1. A50 year old female presents with a sharp chest pain which is worse oninspiration.. Her temperature is 3800C& she has a history of a recent viral infection.. Her pulse is much weaker on inspiration &the JVP is found to be raised
2. A26 year old racing driver is brought to A&E following a RTA. He is dyspnoeic, has a BP of 105/60 &pulse 95. On examination the trachea is deviated to the left & there isdecreased expansion of the left side relative to the right
3. A70 year old man with history of hypertension presents with sudden tearing chestpain radiating to the back. The peripheral pulses are absent & there is awidened mediastinum on CXR
4. A65 year old male complains of a severe crushing pain in his chest.. He is sweating, short of breath, says hefeels sick & appears very drowsy.. The pain is not relieved by GTN spray.
5. An18 year old girl has felt unwell for about 3 weeks, complaining of chest pains,which are worse when she lies flat. Shehas now become short of breath. She isadmitted to hospital where she is found to be in acute pulmonary oedema.
6. Duringthe month following his acute inferior myocardial infarction, a 56 year old manhas become progressively more breathless. On examination he has a loud pan-systolic murmur
7. A24 year old Asian man who has come to work as a chef in an Indian restauranthas a 2 month history of cough, fever, night sweats & weight loss. He has been treated with a number ofantibiotics by the GP but remains unwell. He is admitted with shortness of breath & haemoptysis. On chest x-ray his heart size is normal.
8. A42 year old man is admitted with peripheral oedema & breathlessness. A routine medical examination 6 monthsbefore, was normal. He has no murmurs,but his heart is enlarged both on clinical examination & chest x-ray. Investigations include normal liver functiontests and normal CRP.
1. A49 year old man with recent history of long-haul travel presents with shortnessof breath & haemoptysis. He alsocomplains of chest pain & ECG shows sinus tachycardia
2. A73 year old gentleman presents to A&E with sudden “tearing” chest pain, radiatingto the back. The F1 who is assessing thepatient notices a blood pressure of 150/82 in the left arm and 120/60 in theright arm.
3. A67 year old man recovering from an inferior MI complains of sharp retrosternalchest pain. He comments that leaningforward provides relief of the pain. Theattending medical student claims to have heard a “rub” on auscultation
For each situationbelow, choose the SINGLE most likely diagnosis from the above list.
4. A60 year old Irish woman comes to see you with a progressive 1 year history ofshortness of breath & recent onset of paroxysmal nocturnal dyspnoea. She has been previously well apart fromSydenham’s chorea as a child. She had 6normal pregnancies. On examination shehas plethoric cheeks, the pulse is rapid (110/min), irregular & smallvolume. BP 128/80 JVP normal. The apex is in the 5th midclavicular line & tapping in nature. The 1st heart sound is loud & P2 accentuated. A low pitched mid-diastolic murmur 2/4 isheard in the apex.
5. A50 year old man attends A&E with shortness of breath, fever &hyperdynamic regular pulse of 100 beats per minute. BP 160/60. He has an early diastolic murmur at the left sternal edge. On further enquiry it is found that heattended for a routine dental procedure 2 months ago.
6. A65 year old man had an inferior MI 10 days ago. His initial course was uncomplicated. He suddenly deteriorates with acute left ventricular failure. On examination the pulse is regular 100/min& normal volume & character. BP110/60. The apex beat is dynamic. There is a loud grade 6/6, apical pansystolicmurmur which radiates to the axilla.
7. An80 year old woman presents with recent onset of effort-related chest pain. On examination of the cardiovascular systemshe is found to have a loud ejection systolic murmur & a low pulse pressurewith slow rising pulse.
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