Nokea
A pulmonary embolus occurring while the patient is on the combined oral contraceptive pill:
- A. Is more likely in anti-thrombin III deficiency
- B. Is more likely in protein C deficiency
- C. Is an absolute contraindication to the combined pill
- D. Is an increased risk in smokers
Correct Answer: A
Rationale: Anti-thrombin III deficiency increases the risk of thromboembolic events, including pulmonary embolism, especially in patients on the combined oral contraceptive pill.
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Functional causes of opening Snap (either due to swift opening of AV valve or due to excess flow across the valve) is seen in all, except
- A. Mitral regurgitation
- B. Ventricular septal defect
- C. Atrial septal defect
- D. First degree AV block
Correct Answer: D
Rationale: First degree AV block is not typically associated with an opening snap.
Regarding a supracristal VSD, the following are true EXCEPT
- A. incidence is higher in Asian children
- B. complicated by aortic insufficiency in 50-90% of patients
- C. aortic insufficiency is most often not recognized until late in the lst decade of life
- D. murmur of a supracristal VSD is usually heard at the mid to upper left sternal border
Correct Answer: D
Rationale: Closure of asymptomatic supracristal VSDs at the time of diagnosis is not recommended.
Which painful, tender, pea-sized nodules may appear on the pads of the fingers or toes in bacterial endocarditis?
- A. Osler nodes
- B. Janeway lesions
- C. Subcutaneous nodules
- D. Aschoff nodes
Correct Answer: A
Rationale: Osler nodes are red, painful, intradermal nodes found on pads of the phalanges in bacterial endocarditis. Janeway lesions are painless hemorrhagic areas on palms and soles in bacterial endocarditis. Subcutaneous odules are nontender swellings, located over bony prominences, commonly found in rheumatic fever. Aschoff nodules are small nodules composed of cells and leukocytes found in the interstitial tissues of the heart in rheumatic myocarditis
The following cranial nerves carry pre-ganglionic parasympathetic nerves:
- A. Oculomotor nerve
- B. Trigeminal nerve
- C. Facial nerve
- D. Vagus nerve
Correct Answer: D
Rationale: The vagus nerve carries parasympathetic fibers. The oculomotor, trigeminal, and facial nerves do not.
Down syndrome and VSD
- A. Doesn't close spontaneously as in children without downs
- B. Inaudible murmur is a characteristic feature / Murmur is not audible
- C. Pulmonary Hypertension is a late complication
- D. If no murmur, condition need not be investigated
Correct Answer: C
Rationale: Pulmonary hypertension is a known late complication in Down syndrome with VSD.