MRCP Cardiology

Question 1

Which arrhythmia is most sensitive to cardioversion and therefore requires lower voltage?

Answer 1

Atrial flutter.

Question 2

Role of adenosine in atrial flutter?

Answer 2

Not curative, but can slow and reveal the sawtooth ECG changes.

Question 3

Can radiofrequency ablation cure atrial flutter

Answer 3

Yes- 95% of the time :)

Question 4

MOA in atrial fib
a) Amiodarone
b) Flecianide

Answer 4

a) K+ channel blocker
b) Na+ channel blocker

Question 5

Rate control AF in HF?

Answer 5

Digoxin

Question 6

Rhythm control AF in HF?

Answer 6

Amiodarone

Question 7

Reasons to anti-coagulate in AF? (3)

Answer 7

1) Valvular disease
2) Chadvasc score >1 in men, >2 in women

Question 8

Anti-coagulation duration in a patient with symptoms >48 hrs, aiming to cardiovert?

Answer 8

3 weeks before and at least 4 weeks after

Question 9

Is aspirin recommended to reduce stroke risk in AF?

Answer 9

No

Question 10

1st and 2nd line anti-coag in AF?

Answer 10

1st line= DOAC
2nd line= warfarin.

Question 11

ECG findings in all wolf parkinson white

Answer 11

Delta waves
PR shortening

Question 12

ECG findings in type A WPW and which side is accessory path

Answer 12

Right axis deviation due to L sided accessory pathway

Question 13

ECG findings in type B WPW and which side is accessory path

Answer 13

Left axis deviation due to R sided accessory pathway

Question 14

1st and 2nd line mx of supraventricular tachycardia

Answer 14

1) Vagal maneuvers
2) Adenosine. Rapid bolus IV, 6mg-12mg-18mg

Question 15

Prevention of supraventricular tachy?

Answer 15

Beta blockers
Ablation

Question 16

Definitive mx wolf parkinson white?

Answer 16

Ablation

Question 16

When is adenosine contra-indicated for SVT? What do you give instead?

Answer 16

Asthmatics
Verapamil

Question 16

Prophylaxis SVT. What about in pregnancy

Answer 16

for pregnant lady with SVT prophylaxis - Metoprolol
otherwise - flecainide given there is no structural heart disease .

Question 17

1st line anti-arrhythmic in stable VT?

Answer 17

Amiodarone via central line

Question 18

Which ECG abnormality are following 2 conditions associated with? How do you differentiate between the two?
Jervelle-lange-neilson
Romano- Ward

Answer 18

Long QT
JLV- deafness.
RW- no deafness.

Question 19

Long QT syndrome pathophysiology

Answer 19

Defect alpha subunit of K+ channel

Question 20

3 subtypes of long QT and how they present

Answer 20

LQT1- exertional syncope
LQT2- emotional syncope
LGQT3- happens with sleep

Question 21

3 electrolyte abnormalities associated with long QT

Answer 21

Hypocalcaemia
Hypokalaemia
Hypomagnaemia

Question 22

Name some drugs causing long QT

Answer 22

Soltalol
Amiodarone
SSRIs, tricyclics
Erythomycin
Terfenadine (antihistamine)
Haloperidol
Ondasetron
Methadone

Question 23

When to check LFTs in patients on statins? When to stop statins?

Answer 23

Check LFTs at baseline, 3 months and 12 months. Stop statin if AST/ALT>3 times upper range of normal.

Question 24

What types of patients are more at risk of statin induced myopathy

Answer 24

Female, diabetics, advanced age, low BMI

Question 24

MOA of statins?

Answer 24

Inhibit action of HMG-CoA which is the rate limiting action in cholesterol synthesis

Question 25

What causes S4 heart sounds?

Answer 25

Atria contracting forcefully against stiff/ hypertrophic ventricle, eg in aortic stenosis.