Cardiology SAQ Questions

Questions were made by students on behalf of The Peer Teaching Society. We hope there are no mistakes but are
not liable for any false or misleading information.

1. A 76-year-old women presents in your clinic with complaining that sometimes when shes going up the stairs
she feels faint. Upon taking her history she has stable angina, dyspnoea and heart failure. You suspect she has
a heart valve problem.

a) What would you expect aortic stenosis to sound like and explain the pathophysiology? (3 marks)

b) If this woman had mitral stenosis, what would you expect to see on a chest X-ray? (2 marks)

c) What does mitral stenosis sound like on auscultation? (2 marks)

2. A 43-year-old women presents in your clinic with exertional dyspnoea, fatigue, and a nocturnal cough with
pink frothy sputum. You examine her and from this diagnose her with heart failure.

a) List some clinical signs you might find on examination or on a chest X-ray. (4 marks)

b) What marker might you find in her blood that could be indicative of heart failure? (1 mark)

3. A 35 year old male presented to the A&E who was very febrile. On further questioning, the patient also has
headaches, shortness of breath and arthralgia. On examination, it was noted that there were nail bed
splinter haemorrhages, Osler’s nodes and Janeway lesions of the hands.

List 3 investigations that you would want to do for initial investigations of infective endocarditis. (3 marks)
4. A 65 year old male presented to A&E after his wife had called for an ambulance due to severe chest in the
centre of his chest which was radiating to his left neck and arms. On further questioning, the patient has a
past medical history of angina, hypertension and type 1 diabetes mellitus.

a) Define atherosclerosis (2 marks)

b) List 5 risk factors that can lead to hypertension (5 marks)

c) Give 2 medical and 2 lifestyle interventions that are indicated in the management of ischaemic heart
disease in a primary care setting. (4 marks)

5. A 59-year-old man is seen in the Emergency Department after reporting retrosternal crushing chest pain of
10/10 intensity. He reports the pain is radiating down the left arm and neck. An ECG reveals ST-segment
elevation in leads V1 to V6.

a) Other than chest pain, name 4 other symptoms or signs you may find on the history or examination (4
marks)

b) Name 3 modifiable and 2 non-modifiable risk factors for a STEMI. (5 marks)

6. A 1-day-old infant born at full term is noted to have cyanosis of the oral mucosa. On examination,
respiratory rate is 40 and pulse oximetry is 80%. Congenital heart disease is suspected and Tetralogy of Fallot
is diagnosed after echocardiography.

Name the 4 cardiac defects involved in Tetralogy of Fallot. (4 marks)

 7. A 68-year-old male presents to the Emergency Department with worsening shortness of breath. A chest X-
ray shows classic findings of heart failure.

Name 3 findings that may be seen on the chest X-ray. (3 marks)

8. Describe the differences between 1st, 2nd (type I and II), and 3rd degree heart block. (8 marks)

1st degree –

2nd degree type I (Mobitz I or Wenckebach) –

2nd degree type II (Mobitz II) –

3rd degree –

9. A pulmonary embolism can be caused by a deep vein thromboembolism.

a) Define thrombosis and embolism. (2 marks)

b) What the difference between infarction and ischaemia? (2 marks)

10. Renin is released from the kidney in response to decreased renal perfusion (caused by fluid loss and
hypovolaemia). This activates the renin-angiotensin-aldosterone system.

List 4 effects of RAAS activation. (4 marks)

11. a) What is the difference between essential hypertension and secondary hypertension? (2 marks)

b) Name 3 causes of secondary hypertension outlining a mechanism of action for each (6 marks)

Total Marks (66)

Cardiology SAQ Answers

Question Answers
1. a) Collapsing water hammer pulse
Early diastolic murmur
Leakage of blood into the left ventricle
During diastole due to ineffective coaptation of aortic cusps

b) Enlarged left and right ventricles.

It must be noted that cardiac echos not XR are the better investigation for cardiac murmurs.

c) Pansytolic murmur
Soft S1 sound

I found this diagram helpful when trying to learn heart murmurs.

2. a) 3rd/4th heart sounds

Crepitations in lung bases.
ABCDE – alveolar oedema, Kerley B lines, cardiomegaly, dilated upper lobe vessels, effusions

b) Brain natriuretic peptide, troponin I, troponin T, creatine kinase.

3. Infective endocarditis is an infection of the endocardium of the heart, commonly this affects the
valvular structures.
1st line investigations would often include:
• FBC – anaemia, leucocytosis
• Urinalysis – proteinuria, RBC casts, WBC casts
• Blood cultures – recommend 3 sets prior to starting antibiotics
• ECG
• Echocardiogram
4. a) Accumulation of lipids, macrophages, and smooth muscle cells in the intima of large and medium
sized arteries.

b) Renal disease e.g. renal artery stenosis

Obesity
Pregnancy induced hypertension / pre-eclampsia
Endocrine causes e.g. hyperaldosteronism
High alcohol intake
Metabolic syndrome
Diabetes mellitus
Age >60yrs
FHx of hypertension or coronary artery disease
High salt intake >1.5g/day
Low fruit and vegetable intake
Dyslipidaemia
Physical inactivity
Smoking

c) Antihypertensives
Statins
Aspirin
Diabetic therapy / encouraging better glycaemic control
Smoking cessation
Advice on diet
Encouraging exercise

5. a) Symptoms – nausea/vomiting, light-headed/dizzy, short of breath, sweating/diaphoresis,

anxiety/dread, palpitations.
Signs – pallor, hypotensive, sweating/diaphoresis.

b) Modifiable – smoking, hypertension, diabetes, obesity, physical inactivity, poor diet, cocaine use,
dyslipidaemia, metabolic syndrome
Non-modifiable – advanced age, male sex, family history of CAD, previous CAD
Give leniency if a valid risk factor falls into a grey area between modifiable and non- modifiable, for
example diabetes could fall into either category.

Explanation: Coronary artery disease is common and expect it to come up in medical school exams.
Know the aetiology, epidemiology, presentation, investigations, differentials and management of CAD,
because it is a topic you are expected to know to good detail.

6. Acceptable answers: Ventricular septal defect (VSD), Pulmonary stenosis, Right ventricular
hypertrophy, Overriding/misplaced aorta.

Explanation: Tetralogy of Fallot and other congenital heart conditions are part of the 2a curriculum,
despite feeling like a 3a paediatric topic. Knowing the basics of the common congenital heart
conditions is definitely worth knowing, such as the defects in TOF.

7. CXR findings in heart failure is a classic medical school question. A helpful way to remember is ABCDE:
A – Alveolar oedema (also called bat wings)
B – Kerley B lines (horizontal lines in lower posterior lung fields)
 C – Cardiomegaly (cardiac diameter >0.5 width of the thorax)
D – Dilated upper lobe vessels (also called cephalisation)
E – Pleural effusion (shown as blunting of the costophrenic angles)

8. 1st degree - indicated on an ECG by a prolonged PR interval (the time between atrial depolarisation and
ventricular depolarisation)

Mobitz I – has progressive prolongation of the PR interval followed by a dropped QRS complex

Mobitz type II second degree AV block is a disease of the distal conduction system (His-Purkinje
system). Characterised by intermittently non-conducted P waves not preceded by PR prolongation and
not followed by PR shortening

3rd degree heart block is the complete absence of AV conduction. Atrial rate is ~100 bpm, ventricular
rate ~40 bpm. 2 rates are independent.

9. a) Embolism = blocked vessel caused by a foreign body e.g. a blood clot or an air bubble

Thrombosis = formation of a blood clot inside a blood vessel, this obstructs the flow

b) Infraction = death of heart muscles cells due to a reduced or absent blood supply
 Ischaemia = restriction in blood supply to tissues causing a shortage of oxygen that is needed for cell
function

10. • Increased sympathetic activity

• Increased tubular reabsorption of Na and Cl. K+ excretion. H2O retention.
• Increased aldosterone secretion resulting in Na reabsorption in DCT.
• Arteriolar vasoconstriction
• ADH secretion leading to H2O reabsorption
• Overall salt and water retention and an increase in BP.

11. a) Essential hypertension occurs independent of any identifiable cause.

Secondary hypertension occurs as a result of an identifiable cause

b) Not an exhausted list, see website for more details.

Renal artery stenosis

Chronic renal disease
Primary hyperaldosteronism
Stress
Sleep apnea
Hyper- or hypothyroidism
Pheochromocytoma
Preeclampsia
Aortic coarctation
https://www.cvphysiology.com/Blood%20Pressure/BP023