MD3 Exams special content

Aortic stenosis

High pitched crescendo decrecsendo Systolic murmur that radiates to the carotids

Mitral regurg

Pansystolic murmur heard at the apex

Aortic regurg

high pitched dyastolic decrecendo murmur

Mitral stenosis

low pitched mid to late dyastolic murmur

Tricuspid regurg

Pansystolic murmur louder on inspiration

Infective endocarditis usually affects

Mitral & Aortic

IV drug usually valve issue effects

Tricuspid valve

Bounding pulse / water hammer pulse

Aortic regurge

Pulses Paradoxus

Cardiac tamponade, asthma or COPD excacerbation

Giant v wave JVP

Tricuspid regurg

Tricuspid stenosis

Mid diastolic murmur louder on inspiration

A 65-year-old man with atrial fibrillation has sudden left face and arm weakness greater than leg weakness. His eyes are deviated to the right and he does not recognise his left arm as his own. Most likely arterial territory?

Right middle cerebral artery. Contralateral face and arm weakness, gaze deviation toward the lesion and anosognosia/neglect of the left side point to a right (non-dominant) MCA infarct. The external carotid supplies the face and scalp, not the brain.

A 62-year-old woman has sudden right leg weakness and numbness of the right foot. Her right arm is only mildly affected and her face is spared. She is apathetic and incontinent of urine. Most likely arterial territory?

Left anterior cerebral artery. The leg area of the motor and sensory cortex lies medially in the ACA territory, so contralateral leg-predominant weakness with sparing of the face, plus abulia and incontinence (medial frontal lobe), indicates a left ACA infarct.

A 61-year-old man has sudden vertigo, hoarseness and difficulty swallowing. His uvula deviates to the left, he has a right Horner's syndrome, and pinprick is reduced in the left arm and leg. Most likely arterial territory?

Right posterior inferior cerebellar artery. Right lateral medullary syndrome: nucleus ambiguus involvement causes ipsilateral palatal weakness (uvula deviates away from the lesion) with hoarseness and dysphagia, ipsilateral Horner's syndrome, and contralateral spinothalamic loss. Supplying vessel is the right PICA.

A 68-year-old man has sudden right face and arm weakness greater than leg weakness. His speech is effortful and halting with few words, but he follows commands normally. Most likely arterial territory?

Left middle cerebral artery. Non-fluent (Broca) aphasia with preserved comprehension and right face and arm weakness greater than leg localises to the superior division of the left (dominant) MCA.

A 66-year-old man with atrial fibrillation has sudden left leg weakness and numbness of the left foot. His face and hand are spared. He is apathetic, and a grasp reflex is present in the left hand. Most likely arterial territory?

Right anterior cerebral artery. Contralateral (left) leg-predominant weakness and sensory loss with sparing of the face and frontal release signs (grasp reflex, apathy) is the classic ACA pattern. Right ACA gives left-sided signs.

A 59-year-old man has sudden vertigo and hoarseness. He has a left Horner's syndrome, left limb ataxia, reduced pinprick on the left face and reduced pinprick in the right arm and leg. Power is normal. Most likely arterial territory?

Left posterior inferior cerebellar artery. Left lateral medullary syndrome: ipsilateral (left) Horner's, limb ataxia, facial pain/temperature loss and bulbar dysfunction, with contralateral (right) limb sensory loss. The vessel is the left PICA.

A 72-year-old man has global aphasia, right hemiplegia and a right homonymous hemianopia. His eyes are deviated to the left. Most likely arterial territory?

Left middle cerebral artery. Global aphasia, right hemiplegia and right homonymous hemianopia with gaze deviation toward the lesion indicate a large left MCA infarct, usually from proximal (M1) occlusion.

A 55-year-old woman has sudden vertigo and vomiting with right limb dysmetria and a tendency to fall to the right. There is no weakness or sensory loss. CT shows hypodensity in the right inferior cerebellar hemisphere. Most likely arterial territory?

Right posterior inferior cerebellar artery. An isolated PICA cerebellar infarct causes ipsilateral limb and gait ataxia with vertigo and vomiting, without weakness or sensory loss. Cerebellar signs are ipsilateral, so right-sided signs mean the right PICA.

A 74-year-old woman has left leg paralysis with mild left proximal arm weakness. She is indifferent to her condition, has grasp and suck reflexes and is incontinent of urine. Most likely arterial territory?

Right anterior cerebral artery. Severe contralateral leg paralysis with milder proximal arm weakness, frontal release signs (grasp and suck), indifference and incontinence indicate ACA frontal lobe infarction. The weak left side means the right ACA.

A 69-year-old man has left hemispatial neglect, difficulty copying a drawing (constructional apraxia), a left inferior quadrantanopia and mild left sensory loss. Power is normal. Most likely arterial territory?

Right middle cerebral artery. Left neglect, constructional apraxia and a left inferior quadrantanopia (parietal optic radiation) with minimal weakness point to the inferior (parietal) division of the right MCA.

A 63-year-old woman has vertigo, vomiting, left limb dysmetria and falls toward the left. There is no weakness. CT shows hypodensity in the left inferior cerebellar hemisphere. Most likely arterial territory?

Left posterior inferior cerebellar artery. Ipsilateral (left) cerebellar signs from an infarct in the left inferior cerebellar hemisphere, the territory of the left PICA, without corticospinal involvement (no weakness).

A 58-year-old man has a right foot drop with sensory loss over the right leg. His spontaneous speech is sparse and slow, but he repeats phrases well. There is a right grasp reflex. His face and arm are spared. Most likely arterial territory?

Left anterior cerebral artery. Right leg weakness and sensory loss with sparing of face and arm, plus reduced speech output with preserved repetition (transcortical motor aphasia from the dominant medial frontal lobe) and a grasp reflex, localise to the left ACA.