QuestionSBA
QuestionChoice
This is the most likely diagnosis. This patient has been experiencing angina, dyspnoea and one episode of syncope. Her past medical history includes risk factors for aortic stenosis such as hypertension, high cholesterol and cigarette smoking. The ejection systolic murmur indicates aortic stenosis as the diagnosis.
10027501
a
Aortic stenosis
QuestionChoice
This is incorrect. Although the patient experienced a loss of consciousness with twitching movements, this is also fairly common in vasovagal syncope due to a brief decrease in blood flow to the brain; especially given there is no past medical history of epilepsy. There is no evidence of a post-ictal period and no tongue-biting or incontinence. Her symptoms of angina, dyspnoea and syncope as well as an ejection systolic murmur are more in keeping with a diagnosis of aortic stenosis.
10027504
d
Hypoglycaemia
QuestionChoice
This is incorrect. Although the patient most likely experienced vasovagal syncope, this is not the root cause of the issue. Her symptoms of angina, dyspnoea and syncope as well as an ejection systolic murmur are more in keeping with a diagnosis of aortic stenosis.
10027503
c
Vasovagal syncope
QuestionChoice
This is incorrect. Although the patient presents with breathlessness on exertion and is a smoker, her symptoms of angina, dyspnoea and syncope as well as an ejection systolic murmur are more in keeping with a diagnosis of aortic stenosis.
10027505
e
Chronic Obstructive Pulmonary Disease
QuestionChoice
This is incorrect. Although the patient experienced a loss of consciousness with twitching movements, this is also fairly common in vasovagal syncope due to a brief decrease in blood flow to the brain; especially given there is no past medical history of epilepsy. There is no evidence of a post-ictal period and no tongue-biting or incontinence. Her symptoms of angina, dyspnoea and syncope as well as an ejection systolic murmur are more in keeping with a diagnosis of aortic stenosis.
10027502
b
Tonic-clonic seizure
Concept
Chapter
2693
5984
Seizures and Blackouts
Topic
134
Cardiology
Aortic stenosis
17898
A 63 year old female attends their GP practice with chest pain and shortness of breath on exertion, which has been present for around 6 months. Last week, she lost consciousness while cleaning the kitchen, preceded by light-headedness. Her daughter witnessed the episode, noting brief twitching but no tongue biting or incontinence.

She has a history of hypertension and high cholesterol, and smokes 10 cigarettes per day.


On examination:


 * HR: 78bpm.
 * BP: 146/87.
 * O2 sats: 96% on air.
 * RR 18.
 * Temp: 37.1.


The GP notes an ejection systolic murmur over the second intercostal space on the right side of the sternum.


Which of the following is the most likely underlying diagnosis?
a