Ultimate Finals List - Cardiology

Cardiology Stations

• CABG, heard no heart sounds initially, then listened again and again, then thought dextracardia, then got asked what sternotomy scar could indicate
• CABG, aortic valve replacement and systolic murmur, all due to alcoholic liver disease (?) // Gentleman with a very impressive nicotine stained beard! Plus AF, a raised JVP, midline CABG scar, clicking valve replacement and graft scars on his leg. We had to examine, report our findings and then state what drugs we would expect him to be on 
• Cardiology st: Pt looked well. Had midline sternotomy scar and click THUD which I could hear from end of bed. Pt had no other leg or arm scars. I said it was aortic valve replacement and talked about infective endo.Then time was up. I wish there had been time to recite the causes of AF!
• Cardio - prosthetic at S2, midline sternotomy. Asked about how I knew it was aortic. When I would replace the valve. Porcine vs prosthetic
• Cardiovascular- Patient with sternotomy scar. I couldn’t hear a metallic click (in fact he had incredibly quiet heart sounds) and started to panic when I looked for a scar on the upper thigh but couldn’t see one. So I presented and said if it was a CABG I would expect a scar which was not present. At that point the examiner pointed out a scar near the guy’s ankle! It turned out he had had a CABG and valve replacement (biological) and I was asked what valve was most likely to have been replaced and why. I didn’t know and guessed the mitral- wrong! I didn’t mind this station as it all seemed to make sense and the examiner was lovely.
• CVS – Aortic valve replacement, had collapsing pulse, asked for BP, examiner said 160/60 (wide pulse pressure). Auscultation revealed a click at S2, midline sternotomy scar also. Also a diastolic murmur heard with patient sat forwards in expiration. Asked for diagnosis and reasons for my thinking it is aortic regurgitation.
• CVS - Not 100% certain, CABG scar, and ankle scar, loud 2nd sound, but not metallic, I gave CABG and aortic (porcine) valve replacement (examiner said I did really really well). Unable to hear the mitral heart sounds (everyone found this).
• The patient had a large sternotomy scar and metallic sounding S2 and some people also heard a murmur and he had AF. I only mentioned the prosthetic valves and said it was a aortic valve replacement because of the position of the scar and because I heard it loudest in the aortic area. He seemed happy enough with that cos I saw him tick the pass box.

• Mitral valve replacement in a Marfans patient - then asked about JVP waves
• CVS - young afro-Caribbean lady with a midline sternotomy scar - when palpating for her apex beat I could hear the clicking sound of a valve replacement without even my stethoscope! Nice straightforward station - presented my case and gave some differentials as to the type of valve (mitral/aortic etc), examiner asked what else I would consider giving the patient (warfarin with INR between 3-4) and that was about it // Cardio – MVR – mechanical, heard from bedside!! Q’s on likely causes, warfarin

• CV - lady had clubbing and a metallic valve with massive midline sternotomy, which I thought was aortic valve replacement but now I think was pulm secondary to Fallot's. Asked about what I thought she had and why, and complications of valve replacement

• Cardiology – Radial scar with sternotomy scar and mechanical aortic valve!! Patient had a CABG replacement with the radial artery, and an AV replacement. REMEMBER if there is a scar on the radial side and NO pulse use the other hand, many people made the pulse up!!// CARDIO- the lead in was this lady has high cholesterol and hypertension, please do an cardiovascular examination. I had done a specialist module in cardiology so I was pretty confident with my murmurs, however, this lady had no murmurs, the only things I could find were quiet heart sounds in the aortic and pulmonary regions, and a very weak left radial, I presented my findings and was asked about the causes of a weak left radial, I started going through a list of things I had learnt and then I said possibly cardiac catheterisation via the right radial artery for angioplasty/stent insertion, I think that’s what he wanted as he didn’t ask me any more

• Cardio - difficult, very loud systolic murmur and obvious artifical valve sound (? ball and cage) loudest at left sternal edge, no radiation. Pt had massive sternotomy scar which looked like it had been re-opened at least once. Also thought she had a waterhammer pulse. Examiner asked me which valve, we had been told by numerous consultants that it would be either a mitral or an aortic pathology so I guessed aortic. Examiner didn't seem too bothered but asked me to look at her abdomen and arms, covered in what looked like multiple biopsy or cigarette burns - had no idea. Turns out pt was a former IVDU and thus it was tricuspid valve replacement - haven't met anybody else who got it yet, most people said mitral though

• Congenital cyanotic heart disease with a right-left shunt. I was asked about causes of central cyanosis.

• Cardio exam - irregular pulse in thin old man with rheumatoid hands, no peripheral oedema. JVP very elevated. Thrill over mitral valve. Systolic murmur, louder on expiration and leaning forward, radiated to carotids not to axilla. I said it was aortic stenosis, examiner guided me to mitral valve prolapse.
• Patient had AF and mitral prolaspe, I thought it was Aortic stenosis but the examiner was very nice and led me round to describing mitral prolapse. He then asked me about the pathogenesis of mitral regurg and how it caused LVF

• Some thought it was aortic stenosis but others thought it was mitral regurgitation. He had subconjunctival haemorrhage which they also wanted you to note and this tied in with his being on Warfarin

• CVS - AF and aortic stenosis. Causes, investigations and managament of aortic stenosis and asked about pulse deficit in AF

• Cardio – gentleman with a beautiful pansystolic murmur also heard at the apex but NOWHERE else. Almost too good to be true. Anyway he also had a pacemaker so had to discuss reasons why – big MI I suggested as likely although he was quite thin and the examiner seemed to enjoy taking a few of us along the HOCM route...
• cardio: excellent station...MR murmur, but apex was undisplaced, examiner asked: give me differentials of just systolic murmurs: MR, VSD, TR, AS, A sclerosis, PS....then he said one investigation: ECHO......y is his JVP raised if he doesn’t have oedema or crackles or other signs of HF....the bell went and I said not sure n he said ur right its difficult to say why!:)
• This was quite straight forward until the questioning. Examiner was again ridiculously nice. The case was mitral regurgitation. The examiner asked me to name the causes (which was fun!). When I said Marfan’s, the examiner asked me what valve is more commonly affected with Marfan’s, I said aortic and he nodded and smiled (see..nice!!!). Then when I said mitral valve prolapse, he also asked me the causes of mitral valve prolapse. He then asked what I would hear with a mitral valve prolapse, I said a mid systolic click and he nodded again. Then he asked me the clinical features of mitral valve prolapse, I think he was getting at signs of left ventricular failure. Then he asked me how many cusps the mitral valve has. I had a moment of madness when I said 2..er no 3....er no 2......about twenty times. He then asked me which cusp more commonly prolapses with mitral valve prolapse, I do believe the answer was anterior (because he told me) but I'm not repeating my answer here because I had a REAL moment of madness!!! Still passed though (despite the examiner laughing in my face).

• My CVS station was AS. Nothing much to say. maybe transoesophageal vs transthroracic echo, and when to have surgery
• Cardiovascular exam: Young Patient with audible clicking and midline sternotomy scar. Ejection systolic murmur radiating to the carotids. Asked about causes of aortic stenosis (marfan’s?)

• Blalock shunts

• Examine pulse, JVP, precordium of Harvey, mitral stenosis & tricuspid regurg // With Harvey, we were told that 'the patient has ankle oedema and bibasal crackles, please examine his precordium' .the murmur was pansystolic, radiating to axilla and was associated with S3 and S4. I said mitral regurg but the examiner kept pressing me saying 'but it can't just be mitral regurg, what is it?' I didn't understand and didn't get the answer, but after my time was up I asked what he meant and the answer he wanted was biventricular failure. causes of mitral regurgitation
• Harvey – cardiac murmur simulator – told to inspect and auscultate the precordium only without talking and then to present our findings. Was mitral regurgitation. Displaced apex beat, Pansystolic murmur @ apex radiating to axilla – s1 obliterated, s3 present giving short diastolic sound. Normal splitting in Pulmonary area, Normal in Aortic area and Tricuspid regurgitation at the tricuspid region - Asked Dx (chronic MR with TR due to R sided dilation). Ask what would do – look for signs RH Failure and do an echo. Asked re causes (I said Rheumatic heart disease, SBE, MV Prolapse and Pap muscle Rupture (although said last would be acute so no displ apex). Told under ECHO that the valve was normal – what is the cause ? No idea I guessed must have been cardiomyopathy. Bell went and as I was leaving I was asked what I would look for on Examination – I said signs of alcohol use?! No idea what he wanted there as I had already mentioned RH failure signs>?
• HARVEY cardiac patient simulator. He had dilated cardiomyopathy but most people said mitral regurgiation.

• CVS - aortic stenosis and mitral regurgitation

• There was a soft ejection systolic murmur which I said was a flow murmur, and he asked the other possible reasons that there could be a flow murmur but I didn't know so he moved on.

• HARVEY (mitral regurg and 3rd heart sound)

• 2 murmurs to trick me! mitral regurg and aortic stenosis both radiating loudly... everywhere, in a really talkative patient making it rather difficult to auscultate the pracordium!

• CVS: VSD

• Tetrallogy of fallot!!

• cardio - was asked to explain my understanding of pulmonary hypertension and right sided heart failure and how this might fit with the murmur

• cardio- great my cardio patient must of been ill so I got a normal medical student! no murmurs after all those hours of learning! however his intro led u to believe it may be hocm, however examination was normal. I was then asked why else he may have collapsed while playing football on a hot summers day. duh dehydration- I forgot to do cap refill!