SAQ 997 – Syncope with systolic murmur and trainee performance plan

A trainee examines a 70-year-old man who had syncope while walking up stairs and has had exertional breathlessness for 1 year.

The trainee finds no abnormality and plans discharge if baseline bloods, 12-lead ECG and monitoring are reassuring.

You examine him and find a mid-systolic murmur radiating to the carotids, with crackles to the midzones bilaterally.

Complete the table with the differential diagnosis of this murmur and the clinical significance of each option.

(Marked out of 8.0)
</p> <table class="saq-prop-table" style="width: 100%; max-width: 100%; table-layout: fixed; border-collapse: collapse;"> <thead> <tr> <th style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Condition</th> <th style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Typical auscultation features</th> <th style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Clinical significance</th> </tr> </thead> <tbody> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Aortic stenosis</td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Aortic sclerosis</td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Hypertrophic obstructive cardiomyopathy</td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Mitral regurgitation</td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> </tbody> </table> <p>

/ 8

What disposition advice would you give the trainee, and what is your rationale?

(Marked out of 2.0)

/ 2

The trainee later declines to use the case as a CEX because they performed poorly. As DEMT, list four early warning signs of a trainee in difficulty.

(Marked out of 2.0)

/ 2

List the parts of a performance plan.

(Marked out of 4.0)

/ 4

Total Score: 0 / 16

Percentage: 0%