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  • Question 1 - A 57-year-old female presented to the cardiology centre with a history of chest...

    Incorrect

    • A 57-year-old female presented to the cardiology centre with a history of chest tightness for a few hours, accompanied by pain radiating to the left side of the shoulder and neck. ECG was normal. What is the next best investigation for this patient?

      Your Answer: ECG

      Correct Answer: Cardiac enzymes

      Explanation:

      This patient’s symptoms of angina radiating to the neck and shoulders gives a strong suspicion of MI. Cardiac enzymes such as troponins are highly specific and sensitive for a heart attack.

    • This question is part of the following fields:

      • Cardiovascular System
      26.5
      Seconds
  • Question 2 - A 60-year-old male smoker and a known hypertensive presented with central chest pain...

    Correct

    • A 60-year-old male smoker and a known hypertensive presented with central chest pain radiating to the back. On examination he was tachycardic and hypotensive. His ECG showed inferior ST elevation and his transoesophageal echocardiogram showed a double lumen in the ascending aorta. Which of the following is the most probable diagnosis?

      Your Answer: Dissecting aortic aneurysm

      Explanation:

      The classic history in this high risk patient is suggestive of a dissecting aortic aneurysm. His transoesophageal echocardiogram confirms the diagnosis. ST elevation in ECG is probably due to the extension of the dissection of the aorta which results in compromised coronary blood supply.

    • This question is part of the following fields:

      • Cardiovascular System
      28.4
      Seconds
  • Question 3 - 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: Occlusive coronary atherosclerosis

      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
      51.6
      Seconds
  • Question 4 - A 70-year-old male patient presented with chronic congestive heart failure. Which of the...

    Incorrect

    • 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: Digoxin is more effective than ACE inhibitors in reducing cardiovascular events

      Correct 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
      63.6
      Seconds
  • Question 5 - A 68-year-old male with history of poorly controlled hypertension was admitted with shortness...

    Correct

    • A 68-year-old male with history of poorly controlled hypertension was admitted with shortness of breath on exertion, orthopnoea for three months. He was diagnosed with congestive cardiac failure and was started on digoxin 62.5 μg daily, furosemide 80 mg daily and amiloride 10 mg daily. On admission his lab results showed that his serum urea was 6 mmol/L and serum creatinine was 115 μmol/L. One month later he came for a follow up consultation. On examination he had bilateral ankle oedema. His blood pressure was 138/90 mmHg and pulse rate was 92 bpm. His JVP was not elevated. His apex beat was displaced laterally and he had a few bibasal crepitations on auscultation. There were no cardiac murmurs. His investigation results revealed the following:

      Serum sodium 143 mmol/L (137-144)
      Serum potassium 3.5 mmol/L (3.5-4.9)
      Serum urea 8 mmol/L (2.5-7.5)
      Serum creatinine 140 μmol/L (60-110)
      Serum digoxin 0.7 ng/mL (1.0-2.0)

      CXR showed cardiomegaly and a calcified aorta. ECG showed left ventricular hypertrophy.

      Which of the following is the most appropriate next step in the management of this patient?

      Your Answer: Add an ACE inhibitor to the current regimen

      Explanation:

      From the given history the patient has NYHA grade III heart failure. He can be safely started on an ACE inhibitor as his serum potassium was towards the lower limit. As there an impairment of renal function, his urea, creatinine and serum electrolytes should be closely monitored after commencing an ACE inhibitor. Adding atenolol will not have any clinical benefit. Increasing the digoxin dose is not needed as the patient is in sinus rhythm. Increasing furosemide will only have symptomatic relief.

    • This question is part of the following fields:

      • Cardiovascular System
      17.6
      Seconds
  • Question 6 - The phonocardiogram of a 40-year-old male patient showed a normal S1 but an...

    Incorrect

    • The phonocardiogram of a 40-year-old male patient showed a normal S1 but an abnormal S2. S2 was fixed and widely split. Out of the following, which condition do you think this patient most likely suffering from?

      Your Answer: Aortic stenosis

      Correct Answer: Secundum atrial septal defect

      Explanation:

      The second heart sound (S2) corresponds to the closing of the semilunar valves, first the aortic and then the pulmonary valve. The gap between the closure of these two valves is normally insignificant and is heard as a single heart sound. In certain pathological conditions, this gap increases when there is a delay in right ventricular emptying, but in cases other than an atrial septal defect, the sound is not fixed. In an atrial septal defect, the right ventricle continuously receives blood, causing a delay and a fixed and split S2.

    • This question is part of the following fields:

      • Cardiovascular System
      50
      Seconds
  • Question 7 - 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: Recent asystole

      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
      8.7
      Seconds
  • Question 8 - A female patient presents with pain upon inspiration and dyspnoea. She had a...

    Incorrect

    • A female patient presents with pain upon inspiration and dyspnoea. She had a myocardial infarction four days ago. What is the most probable diagnosis?

      Your Answer: Angina

      Correct Answer: Pericarditis

      Explanation:

      Although viral infection is the most common identifiable cause of acute pericarditis, the condition may be associated with many diseases. Non-viral causes of pericarditis include bacterial infection, MI, chest trauma, and neoplasm. Post-MI pericarditis may develop two to four days after an acute infarction and results from a reaction between the pericardium and the damaged adjacent myocardium. Dressler’s syndrome is a post-MI phenomenon in which pericarditis develops weeks to months after an acute infarction; this syndrome is thought to reflect a late autoimmune reaction mediated by antibodies to circulating myocardial antigens.

    • This question is part of the following fields:

      • Cardiovascular System
      30
      Seconds
  • Question 9 - 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: Femoro-popliteal

      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
      49.2
      Seconds
  • Question 10 - A 70-year-old male patient presented with increased difficulty in breathing during the last...

    Correct

    • 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: 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
      22.3
      Seconds
  • Question 11 - 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: Atrial thrombus

      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
      24.7
      Seconds
  • Question 12 - 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: Bifid P waves

      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
      12.2
      Seconds
  • Question 13 - A 65-year-old male with a history of smoking and alcohol was admitted with...

    Correct

    • A 65-year-old male with a history of smoking and alcohol was admitted with an ST elevation myocardial infarction. He was obese and lives a sedentary lifestyle. What is the non-pharmacological intervention which will be most helpful to reduce future ischaemic events?

      Your Answer: Stopping smoking

      Explanation:

      Stopping smoking is the single most effective non-pharmacological intervention which will reduce future ischaemic events. But the rest of the responses are also important interventions with regards to reducing future ischaemic events.

    • This question is part of the following fields:

      • Cardiovascular System
      40.1
      Seconds
  • Question 14 - A 72-year-old male presents to the ER with acute chest pain, fever and...

    Correct

    • A 72-year-old male presents to the ER with acute chest pain, fever and sweating. ECG shows an acute MI. Which of the following routes will be the most significant in alleviating the patient's pain?

      Your Answer: Intravenous

      Explanation:

      The pain of myocardial infarction is usually severe and requires potent opiate analgesia. Intravenous diamorphine 2.5-5 mg (repeated as necessary) is the drug of choice and is not only a powerful analgesic but also has a useful anxiolytic effect.

    • This question is part of the following fields:

      • Cardiovascular System
      10
      Seconds
  • Question 15 - 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
      14.2
      Seconds
  • Question 16 - A 30-year-old primigravida in her 23rd week of pregnancy presented with palpitations. Her...

    Incorrect

    • A 30-year-old primigravida in her 23rd week of pregnancy presented with palpitations. Her ECG showed supraventricular tachycardia (SVT). 15 minutes after admission the SVT spontaneously reverted to sinus rhythm. She had two episodes of SVT later which were associated with palpitations. Which of the following is the most appropriate treatment for this presentation?

      Your Answer: Amiodarone

      Correct Answer: Verapamil

      Explanation:

      Both long-acting calcium channel blockers and beta blockers improve symptoms of patients with SVT. Verapamil does not have adverse maternal or fetal side effects which would suggest that the use of verapamil in the treatment of supraventricular arrhythmias in pregnancy is safe and effective. Beta blockers are associated with intrauterine fetal growth restriction.

    • This question is part of the following fields:

      • Cardiovascular System
      24.1
      Seconds
  • Question 17 - 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: Domperidone

      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
      29.5
      Seconds
  • Question 18 - An old man presented with headache and weakness of the left half of...

    Incorrect

    • An old man presented with headache and weakness of the left half of the body. His CT scan showed an intracranial bleed (ICB). All of the following factors can lead to ICB except?

      Your Answer: Cocaine use

      Correct Answer: Moderate alcohol use

      Explanation:

      Moderate alcohol intake has no association with intracranial bleeding (ICB), rather some authors suggested that it is protective. Patients with a previous history of DVT, mitral valve prolapse or those using cocaine are at an increased risk of developing an ICB.

    • This question is part of the following fields:

      • Cardiovascular System
      63.9
      Seconds
  • Question 19 - An 8-year-old boy is presented with arthritis, cough and non-blanching purpura. His coagulation...

    Correct

    • An 8-year-old boy is presented with arthritis, cough and non-blanching purpura. His coagulation profile is normal. His CBC: Hb 11.8 TLC 7.2*10^9 Plt 286*10^9. What is the most likely diagnosis?

      Your Answer: Henoch-Schönlein Purpura (HSP)

      Explanation:

      The best answer is Henoch-Schönlein Purpura (HSP). This patient has a characteristic rash and the labs are consistent with this diagnosis.

    • This question is part of the following fields:

      • Cardiovascular System
      38.4
      Seconds
  • Question 20 - 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
      26.2
      Seconds
  • Question 21 - A 65-year-old male patient presented with acute severe central chest pain for one...

    Correct

    • A 65-year-old male patient presented with acute severe central chest pain for one hour. His ECG confirmed the diagnosis of acute ST elevation myocardial infarction and he was treated with thrombolysis. Two days later he developed sudden onset breathlessness and became unwell. On examination he had bibasal crepitation and a systolic murmur at the apex which radiated to the axilla. Which of the following is the most likely cause for this presentation?

      Your Answer: Ruptured papillary muscle

      Explanation:

      The most likely cause for acute breathlessness is due to papillary muscle rupture which causes mitral regurgitation.

    • This question is part of the following fields:

      • Cardiovascular System
      38.4
      Seconds
  • Question 22 - A 13-year-old boy presented with difficulty in breathing on exertion. According to his...

    Correct

    • A 13-year-old boy presented with difficulty in breathing on exertion. According to his mother who was also present, his exercise tolerance has been gradually worsening for the past weeks. It has reached the point where he is unable to participate in his weekly soccer match. Cardiac catheterization was performed and the results are given below.
      Anatomical site
      Oxygen saturation (%)
      Pressure (mmHg)

      Superior vena cava
      73
      -

      Right atrium
      71
      6

      Right ventricle
      72
      -

      Pulmonary artery
      86
      53/13

      PCWP
      -
      15

      Left ventricle
      97
      111/10

      Aorta
      96
      128/61

      Which of the following is the diagnosis?

      Your Answer: Patent ductus arteriosus

      Explanation:

      The oxygen saturation in the pulmonary artery is higher than that of the right ventricle. The pressure of the pulmonary artery and of the PCWP are also high. So patent ductus arteriosus is highly suggestive.

    • This question is part of the following fields:

      • Cardiovascular System
      26.2
      Seconds
  • Question 23 - 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: Check INR 72 hours before procedure, proceed if INR < 2.5

      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
      155.3
      Seconds
  • Question 24 - A 25-year-old male presented with acute severe central chest pain which radiated backwards...

    Incorrect

    • A 25-year-old male presented with acute severe central chest pain which radiated backwards between his scapulae. He didn't have difficulty in breathing and the pain wasn't exacerbated by deep inspiration or a change in position. His father had died due to a heart disease when he was small. He also has a cardiac murmur which was never properly investigated. On examination he was tachycardic with a BP of 165/60 mmHg. There was a diastolic murmur at lower left sternal border which is best heard with the patient sitting forward. Which of the following is the most probable cause for his chest pain?

      Your Answer: Acute myocardial infarction

      Correct Answer: Aortic dissection

      Explanation:

      The most probable diagnosis is Marfan’s syndrome because of a family history of cardiac death and heart murmurs. A characteristic feature is pain which radiates to the back. A wide pulse pressure and a diastolic heart murmur is suggestive of aortic dissection.

    • This question is part of the following fields:

      • Cardiovascular System
      60.8
      Seconds
  • Question 25 - A 72-year-old male with a history of type II diabetes mellitus and hypertension...

    Incorrect

    • A 72-year-old male with a history of type II diabetes mellitus and hypertension for 15 years, presented with gradual onset difficulty in breathing on exertion and bilateral ankle swelling for the past 3 months. On examination he had mild ankle oedema. His JVP was not elevated. His heart sounds were normal but he had bibasal crepitations on auscultation. Which of the following clinical signs has the greatest sensitivity in detecting heart failure in this patient?

      Your Answer: Pulmonary crackles

      Correct Answer: Third heart sound

      Explanation:

      The presence of a third heart sound is the most sensitive indicator of heart failure. All of the other signs can be found in heart failure with varying degrees.

    • This question is part of the following fields:

      • Cardiovascular System
      41.5
      Seconds
  • Question 26 - 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: Pulsus parodoxus

      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
      49.3
      Seconds
  • Question 27 - 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: To detect hyponatraemia

      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
      20.6
      Seconds
  • Question 28 - A 62-year-old obese female presented with dilated veins over the lateral aspect of...

    Incorrect

    • 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: Sapheno-femoral junction

      Correct 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
      11.2
      Seconds
  • Question 29 - A 62-year-old male presented with worsening breathlessness and fatigability. On examination there was...

    Incorrect

    • A 62-year-old male presented with worsening breathlessness and fatigability. On examination there was bilateral ankle swelling and pulsatile liver. Auscultation revealed a pansystolic murmur best heard at the lower left sternal border. Which of the following is the most probable diagnosis?

      Your Answer: Pulmonary stenosis

      Correct Answer: Tricuspid regurgitation

      Explanation:

      All the clinical features are suggestive of tricuspid regurgitation. The pansystolic murmur of mitral regurgitation is best heard at the apex.

    • This question is part of the following fields:

      • Cardiovascular System
      28.9
      Seconds
  • Question 30 - An echocardiogram of a 50-year-old male patient showed an infarct in the anterolateral...

    Incorrect

    • An echocardiogram of a 50-year-old male patient showed an infarct in the anterolateral aspect of the left side of the heart and apex. An angiogram was then done. Obstruction of which of the following arteries is the cause of this myocardial infarction?

      Your Answer: Coronary sinus

      Correct Answer: Left anterior descending artery

      Explanation:

      The left coronary artery is responsible for supplying the entire left side of the heart, however, it divides into the left anterior descending artery which supplies the apex of the heart and the interventricular septum, and the left circumflex artery which supplies the posterolateral part of the left ventricle and a portion of the papillary muscle. The infarction is noted at the apex of the heart and the interventricular septum, therefore, the obstruction has occurred in the left anterior descending artery.

    • This question is part of the following fields:

      • Cardiovascular System
      15.3
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular System (22/31) 71%
Passmed