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  • Question 1 - Which of the following characteristics does the jugular venous waveform have in tricuspid...

    Correct

    • Which of the following characteristics does the jugular venous waveform have in tricuspid regurgitation?

      Your Answer: Large V waves

      Explanation:

      The jugular venous pulsation has a biphasic waveform.

      – The a wave corresponds to right atrial contraction and ends synchronously with the carotid artery pulse. The peak of the ‘a’ wave demarcates the end of atrial systole.
      – The c wave corresponds to right ventricular contraction causing the tricuspid valve to bulge towards the right atrium during RV isovolumetric contraction.
      – The x’ descent follows the ‘c’ wave and occurs as a result of the right ventricle pulling the tricuspid valve downward during ventricular systole (ventricular ejection/atrial relaxation). (As stroke volume is ejected, the ventricle takes up less space in the pericardium, allowing relaxed atrium to enlarge). The x’ (x prime) descent can be used as a measure of right ventricle contractility.
      – The x descent follows the ‘a’ wave and corresponds to atrial relaxation and rapid atrial filling due to low pressure.
      – The v wave corresponds to venous filling when the tricuspid valve is closed and venous pressure increases from venous return – this occurs during and following the carotid pulse.
      – The y descent corresponds to the rapid emptying of the atrium into the ventricle following the opening of the tricuspid valve.

    • This question is part of the following fields:

      • Cardiovascular System
      16.8
      Seconds

  • Question 2 - A 50-year-old patient was admitted to the hospital for elective herniorrhaphy. Which of...

    Correct

    • A 50-year-old patient was admitted to the hospital for elective herniorrhaphy. Which of the following options will lead to a postponement of his operation?

      Your Answer: Myocardial infarction two months ago

      Explanation:

      Patients with a recent cerebrovascular incident (less than 60 days) are at very high risk of cardiac complications when under general anaesthesia. Complications like MI, heart failure and even death. Elective surgery should be postponed till stabilization of the cardiac condition is achieved.

    • This question is part of the following fields:

      • Cardiovascular System
      24.2
      Seconds

  • Question 3 - A 70-year-old man underwent temporary transvenous pacing. While in the coronary care unit...

    Correct

    • A 70-year-old man underwent temporary transvenous pacing. While in the coronary care unit he developed presyncope. His pulse rate was 30 bpm. His ECG showed pacing spikes which were not related to QRS complexes. What is the most appropriate action that can be taken?

      Your Answer: Increase the pacing voltage to a maximum

      Explanation:

      Pacemaker spikes on the ECG indicate that pacemaker is functioning. The most probable cause for this presentation is the change of the position of the tip of the pacing wire. Increasing the voltage will solve the problem. If it works, repositioning of the pacing wire should be done.

    • This question is part of the following fields:

      • Cardiovascular System
      62.9
      Seconds

  • Question 4 - A 42-year-old man presented with palpitations and shortness of breath on exertion. On...

    Incorrect

    • A 42-year-old man presented with palpitations and shortness of breath on exertion. On examination his lungs were clear and heart sounds were normal. There was a left sided parasternal heave. His electrocardiogram (ECG) revealed atrial fibrillation with right axis deviation. Echocardiography showed dilated right heart chambers. Left and right heart catheterisation study revealed the following

      Inferior vena cava Oxygen saturations 63 %
      Superior vena cava Oxygen saturations 59 %
      Right atrium Oxygen saturations 77 %
      Right ventricle Oxygen saturations 78 %
      Pulmonary artery Oxygen saturations 82 %
      Arterial saturation Oxygen saturations 98 %

      What is the most likely diagnosis from the following answers?

      Your Answer: Pulmonary stenosis

      Correct Answer: Atrial septal defect

      Explanation:

      Right ventricular volume overload is indicated by a parasternal heave and right axis deviation. Oxygen saturation in right atrium is higher than oxygen saturation of the inferior and superior vena cavae. So the most probable diagnosis is atrial septal defect.

    • This question is part of the following fields:

      • Cardiovascular System
      128.2
      Seconds

  • Question 5 - A 50-year-old male patient presented with acute chest pain and a non ST...

    Correct

    • A 50-year-old male patient presented with acute chest pain and a non ST elevation myocardial infarction (NSTEMI) was diagnosed. He was treated with aspirin 300 mg and 2 puffs of Glyceryl trinitrate (GTN) spray. According to NICE guidelines, which of the following categories of patients should receive clopidogrel?

      Your Answer: All patients

      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), a beta-blocker and a statin.

    • This question is part of the following fields:

      • Cardiovascular System
      20.1
      Seconds

  • Question 6 - A 24-year-old male with a history of a cardiac murmur which was not...

    Incorrect

    • A 24-year-old male with a history of a cardiac murmur which was not properly followed up, presented with right sided hemiparesis. His blood pressure was 120/70 mmHg. His ECG revealed right bundle branch block with right axis deviation. Which of the following is the most likely cause for this presentation?

      Your Answer: Ventricular septal defect

      Correct Answer: Ostium secundum atrial septal defect

      Explanation:

      Ostium secundum atrial septal defects are known to cause stroke due to the passage of emboli from the right sided circulation to the left sided circulation. ECG shows tall, peaked P waves (usually best seen in leads II and V2) and prolongation of the PR interval, rSR pattern in leads V3 R and V1 as well as right axis deviation.

    • This question is part of the following fields:

      • Cardiovascular System
      58.2
      Seconds

  • Question 7 - A 60-year-old female with a recent history of MI, complained of exertional dyspnoea....

    Incorrect

    • A 60-year-old female with a recent history of MI, complained of exertional dyspnoea. On examination there was a third heart sound. ECG showed ST elevations in leads V1 to V4. Which of the following is the most probable reason for this presentation?

      Your Answer:

      Correct Answer: Left ventricular aneurysm

      Explanation:

      Electrocardiography is characterized by ST elevation that persists several weeks after an acute MI. The features of heart failure (exertional dyspnoea and third or fourth heart sound) favours the diagnosis.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 8 - A 45-year-old smoker presented with sudden onset of chest pain radiating to his...

    Incorrect

    • 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:

      Correct 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
      0
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  • Question 9 - A 50-year-old male presented with acute severe central chest pain and acute ST...

    Incorrect

    • A 50-year-old male presented with acute severe central chest pain and acute ST elevation myocardial infarction was diagnosed. He was treated with streptokinase. 2 days later he was sweating excessively and he was found to be hypotensive. Which of the following cannot be considered as a reason for this presentation?

      Your Answer:

      Correct Answer: Hypotensive effect of streptokinase

      Explanation:

      Hypotensive effect of streptokinase occurs during the streptokinase infusion which is usually transient. Acute mitral regurgitation due to rupture of papillary muscles, ventricular septal defects and reinfarctions (left or right) are known to cause hypotension after 24 hrs. Pulmonary embolism is less likely but cannot be excluded.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 10 - A 65-year-old woman was referred due to a pulse rate of 40 bpm....

    Incorrect

    • A 65-year-old woman was referred due to a pulse rate of 40 bpm. Which of the following answers is associated with the least risk of asystole?

      Your Answer:

      Correct Answer: Complete heart block with a narrow complex QRS

      Explanation:

      From the given answers, complete heart block with a narrow complex QRS complex is associated with the least risk of asystole. Transvenous pacing is indicated by the other given responses.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 11 - A 60-year-old male presented in the OPD with a severe pain in the...

    Incorrect

    • A 60-year-old male presented in the OPD with a severe pain in the chest, which radiated to the jaw and his left shoulder. What is your diagnosis?

      Your Answer:

      Correct Answer: MI

      Explanation:

      Risk of myocardial infarction is high in patients with diabetes mellitus. High levels of sugar in the blood can damage the arteries and lead to an increased risk of atherosclerosis of the coronary arteries. This is why diabetic patients have an increased risk of Myocardial Infarction.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 12 - 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:

      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
      0
      Seconds

  • Question 13 - 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:

      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
      0
      Seconds

  • Question 14 - A 50-year-old male patient was started on amiodarone. Prior to commencement, his blood...

    Incorrect

    • A 50-year-old male patient was started on amiodarone. Prior to commencement, his blood urea and electrolytes were checked. What is the reason for doing this investigation before starting amiodarone?

      Your Answer:

      Correct Answer: To detect hypokalaemia

      Explanation:

      Any antiarrhythmic drugs can potentially cause arrhythmias. Before starting amiodarone, any electrolyte imbalance including hypokalaemia, hypomagnesemia, or hypocalcaemia should be corrected to prevent any arrhythmias.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 15 - In which of the following options does reversed splitting of the second heart...

    Incorrect

    • In which of the following options does reversed splitting of the second heart sound occur?

      Your Answer:

      Correct Answer: Left bundle branch block (LBBB)

      Explanation:

      Reversed splitting of the second heart sound occurs with reversal of the normal A2, P2 pattern – A2 may, therefore, be delayed, as with severe AS and LBBB. P2 may be early, as in Wolff-Parkinson-White Type B and persistent ductus arteriosus. Atrial septal defects show wide fixed splitting. Also, RBBB has wide (not fixed) splitting.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 16 - A 50-year-old male patient with schizophrenia complained of chest pain and palpitations. His...

    Incorrect

    • A 50-year-old male patient with schizophrenia complained of chest pain and palpitations. His ECG revealed torsades de pointes ventricular tachycardia. He was on thioridazine for schizophrenia. What is the most appropriate management for his presentation?

      Your Answer:

      Correct Answer: IV magnesium

      Explanation:

      Thioridazine has a quinidine-like action on the heart and is known to cause cardiac arrhythmias including prolonged PR and QT intervals and widening of QRS complexes. Intravenous magnesium sulphate is regarded as the treatment of choice for this arrhythmia.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 17 - A 30-year-old man presents with hypertension and decreased serum potassium levels. Which hormone...

    Incorrect

    • A 30-year-old man presents with hypertension and decreased serum potassium levels. Which hormone should be tested in addition in order to establish the diagnosis?

      Your Answer:

      Correct Answer: Aldosterone

      Explanation:

      High blood pressure and a low level of potassium in the blood indicates hyperaldosteronism. Therefore, aldosterone should be tested immediately to establish the diagnosis. Hyperaldosteronism, is a medical condition wherein too much aldosterone is produced by the adrenal glands, which can lead to lowered levels of potassium in the blood (hypokalaemia) and increased hydrogen ion excretion (alkalosis).

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 18 - 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 19 - A 30-year-old male presented with exercise related syncope and dyspnoea for 2 weeks....

    Incorrect

    • A 30-year-old male presented with exercise related syncope and dyspnoea for 2 weeks. His father passed away at the age of 40, due to sudden cardiac death. His ECG showed left ventricular hypertrophy with widespread T wave inversions. Which of the following is the most appropriate next investigation to confirm the diagnosis?

      Your Answer:

      Correct Answer: Transthoracic echo

      Explanation:

      The most likely diagnosis is hypertrophic obstructive cardiomyopathy which is suggestive by the history, positive family history and ECG findings. Two-dimensional echocardiography is diagnostic for hypertrophic cardiomyopathy. In general, a summary of echocardiography findings includes abnormal systolic anterior leaflet motion of the mitral valve, LV hypertrophy, 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, and partial systolic closure of the aortic valve in midsystole.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 20 - A 60-year-old previously well male was admitted with a suspected pulmonary embolism. On...

    Incorrect

    • A 60-year-old previously well male was admitted with a suspected pulmonary embolism. On examination his BP was 130/80 mmHg and pulse rate was 88 bpm. His CXR was normal. He was treated with low molecular weight heparin. Which of the following is the most appropriate initial lung investigation for this patient?

      Your Answer:

      Correct Answer: Computed tomographic pulmonary angiography

      Explanation:

      Computed tomographic pulmonary angiography (CTPA) is the standard investigative tool, used for diagnosing a pulmonary embolism. Pulmonary angiography is indicated if CTPA is not available.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 21 - 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:

      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
      0
      Seconds

  • Question 22 - 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 23 - A 60-year-old previously well male patient was admitted with acute severe central chest...

    Incorrect

    • A 60-year-old previously well male patient was admitted with acute severe central chest pain associated with excessive sweating and nausea for the past 45 minutes. On examination he was found to have xanthelasma. His blood pressure was 170/100 mmHg and pulse rate was 104 bpm. His ECG showed ST elevation more than 2mm in leads II, III and aVF. His troponin T was 120 ng/ml. His FBC and renal functions were normal. He was given aspirin, clopidogrel, morphine and IV 5 mg of atenolol. Which of the following is the most appropriate next step?

      Your Answer:

      Correct Answer: Immediate referral to cardiologist for primary angioplasty

      Explanation:

      The diagnosis is acute inferior ST elevation myocardial infarction so the most appropriate management is primary angioplasty.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 24 - A 60-year-old man with previous history of myocardial infarction and hypertension presented with...

    Incorrect

    • A 60-year-old man with previous history of myocardial infarction and hypertension presented with severe retrosternal chest pain for the past 2 hours. During initial management he collapsed and pulseless ventricular tachycardia was detected. The external defibrillator arrived in 3 minutes. From the following answers, what is the most appropriate immediate management of this patient whilst waiting for the defibrillator?

      Your Answer:

      Correct Answer:

      Explanation:

      Immediate Management of Pulseless Ventricular Tachycardia:

      1. Continuous Chest Compressions:
        • Continuous chest compressions should be started immediately to maintain circulation while the defibrillator is being prepared. High-quality chest compressions are crucial and should not be delayed.
      2. Defibrillation:
        • Once the defibrillator arrives, defibrillation should be performed as soon as possible. For pulseless ventricular tachycardia, delivering a shock is critical to attempt to restore a normal heart rhythm.

      Other options:

      He should be given a precordial thump: This is not recommended as a primary action when a defibrillator is available or arriving imminently.

      A ventilation to compression ratio of 30:2 should be commenced: While ventilation is important, continuous chest compressions take precedence in the initial phase. The ratio of 30:2 is used during CPR when ventilations are also being provided, typically when two rescuers are present.

      Await arrival of defibrillator, then deliver shock: Waiting passively without performing chest compressions is not appropriate.

      Intravenous adrenaline should be given: Adrenaline is part of the advanced life support protocol, but the first immediate action should be chest compressions followed by defibrillation.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 25 - A 25-year-old male presented with an episode of syncope. His examination findings were...

    Incorrect

    • A 25-year-old male presented with an episode of syncope. His examination findings were normal. He gave a history of sudden cardiac death of a close relative. His ECG showed incomplete right bundle-branch block and ST-segment elevations in the anterior precordial leads. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Brugada syndrome

      Explanation:

      Brugada syndrome is an autosomal dominant disorder characterized by sudden cardiac death. The positive family history and characteristic ECG findings are in favour of Brugada syndrome. Usually the physical findings are normal.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 26 - A 54-year-old female presents with shortness of breath that has been going on...

    Incorrect

    • A 54-year-old female presents with shortness of breath that has been going on for the last 10 months. Physical examination shows that she has an irregularly irregular pulse and a loud P2 with fixed splitting accompanied by a systolic ejection murmur in the 2nd left intercostal space. Which of the following would be the most likely diagnosis?

      Your Answer:

      Correct Answer: Atrial septal defect (ASD)

      Explanation:

      Atrial septal defect (ASD) is one of the more commonly recognized congenital cardiac anomalies presenting in adulthood. ASD is characterized by a defect in the interatrial septum allowing pulmonary venous return from the left atrium to pass directly to the right atrium. Depending on the size of the defect, size of the shunt, and associated anomalies, this can result in a spectrum of disease ranging from no significant cardiac sequelae to right-sided volume overload, pulmonary arterial hypertension, and even atrial arrhythmias.

      With the routine use of echocardiography, the detection and, therefore, the incidence of ASD is increased compared to earlier incidence studies using catheterization, surgery, or autopsy for diagnosis. The subtle physical examination findings and often minimal symptoms during the first 2-3 decades of life contribute to a delay in diagnosis until adulthood, the majority (more than 70%) of which is detected by the fifth decade of life.

    • This question is part of the following fields:

      • Cardiovascular System
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      Seconds

  • Question 27 - In which condition are β-blockers not recommended as the first line of therapy?...

    Incorrect

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

      Your Answer:

      Correct 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
      0
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  • Question 28 - A 60-year-old patient with hypertension attended his regular clinic. His compliance was poor....

    Incorrect

    • A 60-year-old patient with hypertension attended his regular clinic. His compliance was poor. His blood pressure was 180/100 mmHg. His pulse rate was 85 bpm which was irregularly irregular. On examination there was bibasal crepitation. No murmurs were heard. What is the most likely cause for these findings?

      Your Answer:

      Correct Answer: Left ventricular hypertrophy

      Explanation:

      Left ventricular hypertrophy due to long standing hypertension is the most probable cause. The irregularly irregular pulse was suggestive of atrial fibrillation, which is due to diastolic dysfunction. Poor ventricular filling causes pulmonary congestion which manifests as bibasal crepitations.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 29 - 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:

      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
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      Seconds

  • Question 30 - A previously well 33-year-old female was admitted with a history of recurrent episodes...

    Incorrect

    • 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:

      Correct 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
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SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular System (4/6) 67%
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