Cox & Roper: Clinical Skills - Extended Matching Questions

Table of Contents

1. Chapter 04 - Cardiovascular System
2. Chapter 05 - Respiratory system
3. Chapter 06 - Adominal system
4. Chapter 07 - Rectal examination
5. Chapter 08 - Arms
6. Chapter 09 - Hands
7. Chapter 10 - Legs
8. Chapter 11 - Cranial Nerves
9. Chapter 12 - Necks
10. Chapter 13 - Joints
11. Chapter 14 - Spot Diagnosis
12. Chapter 15 - The electrocardiogram
13. Chapter 16 - The chest X-ray

Chapter 04 - Cardiovascular System

Instructions: Each group of extended matching questions consists of lettered options followed by a list of numbered problems/questions. For each numbered problem/question select the one lettered option that most closely answers the question. You can use the lettered options once, more than once, or not at all.

Topic: Cardiovascular symptoms and signs

Options:

1. Radiofemoral delay
2. Pan-systolic murmur
3. Systolic blood pressure of 220 mmHg
4. Tapping apex beat
5. Chest pain eased by glyceryl trinitrate in 5 minutes
6. Third heart sound
7. Splinter haemorrhages
8. Breathlessness eased by lying flat
9. Slow-rising carotid pulse
10. Bradycardia with pulse rate 20 per minute
11. Chest pain eased by glyceryl trinitrate after an hour

The patients described below have come to see you. Which of these clinical features are they most likely to demonstrate?

1

Scenario 1 a) A 65 year old man is admitted after a collapse when running for the bus. On examination, he has a sustained heaving apex beat that is slightly displaced and an ejection systolic murmur. Choose... Radiofemoral delay Pan-systolic murmur Systolic blood pressure of 220 mmHg Tapping apex beat Chest pain eased by glyceryl trinitrate in 5 minutes Third heart sound Splinter haemorrhages Breathlessness eased by lying flat Slow-rising carotid pulse Bradycardia with pulse rate 20 per minute Chest pain eased by glyceryl trinitrate after an hour Correct. These are features of aortic stenosis which causes a slow rising pulse. See pages 39 and 66.Incorrect. These are features of aortic stenosis which causes a slow rising pulse. See pages 39 and 66.Your answer has been saved.

2

Scenario 2 a) An 80 year old woman is admitted with an excruciating pain between the shoulder-blades. You can palpate the right radial pulse but not the left. Choose... Radiofemoral delay Pan-systolic murmur Systolic blood pressure of 220 mmHg Tapping apex beat Chest pain eased by glyceryl trinitrate in 5 minutes Third heart sound Splinter haemorrhages Breathlessness eased by lying flat Slow-rising carotid pulse Bradycardia with pulse rate 20 per minute Chest pain eased by glyceryl trinitrate after an hour Correct. This pain is suggestive of aortic dissection and the asymmetric pulses increase the likelihood. Dissection may be caused by hypertension. See page 25.Incorrect. This pain is suggestive of aortic dissection and the asymmetric pulses increase the likelihood. Dissection may be caused by hypertension. See page 25.Your answer has been saved.

3

Scenario 3 a) A 70 year old man had a myocardial infarction two years ago. He is now admitted with gradually increasing breathlessness worse on lying flat with crepitations in the lung bases. Choose... Radiofemoral delay Pan-systolic murmur Systolic blood pressure of 220 mmHg Tapping apex beat Chest pain eased by glyceryl trinitrate in 5 minutes Third heart sound Splinter haemorrhages Breathlessness eased by lying flat Slow-rising carotid pulse Bradycardia with pulse rate 20 per minute Chest pain eased by glyceryl trinitrate after an hour Correct. These are features of heart failure, specifically left ventricular failure which can cause a third heart sound. See pages 51, 68 and 69.Incorrect. These are features of heart failure, specifically left ventricular failure which can cause a third heart sound. See pages 51, 68 and 69.Your answer has been saved.

4

Scenario 4 a) A 65 year old woman has been increasingly breathless over the last few years. On auscultation, she has a loud first heart sound and a mid-diastolic murmur. Choose... Radiofemoral delay Pan-systolic murmur Systolic blood pressure of 220 mmHg Tapping apex beat Chest pain eased by glyceryl trinitrate in 5 minutes Third heart sound Splinter haemorrhages Breathlessness eased by lying flat Slow-rising carotid pulse Bradycardia with pulse rate 20 per minute Chest pain eased by glyceryl trinitrate after an hour Correct. These are features of mitral stenosis. A loud first heart sound is usually accompanied by a tapping apex beat. See pages 48 and 63.Incorrect. These are features of mitral stenosis. A loud first heart sound is usually accompanied by a tapping apex beat. See pages 48 and 63.Your answer has been saved.

5

Scenario 5 a) The patient is a 60 year old man who smokes 20 per day. He comes to clinic complaining of a tight pain in the centre of his chest which comes on when he walks uphill. Choose... Radiofemoral delay Pan-systolic murmur Systolic blood pressure of 220 mmHg Tapping apex beat Chest pain eased by glyceryl trinitrate in 5 minutes Third heart sound Splinter haemorrhages Breathlessness eased by lying flat Slow-rising carotid pulse Bradycardia with pulse rate 20 per minute Chest pain eased by glyceryl trinitrate after an hour Correct. This man's smoking puts him at risk of ischaemic heart disease. This pain sounds like stable angina. See pages 22 and 23.Incorrect. This man's smoking puts him at risk of ischaemic heart disease. This pain sounds like stable angina. See pages 22 and 23.Your answer has been saved.