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CARDIOLOGY Questions  1   2   3   4   5   6   7   8

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. Digoxin
  3. Aspirin
  4. Dypyridamole
  5. Warfarin

Answer

 A 28-year-old man who is known to have Hypertrophic Cardiomyopathy has an out of hospital cardiac arrest and is successfully resuscitated. What is the most appropriate mode of treatment?
  1. Alcohol septal ablation
  2. Amiodarone
  3. beta blocker
  4. implantable defibrillator
  5. myomectomy

Answer

 

A 35-year-old healthy woman has a faint systolic murmur on physical examination. An echocardiogram is performed, and she is found to have a bicuspid aortic valve. In explaining the meaning of this finding to her, the most appropriate statement is that?
  1. An aortic valve replacement is eventually likely to be required
  2. Other family members are likely to have the same condition
  3. She should be treated with a cholesterol lowering agent
  4. The problem resulted from past injection drug usage
  5. This is one manifestation of an underlying autoimmune condition

Answer

 A 27 year old woman complained of palpitations, breathlessness and chest pain, radiating to the left arm. These symptoms had developed six weeks previously, after she had witnessed her father dying from a myocardial infarction. In the past 10 years she had been investigated for abdominal pain, headaches, joint pains, and dyspareunia, without serious cause being found for these symptoms.

What is the most likely diagnosis?

  1. depressive episode
  2. factitious disorder
  3. generalized anxiety disorder
  4. hypochondriasis
  5. somatization disorder

Answer
A 65 year old male with left ventricular systolic dysfunction was dyspnoeic on climbing stairs but not at rest. The patient was commenced on Ramipril and Furosemide.

Which one of the following drugs would improve the patient’s prognosis further?

  1. Amiodarone
  2. digoxin
  3. diltiazem
  4. Metoprolol
  5. Isosorbide dinitrate

Answer

 		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 ols
  3. nicotinic acid
  4. resins
  5. statins

Answer
A 69 year old man is treated for chest infection. He has been on a stable dose of warfarin for the last six months as a treatment for atrial fibrillation, with INR recordings between 2-2.5. However, his most recent INR was 5. Which one of the following drugs that has recently been started is likely to be responsible for the increased INR.
  1. Clarithromycin
  2. Co-dydramol
  3. Digoxin
  4. Rifampicin
  5. Temazepam

Answer

 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 atheromatous aorta
Answer

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. cerebrovascular accident
  3. epileptic seizure
  4. pulmonary embolism
  5. ventricular tachycardia

Answer

Left atrial myxoma may be associated with all except-
  1. sudden death
  2. a mid systolic click
  3. systemic emboli
  4. left atrial dilatation
  5. adrenal hyperplasia

Answer

Which one of the following is the most likely mechanism by which Aspirin exerts its beneficial effects in patients with coronary artery disease?
  1. anti inflammatory action
  2. cyclo oxygenase inhibition
  3. glycoprotein IIB/IIIA receptor inhibition
  4. inhibition of binding of adenosine diphosphonate to its platelet receptor
  5. structural changes in platelets

Answer

A 57-year-old female school cleaner is undergoing investigation for breathlessness. All the following would be in keeping with a diagnosis of constrictive pericarditis except
  1. elevated JVP with absent y descent
  2. peripheral oedema
  3. orthopnea
  4. ascites
  5. previous cardiac surgery

Answer

A study reveals an immediate rise in blood pressure following infusion of a hormone in normal volunteers. Which of the following is the most likely hormone used in this study?
  1. angiotensin I
  2. angiotensin II
  3. atrial natriuretic peptide
  4. brain natriuretic peptide
  5. prolactin

Answer

A 55-year-old woman has had worsening shortness of breath for several years. She now has to sleep sitting up on two pillows. She has difficulty swallowing. There is no history of chest pain. She is afebrile. Recently, she suffered a stroke with left hemiparesis. A chest X-ray reveals a near-normal left ventricular size with a prominent left atrial border. Which of the following conditions is most likely to account for these findings?
  1. aortic coarctation
  2. cardiomyopathy
  3. essential hypertension
  4. left renal artery stenosis
  5. mitral valve stenosis

Answer

A 72 year old man noted to have a systolic murmur undergoes an echocardiogram which demonstrates aortic stenosis. Which of the following is associated with a poor prognosis in this patient?
  1. aortic regurgitation
  2. cardiomegaly on chest Xray
  3. clinical features of left ventricular failure
  4. ECG evidence of left ventricular hypertrophy
  5. severe valvular calcification on echocardiography

Answer

A 42 year old male admitted with dyspnoea is noted to have a murmur suggestive of mitral stenosis. The presence of which of the following clinical signs suggests that the mitral valve is mobile?
  1. fourth heart sound
  2. loud second heart sound
  3. opening snap
  4. a soft first heart sound
  5. a third heart sound

Answer

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. anticentromere antibody titre of 1:320
  2. erythrocyte sendimentation rate of 79 mm/ hr
  3. hemoglobin of 10.7 g/dl with MCV of 72fL
  4. serum ferritin of 3400 micromole/L
  5. spherocytes in his peripheral blood smear

Answer

Which ONE of the following statements is true about the diastolic Austin Flint murmur?
  1. it is associated with a loud first heart sound
  2. it is an early sign of aortic regurgitation
  3. it can be distinguished from the murmur of mitral stenosis by absence of presystolic accentuation
  4.  it is due to partial closure of the anterior leaflet of the mitral valve
  5. it does not occur in aortic incompetence secondary to an aortitis

Answer

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

Cyanosis is a typical feature of which of the following conditions
  1. patent ductus arteriosus
  2. ventricular septal defect
  3. total anomalous pulmonary venous drainage
  4. atrial septal defect
  5. mitral atresia

Answer

 

 

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