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  • Question 1 - Which of the options below is not a cause of mid-diastolic murmur? ...

    Correct

    • Which of the options below is not a cause of mid-diastolic murmur?

      Your Answer: Aortic stenosis

      Explanation:

      Causes of Heart Murmurs

      Heart murmurs are abnormal sounds heard during a heartbeat. Aortic stenosis, a condition where the aortic valve narrows, causes an ejection systolic murmur. On the other hand, left atrial myxomas and right atrial myxomas, which are rare tumors, can cause a mid-diastolic murmur by blocking the valve orifice during diastole. Mitral stenosis, which is often the result of rheumatic fever or a congenital defect, causes mid-diastolic murmurs. Lastly, tricuspid stenosis, which is also commonly caused by rheumatic fever, can cause a mid-diastolic murmur. the causes of heart murmurs is important in diagnosing and treating heart conditions.

    • This question is part of the following fields:

      • Cardiology
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  • Question 2 - A 58-year-old man experiences a myocardial infarction (MI) that results in necrosis of...

    Incorrect

    • A 58-year-old man experiences a myocardial infarction (MI) that results in necrosis of the anterior papillary muscle of the right ventricle. This has led to valve prolapse. Which structure is most likely responsible for the prolapse?

      Your Answer: Anterior and posterior cusps of the mitral valve

      Correct Answer: Anterior and posterior cusps of the tricuspid valve

      Explanation:

      Cusps and Papillary Muscles of the Tricuspid and Mitral Valves

      The tricuspid and mitral valves are important structures in the heart that regulate blood flow between the atria and ventricles. These valves are composed of cusps and papillary muscles that work together to ensure proper function.

      The tricuspid valve has three cusps: anterior, posterior, and septal. The papillary muscles of the right ventricle attach to these cusps, with the anterior papillary muscle connecting to both the anterior and posterior cusps.

      The mitral valve, located between the left atrium and ventricle, has only two cusps: anterior and posterior.

      The posterior and septal cusps of the tricuspid valve attach to the posterior papillary muscle of the right ventricle, while the anterior and septal cusps attach to the septal papillary muscle.

      Understanding the anatomy and function of these cusps and papillary muscles is crucial in diagnosing and treating heart conditions such as mitral valve prolapse and tricuspid regurgitation.

    • This question is part of the following fields:

      • Cardiology
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  • Question 3 - A 68-year-old man is being evaluated in the Cardiac Unit. He has developed...

    Incorrect

    • A 68-year-old man is being evaluated in the Cardiac Unit. He has developed a ventricular tachycardia of 160 bpm, appears ill, and has a blood pressure of 70/52 mmHg. What would be the most immediate treatment option?

      Your Answer: Immediate heparinisation

      Correct Answer: DC cardioversion

      Explanation:

      Treatment Options for Ventricular Arrhythmia: Evaluating the Choices

      When faced with a patient experiencing ventricular arrhythmia, it is important to consider the appropriate treatment options. In the scenario of a broad complex tachycardia with low blood pressure, immediate DC cardioversion is the clear choice. Carotid sinus massage and IV adenosine are not appropriate options as they are used in the diagnosis and termination of SVT. Immediate heparinisation is not the immediate treatment for ventricular arrhythmia. Intravenous lidocaine may be considered if the VT is haemodynamically stable, but in this scenario, it cannot be the correct answer choice. It is important to carefully evaluate the available options and choose the most appropriate treatment for the patient’s specific condition.

    • This question is part of the following fields:

      • Cardiology
      0.6
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  • Question 4 - A young marine biologist was snorkelling among giant stingrays when the tail (barb)...

    Incorrect

    • A young marine biologist was snorkelling among giant stingrays when the tail (barb) of one of the stingrays suddenly pierced his chest. The tip of the barb pierced the right ventricle and the man instinctively removed it in the water. When he was brought onto the boat, there was absence of heart sounds, reduced cardiac output and engorged jugular veins.

      What was the most likely diagnosis for the young marine biologist who was snorkelling among giant stingrays and had the tail (barb) of one of the stingrays pierce his chest, causing the tip of the barb to pierce the right ventricle? Upon being brought onto the boat, the young man exhibited absence of heart sounds, reduced cardiac output and engorged jugular veins.

      Your Answer: Haemothorax

      Correct Answer: Cardiac tamponade

      Explanation:

      Differential diagnosis of a patient with chest trauma

      When evaluating a patient with chest trauma, it is important to consider various potential diagnoses based on the clinical presentation and mechanism of injury. Here are some possible explanations for different symptoms:

      – Cardiac tamponade: If a projectile penetrates the fibrous pericardium, blood can accumulate in the pericardial cavity and compress the heart, leading to decreased cardiac output and potential death.
      – Deep vein thrombosis: This condition involves the formation of a blood clot in a deep vein, often in the leg. However, it does not typically cause the symptoms described in this case.
      – Stroke: A stroke occurs when blood flow to the brain is disrupted, usually due to a blockage or rupture of an artery. This is not likely to be the cause of the patient’s symptoms.
      – Pulmonary embolism: If a clot from a deep vein thrombosis travels to the lungs and obstructs blood flow, it can cause sudden death. However, given the history of trauma, other possibilities should be considered first.
      – Haemothorax: This refers to the accumulation of blood in the pleural cavity around a lung. While it can cause respiratory distress and chest pain, it does not typically affect jugular veins or heart sounds.

    • This question is part of the following fields:

      • Cardiology
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  • Question 5 - A 65-year-old retiree visits his GP as he is becoming increasingly breathless and...

    Incorrect

    • A 65-year-old retiree visits his GP as he is becoming increasingly breathless and tired whilst walking. He has always enjoyed walking and usually walks 3 times a week. Over the past year he has noted that he can no longer manage the same distance that he used to be able to without getting breathless and needing to stop. He wonders if this is a normal part of ageing or if there could be an underlying medical problem.
      Which of the following are consistent with normal ageing with respect to the cardiovascular system?

      Your Answer: Blood pressure = 76/54 mmHg

      Correct Answer: Reduced VO2 max

      Explanation:

      Ageing and Cardiovascular Health: Understanding the Normal and Abnormal Changes

      As we age, our organs may still function normally at rest, but they may struggle to respond adequately to stressors such as exercise or illness. One of the key indicators of cardiovascular health is VO2 max, which measures the maximum rate of oxygen consumption during exercise. In normal ageing, VO2 max may decrease along with muscle strength, making intense exertion more difficult. However, significantly reduced VO2 max, left ventricular ejection fraction (LVEF), or stroke volume are not consistent with normal ageing. Additionally, hypotension or hypertension are not typical changes associated with ageing. Understanding these normal and abnormal changes can help us better monitor and manage our cardiovascular health as we age.

    • This question is part of the following fields:

      • Cardiology
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  • Question 6 - The cardiologist is examining a 48-year-old man with chest pain and is using...

    Incorrect

    • The cardiologist is examining a 48-year-old man with chest pain and is using his stethoscope to listen to the heart. Which part of the chest is most likely to correspond to the location of the heart's apex?

      Your Answer: Right fifth intercostal space

      Correct Answer: Left fifth intercostal space

      Explanation:

      Anatomy of the Heart: Intercostal Spaces and Auscultation Positions

      The human heart is a vital organ responsible for pumping blood throughout the body. Understanding its anatomy is crucial for medical professionals to diagnose and treat various heart conditions. In this article, we will discuss the intercostal spaces and auscultation positions related to the heart.

      Left Fifth Intercostal Space: Apex of the Heart
      The apex of the heart is located deep to the left fifth intercostal space, approximately 8-9 cm from the mid-sternal line. This is an important landmark for cardiac examination and procedures.

      Left Fourth Intercostal Space: Left Ventricle
      The left ventricle, one of the four chambers of the heart, is located superior to the apex and can be auscultated in the left fourth intercostal space.

      Right Fourth Intercostal Space: Right Atrium
      The right atrium, another chamber of the heart, is located immediately lateral to the right sternal margin at the right fourth intercostal space.

      Left Second Intercostal Space: Pulmonary Valve
      The pulmonary valve, which regulates blood flow from the right ventricle to the lungs, can be auscultated in the left second intercostal space, immediately lateral to the left sternal margin.

      Right Fifth Intercostal Space: Incorrect Location
      The right fifth intercostal space is an incorrect location for cardiac examination because the apex of the heart is located on the left side.

      In conclusion, understanding the intercostal spaces and auscultation positions related to the heart is essential for medical professionals to accurately diagnose and treat various heart conditions.

    • This question is part of the following fields:

      • Cardiology
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  • Question 7 - A man in his early 40s comes to you with a rash. Upon...

    Incorrect

    • A man in his early 40s comes to you with a rash. Upon examination, you notice that he has eruptive xanthoma. What is the most probable diagnosis?

      Your Answer: Familial combined hyperlipidaemia

      Correct Answer: Familial hypertriglyceridaemia

      Explanation:

      Eruptive Xanthoma and its Association with Hypertriglyceridaemia and Diabetes Mellitus

      Eruptive xanthoma is a skin condition that can occur in individuals with hypertriglyceridaemia and uncontrolled diabetes mellitus. Hypertriglyceridaemia is a condition characterized by high levels of triglycerides in the blood, which can be caused by a number of factors including genetics, diet, and lifestyle. Eruptive xanthoma is a type of xanthoma that appears as small, yellowish bumps on the skin, often in clusters.

      Of the conditions listed, familial hypertriglyceridaemia is the most likely to be associated with eruptive xanthoma. This is a genetic condition that causes high levels of triglycerides in the blood, and can lead to a range of health problems including cardiovascular disease. Uncontrolled diabetes mellitus, which is characterized by high blood sugar levels, can also be a risk factor for eruptive xanthoma.

      It is important for individuals with hypertriglyceridaemia or diabetes mellitus to manage their condition through lifestyle changes and medication, in order to reduce the risk of complications such as eruptive xanthoma. Regular monitoring and treatment can help to prevent the development of this skin condition and other related health problems.

    • This question is part of the following fields:

      • Cardiology
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  • Question 8 - A 72-year-old man is admitted to hospital with exertional chest pain. He reports...

    Incorrect

    • A 72-year-old man is admitted to hospital with exertional chest pain. He reports that this has only begun in the past few days, particularly when climbing hills. The pain is not present when he is at rest.
      What is the gold standard test that you will request for this patient from the following tests?

      Your Answer: Troponin

      Correct Answer: Computed tomography (CT) coronary angiogram

      Explanation:

      Investigating Cardiac Chest Pain: Recommended Tests

      When a patient presents with cardiac chest pain, it is important to conduct appropriate investigations to determine the underlying cause. The following tests are recommended:

      Computed Tomography (CT) Coronary Angiogram: This non-invasive test uses CT scanning to detect any evidence of coronary artery disease and determine its extent. It is considered the gold standard test for investigating cardiac chest pain.

      Angiogram: Before undergoing an angiogram, the patient should first have an exercise tolerance test (ETT) to assess real-time cardiac function during exertion. If the patient experiences ischaemic changes and reduced exercise tolerance, an angiogram may be necessary.

      Chest X-ray: A chest X-ray is not a priority investigation for cardiac chest pain, as it does not aid in diagnosis unless there is evidence of associated heart failure or pleural effusions.

      Full Blood Count: While anaemia could contribute to angina, a full blood count is not a first-line investigation for cardiac chest pain.

      Troponin: Troponin levels may be raised in cases of myocardial damage, but are not necessary for managing angina. The recurring pain and relief with rest indicate angina, rather than a myocardial infarction (MI), which would present with crushing chest pain and dyspnoea that is not alleviated by rest.

    • This question is part of the following fields:

      • Cardiology
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  • Question 9 - A 70-year-old man with a history of chronic cardiac failure with reduced ventricular...

    Incorrect

    • A 70-year-old man with a history of chronic cardiac failure with reduced ventricular systolic function presents with recent onset of increasing breathlessness, and worsening peripheral oedema and lethargy. He is currently taking ramipril and bisoprolol alongside occasional paracetamol.
      What is the most appropriate long-term management?

      Your Answer: Encourage regular exercise and a healthy diet

      Correct Answer: Addition of spironolactone

      Explanation:

      For the management of heart failure, first line options include ACE inhibitors, beta-blockers, and aldosterone antagonists. In this case, the patient was already on a beta-blocker and an ACE inhibitor which had been effective. The addition of an aldosterone antagonist such as spironolactone would be the best option as it prevents fluid retention and reduces pressure on the heart. Ivabradine is a specialist intervention that should only be considered after trying all other recommended options. Addition of furosemide would only provide symptomatic relief. Insertion of an implantable cardiac defibrillator device is a late-stage intervention. Encouraging regular exercise and a healthy diet is important but does not directly address the patient’s clinical deterioration.

    • This question is part of the following fields:

      • Cardiology
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  • Question 10 - You are requested by a nurse to assess a 66-year-old woman on the...

    Incorrect

    • You are requested by a nurse to assess a 66-year-old woman on the Surgical Assessment Unit who is 1-day postoperative, having undergone a laparoscopic cholecystectomy procedure for cholecystitis. She has a medical history of type II diabetes mellitus and chronic kidney disease. Blood tests taken earlier in the day revealed electrolyte imbalances with hyperkalaemia.
      Which of the following ECG changes is linked to hyperkalaemia?

      Your Answer: Reduced PR interval

      Correct Answer: Peaked T waves

      Explanation:

      Electrocardiogram (ECG) Changes Associated with Hypo- and Hyperkalaemia

      Hypo- and hyperkalaemia can cause significant changes in the ECG. Hypokalaemia is associated with increased amplitude and width of the P wave, T wave flattening and inversion, ST-segment depression, and prominent U-waves. As hypokalaemia worsens, it can lead to frequent supraventricular ectopics and tachyarrhythmias, eventually resulting in life-threatening ventricular arrhythmias. On the other hand, hyperkalaemia is associated with peaked T waves, widening of the QRS complex, decreased amplitude of the P wave, prolongation of the PR interval, and eventually ventricular tachycardia/ventricular fibrillation. Both hypo- and hyperkalaemia can cause prolongation of the PR interval, but only hyperkalaemia is associated with flattening of the P-wave. In hyperkalaemia, eventually ventricular tachycardia/ventricular fibrillation is seen, while AF can occur in hypokalaemia.

    • This question is part of the following fields:

      • Cardiology
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  • Question 11 - You are asked to see a 63-year-old man who has been admitted overnight...

    Incorrect

    • You are asked to see a 63-year-old man who has been admitted overnight following a road traffic accident. He sustained extensive bruising to his chest from the steering wheel. The nurses are concerned as he has become hypotensive and tachycardic. There is a history of a previous inferior myocardial infarction some 7 years ago, but nil else of note. On examination his BP is 90/50 mmHg, pulse is 95/min and regular. He looks peripherally shut down. There are muffled heart sounds and pulsus paradoxus.
      Investigations – arterial blood gas - reveal:
      Investigation Result Normal Value
      pH 7.29 7.35–7.45
      pO2 11.9 kPa 11.2–14.0 kPa
      pCO2 6.1 kPa 4.7–6.0 kPa
      ECG Widespread anterior T wave inversion
      Which of the following is the most likely diagnosis?

      Your Answer: Myocarditis

      Correct Answer: Cardiac tamponade

      Explanation:

      Differential Diagnosis for a Patient with Hypotension, Tachycardia, and Muffled Heart Sounds Following a Road Traffic Accident: Cardiac Tamponade, Myocarditis, NSTEMI, Pericarditis, and STEMI

      A 67-year-old man presents with hypotension, tachycardia, and poor peripheral perfusion following a road traffic accident with a steering wheel injury. On examination, muffled heart sounds and pulsus paradoxus are noted, and an ECG shows widespread anterior T-wave inversion. The patient has a history of inferior wall MI seven years ago. Arterial blood gas analysis reveals respiratory acidosis.

      The differential diagnosis includes cardiac tamponade, myocarditis, NSTEMI, pericarditis, and STEMI. While myocarditis can cause similar symptoms and ECG changes, the presence of muffled heart sounds and pulsus paradoxus suggests fluid in the pericardium and cardiac tamponade. NSTEMI and STEMI can also cause acute onset of symptoms and ECG changes, but the absence of ST elevation and the history of trauma make cardiac tamponade more likely. Pericarditis can cause muffled heart sounds and pulsus paradoxus, but the absence of peripheral hypoperfusion and the presence of non-specific ST-T changes on ECG make it less likely.

      In conclusion, the clinical scenario is most consistent with traumatic cardiac tamponade, which requires urgent echocardiography for confirmation and possible guided pericardiocentesis.

    • This question is part of the following fields:

      • Cardiology
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  • Question 12 - Examine the cardiac catheter data provided below for a patient. Which of the...

    Incorrect

    • Examine the cardiac catheter data provided below for a patient. Which of the following clinical scenarios is most consistent with the given information?

      Anatomical site Oxygen saturation (%) Pressure (mmHg) End systolic/End diastolic
      Superior vena cava 74 -
      Inferior vena cava 72 -
      Right atrium 73 5
      Right ventricle 74 20/4
      Pulmonary artery 74 20/5
      Pulmonary capillary wedge pressure - 15
      Left ventricle 98 210/15
      Aorta 99 125/75

      Your Answer: A 65-year-old woman with a two year history of increasing exertional dyspnoea who presents following a single episode of haemoptysis

      Correct Answer: A 17-year-old boy who presents after an episode of exercise-induced syncope

      Explanation:

      Left Ventricular Pressure and Cardiac Conditions

      Left ventricular pressures that exhibit a sharp decline between the LV and aortic systolic pressures are indicative of hypertrophic cardiomyopathy. This condition is consistent with the catheter data obtained from the patient. However, the data are not consistent with other cardiac conditions such as cyanotic congenital heart disease, post-MI VSD or mitral regurgitation, mitral stenosis, or mitral regurgitation. Although aortic stenosis may also present with a left ventricular outflow obstruction, it is not typically associated with exercise-induced syncope. These findings suggest that the patient’s symptoms are likely due to hypertrophic cardiomyopathy.

    • This question is part of the following fields:

      • Cardiology
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  • Question 13 - A 68-year-old woman is admitted to the Cardiology Ward with acute left ventricular...

    Correct

    • A 68-year-old woman is admitted to the Cardiology Ward with acute left ventricular failure. The patient is severely short of breath.
      What would be the most appropriate initial step in managing her condition?

      Your Answer: Sit her up and administer high flow oxygen

      Explanation:

      Managing Acute Shortness of Breath: Prioritizing ABCDE Approach

      When dealing with acutely unwell patients experiencing shortness of breath, it is crucial to follow the ABCDE approach. The first step is to address Airway and Breathing by sitting the patient up and administering high flow oxygen to maintain normal saturations. Only then should Circulation be considered, which may involve cannulation and administering IV furosemide.

      According to the latest NICE guidelines, non-invasive ventilation should be considered as part of non-pharmacological management if simple measures do not improve symptoms.

      It is important to prioritize the ABCDE approach and not jump straight to administering medication or inserting a urinary catheter. Establishing venous access and administering medication should only be done after ensuring the patient’s airway and breathing are stable.

      If the patient has an adequate systolic blood pressure, iv nitrates such as glyceryl trinitrate (GTN) infusion could be considered to reduce preload on the heart. However, most patients can be treated with iv diuretics, such as furosemide.

      In cases of acute pulmonary edema, close monitoring of urine output is recommended, and the easiest and most accurate method is through catheterization with hourly urine measurements. Oxygen should be given urgently if the patient is short of breath.

      In summary, managing acute shortness of breath requires a systematic approach that prioritizes Airway and Breathing before moving on to Circulation and other interventions.

    • This question is part of the following fields:

      • Cardiology
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  • Question 14 - An 82-year-old woman is brought to the Emergency Department after experiencing a sudden...

    Correct

    • An 82-year-old woman is brought to the Emergency Department after experiencing a sudden loss of consciousness while grocery shopping. Upon examination, she is fully alert and appears to be in good health.

      Her vital signs are normal, with a CBG of 5.8 mmol/l. However, her cardiovascular system shows an irregular, low volume heart rate of 90-110 beats per minute, and her blood pressure is 145/120 mmHg while lying down and standing up. Her JVP is raised by 5 cm, and her apex beat is displaced to the mid-axillary line, with diffuse heart sounds. A loud pansystolic murmur is heard at the apex, radiating to the axilla and at the lower left sternal edge, along with a mid-diastolic rumble best heard at the apex. There are occasional bibasal crackles in her chest, which clear up with coughing. Additionally, she has mild peripheral edema up to the mid-calf.

      Based on these clinical findings, what is the most likely cause of her collapse?

      Your Answer: Mixed mitral valve disease

      Explanation:

      This patient exhibits features of mixed mitral valve disease, which can be challenging to diagnose due to contradictory signs. She has a mid-diastolic rumble, low-volume pulse, and atrial fibrillation, indicating mitral stenosis. However, she also has a displaced apex beat and a pan-systolic murmur, indicating mitral regurgitation. Mixed aortic valve disease is also common in these patients. Aortic stenosis and mixed aortic valve disease are unlikely diagnoses based on the clinical findings, while mitral stenosis and mitral regurgitation alone do not fully explain the examination results.

    • This question is part of the following fields:

      • Cardiology
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  • Question 15 - An 81-year-old man with heart failure and depression presents with a sodium level...

    Incorrect

    • An 81-year-old man with heart failure and depression presents with a sodium level of 130. He is currently asymptomatic and his heart failure and depression are well managed. He has mild pitting pedal oedema and is taking ramipril, bisoprolol, simvastatin and citalopram. What is the optimal approach to managing this patient?

      Your Answer: Administer intravenous saline over 1 hour and then recheck

      Correct Answer: Restrict his fluid input to 1.5 l/day and recheck in 3 days

      Explanation:

      Managing Hyponatraemia: Treatment Options and Considerations

      Hyponatraemia, a condition characterized by low serum sodium levels, requires careful management to avoid potential complications. The first step in treating hyponatraemia is to restrict fluid intake to reverse any dilution and address the underlying cause. Administering saline should only be considered if fluid restriction fails, as treating hyponatraemia too quickly can lead to central pontine myelinolysis.

      In cases where medication may be contributing to hyponatraemia, such as with selective serotonin reuptake inhibitors (SSRIs), it is important to weigh the benefits and risks of discontinuing the medication. Abruptly stopping SSRIs can cause withdrawal symptoms, and patients should be gradually weaned off over several weeks or months.

      Other treatment options, such as increasing salt intake or administering oral magnesium supplementation, may not be appropriate for all cases of hyponatraemia. It is important to consider the patient’s overall clinical picture and underlying conditions, such as heart failure, before deciding on a course of treatment.

      Overall, managing hyponatraemia requires a careful and individualized approach to ensure the best possible outcomes for patients.

    • This question is part of the following fields:

      • Cardiology
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  • Question 16 - A 51-year-old woman with a history of hypothyroidism experiences a collapse during her...

    Incorrect

    • A 51-year-old woman with a history of hypothyroidism experiences a collapse during her yoga class. She has been reporting occasional chest pains and difficulty breathing during exercise in the past few weeks. During her physical examination, an ejection systolic murmur is detected at the right upper sternal edge, and her second heart sound is faint. Additionally, she has a slow-rising pulse. What is the most probable cause of her symptoms?

      Your Answer: Mitral valve prolapse

      Correct Answer: Bicuspid aortic valve

      Explanation:

      Differentiating Aortic and Mitral Valve Disorders

      When evaluating a patient with a heart murmur, it is important to consider the characteristics of the murmur and associated symptoms to determine the underlying valve disorder. In a patient under 70 years old, a slow-rising and weak pulse with a history of collapse is indicative of critical stenosis caused by a bicuspid aortic valve. On the other hand, calcific aortic stenosis is more common in patients over 70 years old and presents differently. Aortic valve regurgitation is characterized by a murmur heard during early diastole and a collapsing pulse, but it is less likely to cause syncope. Mitral valve regurgitation causes a pan-systolic murmur at the apex with a laterally displaced apex beat, but it may present with congestive heart failure rather than syncope or angina. Mitral valve prolapse may cause a mid-systolic click, but a pan-systolic murmur at the apex may be present if there is coexisting mitral regurgitation. By understanding the unique features of each valve disorder, clinicians can make an accurate diagnosis and provide appropriate treatment.

    • This question is part of the following fields:

      • Cardiology
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  • Question 17 - A 38-year-old man comes for his 6-week post-myocardial infarction (MI) follow-up. He was...

    Incorrect

    • A 38-year-old man comes for his 6-week post-myocardial infarction (MI) follow-up. He was discharged without medication. His total cholesterol is 9 mmol/l, with triglycerides of 1.2 mmol/l. He is a non-smoker with a blood pressure of 145/75. His father passed away from an MI at the age of 43.
      What is the most suitable initial treatment for this patient?

      Your Answer: Ezetimibe

      Correct Answer: High-dose atorvastatin

      Explanation:

      Treatment Options for a Patient with Hypercholesterolemia and Recent MI

      When treating a patient with hypercholesterolemia and a recent myocardial infarction (MI), it is important to choose the most appropriate treatment option. In this case, high-dose atorvastatin is the best choice due to the patient’s high cholesterol levels and family history. It is crucial to note that medication should have been prescribed before the patient’s discharge.

      While dietary advice can be helpful, it is not the most urgent treatment option. Ezetimibe would only be prescribed if a statin were contraindicated. In this high-risk patient, low-dose atorvastatin is not sufficient, and high-dose atorvastatin is required, provided it is tolerated. If cholesterol control does not improve with high-dose atorvastatin, ezetimibe can be added at a later check-up. Overall, the priority is to control the patient’s high cholesterol levels with medication.

    • This question is part of the following fields:

      • Cardiology
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  • Question 18 - A 59-year-old man, a bus driver, with a history of angina, is admitted...

    Incorrect

    • A 59-year-old man, a bus driver, with a history of angina, is admitted to hospital with chest pain. He is diagnosed and successfully treated for a STEMI, and discharged one week later.
      Which of the following activities is permitted during the first month of his recovery?

      Your Answer: Operating heavy machinery

      Correct Answer: Drinking alcohol (up to 14 units)

      Explanation:

      Post-Myocardial Infarction (MI) Precautions: Guidelines for Alcohol, Machinery, Driving, Sex, and Exercise

      After experiencing a myocardial infarction (MI), also known as a heart attack, it is crucial to take precautions to prevent further complications. Here are some guidelines to follow:

      Alcohol Consumption: Patients should be advised to keep their alcohol consumption within recommended limits, which is now 14 units per week for both men and women.

      Operating Heavy Machinery: Patients should avoid operating heavy machinery for four weeks post MI.

      Bus Driving: Patients should refrain from driving a bus or lorry for six weeks post MI. If the patient had angioplasty, driving is not allowed for one week if successful and four weeks if unsuccessful or not performed.

      Sexual Intercourse: Patients should avoid sexual intercourse for four weeks post MI.

      Vigorous Exercise: Patients should refrain from vigorous exercise for four weeks post MI.

      Following these guidelines can help prevent further complications and aid in the recovery process after a myocardial infarction.

    • This question is part of the following fields:

      • Cardiology
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  • Question 19 - A 33-year-old known intravenous drug user presents to your GP clinic with complaints...

    Incorrect

    • A 33-year-old known intravenous drug user presents to your GP clinic with complaints of fatigue, night sweats and joint pain. During the examination, you observe a new early-diastolic murmur. What is the probable causative organism for this patient's condition?

      Your Answer: Group D streptococci

      Correct Answer: Staphylococcus aureus

      Explanation:

      Common Causes of Infective Endocarditis and their Characteristics

      Infective endocarditis is a serious condition that can lead to severe complications if left untreated. The most common causative organism of acute infective endocarditis is Staphylococcus aureus, especially in patients with risk factors such as prosthetic valves or intravenous drug use. Symptoms and signs consistent with infective endocarditis include fever, heart murmur, and arthritis, as well as pathognomonic signs like splinter hemorrhages, Osler’s nodes, Roth spots, Janeway lesions, and petechiae.

      Group B streptococci is less common than Staphylococcus aureus but has a high mortality rate of 70%. Streptococcus viridans is not the most common cause of infective endocarditis, but it does cause 50-60% of subacute cases. Group D streptococci is the third most common cause of infective endocarditis. Pseudomonas aeruginosa is not the most common cause of infective endocarditis and usually requires surgery for cure.

      In summary, knowing the characteristics of the different causative organisms of infective endocarditis can help in the diagnosis and treatment of this serious condition.

    • This question is part of the following fields:

      • Cardiology
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  • Question 20 - A 55-year-old woman has been suffering from significant pain in her lower limbs...

    Incorrect

    • A 55-year-old woman has been suffering from significant pain in her lower limbs when walking more than 200 meters for the past six months. During physical examination, her legs appear pale and cool without signs of swelling or redness. The palpation of dorsalis pedis or posterior tibial pulses is not possible. The patient has a body mass index of 33 kg/m2 and has been smoking for 25 pack years. What is the most probable vascular abnormality responsible for these symptoms?

      Your Answer: Lymphatic obstruction

      Correct Answer: Atherosclerosis

      Explanation:

      Arteriosclerosis and Related Conditions

      Arteriosclerosis is a medical condition that refers to the hardening and loss of elasticity of medium or large arteries. Atherosclerosis, on the other hand, is a specific type of arteriosclerosis that occurs when fatty materials such as cholesterol accumulate in the artery walls, causing them to thicken. This chronic inflammatory response is caused by the accumulation of macrophages and white blood cells, and is often promoted by low-density lipoproteins. The formation of multiple plaques within the arteries characterizes atherosclerosis.

      Medial calcific sclerosis is another form of arteriosclerosis that occurs when calcium deposits form in the middle layer of walls of medium-sized vessels. This condition is often not clinically apparent unless it is severe, and it is more common in people over 50 years old and in diabetics. It can be seen as opaque vessels on radiographs.

      Lymphatic obstruction, on the other hand, is a blockage of the lymph vessels that drain fluid from tissues throughout the body. This condition may cause lymphoedema, and the most common reason for this is the removal or enlargement of the lymph nodes.

      It is important to understand these conditions and their differences to properly diagnose and treat patients.

    • This question is part of the following fields:

      • Cardiology
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  • Question 21 - A 55-year-old man is experiencing chest pain and shortness of breath three weeks...

    Incorrect

    • A 55-year-old man is experiencing chest pain and shortness of breath three weeks after a myocardial infarction that was treated with percutaneous coronary intervention (PCI) for a proximal left anterior descending artery occlusion. On examination, he has a loud friction rub over the praecordium, bilateral pleural effusions on chest x-ray, and ST elevation on ECG. What is the most probable diagnosis?

      Your Answer: LAD re-stenosis

      Correct Answer: Dressler's syndrome

      Explanation:

      Dressler’s Syndrome

      Dressler’s syndrome is a type of pericarditis that typically develops between two to six weeks after a person has experienced an anterior myocardial infarction or undergone heart surgery. This condition is believed to be caused by an autoimmune response to myocardial antigens. In simpler terms, the body’s immune system mistakenly attacks the heart tissue, leading to inflammation of the pericardium, which is the sac that surrounds the heart.

      The symptoms of Dressler’s syndrome can vary from person to person, but they often include chest pain, fever, fatigue, and shortness of breath. In some cases, patients may also experience a cough, abdominal pain, or joint pain. Treatment for this condition typically involves the use of nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and manage pain. In severe cases, corticosteroids may be prescribed to help suppress the immune system.

    • This question is part of the following fields:

      • Cardiology
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  • Question 22 - What term describes a lack of pulses but regular coordinated electrical activity on...

    Correct

    • What term describes a lack of pulses but regular coordinated electrical activity on an ECG?

      Your Answer: Pulseless electrical activity (PEA)

      Explanation:

      Causes of Pulseless Electrical Activity

      Pulseless Electrical Activity (PEA) occurs when there is a lack of pulse despite normal electrical activity on the ECG. This can be caused by poor intrinsic myocardial contractility or a variety of remediable factors. These factors include hypoxemia, hypovolemia, severe acidosis, tension pneumothorax, pericardial tamponade, hyperkalemia, hypocalcemia, poisoning with a calcium channel blocker, or hypothermia. Additionally, PEA may be caused by a massive pulmonary embolism. It is important to identify and address the underlying cause of PEA in order to improve patient outcomes.

    • This question is part of the following fields:

      • Cardiology
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  • Question 23 - A 25-year-old man with a known harsh ejection systolic murmur on cardiac examination...

    Incorrect

    • A 25-year-old man with a known harsh ejection systolic murmur on cardiac examination collapses and passes away during a sporting event. His father and uncle also died suddenly in their forties. The reason for death is identified as an obstruction of the ventricular outflow tract caused by an abnormality in the ventricular septum.
      What is the accurate diagnosis for this condition?

      Your Answer: Restrictive cardiomyopathy

      Correct Answer: Hypertrophic cardiomyopathy

      Explanation:

      Types of Cardiomyopathy and Congenital Heart Defects

      Cardiomyopathy is a group of heart diseases that affect the structure and function of the heart muscle. There are different types of cardiomyopathy, each with its own causes and symptoms. Additionally, there are congenital heart defects that can affect the heart’s structure and function from birth. Here are some of the most common types:

      1. Hypertrophic cardiomyopathy: This is an inherited condition that causes the heart muscle to thicken, making it harder for the heart to pump blood. It can lead to sudden death in young athletes.

      2. Restrictive cardiomyopathy: This is a rare form of cardiomyopathy that is caused by diseases that restrict the heart’s ability to fill with blood during diastole.

      3. Dilated cardiomyopathy: This is the most common type of cardiomyopathy, which causes the heart chambers to enlarge and weaken, leading to heart failure.

      4. Mitral stenosis: This is a narrowing of the mitral valve, which can impede blood flow between the left atrium and ventricle.

      In addition to these types of cardiomyopathy, there are also congenital heart defects, such as ventricular septal defect, which is the most common congenital heart defect. This condition creates a direct connection between the right and left ventricles, affecting the heart’s ability to pump blood effectively.

      Understanding the different types of cardiomyopathy and congenital heart defects is important for proper diagnosis and treatment. If you experience symptoms such as chest pain, shortness of breath, or fatigue, it is important to seek medical attention promptly.

    • This question is part of the following fields:

      • Cardiology
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  • Question 24 - A 65-year-old woman presents with a 4-month history of dyspnoea on exertion. She...

    Incorrect

    • A 65-year-old woman presents with a 4-month history of dyspnoea on exertion. She denies a history of cough, wheeze and weight loss but admits to a brief episode of syncope two weeks ago. Her past medical history includes, chronic kidney disease stage IV and stage 2 hypertension. She is currently taking lisinopril, amlodipine and atorvastatin. She is an ex-smoker with a 15-pack year history.
      On examination it is noted that she has a low-volume pulse and an ejection systolic murmur heard loudest at the right upper sternal edge. The murmur is noted to radiate to both carotids. Moreover, she has good bilateral air entry, vesicular breath sounds and no added breath sounds on auscultation of the respiratory fields. The patient’s temperature is recorded as 37.2°C, blood pressure is 110/90 mmHg, and a pulse of 68 beats per minute. A chest X-ray is taken which is reported as the following:
      Investigation Result
      Chest radiograph Technically adequate film. Normal cardiothoracic ratio. Prominent right ascending aorta, normal descending aorta. No pleural disease. No bony abnormality.
      Which of the following most likely explains her dyspnoea?

      Your Answer: Aortic regurgitation

      Correct Answer: Aortic stenosis

      Explanation:

      Common Heart Conditions and Their Characteristics

      Aortic stenosis is a condition where the aortic valve does not open completely, resulting in dyspnea, chest pain, and syncope. It produces a narrow pulse pressure, a low volume pulse, and an ejection systolic murmur that radiates to the carotids. An enlarged right ascending aorta is a common finding in aortic stenosis. Calcification of the valve is diagnostic and can be observed using CT or fluoroscopy. Aortic stenosis is commonly caused by calcification of the aortic valve due to a congenitally bicuspid valve, connective tissue disease, or rheumatic heart disease. Echocardiography confirms the diagnosis, and valve replacement or intervention is indicated with critical stenosis <0.5 cm or when symptomatic. Aortic regurgitation is characterized by a widened pulse pressure, collapsing pulse, and an early diastolic murmur heard loudest in the left lower sternal edge with the patient upright. Patients can be asymptomatic until heart failure manifests. Causes include calcification and previous rheumatic fever. Ventricular septal defect (VSD) is a congenital or acquired condition characterized by a pansystolic murmur heard loudest at the left sternal edge. Acquired VSD is mainly a result of previous myocardial infarction. VSD can be asymptomatic or cause heart failure secondary to pulmonary hypertension. Mitral regurgitation is characterized by a pansystolic murmur heard best at the apex that radiates towards the axilla. A third heart sound may also be heard. Patients can remain asymptomatic until dilated cardiac failure occurs, upon which dyspnea and peripheral edema are among the most common symptoms. Mitral stenosis causes a mid-diastolic rumble heard best at the apex with the patient in the left lateral decubitus position. Auscultation of the precordium may also reveal an opening snap. Patients are at increased risk of atrial fibrillation due to left atrial enlargement. The most common cause of mitral stenosis is a previous history of rheumatic fever.

    • This question is part of the following fields:

      • Cardiology
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  • Question 25 - A 48-year-old woman comes to you for consultation after being seen two days...

    Incorrect

    • A 48-year-old woman comes to you for consultation after being seen two days ago for a fall. She has a medical history of type 2 diabetes mellitus, bilateral knee replacements, chronic hypotension, and heart failure, which limits her mobility. Her weight is 120 kg. During her previous visit, her ECG showed that she had AF with a heart rate of 180 bpm. She was prescribed bisoprolol and advised to undergo a 48-hour ECG monitoring. Upon her return, it was discovered that she has non-paroxysmal AF.
      What is the most appropriate course of action?

      Your Answer: Give her amiodarone

      Correct Answer: Start her on digoxin

      Explanation:

      Treatment Options for Atrial Fibrillation in a Patient with Heart Failure

      When treating a patient with atrial fibrillation (AF) and heart failure, the aim should be rate control. While bisoprolol is a good choice, it may not be suitable for a patient with chronic low blood pressure. In this case, digoxin would be the treatment of choice. Anticoagulation with a NOAC or warfarin is also necessary. Cardioversion with amiodarone should not be the first line of treatment due to the patient’s heart failure. Increasing the dose of bisoprolol may not be the best option either. Amlodipine is not effective for rate control in AF, and calcium-channel blockers should not be used in heart failure. Electrical cardioversion is not appropriate for this patient. Overall, the treatment plan should be tailored to the patient’s individual needs and medical history.

      Managing Atrial Fibrillation and Heart Failure: Treatment Options

    • This question is part of the following fields:

      • Cardiology
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  • Question 26 - A 65-year-old woman presents to the Emergency Department with chest pain that has...

    Incorrect

    • A 65-year-old woman presents to the Emergency Department with chest pain that has worsened over the past 2 days. She also reported feeling ‘a little run down’ with a sore throat a week ago. She has history of hypertension and hyperlipidaemia. She reports diffuse chest pain that feels better when she leans forward. On examination, she has a temperature of 37.94 °C and a blood pressure of 140/84 mmHg. Her heart rate is 76 bpm. A friction rub is heard on cardiac auscultation, and an electrocardiogram (ECG) demonstrates ST segment elevation in nearly every lead. Her physical examination and blood tests are otherwise within normal limits.
      Which of the following is the most likely aetiology of her chest pain?

      Your Answer: Post-myocardial infarction syndrome (Dressler syndrome)

      Correct Answer: Post-viral complication

      Explanation:

      Pericarditis as a Post-Viral Complication: Symptoms and Differential Diagnosis

      Pericarditis, inflammation of the pericardium, can occur as a post-viral complication. Patients typically experience diffuse chest pain that improves when leaning forward, and a friction rub may be heard on cardiac auscultation. Diffuse ST segment elevations on ECG can be mistaken for myocardial infarction. In this case, the patient reported recent viral symptoms and then developed acute pericardial symptoms.

      While systemic lupus erythematosus (SLE) can cause pericarditis, other symptoms such as rash, myalgia, or joint pain would be expected, along with a positive anti-nuclear antibodies test. Uraemia can also cause pericarditis, but elevated blood urea nitrogen would be present, and this patient has no history of kidney disease. Dressler syndrome, or post-myocardial infarction pericarditis, can cause diffuse ST elevations, but does not represent transmural infarction. Chest radiation can also cause pericarditis, but this patient has no history of radiation exposure.

    • This question is part of the following fields:

      • Cardiology
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  • Question 27 - A 62-year-old salesman is found to have a blood pressure (BP) of 141/91...

    Incorrect

    • A 62-year-old salesman is found to have a blood pressure (BP) of 141/91 mmHg on a routine medical check. Two months later, his BP was 137/89 mmHg. He leads a physically active life, despite being a heavy smoker. He is not diabetic and his cholesterol levels are low. There is no past medical history of note.
      What is the most suitable course of action for managing this patient?

      Your Answer: Lifestyle advice and an angiotensin-converting enzyme (ACE) inhibitor

      Correct Answer: Lifestyle advice and reassess every year

      Explanation:

      Hypertension Management and Lifestyle Advice

      Managing hypertension requires careful consideration of various factors, including cardiovascular risk, age, and other risk factors. The 2011 NICE guidelines recommend further investigation and assessment for those with a BP of 140/90 mmHg or higher and for those at high risk. Once diagnosed, lifestyle advice and annual reassessment are recommended, with drug therapy considered based on the number of risk factors present.

      For patients with cardiovascular risk factors, lifestyle advice and education on reducing cardiovascular risk are crucial. This includes support for smoking cessation, as smoking is a significant risk factor for cardiovascular disease. Patients with high risk, such as the elderly or heavy smokers, should be monitored annually.

      While pharmacological treatment may be necessary, thiazide diuretics are no longer used first-line for hypertension management. For patients over 55, calcium channel blockers are recommended as first-line treatment. ACE inhibitors would not be used first-line in patients over 55.

      In summary, managing hypertension requires a comprehensive approach that considers various factors, including cardiovascular risk, age, and other risk factors. Lifestyle advice and annual reassessment are crucial for patients with hypertension, with drug therapy considered based on the number of risk factors present.

    • This question is part of the following fields:

      • Cardiology
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  • Question 28 - A 65-year-old insurance broker with mitral stenosis is seen in the Cardiology Clinic....

    Incorrect

    • A 65-year-old insurance broker with mitral stenosis is seen in the Cardiology Clinic. He reports increasing shortness of breath on exertion and general fatigue over the past six months. Additionally, he notes swelling in his feet and ankles at the end of the day. What is the first-line intervention for symptomatic mitral stenosis with a mobile undistorted mitral valve and no left atrial thrombus or mitral regurgitation?

      Your Answer: Mitral valve repair

      Correct Answer: Balloon valvuloplasty

      Explanation:

      Treatment Options for Mitral Valve Disease

      Mitral valve disease can be managed through various treatment options depending on the severity and type of the condition. Balloon valvuloplasty is the preferred option for symptomatic patients with mitral stenosis, while mitral valve repair is the preferred surgical management for mitral regurgitation. Aortic valve replacement is an option if the aortic valve is faulty. Mitral valve replacement with a metallic valve requires high levels of anticoagulation, and therefore repair is preferred if possible. The Blalock–Taussig shunt is a surgical method for palliation of cyanotic congenital heart disease. Mitral valve repair may be considered in patients with mitral stenosis if the valve anatomy is unsuitable for balloon valvuloplasty. However, if the patient has severe symptomatic mitral stenosis with signs of heart failure, mitral valve replacement would be the first line of treatment.

      Treatment Options for Mitral Valve Disease

    • This question is part of the following fields:

      • Cardiology
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  • Question 29 - A 55-year-old woman visits her GP and mentions her diagnosis of heart failure....

    Incorrect

    • A 55-year-old woman visits her GP and mentions her diagnosis of heart failure. She expresses interest in learning about medications that can potentially decrease mortality in heart failure. Which drug has been proven to have this effect?

      Your Answer: Digoxin

      Correct Answer: Spironolactone

      Explanation:

      Common Medications for Heart Failure: Benefits and Limitations

      Heart failure is a chronic condition that affects millions of people worldwide. While there is no cure for heart failure, medications can help manage symptoms and improve quality of life. Here are some common medications used in the treatment of heart failure, along with their benefits and limitations.

      Spironolactone: Recent trials have shown that spironolactone can reduce mortality in severe heart failure. This drug works by antagonizing the deleterious effects of aldosterone on cardiac remodeling, rather than its diuretic effect.

      Simvastatin: While statins are effective in reducing morbidity and mortality in patients with coronary artery disease, their beneficial effects in heart failure remain inconclusive.

      Atenolol: Atenolol has not been shown to be effective in reducing mortality in heart failure and is not used as part of the condition’s management. However, certain beta-blockers like carvedilol, metoprolol, or bisoprolol are recommended in patients who have been stabilized on diuretic and angiotensin-converting enzyme (ACE-I) therapy.

      Furosemide: Furosemide is a mainstay in the treatment of both acute and long-term heart failure, particularly for relieving symptoms of fluid overload. However, there is little data to prove that it improves long-term mortality in patients with chronic congestive cardiac failure (CCF).

      Digoxin: Digoxin does not decrease mortality in heart failure. Its use is reserved for patients in atrial fibrillation and those who cannot be controlled on an ACE-I, beta-blocker, and loop diuretic. Some studies suggest a decreased rate in CHF-related hospital admissions.

      In conclusion, while these medications can help manage symptoms and improve quality of life in heart failure patients, their limitations should also be considered. It is important to work closely with a healthcare provider to determine the best treatment plan for each individual.

    • This question is part of the following fields:

      • Cardiology
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  • Question 30 - A 55-year-old man presents with sudden onset of severe chest pain and difficulty...

    Incorrect

    • A 55-year-old man presents with sudden onset of severe chest pain and difficulty breathing. The pain started while he was eating and has been constant for the past three hours. It radiates to his back and interscapular region.

      The patient has a history of hypertension for three years, alcohol abuse, and is a heavy smoker of 30 cigarettes per day. On examination, he is cold and clammy with a heart rate of 130/min and a blood pressure of 80/40 mm Hg. JVP is normal, but breath sounds are decreased at the left lung base and a chest x-ray reveals a left pleural effusion.

      What is the most likely diagnosis?

      Your Answer: Panic attack

      Correct Answer: Acute aortic dissection

      Explanation:

      Acute Aortic Dissection: Symptoms, Diagnosis, and Imaging

      Acute aortic dissection is a medical emergency that causes sudden and severe chest pain. The pain is often described as tearing and may be felt in the front or back of the chest, as well as in the neck. Other symptoms and signs depend on the arteries involved and nearby organs affected. In severe cases, it can lead to hypovolemic shock and sudden death.

      A chest x-ray can show a widened mediastinum, cardiomegaly, pleural effusion, and intimal calcification separated more than 6 mm from the edge. However, aortography is the gold standard for diagnosis, which shows the origin of arteries from true or false lumen. CT scan and MRI are also commonly used for diagnosis. Transoesophageal echo (TEE) is best for the descending aorta, while transthoracic echo (TTE) is best for the ascending aorta and arch.

      In summary, acute aortic dissection is a serious condition that requires prompt diagnosis and treatment. Symptoms include sudden and severe chest pain, which may be accompanied by other signs depending on the arteries involved. Imaging techniques such as chest x-ray, aortography, CT scan, MRI, TEE, and TTE can aid in diagnosis.

    • This question is part of the following fields:

      • Cardiology
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  • Question 31 - What is the most accurate statement regarding the electrocardiograph? ...

    Incorrect

    • What is the most accurate statement regarding the electrocardiograph?

      Your Answer: Pneumonia causes low-voltage QRS complexes

      Correct Answer: ST depression and tall R waves in leads V1 and V2 are consistent with a diagnosis of a posterior myocardial infarction

      Explanation:

      Common ECG Findings and Their Significance

      Electrocardiogram (ECG) is a valuable tool in diagnosing various cardiac conditions. Here are some common ECG findings and their significance:

      1. ST depression and tall R waves in leads V1 and V2 are consistent with a diagnosis of a posterior myocardial infarction.

      2. Pneumonia causes low-voltage QRS complexes. This can be caused by the dampening effect of extra layers of fat, fluid, or air between the heart and thoracic wall.

      3. The corrected QT interval (QTc) is calculated by Bazett’s formula: QTc = QT interval ÷ square root of the RR interval (in seconds).

      4. A 2-mm ST elevation in leads II, III, aVF, V4, and V5 is consistent with an anterior myocardial infarction. This suggests an inferior lateral infarction, as opposed to just an inferior myocardial infarction.

      5. The S1Q3T3 pattern is seen in up to 20% of patients with a pulmonary embolism. Sinus tachycardia is the most common ECG abnormality seen in patients presenting with pulmonary emboli. Other potential findings include a right ventricular strain pattern, complete and incomplete right bundle branch block (RBBB), and P pulmonale indicating right atrial enlargement.

      Understanding these common ECG findings can aid in the diagnosis and management of various cardiac conditions.

    • This question is part of the following fields:

      • Cardiology
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  • Question 32 - A 65-year-old man visited the dermatology clinic in the summer with a rash...

    Incorrect

    • A 65-year-old man visited the dermatology clinic in the summer with a rash on his forearms, shins, and face. Which medication is most likely to be linked with this photosensitive rash?

      Your Answer: Atenolol

      Correct Answer: Bendroflumethiazide

      Explanation:

      Adverse Effects of Cardiology Drugs

      Photosensitivity is a frequently observed negative reaction to certain cardiology drugs, such as amiodarone and thiazide diuretics. This means that patients taking these medications may experience an increased sensitivity to sunlight, resulting in skin rashes or other skin-related issues. Additionally, ACE inhibitors and A2RBs, which are commonly prescribed for cardiovascular conditions, have been known to cause rashes that may also be photosensitive. It is important for patients to be aware of these potential side effects and to take necessary precautions, such as wearing protective clothing and using sunscreen, when exposed to sunlight.

    • This question is part of the following fields:

      • Cardiology
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  • Question 33 - A 20-year-old man, who recently immigrated to the United Kingdom from Eastern Europe,...

    Incorrect

    • A 20-year-old man, who recently immigrated to the United Kingdom from Eastern Europe, presents to his general practitioner with a history of intermittent dizzy spells. He reports having limited exercise capacity since childhood, but this has not been investigated before. Upon examination, the patient appears slight, has a dusky blue discoloration to his lips and tongue, and has finger clubbing. A murmur is also heard. The GP refers him to a cardiologist.

      The results of a cardiac catheter study are as follows:

      Anatomical site Oxygen saturation (%) Pressure (mmHg)
      End systolic/End diastolic
      Superior vena cava 58 -
      Inferior vena cava 52 -
      Right atrium (mean) 56 10
      Right ventricle 55 105/9
      Pulmonary artery - 16/8
      Pulmonary capillary wedge pressure - 9
      Left atrium 97 -
      Left ventricle 84 108/10
      Aorta 74 110/80

      What is the most likely diagnosis?

      Your Answer: Patent ductus arteriosus

      Correct Answer: Fallot's tetralogy

      Explanation:

      Fallot’s Tetralogy

      Fallot’s tetralogy is a congenital heart defect that consists of four features: ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, and an over-riding aorta. To diagnose this condition, doctors look for specific indicators. A step-down in oxygen saturation between the left atrium and left ventricle indicates a right to left shunt at the level of the ventricles, which is a sign of ventricular septal defect. Pulmonary stenosis is indicated by a significant gradient of 89 mmHg across the pulmonary valve, which is calculated by subtracting the right ventricular systolic pressure from the pulmonary artery systolic pressure. Right ventricular hypertrophy is diagnosed by high right ventricular pressures and a right to left shunt, as indicated by the oxygen saturations. Finally, an over-riding aorta is identified by a further step-down in oxygen saturation between the left ventricle and aorta. While this could also occur in cases of patent ductus arteriosus with right to left shunting, the presence of the other features of Fallot’s tetralogy makes an over-riding aorta the most likely cause of reduced oxygen saturation due to admixture of deoxygenated blood from the right ventricle entering the left heart circulation.

    • This question is part of the following fields:

      • Cardiology
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  • Question 34 - A 42-year-old man presents to the Emergency Department with severe central chest pain...

    Incorrect

    • A 42-year-old man presents to the Emergency Department with severe central chest pain that worsens when lying down, is relieved by sitting forward, and radiates to his left shoulder. He has a history of prostate cancer and has recently completed two cycles of radiotherapy. On examination, his blood pressure is 96/52 mmHg (normal <120/80 mmHg), his JVP is elevated, and his pulse is 98 bpm with a decrease in amplitude during inspiration. Heart sounds are faint. The ECG shows low-voltage QRS complexes. What is the most appropriate initial management for this patient?

      Your Answer: Low-molecular-weight heparin (LMWH)

      Correct Answer: Urgent pericardiocentesis

      Explanation:

      The patient is experiencing cardiac tamponade, which is caused by fluid in the pericardial sac compressing the heart and reducing ventricular filling. This is likely due to pericarditis caused by recent radiotherapy. Beck’s triad of low blood pressure, raised JVP, and muffled heart sounds are indicative of tamponade. Urgent pericardiocentesis is necessary to aspirate the pericardial fluid, preferably under echocardiographic guidance. A fluid challenge with sodium chloride is not recommended as it may worsen the pericardial fluid. Ibuprofen is not effective in severe cases of pericardial effusion. GTN spray, morphine, clopidogrel, and aspirin are useful in managing myocardial infarction, which is a differential diagnosis to rule out. LMWH is not appropriate for tamponade and may worsen the condition if caused by haemopericardium.

    • This question is part of the following fields:

      • Cardiology
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  • Question 35 - A 63-year-old diabetic woman presents with general malaise and epigastric pain of 2...

    Incorrect

    • A 63-year-old diabetic woman presents with general malaise and epigastric pain of 2 hours’ duration. She is hypotensive (blood pressure 90/55) and has jugular venous distension. Cardiac workup reveals ST elevation in leads I, aVL, V5 and V6. A diagnosis of high lateral myocardial infarction is made, and the patient is prepared for percutaneous coronary intervention (PCI).
      Blockage of which of the following arteries is most likely to lead to this type of infarction?

      Your Answer: Right mainstem coronary artery

      Correct Answer: Left (obtuse) marginal artery

      Explanation:

      Coronary Arteries and their Associated ECG Changes

      The heart is supplied with blood by the coronary arteries, and blockages in these arteries can lead to myocardial infarction (heart attack). Different coronary arteries supply blood to different parts of the heart, and the location of the blockage can be identified by changes in the electrocardiogram (ECG) readings.

      Left (obtuse) Marginal Artery: This artery supplies the lateral wall of the left ventricle. Blockages in this artery can cause changes in ECG leads I, aVL, V2, V5, and V6, with reciprocal changes in the inferior leads.

      Anterior Interventricular (Left Anterior Descending) Artery: This artery supplies the anterior walls of both ventricles and the anterior part of the interventricular septum. Blockages in this artery can cause changes in ECG leads V2-V4, sometimes extending to V1 and V5.

      Posterior Interventricular Artery: This artery is a branch of the right coronary artery and supplies the posterior walls of both ventricles. ECG changes associated with blockages in this artery are not specific.

      Right (Acute) Marginal Artery: This artery supplies the right ventricle. Blockages in this artery can cause changes in ECG leads II, III, aVF, and sometimes V1.

      Right Mainstem Coronary Artery: Inferior myocardial infarction is most commonly associated with blockages in this artery (80% of cases) or the left circumflex artery (20% of cases). ECG changes in this type of infarct are seen in leads II, III, and aVF.

      Understanding Coronary Arteries and ECG Changes in Myocardial Infarction

    • This question is part of the following fields:

      • Cardiology
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  • Question 36 - An adolescent with Down's syndrome is being seen at the cardiology clinic due...

    Incorrect

    • An adolescent with Down's syndrome is being seen at the cardiology clinic due to a heart murmur detected during a routine check-up. It is known that approximately half of infants with Down's syndrome have congenital heart defects, and the prevalence remains high throughout their lifespan. What are the five most frequent types of congenital heart disease observed in individuals with Down's syndrome? Please list them in order of decreasing incidence, starting with the most common cause and ending with the least common cause.

      Your Answer: Atrioventricular septal defect, mitral stenosis, aortic stenosis, atrial septal defect, hypoplastic left ventricle

      Correct Answer: Atrioventricular septal defect, ventricular septal defect, tetralogy of Fallot, atrial septal defect, patent ductus arteriosus

      Explanation:

      Congenital Heart Defects in Down’s Syndrome

      Congenital heart defects are common in individuals with Down’s syndrome, with five specific pathologies accounting for approximately 99% of cases. Atrioventricular septal defects and ventricular septal defects occur in roughly a third of cases each, while the remaining third is accounted for by the other three defects. Chromosomal abnormalities, such as trisomy 21, which is commonly associated with Down’s syndrome, can predispose individuals to congenital heart disease. Around 50% of people with Down’s syndrome have one of the five cardiac defects listed above, but the exact cause for this is not yet known.

      The development of endocardial cushions is often impaired in individuals with Down’s syndrome, which can lead to defects in the production of the atrial and ventricular septae, as well as the development of the atrioventricular valves. This explains why atrioventricular septal defects are a common congenital defect in Down’s syndrome, as they involve a common atrioventricular orifice and valve. The severity of the defect depends on its size and the positioning of the leaflets of the common atrioventricular valve, which contribute to defining the degree of shunt. Additionally, the type of ventricular septal defects and atrial septal defects that commonly occur in Down’s syndrome can be explained by the impaired development of endocardial cushions. VSDs are usually of the inlet type, while ASDs are more commonly of the prium type, representing a failure of the endocardial cushion to grow in a superior direction.

    • This question is part of the following fields:

      • Cardiology
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  • Question 37 - A 68-year-old woman came to the Heart Failure Clinic complaining of shortness of...

    Incorrect

    • A 68-year-old woman came to the Heart Failure Clinic complaining of shortness of breath. During the examination, a loud pansystolic murmur was heard throughout her chest. The murmur was more audible during inspiration than expiration, and it was difficult to determine where it was loudest. Additionally, she had distended neck veins and an elevated jugular venous pressure (JVP). What is the most probable diagnosis?

      Your Answer: Aortic sclerosis

      Correct Answer: Tricuspid regurgitation (TR)

      Explanation:

      Differentiating Heart Murmurs: A Guide

      Heart murmurs are abnormal sounds heard during a heartbeat and can indicate underlying heart conditions. Here is a guide to differentiating some common heart murmurs:

      Tricuspid Regurgitation (TR)
      TR presents with a loud pan-systolic murmur audible throughout the chest, often loudest in the tricuspid area. The most common cause is heart failure, with regurgitation being functional due to myocardial dilation. Patients may have raised JVPs, distended neck veins, and signs of right-sided heart failure.

      Aortic Sclerosis
      Aortic sclerosis is a loud murmur early in systole, with normal S1 and S2. It does not affect pulse pressure, and there is no radiation to the right carotid artery. Right-sided murmurs are louder on inspiration.

      Aortic Stenosis
      Aortic stenosis is a mid-systolic ejection murmur, heard best over the aortic area or right second intercostal space, with radiation into the right carotid artery. It may reduce pulse pressure to <40 mmHg, and S2 may be diminished. Pulmonary Stenosis
      Pulmonary stenosis gives a crescendo-decrescendo ejection systolic murmur, loudest over the pulmonary area. It is not pan-systolic, and S2 splitting is widened due to prolonged pulmonic ejection.

      Mitral Regurgitation
      Mitral regurgitation is a pan-systolic murmur heard best over the mitral area, radiating to the axilla. It is not increased on inspiration.

      Remember to listen carefully to S1 and S2, check for radiation, and consider associated symptoms to differentiate heart murmurs.

    • This question is part of the following fields:

      • Cardiology
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  • Question 38 - A 57-year-old male with a known history of rheumatic fever and frequent episodes...

    Incorrect

    • A 57-year-old male with a known history of rheumatic fever and frequent episodes of pulmonary oedema is diagnosed with pulmonary hypertension. During examination, an irregularly irregular pulse was noted and auscultation revealed a loud first heart sound and a rumbling mid-diastolic murmur. What is the most probable cause of this patient's pulmonary hypertension?

      Your Answer: Aortic regurgitation

      Correct Answer: Mitral stenosis

      Explanation:

      Cardiac Valve Disorders: Mitral Stenosis, Mitral Regurgitation, Aortic Regurgitation, Pulmonary Stenosis, and Primary Pulmonary Hypertension

      Cardiac valve disorders are conditions that affect the proper functioning of the heart valves. Among these disorders are mitral stenosis, mitral regurgitation, aortic regurgitation, pulmonary stenosis, and primary pulmonary hypertension.

      Mitral stenosis is a narrowing of the mitral valve, usually caused by rheumatic fever. Symptoms include palpitations, dyspnea, and hemoptysis. Diagnosis is aided by electrocardiogram, chest X-ray, and echocardiography. Management may be medical or surgical.

      Mitral regurgitation is a systolic murmur that presents with a sustained apex beat displaced to the left and a left parasternal heave. On auscultation, there will be a soft S1, a loud S2, and a pansystolic murmur heard at the apex radiating to the left axilla.

      Aortic regurgitation presents with a collapsing pulse with a wide pulse pressure. On palpation of the precordium, there will be a sustained and displaced apex beat with a soft S2 and an early diastolic murmur at the left sternal edge.

      Pulmonary stenosis is associated with a normal pulse, with an ejection systolic murmur radiating to the lung fields. There may be a palpable thrill over the pulmonary area.

      Primary pulmonary hypertension most commonly presents with progressive weakness and shortness of breath. There is evidence of an underlying cardiac disease, meaning the underlying pulmonary hypertension is more likely to be secondary to another disease process.

    • This question is part of the following fields:

      • Cardiology
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  • Question 39 - A man in his early 60s is undergoing treatment for high blood pressure....

    Correct

    • A man in his early 60s is undergoing treatment for high blood pressure. During a dental check-up, his dentist informs him that he has gingival hyperplasia. Which medication is the most probable culprit for this condition?

      Your Answer: Nifedipine

      Explanation:

      Drugs Associated with Gingival Hyperplasia

      Gingival hyperplasia is a condition characterized by an overgrowth of gum tissue, which can lead to discomfort, difficulty in maintaining oral hygiene, and even tooth loss. There are several drugs that have been associated with this condition, including Phenytoin, Ciclosporin, and Nifedipine. These drugs are commonly used to treat various medical conditions, such as epilepsy, organ transplant rejection, and hypertension.

      According to Medscape, drug-induced gingival hyperplasia is a well-known side effect of these medications. The exact mechanism by which these drugs cause gingival hyperplasia is not fully understood, but it is believed to be related to their effect on the immune system and the production of collagen in the gums.

      It is important for healthcare providers to be aware of this potential side effect when prescribing these medications, and to monitor patients for any signs of gingival hyperplasia. Patients who are taking these drugs should also be advised to maintain good oral hygiene and to visit their dentist regularly for check-ups and cleanings.

      In summary, Phenytoin, Ciclosporin, and Nifedipine are drugs that have been associated with gingival hyperplasia. Healthcare providers should be aware of this potential side effect and monitor patients accordingly, while patients should maintain good oral hygiene and visit their dentist regularly.

    • This question is part of the following fields:

      • Cardiology
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  • Question 40 - A 45-year-old man is referred to the Cardiology Clinic for a check-up. On...

    Correct

    • A 45-year-old man is referred to the Cardiology Clinic for a check-up. On cardiac auscultation, an early systolic ejection click is found. A blowing diastolic murmur is also present and best heard over the third left intercostal space, close to the sternum. S1 and S2 heart sounds are normal. There are no S3 or S4 sounds. He denies any shortness of breath, chest pain, dizziness or episodes of fainting.
      What is the most likely diagnosis?

      Your Answer: Bicuspid aortic valve without calcification

      Explanation:

      Differentiating between cardiac conditions based on murmurs and clicks

      Bicuspid aortic valve without calcification is a common congenital heart malformation in adults. It is characterized by an early systolic ejection click and can also present with aortic regurgitation and/or stenosis, resulting in a blowing early diastolic murmur and/or systolic ejection murmur. However, if there is no systolic ejection murmur, it can be assumed that there is no valvular stenosis or calcification. Bicuspid aortic valves are not essentially associated with stenosis and only become symptomatic later in life when significant calcification is present.

      On the other hand, a bicuspid aortic valve with significant calcification will result in aortic stenosis and an audible systolic ejection murmur. This can cause chest pain, shortness of breath, dizziness, or syncope. The absence of a systolic murmur in this case excludes aortic stenosis.

      Mixed aortic stenosis and regurgitation can also be ruled out if there is no systolic ejection murmur. An early systolic ejection click without an ejection murmur or with a short ejection murmur is suggestive of a bicuspid aortic valve.

      Aortic regurgitation alone will not cause an early systolic ejection click. This is often associated with aortic or pulmonary stenosis or a bicuspid aortic valve.

      Lastly, aortic stenosis causes a systolic ejection murmur, while flow murmurs are always systolic in nature and not diastolic.

    • This question is part of the following fields:

      • Cardiology
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  • Question 41 - A 42-year-old man felt dizzy at work and later had a rhythm strip...

    Incorrect

    • A 42-year-old man felt dizzy at work and later had a rhythm strip (lead II) performed in the Emergency Department. It reveals one P wave for every QRS complex and a PR interval of 240 ms.
      What does this rhythm strip reveal?

      Your Answer: Second-degree heart block, Mobitz type 1

      Correct Answer: First-degree heart block

      Explanation:

      Understanding Different Types of Heart Block

      Heart block is a condition where the electrical signals that control the heartbeat are disrupted, leading to an abnormal heart rhythm. There are different types of heart block, each with its own characteristic features.

      First-degree heart block is characterized by a prolonged PR interval, but with a 1:1 ratio of P waves to QRS complexes. This type of heart block is usually asymptomatic and does not require treatment.

      Second-degree heart block can be further divided into two types: Mobitz type 1 and Mobitz type 2. Mobitz type 1, also known as Wenckebach’s phenomenon, is characterized by a progressive lengthening of the PR interval until a QRS complex is dropped. Mobitz type 2, on the other hand, is characterized by intermittent P waves that fail to conduct to the ventricles, leading to intermittent dropped QRS complexes. This type of heart block often progresses to complete heart block.

      Complete heart block, also known as third-degree heart block, occurs when there is no association between P waves and QRS complexes. The ventricular rate is often slow, reflecting a ventricular escape rhythm as the ventricles are no longer controlled by the sinoatrial node pacemaker. This type of heart block requires immediate medical attention.

      Understanding the different types of heart block is important for proper diagnosis and treatment. If you experience any symptoms of heart block, such as dizziness, fainting, or chest pain, seek medical attention right away.

    • This question is part of the following fields:

      • Cardiology
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  • Question 42 - An 82-year-old woman is brought to the Emergency Department after experiencing a sudden...

    Incorrect

    • An 82-year-old woman is brought to the Emergency Department after experiencing a sudden loss of consciousness while shopping. Upon examination, she is fully alert and appears to be in good health.
      Her temperature is normal, and her blood glucose level is 5.8 mmol/l. Her cardiovascular system shows an irregular heart rate of 89 beats per minute with low volume, and her blood pressure is 145/120 mmHg while lying down and standing up. Her jugular venous pressure is not elevated, and her apex beat is forceful but undisplaced. Heart sounds include a soft S2 and a soft ejection systolic murmur that is loudest in the right second intercostal space, with a possible fourth heart sound heard. Her chest reveals occasional bibasal crackles that clear with coughing, and there is no peripheral edema. Based on these clinical findings, what is the most likely cause of her collapse?

      Your Answer: Mitral regurgitation

      Correct Answer: Aortic stenosis

      Explanation:

      Clinical Presentation of Aortic Stenosis

      Aortic stenosis is a condition that presents with symptoms of left ventricular failure, angina, and potential collapse or blackout if the stenosis is critical. A patient with significant aortic stenosis may exhibit several clinical signs, including a low-volume pulse, narrow pulse pressure, slow-rising carotid pulse, undisplaced sustained/forceful apex beat, soft or absent A2, ejection systolic murmur with a fourth heart sound, and pulmonary edema.

      It is important to note that aortic regurgitation would not cause the same examination findings as aortic stenosis. Aortic regurgitation typically presents with an early diastolic murmur and a collapsing pulse. Similarly, mixed mitral and aortic valve disease would not be evident in this clinical scenario, nor would mitral stenosis or mitral regurgitation. These conditions have distinct clinical presentations and diagnostic criteria.

    • This question is part of the following fields:

      • Cardiology
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  • Question 43 - Which statement about congenital heart disease is accurate? ...

    Incorrect

    • Which statement about congenital heart disease is accurate?

      Your Answer: Failure to thrive is often found associated with Fallot's tetralogy at under 3 months of age

      Correct Answer: In Down's syndrome with an endocardial cushion defect, irreversible pulmonary hypertension occurs earlier than in children with normal chromosomes

      Explanation:

      Common Congenital Heart Defects and their Characteristics

      An endocardial cushion defect, also known as an AVSD, is the most prevalent cardiac malformation in individuals with Down Syndrome. This defect can lead to irreversible pulmonary hypertension, which is known as Eisenmenger’s syndrome. It is unclear why children with Down Syndrome tend to have more severe cardiac disease than unaffected children with the same abnormality.

      ASDs, or atrial septal defects, may close on their own, and the likelihood of spontaneous closure is related to the size of the defect. If the defect is between 5-8 mm, there is an 80% chance of closure, but if it is larger than 8 mm, the chance of closure is minimal.

      Tetralogy of Fallot, a cyanotic congenital heart disease, typically presents after three months of age. The murmur of VSD, or ventricular septal defect, becomes more pronounced after one month of life. Overall, the characteristics of these common congenital heart defects is crucial for proper diagnosis and treatment.

    • This question is part of the following fields:

      • Cardiology
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  • Question 44 - A 42-year-old man presents to the Emergency Department with severe central chest pain....

    Incorrect

    • A 42-year-old man presents to the Emergency Department with severe central chest pain. The pain is exacerbated by lying down, relieved by sitting forward, and radiates to the left shoulder. He has recently undergone two cycles of radiotherapy for prostate cancer. Upon examination, his blood pressure is 96/52 mmHg (normal <120/80 mmHg), his jugular venous pressure (JVP) is elevated, and his pulse is 98 bpm, which appears to fade on inspiration. Heart sounds are faint. The electrocardiogram (ECG) reveals low-voltage QRS complexes.
      What is the most appropriate initial management for this condition?

      Your Answer: GTN spray

      Correct Answer: Urgent pericardiocentesis

      Explanation:

      The patient is experiencing cardiac tamponade, which is caused by fluid in the pericardial sac compressing the heart and reducing ventricular filling. This is likely due to pericarditis caused by recent radiotherapy. Beck’s triad of low blood pressure, raised JVP, and muffled heart sounds are indicative of tamponade. Urgent pericardiocentesis is necessary to aspirate the pericardial fluid using a 20 ml syringe and 18G needle under echocardiographic guidance. An ECG should be obtained to rule out MI and PE. GTN spray is used to manage MI, but it is not part of the treatment for tamponade. DC cardioversion is used for unstable cardiac arrhythmias, not tamponade. A fluid challenge with 1 liter of sodium chloride is not recommended as it may worsen the tamponade. LMWH is used to manage pulmonary embolus, but it is not appropriate for tamponade and may worsen the condition if the cause is haemopericardium.

    • This question is part of the following fields:

      • Cardiology
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  • Question 45 - A 50-year-old man with hypertension and type II diabetes mellitus presented to the...

    Incorrect

    • A 50-year-old man with hypertension and type II diabetes mellitus presented to the Emergency Department with diaphoresis, severe central chest pain, and breathlessness. An ECG showed ST elevation in leads II, III, and aVF. Where is the probable location of the responsible arterial stenosis?

      Your Answer: Left anterior descending artery

      Correct Answer: Right coronary artery

      Explanation:

      Coronary Arteries and Their Associated Leads

      The heart is supplied with blood by the coronary arteries. Each artery supplies a specific area of the heart and can be identified by the leads on an electrocardiogram (ECG).

      The right coronary artery supplies the inferior part of the left ventricle, interventricular septum, and right ventricle. The circumflex artery predominantly supplies the left free wall of the left ventricle and would be picked up by leads I, aVL, and V5–6. The left anterior descending artery supplies the septum, apex, and anterior wall of the left ventricle and would be picked up by leads V1–4.

      Proximal aortic stenosis is very rare and would cause problems of perfusion in distal organs before reducing enough blood supply to the heart to cause a myocardial infarction. The left main stem splits into both the circumflex and left anterior descending arteries. Acute occlusion at this location would be catastrophic and a person is unlikely to survive to hospital. It would be picked up by leads V1–6, I, and aVL.

      Understanding the specific areas of the heart supplied by each coronary artery and their associated leads on an ECG can aid in the diagnosis and treatment of cardiac conditions.

    • This question is part of the following fields:

      • Cardiology
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  • Question 46 - An 85-year-old woman attends her general practice for a medication review. She is...

    Incorrect

    • An 85-year-old woman attends her general practice for a medication review. She is currently taking aspirin, simvastatin, atenolol, captopril and furosemide. The general practitioner (GP) performs an examination and notes an irregular pulse with a rate of 100 bpm. The GP makes a referral to the Cardiology Department with a view to establishing whether this woman’s atrial fibrillation (AF) is permanent or paroxysmal and to obtaining the appropriate treatment for her.
      Which of the following is the most recognised risk factor for the development of AF?

      Your Answer: Smoking

      Correct Answer: Alcohol

      Explanation:

      Understanding Risk Factors for Atrial Fibrillation

      Atrial fibrillation (AF) is a common cardiac arrhythmia that can lead to palpitations, shortness of breath, and fatigue. It is most commonly associated with alcohol consumption, chest disease, and hyperthyroidism. Other risk factors include hypertension, pericardial disease, congenital heart disease, cardiomyopathy, valvular heart disease, and coronary heart disease. AF can be classified as paroxysmal, persistent, or permanent, and may be diagnosed incidentally through an electrocardiogram (ECG) finding.

      Once diagnosed, management includes investigating with a 12-lead ECG, echocardiogram, and thyroid function tests. The main objectives are rate control, rhythm control, and reducing the risk of thromboembolic disease. Rhythm control can be achieved through electrical cardioversion or drug therapy, while rate control is managed using medications such as digoxin, β-blockers, or rate-limiting calcium antagonists. Warfarin is indicated for patients with risk factors for stroke, and the risk of ischaemic stroke is calculated using the CHADS2vasc scoring system. Novel oral anticoagulants are also available as an alternative to warfarin in certain patients.

      While hyperthyroidism is a recognized risk factor for AF, obesity and smoking are also associated with an increased risk of developing the condition. Pneumothorax, however, is not a recognized risk factor for AF. Understanding these risk factors can help individuals take steps to reduce their risk of developing AF and manage the condition if diagnosed.

    • This question is part of the following fields:

      • Cardiology
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  • Question 47 - What hormone does the heart produce under stressed conditions? ...

    Incorrect

    • What hormone does the heart produce under stressed conditions?

      Your Answer: Angiotensin II

      Correct Answer: B-type natriuretic peptide (BNP)

      Explanation:

      The cardiovascular system relies on a complex network of hormones and signaling molecules to regulate blood pressure, fluid balance, and other physiological processes. Here are some key players in this system:

      B-type natriuretic peptide (BNP): This hormone is secreted by the ventricle in response to stretch, and levels are elevated in heart failure.

      Angiotensin II: This hormone is produced mostly in the lungs where angiotensin-converting enzyme (ACE) concentrations are maximal.

      C-type natriuretic peptide: This signaling molecule is produced by the endothelium, and not the heart.

      Nitric oxide: This gasotransmitter is released tonically from all endothelial lined surfaces, including the heart, in response to both flow and various agonist stimuli.

      Renin: This enzyme is released from the kidney, in response to reductions in blood pressure, increased renal sympathetic activity or reduced sodium and chloride delivery to the juxtaglomerular apparatus.

      Understanding the roles of these hormones and signaling molecules is crucial for managing cardiovascular health and treating conditions like heart failure.

    • This question is part of the following fields:

      • Cardiology
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  • Question 48 - A 38-year-old man presents to his GP for a routine health check. Upon...

    Incorrect

    • A 38-year-old man presents to his GP for a routine health check. Upon physical examination, no abnormalities are found. However, laboratory test results reveal the following:
      - Serum glucose: 4.5 mmol/L
      - Haemoglobin A1c: 4.2% (22 mmol/mol)
      - Total cholesterol: 5.8 mmol/L
      - LDL cholesterol: 4.2 mmol/L
      - HDL cholesterol: 0.6 mmol/L

      Based on these results, what is the most likely mechanism for injury to the vascular endothelium in this patient?

      Your Answer: Accumulation of sorbitol

      Correct Answer: Collection of lipid in foam cells

      Explanation:

      Atherosclerosis and Related Conditions

      Atherosclerosis is a condition characterized by the accumulation of lipids in arterial walls, leading to the formation of atheromas. This process is often associated with hypercholesterolemia, where there is an increase in LDL cholesterol that can become oxidized and taken up by arterial wall LDL receptors. The oxidized LDL is then collected in macrophages, forming foam cells, which are precursors to atheromas. This process is exacerbated by hypertension, smoking, and diabetes, which can lead to the degradation of LDL to oxidized LDL and its uptake into arterial walls via scavenger receptors in macrophages.

      Diabetes mellitus with hyperglycemia is also associated with the accumulation of sorbitol in tissues that do not require insulin for glucose uptake. This accumulation can contribute to the development of atherosclerosis. However, neutrophilic inflammation, which is often the result of infection, is not related to atherosclerosis and is unusual in arteries. Additionally, atherosclerosis is not a neoplastic process, although mutations can result in neoplastic transformation.

      Overall, the process of atherogenesis is slow and does not involve significant inflammation or activation of complement. the underlying mechanisms of atherosclerosis and related conditions can help in the development of effective prevention and treatment strategies.

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      • Cardiology
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  • Question 49 - A 56-year-old man presents to the Emergency Department with crushing substernal chest pain...

    Incorrect

    • A 56-year-old man presents to the Emergency Department with crushing substernal chest pain that radiates to the jaw. He has a history of poorly controlled hypertension and uncontrolled type II diabetes mellitus for the past 12 years. An electrocardiogram (ECG) reveals ST elevation, and he is diagnosed with acute myocardial infarction. The patient undergoes percutaneous coronary intervention (PCI) and stenting and is discharged from the hospital. Eight weeks later, he experiences fever, leukocytosis, and chest pain that is relieved by leaning forwards. There is diffuse ST elevation in multiple ECG leads, and a pericardial friction rub is heard on auscultation. What is the most likely cause of the patient's current symptoms?

      Your Answer: Infectious myocarditis

      Correct Answer: Dressler’s syndrome

      Explanation:

      Complications of Transmural Myocardial Infarction

      Transmural myocardial infarction can lead to various complications, including Dressler’s syndrome and ventricular aneurysm. Dressler’s syndrome typically occurs weeks to months after an infarction and is characterized by acute fibrinous pericarditis, fever, pleuritic chest pain, and leukocytosis. On the other hand, ventricular aneurysm is characterized by a systolic bulge in the precordial area and predisposes to stasis and thrombus formation. Acute fibrinous pericarditis, which manifests a few days after an infarction, is not due to an autoimmune reaction. Reinfarction is unlikely in a patient who has undergone successful treatment for STEMI. Infectious myocarditis, caused by viruses such as Coxsackie B, Epstein-Barr, adenovirus, and echovirus, is not the most likely cause of the patient’s symptoms, given his medical history.

      Complications of Transmural Myocardial Infarction

    • This question is part of the following fields:

      • Cardiology
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  • Question 50 - A 55-year-old man was brought to the Emergency Department following a car accident....

    Incorrect

    • A 55-year-old man was brought to the Emergency Department following a car accident. Upon examination, there are no visible signs of external bleeding, but his blood pressure is 90/40 mmHg and his heart rate is 120 bpm. He presents with distended neck veins and muffled heart sounds.

      What is the most probable echocardiogram finding in this case?

      Your Answer: Pneumothorax

      Correct Answer: Pericardial effusion

      Explanation:

      Differential Diagnosis for a Trauma Patient with Beck’s Triad

      When a trauma patient presents with hypotension, tachycardia, distended neck veins, and muffled heart sounds, the clinician should suspect pericardial effusion, also known as cardiac tamponade. This condition occurs when fluid accumulates in the pericardial space, compressing the heart and impairing its function. In the context of chest trauma, pericardial effusion is a life-threatening emergency that requires prompt diagnosis and treatment.

      Other conditions that may cause similar symptoms but have different underlying mechanisms include mitral regurgitation, pneumothorax, haemothorax, and pleural effusion. Mitral regurgitation refers to the backflow of blood from the left ventricle to the left atrium due to a faulty mitral valve. While it can be detected on an echocardiogram, it is unlikely to cause Beck’s triad as it does not involve fluid accumulation outside the heart.

      Pneumothorax is the presence of air in the pleural space, which can cause lung collapse and respiratory distress. A tension pneumothorax, in which air accumulates under pressure and shifts the mediastinum, can also compress the heart and impair its function. However, it would not be visible on an echocardiogram, which focuses on the heart and pericardium.

      Haemothorax is the accumulation of blood in the pleural space, usually due to chest trauma or surgery. Like pneumothorax, it can cause respiratory compromise and hypovolemia, but it does not affect the heart directly and would not cause Beck’s triad.

      Pleural effusion is a generic term for any fluid accumulation in the pleural space, which can be caused by various conditions such as infection, cancer, or heart failure. While it may cause respiratory symptoms and chest pain, it does not affect the heart’s function and would not cause Beck’s triad or be visible on an echocardiogram.

      In summary, a trauma patient with Beck’s triad should be evaluated for pericardial effusion as the most likely cause, but other conditions such as tension pneumothorax or haemothorax should also be considered depending on the clinical context. An echocardiogram can help confirm or rule out pericardial effusion and guide further management.

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      • Cardiology
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  • Question 51 - A 70-year-old male presents with abdominal pain.

    He has a past medical history...

    Incorrect

    • A 70-year-old male presents with abdominal pain.

      He has a past medical history of stroke and myocardial infarction. During examination, there was noticeable distension of the abdomen and the stools were maroon in color. The lactate level was found to be 5 mmol/L, which is above the normal range of <2.2 mmol/L.

      What is the most probable diagnosis for this patient?

      Your Answer: Anal fissure

      Correct Answer: Acute mesenteric ischaemia

      Explanation:

      Acute Mesenteric Ischaemia

      Acute mesenteric ischaemia is a condition that occurs when there is a disruption in blood flow to the small intestine or right colon. This can be caused by arterial or venous disease, with arterial disease further classified as non-occlusive or occlusive. The classic triad of symptoms associated with acute mesenteric ischaemia includes gastrointestinal emptying, abdominal pain, and underlying cardiac disease.

      The hallmark symptom of mesenteric ischaemia is severe abdominal pain, which may be accompanied by other symptoms such as nausea, vomiting, abdominal distention, ileus, peritonitis, blood in the stool, and shock. Advanced ischaemia is characterized by the presence of these symptoms.

      There are several risk factors associated with acute mesenteric ischaemia, including congestive heart failure, cardiac arrhythmias (especially atrial fibrillation), recent myocardial infarction, atherosclerosis, hypercoagulable states, and hypovolaemia. It is important to be aware of these risk factors and to seek medical attention promptly if any symptoms of acute mesenteric ischaemia are present.

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      • Cardiology
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  • Question 52 - A 60-year-old man with hypertension and hypercholesterolaemia experienced severe central chest pain lasting...

    Incorrect

    • A 60-year-old man with hypertension and hypercholesterolaemia experienced severe central chest pain lasting one hour. His electrocardiogram (ECG) in the ambulance reveals anterolateral ST segment elevation. Although his symptoms stabilized with medical treatment in the ambulance, he suddenly passed away while en route to the hospital.
      What is the probable reason for his deterioration and death?

      Your Answer: Papillary muscle rupture

      Correct Answer: Ventricular arrhythmia

      Explanation:

      Complications of Myocardial Infarction

      Myocardial infarction (MI) is a serious medical condition that can lead to various complications. Among these complications, ventricular arrhythmia is the most common cause of death. Malignant ventricular arrhythmias require immediate direct current (DC) electrical therapy to terminate the arrhythmias. Mural thrombosis, although it may cause systemic emboli, is not a common cause of death. Myocardial wall rupture and muscular rupture typically occur 4-7 days post-infarction, while papillary muscle rupture is also a possibility. Pulmonary edema, which can be life-threatening, is accompanied by symptoms of breathlessness and orthopnea. However, it can be treated effectively with oxygen, positive pressure therapy, and vasodilators.

      Understanding the Complications of Myocardial Infarction

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      • Cardiology
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  • Question 53 - A 75-year-old man presents to his General Practitioner with chest pain. The man...

    Incorrect

    • A 75-year-old man presents to his General Practitioner with chest pain. The man reports the pain as crushing in nature, exacerbated by exertion, particularly when climbing stairs in his home. The pain is typically relieved by rest, but he has experienced several episodes while watching television in the past two weeks. He has no other medical history and is generally in good health.
      What is the most suitable course of action?

      Your Answer: Provide lifestyle advice, including exercise recommendation

      Correct Answer: Refer to hospital for admission for observation and urgent elective angiogram

      Explanation:

      Appropriate Management for a Patient with Unstable Angina

      Unstable angina is a serious condition that requires urgent medical attention. In the case of a patient displaying textbook signs of unstable angina, such as crushing chest pain occurring at rest, admission to the hospital is necessary. Sending the patient home with only glyceryl trinitrate (GTN) spray is not appropriate, as the patient is at high risk of having a myocardial infarction (MI). Instead, the patient should be seen by Cardiology for consideration of an urgent elective angiogram.

      Prescribing ramipril and simvastatin is not indicated unless there is evidence of hypertension. Lifestyle advice, including exercise recommendation, is also not appropriate for a patient with unstable angina. The immediate problem should be addressed first, which is the need for an angiogram.

      It is important to differentiate between unstable and stable angina. Unstable angina presents with symptoms at rest, indicating a significant worsening of the patient’s cardiac disease. On the other hand, stable angina only presents with symptoms on exertion.

      Sending the patient for percutaneous coronary intervention (PCI) is not necessary unless there is evidence of an MI. The pain experienced due to angina will alleviate itself most commonly at rest, unless the angina is unstable. Therefore, an urgent elective angiogram is the appropriate management for a patient with unstable angina.

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      • Cardiology
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  • Question 54 - A 59-year-old man is admitted to the Intensive Care Unit from the Coronary...

    Incorrect

    • A 59-year-old man is admitted to the Intensive Care Unit from the Coronary Care Ward. He has suffered from an acute myocardial infarction two days earlier. On examination, he is profoundly unwell with a blood pressure of 85/60 mmHg and a pulse rate of 110 bpm. He has crackles throughout his lung fields, with markedly decreased oxygen saturations; he has no audible cardiac murmurs. He is intubated and ventilated, and catheterised.
      Investigations:
      Investigation Result Normal value
      Haemoglobin 121 g/l 135–175 g/l
      White cell count (WCC) 5.8 × 109/l 4–11 × 109/l
      Platelets 285 × 109/l 150–400 × 109/l
      Sodium (Na+) 128 mmol/l 135–145 mmol/l
      Potassium (K+) 6.2 mmol/l 3.5–5.0 mmol/l
      Creatinine 195 μmol/l 50–120 µmol/l
      Troponin T 5.8 ng/ml <0.1 ng/ml
      Urine output 30 ml in the past 3 h
      ECG – consistent with a myocardial infarction 48 h earlier
      Chest X-ray – gross pulmonary oedema
      Which of the following fits best with the clinical picture?

      Your Answer: An intra-aortic balloon pump may be of benefit

      Correct Answer:

      Explanation:

      Treatment Options for Cardiogenic Shock Following Acute Myocardial Infarction

      Cardiogenic shock following an acute myocardial infarction is a serious condition that requires prompt and appropriate treatment. One potential treatment option is the use of an intra-aortic balloon pump, which can provide ventricular support without compromising blood pressure. High-dose dopamine may also be used to preserve renal function, but intermediate and high doses can have negative effects on renal blood flow. The chance of death in this situation is high, but with appropriate treatment, it can be reduced to less than 10%. Nesiritide, a synthetic natriuretic peptide, is not recommended as it can worsen renal function and increase mortality. Nitrate therapy should also be avoided as it can further reduce renal perfusion and worsen the patient’s condition. Overall, careful consideration of treatment options is necessary to improve outcomes for patients with cardiogenic shock following an acute myocardial infarction.

    • This question is part of the following fields:

      • Cardiology
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  • Question 55 - A 50-year-old man with a long-standing history of hypertension visits his primary care...

    Incorrect

    • A 50-year-old man with a long-standing history of hypertension visits his primary care physician for a routine check-up. He mentions experiencing a painful, burning sensation in his legs when he walks long distances and feeling cold in his lower extremities. He has no history of dyslipidaemia. Upon examination, his temperature is 37.1 °C; the blood pressure in his left arm is 174/96 mmHg, heart rate 78 bpm, respiratory rate 16 breaths per minute, and oxygen saturation 98% on room air. He has 1+ dorsalis pedis pulses bilaterally, and his lower extremities are cool to the touch. Cardiac auscultation does not reveal any murmurs, rubs, or gallops. His abdominal examination is unremarkable, and no bruits are heard on auscultation. Renal function tests show a creatinine level of 71 μmol/l (50–120 μmol/l), which is his baseline. What is the most likely defect present in this patient?

      Your Answer: Renal artery stenosis

      Correct Answer: Coarctation of the aorta

      Explanation:

      Cardiovascular Conditions: Symptoms and Characteristics

      Coarctation of the Aorta, Patent Ductus Arteriosus, Renal Artery Stenosis, Atrial Septal Defect, and Bilateral Lower Extremity Deep Vein Thrombosis are all cardiovascular conditions that have distinct symptoms and characteristics.

      Coarctation of the Aorta is characterized by hypertension in the upper extremities and hypotension in the lower extremities. Patients may also experience lower extremity claudication due to low oxygen delivery. Chest X-rays may reveal notching of the ribs. Treatment involves surgical resection of the narrowed lumen.

      Patent Ductus Arteriosus refers to a persistent open lumen in the ductus arteriosus, causing a left-to-right shunt. A constant, machine-like murmur is detected on cardiac auscultation. If left untreated, it can lead to Eisenmenger syndrome and reverse to become a cyanotic right-to-left shunt.

      Renal Artery Stenosis causes decreased blood flow to the kidneys, leading to fluid retention and hypertension. A bruit is typically heard on auscultation of the abdomen, and creatinine levels may be elevated due to decreased renal perfusion.

      Atrial Septal Defect is a congenital abnormality that causes a left-to-right shunt. It can be detected by a fixed, widely split S2 on cardiac auscultation. If left untreated, it can lead to pulmonary hypertension and right heart failure.

      Bilateral Lower Extremity Deep Vein Thrombosis refers to blood clots in the deep veins of the legs, causing lower extremity swelling, warmth, and erythema. It does not cause hypertension, claudication, or cool lower extremities. Lower extremity arterial insufficiency may cause claudication.

    • This question is part of the following fields:

      • Cardiology
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  • Question 56 - A 28-year-old male presents with a blood pressure reading of 170/100 mmHg. Upon...

    Incorrect

    • A 28-year-old male presents with a blood pressure reading of 170/100 mmHg. Upon examination, he exhibits a prominent aortic ejection click and murmurs are heard over the ribs anteriorly and over the back. Additionally, he reports experiencing mild claudication with exertion and has feeble pulses in his lower extremities. What is the most probable diagnosis?

      Your Answer: Aortic stenosis

      Correct Answer: Coarctation of the aorta

      Explanation:

      Coarctation of the Aorta: Symptoms and Diagnosis

      Coarctation of the aorta is a condition that can present with various symptoms. These may include headaches, nosebleeds, cold extremities, and claudication. However, hypertension is the most typical symptom. A mid-systolic murmur may also be present over the anterior part of the chest, back, spinous process, and a continuous murmur may also be heard.

      One important radiographic finding in coarctation of the aorta is notching of the ribs. This is due to erosion by collaterals. It is important to diagnose coarctation of the aorta early on, as it can lead to serious complications such as heart failure, stroke, and aortic rupture.

    • This question is part of the following fields:

      • Cardiology
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  • Question 57 - A woman with known angina currently managed on glyceryl trinitrate (GTN) spray presents...

    Incorrect

    • A woman with known angina currently managed on glyceryl trinitrate (GTN) spray presents to Accident and Emergency with crushing central chest pain. A 12-lead electrocardiogram (ECG) reveals ST depression and flat T waves. She is managed as acute coronary syndrome without ST elevation.
      Which one of the following options is most likely to be used in her immediate management?

      Your Answer: Warfarin

      Correct Answer: Fondaparinux

      Explanation:

      Medications for Acute Coronary Syndrome: Indications and Uses

      Acute coronary syndrome (ACS) is a medical emergency that requires prompt and appropriate treatment to prevent further damage to the heart muscle. The management of ACS involves a combination of medications and interventions, depending on the type and severity of the condition. Here are some commonly used medications for ACS and their indications:

      1. Fondaparinux: This medication is a factor Xa inhibitor that is used for anticoagulation in ACS without ST-segment elevation. It is usually given along with other drugs such as aspirin, clopidogrel, and nitrates to prevent blood clots and reduce the risk of future cardiovascular events.

      2. Warfarin: This medication is used for the treatment and prevention of venous thrombosis and thromboembolism. It is not indicated for the immediate management of ACS.

      3. Furosemide: This medication is a diuretic that is used to treat pulmonary edema in patients with heart failure. It is not indicated for ACS as it may cause dehydration.

      4. Paracetamol: This medication is not effective as an analgesic option for ACS. Morphine is commonly used for pain relief in ACS.

      5. Simvastatin: This medication is a statin that is used for the long-term management of high cholesterol levels. It is not indicated for the initial management of ACS.

      In summary, the management of ACS involves a combination of medications and interventions that are tailored to the individual patient’s needs. Prompt and appropriate treatment can help improve outcomes and reduce the risk of future cardiovascular events.

    • This question is part of the following fields:

      • Cardiology
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  • Question 58 - A 50-year-old man with atrial fibrillation visited the Cardiology Clinic for electrophysiological ablation....

    Incorrect

    • A 50-year-old man with atrial fibrillation visited the Cardiology Clinic for electrophysiological ablation. What is the least frequent pathological alteration observed in atrial fibrillation?

      Your Answer: Left atrial thrombus

      Correct Answer: Fourth heart sound

      Explanation:

      Effects of Atrial Fibrillation on the Heart

      Atrial fibrillation is a condition characterized by irregular and rapid heartbeats. This condition can have several effects on the heart, including the following:

      Fourth Heart Sound: In conditions such as hypertensive heart disease, active atrial contraction can cause active filling of a stiff left ventricle, leading to the fourth heart sound. However, this sound cannot be heard in atrial fibrillation.

      Apical-Radial Pulse Deficit: Ineffective left ventricular filling can lead to cardiac ejections that cannot be detected by radial pulse palpation, resulting in the apical-radial pulse deficit.

      Left Atrial Thrombus: Stasis of blood in the left atrial appendage due to ineffective contraction in atrial fibrillation is the main cause of systemic embolisation.

      Reduction of Cardiac Output by 20%: Ineffective atrial contraction reduces left ventricular filling volumes, leading to a reduction in stroke volume and cardiac output by up to 20%.

      Symptomatic Palpitations: Palpitations are the most common symptom reported by patients in atrial fibrillation.

      Overall, atrial fibrillation can have significant effects on the heart and may require medical intervention to manage symptoms and prevent complications.

    • This question is part of the following fields:

      • Cardiology
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  • Question 59 - A previously healthy 58-year-old man collapsed while playing with his grandchildren. Although he...

    Incorrect

    • A previously healthy 58-year-old man collapsed while playing with his grandchildren. Although he quickly regained consciousness and became fully alert, his family called an ambulance. The emergency medical team found no abnormalities on the electrocardiogram. Physical examination was unremarkable. However, the patient was admitted to the Coronary Care Unit of the local hospital. During the evening, the patient was noted to have a fast rhythm with a wide complex on his monitor, followed by hypotension and loss of consciousness.
      After electrical cardioversion with 200 watt-seconds of direct current, which one of the following may possible therapy include?

      Your Answer: Digitalis

      Correct Answer: Amiodarone

      Explanation:

      The patient in the scenario is experiencing a fast rhythm with wide complexes, which is likely ventricular tachycardia (VT). As the patient is unstable, electrical cardioversion was attempted first, as recommended by the Resuscitation Council Guideline. If cardioversion fails and the patient remains unstable, intravenous amiodarone can be used as a loading dose of 300 mg over 10-20 minutes, followed by an infusion of 900 mg/24 hours. Amiodarone is a class III anti-arrhythmic agent that prolongs the repolarization phase of the cardiac action potential by blocking potassium efflux. Side-effects associated with amiodarone include deranged thyroid and liver function tests, nausea, vomiting, bradycardia, interstitial lung disease, jaundice, and sleep disorders.

      Epinephrine is used in the treatment of acute anaphylaxis and cardiopulmonary resuscitation. It acts on adrenergic receptors, causing bronchodilation and vasoconstriction. Side-effects associated with epinephrine include palpitations, arrhythmias, headache, tremor, and hypertension.

      Intravenous propranolol is a non-selective β-adrenergic receptor blocker that has limited use in treating arrhythmias and thyrotoxic crisis. It is contraindicated in patients with severe hypotension, asthma, COPD, bradycardia, sick sinus rhythm, atrioventricular block, and cardiogenic shock. Side-effects associated with propranolol include insomnia, nightmares, nausea, diarrhea, bronchospasm, exacerbation of Raynaud’s, bradycardia, hypotension, and heart block.

      Digoxin, a cardiac glycoside extracted from the plant genus Digitalis, can be used in the treatment of supraventricular arrhythmias and heart failure. However, it is of no use in this scenario as the patient is experiencing a broad complex tachycardia. Digoxin has a narrow therapeutic window, and even small changes in dosing can lead to toxicity. Side-effects associated with digoxin include nausea, vomiting, diarrhea, bradycardia, dizziness, yellow vision, and eosinophilia.

      Diltiazem, a non-dihydropyridine calcium channel blocker, is normally used for hypertension and prophylaxis and treatment of ang

    • This question is part of the following fields:

      • Cardiology
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  • Question 60 - What condition would make exercise testing completely unsafe? ...

    Correct

    • What condition would make exercise testing completely unsafe?

      Your Answer: Severe aortic stenosis

      Explanation:

      Contraindications for Exercise Testing

      Exercise testing is a common diagnostic tool used to evaluate a patient’s cardiovascular health. However, there are certain conditions that make exercise testing unsafe or inappropriate. These conditions are known as contraindications.

      Absolute contraindications for exercise testing include acute myocardial infarction (heart attack) within the past two days, unstable angina, uncontrolled cardiac arrhythmias, symptomatic severe aortic stenosis, uncontrolled heart failure, acute pulmonary embolism or pulmonary infarction, acute myocarditis or pericarditis, and acute aortic dissection. These conditions are considered absolute contraindications because they pose a significant risk to the patient’s health and safety during exercise testing.

      Relative contraindications for exercise testing include left main coronary stenosis, moderate stenotic valvular heart disease, electrolyte abnormalities, severe arterial hypertension, tachyarrhythmias or bradyarrhythmias, hypertrophic cardiomyopathy, mental or physical impairment leading to an inability to exercise adequately, and high-degree atrioventricular (AV) block. These conditions are considered relative contraindications because they may increase the risk of complications during exercise testing, but the benefits of testing may outweigh the risks in certain cases.

      It is important for healthcare providers to carefully evaluate a patient’s medical history and current health status before recommending exercise testing. If contraindications are present, alternative diagnostic tests may be necessary to ensure the safety and well-being of the patient.

    • This question is part of the following fields:

      • Cardiology
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SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiology (7/60) 12%
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