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  • Question 1 - 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: Renal clearance

      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
      4.1
      Seconds

  • Question 2 - A 40 years old man collapsed at home and died. The GP's report...

    Incorrect

    • A 40 years old man collapsed at home and died. The GP's report says he suffered from type 2 Diabetes Mellitus and his BMI was 35. What is the most likely cause of death?

      Your Answer: Heart Failure

      Correct Answer: Myocardial infarction

      Explanation:

      Diabetic patients usually have a higher risk of developing cardiovascular events by 2-4x that of the general population. In addition, diabetic patients are often obese and possibly have hyperlipidaemia, which are great risk factors of cardiovascular incidents.

    • This question is part of the following fields:

      • Cardiovascular System
      4.8
      Seconds

  • Question 3 - What is correct statement regarding pulsus alternans? ...

    Correct

    • What is correct statement regarding pulsus alternans?

      Your Answer: It is found in association with a third heart sound

      Explanation:

      Pulsus alternans is the alternation of one strong and one weak beat without a change in the cycle length. It occurs most commonly in heart failure due to increased resistance to LV ejection, as occurs in hypertension, aortic stenosis, coronary atherosclerosis, and dilated cardiomyopathy. Pulsus alternans is usually associated with an S3 gallop, which is associated with a poor prognosis. It usually disappears with treatment of the heart failure.

    • This question is part of the following fields:

      • Cardiovascular System
      6.6
      Seconds

  • Question 4 - A 70-year-old male patient presented with increased difficulty in breathing during the last...

    Incorrect

    • A 70-year-old male patient presented with increased difficulty in breathing during the last 4 months. He was diagnosed with mitral stenosis. On examination his BP was 120/80 mmHg and pulse rate was 68 bpm. There were bibasal crepitations on auscultation. He was on bisoprolol, furosemide and ISDN. From the given answers, what is the most likely indication of worsening of his mitral stenosis?

      Your Answer: Periods of complete heart block

      Correct Answer: Haemoptysis

      Explanation:

      Haemoptysis is a symptom which indicates the worsening of mitral stenosis. It occurs due to the rupture of pulmonary veins or the capillary system due to pulmonary venous hypertension. Elevated serum creatinine is seen in worsening aortic stenosis. Worsening of tricuspid regurgitation causes ascites and a pulsatile liver.

    • This question is part of the following fields:

      • Cardiovascular System
      7.2
      Seconds

  • Question 5 - A 65-year-old male presented with acute ST elevation myocardial infarction and thrombolysis was...

    Incorrect

    • A 65-year-old male presented with acute ST elevation myocardial infarction and thrombolysis was planned. Which of the following is an absolute contraindication for thrombolysis?

      Your Answer: Family history of haemophilia

      Correct Answer: Intracerebral Haemorrhage

      Explanation:

      Absolute contraindications for fibrinolytic use in STEMI

      Prior intracranial haemorrhage (ICH)
      Known structural cerebral vascular lesion
      Known malignant intracranial neoplasm
      Ischemic stroke within 3 months
      Suspected aortic dissection
      Active bleeding or bleeding diathesis (excluding menses)
      Significant closed head trauma or facial trauma within 3 months
      Intracranial or intraspinal surgery within 2 months
      Severe uncontrolled hypertension (unresponsive to emergency therapy)
      For streptokinase, prior treatment within the previous 6 months

    • This question is part of the following fields:

      • Cardiovascular System
      7.2
      Seconds

  • Question 6 - The ECG of a 29-year-old female shows an irregular rhythm with a HR...

    Incorrect

    • The ECG of a 29-year-old female shows an irregular rhythm with a HR of 154 bpm. She presented complaining of heart palpitations and hot flashes for the past 4 days. What is the most likely treatment?

      Your Answer: Verapamil

      Correct Answer: Beta blockers

      Explanation:

      At 29 years old, the most probable cause of this arrhythmia is thyrotoxicosis. β blockers relieve symptoms such as tachycardia, tremor, and anxiety in thyrotoxic patients. β blockade should be used as the primary treatment only in patients with thyrotoxicosis due to thyroiditis.

    • This question is part of the following fields:

      • Cardiovascular System
      6.7
      Seconds

  • Question 7 - A 48-year-old male presented with exertional angina for 2 weeks. He has no...

    Incorrect

    • A 48-year-old male presented with exertional angina for 2 weeks. He has no significant past medical history or cardiac risk factors except a total cholesterol of 5.8 mmol/L. He has been already started on aspirin. Which of the following is the most suitable drug combination for him?

      Your Answer: Calcium-channel blocker and nitrate

      Correct Answer: B-blocker and statin

      Explanation:

      Beta blockers and calcium channel blockers have proven prognostic benefits. Nitrates don’t have any proven prognostic benefits. A statin is indicated for a patient with angina and cholesterol level of 5.5 to 8.5 to prevent risk of myocardial infarction. So the preferred combination from the given answers is beta blocker + statin.

    • This question is part of the following fields:

      • Cardiovascular System
      3.6
      Seconds

  • Question 8 - Which of the following is not an indication for an implantable cardiac defibrillator?...

    Incorrect

    • Which of the following is not an indication for an implantable cardiac defibrillator?

      Your Answer: Hypertrophic obstructive cardiomyopathy

      Correct Answer: Wolff-Parkinson White syndrome

      Explanation:

      Class I indications (i.e., the benefit greatly outweighs the risk, and the treatment should be administered): -Structural heart disease, sustained VT
      -Syncope of undetermined origin, inducible VT or VF at electrophysiologic study (EPS)
      -Left ventricular ejection fraction (LVEF) ≤35% due to prior MI, at least 40 days post-MI, NYHA class II or III
      -LVEF ≤35%, NYHA class II or III
      -LVEF ≤30% due to prior MI, at least 40 days post-MI
      -LVEF ≤40% due to prior MI, inducible VT or VF at EPS

      Class IIa indications (i.e., the benefit outweighs the risk and it is reasonable to administer the treatment):
      -Unexplained syncope, significant LV dysfunction, nonischaemic cardiomyopathy
      -Sustained VT, normal or near-normal ventricular function
      -Hypertrophic cardiomyopathy with 1 or more major risk factors
      -Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) with 1 or more risk factors for sudden cardiac death (SCD)
      -Long QT syndrome, syncope or VT while receiving beta-blockers
      -Nonhospitalized patients awaiting heart transplant
      -Brugada syndrome, syncope or VT
      -Catecholaminergic polymorphic VT, syncope or VT while receiving beta-blockers
      -Cardiac sarcoidosis, giant cell myocarditis, or Chagas disease

    • This question is part of the following fields:

      • Cardiovascular System
      9.6
      Seconds

  • Question 9 - A 60-year-old man with atrial fibrillation (AF) who is on warfarin and is...

    Incorrect

    • A 60-year-old man with atrial fibrillation (AF) who is on warfarin and is awaiting tooth extraction. Recent INR was 2.7 and his target INR was 2.0-3.0. Which of the following is the most appropriate management?

      Your Answer: Admit to hospital + switch to intravenous heparin prior to extraction

      Correct Answer:

      Explanation:

      The latest reserches say that simple tooth extraction in patients on warfarin treatment can be performed safely without high risk of bleeding, providing that the INR is equal to or less than 3.5 on the day of extraction. A close follow-up and monitoring of patients taking warfarin is mandatory after dental extraction.

    • This question is part of the following fields:

      • Cardiovascular System
      2.7
      Seconds

  • Question 10 - A 55-year-old male with a history of myocardial infarction 4 years ago, was...

    Incorrect

    • A 55-year-old male with a history of myocardial infarction 4 years ago, was admitted with a history of fever for the past 2 weeks. On investigation, his echocardiography revealed a small vegetation around the mitral valve. His blood culture was positive for Streptococcus viridans. Which of the following is the most appropriate antibiotic therapy?

      Your Answer: IV vancomycin + rifampicin + gentamicin

      Correct Answer: IV benzylpenicillin

      Explanation:

      According to the American Heart Association (AHA) penicillin-susceptible S viridans, S bovis, and other streptococci (MIC of penicillin of ≤0.1 mcg/mL) should be treated with penicillin G or ceftriaxone or penicillin G + a gentamicin combination or vancomycin (if allergy to penicillin).

    • This question is part of the following fields:

      • Cardiovascular System
      6.7
      Seconds

  • Question 11 - Concerning myosin, which of the following statements is true? ...

    Correct

    • Concerning myosin, which of the following statements is true?

      Your Answer: Myosin heavy chain mutations are associated with development of familial hypertrophic cardiomyopathy

      Explanation:

      Myosin is a protein found in contractile tissues. It is described in two groups: conventional myosin, which is arranged in pairs of light chains against pairs of heavy chain myosin. Unconventional myosin that is not arranged in filaments,  preforms many functions in a wide range of cells, such as in organelle transport and in endocytosis. Myosin contains Adenosine triphosphate (ATP) and contains actin binding sites to preform its function. Other types of mutations in myosin can be seen besides the heavy chain mutation cardiomyopathy and they include: Carney’s complex , Usher syndrome and non-syndromic deafness

    • This question is part of the following fields:

      • Cardiovascular System
      2.6
      Seconds

  • Question 12 - 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: Transthoracic Echocardiography

      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
      5.2
      Seconds

  • Question 13 - A 25-year-old previously well female, in her 10th week of pregnancy presented with...

    Incorrect

    • A 25-year-old previously well female, in her 10th week of pregnancy presented with a left sided painful calf swelling. An ultrasound scan revealed deep venous thrombosis (DVT) of her left leg. Which of the following is the most appropriate management of this patient?

      Your Answer: Initiate and then continue treatment with heparin and warfarin until delivery

      Correct Answer: Initiate and then continue treatment with heparin until delivery

      Explanation:

      Warfarin is contraindicated during pregnancy due to its teratogenic effects. She should be given heparin throughout her pregnancy. It can be converted to warfarin if necessary after the delivery.

    • This question is part of the following fields:

      • Cardiovascular System
      4.8
      Seconds

  • Question 14 - A 80-year-old male was found on the floor. His blood pressure was 100/60...

    Correct

    • A 80-year-old male was found on the floor. His blood pressure was 100/60 mmHg. His core temperature was 31ºC. His FBC and serum electrolytes were within normal limits. Which of the following would be found in his ECG?

      Your Answer: Long QT interval

      Explanation:

      Hypothermia is defined as a core body temperature of < 35 °C.
      Hypothermia may produce the following ECG changes:
      -Bradyarrhythmia
      -Osborne Waves (= J waves)
      -Prolonged PR, QRS and QT intervals
      -Shivering artefact
      -Ventricular ectopics
      -Cardiac arrest due to VT, VF or asystole

    • This question is part of the following fields:

      • Cardiovascular System
      4.3
      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: ACE inhibitor + beta-blocker + statin + aspirin

      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
      2.7
      Seconds

  • Question 16 - 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
      2.6
      Seconds

  • Question 17 - Which of the following statements describe the mechanism of fibrates most accurately? ...

    Incorrect

    • Which of the following statements describe the mechanism of fibrates most accurately?

      Your Answer: Bile acid sequestration

      Correct Answer: Increased lipoprotein lipase activity via PPAR-alpha

      Explanation:

      The main mechanism of fibrate drugs is activation of gene transcription factors known as PPARs, particularly PPAR-?, which regulate the expression of genes that control lipoprotein metabolism. There are several consequences of PPAR-? activation, which reduce circulating LDL cholesterol and triglycerides and increase HDL cholesterol.

    • This question is part of the following fields:

      • Cardiovascular System
      6.3
      Seconds

  • Question 18 - A 65-year-old man with hypertension presented with sudden onset right arm weakness which...

    Correct

    • A 65-year-old man with hypertension presented with sudden onset right arm weakness which resolved after 10 hrs. He has had 2 similar episodes during the last 6 weeks. On examination his blood pressure was 140/80 mmHg and pulse rate was 88 bpm. His ECG showed atrial fibrillation and the CT scan of his brain was normal. Which of the following is the most appropriate management for this patient?

      Your Answer: Warfarin

      Explanation:

      CHA₂DS₂-VASc score is used for atrial fibrillation stroke risk calculation.
      Congestive heart failure – 1 point
      Hypertension – 1 point
      Age >75 years – 2 points
      Diabetes mellitus – 1 point
      Stroke/Transient Ischemic Attack/Thromboembolic event – 2 points
      Vascular disease (prior MI, PAD, or aortic plaque) – 1 point
      Age 65 to 74 years – 1 point
      Sex category (i.e., female sex) – 1 point
      Score of 2 or more is considered as high risk and anticoagulation is indicated. This patient’s score is 4, so he needs life-long warfarin to prevent a stroke.

    • This question is part of the following fields:

      • Cardiovascular System
      4.2
      Seconds

  • Question 19 - A 1-month-old boy was brought to the ED by his mother because he...

    Incorrect

    • A 1-month-old boy was brought to the ED by his mother because he has been irritable and feeding poorly for the last 24 hours. His CXR shows cardiomegaly but with clear lung fields while his ECG shows a regular narrow complex tachycardia with difficulty identifying the P wave. The boy is conscious but has cold extremities. What is the most appropriate next step?

      Your Answer: Administer fluid bolus

      Correct Answer: Synchronized DC cardio-version

      Explanation:

      The most possible diagnosis is SVT. The boy is suffering from hemodynamic instability, as indicated by his cold extremities. DC cardioversion is the treatment of choice.

    • This question is part of the following fields:

      • Cardiovascular System
      3
      Seconds

  • Question 20 - A 13-year-old girl is brought by her mother to the A&E with breathlessness,...

    Incorrect

    • A 13-year-old girl is brought by her mother to the A&E with breathlessness, fatigue and palpitations. Anamnesis does not reveal any syncope or chest pain in the past. on the other hand, these symptoms were present intermittently for a year. Clinical examination reveals a pan-systolic murmur associated with giant V waves in the jugular venous pulse. Chest auscultation and resting ECG are normal. 24 hour ECG tape shows a short burst of supraventricular tachycardia. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Ebstein's anomaly

      Explanation:

      Ebstein’s anomaly is characterised by apical displacement and adherence of the septal and posterior leaflets of the tricuspid valve to the underlying myocardium, thereby displacing the functional tricuspid orifice apically and dividing the right ventricle into two portions. The main haemodynamic abnormality leading to symptoms is tricuspid valve incompetence. The clinical spectrum is broad; patients may be asymptomatic or experience right-sided heart failure, cyanosis, arrhythmias and sudden cardiac death (SCD). Many Ebstein’s anomaly patients have an interatrial communication (secundum atrial septal defect (ASD II) or patent foramen ovale). Other structural anomalies may also be present, including a bicuspid aortic valve (BAV), ventricular septal defect (VSD), and pulmonary stenosis. The morphology of the tricuspid valve in Ebstein anomaly, and consequently the clinical presentation, is highly variable. The tricuspid valve leaflets demonstrate variable degrees of failed delamination (separation of the valve tissue from the myocardium) with fibrous attachments to the right ventricular endocardium.
      The displacement of annular attachments of septal and posterior (inferior) leaflets into the right ventricle toward the apex and right ventricular outflow tract is the hallmark finding of Ebstein anomaly.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular System (18/19) 95%
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