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  • Question 1 - A 70 yr. old female was brought in by the paramedics after she...

    Incorrect

    • A 70 yr. old female was brought in by the paramedics after she collapsed whilst shopping. She has a tachycardia of 150 bpm and her BP is 100/60 mmHg. Her ECG showed a broad complex tachycardia. Which of the following is more suggestive of a ventricular tachycardia (VT) over a supraventricular tachycardia (SVT) with aberrant conduction?

      Your Answer: A corrected QT interval of 420ms

      Correct Answer: Atrioventricular dissociation

      Explanation:

      To differentiate VT from SVT with aberrant conduction the following electrocardiographic features should be looked for:

      Evidence of preceding atrial activity for SVT. Oesophageal leads are helpful if P waves are hidden in the QRS complex.
      QRS duration more than 140 ms for VT.
      QRS morphology: Features of QRS morphology that favour SVT are RBBB or triphasic patterns like rSR in V1 and qRS in V6. Monophasic pattern like R or qR in V1 and rS or QS in V6 or multiple morphology QRS complexes favour VT.
      AV dissociation for VT.

    • This question is part of the following fields:

      • Cardiology
      114.7
      Seconds

  • Question 2 - 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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      Seconds

  • Question 3 - 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 4 - A 35 yr. old female with systemic lupus erythematosus (SLE) was brought to...

    Incorrect

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

      Your Answer:

      Correct Answer: Urgent transthoracic echocardiogram

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
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  • Question 5 - 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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  • Question 6 - 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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  • Question 7 - 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:

      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
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  • Question 8 - 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 9 - 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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  • Question 10 - A 55 yr. old man presented with retrosternal chest pain associated with excessive...

    Incorrect

    • A 55 yr. old man presented with retrosternal chest pain associated with excessive sweating and vomiting. On examination his BP was 100/60 mmHg and pulse rate was 72 bpm. Bibasal crepitations were auscultated. His ECG showed ST elevation in V1 to V4 and ST depression in leads II, III and aVF. Which of the following would be the finding during angioplasty?

      Your Answer:

      Correct Answer: Complete occlusion of the left anterior descending artery

      Explanation:

      The ECG findings are suggestive of anterior myocardial infarction and the most likely artery affected is the left anterior descending artery. Occlusion of the right coronary artery will be shown by ST elevation in lead II, III, aVF and occlusion of the circumflex artery will show changes in leads I, aVL, V5 and V6. To have ST elevation, there should be complete occlusion of the artery.

    • This question is part of the following fields:

      • Cardiology
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  • Question 11 - 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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  • Question 12 - A 75 yr. old male with rheumatoid arthritis underwent a colectomy 2 days...

    Incorrect

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

      Your Answer:

      Correct Answer: IV diamorphine + arrange percutaneous coronary intervention

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
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  • Question 13 - 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:

      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
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  • Question 14 - 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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  • Question 15 - A 13 yr. old boy presented with difficulty in breathing on exertion. According...

    Incorrect

    • A 13 yr. old boy presented with difficulty in breathing on exertion. According to his mother who was also present, his exercise tolerance has been gradually worsening for the past weeks. It has reached the point where he is unable to participate in his weekly soccer match. Cardiac catherization was performed and the results are given below: (Anatomical site vs Oxygen saturation (%)vs Pressure (mmHg)) Superior vena cava: 73 ,–. Right atrium: 71, 6. Right ventricle: 72, –. Pulmonary artery: 86, 53/13. PCWP: –, 15. Left ventricle: 97, 111/10. Aorta: 96, 128/61. Which of the following is the diagnosis?

      Your Answer:

      Correct Answer: Patent ductus arteriosus

      Explanation:

      The oxygen saturation in the pulmonary artery is higher than that of the right ventricle. The pressure of the pulmonary artery and of the PCWP are also high. So patent ductus arteriosus is highly suggestive.

    • This question is part of the following fields:

      • Cardiology
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  • Question 16 - A 65 yr. old man with hypertension presented with sudden onset right arm...

    Incorrect

    • 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:

      Correct 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
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  • Question 17 - A 25 yr. old female presented with a history of sudden collapse. She...

    Incorrect

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

      Your Answer:

      Correct Answer: Start on a beta-blocker

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
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  • Question 18 - Which of the following statements describe the mechanism of fibrates most accurately? ...

    Incorrect

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

      Your Answer:

      Correct 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
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  • Question 19 - 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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  • Question 20 - 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 21 - 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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  • Question 22 - A 80 yr. old male patient with ischaemic heart disease, hypertension and dyslipidaemia...

    Incorrect

    • A 80 yr. old male patient with ischaemic heart disease, hypertension and dyslipidaemia presented with productive cough, fever with chills and loss of appetite for 4 days. On examination he was unwell and febrile with a temperature of 38.3. His blood pressure was 130/80mmHg and pulse rate was 140 bpm. Respiratory rate was 18 breaths per minute. On auscultation there were crepitations over the left lower zone of his chest. His abdomen was soft and non-tender. ECG showed an irregular narrow complex tachycardia. Which of the following is the most appropriate acute management to treat his tachycardia?

      Your Answer:

      Correct Answer: Antibiotics

      Explanation:

      The most likely diagnosis is acute atrial fibrillation (AF) precipitated by acute pneumonia. History of fever, cough and the auscultation findings support it. So the most appropriate management is treating the pneumonia with antibiotics. Treating the underlying cause will reduce the heart rate. Other responses are helpful in the management of chronic AF.

    • This question is part of the following fields:

      • Cardiology
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  • Question 23 - A 20 yr. old male presented after an episode where he had collapsed....

    Incorrect

    • A 20 yr. old male presented after an episode where he had collapsed. This was the second time he has collapsed during the past 3 weeks. His father passed away at the age of 40 due to sudden cardiac death. Echocardiography showed evidence of hypertrophic cardiomyopathy. His 24 hr ECG revealed several short runs of non sustained ventricular tachycardia (VT). Which of the following is the most appropriate management for this patient?

      Your Answer:

      Correct Answer: Implantable cardiovertor defibrillator

      Explanation:

      This patient has a high risk of sudden cardiac death due to a strong family history and non sustained VT. So the most appropriate management is implantable cardiovertor defibrillator.

    • This question is part of the following fields:

      • Cardiology
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  • Question 24 - Which of the following is not associated with right axis deviation? ...

    Incorrect

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

      Your Answer:

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

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
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  • Question 25 - A 60 yr. old male with no past medical history presented to Casualty...

    Incorrect

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

      Your Answer:

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

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
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  • Question 26 - A 9 year-old boy with central cyanosis underwent cardiac catheterization. His study results...

    Incorrect

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

      Your Answer:

      Correct Answer: Tetralogy of Fallot

      Explanation:

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

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

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

    • This question is part of the following fields:

      • Cardiology
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  • Question 27 - A 72 yr. old male presented to the Emergency Department with a broad...

    Incorrect

    • A 72 yr. old male presented to the Emergency Department with a broad complex tachycardia. Which of the following features is more suggestive that this has resulted because of a supraventricular tachycardia (SVT) rather than a ventricular tachycardia (VT)?

      Your Answer:

      Correct Answer: Absence of QRS concordance in chest leads on ECG

      Explanation:

      To differentiate ventricular tachycardia (VT) from supraventricular tachycardia (SVT) with aberrant conduction the following electrocardiographic features should be looked for:

      Evidence of preceding atrial activity for SVT. Oesophageal leads are helpful if P waves are hidden in the QRS complex.
      QRS duration more than 140 ms for VT.
      QRS morphology: Features of QRS morphology that favour SVT are RBBB or triphasic patterns like rSR in V1 and qRS in V6. Monophasic pattern like R or qR in V1 and rS or QS in V6 or multiple morphology QRS complexes favour VT.
      AV dissociation for VT.

    • This question is part of the following fields:

      • Cardiology
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  • Question 28 - From the following responses, what is the commonest cardiovascular abnormality associated with Marfan's...

    Incorrect

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

      Your Answer:

      Correct Answer: Aortic root dilatation

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
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  • Question 29 - A 60 yr. old man presented with severe central chest pain for the...

    Incorrect

    • 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:

      Correct 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
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  • Question 30 - A 42 yr. old female presented with pain in her calves during walking...

    Incorrect

    • 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:

      Correct 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
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