-
Question 1
Incorrect
-
Which type of myocardial infarction has the worst prognosis?
Your Answer: Anterior wall MI with continuing frequent ventricular ectopy
Correct Answer: Anterior wall MI complicated with continuing left ventricular failure and an exercise tolerance of 3 METS on a predischarge exercise test
Explanation:Exercise tolerance of 3 METS on a predischarge exercise test is the most important indicator of a poor post-MI prognosis. Other similar features that predispose the individual to a poor prognosis are resuscitation from a secondary ventricular tachyarrhythmia after the fist 24h and poor left ventricular function on echo.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 2
Correct
-
A 56-year-old man injected his usual insulin dose and went to the washroom to wash his hands before going to dinner. His wife found him unconscious in the washroom a few minutes later. Which of the following investigations needs to be done?
Your Answer: Random capillary glucose
Explanation:The state of this patient is most likely a diabetic coma caused by hypoglycaemic shock. A random capillary glucose check can confirm the glucose level and whether prompt IM glucagon should be given.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 3
Incorrect
-
A 59-year-old man complains of weakness in his right lower and upper limb since 3 for a few hours. He is has been taking Digoxin for 2 years. What is the most definitive investigation for this condition?
Your Answer: CT head
Correct Answer: Angiography
Explanation:Digoxin is a cardiac glycoside, having positive inotropic effects on the heart. It increases the strength of contractility of the heart, increasing the heart rate, but lowering blood pressure. This patient developed weakness in his limbs most likely caused by extremely low blood pressure that could be due to diseased blood vessels reacting to the side-effects of digoxin, therefore an angiography would be the best investigation.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 4
Correct
-
Wolff-Parkinson-White syndrome is not linked with which of the following?
Your Answer: Ventricular tachycardia in the absence of drug therapy
Explanation:Ventricular tachycardia is not linked with Wolff-Parkinson-White syndrome. The other options are linked to WPW syndrome.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 5
Incorrect
-
A 32-year-old previously well primigravida in her 16th week of pregnancy came to the antenatal clinic for a routine review. Her blood pressure was 152/90 mmHg. On her last clinic visit 4 weeks ago her blood pressure was 148/86 mmHg. She was put on ambulatory blood pressure monitoring and her mean blood pressure was 148/88 mmHg. Her urine examination was negative for protein. Which of the following is the most likely diagnosis?
Your Answer: Pregnancy-induced hypertension
Correct Answer: Pre-existing hypertension
Explanation:Pre-eclampsia is excluded from negative proteinuria. White coat hypertension is excluded with ambulatory blood pressure monitoring. Pregnancy induced hypertension develops after 20 weeks of gestation. So the most likely answer is pre-existing hypertension. She should be investigated for a secondary cause for hypertension.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 6
Correct
-
In which of the following options does reversed splitting of the second heart sound occur?
Your 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
-
-
Question 7
Correct
-
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: 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.Â
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 8
Incorrect
-
Patients on digoxin therapy are required to receive an initially higher dose of the drug, in order to amplify the effect of the treatment. Which of the following makes this requirement necessary?
Your Answer: Bioavailability
Correct Answer: Half-life
Explanation:A loading dose is required for drugs that are eliminated from the body in a slow, progressive manner. Half-life is the indicator showing if a drug has a fast, intermediate or slow elimination rate.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 9
Correct
-
A 50-year-old smoker with a history of hypertension presented with acute severe chest pain and acute myocardial infarction was diagnosed. Which of the following is a contraindication for thrombolysis?
Your Answer: History of likely ischaemic stroke within the past month
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
-
-
Question 10
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
-
-
Question 11
Correct
-
A 62 year-old patient with a history of a stroke, presented with chest pain and exertional dyspnoea. ECG revealed atrial fibrillation and on chest X-ray there was straightening of the left heart border. The most likely diagnosis will be?
Your Answer: Rheumatic mitral valve stenosis
Explanation:Symptoms of exertional dyspnoea, atrial fibrillation and radiological evidence of straightening of the left heart border favours the diagnosis of rheumatoid mitral valve stenosis.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 12
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: Bubble 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
-
-
Question 13
Correct
-
A 36-year-old patient who is a known IV drug abuser presented with complaints of sudden onset of sharp excruciating chest pain, which increases on inspiration and is relieved by bending forward. He also complained of shortness of breath for the last few months. The most likely diagnosis would be?
Your Answer: Pericarditis
Explanation:The chief symptoms of pericarditis comprise of sudden onset of sharp chest pain, that is relieved by bending forward and is exacerbated by deep inspiration. Symptoms can vary among the individuals but these are the chief symptoms.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 14
Correct
-
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: 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
-
-
Question 15
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
-
-
Question 16
Correct
-
A 30-year-old male patient presented with palpitations that occur randomly at rest. There have however been episodes of fast palpitations and dizziness on exertion. On examination there was a systolic murmur at the apex as well as a prominent apex beat and the chest was clear. Which of the following is LEAST likely to suggest a diagnosis of hypertrophic cardiomyopathy?
Your Answer: A history of hypertension for 10 years
Explanation:Hypertrophic cardiomyopathy is an autosomal dominant condition. Patients present with sudden cardiac death, dyspnoea, syncope and presyncope, angina, palpitations, orthopnoea and paroxysmal nocturnal dyspnoea, Congestive heart failure and dizziness. Physical findings include double or triple apical impulse, prominent a wave in the JVP, an ejection systolic crescendo-decrescendo murmur and a holosystolic murmur at the apex and axilla of mitral regurgitation.
ECG shows ST-T wave abnormalities and LVH, axis deviation (right or left), conduction abnormalities (P-R prolongation, bundle-branch block), sinus bradycardia with ectopic atrial rhythm, atrial enlargement, abnormal and prominent Q wave in the anterior precordial and lateral limb leads.
2D echocardiography shows abnormal systolic anterior leaflet motion of the mitral valve, LVH, left atrial enlargement, small ventricular chamber size, septal hypertrophy with septal-to-free wall ratio greater than 1.4:1, mitral valve prolapse and mitral regurgitation, decreased midaortic flow, partial systolic closure of the aortic valve in midsystole -
This question is part of the following fields:
- Cardiovascular System
-
-
Question 17
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
-
-
Question 18
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: Continuous chest compressions should be started
Correct Answer:
Explanation:Immediate Management of Pulseless Ventricular Tachycardia:
- 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.
- 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.
- Continuous Chest Compressions:
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 19
Correct
-
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: 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
-
-
Question 20
Correct
-
A 65-year-old previously well man was referred due to an abnormal heart sound which was detected during a medical check up. On examination he looked well. His blood pressure was 120/70 mmHg and pulse rate was 68 bpm which was regular. His jugular venous pressure was not elevated and he didn't have ankle oedema. He had an early diastolic murmur, best heard at the left sternal edge, which was more clear in expiration when the patient leant forward. His lungs were clear. His FBC, Urea and electrolytes, LFTs and lipid profile were normal. His ECG showed sinus rhythm. His chest X-ray was normal. Echocardiography showed mild to moderate aortic regurgitation with normal left ventricular size and normal function.
Which of the following is the most appropriate way of managing this patient?Your Answer: Start him on an angiotensin-converting enzyme (ACE) inhibitor
Explanation:Although this patient’s left ventricular function is normal at the time of examination, there is chance of deterioration of it due to aortic regurgitation. It is found that ACE inhibitors slow the development of left ventricular dysfunction. So this patient should be started on an ACE inhibitor.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 21
Incorrect
-
A 44-year-old man presents suffering from retrosternal chest pain that started 2 hours ago and radiates to the throat. Which investigation would you immediately perform?
Your Answer: Electrocardiogram
Correct Answer: Troponin levels
Explanation:The patient’s age and symptoms are indicating a myocardial infarction. Although, the cause of the pain could also be related to the digestive system, a possible myocardial infarction should be excluded or, if present, managed immediately. Troponins are used to establish the diagnosis. Levels of troponin can become elevated in the blood within 3 or 4 hours after heart injury and may remain elevated for 10 to 14 days.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 22
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: Start an ACE inhibitor
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
-
-
Question 23
Correct
-
A 25-year-old previously well male presented with chest discomfort and difficulty in breathing while running to the bus. Symptoms disappeared after resting. But the symptoms reappeared whilst he was climbing the stairs. On examination he was not dyspnoeic at rest. BP was 110/70 mmHg and pulse rate was 72 bpm. His heart sounds were normal. There was an additional clicking noise in the fourth left intercostal space which is heard with each heartbeat. Which of the following is the most probable cause for his presentation?
Your Answer: Spontaneous pneumothorax
Explanation:The given history is more compatible with spontaneous pneumothorax. Left-sided pneumothoraxes may be associated with a clicking noise, which is heard with each heart-beat and can sometimes be heard by the patient.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 24
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
-
-
Question 25
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
-
-
Question 26
Correct
-
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: 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
-
-
Question 27
Correct
-
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: 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
-
-
Question 28
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: Popliteal veins
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
-
-
Question 29
Correct
-
A 60-year-old male patient with NSTEMI was started on low dose aspirin as secondary prevention. Which of the following, describe the action of aspirin as an antiplatelet agent?
Your Answer: Inhibits the production of thromboxane A2
Explanation:The antithrombotic action of aspirin is due to inhibition of platelet function by acetylation of the platelet cyclooxygenase (COX) at the functionally important amino acid serine529. This prevents the access of the substrate (arachidonic aid) to the catalytic site of the enzyme at tyrosine385 and results in an irreversible inhibition of platelet-dependent thromboxane formation.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 30
Correct
-
A 75-year-old female has developed recurrent breathlessness after having a mitral valve replacement 13 years ago. Her husband has also noticed a prominent pulsation in her neck. She has also complained of ankle swelling and pain in the abdomen. Choose the most probable diagnosis from the list of options.
Your Answer: Tricuspid regurgitation
Explanation:Multiple symptoms point towards tricuspid regurgitation: recurrent breathlessness (if the cause if LV dysfunction); a prominent pulsation in her neck (giant V waves); pain in the abdomen (pain in liver upon exertion); and ankle swelling.
-
This question is part of the following fields:
- Cardiovascular System
-
SESSION STATS - PERFORMANCE PER SPECIALTY
