Exam (elaborations)
ROYAL COLLEGE OF SURGEONS IRELAND-CARDIORESPIRATORY SYSTEM PAST YEAR PAPER(JUNE)
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JUNE 2007 PAST YEAR PAPER-MCQ AND ESSAY QUESTIONS
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Intermediate Cycle ‘06’07Semester 1 Assessment
June 2006
Cardiorespiratory
Duration 180 Minutes
Total Marks 150
Section A
Answer all questions in this section
PLEASE USE A SEPARATE ANSWER BOOK FOR THIS QUESTION
1. CPC 45 Minutes
A 60 year old man presents to casualty with a 2 hour history of severe chest pain
associated with sweating,
nausea and dyspnoea. He also had one episode of syncope and collapse to the ground.
He has a past
medical history of angina pectoris, hypertension and non-insulin dependent diabetes
mellitus (NIDDM).
Current systems review reveals a 3 month history of intermittent constipation with
episodes of bleeding PR.
He is a social drinker and a life-long smoker (30 cigs per day). Family history reveals
that 3 siblings have
developed colorectal carcinoma at a young age. His medications include glucophage,
a diuretic, a beta-
blocker and sublingual trinitrate spray.
On examination in casualty, he is pale and diaphoretic and somewhat restless. There
is a large area of
bruising over the right shoulder and flank. He is placed on oxygen by mask and given
morphine for pain relief and aspirin. Examination of the chest reveals bibasal
crepitations and a chest x-ray shows prominent venous markings. Bloods are taken
and these reveal an elevated troponin and an elevated creatine kinase.
FBC shows a haemoglobin of 6g/dl (13.5-18.0). Blood glucose is high. He is referred
for an emergency
angiogram.
a) What risk factors does he have for ischaemic heart disease?
- a life-long smoker (30 cigs per day)
, - hypertension
-non-insulin dependent diabetes mellitus (NIDDM).
-Male gender
-Old age
b) Define the terms in bold type.
-Dyspnoea: shortness of breath
-angina pectoris: transient cardiac ischaemia without cell death resulting in
substernal chest pain
-hypertension: a sustained diastolic blood pressure>90mmHg and/or systolic blood
pressure > 140mmHg / Increase in blood pressure within the systemic circulation
(systemic hypertension) or pulmonary arterial circulation (pulmonary
hypertension).
-carcinoma: A malignant tumour of epithelial cells (derived from the ectoderm).
c)Give an explanation for the statement which is underlined.
Examination of the chest reveals bibasal crepitations and a chest x-ray shows
prominent venous markings –
on auscultation, a rattling/ crackling sound was produced at both sides of the lungs
and on chest x-ray, image of pulmonary vein was prominent.
d) Give possible explanations for the elevated creatine kinase.
Creatine Kinase is a cardiac enzyme residing in myocardial cells and is released to
the bloodstream upon myocardial cell membrane damage. An elevated creatine
kinase might suggest myocardial damage e.g. infacrtion.
e) Why was he given aspirin on admission?
Stabilize plaque and arrest thrombus
Irreversible inhibition of platelet aggregation
Reduce mortality in patients with STEMI
f) Which of the medications would be used to treat his hypertension?
beta blocker
g) Describe the ECG changes below.
ST elevation
Absence of q waves
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