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A 55 year old man with a history of poorly controlled hypertension presents with a history of sudden-onset central chest pain. There are no diagnostic electrocardiogram (ECG) abnormalities, and an interval troponin concentration is not diagnostic of myocardial infarction. What diagnosis should be confirmed or excluded next?

  • Pericarditis
  • Aortic dissection (correct)
  • Pneumothorax
  • Anxiety
  • Myocarditis

    • The term 'orthopnoea' refers to breathlessness (dyspnoea) in a particular situation. What situation does it describe?

    Breathlessness on lying flat

    A 75 year old woman presents to her family physician with a 24-hour history of rapid, irregular palpitations accompanied by fatigue. In an elderly patient, what is the most likely cause of palpitations?

  • Ventricular ectopic (premature) beats
  • Atrial ectopic (premature) beats
  • Ventricular tachycardia
  • Supraventricular tachycardia
  • Atrial fibrillation (correct)

    • A 74 year old woman presents with breathlessness. She is found to have an elevated jugular venous pressure (JVP). Which of the following conditions is most likely to explain this physical finding?

    <p>Recurrent pulmonary embolism</p> Signup and view all the answers

    A 56 year old man presents with a history of headache. He is noted to have a loud second heart sound on auscultation. Which of the following pathologies could explain this finding?

    <p>Aortic incompetence</p> Signup and view all the answers

    Which of the following pathologies can be associated with an early diastolic murmur?

    <p>Marfan's syndrome</p> Signup and view all the answers

    An 80 year old woman with a history of palpitation presents with a painful left leg. On examination, pulse rate is 80 beats/min and irregular, blood pressure (BP) 170/96 mmHg. The left leg is pale, cold, and sensation is reduced. The popliteal, dorsalis pedis and posterior tibial pulses cannot be felt. Her only regular medications are aspirin and digoxin. What is the most likely diagnosis?

    <p>Acute arterial plaque rupture with lower limb ischaemia</p> Signup and view all the answers

    A 50 year old man is assessed because of 3 weeks of fever and influenza-like symptoms. Examination findings are tachycardia (heart rate 105 beats/min), and a large pulse pressure, BP 140/45 mmHg. Initially it was thought a murmur was present but repeat examination reveals no murmur. Investigations reveal no evidence of chest or urinary infection. What are these findings most compatible with?

    <p>Acute myocarditis</p> Signup and view all the answers

    You assess a 62 year old woman 2 days after treatment for anterior myocardial infarction. On examination she is tachycardic and tachypnoeic, and has a harsh systolic murmur radiating to the right side of the chest. There are fine inspiratory crepitations audible at the lung bases. What is the most likely explanation for these findings?

    <p>Papillary muscle rupture and mitral incompetence</p> Signup and view all the answers

    Which of the following physical signs is associated with left ventricular failure?

    <p>A gallop rhythm with a third heart sound</p> Signup and view all the answers

    A 55 year old man with type 2 diabetes presents with a 1-hour history of severe central chest pain. Which of the following statements is true?

    <p>A normal baseline troponin and elevated 6-hour troponin level is suspicious of myocardial infarction</p> Signup and view all the answers

    A 72 year old hypertensive woman presents with a history of sudden-onset, rapid, irregular palpitation. She has had several episodes over the previous 3 months, which have resolved within 1 hour. She feels tired and slightly lightheaded during episodes. From this history, which of the following most likely explains her symptoms?

    <p>Atrial fibrillation</p> Signup and view all the answers

    In the management of cardiac arrest, which of the following most accurately describes basic life support (BLS)?

    <p>Support of airway, breathing and circulation, and assessment of disability and exposure, (ABCDE)</p> Signup and view all the answers

    A pulseless electrical activity (PEA) cardiac arrest is initially managed with immediate defibrillation.

    <p>False</p> Signup and view all the answers

    A 65 year old female presents with chest pain, and the 12-lead ECG shows evidence of acute inferior myocardial infarction complicated by hypotension. An echocardiogram is performed and shows markedly reduced movement of the right ventricular walls, indicating that right ventricular infarction has occurred. Left ventricular function is only mildly impaired. Which of the following physical signs would be expected in this situation?

    <p>Tachycardia, elevated jugular venous pulse due to failure of right ventricular pump function, and hepatomegaly</p> Signup and view all the answers

    What relationship does Starling's Law of the heart describe?

    <p>The relationship between cardiac filling (preload) and cardiac output.</p> Signup and view all the answers

    What underlying pathophysiological changes is chronic cardiac failure associated with?

    <p>Activation of the renin-angiotensin-aldosterone system (RAAS)</p> Signup and view all the answers

    Loop diuretics such as furosemide and bumetanide have which of the following effects?

    <p>Diuresis due to inhibition of sodium and water reabsorption</p> Signup and view all the answers

    β-Adrenoceptor antagonists (B-blockers) are used in which of the following situations?

    <p>Chronic left ventricular systolic dysfunction</p> Signup and view all the answers

    A 71 year old woman with a history of hypertension presents with fatigue and rapid, irregular palpitations. She normally takes enalapril for blood pressure control. Clinical examination reveals an irregularly irregular pulse, rate 125beats/min, and BP 128/86 mmHg. Cardiovascular examination is otherwise normal. A 12-lead ECG is performed, which shows atrial fibrillation with poor ventricular rate control, but no other abnormality. Which of the following drugs is the most suitable agent to control heart rate in this patient?

    <p>β-blocker</p> Signup and view all the answers

    An 85 year old man presents with a 6-month history of sudden episodes of lightheadedness, which last up to 15 seconds. He is admitted to hospital with an episode of syncope resulting in facial injury. Examine the rhythm strip below. Which conduction abnormality does this show?

    <p>Mobitz type II second-degree AV block</p> Signup and view all the answers

    Which of the following rhythms is NOT commonly associated with sick sinus syndrome (sinoatrial disease)?

    <p>Ventricular tachycardia</p> Signup and view all the answers

    A 75 year old woman has a history of hypertension and diabetes. She presents with atrial fibrillation. What is her CHA2DS2-VASc score?

    <p>5</p> Signup and view all the answers

    Which of the following drugs is known to be effective in preventing stroke in patients with atrial fibrillation?

    <p>Apixaban</p> Signup and view all the answers

    The ECG below shows a regular, narrow complex tachycardia in a patient presenting with sudden-onset, rapid palpitation. Which of the following should be used first in attempting to terminate this rhythm?

    <p>Vagal manoeuvres, e.g. Valsalva manoeuvre</p> Signup and view all the answers

    For which of the following scenarios would a permanent pacemaker be an appropriate treatment?

    <p>Sick sinus syndrome associated with syncope</p> Signup and view all the answers

    Which of the following patients is a suitable candidate for an implantable cardiac defibrillator?

    <p>An 80 year old man with a history of anterior myocardial infarction 6 months previously; he is fit, has never experienced arrhythmia, and a cardiac magnetic resonance scan shows poor left ventricular function (left ventricular ejection fraction 28%)</p> Signup and view all the answers

    A 17 year old male presents to the emergency department with an episode of collapse. Witnesses report he became extremely blue at the time of collapse, which occurred on walking. The patient tells you he has a history of congenital heart disease. On examination you note he is centrally cyanosed. Which of the following congenital conditions is the most likely explanation for this presentation?

    <p>Tetralogy of Fallot</p> Signup and view all the answers

    Which of the following is true of Eisenmenger's syndrome?

    <p>Life expectancy is markedly reduced</p> Signup and view all the answers

    Study Notes

    Cardiology Multiple Choice Questions

    • Question 16.1: A 55-year-old man with poorly controlled hypertension presents with sudden chest pain. ECG is normal and troponin is not diagnostic of myocardial infarction. The next diagnosis to confirm or exclude is aortic dissection.

    • Question 16.2: Orthopnea is breathlessness experienced immediately upon lying down, often associated with heart failure.

    • Question 16.3: Rapid, irregular palpitations in an elderly patient are most likely caused by atrial fibrillation.

    • Question 16.4: Elevated jugular venous pressure (JVP) is most likely due to increased left atrial pressure, possibly from recurrent pulmonary embolism.

    • Question 16.5: A loud second heart sound with a history of a headache suggests aortic incompetence.

    • Question 16.6: Early diastolic murmurs are commonly associated with mitral valve prolapse.

    • Question 16.7: A 74-year-old woman with elevated JVP, likely has increased left atrial pressure. Pale, cold, and absent peripheral pulses in the left leg suggest acute arterial plaque rupture with lower limb ischemia.

    • Question 16.8: A 50-year-old man with fever, tachycardia, and high pulse pressure, but no murmur, likely has acute viral pericarditis.

    • Question 16.9: A 62-year-old woman with a recent anterior myocardial infarction, harsh systolic murmur radiating to the right, and fine inspiratory crackles, likely has papillary muscle rupture and mitral incompetence.

    • Question 16.10: A gallop rhythm with a third heart sound (S3) is associated with left ventricular failure.

    • Question 16.11: A 55-year-old man with type 2 diabetes presenting with a 1-hour history of severe central chest pain likely has acute coronary syndrome.

    • Question 16.12: Rapid, irregular palpitations in a woman with a history of several short episodes, likely indicates atrial fibrillation.

    • Question 16.13: Basic life support (BLS) during cardiac arrest involves airway, breathing, and circulation support (ABC).

    • Question 16.14: Pulseless electrical activity (PEA) during cardiac arrest is initially managed with immediate defibrillation and CPR.

    • Question 16.15: A patient with markedly reduced right ventricular movement and mildly impaired left ventricular function after an acute inferior myocardial infarction likely has a tachycardic pulse, absent jugular venous pulse, and acute development of peripheral edema and acute ascites.

    • Question 16.16: Starling's Law relates cardiac output to cardiac filling (preload).

    • Question 16.17: Chronic cardiac failure is associated with activation of the renin-angiotensin-aldosterone system(RAAS)

    • Question 16.18: Loop diuretics increase urine output by reducing sodium and water reabsorption.

    • Question 16.19: Beta-blockers are used to treat chronic left-ventricular systolic dysfunction (a form of heart failure).

    • Question 16.20: Atrial fibrillation with poor ventricular rate control in an elderly patient requires a beta blocker to control heart rate.

    • Question 16.21: The rhythm strip shows Wenckebach (Mobitz type I) second-degree atrioventricular (AV) block.

    • Question 16.22: Ventricular tachycardia is not a common rhythm associated with the sick sinus syndrome.

    • Question 16.23: A 75-year-old woman with atrial fibrillation has a CHA2DS2-VASc score of 3.

    • Question 16.24: Apixaban is effective in preventing stroke in patients with atrial fibrillation.

    • Question 16.25: Vagal maneuvers (e.g., Valsalva) are the initial treatment for a narrow complex tachycardia.

    • Question 16.26: A permanent pacemaker is indicated for conditions like sick sinus syndrome with syncope.

    • Question 16.27: An implantable cardioverter-defibrillator (ICD) is suitable for patients with a history of significant ventricular arrhythmias.

    • Question 16.28: A 17-year-old patient experiencing cyanosis, collapse from exertion, presenting with a history of congenital heart disease likely has tetralogy of Fallot.

    • Question 16.29: Eisenmenger's syndrome is characterized by left-to-right shunting of blood reversed by pulmonary hypertension.

    • Question 16.30: A 48-year-old woman collapsing during a marathon with normal blood pressure and regular pulse, but a loud, high-pitched systolic murmur, likely has a dilated cardiomyopathy, particularly if there's a history of the condition, particularly if there's a family history or a known congenital cardiac anomaly.

    • Question 16.31: A 21-year-old man with flu-like symptoms, pleuritic chest pain, tachycardia, and a systolic-diastolic murmur likely has acute viral pericarditis.

    • Question 16.32: The appropriate initial treatment for acute pericarditis symptoms is oral ASA (e.g., ibuprofen or naproxen).

    • Question 16.33: Dilated cardiomyopathy is characterized by cardiac enlargement (dilatation) and thinning of the ventricular walls.

    • Question 16.34: Chronic alcohol abuse is a known cause of dilated cardiomyopathy; it is associated with myocardial damage, especially in those with a family history of the condition.

    • Question 16.35: Hypertrophic cardiomyopathy is characterized by asymmetric left ventricular hypertrophy, with the interventricular septum being predominantly affected.

    • Question 16.36: Cardiac transplantation is considered for patients with end-stage cardiomyopathy, who have poor quality of life despite optimal medical therapy.

    • Question 16.37: A 75-year-old woman with severe central chest pain, likely has a hypertrophic cardiomyopathy.

    • Question 16.38: Beta-blocker therapy is known to reduce the risk of sudden death in patients with atrial fibrillation and hypertrophic cardiomyopathy, specifically.

    • Question 16.39: Acute anterior ST elevation myocardial infarction, without significant coronary artery disease, is likely precipitated by acute emotional stress.

    • Question 16.40: Excessive alcohol consumption is strongly associated with atrial fibrillation and dilated cardiomyopathy.

    • Question 16.41: Atrial myxoma is a benign tumour most commonly found in the left atrium,.

    • Question 16.42: Chronic pericardial constriction is a late-stage complication of conditions like tuberculous or viral pericarditis, and it is irreversible.

    • Question 16.43: Elevated jugular venous pressure, pitting edema, and quiet heart sounds in a 75-year-old male smoker with shortness of breath, suggest pericardial effusion.

    • Question 16.44: Patients with pericarditis typically show ST depression, not ST elevation.

    • Question 16.45: The most common ECG finding in pulmonary embolus is the presence of a S1Q3T3 pattern, which consists of deep S waves.

    • Question 16.46: Pulsus paradoxus is a significant indicator of cardiac tamponade, characterised by a decrease in blood pressure during inspiration.

    • Question 16.47: Furosemide (a loop diuretic) is effective for symptom control in heart failure but has not been shown to improve survival.

    • Question 16.48: Dipyridamole is a phosphodiesterase inhibitor.

    • Question 16.49: Smoking is the most significant modifiable lifestyle risk factor for myocardial infarction.

    • Question 16.50: Percutaneous coronary intervention (PCI) offers the quickest time-dependent benefit in the case of ST elevation myocardial infarction(STEMI).

    • Question 16.51: An 80-year-old female patient with swelling in the ankles and shortness of breath is most likely to have a restrictive cardiomyopathy.

    • Question 16.52: Thyroid dysfunction is a possible cause of structural cardiac issues, such as dilated cardiomyopathy, and symptoms may not present initially.

    • Question 16.53: Troponin I is a cardiac biomarker used in the diagnosis of myocardial injury.

    • Question 16.54: ST segment elevation in leads representing the affected area of the heart is indicative of a possible stent occlusion.

    • Question 16.55: A 48-year-old female experiencing sudden, severe chest pain during strenuous activities could have a hypertrophic cardiomyopathy.

    • Question 16.56: Pulseless electrical activity (PEA) during cardiac arrest is a serious situation requiring immediate interventions.

    • Question 16.57: Diabetes mellitus acts as a protective factor against abdominal aortic aneurysm progression.

    • Question 16.58: Capillary refill time <2 seconds is a reassuring indicator of adequate peripheral blood perfusion, a key sign for acute limb ischemia.

    • Question 16.59: Smoking cessation is the most effective intervention to reduce aortic aneurysm rupture risk.

    • Question 16.60: Buerger's disease, a form of vasculitis, is the most likely diagnosis for limb ischemia in a 30-year-old smoker.

    • Question 16.61: Surgery for acute dissection of the ascending aorta is the intervention likely to reduce mortality.

    • Question 16.62: Pregnancy can be a predisposing factor for acute aortic dissection, sometimes as an intramural haematoma precursor.

    • Question 16.63: The common ECG finding in patients with inferior STEMI is the presence of ST-segment elevation in leads II, III, and aVF).

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