Options: 

A.   Atherosclerosis

B.   COPD

C.   Hyperlipidemia 

D.   pericarditis

E.   rheumatic fever  

F.    HCM

G.   Arrhythmias

H.   MI

I.      Heart failure 

J.    cardiac tamponade

 

1.    A 56 year old obese truck driver comes into A & E very distressed and is complaining of chest pain, shortness of breath and been ‘feeling his heart thumping out of his chest. He is very worried as a month ago he had a MI and is worried he may be having another one.

2.    A 70 year old smoker has had trouble breathing over the past 6 months and complains of constant tiredness and lack of energy. He has noticed his ankles are swollen. 

3.    A teenage has an echo of his heart for a school project. He is asked to go for further test as it shows some abnormalities which he describes as ' a thickened wall which divide the chambers which has caused one of the chambers to become narrower'.

4.    A Indian gentleman who has recently had a streptococcal infection comes in complaining of shortness of breath. On examination a friction rub can be heard on auscultation. He also mentions that he has been feeling stiff over the past few days and has not been able to move around much. 

5.    A 50 year old female smoker was prescribed aspirin and give lifestyle modification advice after an annual BUPA check up. What is the doctor trying to prevent? 

 

Answers: GIFEH

Note: A friction rub is definitely pericarditis, but with the stiff joints, Rheumatic Fever is more likely. Pericarditis is usually TB or viral, rather than streptococcal. In the real exam, Q4 would have a murmur rather than a friction rub.