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  • Question 1 - A 42 yr. old previously well woman presented with acute severe central chest...

    Incorrect

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

      Your Answer: Left ventricular aneurysm

      Correct Answer: Takotsubo cardiomyopathy

      Explanation:

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

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

    • This question is part of the following fields:

      • Cardiology
      31.1
      Seconds

  • Question 2 - 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
      24.1
      Seconds

  • Question 3 - A 42 yr. old female presented with pain in her calves during walking...

    Correct

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

      Your Answer: Type III hyperlipidaemia

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
      11.9
      Seconds

  • Question 4 - A 72 yr. old female patient with a history of atrial fibrillation was...

    Correct

    • 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: 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
      15.4
      Seconds

  • Question 5 - A 65 yr. old heavy smoker presented with acute central chest pain for...

    Correct

    • A 65 yr. old heavy smoker presented with acute central chest pain for 2 hours. Which of the following ECG findings is an indication for thrombolysis in this patient?

      Your Answer: 1 mm ST elevation in 2 limb leads

      Explanation:

      Thrombolytic therapy is indicated in patients with evidence of ST-segment elevation MI (STEMI) or presumably new left bundle-branch block (LBBB) presenting within 12 hours of the onset of symptoms if there are no contraindications to fibrinolysis. STEMI is defined as new ST elevation at the J point in at least two contiguous leads of 2 mm (0.2 mV) or more in men or 1.5 mm (0.15 mV) in women in leads V2-V3 and/or 1 mm (0.1 mV) or more in other contiguous limb leads.

    • This question is part of the following fields:

      • Cardiology
      9.2
      Seconds

  • Question 6 - A 45 yr. old male was discharged recently after treatment of bleeding peptic...

    Correct

    • 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: 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
      72
      Seconds

  • Question 7 - What is correct statement regarding pulsus alternans? ...

    Correct

    • What is correct statement regarding pulsus alternans?

      Your Answer: It is found in association with a third heart sound

      Explanation:

      Pulsus alternans is the alternation of one strong and one weak beat without a change in the cycle length. It occurs most commonly in heart failure due to increased resistance to LV ejection, as occurs in hypertension, aortic stenosis, coronary atherosclerosis, and dilated cardiomyopathy. Pulsus alternans is usually associated with an S3 gallop, which is associated with a poor prognosis. It usually disappears with treatment of the heart failure.

    • This question is part of the following fields:

      • Cardiology
      245
      Seconds

  • Question 8 - A 60 yr. old man presented with severe central chest pain for the...

    Correct

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

      Your Answer: Coronary angiography and rescue PCI

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
      237.3
      Seconds

  • Question 9 - A 50 yr. old male presented with episodes of collapse during the last...

    Correct

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

      Your Answer: Aortic stenosis

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
      56
      Seconds

  • Question 10 - A 85 yr. old male with a history of hypertension presented with a...

    Correct

    • A 85 yr. old male with a history of hypertension presented with a couple of pre-syncopal episodes. He describes these episodes as him having felt as if he was going to faint and he has had to sit down. There were no precipitating factors, associated chest pain or palpitations. He doesn't have chest pain, shortness of breath on exertion, orthopnoea or paroxysmal nocturnal dyspnoea. On examination he looked well. Blood pressure was 140/80 mmHg and pulse rate was 78 bpm which was irregular. His lungs were clear and heart sounds were normal. ECG showed sinus rhythm with occasional ventricular ectopic beats. Which of the following is an indication for permanent pacemaker implantation?

      Your Answer: Second-degree block associated with symptoms

      Explanation:

      Indications for permanent pacemaker implantation

      -Sinus node dysfunction
      -Acquired Atrioventricular(AV) block (Complete third-degree AV block with or without symptoms, Symptomatic second degree AV block, Mobitz type I and II, Exercise-induced second or third degree AV block in the absence of myocardial infarction, Mobitz II with widened QRS complex)
      -Chronic bifascicular block
      -After acute phase of myocardial infarction
      -Neurocardiogenic syncope and hypersensitive carotid sinus syndrome
      -Post cardiac transplantation
      -Hypertrophic cardiomyopathy
      -Pacing to detect and terminate tachycardia
      -Cardiac resynchronization therapy in patients with severe systolic heart failure
      -Patients with congenital heart disease

    • This question is part of the following fields:

      • Cardiology
      80.9
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiology (9/10) 90%
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