Cardiology RACP MCQs Flashcards
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
D
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
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
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
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
B
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
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
RACP 2022b Q14.
Where does the right bundle traverse after interventricular septum?
A. Perimembranous septum
B. Chordae tendinae
C. Papillary muscle
D. Moderator band
D
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
B
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
RACP 2022b Q54.
What serum marker is increased with commencing of angiotensin receptor-
neprilysin inhibitors (ARNI)?
A. BNP
B. NT-proBNP
C. ADH
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.
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
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
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
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
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
RACP 2021 Q150.
What is the most common manifestation of cardiac sarcoidosis?
A. Heart failure
B. Heart block
C. Pericarditis
D. Valvular dysfunction
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
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
D
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
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
C
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
C
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
RACP 2021 Oct Q47. Hypertrophic cardiomyopathy, rash, nephrotic syndrome
a. Fabrys Disease
b. Sarcidosis
c. Lyme disease
d. Lupus
A
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)
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
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
B
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 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 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 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 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 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 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 2017
a) Extrinsic Allergic Alveolitis
b) Sarcoidosis
c) Non-specific Interstitial Pneumonia
d) Tuberculosis
e) Lung cancer
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 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 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
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
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
