MRCP(UK)-1 PREPARATION By Sumanta Sirs Academy Hematology Question-02 An 82-year-old man presents to the Cardiology Clinic with syncopal attacks. His GP has been treating him for worsening hypertensive heart failure. He takes furosemide, 80 mg and ramipril, 10 mg, with the recent addition of a small dose of spironolactone. Around 2 weeks ago he presented with an angina attack to the Emergency Department after getting chest pain whilst out shopping at the supermarket. On examination his BP is 165/122 mmHg. His pulse is 92 bpm, heart sounds reveal a systolic murmur loudest in the aortic area, but no ejection click. He has bibasal crackles on auscultation of the chest. The table below contains investigation results. Hb 12.9 g/dl WCC 5.9 × 109/litre PLT 189 × 109/litre Na+ 138 mmol/litre K+ 5.4 mmol/litre Creatinine 201 μmol/litre Chest X-ray Bilateral basal infiltrates consistent with fluid, and cardiomegaly Which one of the following is the most likely cause of his aortic stenosis? A-Subacute bacterial endocarditis B-Rheumatic fever C-Bicuspid aortic valve D-Malformed tricuspid aortic valve E-Senile degenerative aortic stenosis
Posted on: Mon, 17 Mar 2014 07:00:01 +0000
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