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  • Question 1 - 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: Acute myocardial infarction

      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
      51.5
      Seconds

  • Question 2 - A 42 yr. old male patient who was on enalapril for hypertension presented...

    Incorrect

    • A 42 yr. old male patient who was on enalapril for hypertension presented with generalized body weakness. Investigations revealed hyperkalaemia. Which of the following can be expected in his ECG?

      Your Answer:

      Correct Answer: Tall, tented T waves

      Explanation:

      In hyperkalaemia the ECG will show tall, tented T waves as well as small P waves and widened QRS complexes. 

    • This question is part of the following fields:

      • Cardiology
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      Seconds

  • Question 3 - A 28 yr. old male was screened for hypertrophic cardiomyopathy (HOCM). His father...

    Incorrect

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

      Your Answer:

      Correct Answer: Septal wall thickness of 3.3 cm

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
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      Seconds

  • Question 4 - A 25 yr. old previously well female, in her 10th week of pregnancy...

    Incorrect

    • 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:

      Correct 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
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      Seconds

  • Question 5 - 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:

      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
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      Seconds

  • Question 6 - A 65 yr. old male presented with acute ST elevation myocardial infarction and...

    Incorrect

    • A 65 yr. old male presented with acute ST elevation myocardial infarction and thrombolysis was planned. Which of the following is an absolute contraindication for thrombolysis?

      Your Answer:

      Correct Answer: Intracerebral Haemorrhage

      Explanation:

      Absolute contraindications for fibrinolytic use in STEMI

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

    • This question is part of the following fields:

      • Cardiology
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      Seconds

  • Question 7 - 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
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      Seconds

  • Question 8 - A 30 yr. old male patient presented with palpitations that occur randomly at...

    Incorrect

    • A 30 yr. old male patient presented with palpitations that occur randomly at rest. There have however been episodes of fast palpitations and dizziness on exertion. On examination there was a systolic murmur at the apex as well as a prominent apex beat and the chest was clear. Which of the following is LEAST likely to suggest a diagnosis of hypertrophic cardiomyopathy?

      Your Answer:

      Correct Answer: A history of hypertension for 10 years

      Explanation:

      Hypertrophic cardiomyopathy is an autosomal dominant condition. Patients present with sudden cardiac death, dyspnoea, syncope and presyncope, angina, palpitations, orthopnoea and paroxysmal nocturnal dyspnoea, Congestive heart failure and dizziness. Physical findings include double or triple apical impulse, prominent a wave in the JVP, an ejection systolic crescendo-decrescendo murmur and a holosystolic murmur at the apex and axilla of mitral regurgitation.
      ECG shows ST-T wave abnormalities and LVH, axis deviation (right or left), conduction abnormalities (P-R prolongation, bundle-branch block), sinus bradycardia with ectopic atrial rhythm, atrial enlargement, abnormal and prominent Q wave in the anterior precordial and lateral limb leads.
      2D echocardiography shows abnormal systolic anterior leaflet motion of the mitral valve, LVH, left atrial enlargement, small ventricular chamber size, septal hypertrophy with septal-to-free wall ratio greater than 1.4:1, mitral valve prolapse and mitral regurgitation, decreased midaortic flow, partial systolic closure of the aortic valve in midsystole

    • This question is part of the following fields:

      • Cardiology
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      Seconds

  • Question 9 - A 30 yr. old male presented with exercise related syncope and dyspnoea for...

    Incorrect

    • A 30 yr. old male presented with exercise related syncope and dyspnoea for 2 weeks. His father passed away at the age of 40, due to sudden cardiac death. His ECG showed left ventricular hypertrophy with widespread T wave inversions. Which of the following is the most appropriate next investigation to confirm the diagnosis?

      Your Answer:

      Correct Answer: Transthoracic echo

      Explanation:

      The most likely diagnosis is hypertrophic obstructive cardiomyopathy which is suggestive by the history, positive family history and ECG findings. Two-dimensional echocardiography is diagnostic for hypertrophic cardiomyopathy. In general, a summary of echocardiography findings includes abnormal systolic anterior leaflet motion of the mitral valve, LV hypertrophy, left atrial enlargement, small ventricular chamber size, septal hypertrophy with septal-to-free wall ratio greater than 1.4:1, mitral valve prolapse and mitral regurgitation, decreased midaortic flow, and partial systolic closure of the aortic valve in midsystole.

    • This question is part of the following fields:

      • Cardiology
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      Seconds

  • Question 10 - A 72 yr. old male with a history of type II diabetes mellitus...

    Incorrect

    • A 72 yr. old male with a history of type II diabetes mellitus and hypertension for 15 years, presented with gradual onset difficulty in breathing on exertion and bilateral ankle swelling for the past 3 months. On examination he had mild ankle oedema. His JVP was not elevated. His heart sounds were normal but he had bibasal crepitations on auscultation. Which of the following clinical signs has the greatest sensitivity in detecting heart failure in this patient?

      Your Answer:

      Correct Answer: Third heart sound

      Explanation:

      The presence of a third heart sound is the most sensitive indicator of heart failure. All of the other signs can be found in heart failure with varying degrees.

    • This question is part of the following fields:

      • Cardiology
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  • Question 11 - A 68 yr. old male with history of poorly controlled hypertension was admitted...

    Incorrect

    • A 68 yr. old male with history of poorly controlled hypertension was admitted with shortness of breath on exertion, orthopnoea for three months. He was diagnosed with congestive cardiac failure and was started on digoxin 62.5 μg daily, furosemide 80mg daily and amiloride 10mg daily. On admission his lab results showed that his serum urea was 6 mmol/L and serum creatinine was 115 μmol/L. One month later he came for a follow up consultation. On examination he had bilateral ankle oedema. His blood pressure was 138/90 mmHg and pulse rate was 92 bpm. His JVP was not elevated. His apex beat was displaced laterally and he had a few bibasal crepitations on auscultation. There were no cardiac murmurs. His investigation results revealed the following: Serum sodium 143 mmol/L (137-144), Serum potassium 3.5 mmol/L (3.5-4.9), Serum urea 8 mmol/L (2.5-7.5), Serum creatinine 140 μmol/L (60-110), Serum digoxin 0.7 ng/mL (1.0-2.0). CXR showed cardiomegaly and a calcified aorta. ECG showed left ventricular hypertrophy. Which of the following is the most appropriate next step in the management of this patient?

      Your Answer:

      Correct Answer: Add an ACE inhibitor to the current regimen

      Explanation:

      From the given history the patient has NYHA grade III heart failure. He can be safely started on an ACE inhibitor as his serum potassium was towards the lower limit. As there an impairment of renal function, his urea, creatinine and serum electrolytes should be closely monitored after commencing an ACE inhibitor. Adding atenolol will not have any clinical benefit. Increasing the digoxin dose is not needed as the patient is in sinus rhythm. Increasing furosemide will only have symptomatic relief.

    • This question is part of the following fields:

      • Cardiology
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      Seconds

  • Question 12 - Which of the following indicates the opening of tricuspid valve in jugular venous...

    Incorrect

    • Which of the following indicates the opening of tricuspid valve in jugular venous waveform?

      Your Answer:

      Correct Answer: y descent

      Explanation:

      The a wave indicates atrial contraction. The c wave indicates ventricular contraction and the resulting bulging of 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 the tricuspid valve downward. The y descent indicates the filling of the ventricle after tricuspid opening.

    • This question is part of the following fields:

      • Cardiology
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      Seconds

  • Question 13 - A 52 yr. old female who was a smoker, with a history of...

    Incorrect

    • A 52 yr. old female who was a smoker, with a history of asymptomatic atrial septal defect (ASD) presented with difficulty in breathing on exertion and ankle oedema for the past 2 weeks. She has defaulted on her follow up for ASD. On examination she was cyanosed and clubbing was noted. Her pulse rate was 92 and blood pressure was 100/60 mmHg. Echocardiography revealed a dilated right ventricle of the heart. The right ventricular pressure was 90 mmHg. Significant tricuspid and pulmonary regurgitation were also noted. Which of the following is the most probable diagnosis?

      Your Answer:

      Correct Answer: Eisenmenger’s syndrome

      Explanation:

      According to echocardiography findings pulmonary pressure is closer to systemic blood pressure and it is evidence of pulmonary hypertension. Because of the reversal of shunt due to pulmonary hypertension, cyanosis and clubbing have developed. So the most probable diagnosis is Eisenmenger’s syndrome.

    • This question is part of the following fields:

      • Cardiology
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      Seconds

  • Question 14 - A 50 yr. old male patient with schizophrenia complained of chest pain and...

    Incorrect

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

      Your Answer:

      Correct Answer: IV magnesium

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
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  • Question 15 - A 60 yr. old man with previous history of myocardial infarction and hypertension...

    Incorrect

    • A 60 yr. old man with previous history of myocardial infarction and hypertension presented with severe retrosternal chest pain for the past 2 hours. During initial management he collapsed and pulseless ventricular tachycardia was detected. The external defibrillator arrived in 3 minutes. From the following answers, what is the most appropriate immediate management of this patient?

      Your Answer:

      Correct Answer: He should be given a precordial thump

      Explanation:

      A precordial thumb is not routinely recommended because of its very low success rate for cardioversion of a shockable rhythm. It’s only recommended when there is a delay in getting the defibrillator.

    • This question is part of the following fields:

      • Cardiology
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  • Question 16 - A 50 yr. old male presented with acute severe central chest pain and...

    Incorrect

    • A 50 yr. old male presented with acute severe central chest pain and acute ST elevation myocardial infarction was diagnosed. He was treated with streptokinase. 2 days later he was sweating excessively and he was found to be hypotensive. Which of the following cannot be considered as a reason for this presentation?

      Your Answer:

      Correct Answer: Hypotensive effect of streptokinase

      Explanation:

      Hypotensive effect of streptokinase occurs during the streptokinase infusion which is usually transient. Acute mitral regurgitation due to rupture of papillary muscles, ventricular septal defects and reinfarctions (left or right) are known to cause hypotension after 24 hrs. Pulmonary embolism is less likely but cannot be excluded.

    • This question is part of the following fields:

      • Cardiology
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      Seconds

  • Question 17 - A 65 yr. male patient was started on warfarin for chronic atrial fibrillation...

    Incorrect

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

      Your Answer:

      Correct Answer: Factor XII

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
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      Seconds

  • Question 18 - A 26 yr. old male was being investigated further following several hypertensive episodes....

    Incorrect

    • A 26 yr. old male was being investigated further following several hypertensive episodes. There was a marked difference in his systolic blood pressures between the right brachial and the right femoral arteries. Which of the following is most probable diagnosis?

      Your Answer:

      Correct Answer: Coarctation of the aorta

      Explanation:

      From the given physical findings (the difference in BP between the radial and femoral arteries), the most probable diagnosis is coarctation of the aorta.

    • This question is part of the following fields:

      • Cardiology
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  • Question 19 - 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
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      Seconds

  • Question 20 - 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
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  • Question 21 - 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
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  • Question 22 - A 24 yr. old male with a history of a cardiac murmur which...

    Incorrect

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

      Your Answer:

      Correct Answer: Ostium secundum atrial septal defect

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
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      Seconds

  • Question 23 - A 30 yr. old primigravida in her 23rd week of pregnancy presented with...

    Incorrect

    • A 30 yr. old primigravida in her 23rd week of pregnancy presented with palpitations. Her ECG showed supraventricular tachycardia (SVT). 15 minutes after admission the SVT spontaneously reverted to sinus rhythm. She had two episodes of SVT later which were associated with palpitations. Which of the following is the most appropriate treatment for this presentation?

      Your Answer:

      Correct Answer: Verapamil

      Explanation:

      Both long-acting calcium channel blockers and beta blockers improve symptoms of patients with SVT. Verapamil does not have adverse maternal or fetal side effects which would suggest that the use of verapamil in the treatment of supraventricular arrhythmias in pregnancy is safe and effective. Beta blockers are associated with intrauterine fetal growth restriction.

    • This question is part of the following fields:

      • Cardiology
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  • Question 24 - 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
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  • Question 25 - A 60 yr. old female presented after an acute overdose of amiodarone. Her...

    Incorrect

    • A 60 yr. old female presented after an acute overdose of amiodarone. Her blood pressure was 110/70 mmHg and pulse rate was 35 bpm. She was given 500mcg of atropine but there was no response. Which of the following is the most appropriate next step?

      Your Answer:

      Correct Answer: Isoprenaline

      Explanation:

      Permanent pacing is not indicated as the bradycardia is reversible. Temporary pacing is the definite treatment. Isoprenaline can be used until temporary pacing is available.

    • This question is part of the following fields:

      • Cardiology
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  • Question 26 - A 50 yr. old male patient presented with acute chest pain and a...

    Incorrect

    • A 50 yr. old male patient presented with acute chest pain and a non ST elevation myocardial infarction (NSTEMI) was diagnosed. He was threated with aspirin 300mg and 2 puffs of glyceral trin (GTN) spray. According to NICE guidelines, which of the following categories of patients should receive clopidogrel?

      Your Answer:

      Correct Answer: All patients

      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), a beta-blocker and a statin.

    • This question is part of the following fields:

      • Cardiology
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      Seconds

  • Question 27 - Which of the following gives the annual incidence of deep venous thrombosis (DVT)...

    Incorrect

    • Which of the following gives the annual incidence of deep venous thrombosis (DVT) in the general population?

      Your Answer:

      Correct Answer: about 2 per 1000

      Explanation:

      Annual incidence of DVT in the general population is about 1 per 1000 adults. So the most suitable answer is about 2 per 1000.

    • This question is part of the following fields:

      • Cardiology
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      Seconds

  • Question 28 - A 25 yr. old male presented with an episode of syncope. His examination...

    Incorrect

    • A 25 yr. old male presented with an episode of syncope. His examination findings were normal. He gave a history of sudden cardiac death of a close relative. His ECG showed incomplete right bundle-branch block and ST-segment elevations in the anterior precordial leads. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Brugada syndrome

      Explanation:

      Brugada syndrome is an autosomal dominant disorder characterized by sudden cardiac death. The positive family history and characteristic ECG findings are in favour of Brugada syndrome. Usually the physical findings are normal.

    • This question is part of the following fields:

      • Cardiology
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      Seconds

  • Question 29 - A 65 yr. old woman was referred due to a pulse rate of...

    Incorrect

    • A 65 yr. old woman was referred due to a pulse rate of 40 bpm. Which of the following answers is associated with the least risk of asystole?

      Your Answer:

      Correct Answer: Complete heart block with a narrow complex QRS

      Explanation:

      From the given answers, complete heart block with a narrow complex QRS complex is associated with the least risk of asystole. Transvenous pacing is indicated by the other given responses.

    • This question is part of the following fields:

      • Cardiology
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  • Question 30 - A 70 yr. old man underwent temporary transvenous pacing. While in the coronary...

    Incorrect

    • A 70 yr. old man underwent temporary transvenous pacing. While in the coronary care unit he developed pre-syncope. His pulse rate was 30 bpm. His ECG showed pacing spikes which were not related to QRS complexes. What is the most appropriate action that can be taken?

      Your Answer:

      Correct Answer: Increase the pacing voltage to a maximum

      Explanation:

      Pacemaker spikes on the ECG indicate that pacemaker is functioning. The most probable cause for this presentation is the change of the position of the tip of the pacing wire. Increasing the voltage will solve the problem. If it works, repositioning of the pacing wire should be done.

    • This question is part of the following fields:

      • Cardiology
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      Seconds

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