Cardiology RACP MCQs Flashcards by Jaspreet Unknown

RACP 2022a Q28.
Which of the following drugs has cardiovascular mortality benefit in heart
failure with preserved fraction?
a. ACE inhibitior and neprolysin inhibitor
b. Angiotensin receptor blocker
c. Beta blocker
d. Sodium glucose transport 2 inhibitors

Answer D: SGLT2i

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RACP 2022a 37.75M presents in heart failure. Previous unilateral carpal tunnel release. He has a mild normocytic anaemia eGFR 56 No abnormality on electrophoresis
Elevated kappa and lamda chains but kappa lamda ratio not elevated.
Pyrophosphate bone scan shows elevated uptake in the heart muscle relative
to vertebrae What is the most likely cause
a. Beta microglobulin
b. AL
c. AA
d. ATTR

Answer D ATTR

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RACP 2022a Q 7
Patients with Noonan’s syndrome typically have wide spaced eyes, webbed neck and widely spaced nipples. What is the most common cardiac issue associated with Noonan’s Syndrome?
a. AS
b. MR
c. PS
d. TR

Answer C: PS

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RACP 2022a Q38.
29F presents with several weeks of dizziness upon standing. Supine BP
122, standing 124. Heart rate is 90 supine, 128 standing. ECG shows sinus tachycardia What is the most likely cause?
a. Addison disease
b. Panic disorder
c. POTS
d. Hereditary sensory and autonomic neuropathy

Answer C POTS

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RACP 2022a 40. Asymptomatic young-ish man with bicuspid aortic valve and aortic root dilatation. No other risk factors. What is the threshold of aortic root dilatation before surgery is needed?
a. >45mm
b. >50mm
c. >55mm
d. >60mm

Answer C > 55 mm

If bicuspid valve with RF then 50 mm

Indications for surgery:
- Ascending aorta diameter > 55 mm
- in Marfan’s / Loeys Dietz > 45 mm
- in bicuspid valve with RF > 50 mm

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RACP 2022a Q87.EMQ: Which of the following causative organisms of infective endocarditis is
associated with bowel cancer?
a. Coxiella burnetti
b. Strep gallolyticus
c. Haemophilus influenza
d. Acetinobacter Baumanii
e. Staph aureus
f. Aspergillus

Answer B: Strep gallolyticus

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RACP 2022a Q88.EMQ: Which of the following causative organisms of infective endocarditis is
culture negative?
a. Coxiella burnetti
b. Strep gallolyticus
c. Haemophilus influenza
d. Acetinobacter Baumanii
e. Staph aureus
f. Aspergillus

Answer A: Coxeilla burnetti

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RACP 2022b Q14.
Where does the right bundle traverse after interventricular septum?
A. Perimembranous septum
B. Chordae tendinae
C. Papillary muscle
D. Moderator band

Answer D: Moderator band

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RACP 2022b 30. Neonatal heart block is associated with antibodies anti-Ro/SSA and anti-La/SSB.
What period of gestation does neonatal heart block develop?
A. 12-18 weeks
B. 18-24 weeks
C. 24-30 weeks
D. 30-36 weeks

Answer B: 18-24 weeks

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RACP 2022b 35.
Which sign is suggestive of aortic root abscess in endocarditis?
A. J point depression
B. PR prolongation
C. ST elevation
D. T wave inversion

Answer B: PR prolongation

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RACP 2022b Q54.
What serum marker is increased with commencing of angiotensin receptor-
neprilysin inhibitors (ARNI)?

A. BNP
B. NT-proBNP
C. ADH

Answer A: BNP

The precursor proBNP is not directly affected by angiotensin receptor-neprilysin inhibitors (ARNI) such as sacubitril/valsartan because ARNI primarily inhibit neprilysin, an enzyme that degrades several vasoactive peptides, including B-type natriuretic peptide (BNP) but not its precursor proBNP or its cleavage product NT-proBNP.

Here’s why proBNP (and NT-proBNP) remains normal while BNP rises with ARNI use:

1.	BNP and NT-proBNP are generated from the same precursor, proBNP:
*	The heart secretes proBNP, which is then cleaved into two products: the active hormone BNP and the biologically inactive fragment NT-proBNP.
*	ARNI inhibits neprilysin, leading to reduced degradation of BNP, thereby increasing circulating BNP levels.
2.	Neprilysin doesn’t degrade proBNP or NT-proBNP:
*	Neprilysin is responsible for breaking down active BNP, not proBNP or NT-proBNP. Therefore, ARNI does not affect the levels of proBNP or NT-proBNP, as they are not neprilysin substrates.
*	This is why proBNP synthesis and cleavage continue as usual, and proBNP (and NT-proBNP) levels remain normal in patients on ARNI therapy.
3.	Clinical relevance:
*	NT-proBNP levels are often preferred over BNP for monitoring heart failure in patients on ARNI, as NT-proBNP is unaffected by neprilysin inhibition, giving a clearer picture of heart failure severity or response to treatment.

In summary, since neprilysin does not degrade proBNP or NT-proBNP, their levels remain stable, while BNP increases due to reduced degradation.

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RACP 2021 Q3.
A 54 year old man has severe aortic regurgitation on echocardiogram. He has no cardiac symptoms. What feature in echocardiogram would be the strongest indication for AV replacement?
A. Anterior mitral valve leaflet fluttering
B. Holodiastolic reversal of flow
C. LVEF <50%
D. LVEDD <65

Answer C : Heart failure LVEF < 50%

Indications for AR surgery:
- LVEF < 50%
- LVESD > 50 mm
- concomitant CABG
- severe symptomatic AR

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Q30. What causes a capture beat on an ECG showing VT?
A. Sinus and ventricular activity fuse to form a hybrid complex
B. The distance from QRS to nadir S wave >100s
C. Sinus node firing causes ventricle to produce a normal QRS
D. A rabbit ear RSR shape where left ear larger than right ear

Answer C: Capture beat shown here - normal ventricular beat after sinus node firing

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RACP 2021 Q74.
A 72 year old man has a history of AF and is known to be a fast CYP2D6 metaboliser with a history of previous codeine toxicity. Which rate control agent will be expected to have an expected increased dose, given the pharmacogenetics?
A. Amiodarone
B. Metoprolol
C. Digoxin
D. Verapamil

Answer B: Metoprolol

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RACP 2021 Q77.
A 76 year old male presents with 24 hour history of chest pain. His ECG shows an evolving anterior MI. The
next day he has a new diastolic murmur. An urgent TTE demonstrates a VSD. He is hemodynamically stable. What is the best option for management of his VSD?
A. Medical management
B. Balloon pump
C. PCI
D. Surgical repair of VSD

Answer D: Surgical repair

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RACP 2021 Q146.
What drives the process of carditis in acute rheumatic fever?
A. Bacterial infection
B. Endotoxin release
C. Exotoxin release
D. Molecular mimicry

Answer D: Molecular mimicry

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RACP 2021 Q150.
What is the most common manifestation of cardiac sarcoidosis?
A. Heart failure
B. Heart block
C. Pericarditis
D. Valvular dysfunction

Answer B: CHB

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RACP 2021 Oct Q2.
ECG showing electrical alternans. What condition would you see this in?
a. Pleural effusion
b. STEMI
c. Pericardial effusion
d. Atrial fibrillation

Answer C: Pericardial effusion

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RACP 2021 Q17.
When can you drive after pacemaker insertion?
A. 1 day
B. 3 days
C. 7 days
D. 2 weeks
E. 1 month
F. 2 months
G. 3 months
H. 6 months

Answer D - 2 weeks

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RACP 2021 Oct Q18. When can you drive after cardiac arrest?

A. 1 day
B. 3 days
C. 7 days
D. 2 weeks
E. 1 month
F. 2 months
G. 3 months
H. 6 months

H - 6 months

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RACP 2021 Oct Q25.
What is the most common side effect of ticagrelor that leads to it needing to be ceased?
a. Diarrhoea
b. Nausea
c. Dyspnoea
d. Dizziness

Ans C Dyspnoea

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RACP 2021 Oct 29. What is the main anatomical finding on complex transposition of the great
arteries?
a. Overriding aorta
b. left superior vena cava
c. Ventricular aortic discordance
d. Pulmonary communicating artery

Answer C Ventricular aortic discordance

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RACP 2021 Oct 41. Dabigatran affects testing of which lupus antibody procoagulant
a. lupus anticoagulant
b. beta 2 microglobulin
c. anti cardiolipin
d. anti thrombin

Answer A

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RACP 2021 Oct Q47. Hypertrophic cardiomyopathy, rash, nephrotic syndrome
a. Fabrys Disease
b. Sarcidosis
c. Lyme disease
d. Lupus

Ans A Fabry’s disease

Fabry’s Disease is a rare genetic disorder caused by a deficiency of the enzyme alpha-galactosidase A, leading to the buildup of globotriaosylceramide (Gb3) in various tissues. This accumulation can affect multiple organs, leading to a range of symptoms, including:

Hypertrophic cardiomyopathy (HCM): The most common cardiac manifestation in Fabry’s Disease is hypertrophic cardiomyopathy, which results from the deposition of Gb3 in the heart muscle.
Rash: Patients often develop a characteristic angiokeratoma, which is a rash consisting of small, dark red to blue spots commonly found on the skin, especially in the lower abdomen, buttocks, and thighs.
Nephrotic syndrome: Kidney involvement in Fabry’s Disease can lead to nephrotic syndrome, which manifests as proteinuria, edema, and low albumin levels.

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RACP 2021 Oct Q81. Long question of lady with aching joints history of heart failure. Bloods show anaemia, high calcium. PET shows amyloid uptake in organs but not the heart. What sort of amyloid is present? a. B2 microglobulin amyloid b. AL c. TTR d. Amyloid A (AA)

Answer B AL (unsure)

RACP 2020a Q7. Carcinoid syndrome is associated with heart failure. Which of the following is the pathogenesis of this? A) Cardiomyopathy B) Pericardial effusion C) Atherosclerotic disease D) Valvular disorder

The correct answer is D. Valvular disorder. Justification: In carcinoid syndrome, the most common cardiac manifestation is carcinoid heart disease, which primarily affects the heart valves. The pathogenesis involves the release of serotonin and other vasoactive substances by carcinoid tumors, typically of the gastrointestinal tract. These substances circulate and cause fibrotic changes in the heart, particularly affecting the right-sided heart valves (tricuspid and pulmonic valves). • Valvular disorder: The serotonin-induced fibrosis leads to tricuspid regurgitation and pulmonic valve disease, often resulting in right-sided heart failure. The left side of the heart is usually spared unless there is a patent foramen ovale or bronchial carcinoid allowing the substances to bypass the lungs, where they are normally metabolized. Explanation of other options: • A. Cardiomyopathy: While heart failure can occur, the primary pathology in carcinoid heart disease is valvular damage, not a cardiomyopathy. • B. Pericardial effusion: This is not a common feature of carcinoid heart disease. • C. Atherosclerotic disease: Carcinoid syndrome does not typically cause atherosclerosis; the heart failure is due to valvular fibrosis. In summary, the heart failure in carcinoid syndrome is primarily caused by a valvular disorder due to fibrotic changes, especially in the right-sided heart valves.

RACP 2020a Q8. Which of the following summarizes the relationship between cardiovascular events and blood pressure readings? A) Linear B) J curve C) Exponential D) U curve

The correct answer is B. J curve. Justification: The relationship between blood pressure and cardiovascular events (such as stroke, heart attack, and heart failure) is often described as a J-curve. This means that: • At higher blood pressure levels, there is a clear increased risk of cardiovascular events (the upward slope of the curve). • However, very low blood pressure levels can also be associated with an increased risk of adverse cardiovascular outcomes, particularly in certain populations (e.g., elderly patients, those with coronary artery disease), representing the second upward slope of the curve. Explanation of Other Options: • A. Linear: This would imply a straight-line relationship where cardiovascular events consistently increase with increasing blood pressure, which does not account for the potential risks of low blood pressure. • C. Exponential: An exponential relationship implies a very rapid increase in cardiovascular events with increasing blood pressure, but it does not capture the increased risk at very low blood pressure levels. • D. U curve: This would imply that there is an increased risk at both very low and very high blood pressure levels, with minimal risk at moderate levels. However, in clinical studies, the increased risk at low blood pressure is not as pronounced or symmetric as in a true U-shape, hence the preference for describing this as a J-curve. High-Yield Point: The J-curve phenomenon is important in clinical practice because it suggests that while it is important to lower blood pressure to reduce cardiovascular risk, over-aggressive lowering of blood pressure can be harmful, particularly in patients with pre-existing cardiovascular conditions. Therefore, individualized treatment goals are crucial.

RACP 2020a Q9. What ECG feature is part of the diagnostic criteria for acute rheumatic fever? A) Wide QRS complex B) Prolonged PR interval C) ST depression D) Narrow QRS complex

Answer B Prolonged PR interval Major Criteria: Carditis Polyarthritis Sydenham's chorea Erythema marginatum Subcutaneous nodules Minor Criteria: Polyarthralgia Prolonged PR interval on ECG Fever Elevated acute phase reactants (e.g., CRP, ESR) Evidence of preceding Group A Streptococcal (GAS) infection: Positive throat culture for GAS Elevated or rising anti-streptolysin O (ASO) titers or other streptococcal antibodies A diagnosis of ARF typically requires evidence of a preceding GAS infection plus either two major criteria or one major and two minor criteria.

RACP 2020a 16. You are asked to see a patient with known hypertrophic cardiomyopathy in cardiogenic shock. On examination: sinus rhythm HR 105, BP 85/50, 92% on 6L Hudson Mask. Echo shows normal LV function with severe LVOT obstruction and systolic anterior motion of the mitral valve. In addition to careful fluid resuscitation, which of the following pharmacological therapies will be most beneficial? A) Adrenalin B) Beta blockers C) Dobutamine D) Glyceryl trinitrate

RACP 2020a 30. Which valve is most commonly affected in Ebstein's anomaly A) Aortic B) Mitral C) Tricuspid D) Pulmonary infarction

The correct answer is C. Tricuspid. Justification: Ebstein’s anomaly is a congenital heart defect characterized by the abnormal development of the tricuspid valve. In this condition, the tricuspid valve leaflets are displaced downward into the right ventricle, causing a portion of the right ventricle to become “atrialized” (functioning more like part of the atrium). This leads to tricuspid regurgitation and, in severe cases, right-sided heart failure. Explanation of Other Options: • A. Aortic: The aortic valve is not typically involved in Ebstein’s anomaly. • B. Mitral: The mitral valve affects the left side of the heart and is not primarily affected in Ebstein’s anomaly. • D. Pulmonary: While the pulmonary valve can sometimes be affected indirectly due to altered right heart function, it is not the primary valve involved in Ebstein’s anomaly. High-Yield Point: The hallmark of Ebstein’s anomaly is the downward displacement and dysfunction of the tricuspid valve, leading to significant tricuspid regurgitation.

RACP 2020 49. Gentleman presents 14 hours post chest pain with an ECG showing inferior ST elevation. His JVP is elevated with a blood pressure of 85/50. A bed side ECHO reveals right ventricular dilation and right inferior wall hypokinesis. Best option for immediate management of hypotension. A) IABP B) PCI C) Dobutamine D) IV fluids

RACP 2020 65. What is the most common form of Ehlers Danlos syndrome? A) Cardiac-valvular B) Classic C) Hypermobile D) Vascular cell

RACP 2020 1. ECG showing inferior STEMI, complete heart block. What would cause variable intensity of the 1st heart sound A) AV dissociation B) Pericardial effusion C) Papillary muscle dysfunction

RACP 2020 9. Lipoprotein a increases risk of cardiovascular disease. What causes increased lipoprotein A levels A) Increased apo a receptor B) Increased LDL C) Increased Hepatic synthesis D) Dietary intake

RACP 2020 12. What form of cardiac amyloid has the worst prognosis if left untreated A) AL amyloid B) Transthyretin C) AA amyloid

RACP 2020 17. What reduces the sensitivity of BNP in heart failure? A) Age B) Obesity C) Renal Failure D) Sepsis

RACP 2020 20. Which valve is abnormal in Ebstein's anomaly? A) Mitral B) Pulmonary C) Tricuspid D) Aortic

RACP 2020 19. A patient with a prosthetic aortic valve is undergoing a dental extraction. What prophylaxis should he receive? A) Amoxicillin monotherapy B) Amoxicillin-Clavulanic Acid C) No prophylaxis D) Amoxicillin + Metronidazole

RACP 2020 26. Which antibiotic is most associated with QT prolongation? A) Ceftriaxone B) Amoxicillin C) Gentamicin D) Ciprofloxacin

RACP 2020 45. 35 year old female presents with palpitations. ECG as shown - what is the diagnosis? A) Sinus tachycardia B) B) Multifocal atrial tachycardia C) C) Atrial flutter D) AVNRT

RACP 2019 Question 19 A 65 year old male has stable angina. Coronary angiogram demonstrates an 80% mid-LAD lesion and a 90% mid-RCA lesion. The next most appropriate management is: A. Percutaneous coronary intervention B. Coronary artery bypass grafting C. Maximal medical management D. supervised exercise program

RACP 2019 Question 28 Which of the following can cause electrical alternans? A. Acute rheumatic fever B. Pericardial effusion C. Takotsubo cardiomyopathy D. Cardiac amyloidosis

RACP 2019 Question 33 What best describes the relationship between blood pressure and cardiovascular risk? A. Exponential B. Linear C. U curve D. J curve

RACP 2019 Question 34 Which drug is most likely to cause rebound hypertension when stopped abruptly after chronic use? A. Clonidine B. Prazosin C. Metoprolol D. Hydralazine

RACP 2019 Question 52 A 65 year old male presents with an acute exacerbation of COPD. His ECG is shown below: What is shown in the ECG? A. Atrial fibrillation B. AV nodal reentrant tachycardia C. Atrial flutter with variable AV block D. Multifocal atrial tachycardia

RACP 2019 Question 66 A 39 year old man presents with syncope and a new heart murmur. He had a brother who died at age 39 secondary to hypertrophic cardiomyopathy. Transthoracic echocardiogram shows septal thickening consistent with hypertrophic cardiomyopathy. Which intervention improves mortality? A. Implantable cardioverter-defibrillator B. Beta-blocker C. Diuretics D. Dihydropyridine calcium channel blocker

RACP 2019 Question 75 Ebstein’s anomaly commonly affects which valve? A. Pulmonary B. Tricuspid C. Aortic D. Mitral

RACP 2019 Question 89 A 26yo Indigenous woman presents with arthralgias, rash and a new cardiac murmur on auscultation. She mentions she had been unwell recently with a sore throat. What is the most likely diagnosis? A. Acute rheumatic fever B. Infective endocarditis C. Sarcoidosis D. Pericardial effusion

RACP 2019 Question 9 A 78 year old man with a history of coronary artery bypass graft develops chest pain and dies. The cause of death is documented as an acute myocardial infarction. Which type of infarct is this? A. Type 1 B. Type 2 C. Type 3 D. Type 4

RACP 2019 Question 30 A patient presents with an acute stroke. An echocardiogram is performed as part of the routine stroke work up. His echocardiogram is shown below. What is the cause for this patient’s stroke? A. Mitral valve vegetation B. Ventricular septal defect C. Left ventricular thrombus D. Left atrial myxoma

RACP 2019 Question 41 What is the most common cardiovascular manifestation of IgG4 disease? A. Inflammatory aorta aneurysm B. Recurrent pericarditis C. Endocarditis D. Myocarditis

RACP 2018 Q24. A 45-year-old female presents with palpitations and light-headedness. The ECG is shown. What is the cardiac rhythm? A. Atrial fibrillation. B. AV nodal re-entrant tachycardia. C. Multifocal atrial tachycardia. D. Torsade de pointes. E. Ventricular tachycardia.

RACP 2018a 29. A 64-year-old man is receiving candesartan, hydrochlorothiazide and amlodipine at maximal doses for hypertension. A 24-hour blood pressure monitor shows the average BP to be 164/86 mmHg. The addition of which drug is likely to have the greatest effect in reducing the blood pressure? A. Hydralazine. B. Moxonidine. C. Perindopril. D. Prazosin. E. Spironolactone.

RACP 2018a 60. Which factor is the strongest indication for surgery in native valve bacterial endocarditis? A. Intravenous drug use and tricuspid valve endocarditis. B. Mobile vegetation of 5 mm on ECHO C. Pulmonary infarction. D. Staphylococcal bacteraemia for 3 days despite therapy. E. Valve regurgitation resulting in heart failure.

RACP 2018a 73. A 54-year-old man presents with sudden onset palpitations and is found to be in atrial fibrillation. The decision is made to attempt pharmacological cardioversion. He is prescribed flecainide and metoprolol. What is the purpose of metoprolol? A. Prevent 1:1 conduction if atrial flutter occurs. B. Reduce myocardial ischaemia if coronary artery disease is present. C. Reduce sympathomimetic complications of flecainide (e.g. tremor). D. Reduce the risk of flecainide induced ventricular arrhythmias. E. Synergistically increase the chance of reversion to sinus rhythm.

RACP 2018 92. An 86-year-old patient is admitted to hospital with a chest infection. She has chronic atrial fibrillation with previous cardioembolic left middle cerebral infarct 12 months ago. Her medications include dabigatran 110 mg BD. When medically stable her creatinine clearance is 20 mL/min. She functions independently at home, walks with a frame and had one fall 6 months ago. What is the best option for her long-term stroke prevention? A. Change to aspirin. B. Change to clopidogrel. C. Change to warfarin. D. Continue dabigatran. E. No antiplatelet or anticoagulation therapy.

RACP 2018a For the clinical scenario described, what is the cardiac lesion? 95.A 64-year-old woman undergoes cardiac catheterisation during which simultaneous pressure measurements (measured in mmHg) are recorded from the left ventricle (red solid line) and aorta (green dashed line). The pressure traces are shown in the figure. A. Aortic regurgitation. B. Aortic stenosis. C. Atrial septal defect. D. Coarctation of the aorta. E. Mitral regurgitation. F. Mitral stenosis. G. Patent ductus arteriosus. H. Ventricular septal defect.

RACP 2018a Q96 A 46-year-old man undergoes cardiac catheterisation due to a history of breathlessness. Pressure measurements and oxygen saturations are shown in the table. For the clinical scenario described, what is the cardiac lesion? A. Aortic regurgitation. B. Aortic stenosis. C. Atrial septal defect. D. Coarctation of the aorta. E. Mitral regurgitation. F. Mitral stenosis. G. Patent ductus arteriosus. H. Ventricular septal defect.

RACP 2018b 109.Which of the following is a minor criterion for the diagnosis of acute rheumatic fever? A. Carditis. B. Polyarthritis. C. Prolonged PR interval. D. Proteinuria. E. Subcutaneous nodules.

RACP 2018b 112.By which mechanism does dobutamine predominantly increase cardiac output? A. Activation of cell surface dopamine receptors. B. Inhibition of alpha-adrenoceptors. C. Reduction in breakdown of cyclic AMP. D. Relaxation of vascular smooth muscle. E. Stimulation of beta-adrenoceptors.

RACP 2018 117.Molecular mimicry may account for the development of carditis in acute rheumatic fever. The streptococcal M protein and N-acetyl-beta-D-glucosamine share epitopes with which component of cardiac tissue? A. Actin. B. Desmosomes. C. Myosin. D. T-tubules. E. Troponin.

RACP 2018b 121.Which of the following is a relative contraindication to the use of adenosine in supraventricular tachycardia? A. Child–Pugh class C cirrhosis. B. End-stage chronic kidney disease. C. Poorly-controlled hypertension. D. Severe asthma. E. Third trimester pregnancy.

RACP 2018 142.Cardiac relaxation is an active process. Which protein is the major component of active cardiac relaxation? A. Actin. B. Relaxin. C. Telethonin. D. Titin. E. Tropomyosin.

RACP 2018 162.A fluid bolus given during resuscitation can increase blood pressure by an increase in which physiological parameter? A. Heart rate. B. Myocardial contractility. C. Oxygen binding capacity. D. Preload. E. Systemic vascular resistance.

RACP 2017a Q33 Question 33 A 38-year-old male presents with dyspnoea. He has a background of metastatic testicular cancer and is one week post his fourth cycle of BEP (Bleomycin, Etoposide, Cisplatin) chemotherapy. He is saturating at 84% on room air. What is the most likely cause of dyspnoea? a) LV dysfunction b) Pericardial effusion c) Lymphangitis carcinomatosis d) Pulmonary fibrosis e) Coronary vasospasm

RACP 2017a Q35 A 64-year-old male, with a recent history of myocardial infarction presents to ED with chest pain. He is tachycardic with a rate of 150bpm, with a BP of 70/40 mm Hg. He has a reduced level of consciousness. His ECG is shown below. What is the next step most appropriate step in management? a) Flecainide b) Adenosine c) Amiodarone d) DC Cardioversion e) Urgent Percutaneous Coronary Intervention

RACP 2017a Q39 A 40-year-old male is found to have large coronary artery aneurysms on CT angiography. What is the likely underlying cause? a) Bechet's disease b) Marfan’s Syndrome c) Syphilis d) Kawasaki Disease e) Takayasu Arteritis

RACP 2017 Question 43 Which of the following conditions is most associated with silent myocardial infarction due to atherosclerosis? a) Hypertriglyceridemia b) Smoking c) Obesity d) Diabetes Mellitus e) Psychiatric disorder

RACP 2017 A 75 man is admitted with Community Acquired Pneumonia. On day three of admission he has a cardiac arrest on the ward. He is given IV Adrenaline 1mg and has 4 cycles of CPR, receiving a further 1mg of Adrenaline after the 2 nd cycle. This is displayed on the monitor at the next rhythm check: What is the next most appropriate step in management? a) Magnesium Sulphate b) IV Adrenaline 1mg c) IV Amiodarone 300mg d) Defibrillation with 200 Joules e) Cardiac Catheterisation

RACP 2017a Question 50 An 86-year-old man is diagnosed with Atrial Fibrillation. Which of the following represents the strongest contra-indication to the use of Dabigatran? a) Age > 85 years b) Creatinine > 230 mmol/L c) A fall in the past three months d) Prostate Cancer e) Blood Pressure of 190/85 mm Hg

RACP 2017a Question 58 A 74-year-old male presents with progressive dyspnoea on a background of a 50-pack-year smoking history. CT Chest shows bulky mediastinal lymphadenopathy. What is the most likely diagnosis? a) Lung Adenocarcinoma b) Hodgkin’s Lymphoma c) Small Cell Lung Cancer d) Germ Cell Tumour e) Thymic mass

RACP 2017 a) Extrinsic Allergic Alveolitis b) Sarcoidosis c) Non-specific Interstitial Pneumonia d) Tuberculosis e) Lung cancer

RACP 2017 86 A patient presents with acute dyspnoea. Which of the following is associated with a paradoxical arterial pulse > 10 mm Hg? a) Congestive Cardiac Failure b) Pulmonary Hypertension c) Severe Asthma d) Atrial Fibrillation e) Pneumonia

RACP 2017 A 47-year-old female is found to be hypertensive on a 24 hour ambulatory blood pressure monitor with an average systolic pressure of 145. She has a background of hypertrophic cardiomyopathy. Which of the following anti-hypertensive agents is most appropriate to prescribe? a) Thiazide diuretic b) Beta blocker c) ACE inhibitor d) dihydropyridine calcium channel blocker e) Prazosin

RACP 2017a Many of the risk factors for atherosclerosis are also risk factors for Abdominal Aortic Aneurysms. Which of these risk factors confers the greatest risk of extension of a pre-existing Abdominal Aortic Aneurysm? a) Diabetes Mellitus b) High blood pressure c) Hypercholesterolaemia d) Smoking e) Obesity

RACP 2017 Q 7 What is the mechanism by which Dobutamine increases cardiac output? a) Cell surface dobutamine receptors b) Inhibition of α-adrenergic receptors c) Activation of β-adrenergic receptors d) Relaxation of vascular smooth muscle e) Inhibition of cyclic AMP breakdown

RACP 2017 Q41 Which of the following is most suggestive of diastolic heart failure on transthoracic echocardiography? a) Reduced fractional shortening b) E/A ratio of < 1 c) Reduced mitral leaflet excursion d) Left Ventricular dysfunction e) Increased end-diastolic left ventricular diameter

RACP 2016a Which of the following is most suggestive of diastolic heart failure on transthoracic echocardiography? a) Reduced fractional shortening b) Continue current antiplatelet c) Reduced mitral leaflet excursion d) Left Ventricular dysfunction e) Increased end-diastolic left ventricular diameter

RACP 2016 Question 15 A 45-year-old man has recurrent syncope when standing for long periods and when seeing noxious stimuli like blood. What is an indication for cardiac pacing? A. Syncope despite midodrine B. Syncope more than once a week C. Syncope causing injury D. Syncope associated with carotid hypersensitivity E. Vasodepressor response on tilt table testing

RACP 2016 Question 19 A 76 year old man presented to ED with central tearing chest pain. Aortic dissection was confirmed on CT. His BP was 164/70 and his HR was 68. What is the most appropriate initial agent for his blood pressure? A. ACE inhibitor B. Beta blocker C. Calcium channel blocker D. Hydralazine E. Inorganic nitrates

RACP 2016 Question 23 A 50 year old man with a history of mild hypertension on a beta blocker presents with new onset angina, with his chest pain responding to aspirin. He has a positive exercise stress test at a high workload. His coronary angiogram demonstrates 50% mid-right coronary artery stenosis. Which of these medications is associated with the greatest reduction in risk of future acute MI? A. Angioplasty and stent B. Angiotensin converting enzyme inhibitor C. Clopidogrel D. Diltiazem E. HMG CoA inhibitor

RACP 2016 Question 26 What is the most common cardiac abnormality in Turner’s syndrome? A. Atrial septal defect B. Bicuspid aortic valve C. Coarctation of aorta D. Partial anamolous pulmonary drainage system E. Pulmonary stenosis

RACP 2016 Question 38 A 73 year old man is admitted to hospital with community acquired pneumonia. 3 days later he has a cardiac arrest. He is given 1mg adrenaline followed by 3 cycles of CPR and a further 1mg of adrenaline. There is no sign of cardiac output. A rhythm checks shows the following: Apart from continuing compressions, what is the next most appropriate step? A) 1mg adrenaline IV B) 300mg amiodarone IV C) Magnesium IV D) Transcutaneous pacing E) Deliver a shock

RACP 2016 Question 56 A 58 year old male is referred for a right heart catheterisation study for investigation of dysponea secondary to pulmonary hypertension diagnosed on echo with a RSVP of 76mmHg. The results of the study are as follows (normal ranges in brackets) PCWP = 22mmHg (<17mmHg) PAP = 77/30mmHg (25/15mmHg) RA pressure = 12mmHg (2-6mmHg) Which of the following would be the most appropriate treatment of this patient? A) Bosentan B) Isosorbide mononitrate C) Frusemide D) Sildenafil E) Nifedipine

RACP 2016 Question 85 An otherwise well 82 year old female is investigated for an incidental heart murmur. She describes symptoms of dyspnoea only on marked exertion. A transthoracic echocardiogram showed a bicuspid aortic sclerotic valve with an area of 0.8cm 2 and moderate to severe aortic regurgitation. A coronary angiogram was normal. What would be the best management option? A. Aortic valve balloon valvuloplasty B. Medical management C. Observation D. Surgical aortic valve repair E. TAVI

RACP 2016 Question 87 Atrial fibrillation is caused by multiple micro re entrant pathways. These arise adjacent to which structure? A) AV node B) Carotid sinus C) Pulmonary veins D) Left atrial appendage E) Sinoatrial node

RACP 2016b Question 4 Which of the following contributes to the formation of a transudate? A. Central venous pressure B. Systolic blood pressure C. Plasma oncotic pressure D. Transcapillary pressure E. Pulse pressure

RACP 2016b Question 10 Intracellular sodium movement is responsible for which part of the cardiac action potential A. Phase 0 B. Phase 1 C. Phase 2 D. Phase 3 E. Phase 4

RCAP 2016b Question 18 In heart failure, what significant alteration changes the cardio myocytes excitation-contraction function that impairs myocytes contractility? A. Cardiac myocytes apoptosis B. Decrease function in sarcoplasmic reticulum Ca2+ ATP C. Disruption in sarcomere to extracellular matrix link D. Down regulation in beta adrenergic receptor activity E. Increased expression in beta myosin heavy chains

RACP 2016b Question 40 What is the most common cause of abnormally large U waves on ECG? A. Acidosis B. Hypothermia C. Myocardial Ischaemia D. Hypokalaemia E. Left Ventricular Hypertrophy

RACP 2016b Question 60 Which of the following is most suggestive of a non-cardiogenic cause of pulmonary oedema? A) Normal left ventricular function on echocardiogram B) Normal pulmonary capillary wedge pressure C) Normal troponin D) Clinical signs of sepsis E) Evidence of pulmonary oedema on CXR

RACP 2016 Question 67 A 73 year old female is bought to ED by ambulance with palpitations. The ambulance recorded ED is shown below. When she arrives in ED the palpitations have resolved, her heart rate is 70 beats per minute and regular and her blood pressure is 150/90. Which of the following medications is the best agent to prevent further episodes of this rhythm? A) Adenosine B) Amiodarone C) Bisoprolol D) Digoxin E) Flecainide F) Magnesium Sulphate G) Metoprolol H) Verapamil

Question 68 A 68 year old lady with limited scleroderma with calcinosis, oesophageal dysmotility and sclerodactyly presents with palpitations. A) Adenosine B) Amiodarone C) Bisoprolol D) Digoxin E) Flecainide F) Magnesium Sulphate G) Metoprolol H) Verapamil

RACP 2015 Question 6 A patient presents with acute dyspnoea. What can causes arterial paradoxus > 10mmHg. A. CCF B. Pulm HTN C. Pneumonia D. Asthma E. AF

RACP 2015 Question 13 A 35 year old male presents with an episode of syncope, regaining consciousness after 1 minute. He had no significant past medical history. An ECG was performed: What is this likely cause of his syncope? A. Atrioventricular block B. Brugada syndrome C. Wolf Parkinson White Syndrome D. Hypertrophic obstructive cardiomyopathy E. Long QT Syndrome

RACP 2015 Question 27 A patient presents with wide complex tachycardia. Which of the following would be clinically consistent with ventricular tachycardia rather than SVT with aberrant conduction? A. Arterial paradoxus >30 B. Jugular vein canon a waves C. Early diastolic murmur D. Pansystolic murmur E. Pericardial rub

RACP 2015 Question 45 An 80 year old man with a background of chronic atrial fibrillation has been admitted to hospital with sepsis. During his admission he is noted to be in fast AF with a rate of 152pm. What would be the best drug to manage his fast AF? A. Amiodarone B. Flecanide C. Lidocaine D. Verapamil E. Metoprolol

RACP 2015 What does the ECG show? A. Atrial fibrillation B. Atrial flutter with 2:1 block C. Atrial tachycardia with aberrant conduction D. Atrial tachycardia with reentry circuit E. Junctional tachycardia F. Ventricular tachycardia

RACP 2015 Question 5 When performing cardioversion on patients with an unstable arrhythmia it is important to time the delivery of the shock. At what point on the ECG should the shock be synchronised with? A. P B. Q C. R D. S E. T

RACP 2015 Question 26 The way we say the limitations of exercise testing is due to respiratory rather than a cardiac cause is: A. Stroke volume of x B. VO2 max of x C. Anaerobic respiration threshold changes ?direction D. Blood pressure change of x E. Rhubarb

RACP 2015 Question 43 What abnormality would be expected to be found in an adult that had underwent a successful Tetralogy of Fallot repair as a child? A. Aortic stenosis B. Eisenmenger syndrome C. Left ventricular dysfunction D. Pulmonary artery incompetence E. Ventricular septal defect

RACP 2015 Question You are called to a cardiac arrest on the ward. Good-quality chest compressions are underway. Adrenaline 1mg has already been given. At the next rhythm check, the monitor and clinical picture is felt to be pulseless electrical activity. What medication is most likely to be beneficial? A. Amiodarone B. Adrenaline C. Atropine D. Rhubarb E. Rhubarb

RACP 2015 Which of the following changes is most likely in a young adult female with a primum ASD? A. Frequent atrial ectopics B. Increased PR interval C. Left atrial hypertrophy D. Left ventricular hypertrophy E. Rhubarb

Answer A Primum ASD is a type of atrial septal defect that affects the lower part of the atrial septum, close to the atrioventricular valves5. ASDs can lead to abnormal heart rhythms, particularly in the atria. As the search results indicate, "Long term effects of moderate to large atrial septal defects can include abnormal heart rhythms, most often atrial flutter or atrial fibrillation"2. The abnormal heart rhythms are related to the stretching of the atrial chamber due to extra blood flow2. This stretching creates conditions where the heart's upper chambers (atria) can start to beat very rapidly, causing symptoms such as palpitations

RACP 2015 Question An 80M presents to hospital with typical chest pain over several hours. ECG suggests inferior infarct. BP 80/60, HR 60-70 sinus. Cool eripheries. Markedly elevated JVP with positive Kussmaul's sign. What is the next step in his managment? A. Fluid bolus B. Urgent revascularisation C. IABP D. Pericardiocentesis E. GTN infusion

Answer A: Fluid bolus Pre-load dependent to maintain BP

RACP 2015 Question Cardiopulmonary exercise testing is used to assess a person’s physiological reserve, usually prior to major surgery, or heart or lung transplant. Which of the following features on CPET favours a pulmonary problem over a cardiac problem? A. Early anaerobic transition B. HR 80% of predicted C. Low VO2 max (<14ml/kg/min) D. Ventilation 100% of predicted E. Rhubarb

Answer D CPET can differentiate between cardiac and pulmonary causes of exercise intolerance by analyzing various parameters. A high ventilation relative to predicted values, along with other factors like reduced breathing reserve and abnormal VE/VCO2 slope, points towards a pulmonary etiology rather than a cardiac one

RACP 2015 What is the pathological process which would cause this appearance in a left heart catheter trace? A. Mitral stenosis B. Aortic stenosis C. Hypertrophic cardiomyopathy D. Aortic regurgitation E. Rhubarb

Answer C: HOCM This represents Brockenbrough–Braunwald–Morrow sign.

Cardiology RACP MCQs Flashcards

(107 cards)