Pastest + MRCP part-1 Revision Question Bank 2025 Clinical Science & Basic Science (11 Voolume Set)

Publisher: Pastest+

Language: English

ISBN:----- 

Year: 2005

Edition:1st

Pages:4400

Author: Pastest

Product Type: Paperback

Condition: New

Price: ₹14,995/-

Delivery Time:7-8 days

Description

Cardiology (368)

ULBS Question bank 1 of 368 A 72-year-old white man is referred to the outpatients department with a 6-month history of progressive exertional dyspnoes. His ankles swell as the day progresses. There is no associated chest discomfort. He is an ex smoker of 3 years and drinks & pints of beer per week. He has not seen his general practitioner in the past 15 years. The only history is that of mild asthma as a child. His father died of a myocardial infarct aged 65 years. Blood pressure is 150/86 mmHg. Results of investigations are: renal function, normal; cholesterol, 6.8 mmol/l, electrocardiogram, sinus rhythm left bundle branch block; echocardiogram, dilated and impaired left ventricular function with ejection fraction of 30%, mild-to-moderate mitral regurgitation, no left ventricular hypertrophy

What is the most likely underlying aetiology?

A

Alcohol

B. Coronary artery disease

C

Hypertension

D

Valvular heart disease

E Viral myocarditis

Explanation

Coronary artery disease

Coronary artery disease is the most likely underlying actiology. Chronic heart failure is not an absolute diagnosu, and a cause must be found. In the UK, the most common aetiology is underlying ischaemic heart disease (IHD), at=50-66% of cases. This patient has several risk factors for IHD, which adds weight to the like block is also likely to be ischaemic in origin. likelihood of this being the diagnosis. Left bundle branch

Valvular heart disease

Valvular heart disease is incorrect. The mitral regurgitation in this patient is most likely to be secondary to left ventricular dilatation and subsequent annular dilatation of the mitral valve ring. This will contribute to the development of pulmonary hypertension.

Alcohol

Alcohol is incorrect. This patient has a significant intake of alcohol, but the overall clinical picture indicates cardiac dysfunction as opposed to decompensated liver disease (in isolation). It is also a little late in life to develop alcoholic cardiomyopathy, which is usually seen in individuals aged 30-50 years

Hypertension

Hypertension is incorrect. This patient is hypertensive, but this in isolation is highly unlikely to be responsible for his overall clinical condition. If hypertension was accountable in isolation, we would expect to see abnormal renal function.

Viral myocarditis

Viral myocarditis is incorrect. Viral myocarditis is more likely to occur in younger patients. He is not complaining of chest discomfort or systemic symptoms and there is no evidence of these features from the electrocardiogram or echocardiogram.