Austin Block 1

1

Characteristic findings in a patient with long-standing mitral stenosis include:


  A high pitched diastolic murmur

  A soft first heart sound

  A left parasternal heave suggesting pulmonary hypertension

  A displaced apex beat

  An opening snap occurring just before the second heart sound

2

Recognised features of severe cardiac failure include:


  tiredness

  nocturia

  nocturnal cough

  epigastric pain

  all of the above

3

Which of the following is true of jugular venous pressure?


  The external jugular vein is a reliable guide to right atrial pressure

  The JVP is measured from the suprasternal notch

  The normal JVP, unlike the blood pressure, does not rise with anxiety

  The normal JVP does not rise on abdominal compression

  The a wave is prominent in patients with atrial fibrillation

4

Which of the following is true of cardiac murmurs?


  Diastolic murmurs are commonly heard in elderly patients with heart failure due to cardiomyopathy

  Ventricular septal defects produce pansystolic murmurs

  An early high-pitched diastolic murmur suggests mitral stenosis

  An early systolic murmur suggests mitral valve prolapse

  Mitral diastolic murmurs are best heard at the left sternai edge with the patient leaning forward

5

A 75 year old woman collapsed while walking to the toilet 8 days after a laparotomy. Which of the following is not consistent with a pulmonary embolus?


  A preceding history of a painful swollen right calf

  An elevated jugular venous pressure

  A palpable right ventricular impulse

  A new right bundle branch block on ECG

  None of the above

6

Typical chest findings in a large right pleural effusion include:


  Normal chest expansion

  Slightly reduced percussion note

  Absent breath sounds

  Increased vocal resonance

  Pleural friction rub

7

Bronchial carcinoma:


  Is the commonest type of fatal cancer in males in Australia

  Typically presents with massive haemoptysis

  Is adenocarcinoma in approximately 50% of cases

  Is usually suitable for surgical resection

  Is not associated with asbestos exposure

8

Which of the following does not cause an elevated jugular venous pressure?


  pericardial effusion

  biventricular heart failure

  tricuspid stenosis

  aortic regurgitation

  massive pulmonary embolus

9

A 25 year old man is brought to the Emergency Department by ambulance after a car accident. On arrival he is cyanosed and breathless. His trachea is deviated to the right. Percussion note is resonant over both sides of the chest but there are no audible breath sounds on the left side. The most likely diagnosis is:


  haemorrhage into the left lung

  left haemothorax

  tension pneumothorax

  ruptured arch of aorta

  massive pulmonary embolism

10

Which of the following statements about the apical impulse is true?


  lt is prominent in patients with mitral stenosis

  lt is usually displaced in patients with aortic stenosis.

  it can be used as a guide to displacement of the mediastinum

  lt is usually felt in the 4th left intercostal space, midclavicular line

  lt is usually displaced in patients with essential hypertension

11

From your history you suspect that a patient has left lower lobe pneumonia. Which of the following physical signs is most compatible with this diagnosis?


  Mediastinal displacement to the left

  A normal percussion note over the left lower chest

  Deviation of the trachea to the left

  Diminshed breath sounds over the left lower chest

  Increased vocal resonance over the left lower chest

12

You are likely to find a sinus tachycardia in all of the following except


  A patient with a pulmonary embolus

  A patient with raised intracranial pressure

  A patient with pneumonia

  A patient with Grave's disease

  A patient with heart failure

13

Which of the following is not associated with clubbing of the fingers?


  Cyanotic heart disease

  Bronchiectasis

  Cirrhosis of the liver

  Diabetes mellitus

  Lung cancer

14

Secondary hypertension is not associated with:


  cyclosporine

  coarctation of the aorta

  primary aldosteronism

  hypothyroidism

  phaeochromocytoma

15

In differentiating chronic congestive cardiac failure from cirrhosis of the liver, which of the following is the most useful physical sign?


  blood pressure

  ascites

  jaundice

  raised jugular venous pressure

  oedema of the ankles

16

You are likely to find a bradycardia in all of the following EXCEPT:


  A patient on atenolol therapy

  A patient with raised intracranial pressure

  A patient with an inferior myocardial infarction

  A patient with sick sinus syndrome

  A patient on ipratropium therapy

17

All of the following statements are true of an atrial septal defect except:


  Fixed splitting of the first heart sound is a characteristic finding

  Paradoxical embolism may occur

  Atrial fibrillation commonly develops in middle age

  Incomplete right bundle branch block is commonly present on the ECG

  A mid-systolic fiow murmur is commonly audible

18

A 40 year old man is brought to the Emergency Deparstment. He is centrally cyanosed and his blood pressure is unrecordable. Two hours earlier he was stung by a bee and immediately developed generalized urticarial rash and wheeze. Which of the following drugs is most urgently required by this patient:


  Salbutamol

  Adrenaline

  Hydrocortisone

  Antihistamine

  Atropine