Experienced Cardiology Objective Type Questions And Answers

91- Angina due to an imbalance between O2 supply and demand without atherosclerosis would most likely be seen in which of the following circumstances?
1) aortic regurgitation
2) cardiac tamponade
3) pulmonary regurgitation
4) right heart failure
5) tricuspid regurgitation
Answer-1

92- An 18 year old man had repeated episodes of breathlessness and palpitations, lasting about 20 minutes and resolving gradually. There were no abnormal physical signs. What is the most likely cause of these features?
1) Drug abuse
2) Panic disorder
3) Paroxysmal supraventricular tachycardia
4) Personality disorder
5) Thyrotoxicosis
Answer-2

93- A previously well 60 year old lady is admitted with an Acute Anterior Myocardial Infarction. A random blood glucose concentration was found to be 12.1 mmol/L (<6.7). What is the optimal management of her blood sugar?
1) Diet
2) Gliclazide
3) Intravenous insulin plus dextrose
4) Metformin
5) Subcutaneous insulin
Answer-3

94- A 65-year-old was advised to start oral digoxin at a dose of 250 µg daily. His physician explained that the full effect of this treatment would not be apparent for at least a week. Which one of the following pharmacokinetic variables did the physician use to give this explanation?
1) bioavailablity
2) half-life
3) plasma protein binding
4) renal clearance
5) volume of distribution
Answer-2

95- A 75 year-old lady presents with sudden breathlessness and palpitations. On examination, she was observed to have an irregular heart beat with rate of 140 bpm, BP 150/84 and normal heart sounds. On auscultation of the chest, Fine basal crepitations are heard. An ECG confirms AF and an old inferior MI. She is anticoagulated with heparin and given diuretics. Her heart rate remains rapid. What is the most appropriate management of the lady's AF?
1) DCCV.
2) IV amiodarone.
3) IV betablocker.
4) IV digoxin.
5) Oral quinidine therapy.
Answer-4

96- A 45 year old female presents with a two day history of fever and joint pains. She has a past history of hypertension for which she is receiving anti-hypertensives. On examination she has a temperature of 38 Celsius, a facial rash and slight swelling with tenderness of the wrist and ankle joints. Which of the following anti-hypertensives may be
responsible for her presentation.
1) Minoxidil
2) Phenoxybenzamine
3) Hydrallazine
4) Alpha-methyldopa
5) Bendrofluazide
Answer-3

97- A 70-year-old man with dilated cardiomyopathy remains symptomatic in NYHA class 2 due to chronic heart failure. On examination his pulse is 90 regular, BP 140/90, heart sounds normal, chest auscultation did not reveal any abnormalities. He is currently taking Lisinopril 30 mg OD and Frusemide 80 mg OD. What is the best treatment option?
1) Amiodarone
2) Carvedilol
3) Digoxin
4) Spironolactone
5) Valsartan
Answer-2

98- A 40-year-old man received an orthotopic cardiac transplant 7 years ago to treat a dilated cardiomyopathy. Since that time he has been healthy, with no episodes of rejection or infection. Over the next year, however, he develops fatigue with exercise. He has worsening pedal edema and orthopnea. On physical examination, his vital signs are Temperature 36.3°C, Pulse 78, Respiratory rate 16, and BP 130/70 mm Hg. There are no murmurs, rubs, or gallops audible. Bibasilar crackles in the lungs are audible. Which of the following conditions is most likely to account for these findings?
1) Angiosarcoma
2) Coronary arteriopathy
3) Mitral valvular stenosis
4) Myocarditis
5) Pulmonary hypertension
Answer-2

99- Which of the following statements concering the treatment of acute myocardial infarction is correct?
1) A pansystolic murmur developing within the first 24 hours does not require further investigation.
2) Dipyridamole therapy reduces reinfarction within the first year.
3) Heparin is beneficial if given with streptokinase.
4) Prophylactic lignocaine given in the first 48 hours is effective in preventing ventricular fibrillation
5) Treatment with a dihydropyridine calcium antagonist is associated with increased cardiovascular mortality.
Answer-5

100- A 70-year-old man is admitted with an acute Q-wave inferior Myocardial Infarction. On day 5, he suddenly develops pulmonary oedema and a loud systolic murmur. Which of the following would be the most useful in establishing a diagnosis?
1) chest X-ray
2) coronary arteriography
3) ECG
4) right heart catheterisation and oximetry
5) serum cardiac enzymes
Answer-4

101- A 65-year-old man has longstanding stable heart failure treated with frusemide and enalapril. He complains of swelling in his left knee and his GP treats him with Rofecoxib, a cyclo-oxygenase-2 (COX-2) inhibitor. Two weeks later the patient has increasing breathlessness and ankle oedema.
Which one of the following effects of rofecoxib is the most likely to explain his symptoms?
1) decreased absorption of frusemide from the gut
2) decreased myocardial contractility
3) reduced effective action of enalapril
4) the onset of anaemia
5) the onset of fluid retention
Answer-5

102- Which of the following statements are true of coronary artery anatomy?
1) Right bundle branch block in acute anterior myocardial infarction suggests obstruction prior to the first septal branch of the left anterior descending coronary
artery
2) the posterior descending artery is usually a branch of the circumflex artery
3) The sinus node is supplied by a branch of the right coronary in over 90% of subjects.
4) The AV node is supplied by the left anterior descending coronary artery.
5) The left main stem is about 4 cm long
Answer-1

103- A 34 year old male presents with episodes of breathlessness on exertion. Examination reveals a loud P2 and fixed splitting of the second sound. Which of the following may be responsible for these signs?
1) Maternal chicken pox infection
2) Maternal thalidomide therapy
3) 47 XXY karyotype
4) Homocystinuria
5) Excess maternal alcohol consumption
Answer-5

104- A 72-year-old man presents with an episode of collapse. He has had two similar episodes recently, each lasting about one minute. Four years ago he suffered an anterior myocardial infarction. On examination he was orientated and symptom-free with a regular pulse rate of 80 bpm, BP 140/80 mmHg and the apex beat was displaced to the left. There was an apical systolic murmur. There were no signs of trauma. ECG showed sinus rhythm, Q waves and ST segment elevation anteriorly without reciprocal depression. What is the diagnosis?
1) acute anterior myocardial infarction
2) cerebrocasvular accident
3) epileptic seizure
4) pulmonary embolism
5) ventricular tachycardia
Answer-5

105 - Deficiency of which one of the following trace elements is implicated as a cause of cardiomyopathy?
1) chromium
2) copper
3) manganese
4) selenium
5) zinc
Answer-4
Selenium deficiency is one of the reversible causes of dilated cardiomyopathy.

106- A 40-year-old man attending a routing screening has a blood pressure of 166/100 mmHg. Two weeks later his blood pressure was 150/90 mmHg. He does not smoke. He drinks 35 units alcohol / week. His body mass index (BMI) is 30 kg/m2 (20 - 25). What is the best management strategy?
1) amlodipine
2) atenolol
3) bendrofluazide
4) enalapril
5) lifestyle advice
Answer-5

107- A 78 year old female is referred by her GP with high blood pressure. Over the last three months her blood pressure is noted to be around 180/80 mmHg. She has a body mass index of 25.5kg/m2, is a nonsmoker. There are no features to suggest a secondary cause for her hypertension. Which of the following is the most appropriate treatment for her blood pressure?
1) Alpha-Blocker
2) Angiotensin Converting Enzyme (ACE) Inhibitor
3) Angiotensin Blocker
4) Beta-blocker
5) Calcium channel blocker
Answer-5

108- Which of the following compounds has a vasodilating effect?
1) Antidiuretic hormone
2) Calcitonin
3) Endothelin
4) Renin
5) Somatostatin
Answer-2

109- A 14-year-old boy presents with hypertension. Which of the following statements concerning hypertension in the young is true?
1) Sodium nitroprusside is useful for the long-term treatment of severe cases.
2) Headache is the usual presenting feature.
3) It is defined as systolic blood pressure above the 99th centile for age.
4) Abnormalities are frequently seen on DMSA scan.
5) Aortic coarctation is the commonest secondary cause.
Answer-4

110- A new antihypertensive drug needs to be investigated to establish its relative potency.
Which of the following techniques is most appropriate for this purpose?
1) bioassay
2) case-control study
3) double-blind, randomized, placebo controlled study
4) postmarketing surveillance
5) sequential trial
Answer-1

111- A 53-year-old man presented with hypertension of 150/110 and is found to have the following results on investigation. Raised serum sodium, raised urinary potassium excretion and normal serum renin. What is the likely diagnosis?
1) Adrenocortical adenoma
2) Coarctation of aorta
3) Malignant hypertension
4) Pheochromocytoma
5) Renal tumour
Answer-1

112-A 29-year-old female who is 22 weeks pregnant is noted to have a blood pressure of 150/90 mmHg on 3 separate occasions. Urine protein is negative. Which of the following would be the first line treatment?
1) alpha Methyl Dopa
2) Atenolol
3) Magnesium Sulphate
4) Nifedipine
5) Salbutamol
Answer-1

113-A 58-year-old man presents with sudden onset chest pain. He has a known history of ischaemic heart disease. ECG shows ST segment elevation in V1-V5 without reciprocal depression. In which territory is the infarction most likely to have take place?
1) Anterior
2) Inferior
3) Lateral
4) Inferio-lateral
5) Posterior
Answer-1
This MI is likely to be in the LAD and represents an anterior MI.

114-An 54-year-old male redevelops chest pain 72 hours after treatment for an anterior myocardial infarction. Which of the following markers will be the most sensitive in detecting reinfarction?
1) CK-MB
2) LDH
3) Myoglobin
4) Troponin I
5) Troponin T
Answer-1
Although troponin is highly sensitive and specific it remains elevated for at least one week after infarction. Similarly LDH will be present for approximately one
week after infarction. After myocardial infarction, CK-MB levels become elevated within 3 to 8 hours, peak within 9 to 30 hours, and return to normal after 48 to 72
hours. Although myoglobin has a short half life and rises quickly after an MI and is cleared after an MI, it is not specific enough for diagnostic use.

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Cardiology Online Quiz Questions And Answers

31- In a patient presenting with aortic stenosis, which of the following findings would be most helpful in establishing a diagnosis of congenital bicuspid valve as the etiology?
1) age
2) calcified leaflets
3) commissural fusion on ECHO
4) negative history for rheumatic fever
5) systolic ejection click
Answer-5

32- A 55-year-old woman was found to have ++ glycosuria and had a maternal history of Type II diabetes mellitus. She was a smoker of 20 cigarettes per day. Examination reveals no specific abnormalities apart from a BMI of 30. Blood pressure was 132/88 mmHg. Investigations reveal:
serum creatinine 80 µmol/L (60 – 110) plasma glucose (fasting) 11.3 mmol/L (3.0 – 6.0) total serum cholesterol 5.5 mmol/L (<5.2) HDL cholesterol 1.4 mmol/L (>1.55) What is most likely to improve her life expectancy?
1) Metformin 500 mg bd
2) Ramipril 10 mg daily
3) Simvastatin 10 mg daily
4) Stopping smoking
5) Weight loss to achieve a BMI of 25
Answer-4

33- Which of the following concerning the use of intravenous bicarbonate in cardiorespiratory arrest is correct?
1) exacerbates intracellular acidosis
2) has a positive inotropic effect on ischaemic myocardium
3) improves oxygen release to the tissues
4) increases cerebral blood flow
5) reduces pre-existent hyperkalemia
Answer-1

34- Primary prevention trials for the treatment of hypercholesterolaemia reveal a reduction in all cause mortality following treatment with which of the following?
1) Fibrates
2) Fish Oils
3) Nicotinic acid
4) Resins
5) Statins
Answer-5

35- A 30-year-old man presents with a history of transient loss of consciousness and palpitations. His ECG shows ventricular tachycardia. Which of the following treatments should be avoided?
1) adenosine
2) amiodarone
3) DC cardioversion
4) flecainide
5) verapamil
Answer-5

36- A 56 year old male with left ventricular systolic dysfunction was dyspnoeic on climbing stairs but not at rest. The patient was commenced on ramipril and frusemide. Which one of the following drugs would improve the patient's prognosis?
1) Amiodarone
2) Amlodipine
3) Bisoprolol
4) Digoxin
5) Nitrate therapy
Answer-3
This patient has NYHA stage II heart failure. Studies such as CIBIS-II and MERITHF reveal that beta-blockers significantly reduce morbidity and mortality in heart
failure.

37- A 44-year-old man has had no major medical problems throughout his life, except for arthritis pain involving all extremities for the past couple of years. He has had worsening orthopnoea and ankle oedema in the past six months. He is afebrile. There is no chest pain. A chest X-ray shows cardiomegaly with both enlarged left and right heart borders, along with pulmonary oedema. Laboratory test findings include sodium 139 mmol/L, potassium 4.3 mmol/L, urea 7 mmol/L creatinine 95 µmol/L, and glucose 8.6 mmol/L. Which of the following additional laboratory test findings is he most likely to have?
1) Anti-centromere antibody titer of 1:320
2) Erythrocyte sedimentation rate of 79 mm/Hr
3) Haemoglobin of 10.7 g/dL with MCV of 72 fL
4) Serum ferritin of 3400 pmol/L
5) Spherocytes in his peripheral blood smear
Answer-4

38- Which of the following is a recognised feature of abetalipoproteinaemia?
1) a high serum cholesterol
2) palmar xanthomas
3) advanced atherosclerotic vascular disease
4) abnormal red blood cell morphology
5) severe mental retardation
Answer-4
Acanthocytes are seen in abetalipoproteinaemia.
Retinitis pigmentosa is seen in abetalipoproteinaemia. Mental retardation is not present but motor abnormalities and neurodegenerative are seen.

39- Which of the following infections is least likely to cause myocarditis?
1) Coxsackie virus
2) Diphtheria
3) Chagas Disease
4) Syphillis
5) Toxoplasmosis
Answer-4
Quaternary syphilis involves the cardiovascular system commonly in form of ascending aortic aneurysm and aortic regurgitation. Diphtheria,coxsackie virus,
Chagas disease and toxoplasmosis are all associated with myocarditis.

40- A 68 year old woman was admitted to hospital with evidence of biventricular cardiac failure. On examination her pulse was 100 beats per minute (sinus rhythm), and her blood pressure was 140/60 mmHg. She had haemorrhages in both fundi. Her condition improved after intravenous diuretics. Investigations revealed: haemoglobin 5.6 g/dl (11.5 – 16.5) haematocrit 0.19 (0.36 – 0.47) MCV 118 fl (80 – 96) MCH 33.0 pg (28 – 32) WCC 3.4 x 109/L (4 – 11) platelet count 95 x 109/L (150 – 400) What is the next most appropriate step in management?
1) blood transfusion
2) bone marrow aspiration
3) intramuscular vitamin B12 alone
4) intramuscular vitamin B12 and oral folic acid together
5) oral folic acid alone
Answer-2

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Cardiology Multiple Choice Questions And Answers

21- Which of the following concerning congenital heart disease is correct?
1) ASD is the commonest malformation at birth
2) congenital complete heart block is usually associated with Anti-Ro antibodies in the mother
3) Ebstein's anomaly is associated with maternal exposure to lithium carbonate
4) Hypoplastic left heart syndrome is characterised by a large, dilated left ventricle
5) Osteogenesis imperfecta is associated with aortic stenosis
Answer-3

22- Which of the following regarding the anatomy of the heart is true?
1) The aortic valve is tricuspid.
2) The ascending aorta is entirely outside the pericardial sac.
3) The left atrial appendage is identified readily by transthoracic echocardiography.
4) The pulmonary trunk lies anterior to the ascending aorta.
5) The right atrium is posterior to the left atrium.
Answer-1

23- A patient presents with atrial fibrillation and later they revert to sinus rhythm. Under which of the following circumstances is the patient more likely to remain in sinus rhythm?
1) age > 75 years old
2) been commenced on warfarin
3) left atrium size > 6 cm on ECHO
4) short history of AF
5) ventricular rate on presentation of 130 bpm
Answer-4

24- A 68-year-old man has been very ill for months following the onset of chronic liver disease with hepatitis C infection. He experiences a sudden loss of consciousness and then exhibits paraplegia on the right. A cerebral angiogram reveals lack of perfusion in the left middle cerebral artery istribution. The most likely cardiac lesion to be associated with this finding is?
1) Acute rheumatic fever
2) Left atrial myxoma
3) Libman-Sacks endocarditis
4) Non-bacterial thrombotic endocarditis
5) Paradoxical thromboembolus
Answer-4

25- A 65 year old man presents with severe central crushing chest pain. ECG shows evidence of an inferior myocardial infarction. He receives TPA, Heparin and Aspirin. Four hours after initial presentation, he starts feeling dizzy and breathless. His pulse is 40 bpm regular, BP 80/50. Heart sounds are soft and chest clear to auscultation. ECG shows 2:1 AV block with T wave inversion inferiorly. IV atropine was administered but had no effect. What is the next most important treatment?
1) IV Dopamine.
2) IV Isoprenaline.
3) Insert a permanent pacemaker.
4) Insert a temporary pacemaker.
5) Monitor his progress.
Answer-4

26- A 70-year-old male is referred by his GP for management of recently diagnosed congestive heart failure. The patient has a history of poorly controlled hypertension. Over the last three months he has been aware of deteriorating shortness of breath, fatigue, and orthopnea. Over the last month he had been commenced on Digoxin (62.5 micrograms daily), Frusemide (80 mg daily), and amiloride 10 mg. On examination he has a pulse of 96 bpm regular, a blood pressure of 132/88 mmHg. His JVP was not raised, he had some scattered bibasal crackles on auscultation with a displaced apex beat in the anterior axillary line, 6th intercostal space. Auscultation of the heart revealed no murmurs and he had peripheral oedema to the mid tibia. Investigations showed: electrolytes normal serum urea concentration 17 mmol/l (NR 2-8 mmol/l) creatinine 175 micromol/l (NR 55-110) Serum digoxin 0.7 ng/mL {therapeutic: 1.0-2.0} One month previously his urea had been 11 mmol/l and creatinine 110
micromol/l. An ECG reveals left ventricular hypertrophy and Chest X-ray shows cardiomegaly and calcified aorta. What is the most appropriate next step in management?
1) Add an ACE inhibitor to the current regimen
2) Add atenolol at a dose of 25mg daily
3) Increase digoxin to 0.25 mg daily
4) Increase frusemide to 80 mg twice daily
5) Maintain on current therapy.
Answer-1

27- A 14-year-old boy presents with hypertension. Which of the following statements concerning hypertension in the young is true?
1) Sodium nitroprusside is useful for the long-term treatment of severe cases.
2) Headache is the usual presenting feature.
3) It is defined as systolic blood pressure above the 99th centile for age.
4) Abnormalities are frequently seen on DMSA scan.
5) Aortic coarctation is the commonest secondary cause.
Answer-4

28- A 23 year old male presents with a deep vein thrombosis. He has no past medical history but his mother has suffered from deep vein thromboses. Which of the following is likely to be found on haematological assessment?
1) Factor V Leiden mutation
2) Protein S deficiency
3) Protein C deficiency
4) Antithrombin deficiency
5) Lupus anticoagulant
Answer-4

29- In a normal heart, the oxygen saturation of a sample of blood taken from a catheter in the pulmonary capillary wedge position should be equal to a sample from which of the following?
1) coronary sinus
2) femoral artery
3) pulmonary artery
4) right atrium
5) right ventricle
Answer-2

30 -A 60-year-old man with a past history of controlled hypertension presents with acute onset weakness of his left arm, that resolved over 12 hours. He had suffered two similar episodes over the last three months. Examination reveals a blood pressure of 132/82 mmHg and he is in atrial fibrillation with a ventricular rate of 85 per minute. CT brain scan is normal.
What is the most appropriate management?
1) amiodarone
2) aspirin
3) digoxin
4) dipyridamole
5) warfarin
Answer-5

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Cardiology Objective Type Questions And Answers

11- A 17 year old girl was found collapsed and drowsy. Her 12-lead ECG showed a sinus tachycardia of 120 beats per minute with a corrected QT interval of 500 ms (normal <470). Which of the following is the most likely cause of her presentation?
1) Amphetamine
2) Diphenhydramine
3) Glue sniffing
4) Methadone
5) Methanol
Answer-2
Many drugs can cause a prolonged QT interval. more

12- A randomised double-blind placebo controlled study of a cholesterollowering drug for the primary prevention of coronary heart disease was conducted. It had a five-year follow up period.
The results showed an absolute risk of myocardial infarction in the group-receiving placebo during was 10 per cent. The relative risk of those given the cholesterol lowering medication was 0.8 What number of patients will need to be treated with the drug for five years to prevent one myocardial infarction?
1) 20
2) 40
3) 50
4) 80
5) 100
Answer-3

13- Which ONE of the following is true regarding acute pulmonary embolism?
1) a normal ECG excludes the diagnosis
2) embolectomy is more effective than thrombolysis in improving survival
3) Heparin is as effective as thrombolytic therapy
4) the presence of hypoxaemia is an indication for thrombolysis
5) thrombolysis administered through a peripheral vein is as effective as through a pulmonary artery catheter
Answer-5

14- A 70-year-old woman has a history of dyspnoea and palpitations for six months. An ECG at that time showed atrial fibrillation. She was given digoxin, diuretics and aspirin. She now presents with two short-lived episodes of altered sensation in the left face, left arm and leg. There is poor coordination of the left hand. ECHO was normal as was a CT head scan.
What is the most appropriate next step in management?
1) anticoagulation
2) carotid endarterectomy
3) clopidogrel
4) corticosteroid treatment
5) no action
Answer-1

15- A 21 year old man with Hypertrophic Cardiomyopathy presents in clinic with dizzy spells but has not had any syncopal episodes. Which of the following, if present, would be indicate an increased risk of sudden cardiac death?
1) Asymmetric septal hypertrophy with maximum wall thickness of 2.1 cm
2) Blood Pressure drop of 20mmHg during peak exercise tolerance testing
3) Left Ventricular Outflow Tract Gradient of 80 mmHg
4) Systolic Anterior Movement of the mitral valve on echocardiography
5) Worsening exertional angina
Answer-2

16- Whilst attending the cardiology clinic, the staff nurse measures the blood pressure of a 61-year-old man, and finds that it is 183/100 mmHg sitting and 190/105 standing. He has a heart rate of 81/minute, with an irregularly irregular rhythm. On auscultation of the heart, there are no murmurs, but he has bibasilar crackles on chest examination. Which of the following pathological findings is most likely to be present?
1) Left ventricular hypertrophy
2) Left atrial myxoma
3) Occlusive coronary atherosclerosis
4) Cor pulmonale
5) Mitral regurgitation
Answer-1

17- A 24-year-old woman develops infective endocarditis involving the aortic valve. She receives a porcine bioprosthesis because of her desire to have children and not to take anticoagulant medication. After ten years, she must have this prosthetic valve replaced. Which of the following pathologic findings in the bioprosthesis has most likely led to the need for replacement?
1) Calcification with stenosis
2) Dehiscence
3) Infective endocarditis
4) Strut failure
5) Thrombosis
Answer-1
The bioprosthesis has the advantage of not requiring anticoagulation, but it does not wear well with time, and typically must be replaced within 5 to 10 years

18- A randomised, double-blind, placebo controlled trial of a cholesterol lowering drug in the primary prevention of coronary heart disease is reported. 1000 subjects are treated with the active drug, and 1000 are given placebo. They are followed up over a five year period and 100 individuals in the placebo group and 80 in the treatment group suffer a myocardial infarction. What is the annual percentage risk of myocardial infarction in the group treated with placebo?
1) 0.5%
2) 2%
3) 5%
4) 8%
5) 10%
Answer-2

19- A 25-year-old previously healthy woman has worsening fatigue with dyspnoea, palpitations, and fever over the past one week. Her vital signs on admission to the hospital show Temperature 38.9°C Respiratory rate 30/min Pulse 105 bpm and BP 95/65 mmHg. Her heart rate is irregular.
An ECG shows diffuse ST-T segment changes. A Chest X-ray shows mild cardiomegaly. An echocardiogram shows slight mitral and tricuspid regurgitation but no valvular vegetations. Her troponin I is 12 ng/mL. She recovers over the next two weeks with no apparent sequelae. Which of the following laboratory test findings best explains the underlying etiology for these events?
1) ANCA titer of 1:80
2) Anti-streptolysin O titer of 1:512
3) Blood culture positive for Streptococcus, viridans group
4) Coxsackie B serologic titer of 1:160
5) Total serum cholesterol of 9.6 mmol/l
Answer-4

20- A 74-year-old man presented with acute pain, pallor and absent pulses in his right leg. Investigations revealed an embolus in his femoral artery. What is the most likely source of this embolus?
1) marantic endocarditis
2) paradoxical emboli
3) rheumatic endocardial vegetations
4) right ventricular thrombi
5) thrombi from an atheromatous aorta
Answer-5

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100 Top Cardiology Objective Type Questions And Answers

1- A previously well 27-year-old woman presents with a history of transient ischaemic attack affecting her right side and speech. She had returned to the United Kingdom from a holiday in New Zealand two days previously. On examination there was nothing abnormal to find. An ECG, chest X-ray, CT brain scan and routine haematology and biochemistry were all normal. What is the most likely underlying abnormality?
1) atrial myxoma
2) carotid artery stenosis
3) embolus from paroxysmal atrial fibrillation
4) patent foramen ovale
5) subarachnoid haemorrhage
Answer-4
This is a typical cause of stroke in a young person due to prolonged immobilty. Deep vein thrombosis with patent foramen ovale will cause paradoxical embolism
and stroke.

2- A 51-year-old woman has had several syncopal episodes over the past year. Each episode is characterized by sudden but brief loss of consciousness. She has no chest pain. She has no ankle edema. On brain MRI there is a 1.5 cm cystic area in the left parietal cortex. A chest X-ray shows no cardiac enlargement, and her lung fields are normal. Her serum total cholesterol is 6.5 mmol/L. Which of the following cardiac lesions is she most likely to have?
1) Cardiac amyloidosis
2) Ischemic cardiomyopathy
3) Left atrial myxoma
4) Mitral valve prolapse
5) Tuberculous pericarditis
Answer-3
Atrial myxomas are more often on the left. Though benign, they can occlude the mitral valve and produce sudden loss of cardiac output. They may embolize small
portions of themselves or thrombus forned over their surface.

3- A 66-year-old man has developed chronic renal failure with a serum urea of 60 mmol/L and creatinine of 650 micromol/L. Auscultation of the chest reveals a friction rub over the cardiac apex. He is most likley to have a pericarditis that is termed?
1) Constrictive
2) Fibrinous
3) Hemorrhagic
4) Purulent
5) Serous
Answer-2
The uraemia leads to exudation of fibrin onto the epicardial and pericardial surfaces. Haemorrhagic pericarditis is more typical of tuberculosis or metastatic
tumour. Serous pericarditis is more typical of collagen vascular diseases.

4- Which ONE of the following is a contraindication to thrombolysis?
1) age over 75 years
2) the presence of atrial fibrillation
3) asthma
4) pregnancy
5) background diabetic retinopathy
Answer-4

5- Which of the following anti-microbials is associated with prolongation of the QT interval?
1) Co-amoxiclav
2) Gentamicin
3) Cefuroxime
4) Erythromycin
5) Isoniazid
Answer-5
The macrolides are associated with a prolongation of the QT interval. Other
antimicrobials associated with prolonged QT include quinine, levofloxacin.

6- A 60-year-old man presents with an inferior MI and receives thrombolysis. 4 hours following initial presentation he becomes acutely breathless. His ECG demonstrates sinus tachycardia (rate 108bpm) with T wave inversion inferiorly. His ST segments are normal. On examination his JVP is elevated at 5 cm. Chest was clear to auscultation. Following 80 mg of Frusemide he deteriorates. His BP is now 80/60 and his urine output over the last 2 hours is 5 mls. What is the best investigative
measure?
1) Arterial Blood Gases
2) Central Venous Pressure Monitoring
3) Chest X-Ray
4) Echocardiography
5) Pulmonary Capillary Wedge Pressure Monitoring
Answer-5

7- Which of the following is a recognised feature of massive pulmonary embolism?
1) reduced plasma lactate levels
2) an increase in serum troponin levels
3) an arterial pH less than 7.2
4) blood gases show increased pCO2 on air
5) normal D-dimer levels
Answer-2

8- A 60-year-old man has worsening congestive heart failure with increasing pulmonary oedema. His blood pressure is normal. He has been healthy all his life with no major illnesses. A serum glucose is 5.6 mmol/L. His total serum cholesterol is 4.8 mmol/L. The serum creatine kinase is not elevated. The most likely explanation for these findings is?
1) Alcoholic cardiomyopathy
2) Aortic dissection
3) Calcified bicuspid aortic valve
4) Mitral valve annulus calcification
5) Tricuspid valve endocarditis
Answer-3

9- During auscultation of the heart you discover a wide fixed splitting of the second heart sound. In which of the following conditions does this occur?
1) an uncomplicated ASD
2) Fallot's tetralogy
3) aortic stenosis
4) Right Bundle Branch Block
5) constrictive pericarditis
Answer-1
There is a single sound in Fallot's because of an absent P2. Aortic stenosis leads to reversed splitting (also seen with LBBB and ventricular pacemaker). In RBBB there
is wide splitting of S2 but it is not fixed.

10- A 62 year old man has experienced substernal chest pain upon exertion with increasing frequency over the past 1 year. An electrocardiogram shows T wave inversion in the anterolateral leads at rest. He has a total serum cholesterol of 7.0 mmol/l. On angiography, he has an 85% narrowing of the left anterior descending artery. Which of the following events is most likely to occur in this patient?
1) A systemic artery embolus from thrombosis in a peripheral vein.
2) A systemic artery embolus from a left atrial mural thrombus.
3) Pulmonary embolism from a left ventricular mural thrombus
4) A systemic artery embolus from a left ventricular mural thrombus.
5) Pulmonary embolism from thrombosis in a peripheral vein.
Answer-4
The suggestion here is that this man has coronary artery disease with an impending myocardial infarction. Infarction of the LAD would cause necrosis of the left ventricle. Thrombus may form on an area of dyskinetic ventricle. Therefore he is most at risk of embolus of thrombus from the LV.



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