00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Mins)
Retry this test Dashboard

  • Question 1 - A 50 yr. old male presented with acute severe central chest pain and...

    Correct

    • 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: 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
      27.8
      Seconds

  • Question 2 - A 50 yr. old male patient with schizophrenia complained of chest pain and...

    Correct

    • 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: 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
      14.5
      Seconds

  • Question 3 - A 42 yr. old previously well woman presented with acute severe central chest...

    Correct

    • 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: 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
      73
      Seconds

  • Question 4 - A 50 yr. old male presented with episodes of collapse during the last...

    Incorrect

    • 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 regurgitation

      Correct 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
      104.2
      Seconds

  • Question 5 - Which of the following statements describe the mechanism of fibrates most accurately? ...

    Correct

    • Which of the following statements describe the mechanism of fibrates most accurately?

      Your Answer: Increased lipoprotein lipase activity via PPAR-alpha

      Explanation:

      The main mechanism of fibrate drugs is activation of gene transcription factors known as PPARs, particularly PPAR-α, which regulate the expression of genes that control lipoprotein metabolism. There are several consequences of PPAR-α activation, which reduce circulating LDL cholesterol and triglycerides and increase HDL cholesterol.

    • This question is part of the following fields:

      • Cardiology
      22.2
      Seconds

  • Question 6 - A 42 yr. old man presented with palpitations and shortness of breath on...

    Incorrect

    • A 42 yr. old man presented with palpitations and shortness of breath on exertion. On examination his lungs were clear and heart sounds were normal. There was a left sided parasternal heave. His electrocardiogram (ECG) revealed atrial fibrillation with right axis deviation. Echocardiography showed dilated right heart chambers. Left and right heart catheterisation study revealed the following: Inferior vena cava Oxygen saturations 63 %, Superior vena cava Oxygen saturations 59 %, Right atrium Oxygen saturations 77 %, Right ventricle Oxygen saturations 78 %, Pulmonary artery Oxygen saturations 82 %, Arterial saturation Oxygen saturations 98 %. What is the most likely diagnosis from the following answers?

      Your Answer: Patient ductus arteriosus

      Correct Answer: Atrial septal defect

      Explanation:

      Right ventricular volume overload is indicated by a parasternal heave and right axis deviation. Oxygen saturation in right atrium is higher than oxygen saturation of the inferior and superior vena cavae. So the most probable diagnosis is atrial septal defect.

    • This question is part of the following fields:

      • Cardiology
      47.5
      Seconds

  • Question 7 - A 60 yr. old previously well male was admitted with a suspected pulmonary...

    Correct

    • A 60 yr. old previously well male was admitted with a suspected pulmonary embolism. On examination his BP was 130/80 mmHg and pulse rate was 88 bpm. His CXR was normal. He was treated with low molecular weight heparin. Which of the following is the most appropriate initial lung investigation for this patient?

      Your Answer: Computed tomographic pulmonary angiography

      Explanation:

      Computed tomographic pulmonary angiography (CTPA) is the standard investigative tool, used for diagnosing a pulmonary embolism. Pulmonary angiography is indicated if CTPA is not available.

    • This question is part of the following fields:

      • Cardiology
      10.1
      Seconds

  • Question 8 - A 62 yr. old male presented with worsening breathlessness and fatiguability. On examination...

    Incorrect

    • A 62 yr. old male presented with worsening breathlessness and fatiguability. On examination there was bilateral ankle swelling and pulsatile liver. Auscultation revealed a pansystolic murmur best heard at the lower left sternal border. Which of the following is the most probable diagnosis?

      Your Answer: Mitral regurgitation

      Correct Answer: Tricuspid regurgitation

      Explanation:

      All the clinical features are suggestive of tricuspid regurgitation. The pansystolic murmur of mitral regurgitation is best heard at the apex.

    • This question is part of the following fields:

      • Cardiology
      16.7
      Seconds

  • Question 9 - A 30 yr. old male, who is the brother of a patient with...

    Correct

    • 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: 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
      10.4
      Seconds

  • Question 10 - A 65 yr. old previously well man was referred due to an abnormal...

    Incorrect

    • A 65 yr. old previously well man was referred due to an abnormal heart sound which was detected during a medical check up. On examination he looked well. His blood pressure was 120/70 mmHg and pulse rate was 68 bpm which was regular. His jugular venous pressure was not elevated and he didn't have ankle oedema. He had an early diastolic murmur, best heard at the left sternal edge, which was more clear in expiration when the patient leant forward. His lungs were clear. His FBC, Urea and electrolytes, LFTs and lipid profile were normal. His ECG showed sinus rhythm. His chest X-ray was normal. Echocardiography showed mild to moderate aortic regurgitation with normal left ventricular size and normal function. Which of the following is the most appropriate way of managing this patient?

      Your Answer: Start him on aspirin

      Correct Answer: Start him on an angiotensin-converting enzyme (ACE) inhibitor

      Explanation:

      Although this patient’s left ventricular function is normal at the time of examination, there is chance of deterioration of it due to aortic regurgitation. It is found that ACE inhibitors slow the development of left ventricular dysfunction. So this patient should be started on an ACE inhibitor.

    • This question is part of the following fields:

      • Cardiology
      79.9
      Seconds

  • Question 11 - A 30 yr. old male presented with exercise related syncope and dyspnoea for...

    Correct

    • 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: 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
      12.2
      Seconds

  • Question 12 - Which of the following is not an indication for an implantable cardiac defibrillator?...

    Incorrect

    • Which of the following is not an indication for an implantable cardiac defibrillator?

      Your Answer: Previous myocardial infarction with non-sustained VT on 24 hr monitoring

      Correct Answer: Wolff-Parkinson White syndrome

      Explanation:

      Class I indications (i.e., the benefit greatly outweighs the risk, and the treatment should be administered): -Structural heart disease, sustained VT
      -Syncope of undetermined origin, inducible VT or VF at electrophysiologic study (EPS)
      -Left ventricular ejection fraction (LVEF) ≤35% due to prior MI, at least 40 days post-MI, NYHA class II or III
      -LVEF ≤35%, NYHA class II or III
      -LVEF ≤30% due to prior MI, at least 40 days post-MI
      -LVEF ≤40% due to prior MI, inducible VT or VF at EPS

      Class IIa indications (i.e., the benefit outweighs the risk and it is reasonable to administer the treatment):
      -Unexplained syncope, significant LV dysfunction, nonischaemic cardiomyopathy
      -Sustained VT, normal or near-normal ventricular function
      -Hypertrophic cardiomyopathy with 1 or more major risk factors
      -Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) with 1 or more risk factors for sudden cardiac death (SCD)
      -Long QT syndrome, syncope or VT while receiving beta-blockers
      -Nonhospitalized patients awaiting heart transplant
      -Brugada syndrome, syncope or VT
      -Catecholaminergic polymorphic VT, syncope or VT while receiving beta-blockers
      -Cardiac sarcoidosis, giant cell myocarditis, or Chagas disease

    • This question is part of the following fields:

      • Cardiology
      17.6
      Seconds

  • Question 13 - A 65 yr. old male patient presented with acute severe central chest pain...

    Correct

    • A 65 yr. old male patient presented with acute severe central chest pain for one hour. His ECG confirmed the diagnosis of acute ST elevation myocardial infarction and he was treated with thrombolysis. Two days later he developed sudden onset breathlessness and became unwell. On examination he had bibasal crepitation and a systolic murmur at the apex which radiated to the axilla. Which of the following is the most likely cause for this presentation?

      Your Answer: Ruptured papillary muscle

      Explanation:

      The most likely cause for acute breathlessness is due to papillary muscle rupture which causes mitral regurgitation.

    • This question is part of the following fields:

      • Cardiology
      18.3
      Seconds

  • Question 14 - 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: Complete heart block with a broad complex QRS

      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
      22.5
      Seconds

  • Question 15 - A 65 yr. old man with hypertension presented with sudden onset right arm...

    Correct

    • A 65 yr. old man with hypertension presented with sudden onset right arm weakness which resolved after 10 hrs. He has had 2 similar episodes during the last 6 weeks. On examination his blood pressure was 140/80 mmHg and pulse rate was 88 bpm. His ECG showed atrial fibrillation and the CT scan of his brain was normal. Which of the following is the most appropriate management for this patient?

      Your Answer: Warfarin

      Explanation:

      CHA₂DS₂-VASc score is used for atrial fibrillation stroke risk calculation.
      Congestive heart failure – 1 point
      Hypertension – 1 point
      Age ≥75 years – 2 points
      Diabetes mellitus – 1 point
      Stroke/Transient Ischemic Attack/Thromboembolic event – 2 points
      Vascular disease (prior MI, PAD, or aortic plaque) – 1 point
      Age 65 to 74 years – 1 point
      Sex category (i.e., female sex) – 1 point
      Score of 2 or more is considered as high risk and anticoagulation is indicated. This patient’s score is 4, so he needs life-long warfarin to prevent a stroke.

    • This question is part of the following fields:

      • Cardiology
      36.5
      Seconds

  • Question 16 - A 68 yr. old male with history of poorly controlled hypertension was admitted...

    Correct

    • 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: 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
      17.7
      Seconds

  • Question 17 - 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: Right-to-left shunt

      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
      86.7
      Seconds

  • Question 18 - A 80 yr. old male with hypertension presented with his second episode of...

    Incorrect

    • A 80 yr. old male with hypertension presented with his second episode of atrial fibrillation. He was warfarinised and discharged. Later he was reviewed and found to be in sinus rhythm. Which of the following is the most appropriate next step?

      Your Answer: Continue warfarin for 6 months

      Correct Answer: Continue lifelong warfarin

      Explanation:

      CHA₂DS₂-VASc score is used for atrial fibrillation stroke risk calculation.
      Congestive heart failure – 1 point
      Hypertension – 1 point
      Age ≥75 years – 2 points
      Diabetes mellitus – 1 point
      Stroke/Transient Ischemic Attack/Thromboembolic event – 2 points
      Vascular disease (prior MI, PAD, or aortic plaque) – 1 point
      Age 65 to 74 years – 1 point
      Sex category (i.e., female sex) – 1 point
      A score of 2 or more is considered as high risk and anticoagulation is indicated. This patient’s score is 3, so he needs life long warfarin to prevent stroke.

    • This question is part of the following fields:

      • Cardiology
      49.3
      Seconds

  • Question 19 - 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: Those who have a predicted 12 month mortality > 10%

      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
      48.1
      Seconds

  • Question 20 - A 60 yr. old patient with hypertension attended his regular clinic. His compliance...

    Incorrect

    • A 60 yr. old patient with hypertension attended his regular clinic. His compliance was poor. His blood pressure was 180/100 mmHg. His pulse rate was 85 bpm which was irregularly irregular. On examination there was bibasal crepitation. No murmurs were heard. What is the most likely cause for these findings?

      Your Answer: Cor pulmonale

      Correct Answer: Left ventricular hypertrophy

      Explanation:

      Left ventricular hypertrophy due to long standing hypertension is the most probable cause. The irregularly irregular pulse was suggestive of atrial fibrillation, which is due to diastolic dysfunction. Poor ventricular filling causes pulmonary congestion which manifests as bibasal crepitations.

    • This question is part of the following fields:

      • Cardiology
      50.7
      Seconds

  • Question 21 - 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: Percussion pacing

      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
      37.5
      Seconds

  • Question 22 - 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: Amiodarone

      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
      17.8
      Seconds

  • Question 23 - A 18 yr. old male was screened for hypertrophic cardiomyopathy (HOCM) as his...

    Correct

    • A 18 yr. old male was screened for hypertrophic cardiomyopathy (HOCM) as his brother had the same condition. What is the echocardiographic finding that is related to the highest risk of sudden cardiac death?

      Your Answer: Significant thickening of the interventricular septum

      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
      14.3
      Seconds

  • Question 24 - A 60 year old male patient with a history of heavy smoking was...

    Incorrect

    • 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: Troponin I

      Correct 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
      19.2
      Seconds

  • Question 25 - Which of the following is the mechanism of action of bivalirudin in acute...

    Correct

    • Which of the following is the mechanism of action of bivalirudin in acute coronary syndrome?

      Your Answer: Reversible direct thrombin inhibitor

      Explanation:

      Bivalirudin is a competitive, direct thrombin inhibitor. It inhibits both free and clot-bound thrombin and thrombin-induced platelet aggregation. Thrombin enables fibrinogen conversion to fibrin during the coagulation cascade. So inhibition of fibrinogen conversion to fibrin inhibits thrombus development.

    • This question is part of the following fields:

      • Cardiology
      16.3
      Seconds

  • Question 26 - A 48 yr. old male presented with exertional angina for 2 weeks. He...

    Correct

    • A 48 yr. old male presented with exertional angina for 2 weeks. He has no significant past medical history or cardiac risk factors except a total cholesterol of 5.8 mmol/L. He has been already started on aspirin. Which of the following is the most suitable drug combination for him?

      Your Answer: B-blocker and statin

      Explanation:

      Beta blockers and calcium channel blockers have proven prognostic benefits. Nitrates don’t have any proven prognostic benefits. A statin is indicated for a patient with angina and cholesterol level of 5.5 to 8.5 to prevent risk of myocardial infarction. So the preferred combination from the given answers is beta blocker + statin.

    • This question is part of the following fields:

      • Cardiology
      48
      Seconds

  • Question 27 - 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: History of peptic ulcer disease

      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
      13.5
      Seconds

  • Question 28 - A 60 yr. old previously well male patient was admitted with acute severe...

    Correct

    • A 60 yr. old previously well male patient was admitted with acute severe central chest pain associated with excessive sweating and nausea for the past 45 minutes. On examination he was found to have xanthelasma. His blood pressure was 170/100 mmHg and pulse rate was 104 bpm. His ECG showed ST elevation more than 2mm in leads II, III and aVF. His troponin T was 120 ng/ml. His FBC and renal functions were normal. He was given aspirin, clopidogrel, morphine and IV 5mg of atenolol. Which of the following is the most appropriate next step?

      Your Answer: Immediate referral to cardiologist for primary angioplasty

      Explanation:

      The diagnosis is acute inferior ST elevation myocardial infarction so the most appropriate management is primary angioplasty.

    • This question is part of the following fields:

      • Cardiology
      27.9
      Seconds

  • Question 29 - A 65 yr. old male patient admitted with myocardial infarction received thrombolysis, which...

    Correct

    • A 65 yr. old male patient admitted with myocardial infarction received thrombolysis, which lead to full resolution of the ST elevations on his ECG. He was on aspirin, clopidogrel, atorvastatin and enalapril. The next day he complained of pain in his legs and there was a diffuse petechial rash over his lower legs, especially in the feet. All his peripheral pulses were palpable. His FBC revealed neutrophilia with eosinophilia. His IgE antibodies were 3 kU/L (<2). What is the most likely reason for this presentation?

      Your Answer: Cholesterol emboli

      Explanation:

      He has a consequence of atherosclerotic disease (MI). The most probable diagnosis is cutaneous cholesterol emboli as it is more common after anticoagulation or thrombolytics, the skin involvement, eosinophilia and raised IgE. It is more common above 60 yrs. of age.

    • This question is part of the following fields:

      • Cardiology
      10.5
      Seconds

  • Question 30 - A 28 yr. old male was screened for hypertrophic cardiomyopathy (HOCM). His father...

    Correct

    • 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: 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
      10.8
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiology (16/30) 53%
Passmed
Retry this test Dashboard