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  • Question 1 - A 72-year-old male was admitted with acute right leg pain at rest. On...

    Incorrect

    • A 72-year-old male was admitted with acute right leg pain at rest. On examination, the right leg was white and peripheral pulses were not palpable. He gives a history of intermittent claudication for the past two years. What is the most probable cause for this presentation?

      Your Answer: Diabetes mellitus

      Correct Answer: Atrial fibrillation

      Explanation:

      This presentation is compatible with acute limb ischemia, which is a surgical emergency. Thromboembolism following atrial fibrillation is the most probable cause for this presentation as there is no history of prolonged immobilization or other associated risk factors in this male patient.

    • This question is part of the following fields:

      • Cardiovascular System
      28.2
      Seconds

  • Question 2 - A 65-year-old male presented with acute ST elevation myocardial infarction and thrombolysis was...

    Correct

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

      Your Answer: Intracerebral Haemorrhage

      Explanation:

      Absolute contraindications for fibrinolytic use in STEMI

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

    • This question is part of the following fields:

      • Cardiovascular System
      9.6
      Seconds

  • Question 3 - A 59-year-old man complains of weakness in his right lower and upper limb...

    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
      16.9
      Seconds

  • Question 4 - A 54-year-old female presents with shortness of breath that has been going on...

    Correct

    • 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: 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
      13.6
      Seconds

  • Question 5 - Which of the following is the site where B-type natriuretic peptide is mainly...

    Incorrect

    • Which of the following is the site where B-type natriuretic peptide is mainly secreted?

      Your Answer: Atrial myocardium

      Correct Answer: Ventricular myocardium

      Explanation:

      B-type natriuretic peptide (BNP) is secreted mainly from the left ventricle and it is secreted as a response to stretching caused by increased ventricular blood volume.

    • This question is part of the following fields:

      • Cardiovascular System
      5.8
      Seconds

  • Question 6 - An echocardiogram of a 50-year-old male patient showed an infarct in the anterolateral...

    Correct

    • 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: 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
      10.3
      Seconds

  • Question 7 - A 57-year-old female presented to the cardiology centre with a history of chest...

    Correct

    • A 57-year-old female presented to the cardiology centre with a history of chest tightness accompanied by pain radiating to the left side of the neck and left shoulder. The pain started 3 hours ago. 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
      8.8
      Seconds

  • Question 8 - A 30-year-old male, who is the brother of a patient with hypertrophic cardiomyopathy...

    Correct

    • A 30-year-old male, who is the brother of a patient with hypertrophic cardiomyopathy has come for the screening. Which of the following is the most appropriate method of screening?

      Your Answer: Echocardiography

      Explanation:

      12-lead electrocardiography and transthoracic echocardiography are recommended as a screening method for family members of patients with HCM.

    • This question is part of the following fields:

      • Cardiovascular System
      6.3
      Seconds

  • Question 9 - 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
      44.7
      Seconds

  • Question 10 - The ECG of a 29-year-old female shows an irregular rhythm with a HR...

    Correct

    • 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: 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
      8.1
      Seconds

  • Question 11 - A 55-year-old female with a history of hypertension presented with severe central chest...

    Correct

    • A 55-year-old female with a history of hypertension presented with severe central chest pain for the past one hour, associated with sweating and vomiting. Her ECG showed ST elevation myocardial infarction, evident in leads V2-V4. Which of the following is an absolute contraindication for thrombolysis?

      Your Answer: Intracranial neoplasm

      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
      15.9
      Seconds

  • Question 12 - A 80-year-old male patient with ischaemic heart disease, hypertension and dyslipidemia presented with...

    Incorrect

    • A 80-year-old male patient with ischaemic heart disease, hypertension and dyslipidemia presented with productive cough, fever with chills and loss of appetite for 4 days. On examination he was unwell and febrile with a temperature of 38.3. His blood pressure was 130/80 mmHg and pulse rate was 140 bpm. Respiratory rate was 18 breaths per minute. On auscultation there were crepitations over the left lower zone of his chest. His abdomen was soft and nontender. ECG showed an irregular narrow complex tachycardia. Which of the following is the most appropriate acute management to treat his tachycardia?

      Your Answer: Amiodarone

      Correct Answer: Antibiotics

      Explanation:

      The most likely diagnosis is acute atrial fibrillation (AF) precipitated by acute pneumonia. History of fever, cough and the auscultation findings support it. So the most appropriate management is treating the pneumonia with antibiotics. Treating the underlying cause will reduce the heart rate. Other responses are helpful in the management of chronic AF.

    • This question is part of the following fields:

      • Cardiovascular System
      86.5
      Seconds

  • Question 13 - A 28-year-old male was admitted with palpitations and chest discomfort for the past...

    Incorrect

    • A 28-year-old male was admitted with palpitations and chest discomfort for the past 1 hour. On examination his pulse rate was 200 bpm and blood pressure was 80/50 mmHg. His ECG revealed narrow complex tachycardia with a heart rate of 200 bpm. Which of the following is the most appropriate management of this patient?

      Your Answer: Adenosine 3 mg bolus up to 12 mg

      Correct Answer: Synchronised DC synchronised cardioversion

      Explanation:

      Narrow complex tachycardia with hypotension is a medical emergency. Immediate synchronized cardioversion is the ideal management.

    • This question is part of the following fields:

      • Cardiovascular System
      36.2
      Seconds

  • Question 14 - A 65-year-old man with hypertension presented with sudden onset right arm weakness which...

    Correct

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

      Your Answer: Warfarin

      Explanation:

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

    • This question is part of the following fields:

      • Cardiovascular System
      23.7
      Seconds

  • Question 15 - 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: Angina

      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
      8.6
      Seconds

  • Question 16 - 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: Give thrombolysis immediately

      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
      105.6
      Seconds

  • Question 17 - A 30-year-old male presented with palpitations for 1 week. The palpitations were intermittent...

    Correct

    • A 30-year-old male presented with palpitations for 1 week. The palpitations were intermittent and lasted a few hours per day. Which of the following is the most appropriate management?

      Your Answer: 24 hr ECG

      Explanation:

      Palpitations can be due to many reasons. As palpitations are not constant in this case, a 24 hr ECG is important to isolate these episodes and find any cardiac cause. Drugs depend on the cause for the palpitations.

    • This question is part of the following fields:

      • Cardiovascular System
      8.3
      Seconds

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

    Correct

    • 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: 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
      8
      Seconds

  • Question 19 - A 25-year-old girl's ECG revealed a normal PR interval and QRS while the...

    Correct

    • 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: 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
      34
      Seconds

  • Question 20 - A 72-year-old male with a history of type II diabetes mellitus and hypertension...

    Correct

    • 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: 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
      36.8
      Seconds

  • Question 21 - 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: Mitral regurgitation

      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
      28.3
      Seconds

  • Question 22 - A 30-year-old male with Down's Syndrome was found to have a systolic murmur...

    Incorrect

    • A 30-year-old male with Down's Syndrome was found to have a systolic murmur during routine clinical examination. Which of the following is the most common cardiac defect associated with Down's Syndrome which will explain this finding?

      Your Answer: Ventricular septal defect

      Correct Answer: Endocardial cushion defect

      Explanation:

      Atrioventricular septal defect (AVSD) also known as endocardial cushion defect is the most common cardiac abnormality in Down’s Syndrome.

    • This question is part of the following fields:

      • Cardiovascular System
      21.3
      Seconds

  • Question 23 - A 55-year-old man presented with retrosternal chest pain associated with excessive sweating and...

    Correct

    • A 55-year-old man presented with retrosternal chest pain associated with excessive sweating and vomiting. On examination his BP was 100/60 mmHg and pulse rate was 72 bpm. Bibasal crepitations were auscultated. His ECG showed ST elevation in V1 to V4 and ST depression in leads II, III and aVF. Which of the following would be the finding during angioplasty?

      Your Answer: Complete occlusion of the left anterior descending artery

      Explanation:

      The ECG findings are suggestive of anterior myocardial infarction and the most likely artery affected is the left anterior descending artery. Occlusion of the right coronary artery will be shown by ST elevation in lead II, III, aVF and occlusion of the circumflex artery will show changes in leads I, aVL, V5 and V6. To have ST elevation, there should be complete occlusion of the artery.

    • This question is part of the following fields:

      • Cardiovascular System
      34
      Seconds

  • Question 24 - 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: Beta-blocker + statin + aspirin + clopidogrel

      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
      98.3
      Seconds

  • Question 25 - A 60-year-old female with a recent history of MI, complained of exertional dyspnoea....

    Correct

    • 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: 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
      21.1
      Seconds

  • Question 26 - From the following responses, what is the commonest cardiovascular abnormality associated with Marfan's...

    Correct

    • From the following responses, what is the commonest cardiovascular abnormality associated with Marfan's syndrome of an adult?

      Your 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
      18.8
      Seconds

  • Question 27 - A 60-year-old patient was admitted to the surgery department for elective herniorrhaphy. Due...

    Correct

    • A 60-year-old patient was admitted to the surgery department for elective herniorrhaphy. Due to a problem in his history, his operation was postponed. Which of the following is the most likely cause for this postponement?

      Your Answer: MI 2 months ago

      Explanation:

      After an MI, elective surgeries are recommended to be delayed for at least 6 months. This will help the patient become physically fit for the stress of surgery. Any surgery before this can carry a significant increased risk of mortality.

    • This question is part of the following fields:

      • Cardiovascular System
      11.1
      Seconds

  • Question 28 - 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
      28.2
      Seconds

  • Question 29 - 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
      13.4
      Seconds

  • Question 30 - A 2-day-old girl is admitted by her mother because she gets cyanotic upon...

    Incorrect

    • A 2-day-old girl is admitted by her mother because she gets cyanotic upon feeding and she wouldn't stop crying. The doctors suspect a congenital heart disease. What is the most probable aetiology?

      Your Answer: Tetralogy of Fallot

      Correct Answer: Transposition of the great arteries

      Explanation:

      Transposition of the great arteries results in a significant hypoxemic status that is observed clinically by central cyanosis. The bluish discoloration of the skin and mucous membranes is therefore the basic pattern of clinical presentation in transposition. Its onset and severity depend on anatomical and functional variants that influence the degree of mixing between the two circulations. Limited intercirculatory mixing, usually present if the ventricular septum is intact or the atrial septal defect is restrictive, is related to progressive and profound central cyanosis evident within the first hours of life. Tachypnoea, tachycardia, diaphoresis, poor weight gain, a gallop rhythm, and eventually hepatomegaly can be then detected later on during infancy. Heart murmurs associated with left outflow tract obstruction, due to a persistent arterial duct or a septal defect may be heard, but they are not a constant finding.

    • This question is part of the following fields:

      • Cardiovascular System
      41.4
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular System (19/30) 63%
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