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  • Question 1 - A 28 yr. old primigravida in her 24th week of pregnancy presented with...

    Correct

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

      Your Answer: Tachycardia

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
      32.5
      Seconds

  • Question 2 - A 30 yr. old male was brought in with a history of a...

    Correct

    • A 30 yr. old male was brought in with a history of a stab injury to left chest. He was complaining of chest pain. On examination he was tachycardic, hypotensive and had an elevated JVP, pulsus paradoxus and muffled heart sounds. Respiratory examination was unremarkable. Which of the following is most probable diagnosis?

      Your Answer: Cardiac tamponade

      Explanation:

      Becks triad (hypotension, elevated systemic venous pressure, often with jugular venous distention and muffled heart sounds) is a characteristic collection of clinical findings found in cardiac tamponade. Pulsus paradoxus is also associated with it. The history and clinical findings in this scenario are compatible with the diagnosis of cardica tamponade. The normal respiratory examination excludes tension pneumothorax.

    • This question is part of the following fields:

      • Cardiology
      14.8
      Seconds

  • Question 3 - A 60 yr. old female presented with difficulty in breathing. What is the...

    Incorrect

    • A 60 yr. old female presented with difficulty in breathing. What is the clinical sign that will indicate the presence of established pulmonary hypertension?

      Your Answer: Displaced apex beat

      Correct Answer: Raised jugular venous pressure

      Explanation:

      A prominent A wave is observed in the jugular venous pulse and this indicates the presence of established pulmonary hypertension. In addition the pulmonic component of the second heart sound (P2) may be increased and the P2 may demonstrate fixed or paradoxical splitting. The signs of right ventricular failure include a high-pitched systolic murmur of tricuspid regurgitation, hepatomegaly, a pulsatile liver, ascites, and peripheral oedema.

    • This question is part of the following fields:

      • Cardiology
      10.5
      Seconds

  • Question 4 - A 75 yr. old male with rheumatoid arthritis underwent a colectomy 2 days...

    Correct

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

      Your Answer: IV diamorphine + arrange percutaneous coronary intervention

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
      23.6
      Seconds

  • Question 5 - A 60 year old male patient with a history of heavy smoking was...

    Correct

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

      Your Answer: None

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
      17.3
      Seconds

  • Question 6 - A 25 yr. old previously well female, in her 10th week of pregnancy...

    Correct

    • A 25 yr. old previously well female, in her 10th week of pregnancy presented with a left sided painful calf swelling. An ultrasound scan revealed deep venous thrombosis (DVT) of her left leg. Which of the following is the most appropriate management of this patient?

      Your Answer: Initiate and then continue treatment with heparin until delivery

      Explanation:

      Warfarin is contraindicated during pregnancy due to its teratogenic effects. She should be given heparin throughout her pregnancy. It can be converted to warfarin if necessary after the delivery.

    • This question is part of the following fields:

      • Cardiology
      27.1
      Seconds

  • Question 7 - A 55 yr. old male with a history of myocardial infarction 4 years...

    Correct

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

      Your Answer: IV benzylpenicillin

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
      24.2
      Seconds

  • Question 8 - A 60 yr. old male patient with hypertension presented with acute onset retrosternal...

    Correct

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

      Your Answer: Chewable aspirin 300 mg

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
      31.9
      Seconds

  • Question 9 - Which of the following is not associated with right axis deviation? ...

    Correct

    • Which of the following is not associated with right axis deviation?

      Your Answer: Wolf-Parkinson-White syndrome with right-sided accessory pathway

      Explanation:

      Causes for right axis deviation:
      -Right ventricular hypertrophy and Left posterior fascicular block
      -Lateral myocardial infarction.
      -Acute or chronic lung diseases: Pulmonary embolism, pulmonary hypertension, chronic obstructive pulmonary disease (COPD), cor pulmonale.
      -Congenital heart disease (e.g., dextrocardia, secundum atrial septal defect).
      -Wolff-Parkinson-White syndrome.
      -Ventricular ectopic rhythms (e.g., ventricular tachycardia).

    • This question is part of the following fields:

      • Cardiology
      27
      Seconds

  • Question 10 - A 60 yr. old male presented with ventricular tachycardia which was successfully cardioverted....

    Correct

    • A 60 yr. old male presented with ventricular tachycardia which was successfully cardioverted. To check whether he had prolonged QT interval, which of the following is the most appropriate method to measure the QT interval in ECG?

      Your Answer: Time between the start of the Q wave and the end of the T wave

      Explanation:

      The QT interval is the time from the start of the Q wave to the end of the T wave. It represents the time taken for ventricular depolarisation and repolarisation. The QT interval should be measured in either lead II or V5-6.

    • This question is part of the following fields:

      • Cardiology
      15.3
      Seconds

  • Question 11 - A 9 year-old boy with central cyanosis underwent cardiac catheterization. His study results...

    Incorrect

    • A 9 year-old boy with central cyanosis underwent cardiac catheterization. His study results were given below:
      • Right atrium 7 mmHg  - Saturation 60 %
      • Right ventricle 110/6 mmHg  - Saturation 55 %
      • Pulmonary artery 20/5 mmHg - Saturation 55 %
      • Left atrium (mean) 9 mmHg - Saturation 98 %
      • Left ventricle 110/80 mmHg - Saturation 87 %
      • Aorta 110/80 mmHg - Saturation 76 %
      Which the following abnormalities are present in this patient?

      Your Answer:

      Correct Answer: Tetralogy of Fallot

      Explanation:

      Based on the provided cardiac catheterization results, the following abnormalities are present in this patient:

      1. Central Cyanosis: The presence of central cyanosis indicates decreased oxygenation of the blood. This is likely due to an intracardiac shunt, causing unoxygenated blood to mix with oxygenated blood.
      2. Right-to-Left Shunt: The saturation readings in the right atrium (60%), right ventricle (55%), and pulmonary artery (55%) are all lower than the expected systemic saturation of 98%. This suggests a right-to-left shunt, allowing deoxygenated blood from the right side of the heart to enter the systemic circulation without passing through the lungs.
      3. Pulmonary Hypertension: The pulmonary artery pressure of 20/5 mmHg is elevated compared to normal values, indicating pulmonary hypertension. This could be secondary to increased pulmonary blood flow or resistance, often seen in the presence of a right-to-left shunt.
      4. Left-to-Right Shunt: Although not explicitly stated in the results, the elevated left atrial pressure (9 mmHg) suggests increased left-sided filling pressures. This could be due to increased blood flow from a left-to-right shunt, which commonly occurs in congenital heart defects.
      5. Normal Left Ventricular Pressure: The left ventricular pressure (110/80 mmHg) falls within normal limits, indicating that the left ventricle is not significantly affected by the shunting.

      Based on these findings, a likely diagnosis would be a congenital heart defect causing a right-to-left shunt, such as Tetralogy of Fallot or Eisenmenger syndrome, resulting in central cyanosis and pulmonary hypertension.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

  • Question 12 - A 35 yr. old female with systemic lupus erythematosus (SLE) was brought to...

    Incorrect

    • A 35 yr. old female with systemic lupus erythematosus (SLE) was brought to Casualty, complaining of chest pain and worsening difficulty in breathing for the past 36 hrs. On examination she was tachypnoeic, her BP was 85/65 mmHg and peripheral oxygen saturation was 98% on air. Her cardiac examination was normal but her jugular venous pressure was elevated. She didn't have ankle oedema. Her ECG showed sinus tachycardia and her CXR showed clear lung fields with a slightly enlarged heart. Which of the following is the most appropriate next step?

      Your Answer:

      Correct Answer: Urgent transthoracic echocardiogram

      Explanation:

      Acute breathlessness in SLE can be due to a pericardial effusion or a pulmonary embolism. Normal peripheral oxygen saturation and normal ECG, make the diagnosis of pulmonary embolism less likely. To exclude pericardial effusion, an urgent transthoracic echocardiogram is needed.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

  • Question 13 - A 50 yr. old smoker with a history of hypertension presented with acute...

    Incorrect

    • A 50 yr. old smoker with a history of hypertension presented with acute severe chest pain and acute myocardial infarction was diagnosed. Which of the following is a contraindication for thrombolysis?

      Your Answer:

      Correct Answer: History of likely ischaemic stroke within the past month

      Explanation:

      Absolute contraindications for fibrinolytic use in STEMI

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

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

  • Question 14 - A 70 yr. old male patient presented with increased difficulty in breathing during...

    Incorrect

    • A 70 yr. old male patient presented with increased difficulty in breathing during the last 4 months. He was diagnosed with mitral stenosis. On examination his BP was 120/80 mmHg and pulse rate was 68 bpm. There were bibasal crepitations on auscultation. He was on bisoprolol, frusemide and ISDN. From the given answers, what is the most likely indication of worsening of his mitral stenosis?

      Your Answer:

      Correct Answer: Haemoptysis

      Explanation:

      Haemoptysis is a symptom which indicates the worsening of mitral stenosis. It occurs due to the rupture of pulmonary veins or the capillary system due to pulmonary venous hypertension. Elevated serum creatinine is seen in worsening aortic stenosis. Worsening of tricuspid regurgitation causes ascites and a pulsatile liver.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

  • Question 15 - A 55 yr. old female with a history of hypertension presented with severe...

    Incorrect

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

      Your Answer:

      Correct Answer: Intracranial neoplasm

      Explanation:

      Absolute contraindications for fibrinolytic use in STEMI

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

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

  • Question 16 - A 30 yr. old male, who is the brother of a patient with...

    Incorrect

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

      Your Answer:

      Correct Answer: Echocardiography

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

  • Question 17 - A 34 yr. old male presented with exertional dyspnoea and chest pain for...

    Incorrect

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

      Your Answer:

      Correct Answer: Degree of left ventricular hypertrophy

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

  • Question 18 - A 65 yr. old male with a history of smoking and alcohol was...

    Incorrect

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

      Your Answer:

      Correct Answer: Stopping smoking

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

  • Question 19 - From the following responses, what is the commonest cardiovascular abnormality associated with Marfan's...

    Incorrect

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

      Your Answer:

      Correct Answer: Aortic root dilatation

      Explanation:

      The main cardiovascular manifestations associated with Marfan’s syndrome are aortic dilatation and mitral valve prolapse.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

  • Question 20 - Which one of the following responses is the least likely to be associated...

    Incorrect

    • Which one of the following responses is the least likely to be associated with primary pulmonary hypertension?

      Your Answer:

      Correct Answer: Recurrent pulmonary embolism

      Explanation:

      Connective-tissue diseases, liver cirrhosis, exposure to anorexigens and likely other alpha-adrenergic stimulants [e.g., cocaine, amphetamines] and HIV infection are associated with primary pulmonary hypertension. Recurrent pulmonary emboli, chronic lung diseases, left heart diseases are causes for secondary pulmonary hypertension. Pulmonary vascular hypertension after use of fenfluramine is rarely reported.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

  • Question 21 - A 72 yr. old female patient with a history of atrial fibrillation was...

    Incorrect

    • A 72 yr. old female patient with a history of atrial fibrillation was admitted with recurrent episodes of syncopal attacks. Her ECG showed torsade de pointes. What is the drug which does not cause the above presentation?

      Your Answer:

      Correct Answer: Omeprazole

      Explanation:

      Drugs causing torsades de pointes are Amiodarone, Chlorpromazine, Clarithromycin, Disopyramide, Dofetilide, Erythromycin, Haloperidol, Methadone, Procainamide, Quinidine, Sotalol, Levofloxacin, Moxifloxacin, Nilotinib, Ondansetron, Ranolazine, Sunitinib, Ziprasidone, Amitriptyline, Ciprofloxacin, Imipramine, Chlorthalidone, Dasatinib, Hydrochlorothiazide, Furosemide.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

  • Question 22 - Which of the following features of the jugular venous waveform indicates the closure...

    Incorrect

    • Which of the following features of the jugular venous waveform indicates the closure of the tricuspid valve?

      Your Answer:

      Correct Answer: c wave

      Explanation:

      The a wave indicates atrial contraction. The c wave indicates ventricular contraction and resulting bulging of the tricuspid valve into the right atrium during isovolumetric systole. The v wave indicates venous filling. The x descent indicates the atrium relaxation and the movement of tricuspid valve downward. The y descent indicates the filling of the ventricle after the opening of the tricuspid valve.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

  • Question 23 - A 25 yr. old female presented with a history of sudden collapse. She...

    Incorrect

    • A 25 yr. old female presented with a history of sudden collapse. She had been playing netball and had suddenly collapsed. This collapse had been accompanied by a brief period of loss of consciousness. She experienced palpitations for a brief period prior to losing consciousness. On examination her BP was 120/70 mmHg and pulse rate was 72 bpm, which was regular. The rest of the examination was also normal. She had similar experience of collapse, about two years ago. She was well except for these two incidents and she has not been on any medication. All the investigations done at the first presentation (2 years ago), including FBC, ECG and echocardiography were normal. Her ECG done at this presentation revealed QT prolongation of 0.50 s. FBC, CXR and other investigations were normal. Which of the following is the best way of managing this patient?

      Your Answer:

      Correct Answer: Start on a beta-blocker

      Explanation:

      Beta-blockers are drugs of choice for patients with LQTS. The protective effect of beta-blockers is related to their adrenergic blockade, which diminishes the risk of cardiac arrhythmias. They may also reduce the QT interval in some patients.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

  • Question 24 - A 60 yr. old male patient with NSTEMI was started on low dose...

    Incorrect

    • A 60 yr. old male patient with NSTEMI was started on low dose aspirin as secondary prevention. Which of the following, describe the action of aspirin as an antiplatelet agent?

      Your Answer:

      Correct Answer: Inhibits the production of thromboxane A2

      Explanation:

      The antithrombotic action of aspirin is due to inhibition of platelet function by acetylation of the platelet cyclooxygenase (COX) at the functionally important amino acid serine529. This prevents the access of the substrate (arachidonic aid) to the catalytic site of the enzyme at tyrosine385 and results in an irreversible inhibition of platelet-dependent thromboxane formation.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

  • Question 25 - Which of the following is the site where B-type natriuretic peptide is mainly...

    Incorrect

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

      Your Answer:

      Correct Answer: Ventricular myocardium

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

  • Question 26 - A 45 yr. old male was discharged recently after treatment of bleeding peptic...

    Incorrect

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

      Your Answer:

      Correct Answer: Primary angioplasty

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

  • Question 27 - A 25 yr. old male presented with acute severe central chest pain which...

    Incorrect

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

      Your Answer:

      Correct Answer: Aortic dissection

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

  • Question 28 - A 65 yr. male patient was started on warfarin for chronic atrial fibrillation...

    Incorrect

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

      Your Answer:

      Correct Answer: Factor XII

      Explanation:

      Carboxylation of factor II, VII, IX, X and protein C is affected by warfarin. Factor XII is not affected.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

  • Question 29 - A 50 yr. old male with a history of type II diabetes mellitus...

    Incorrect

    • A 50 yr. old male with a history of type II diabetes mellitus and hypertension presented with exertional dyspnoea and chest pain for 2 weeks. On examination his blood pressure was 145/80 mmHg. On auscultation reversed splitting of the second heart sound and bibasal crepitations were detected. What would be the most likely finding on his ECG?

      Your Answer:

      Correct Answer: Left bundle branch block

      Explanation:

      When closure of the pulmonary valve occurs before the aortic valve, reversed splitting occurs. The causes of reversed splitting are aortic stenosis, hypertrophic cardiomyopathy, left bundle branch block (LBBB), and a ventricular pacemaker.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

  • Question 30 - A 60 yr. old male with no past medical history presented to Casualty...

    Incorrect

    • A 60 yr. old male with no past medical history presented to Casualty with acute chest pain. ST elevation myocardial infarction (STEMI) is diagnosed following an ECG on arrival. He was subsequently successfully thrombolysed. Which of the following combinations of drugs is the most suitable combination for him to be taking 4 weeks after his STEMI?

      Your Answer:

      Correct Answer: ACE inhibitor + beta-blocker + statin + aspirin + clopidogrel

      Explanation:

      According to NICE guidelines (2013) all people who have had an acute MI, treatment should be offered with ACE inhibitor, dual antiplatelet therapy (aspirin plus a second antiplatelet agent), beta-blocker and a statin.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiology (9/10) 90%
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