis is likely to be acute pericarditis, possibly secondary to high urea levels seen in renal failure.

Question 90

Di Georges syndrome is due to a deletion on 22q11. a. true b. false

Answer 90

Di Georges syndrome is due to a deletion on 22q11.

Question 91

features of Di Georges syndrome

Answer 91

True - Remember CATCH 22 - Cardiac malformation, Abnormal facies, Thymic hypoplasia, Cleft palate, Hypoparathyroidism, 22 q11 deletion.

Question 92

Turner syndrome is associated with tall stature. a. true b. false

Answer 92

False - it is associated with short stature.

Question 93

Turner syndrome is associated with tall stature. a. true b. false

Answer 93

False - it is associated with short stature.

Question 94

A patient presents after a road traffic accident with a tachycardia, hypotension, raised JVP and muffled heart sounds. The likely cause of these signs is constrictive pericarditis. a. true b. false

Answer 94

False - The likely diagnosis is pericardial tamponade secondary to trauma. Becks triad is seen above, a collection of signs seen in acute pericardial tamponade. These are hypotension, raised JVP and muffled heart sounds.

Question 95

Pulsus paradoxus is a sign which may be seen in patients with pericardial tamponade. a. true b. false

Answer 95

True - This is a sign that may be seen in patients with pericardial tamponade. On inspiration, the radial pulse may not be palpated but a heart beat may still be heard on auscultation, hence the paradox. The term "pulsus paradoxus" refers to a significant fall in systolic blood pressure during inspiration.

Question 96

Pulsus paradoxus is a sign which may be seen in patients with pericardial tamponade. a. true b. false

Answer 96

True - This is a sign that may be seen in patients with pericardial tamponade. On inspiration, the radial pulse may not be palpated but a heart beat may still be heard on auscultation, hence the paradox. The term "pulsus paradoxus" refers to a significant fall in systolic blood pressure during inspiration.

Question 97

Alcohol can cause disease of the heart muscle. a. true b. false

Answer 97

True - Alcoholic heart disease is a common disorder of heart muscle. Alcohol is directly toxic to the heart leading to a disease similar in presentation to that of dilated cardiomyopathy.

Question 98

Alcoholic heart disease is a common disorder of heart muscle. Alcohol is directly toxic to the heart leading to a disease similar in presentation to that of ?

Answer 98

of dilated cardiomyopathy.

Question 99

Mitral valve disease can cause enlargement of the left atrium. a. true b. false

Answer 99

True - both mitral stenosis and mitral regurgitation can cause enlargement of the left atrium.