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  • Question 1 - A young alcoholic male patient presented at hospital with complaints of tachycardia and...

    Correct

    • A young alcoholic male patient presented at hospital with complaints of tachycardia and palpitations for the past few hours. During examination, his blood pressure and ECG were normal. What would be the next step in management of this patient?

      Your Answer: Reassure and life Style modification

      Explanation:

      Normal blood pressure and ECG rule out any pathological cause of the complaints described in this scenario. These symptoms are most probably due to anxiety or effects of alcohol intake. Lifestyle modification will be the best management plan along with reassurance to calm the patient.

    • This question is part of the following fields:

      • Cardiovascular System
      34
      Seconds

  • Question 2 - A 20-year-old male presented after an episode where he had collapsed. This was...

    Correct

    • A 20-year-old male presented after an episode where he had collapsed. This was the second time he has collapsed during the past 3 weeks. His father passed away at the age of 40 due to sudden cardiac death. Echocardiography showed evidence of hypertrophic cardiomyopathy. His 24 hr ECG revealed several short runs of nonsustained ventricular tachycardia (VT). Which of the following is the most appropriate management for this patient?

      Your Answer: Implantable cardiovertor defibrillator

      Explanation:

      This patient has a high risk of sudden cardiac death due to a strong family history and non sustained VT. So the most appropriate management is implantable cardiovertor defibrillator.

    • This question is part of the following fields:

      • Cardiovascular System
      76.8
      Seconds

  • Question 3 - A 70-year-old male patient presented with chronic congestive heart failure. Which of the...

    Correct

    • A 70-year-old male patient presented with chronic congestive heart failure. Which of the following is the most important factor to consider when prescribing drugs for this patient?

      Your Answer: Administration of a B-blocker reduces the time spent in hospital

      Explanation:

      It is proven that spironolactone has survival benefits and loop diuretics only give symptomatic relief. Beta blockers are however, known to improve exercise tolerance, left ventricular function and reduce symptoms. They also reduce the mortality associated with heart failure. So administration of beta blockers will reduce the time spent in hospital by improving symptoms.

    • This question is part of the following fields:

      • Cardiovascular System
      121.7
      Seconds

  • Question 4 - A 65-year-male patient was started on warfarin for chronic atrial fibrillation (AF). Which...

    Correct

    • 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: 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
      23.2
      Seconds

  • Question 5 - 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: Atenolol

      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
      38.7
      Seconds

  • Question 6 - A 62-year-old obese female presented with dilated veins over the lateral aspect of...

    Correct

    • A 62-year-old obese female presented with dilated veins over the lateral aspect of her right ankle. Which of the following is most responsible for her presentation?

      Your Answer: Short saphenous vein

      Explanation:

      Varicose veins (venous insufficiency syndrome) are dilated, tortuous veins due to reverse venous flow. All the given veins can be affected from this condition. As the patient has varicose veins over lateral aspect of ankle, the short saphenous vein is affected. The great or long saphenous vein travels along the medial aspect of the ankle

    • This question is part of the following fields:

      • Cardiovascular System
      31.4
      Seconds

  • Question 7 - A 13-year-old girl is brought by her mother to the A&E with breathlessness,...

    Correct

    • 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: 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
      39
      Seconds

  • Question 8 - A 72-year-old female patient with a history of atrial fibrillation was admitted with...

    Correct

    • 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: 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
      33.3
      Seconds

  • Question 9 - Which of the following is suggestive of co-existence of mitral regurgitation and mitral...

    Incorrect

    • Which of the following is suggestive of co-existence of mitral regurgitation and mitral stenosis?

      Your Answer:

      Correct Answer: Displaced apex beat

      Explanation:

      Apex beat displacement is caused by mitral regurgitation and because it is not found in mitral stenosis, it is suggestive of mixed mitral disease. The other given responses occur in mitral stenosis.

    • This question is part of the following fields:

      • Cardiovascular System
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      Seconds

  • Question 10 - Which of the following features of the jugular venous waveform indicates the closure...

    Incorrect

    • Which of the following features of the jugular venous waveform indicates the closure of the tricuspid valve?

      Your Answer:

      Correct Answer: c wave

      Explanation:

      The a wave indicates atrial contraction. The c wave indicates ventricular contraction and resulting bulging of the tricuspid valve into the right atrium during isovolumetric systole. The v wave indicates venous filling. The x descent indicates the atrium relaxation and the movement of tricuspid valve downward. The y descent indicates the filling of the ventricle after the opening of the tricuspid valve.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 11 - The conductive system of the heart anatomically includes the: ...

    Incorrect

    • The conductive system of the heart anatomically includes the:

      Your Answer:

      Correct 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
      0
      Seconds

  • Question 12 - A 65-year-old man was seen at autopsy. He had swollen legs and signs...

    Incorrect

    • A 65-year-old man was seen at autopsy. He had swollen legs and signs of a transudate fluid at his liver. Before passing away, he was treated for bronchitis and TB. What is the most probable cause of the transudate?

      Your Answer:

      Correct Answer: Cardiac failure

      Explanation:

      The patient most probably experienced congestive hepatopathy and leg oedema due to right sided cardiac failure.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 13 - 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 14 - A 72-year-old male presented to the Emergency Department with a broad complex tachycardia....

    Incorrect

    • A 72-year-old male presented to the Emergency Department with a broad complex tachycardia. Which of the following features is more suggestive that this has resulted because of a supraventricular tachycardia (SVT) rather than a ventricular tachycardia (VT)?

      Your Answer:

      Correct Answer: Absence of QRS concordance in chest leads on ECG

      Explanation:

      To differentiate ventricular tachycardia (VT) from supraventricular tachycardia (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 15 - A 57-year-old female arrives at the emergency due to chest pain, shortness of...

    Incorrect

    • A 57-year-old female arrives at the emergency due to chest pain, shortness of breath and palpitations. ECG is done which shows a supraventricular tachycardia with a heart rate of 220/min. carotid massage fails to bring the heart rate down. How would you manage this patient?

      Your Answer:

      Correct Answer: DC shock

      Explanation:

      Synchronized electrical cardioversion may also be used to treat stable ventricular tachycardia (VT) that does not respond to a trial of intravenous medications. Unstable patients with SVT and a pulse are always treated with synchronized cardioversion. The appropriate voltage for cardioverting SVT is 50-100 J. This is what AHA recommends and also SVT converts quite readily with 50-100 J.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 16 - A 45-year-old male complains of angina pain. Which of the following features on...

    Incorrect

    • A 45-year-old male complains of angina pain. Which of the following features on exercise testing would have the strongest predictive value for ischaemic heart disease?

      Your Answer:

      Correct Answer: Decline in systolic BP by 20 mmHg in stage 1 of the Bruce protocol

      Explanation:

      The classic criteria for visual interpretation of positive stress test findings include the following:J point (the junction of the point of onset of the ST-T wave; it is normally at or near the isoelectric baseline of the ECG), ST80 (the point that is 80 msec from the J point), depression of 0.1 mV (1 mm) or more and ST-segment slope within the range of ± 1 mV/sec in 3 consecutive beats

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 17 - A 42-year-old male patient who was on enalapril for hypertension presented with generalized...

    Incorrect

    • A 42-year-old male patient who was on enalapril for hypertension presented with generalized body weakness. Investigations revealed hyperkalaemia. Which of the following can be expected in his ECG?

      Your Answer:

      Correct Answer: Tall, tented T waves

      Explanation:

      In hyperkalaemia the ECG will show tall, tented T waves as well as small P waves and widened QRS complexes. 

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 18 - A 65-year-old male patient admitted with myocardial infarction received thrombolysis, which lead to...

    Incorrect

    • A 65-year-old male patient admitted with myocardial infarction received thrombolysis, which lead to full resolution of the ST elevations on his ECG. He was on aspirin, clopidogrel, atorvastatin and enalapril. The next day he complained of pain in his legs and there was a diffuse petechial rash over his lower legs, especially in the feet. All his peripheral pulses were palpable. His FBC revealed neutrophilia with eosinophilia. His IgE antibodies were 3 kU/L (<2). What is the most likely reason for this presentation?

      Your Answer:

      Correct Answer: Cholesterol emboli

      Explanation:

      He has a consequence of atherosclerotic disease (MI). The most probable diagnosis is cutaneous cholesterol emboli as it is more common after anticoagulation or thrombolytics, the skin involvement, eosinophilia and raised IgE. It is more common above 60 yrs. of age.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 19 - A 54-year-old patient presented with a dry cough after starting treatment for hypertension....

    Incorrect

    • A 54-year-old patient presented with a dry cough after starting treatment for hypertension. He was prescribed ramipril 2.5mg and the dry cough started after that, which disturbed his sleep. His blood pressure was normal. Which of the following is the most appropriate management?

      Your Answer:

      Correct Answer: Stop the ramipril and prescribe candesartan

      Explanation:

      ACE inhibitors are known to cause a dry cough and they should be stopped, to settle the cough. The next drug of choice is an angiotensin receptor blocker such as candesartan.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 20 - A 50-year-old patient was admitted to the hospital for elective herniorrhaphy. Which of...

    Incorrect

    • 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:

      Correct 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
      0
      Seconds

  • Question 21 - A 25-year-old girl's ECG revealed a normal PR interval and QRS while the...

    Incorrect

    • A 25-year-old girl's ECG revealed a normal PR interval and QRS while the QT is prolonged. History reveals she has been having frequent fainting attacks since childhood. What is the cause of these syncopal attacks?

      Your Answer:

      Correct Answer: Torsade de pointes

      Explanation:

      Patients with a long QT wave syndrome are prone to recurrent syncope if they have Torsade’s de pointes since it degenerates into fibrillation of the ventricles.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 22 - A 32-year-old male who was on methadone has suddenly collapsed while running and...

    Incorrect

    • A 32-year-old male who was on methadone has suddenly collapsed while running and was found dead. What is the most likely cause for his death?

      Your Answer:

      Correct Answer: Prolonged QT

      Explanation:

      Methadone and cocaine can cause QT prolongation through the direct effects on the resting membrane potential. Methadone can increase QT dispersion in addition to QT interval. Methadone inhibits the Human Ether-a-go-go Related Gene (hERG) and causes QTc prolongation and development of Torsades de point. Brugada-like syndrome is another condition found in methadone users which predisposes the users to life-threatening ventricular tachycardia and sudden cardiac death.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 23 - 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:

      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
      0
      Seconds

  • Question 24 - A 44-year-old man complains of unceasing chest pain which is aggravated by inspiration...

    Incorrect

    • A 44-year-old man complains of unceasing chest pain which is aggravated by inspiration four weeks after his MI. His temperature is 37.5C and ESR is 45mm/h. What is the single most likely explanation for the abnormal investigations

      Your Answer:

      Correct Answer: Dressler syndrome

      Explanation:

      Dressler syndrome signs and symptoms include pericarditis, low-grade fever, and pleuritic chest pain. It commonly occurs two to five weeks following the initial event or for as long as three months.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 25 - 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 26 - A 52-year-old female who was a smoker, with a history of asymptomatic atrial...

    Incorrect

    • A 52-year-old female who was a smoker, with a history of asymptomatic atrial septal defect (ASD) presented with difficulty in breathing on exertion and ankle oedema for the past 2 weeks. She has defaulted on her follow up for ASD. On examination she was cyanosed and clubbing was noted. Her pulse rate was 92 and blood pressure was 100/60 mmHg. Echocardiography revealed a dilated right ventricle of the heart. The right ventricular pressure was 90 mmHg. Significant tricuspid and pulmonary regurgitation were also noted. Which of the following is the most probable diagnosis?

      Your Answer:

      Correct Answer: Eisenmenger's syndrome

      Explanation:

      According to echocardiography findings pulmonary pressure is closer to systemic blood pressure and it is evidence of pulmonary hypertension. Because of the reversal of shunt due to pulmonary hypertension, cyanosis and clubbing have developed. So the most probable diagnosis is Eisenmenger’s syndrome.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 27 - 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:

      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
      0
      Seconds

  • Question 28 - 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 29 - 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
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  • Question 30 - 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

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular System (7/8) 88%
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