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  • Question 1 - A 85 yr. old previously well man was found to have a BP...

    Incorrect

    • A 85 yr. 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 a calcium channel blocker

      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:

      • Cardiology
      5
      Seconds

  • Question 2 - A 54 yr. old heavy smoker presented with acute chest pain for 3...

    Incorrect

    • A 54 yr. old heavy smoker presented with acute chest pain for 3 hrs which associated with excessive sweating and vomiting. His past medical history was unremarkable but his father has passed away due to a heart attack at the age of 50. Examination findings were normal and ECG was also normal. He was pain free after 12 hours from admission. What is the most appropriate investigation that cab be done at this moment?

      Your Answer:

      Correct Answer: Troponin T

      Explanation:

      The positive family history and the smoking make him an ideal candidate for a myocardial infarction. The chest pain is also a suggestive symptom. So troponin is needed to rule out MI.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

  • Question 3 - A 60 yr. old man presented with difficulty in breathing. On examination he...

    Incorrect

    • A 60 yr. old man presented with difficulty in breathing. On examination he was severely dyspnoeic and tachycardic. What is the clinical sign that would favour the diagnosis of cardiac tamponade over constrictive pericarditis?

      Your Answer:

      Correct Answer: Pulsus paradoxus

      Explanation:

      Pulsus paradoxus is defined as the exaggerated fall in systolic blood pressure during inspiration by greater than 10 mmHg. Cardiac tamponade is the classic cause of pulsus paradoxus. Kussmaul’s sign (a rise in the jugular venous pressure on inspiration) is mostly seen in constrictive pericarditis. Hypotension, muffled heart sounds and raised JVP can be seen in both conditions.

    • This question is part of the following fields:

      • Cardiology
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      Seconds

  • Question 4 - A 50 yr. old smoker with a history of hypertension presented with acute...

    Incorrect

    • A 50 yr. 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:

      Correct 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:

      • Cardiology
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      Seconds

  • Question 5 - A 25 yr. old male presented with acute severe central chest pain which...

    Incorrect

    • A 25 yr. 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:

      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:

      • Cardiology
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  • Question 6 - A 28 yr. old primigravida in her 24th week of pregnancy came for...

    Incorrect

    • A 28 yr. old primigravida in her 24th week of pregnancy came for the routine follow up. She was asymptomatic at the time of examination. Her blood pressure was 152/92 mmHg and pulse rate was 90 bpm. Her blood pressure at the booking visit had been 132/80 mmHg. Her other examination findings were normal. Which of the following is the best method to use to treat her?

      Your Answer:

      Correct Answer: Labetalol

      Explanation:

      Methyldopa is the drug of first choice for the control of mild to moderate hypertension in pregnancy. Labetalol is also considered as a first line drug for hypertension in pregnancy. Calcium channel blockers and hydralazine are considered as second line drugs. Beta-blockers (except labetalol), angiotensin receptor blockers, angiotensin-converting enzyme inhibitors and thiazides are not recommended.

    • This question is part of the following fields:

      • Cardiology
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  • Question 7 - A 52 yr. old female who was a smoker, with a history of...

    Incorrect

    • A 52 yr. 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:

      • Cardiology
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  • Question 8 - A 70 yr. old male patient presented with increased difficulty in breathing during...

    Incorrect

    • A 70 yr. 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, frusemide and ISDN. From the given answers, what is the most likely indication of worsening of his mitral stenosis?

      Your Answer:

      Correct 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:

      • Cardiology
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      Seconds

  • Question 9 - A 42 yr. old previously well woman presented with acute severe central chest...

    Incorrect

    • A 42 yr. old previously well woman presented with acute severe central chest pain for the past 2 hours. She has a family history of premature coronary artery disease. Her husband passed away recently due to prostate cancer. On examination her blood pressure was 130/80 mmHg and pulse rate was 80 bpm. Her ECG showed ST segment elevation and her troponin was slightly elevated. Emergency angiogram revealed slight wall irregularities with no luminal obstruction. Cardiovascular MR showed an apical ballooning of the myocardium resembling an octopus pot. Which of the following is the most likely cause for the ST segment elevation?

      Your Answer:

      Correct Answer: Takotsubo cardiomyopathy

      Explanation:

      Causes for ST segment elevation other than myocardial infarction
      Natural variants
      -Early repolarization
      -Left ventricular hypertrophy and hypertrophic cardiomyopathy
      -Left bundle branch block
      Artefacts
      -Leads mispositioning
      -Electrical cardioversion
      Cardiovascular diseases
      -Pericarditis/ Myocarditis
      -Aortic dissection
      -Prinzmetal’s angina
      -Takotsubo Cardiomyopathy
      -Brugada Syndrome and arrhythmogenic right ventricular cardiomyopathy/dysplasia
      Pulmonary diseases
      -Pulmonary thromboembolism
      -Pneumothorax
      -Atelectasis and pulmonary metastases
      Gastrointestinal diseases
      -Acute pancreatitis
      -Acute cholecystitis
      Other conditions
      -Hyperkalaemia
      -Drug induced ST segment elevation (e.g. – clozapine)
      -Haemorrhagic cerebrovascular disease

      Coronary artery disease and myocardial infarction can be excluded with a negative angiogram and a slightly elevated troponin. Hypertrophic cardiomyopathy can be excluded with cardiovascular MR findings. Left ventricular aneurysm usually occurs following a myocardial infarction, but there is no positive history for that. The characteristic findings on cardiovascular MR confirms the diagnosis of Takotsubo cardiomyopathy.

    • This question is part of the following fields:

      • Cardiology
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  • Question 10 - A 28 yr. old primigravida in her 24th week of pregnancy presented with...

    Incorrect

    • A 28 yr. old primigravida in her 24th week of pregnancy presented with a history of palpitations, which are fast and regular. She doesn't complain of any episodes of collapse. On examination she was well, pulse rate was 102 bpm, which was regular and her blood pressure was 110/70 mmHg. Her JVP was not elevated. Heart sounds were normal. ECH showed sinus tachycardia. Which of the following can be expected because of the  physiological changes which occur in the boy during pregnancy?

      Your Answer:

      Correct Answer: Tachycardia

      Explanation:

      The cardiovascular alterations which occur during pregnancy are for the optimal growth and development of the foetus and help to protect the mother from the risks of delivery, such as haemorrhage. The changes are characterized by an increased vascular volume, cardiac output, and heart rate, with a marked fall in vascular resistance and reduction in blood pressure.

    • This question is part of the following fields:

      • Cardiology
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  • Question 11 - A 50 yr. old male presented with episodes of collapse during the last...

    Incorrect

    • A 50 yr. old male presented with episodes of collapse during the last month. Each episode persisted for about 2-3 minutes. They were self-limiting and associated with twitching of the limbs. There was no associated tonic-clonic movements, tongue biting, urinary or faecal incontinence. On examination he had reversed splitting of S2 and an ejection systolic murmur at the right sternal border. His electrocardiogram (ECG) showed left ventricular hypertrophy with strain pattern. CXR showed an area of calcification over the cardiac silhouette. Which of the following is the most probable diagnosis of this patient?

      Your Answer:

      Correct Answer: Aortic stenosis

      Explanation:

      The classic triad of symptoms in patients with aortic stenosis is chest pain, heart failure and syncope. Pulsus parvus et tardus, pulsus alternans, hyperdynamic left ventricle, reversed splitting of the S2, prominent S4 and systolic murmur are some of the common findings of aortic stenosis. A calcified aortic valve is found in almost all adults with hemodynamically significant aortic stenosis.

    • This question is part of the following fields:

      • Cardiology
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  • Question 12 - A 32 yr. old previously well primigravida in her 16th week of pregnancy...

    Incorrect

    • A 32 yr. 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:

      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:

      • Cardiology
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  • Question 13 - A 60 yr. old man presented with severe central chest pain for the...

    Incorrect

    • A 60 yr. old man presented with severe central chest pain for the last 2 hours. He was on insulin for diabetes mellitus and he was dependent on haemodialysis because of end stage renal failure. He had undergone haemodialysis 48 hours prior to this presentation. His ECG showed an acute inferior myocardial infarction. Despite thrombolysis and other appropriate treatment, he continued to have chest pain after 6 hours from the initial presentation. His blood pressure was 88/54 mmHg and he had bibasal crepitations. His investigation results are given below.
      Serum sodium 140 mmol/l (137-144),
      Serum potassium 6.6 mmol/l (3.5-4.9),
      Serum urea 50 mmol/l (2.5-7.5),
      Serum creatinine 940 μmol/l (60-110),
      Haemoglobin 10.2g/dl (13.0-18.0),
      Troponin T >24 g/l (<0.04),
      Left ventricular ejection fraction was 20%.

      What is the most appropriate management for this patient?

      Your Answer:

      Correct Answer: Coronary angiography and rescue PCI

      Explanation:

      According to the history the patient has cardiogenic shock and pulmonary oedema. On-going ischaemia is indicated by persisting symptoms. So the most appropriate management is coronary angiography and rescue PCI. There are no indications for blood transfusion at this moment and it will aggravate the pulmonary oedema. Haemodialysis, beta blockers and furosemide cannot be given due to low blood pressure.

    • This question is part of the following fields:

      • Cardiology
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  • Question 14 - A 60 yr. old previously well male was admitted with a suspected pulmonary...

    Incorrect

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

      Your Answer:

      Correct Answer: Computed tomographic pulmonary angiography

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
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      Seconds

  • Question 15 - A 60 year old male patient with a history of heavy smoking was...

    Incorrect

    • A 60 year old male patient with a history of heavy smoking was admitted complaining of acute severe central chest pain for the past one hour. His blood pressure was 150/90 mmHg and pulse rate was 88 bpm. His peripheral oxygen saturation was 93%. ECG showed ST elevation > 2mm in lead II, III and aVF. He was given loading doses of aspirin, clopidogrel and atorvastatin and face mask oxygen was given. Which one of the following investigations should be done and then depending on result, definitive treatment can be initiated?

      Your Answer:

      Correct Answer: None

      Explanation:

      The history and ECG findings are adequate to begin cardiac revascularization of this patient. There is no need for cardiac markers to confirm the diagnosis. Further delay in starting definite treatment is not recommended.

    • This question is part of the following fields:

      • Cardiology
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  • Question 16 - A 32 yr. old male who was on methadone has suddenly collapsed while...

    Incorrect

    • A 32 yr. 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:

      • Cardiology
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      Seconds

  • Question 17 - A 24 yr. old male with a history of a cardiac murmur which...

    Incorrect

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

      Your Answer:

      Correct Answer: Ostium secundum atrial septal defect

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
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  • Question 18 - A 45 yr. old male was discharged recently after treatment of bleeding peptic...

    Incorrect

    • A 45 yr. old male was discharged recently after treatment of bleeding peptic ulcers. 3 days after discharge he was readmitted complaining of acute severe chest pain for the past 1 hour. His ECG showed an acute ST elevation myocardial infarction. His FBC, blood urea, serum electrolytes and serum creatinine were within normal ranges. Faecal occult blood was negative. Which of the following is the most appropriate management for this patient?

      Your Answer:

      Correct Answer: Primary angioplasty

      Explanation:

      The patient has a recent history of bleeding peptic ulcer disease, which is an absolute contraindication for thrombolysis. So he should be offered primary angioplasty.

    • This question is part of the following fields:

      • Cardiology
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  • Question 19 - A 62 yr. old male presented with worsening breathlessness and fatiguability. On examination...

    Incorrect

    • A 62 yr. old male presented with worsening breathlessness and fatiguability. 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:

      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:

      • Cardiology
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  • Question 20 - A 20 yr. old male presented after an episode where he had collapsed....

    Incorrect

    • A 20 yr. 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 non sustained ventricular tachycardia (VT). Which of the following is the most appropriate management for this patient?

      Your Answer:

      Correct 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:

      • Cardiology
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  • Question 21 - A 65 yr. male patient was started on warfarin for chronic atrial fibrillation...

    Incorrect

    • A 65 yr. male patient was started on warfarin for chronic atrial fibrillation (AF). Which of the following clotting factors is not affected by warfarin?

      Your Answer:

      Correct 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:

      • Cardiology
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  • Question 22 - A 60 yr. old male patient with hypertension presented with acute onset retrosternal...

    Incorrect

    • A 60 yr. old male patient with hypertension presented with acute onset retrosternal chest pain for 3 hours. On examination his pulse rate was 68 bpm, BP was 100/60 mmHg and JVP was seen 3mm from the sternal notch. Respiratory examination was normal. His ECG showed narrow QRS complexes, ST segment elevation of 2mm in leads II, III and aVF and a complete heart block. What is the most immediate treatment from the following answers?

      Your Answer:

      Correct Answer: Chewable aspirin 300 mg

      Explanation:

      The diagnosis is inferior ST elevation myocardial infarction. As the right coronary artery supplies the SA and AV nodes and bundle of His, conduction abnormalities are more common with inferior MIs. The most immediate drug management is high dose Aspirin. Definite treatment is urgent cardiac revascularization.

    • This question is part of the following fields:

      • Cardiology
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  • Question 23 - A 34 yr. old male presented with exertional dyspnoea and chest pain for...

    Incorrect

    • A 34 yr. old male presented with exertional dyspnoea and chest pain for the past 2 weeks. On examination there was a mid-systolic murmur which is best heard at the apex and double apical impulse. His ECG showed left ventricular hypertrophy (LVH). What is the risk factor which would be most indicative of the potential for sudden death in this patient?

      Your Answer:

      Correct Answer: Degree of left ventricular hypertrophy

      Explanation:

      The history is suggestive of hypertrophic obstructive cardiac myopathy. The degree of left ventricular hypertrophy is strongly associated with sudden cardiac death.

    • This question is part of the following fields:

      • Cardiology
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  • Question 24 - A 42 yr. old man presented with palpitations and shortness of breath on...

    Incorrect

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

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

      What is the most likely diagnosis from the following answers?

      Your Answer:

      Correct Answer: Atrial septal defect

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
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  • Question 25 - A 65 yr. old previously well man was referred due to an abnormal...

    Incorrect

    • A 65 yr. 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:

      Correct 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:

      • Cardiology
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  • Question 26 - A 75 yr. old male with rheumatoid arthritis underwent a colectomy 2 days...

    Incorrect

    • A 75 yr. old male with rheumatoid arthritis underwent a colectomy 2 days ago for colon cancer. He was put on a prophylactic dose of low molecular weight heparin post operatively as well as prednisolone. Now he complains of central chest pain and his ECG revealed an acute ST elevation myocardial infarction. He was given aspirin and oxygen as the initial treatment. Which of the following is the most appropriate management for this patient?

      Your Answer:

      Correct Answer: IV diamorphine + arrange percutaneous coronary intervention

      Explanation:

      There is a high risk of bleeding due to recent surgery and heparin. So thrombolysis is not an option. The most appropriate management is percutaneous coronary intervention.

    • This question is part of the following fields:

      • Cardiology
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  • Question 27 - A 42 yr. old female presented with pain in her calves during walking...

    Incorrect

    • A 42 yr. old female presented with pain in her calves during walking which settled after resting. On examination there were orange colour deposits in the her palmar creases. Her fasting lipid profile showed a total cholesterol of 9.2 mmol/l (<5) and triglycerides of 7.0 mmol/l (<2). Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Type III hyperlipidaemia

      Explanation:

      Palmar xanthomas are found in type III hyperlipoproteinemia. Her total cholesterol level and triglyceride level support the diagnosis.

    • This question is part of the following fields:

      • Cardiology
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  • Question 28 - A 55 yr. old male with a history of myocardial infarction 4 years...

    Incorrect

    • A 55 yr. old male with a history of myocardial infarction 4 years ago, was admitted with a history of fever for the past 2 weeks. On investigation, his echocardiography revealed a small vegetation around the mitral valve. His blood culture was positive for Streptococcus viridans. Which of the following is the most appropriate antibiotic therapy?

      Your Answer:

      Correct Answer: IV benzylpenicillin

      Explanation:

      According to the American Heart Association (AHA) penicillin-susceptible S viridans, S bovis, and other streptococci (MIC of penicillin of ≤0.1 mcg/mL) should be treated with penicillin G or ceftriaxone or penicillin G + a gentamicin combination or vancomycin (if allergy to penicillin).

    • This question is part of the following fields:

      • Cardiology
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  • Question 29 - A 50 yr. old male patient with schizophrenia complained of chest pain and...

    Incorrect

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

      Your Answer:

      Correct Answer: IV magnesium

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
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  • Question 30 - A 28 yr. old male was screened for hypertrophic cardiomyopathy (HOCM). His father...

    Incorrect

    • A 28 yr. old male was screened for hypertrophic cardiomyopathy (HOCM). His father has passed away recently at the age of 48 and found to have HOCM during post mortem examination. On examination of this patient his BP was 142/84 mmHg and pulse rate was 68 bpm which was regular. There was a mid systolic murmur and a double apex beat. Echocardiography showed a septal wall thickness of 3.3 cm. What is the factor most closely linked to his 20 year risk of sudden cardiac death?

      Your Answer:

      Correct Answer: Septal wall thickness of 3.3 cm

      Explanation:

      There are five prognostic factors which indicate poor prognosis in HOCM:
      -family history of HOCM-related sudden cardiac death
      -unexplained recent syncope
      -large left ventricular wall thickness (MLVWT ≥ 30 mm)
      -multiple bursts of nsVT on ambulatory electrocardiography
      -hypotensive or attenuated blood pressure response to exercise

    • This question is part of the following fields:

      • Cardiology
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      Seconds

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