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  • Question 1 - A 72-year-old man presents to the emergency department with dyspnoea and low exercise...

    Incorrect

    • A 72-year-old man presents to the emergency department with dyspnoea and low exercise tolerance. He's known to have a history of ischemic heart disease on medication. Which drug most probably caused his presenting complaint?

      Your Answer: Codeine

      Correct Answer: Diclofenac Sodium

      Explanation:

      Diclofenac sodium is a non-selective reversible and competitive inhibitor of cyclooxygenase (COX), subsequently blocking the conversion of arachidonic acid into prostaglandin precursors. This leads to an inhibition of the formation of prostaglandins that are involved in pain, inflammation and fever. Clinical trials of several COX-2 selective and non-selective NSAIDs of up to three years duration have shown an increased risk of serious cardiovascular (CV) thrombotic events, including myocardial infarction (MI), and stroke, which can be fatal.

    • This question is part of the following fields:

      • Cardiovascular System
      153.4
      Seconds

  • Question 2 - A 60-year-old female presented after an acute overdose of amiodarone. Her blood pressure...

    Incorrect

    • A 60-year-old female presented after an acute overdose of amiodarone. Her blood pressure was 110/70 mmHg and pulse rate was 35 bpm. She was given 500 mcg of atropine but there was no response. Which of the following is the most appropriate next step?

      Your Answer: Glucagon

      Correct Answer: Isoprenaline

      Explanation:

      Permanent pacing is not indicated as the bradycardia is reversible. Temporary pacing is the definite treatment. Isoprenaline can be used until temporary pacing is available.

    • This question is part of the following fields:

      • Cardiovascular System
      69.4
      Seconds

  • Question 3 - A previously well 33-year-old female was admitted with a history of recurrent episodes...

    Correct

    • A previously well 33-year-old female was admitted with a history of recurrent episodes of palpitations. She didn't have chest pain. She frequently drank plenty of coffee and alcohol. Her blood pressure was 120/80 mmHg and pulse rate was 200 bpm which was regular. There was no sign of heart failure. Her ECG revealed narrow complex tachycardia. She was given 3mg of IV adenosine but there was no response. Which of the following is the most appropriate management if she doesn't respond to 6mg of IV adenosine?

      Your Answer: IV 12mg adenosine

      Explanation:

      Vagal manoeuvres can be tried first. If not responding to these then adenosine can be trialled. If 3mg of adenosine has no effect, then give adenosine 6 mg rapid IV push. If patient does not convert, give adenosine 12 mg rapid IV push. Can repeat 12 mg dose of adenosine once if there is no response. If no response, diltiazem or beta-blockers can be given as alternatives.

    • This question is part of the following fields:

      • Cardiovascular System
      41
      Seconds

  • Question 4 - A non-cyanosed 1-year-old female patient has a continuous murmur which is loudest at...

    Incorrect

    • A non-cyanosed 1-year-old female patient has a continuous murmur which is loudest at the left sternal edge. What pulse abnormality is most associated with patent ductus arteriosus if that's her suspected diagnosis?

      Your Answer: Bisferiens pulse

      Correct Answer: Collapsing pulse

      Explanation:

      DIAGNOSIS:
      A consensus definition for hemodynamically significant PDA is lacking. The diagnosis is often suspected clinically, when an infant demonstrates signs of excessive shunting from the arterial to pulmonary circulation. Continuous or a systolic murmur; note, a silent PDA may also occur when the ductus shunt is large enough that nonturbulent flow fails to generate a detectible murmur.
      A low diastolic blood pressure (due to runoff into the ductus during diastole, more frequent in the most premature infants).
      A wide pulse pressure (due to ductus runoff or steal)Hypotension (especially in the most premature infants)
      Bounding pulses
      Increased serum creatinine concentration or oliguria
      Hepatomegaly

    • This question is part of the following fields:

      • Cardiovascular System
      35.1
      Seconds

  • Question 5 - A 44-year-old man presents suffering from retrosternal chest pain that started 2 hours...

    Incorrect

    • A 44-year-old man presents suffering from retrosternal chest pain that started 2 hours ago and radiates to the throat. Which investigation would you immediately perform?

      Your Answer: Electrocardiogram

      Correct Answer: Troponin levels

      Explanation:

      The patient’s age and symptoms are indicating a myocardial infarction. Although, the cause of the pain could also be related to the digestive system, a possible myocardial infarction should be excluded or, if present, managed immediately. Troponins are used to establish the diagnosis. Levels of troponin can become elevated in the blood within 3 or 4 hours after heart injury and may remain elevated for 10 to 14 days.

    • This question is part of the following fields:

      • Cardiovascular System
      13.6
      Seconds

  • Question 6 - A 54-year-old heavy smoker presented with acute chest pain for 3 hrs which...

    Incorrect

    • A 54-year-old heavy smoker presented with acute chest pain for 3 hrs which associated with excessive sweating and vomiting. His past medical history was unremarkable but his father has passed away due to a heart attack at the age of 50. Examination findings were normal and ECG was also normal. He was pain free after 12 hours from admission. What is the most appropriate investigation that can be done at this moment?

      Your Answer: Exercise ECG

      Correct Answer: Troponin T

      Explanation:

      The positive family history and the smoking make him an ideal candidate for a myocardial infarction. The chest pain is also a suggestive symptom. So troponin is needed to rule out MI.

    • This question is part of the following fields:

      • Cardiovascular System
      58.8
      Seconds

  • Question 7 - Bicuspid aortic valve is in association with which of the following. ...

    Incorrect

    • Bicuspid aortic valve is in association with which of the following.

      Your Answer: Anomalous left main stem (LMS) origin in 5% of cases

      Correct Answer: Coarctation of the aorta

      Explanation:

      Bicuspid aortic valve is the most common congenital cardiovascular anomaly, occurring in 1-2% of the population. Coarctation and bicuspid aortic valve occur more frequently in males with a prevalence of approximately 4:1. A high prevalence of these same cardiovascular lesions is also found in women with Turner’s syndrome.

    • This question is part of the following fields:

      • Cardiovascular System
      28.2
      Seconds

  • Question 8 - Which of the following is not associated with atrial myxoma? ...

    Correct

    • Which of the following is not associated with atrial myxoma?

      Your Answer: J wave on ECG

      Explanation:

      J waves in an ECG is associated with hypothermia, hypercalcemia, the Brugada syndrome, and idiopathic ventricular fibrillation. The other responses are all associated with atrial myxoma

    • This question is part of the following fields:

      • Cardiovascular System
      17.1
      Seconds

  • Question 9 - In which condition are β-blockers not recommended as the first line of therapy?...

    Correct

    • In which condition are β-blockers not recommended as the first line of therapy?

      Your Answer: Hypertension

      Explanation:

      For patients with hypertension, ACE inhibitors, diuretics, or calcium-channel blockers are given as first-line pharmacological agents. Patients with angina, chronic heart failure, myocardial infarction, and permanent atrial fibrillation with rapid ventricular rate, are given β-blockers as first-line therapy. In these cases, increased cardiac activity can not be met by the amount of blood being supplied to the heart. Giving β-blockers will reduce the workload of the heart and slow down the cardiac activity.

    • This question is part of the following fields:

      • Cardiovascular System
      19
      Seconds

  • Question 10 - A 55-year-old man presented with retrosternal chest pain associated with excessive sweating and...

    Correct

    • A 55-year-old man presented with retrosternal chest pain associated with excessive sweating and vomiting. On examination his BP was 100/60 mmHg and pulse rate was 72 bpm. Bibasal crepitations were auscultated. His ECG showed ST elevation in V1 to V4 and ST depression in leads II, III and aVF. Which of the following would be the finding during angioplasty?

      Your Answer: Complete occlusion of the left anterior descending artery

      Explanation:

      The ECG findings are suggestive of anterior myocardial infarction and the most likely artery affected is the left anterior descending artery. Occlusion of the right coronary artery will be shown by ST elevation in lead II, III, aVF and occlusion of the circumflex artery will show changes in leads I, aVL, V5 and V6. To have ST elevation, there should be complete occlusion of the artery.

    • This question is part of the following fields:

      • Cardiovascular System
      48.5
      Seconds

  • Question 11 - A 30-year-old male patient presented with palpitations that occur randomly at rest. There...

    Correct

    • A 30-year-old male patient presented with palpitations that occur randomly at rest. There have however been episodes of fast palpitations and dizziness on exertion. On examination there was a systolic murmur at the apex as well as a prominent apex beat and the chest was clear. Which of the following is LEAST likely to suggest a diagnosis of hypertrophic cardiomyopathy?

      Your Answer: A history of hypertension for 10 years

      Explanation:

      Hypertrophic cardiomyopathy is an autosomal dominant condition. Patients present with sudden cardiac death, dyspnoea, syncope and presyncope, angina, palpitations, orthopnoea and paroxysmal nocturnal dyspnoea, Congestive heart failure and dizziness. Physical findings include double or triple apical impulse, prominent a wave in the JVP, an ejection systolic crescendo-decrescendo murmur and a holosystolic murmur at the apex and axilla of mitral regurgitation.
      ECG shows ST-T wave abnormalities and LVH, axis deviation (right or left), conduction abnormalities (P-R prolongation, bundle-branch block), sinus bradycardia with ectopic atrial rhythm, atrial enlargement, abnormal and prominent Q wave in the anterior precordial and lateral limb leads.
      2D echocardiography shows abnormal systolic anterior leaflet motion of the mitral valve, LVH, left atrial enlargement, small ventricular chamber size, septal hypertrophy with septal-to-free wall ratio greater than 1.4:1, mitral valve prolapse and mitral regurgitation, decreased midaortic flow, partial systolic closure of the aortic valve in midsystole

    • This question is part of the following fields:

      • Cardiovascular System
      116
      Seconds

  • Question 12 - A 80-year-old male patient with ischaemic heart disease, hypertension and dyslipidemia presented with...

    Correct

    • A 80-year-old male patient with ischaemic heart disease, hypertension and dyslipidemia presented with productive cough, fever with chills and loss of appetite for 4 days. On examination he was unwell and febrile with a temperature of 38.3. His blood pressure was 130/80 mmHg and pulse rate was 140 bpm. Respiratory rate was 18 breaths per minute. On auscultation there were crepitations over the left lower zone of his chest. His abdomen was soft and nontender. ECG showed an irregular narrow complex tachycardia. Which of the following is the most appropriate acute management to treat his tachycardia?

      Your Answer: Antibiotics

      Explanation:

      The most likely diagnosis is acute atrial fibrillation (AF) precipitated by acute pneumonia. History of fever, cough and the auscultation findings support it. So the most appropriate management is treating the pneumonia with antibiotics. Treating the underlying cause will reduce the heart rate. Other responses are helpful in the management of chronic AF.

    • This question is part of the following fields:

      • Cardiovascular System
      128
      Seconds

  • Question 13 - A 32-year-old previously well primigravida in her 16th week of pregnancy came to...

    Correct

    • A 32-year-old previously well primigravida in her 16th week of pregnancy came to the antenatal clinic for a routine review. Her blood pressure was 152/90 mmHg. On her last clinic visit 4 weeks ago her blood pressure was 148/86 mmHg. She was put on ambulatory blood pressure monitoring and her mean blood pressure was 148/88 mmHg. Her urine examination was negative for protein. Which of the following is the most likely diagnosis?

      Your Answer: Pre-existing hypertension

      Explanation:

      Pre-eclampsia is excluded from negative proteinuria. White coat hypertension is excluded with ambulatory blood pressure monitoring. Pregnancy induced hypertension develops after 20 weeks of gestation. So the most likely answer is pre-existing hypertension. She should be investigated for a secondary cause for hypertension.

    • This question is part of the following fields:

      • Cardiovascular System
      66
      Seconds

  • Question 14 - The conductive system of the heart anatomically includes the: ...

    Correct

    • The conductive system of the heart anatomically includes the:

      Your Answer: Atrioventricular node

      Explanation:

      The cardiac conduction system is a collection of nodes and specialised cells including the:
      Sinoatrial node
      Atrioventricular node
      Atrioventricular bundle (bundle of His)
      Purkinje fibres

    • This question is part of the following fields:

      • Cardiovascular System
      26.1
      Seconds

  • Question 15 - A 60-year-old male with no past medical history presented to Casualty with acute...

    Incorrect

    • A 60-year-old male with no past medical history presented to Casualty with acute chest pain. ST elevation myocardial infarction (STEMI) is diagnosed following an ECG on arrival. He was subsequently successfully thrombolysed. Which of the following combinations of drugs is the most suitable combination for him to be taking 4 weeks after his STEMI?

      Your Answer: Beta-blocker + statin + aspirin + clopidogrel

      Correct Answer: ACE inhibitor + beta-blocker + statin + aspirin + clopidogrel

      Explanation:

      According to NICE guidelines (2013) all people who have had an acute MI, treatment should be offered with ACE inhibitor, dual antiplatelet therapy (aspirin plus a second antiplatelet agent), beta-blocker and a statin.

    • This question is part of the following fields:

      • Cardiovascular System
      72.3
      Seconds

  • Question 16 - A 41-year-old male was involved in a fight and received a stab wound...

    Correct

    • A 41-year-old male was involved in a fight and received a stab wound in the left 4th intercostal space. He was transferred to ER immediately with a BP 80/40 and HR 125. On examination, his neck veins are dilated and his heart sounds are faint. His trachea is central. What is the SINGLE most likely diagnosis?

      Your Answer: Cardiac tamponade

      Explanation:

      The cardinal symptom of the cardiac tamponade is a shocked patient with tachycardia and congested neck veins.

    • This question is part of the following fields:

      • Cardiovascular System
      24
      Seconds

  • Question 17 - Patients on digoxin therapy are required to receive an initially higher dose of...

    Incorrect

    • Patients on digoxin therapy are required to receive an initially higher dose of the drug, in order to amplify the effect of the treatment. Which of the following makes this requirement necessary?

      Your Answer: Bioavailability

      Correct Answer: Half-life

      Explanation:

      A loading dose is required for drugs that are eliminated from the body in a slow, progressive manner. Half-life is the indicator showing if a drug has a fast, intermediate or slow elimination rate.

    • This question is part of the following fields:

      • Cardiovascular System
      40.5
      Seconds

  • Question 18 - A 32-year-old primigravida in her 37th week of pregnancy was admitted for the...

    Correct

    • A 32-year-old primigravida in her 37th week of pregnancy was admitted for the management of pre-eclampsia. Her blood pressure was 180/110 mmHg and urine protein was +++. Magnesium sulphate was started. Which of the following are important parameters that should be monitored during the administration of magnesium sulphate?

      Your Answer: Reflexes + respiratory rate

      Explanation:

      The clinical effect and toxicity of MgSO4 can be linked to its concentration in plasma. A concentration of 1.8 to 3.0 mmol/L has been suggested for treatment of eclamptic convulsions. Maternal toxicity is rare when MgSO4 is carefully administered and monitored. The first warning of impending toxicity in the mother is loss of the patellar reflex at plasma concentrations between 3.5 and 5 mmol/L. Respiratory paralysis occurs at 5 to 6.5 mmol/L. Cardiac conduction is altered at greater than 7.5 mmol/L, and cardiac arrest can be expected when concentrations of magnesium exceed 12.5 mmol/L. Careful attention to the monitoring guidelines can prevent toxicity. Deep tendon reflexes, respiratory rate, urine output and serum concentrations are the most commonly monitored parameters.

    • This question is part of the following fields:

      • Cardiovascular System
      37.2
      Seconds

  • Question 19 - A 70-year-old female was brought in by the paramedics after she collapsed whilst...

    Incorrect

    • A 70-year-old female was brought in by the paramedics after she collapsed whilst shopping. She has a tachycardia of 150 bpm and her BP is 100/60 mmHg. Her ECG showed a broad complex tachycardia. Which of the following is more suggestive of a ventricular tachycardia (VT) over a supraventricular tachycardia (SVT) with aberrant conduction?

      Your Answer: Heart rate of 160 bpm

      Correct Answer: Atrioventricular dissociation

      Explanation:

      To differentiate VT from SVT with aberrant conduction the following electrocardiographic features should be looked for:

      Evidence of preceding atrial activity for SVT. Oesophageal leads are helpful if P waves are hidden in the QRS complex.
      QRS duration more than 140 ms for VT.
      QRS morphology: Features of QRS morphology that favour SVT are RBBB or triphasic patterns like rSR in V1 and qRS in V6. Monophasic pattern like R or qR in V1 and rS or QS in V6 or multiple morphology QRS complexes favour VT.
      AV dissociation for VT.

    • This question is part of the following fields:

      • Cardiovascular System
      90.6
      Seconds

  • Question 20 - A 45-year-old smoker presented with sudden onset of chest pain radiating to his...

    Correct

    • A 45-year-old smoker presented with sudden onset of chest pain radiating to his left arm, with associated sweating. ECG showed ST elevation in leads I, aVL and V1-V4. The most likely diagnosis would be?

      Your Answer: Anterior MI

      Explanation:

      An anterior wall myocardial infarction is characterised by ST elevation in leads I, aVL and V1-V5.

    • This question is part of the following fields:

      • Cardiovascular System
      33.8
      Seconds

  • Question 21 - A 59-year-old man complains of weakness in his right lower and upper limb...

    Incorrect

    • A 59-year-old man complains of weakness in his right lower and upper limb since 3 for a few hours. He is has been taking Digoxin for 2 years. What is the most definitive investigation for this condition?

      Your Answer: CT head

      Correct Answer: Angiography

      Explanation:

      Digoxin is a cardiac glycoside, having positive inotropic effects on the heart. It increases the strength of contractility of the heart, increasing the heart rate, but lowering blood pressure. This patient developed weakness in his limbs most likely caused by extremely low blood pressure that could be due to diseased blood vessels reacting to the side-effects of digoxin, therefore an angiography would be the best investigation.

    • This question is part of the following fields:

      • Cardiovascular System
      31.8
      Seconds

  • Question 22 - Examination results for a middle age female post myocardial infarction are as follows:...

    Incorrect

    • Examination results for a middle age female post myocardial infarction are as follows:
      Sodium = 136 mmol/L
      Potassium = 6.2mmol/L
      Urea = 5.0 mmol/L
      ECG revealed a prolonged QRS complex and tented T waves. What is the most appropriate management?

      Your Answer:

      Correct Answer: Calcium gluconate

      Explanation:

      Calcium gluconate is used as a cardio protective agent in people with high blood potassium levels, another alternative being the use of calcium chloride. It is recommended when the potassium levels are high (>6.5 mmol/l) or when the electrocardiogram (ECG) shows changes due to high blood potassium. Though it does not have an effect on potassium levels in the blood, it reduces the excitability of cardiomyocytes, thereby lowering the likelihood of cardiac arrhythmias.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 23 - A 63-year-old heavy smoker complains of pain on exertion in both calves and...

    Incorrect

    • A 63-year-old heavy smoker complains of pain on exertion in both calves and his buttocks. He has also recently developed erectile dysfunction. On examination, peripheral pulses in both lower limbs including distal and femoral are absent. Where is the single most probable site of obstruction?

      Your Answer:

      Correct Answer: Aorto iliac

      Explanation:

      The penis receives its blood supply by the internal pudendal artery, a branch of the internal iliac artery. Erectile dysfunction indicates obstruction at the level of the common iliac arteries or higher.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 24 - A 8-year-old girl with suspected patent foramen ovale, presented with her parents for...

    Incorrect

    • A 8-year-old girl with suspected patent foramen ovale, presented with her parents for the confirmation of the diagnosis. Which of the following is the best investigation to confirm the diagnosis?

      Your Answer:

      Correct Answer: Transoesophageal Echocardiography

      Explanation:

      A 3-dimensional transoesophageal echocardiography (3D TEE) provides direct visualization of the entire PFO anatomy and surrounding structures. It allows more accurate diagnosis.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 25 - A 40-year-old female presented with palmar xanthomas and tuberoeruptive xanthomas on her elbows...

    Incorrect

    • A 40-year-old female presented with palmar xanthomas and tuberoeruptive xanthomas on her elbows and knees. Which of the following is the most probable diagnosis?

      Your Answer:

      Correct Answer: Type III hyperlipoproteinaemia

      Explanation:

      Palmar xanthomas and tuberoeruptive xanthomas are found in type III hyperlipoproteinemia (dysbetalipoproteinemia,broad-beta disease, remnant removal disease)

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 26 - From the following responses, what is the commonest cardiovascular abnormality associated with Marfan's...

    Incorrect

    • From the following responses, what is the commonest cardiovascular abnormality associated with Marfan's syndrome of an adult?

      Your Answer:

      Correct Answer: Aortic root dilatation

      Explanation:

      The main cardiovascular manifestations associated with Marfan’s syndrome are aortic dilatation and mitral valve prolapse.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 27 - A 72-year-old female patient with a history of atrial fibrillation was admitted with...

    Incorrect

    • A 72-year-old female patient with a history of atrial fibrillation was admitted with recurrent episodes of syncopal attacks. Her ECG showed torsade de pointes. What is the drug which does not cause the above presentation?

      Your Answer:

      Correct Answer: Omeprazole

      Explanation:

      Drugs causing torsades de pointes are Amiodarone, Chlorpromazine, Clarithromycin, Disopyramide, Dofetilide, Erythromycin, Haloperidol, Methadone, Procainamide, Quinidine, Sotalol, Levofloxacin, Moxifloxacin, Nilotinib, Ondansetron, Ranolazine, Sunitinib, Ziprasidone, Amitriptyline, Ciprofloxacin, Imipramine, Chlorthalidone, Dasatinib, Hydrochlorothiazide, Furosemide.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 28 - A 85-year-old previously well man was found to have a BP of 155/90...

    Incorrect

    • A 85-year-old previously well man was found to have a BP of 155/90 mmHg. His average reading from the monitoring of his ambulatory BP was 147/92 mmHg. His calculated 10 year cardiovascular risk was 15%. Which of the following is the most appropriate management of this patient?

      Your Answer:

      Correct Answer: Give lifestyle advice and repeat blood pressure in 6 months

      Explanation:

      According to different guidelines for patients above 80 years, the targeted systolic blood pressure varies from 140-150 mmHg. As this patient’s BP is within that range, he can be kept under observation.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 29 - A 60-year-old male presented with ventricular tachycardia which was successfully cardioverted. To check...

    Incorrect

    • A 60-year-old male presented with ventricular tachycardia which was successfully cardioverted. To check whether he had prolonged QT interval, which of the following is the most appropriate method to measure the QT interval in ECG?

      Your Answer:

      Correct Answer: Time between the start of the Q wave and the end of the T wave

      Explanation:

      The QT interval is the time from the start of the Q wave to the end of the T wave. It represents the time taken for ventricular depolarisation and repolarisation. The QT interval should be measured in either lead II or V5-6.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 30 - A 65-year-male patient was started on warfarin for chronic atrial fibrillation (AF). Which...

    Incorrect

    • A 65-year-male patient was started on warfarin for chronic atrial fibrillation (AF). Which of the following clotting factors is not affected by warfarin?

      Your Answer:

      Correct Answer: Factor XII

      Explanation:

      Carboxylation of factor II, VII, IX, X and protein C is affected by warfarin. Factor XII is not affected.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular System (11/21) 52%
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