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  • Question 1 - During a routine GP check-up, a 33-year-old woman is found to have a...

    Incorrect

    • During a routine GP check-up, a 33-year-old woman is found to have a mid-diastolic rumbling murmur accompanied by a loud first heart sound. What valvular abnormality is likely causing this?

      Your Answer: Mitral regurgitation

      Correct Answer: Mitral stenosis

      Explanation:

      Valvular Murmurs

      Valvular murmurs are a common topic in medical exams, and it is crucial to have a good of them. The easiest way to approach them is by classifying them into systolic and diastolic murmurs. If the arterial valves, such as the aortic or pulmonary valves, are narrowed, ventricular contraction will cause turbulent flow, resulting in a systolic murmur. On the other hand, if these valves are incompetent, blood will leak back through the valve during diastole, causing a diastolic murmur.

      Similarly, the atrioventricular valves, such as the mitral and tricuspid valves, can be thought of in the same way. If these valves are leaky, blood will be forced back into the atria during systole, causing a systolic murmur. If they are narrowed, blood will not flow freely from the atria to the ventricles during diastole, causing a diastolic murmur.

      Therefore, a diastolic murmur indicates either aortic/pulmonary regurgitation or mitral/tricuspid stenosis. The loud first heart sound is due to increased force in closing the mitral or tricuspid valve, which suggests stenosis. the different types of valvular murmurs and their causes is essential for medical professionals to diagnose and treat patients accurately.

    • This question is part of the following fields:

      • Cardiology
      31.9
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  • Question 2 - What are the clinical signs that indicate a child has acute rheumatic fever...

    Correct

    • What are the clinical signs that indicate a child has acute rheumatic fever carditis?

      Your Answer: Pericardial rub

      Explanation:

      Acute Rheumatic Fever

      Acute rheumatic fever is a condition that occurs after a bacterial infection and is caused by pathogenic antibodies. It is characterized by a systemic inflammatory response that affects the heart, joints, and skin. The condition is triggered by antibodies that cross-react with cardiac tissue, which can lead to pancarditis, arthritis, and intra-dermal inflammation. The diagnosis of acute rheumatic fever is based on a combination of clinical and investigatory findings, which are known as the revised Jones criteria.

      The pancarditis associated with acute rheumatic fever can cause a sustained tachycardia, which is particularly prominent at night. Conduction abnormalities, including prolonged PR interval, are also common. Pericarditis may be detected clinically with a pericardial rub, and patients may exhibit features of congestive cardiac failure, such as cardiomegaly. Several murmurs are recognized in patients with acute rheumatic fever, including aortic regurgitation, mitral regurgitation, and the Carey Coombs murmur.

      In summary, acute rheumatic fever is a serious condition that can have significant effects on the heart, joints, and skin. Early diagnosis and treatment are essential to prevent complications and improve outcomes. The revised Jones criteria provide guidance for clinicians in making an accurate diagnosis and initiating appropriate treatment.

    • This question is part of the following fields:

      • Cardiology
      15.7
      Seconds
  • Question 3 - A 65-year-old man presents to the Emergency Department with sudden onset epigastric discomfort....

    Incorrect

    • A 65-year-old man presents to the Emergency Department with sudden onset epigastric discomfort. He has a significant past medical history of hypercholesterolaemia and type II diabetes mellitus, and he is a heavy smoker. On examination, his pulse is 30 bpm; he is hypotensive and has distended neck veins. The chest is clear to auscultation. Initial blood tests reveal an elevated troponin level, and an electrocardiogram (ECG) shows hyperacute T-waves in leads II, III and aVF.
      What is the most likely diagnosis?

      Your Answer: Anterolateral MI

      Correct Answer: Right/inferior MI

      Explanation:

      Understanding the Different Types of Myocardial Infarction: A Guide to ECG Changes and Symptoms

      Myocardial infarction (MI) can occur in different areas of the heart, depending on which artery is occluded. Right/inferior MIs, which account for up to 40-50% of cases, are caused by occlusion of the RCA or, less commonly, a dominant left circumflex artery. Symptoms include bradycardia, hypotension, and a clear chest on auscultation. Conduction disturbances, particularly type II and III heart blocks, are also common. ECG changes include ST-segment elevation in leads II, III, and aVF, and reciprocal ST-segment depression in aVL (± lead I).

      Anterolateral MIs are possible, but less likely to present with bradycardia, hypotension, and a clear chest. An anterior MI, caused by occlusion of the LAD, is associated with tachycardia rather than bradycardia.

      Other conditions, such as acute pulmonary edema and pulmonary embolism, may present with similar symptoms but have different ECG changes and additional features. Understanding the ECG changes and symptoms associated with different types of MI can help with accurate diagnosis and appropriate treatment.

    • This question is part of the following fields:

      • Cardiology
      103
      Seconds
  • Question 4 - A 20-year-old female patient visited her doctor complaining of general malaise, lethargy, and...

    Incorrect

    • A 20-year-old female patient visited her doctor complaining of general malaise, lethargy, and fatigue. She couldn't pinpoint when the symptoms started but felt that they had been gradually developing for a few months. During the physical examination, the doctor detected a murmur and referred her to a cardiologist based on the findings. The cardiac catheterization results are as follows:

      Anatomical site Oxygen saturation (%) Pressure (mmHg)
      End systolic/End diastolic
      Superior vena cava 77 -
      Right atrium (mean) 79 7
      Right ventricle 78 -
      Pulmonary artery 87 52/17
      Pulmonary capillary wedge pressure - 16
      Left ventricle 96 120/11
      Aorta 97 120/60

      What is the most accurate description of the murmur heard during the chest auscultation of this 20-year-old woman?

      Your Answer: A pansystolic murmur, heard loudest at the apex and radiating to the axilla

      Correct Answer: A continuous 'machinery' murmur at the left upper sternal edge with late systolic accentuation

      Explanation:

      Characteristics of Patent Ductus Arteriosus

      Patent ductus arteriosus is a condition that is characterized by an unusual increase in oxygen saturation between the right ventricle and pulmonary artery. This is often accompanied by elevated pulmonary artery pressures and a high wedge pressure. These data are typical of this condition and can be used to diagnose it. It is important to note that patent ductus arteriosus can lead to serious complications if left untreated, including heart failure and pulmonary hypertension. Therefore, early detection and treatment are crucial for improving outcomes and preventing long-term complications.

    • This question is part of the following fields:

      • Cardiology
      202.9
      Seconds
  • Question 5 - A 25-year-old man presents to the Emergency Department with severe vomiting and diarrhoea...

    Incorrect

    • A 25-year-old man presents to the Emergency Department with severe vomiting and diarrhoea that has lasted for four days. He has been unable to keep down any fluids and is dehydrated, so he is started on an intravenous infusion. Upon investigation, his potassium level is found to be 2.6 mmol/L (3.5-4.9). What ECG abnormality would you anticipate?

      Your Answer: Wide QRS complexes

      Correct Answer: S-T segment depression

      Explanation:

      Hypokalaemia and Hyperkalaemia

      Hypokalaemia is a condition characterized by low levels of potassium in the blood. This can be caused by excess loss of potassium from the gastrointestinal or renal tract, decreased oral intake of potassium, alkalosis, or insulin excess. Additionally, hypokalaemia can be seen if blood is taken from an arm in which IV fluid is being run. The characteristic ECG changes associated with hypokalaemia include S-T segment depression, U-waves, inverted T waves, and prolonged P-R interval.

      On the other hand, hyperkalaemia is a condition characterized by high levels of potassium in the blood. This can be caused by kidney failure, medications, or other medical conditions. The changes that may be seen with hyperkalaemia include tall, tented T-waves, wide QRS complexes, and small P waves.

      It is important to understand the causes and symptoms of both hypokalaemia and hyperkalaemia in order to properly diagnose and treat these conditions. Regular monitoring of potassium levels and ECG changes can help in the management of these conditions.

    • This question is part of the following fields:

      • Cardiology
      55.4
      Seconds
  • Question 6 - A 60-year-old woman undergoes cardiac catheterisation. A catheter is inserted in her right...

    Correct

    • A 60-year-old woman undergoes cardiac catheterisation. A catheter is inserted in her right femoral vein in the femoral triangle and advanced through the iliac veins and inferior vena cava to the right side of the heart so that right chamber pressures can be recorded.
      What two other structures pass within the femoral triangle?

      Your Answer: Femoral artery, femoral nerve

      Explanation:

      Anatomy of the Femoral Triangle

      The femoral triangle is a triangular area on the anterior aspect of the thigh, formed by the crossing of various muscles. Within this area, the femoral vein, femoral artery, and femoral nerve lie medial to lateral (VAN). It is important to note that the inguinal lymph nodes and saphenous vein are not part of the femoral triangle. Understanding the anatomy of the femoral triangle is crucial for medical professionals when performing procedures in this area.

    • This question is part of the following fields:

      • Cardiology
      15.1
      Seconds
  • Question 7 - 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: Acute myocardial infarction

      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
      267.1
      Seconds
  • Question 8 - A 30-year-old woman patient presents with a subacute history of lethargy and low-grade...

    Correct

    • A 30-year-old woman patient presents with a subacute history of lethargy and low-grade fever. Among other findings, full clinical examination reveals retinal haemorrhages with pale centres, painful red raised lesions on the hands and feet and subcentimetre, non-tender, raised papules on the palms and soles of the feet.
      What is the underlying condition?

      Your Answer: Endocarditis

      Explanation:

      Clinical Signs and Diagnosis of Subacute Bacterial Endocarditis

      Subacute bacterial endocarditis (SBE) is a condition caused by Streptococcus viridans, an oral commensal, and presents with malaise, weakness, and low-grade fever. Diagnosis is often delayed due to non-specific presentation, but it should be suspected in any febrile or unwell patient with a new or changing murmur. The three classic clinical signs of SBE are finger clubbing, Roth spots, and Osler’s nodes, along with Janeway lesions, which are subcentimeter, non-tender, raised papules on the palms and soles of the feet. Confirmation of SBE usually requires three separate sets of blood cultures taken in a 24-hour period, ideally during times the patient is febrile.

      While Janeway lesions may be found in systemic lupus erythaematosus (SLE), the combination of the three described findings is unique to SBE. Tuberculosis does not present with the above constellation of findings but would be expected to present with chronic cough, haemoptysis, fever, and night sweats. Subacute meningococcal septicaemia typically gives a non-blanching petechial rash in the context of fulminating sepsis and does not present subacutely as described here. Rheumatoid arthritis (RA) patients may have subcutaneous rheumatoid nodules on the extensor surfaces of the limbs, but RA does not give the findings described.

    • This question is part of the following fields:

      • Cardiology
      73
      Seconds
  • Question 9 - A 57-year-old woman presents to the Emergency Department with sudden onset of palpitations...

    Incorrect

    • A 57-year-old woman presents to the Emergency Department with sudden onset of palpitations and shortness of breath. She is speaking in broken sentences and appears distressed, with visible sweating. Her vital signs are as follows: blood pressure 70/30, heart rate 180 bpm, respiratory rate 28, and sats 98% on air. Upon auscultation, there are crepitations at both lung bases. The patient reports experiencing crushing chest pain during the assessment. A 12-lead electrocardiogram (ECG) reveals a regular broad complex tachycardia. What is the most appropriate next step in managing this patient?

      Your Answer: Loading dose of intravenous (iv) amiodarone 300 mg

      Correct Answer: Sedation and synchronised direct current (DC) shock

      Explanation:

      Management of Ventricular Tachycardia with a Pulse: Choosing the Right Intervention

      When faced with a patient in ventricular tachycardia (VT) with a pulse, the presence of adverse signs is a crucial factor in determining the appropriate intervention. Adverse signs such as syncope, chest pain, heart failure, and altered consciousness indicate imminent risk of deterioration and potential cardiac arrest. In such cases, prompt direct current (DC) cardioversion is necessary, and sedation may be required if the patient is conscious.

      While drug therapy may be an option in the absence of adverse signs, it is unlikely to work quickly enough in the presence of such signs. For instance, an amiodarone loading dose may not be effective in a patient with heart failure and shock. Similarly, beta blockers like iv metoprolol are not indicated in the acute management of VT with a pulse.

      In contrast, immediate precordial thump has limited utility and is only indicated in a witnessed monitored cardiac arrest. A fluid challenge may be given, but it is unlikely to address the underlying problem. Therefore, in the presence of adverse signs, DC shock is the best option for managing VT with a pulse.

    • This question is part of the following fields:

      • Cardiology
      81.1
      Seconds
  • Question 10 - A 60-year-old man is seen at cardiology outpatients 6 weeks after an anterior...

    Incorrect

    • A 60-year-old man is seen at cardiology outpatients 6 weeks after an anterior myocardial infarction. His wife complains that she cannot sleep at night due to his constant coughing and throat clearing.
      Which medication is likely causing these symptoms?

      Your Answer: Atenolol

      Correct Answer: Perindopril

      Explanation:

      Common Side-Effects of Cardiovascular Medications

      Cardiovascular medications are commonly prescribed to manage various heart conditions. However, they can also cause side-effects that can affect a patient’s quality of life. Here are some common side-effects of popular cardiovascular medications:

      Perindopril: This medication can cause a dry, persistent cough, as well as hyperkalaemia, fatigue, dizziness, and hypotension.

      Amiodarone: Side-effects of this medication include dizziness, visual disturbance, unco-ordination, tremors, paraesthesia, deranged liver function tests (LFTs), deranged thyroid function tests (TFTs), and lung fibrosis.

      Atenolol: β-blockers like atenolol can cause fatigue, Raynaud’s phenomenon, bronchospasm, change in bowel habit, and sexual dysfunction.

      Atorvastatin: Statins like atorvastatin can cause myopathy/myositis, derangement of glucose control, and deranged LFTs.

      Candesartan: Angiotensin receptor blockers like candesartan can cause dizziness, headache, hyperkalaemia, and first-dose orthostatic hypotension. They are often prescribed to patients who are intolerant of ACE inhibitors due to dry cough.

      In conclusion, patients taking cardiovascular medications should be aware of these potential side-effects and report any concerns to their healthcare provider.

    • This question is part of the following fields:

      • Cardiology
      22.7
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiology (3/10) 30%
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