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A 34-year-old professional footballer is evaluated for symptoms of ‘dizziness’ during exercise. Physical examination reveals a laterally displaced apical impulse. On auscultation, there is a 2/6 mid-systolic murmur in the aortic area that increases on sudden standing. The ECG shows LVH and Q waves in the V2-V5 leads.
What is the most likely diagnosis?
1- Young-onset hypertension
2- Acute MI
3- Aortic stenosis
4- Hypertrophic cardiomyopathy
5- Atrial septal defect

Answer: 4- Hypertrophic cardiomyopathy

What is the most likely lipid abnormality in a 48-year-old Asian man with good glycaemic control?
1- Elevated high-density lipoprotein (HDL)
2- Elevated low-density lipoprotein (LDL)
3- Elevated LDL/elevated triglycerides
4- Low HDL/elevated LDL
5- Low HDL/elevated triglycerides

Answer: 5- Low HDL/elevated triglycerides

A 65-year-old woman with a history of heavy smoking presents for review. She has woken during the early hours of the morning for the second time with shortness of breath so bad that she had to fling open the windows. On examination there are crackles in the lung bases, her chest X-ray shows bilateral fluffy perihilar shadowing. ECG reveals small anterior Q waves and a sinus tachycardia of 105 bpm.
What diagnosis fits best with this clinical picture?
1- Cryptogenic fibrosing alveolitis
2- Pulmonary embolus
3- Exacerbation of COPD
4- Sarcoidosis
5- Pulmonary oedema

Answer: 5- Pulmonary oedema

All the followings are true regarding PCI  vs Fibrinloytic therapy in STEMI

  1.  PCI is Favorable as an initial reperfusion strategy
  2. Indicated in those with bleeding tendency
  3. Identifies the site of thrombotic occlusion
  4. Less effective in cardiogenic shock
  5. Better survival benefit

Answer: 4- Less effective in cardiogenic shock

A 65-year-old woman with a history of heavy smoking presents for review. She has woken during the early hours of the morning for the second time with shortness of breath so bad that she had to fling open the windows. On examination there are crackles in the lung bases, her chest X-ray shows bilateral fluffy perihilar shadowing. ECG reveals small anterior Q waves and a sinus tachycardia of 105 bpm.
What diagnosis fits best with this clinical picture?
1- Cryptogenic fibrosing alveolitis
2- Pulmonary embolus
3- Exacerbation of COPD
4- Sarcoidosis
5- Pulmonary oedema

Answer: 5- Pulmonary oedema

Which of the following is true regarding chronic stable angina?

  1. The presenting ECG is almost diagnostic for ischemia
  2. Resting symptoms
  3. Never presented as a dyspnea
  4. Unrelated to weather
  5. Can occur with normal coronary arteries

Answer: 5- Can occur with normal coronary arteries

A 65-year-old woman with a history of heavy smoking presents for review. She has woken during the early hours of the morning for the second time with shortness of breath so bad that she had to fling open the windows. On examination there are crackles in the lung bases, her chest X-ray shows bilateral fluffy perihilar shadowing. ECG reveals small anterior Q waves and a sinus tachycardia of 105 bpm.
What diagnosis fits best with this clinical picture?
1- Cryptogenic fibrosing alveolitis
2- Pulmonary embolus
3- Exacerbation of COPD
4- Sarcoidosis
5- Pulmonary oedema

Answer: 5- Pulmonary oedema

Which of the followings is unlikely in valvular heart disease?

  1. High LV preload in MS
  2. High LV preload in MR
  3. Low LV preload in AR
  4.  High LV after load in AS
  5.  High RV after load in pulmonary valve stenosis

Answer: 3- Low LV preload in AR

A 64-year-old woman presents with an episode of syncope while out shopping. On more direct questioning she also reports a few episodes of fast palpitations, which she is able to tap out on her hand. She is discharged to await an outpatient 24-h ECG Holter recording. Unfortunately she is readmitted after suffering a fit while in bed, her husband felt her pulse at the time and claims that she was pulseless for a few seconds.
What diagnosis fits best with this clinical picture?
1- Paroxysmal atrial fibrillation
2- Atrial flutter
3- Sick-sinus syndrome
4- Multiple transient ischaemic attacks
5- Epilepsy

Answer: 3- Sick-sinus syndrome

A 65-year-old woman with a history of heavy smoking presents for review. She has woken during the early hours of the morning for the second time with shortness of breath so bad that she had to fling open the windows. On examination there are crackles in the lung bases, her chest X-ray shows bilateral fluffy perihilar shadowing. ECG reveals small anterior Q waves and a sinus tachycardia of 105 bpm.
What diagnosis fits best with this clinical picture?
1- Cryptogenic fibrosing alveolitis
2- Pulmonary embolus
3- Exacerbation of COPD
4- Sarcoidosis
5- Pulmonary oedema

Answer: 5- Pulmonary oedema

Regarding Mitral valve stenosis(MS) all true Except

  1. A slowly progressive disease
  2. The higher the heart rate is , the less symptoms
  3. Anticoagulation is recommended with warfarin
  4. Pulmonary venous congestion
  5. Pulmonary hypertension

Answer: 2- The higher the heart rate is , the less symptoms

A 42-year-old painter presents to A&E with symptoms of vertigo, diplopia and gait unsteadiness at the end of a busy afternoon painting the interior of a property. On examination there is a markedly lower blood pressure in the left arm.
What diagnosis fits best with this clinical picture?
1- Anterior circulation transient ischaemic attack
2- Subclavian steal syndrome
3- Vestibular neuronitis
4- Posterior circulation transient ischaemic attack
5- Unexplained cardiac arrhythmia

Answer: 2- Subclavian steal syndrome

A 70-year-old-man reverts to atrial fibrillation after several attempts at cardioversion, but remains symptomatic despite rate control with digoxin and metoprolol. He developed pulmonary fibrosis with amiodarone.
Which of the following will be the next step in the management of this patient?
1- Switch metoprolol to amlodipine
2- Double the dose of digoxin
3- Perform radiofrequency ablation of the AV node, and implant a pacemaker
4- Make another attempt at cardioversion
5- Implant a cardiovertor defibrillator

Answer: 3- Perform radiofrequency ablation of the AV node, and implant a pacemaker

Regarding HCM: all the followings increase the LVOT obstruction true Except:

  1. Standing
  2. Dehydration
  3. Vasodilator
  4. Beta blockers
  5.  Nitrates

Answer: 4-Beta blockers

A 65-year-old woman with a history of heavy smoking presents for review. She has woken during the early hours of the morning for the second time with shortness of breath so bad that she had to fling open the windows. On examination there are crackles in the lung bases, her chest X-ray shows bilateral fluffy perihilar shadowing. ECG reveals small anterior Q waves and a sinus tachycardia of 105 bpm.
What diagnosis fits best with this clinical picture?
1- Cryptogenic fibrosing alveolitis
2- Pulmonary embolus
3- Exacerbation of COPD
4- Sarcoidosis
5- Pulmonary oedema

Answer: 5- Pulmonary oedema

Regarding AF, select the most appropriate

  1. Rate control is less effective than rate control
  2. Is paroxysmal when continue > one week
  3. NOAC shouldn’t be used in Valvular AF
  4. Anticoagulation is routinely indicated
  5. Cardioversion is routinely indicated

Answer: 3- NOAC shouldn’t be used in Valvular AF

A 65-year-old woman with a history of heavy smoking presents for review. She has woken during the early hours of the morning for the second time with shortness of breath so bad that she had to fling open the windows. On examination there are crackles in the lung bases, her chest X-ray shows bilateral fluffy perihilar shadowing. ECG reveals small anterior Q waves and a sinus tachycardia of 105 bpm.
What diagnosis fits best with this clinical picture?
1- Cryptogenic fibrosing alveolitis
2- Pulmonary embolus
3- Exacerbation of COPD
4- Sarcoidosis
5- Pulmonary oedema

Answer: 5- Pulmonary oedema

A 65-year-old woman with a history of heavy smoking presents for review. She has woken during the early hours of the morning for the second time with shortness of breath so bad that she had to fling open the windows. On examination there are crackles in the lung bases, her chest X-ray shows bilateral fluffy perihilar shadowing. ECG reveals small anterior Q waves and a sinus tachycardia of 105 bpm.

What diagnosis fits best with this clinical picture?
1- Cryptogenic fibrosing alveolitis
2- Pulmonary embolus
3- Exacerbation of COPD
4- Sarcoidosis
5- Pulmonary oedema

Answer: 5- Pulmonary oedema

A 65-year-old woman with a history of heavy smoking presents for review. She has woken during the early hours of the morning for the second time with shortness of breath so bad that she had to fling open the windows. On examination there are crackles in the lung bases, her chest X-ray shows bilateral fluffy perihilar shadowing. ECG reveals small anterior Q waves and a sinus tachycardia of 105 bpm.
What diagnosis fits best with this clinical picture?
1- Cryptogenic fibrosing alveolitis
2- Pulmonary embolus
3- Exacerbation of COPD
4- Sarcoidosis
5- Pulmonary oedema

Answer: 5- Pulmonary oedema

A 78-year-old-man presents to Casualty with a history of syncope. An ECG shows complete heart block.
Which of the following physical signs is consistent with the diagnosis?
1- Regular cannon ‘a’ waves on JVP
2- Soft first heart sound

3- Low-volume pulse
4- Basal systolic murmur
5- Loud second heart sound

Answer: 4- Basal systolic murmur

A 56-year-old man has known tricuspid regurgitation.
Which part of the jugular venous waveform is likely to be most prominent?
1- a wave
2- c wave
3- v wave
4- x descent
5- y descent

Answer: 3- v wave

A 50-year-old woman presents with an acute myocardial infarction, and thrombolysis is being considered.
Which one of the following would be an absolute contraindication for thrombolytic therapy?
1- Background diabetic retinopathy
2- Past history of a minor stroke 5 years ago with full recovery and no evidence of underlying cerebrovascular lesion
3- Menstruation
4- Dyspeptic symptoms
5- Resting blood pressure 220/130 mmHg

Answer: 5- Resting blood pressure 220/130 mmHg

A 45-year-old man with a strong family history of ischaemic heart disease presents with atypical chest pains. Electrocardiographic (ECG) exercise testing shows J point depression of 1 mm with a heart rate of 120 beats/min (bpm).
What is the most appropriate next step?
1- Coronary angiography
2- Dobutamine stress echocardiography
3- Radionuclide myocardial perfusion scanning
4- Reassure and discharge
5- Repeat ECG exercise testing on anti-anginal medication

Answer: 4- Reassure and discharge

A 17-year-old youth is brought to the GP by his mother. He was previously seen 2 weeks earlier suffering from acute pharyngitis. His teeth are in generally poor condition, but otherwise there is no previous medical history. On examination he is febrile with a temperature of 38.2 A°C, and has a polyarthritis affecting his knees, ankles, wrists and elbows. He also appears to have subcutaneous nodules over his elbows, and mitral regurgitation on cardiovascular examination.
What diagnosis fits best with this clinical picture?

1- Bacterial endocarditis
2- Juvenile rheumatoid arthritis
3- Scarlet fever
4- Rheumatic fever
5- Congenital valvular heart disease

Answer: 4- Rheumatic fever

A 56-year-old man presents with a cardiac rhythm disorder.
Which one of the following scenarios would be an indication for temporary transvenous cardiac pacemaker insertion?
1- Asymptomatic 2.8 s sinus pauses
2- A short period of complete heart block complicating inferior myocardial infarction, (pre-thrombolysis) with blood pressure 110/70 mmHg
3- Asymptomatic complete heart block with broad complex ventricular complexes at 35 bpm
4- Mobitz II AV block complicating anterior myocardial infarction with blood pressure 110/70 mmHg
5- Bifascicular block prior to aortic aneurysm repair

Answer: 4- Mobitz II AV block complicating anterior myocardial infarction with blood pressure 110/70 mmHg

A 65-year-old woman with a history of heavy smoking presents for review. She has woken during the early hours of the morning for the second time with shortness of breath so bad that she had to fling open the windows. On examination there are crackles in the lung bases, her chest X-ray shows bilateral fluffy perihilar shadowing. ECG reveals small anterior Q waves and a sinus tachycardia of 105 bpm.

What diagnosis fits best with this clinical picture?
1- Cryptogenic fibrosing alveolitis
2- Pulmonary embolus
3- Exacerbation of COPD
4- Sarcoidosis
5- Pulmonary oedema

Answer: 5- Pulmonary oedema

A 15-year-old patient undergoes echocardiography, which shows a right-sided aortic arch.
Which cardiac condition is most likely?
1- Coarctation of the aorta
2- Ebstein’s anomaly
3- Tetralogy of Fallot
4- Hypoplastic left ventricle
5- Noonan’s syndrome

Answer: 3- Tetralogy of Fallot

A 36-year-old old woman presents with a cerebral infarct following treatment for a deep vein thrombosis. Cardiovascular examination is entirely normal.
The most likely underlying cardiac abnormality is?
1- Partial anomalous pulmonary venous drainage
2- Ostium primum atrial septal defect
3- Ostium secundum
4- Common atrium
5- Patent foramen ovale

Answer: 5- Patent foramen ovale

A 60-year-old lady has evidence of left ventricular dysfunction.
Which of the following causes an increase in end-diastolic left ventricular dimension?
1- Patent ductus arteriosus
2- Hypertrophic cardiomyopathy
3- Severe mitral regurgitation
4- Pericardial effusion
5- Mitral stenosis

Answer: 3- Severe mitral regurgitation

 

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