CVS End of Block

Question 1

What are the components of Tetralogy of Fallot?

Answer 1

Aortic override, pulmonary stenosis, right ventricular hypertrophy and ventricular septal defect.

Question 2

In adulthood, common complications of an unrepaired atrial septal defect include?

Answer 2

Atrial arrhythmias and right heart failure

Question 3

An atheromatous lesion consists of:

Answer 3

A plaque of intimal thickening of an arterial wall, due mainly to accumulation of lipids, proliferation of smooth muscle cells and formation of fibrous tissue.

Question 4

Clinical features of critical limb ischaemia as a consequence of peripheral vascular disease include:

A. Absent pulses with normal capillary refill

B. Ulceration due to venous hypertension

C. Rest pain, ulceration and gangrene with absent pulses

D. A white leg due to acute arterial embolization

E. Calf pain on walking with absent pulses

Answer 4

C. Rest pain, ulceration and gangrene with absent pulses.

Question 5

Which of the following symptoms is accepted as increasing the risk of Sudden Cardiac Death in a patient with Hypertrophic Cardiomyopathy (HCM)?

A. Chest pain

B. Peripheral oedema

C. Syncope

D. Breathlessness

E. Headache

Answer 5

C. Syncope

Question 6

A blood pressure of 163/58 mmHg (mean arterial pressure = 93mmHg) would be consistent with which valvular lesion?

Answer 6

Aortic regurgitation

Question 7

Which valvular abnormality would be associated with normal pulmonary artery pressures and large A waves in the JVP?

A. Aortic regurgitation

B. Mitral regurgitation

C. Mitral stenosis

D. Tricuspid regurgitation

E. Tricuspid stenosis

Answer 7

E. Tricuspid stenosis

Question 8

The chamber most likely to be injured in anterior penetrating chest trauma:

A. Left ventricle

B. Left atrium

C. Right Ventricle

D. Right atrium

Answer 8

C. Right Ventricle

Question 9

A 28 year old male patient visits the GP surgery complaining of palpitations. During initial assessment you find that his BP is 185/120. You organise a 24 PB monitoring and send off a blood sample for FBC, glucose, U&Es. His K comes back as 3.5 mMol/l (normal 4.5-5.5 mMol). The patient at this point is on no medication. What is the most likely cause of his hypertension?

A. Renal artery stenosis

B. Policystic kidney disease

C. Pheochromocytoma

D. Hyperaldesteronism

E. Hyperthyroidism

Answer 9

D. Hyperaldesteronism

Question 10

Of the list below which event is unlikely to happen in heart failure?

A. A compensatory increase in sympathetic tone

B. A decreased parasympathetic innervation to the heart via the vagus nerve.

C. An increase in renin production

D. An increase is ANP/BNP levels

E. A compensatory decrease in circulating volume

Answer 10

E. A compensatory decrease in circulating volume

Question 11

In a patient with a complete occlusion of the LAD where would you expect to see the most pronounced ST elevation?

Answer 11

In v2, v3, v4

Question 12

A 68 year old female patient is brought to A&E by ambulance. She has experienced chest pain for the last half an hour, is pale and clammy. On the 12 lead ECG the QRS complexes are wide (more than 200 milliseconds). There is a deep QS wave in v1-v4 and the QRS in M shaped in v5-v6. What is the reason for this?

A. Ventricular tachycardia

B. A Mobitz type I block

C. Right bundle branch block

D. Left bundle branch block

E. Wolff-Parkinson-Wight syndrome

Answer 12

D. Left bundle branch block

Question 13

A patient has a coronary plaque. The fibrous cap has been eroded and the lipid core is exposed to the blood flow. On top of the plaque there is a platelet clot forming that almost occludes the artery but from time to time bits of the thrombus brake off keeping the lumen patent. What condition is compatible with the above picture?

Answer 13

NSTEMI

Question 14

A 39 year old anxious male patient present with to A&E with chest pain. The pain started about 2 hours ago and is of variable intensity and does not radiate. The patient has a fine tremor, is pale and tachycardic. Otherwise the observations are unremarkable. However, on the ECG there is a slight ST elevation in v1-v3. This may be a normal variant. How would you investigate this patient further?

A. Given the atypical presentation and the age reassure him and send him home.

B. Organise an exercise test

C. Use high sensitivity troponin testing at 1 and 3 hours to rule out cardiac hypoxia.

D. Do a stress echocardiogram

E. Organize a CT angiogram

Answer 14

C. Use high sensitivity troponin testing at 1 and 3 hours to rule out cardiac hypoxia.

Question 15

Which ion channel/pumps in cardiomyocytes is blocked by local anaesthetics?

Answer 15

Voltage gated Sodium channel

Question 16

Which ion/channel in cardiomyocytes is blocked by drugs causing pharmacologically acquired long QT-syndrome (LQTS)

Answer 16

Voltage gated Potassium channel

Question 17

Which common valvular heart disease would result in a systolic crescendo-decrescendo murmur?

Answer 17

Aortic stenosis

Question 18

Which phase of the ECG corresponds to the beginning of the rapid passive ventricular filling?

A. The period between the T and the P wave

B. The PQ interval

C. The QRS complex

D. The ST segment

E. The T wave

Answer 18

D. The ST segment

Question 19

Name the mediator that when activated causes a reduction in the circulating volume:

A. Adrenalin/noradrenaline

B. Endothelin

C. Bradykinin

D. BNP

E. Histamine

Answer 19

D. BNP

Question 20

This medication inhibits the Na++/K+/2Cl- carrier in thick ascending limb of the loop of Henle.

A. Glyceryl Trinitrate

B. Furosemide

C. Bendroflumethiazide

D. Hydralazine

E. Indapamide

Answer 20

B. Furosemide

Question 21

Of the events described below which one happens as a result of angiotensin 2 production?

A.The activation of the baroreceptors in the carotid artery

B. An increase in the sympathetic innervation of the kidney.

C. Increased vasoconstriction of the efferent arterioles

D. Increased vasoconstriction of the afferent arterioles

E. The activation of the low pressure baroreceptors in the atria/ventricles.

Answer 21

C. Increased vasoconstriction of the efferent arterioles

Question 22

A 23 year old female patient is 6 months pregnant. She lives on the 6th floor of a council high-rise building. She presents to the GP because the previous day, when the lift was broken, she experienced central gripping chest pain as she was climbing the stairs. She is known to have a systolic murmur. She is referred to cardiology where a Doppler ECHO finds severe aortic stenosis. What is the cause of of the chest pain?

A. Due to the increased pressure the semilunar valves cover up the openings of the coronary arteries.

B. Her heart rate is so high that diastolic flow in the coronary arteries is compromised.

C. Due to the pregnancy pressing on the iliac veins her preload is too low.

D. The stenotic valve results in high blood pressure in the aorta

E. Her circulating volume is increased, increasing oxygen demand in the myocardium.

Answer 22

E. Her circulating volume is increased, increasing oxygen demand in the myocardium.

Question 23

Heart rate is slowed by this medication acting on the β receptors of the heart…

A. Lidocaine

B. Fleicanide

C. Verapamil

D. Digoxin

E. Bisoprolol

Answer 23

E. Bisoprolol

Question 24

In patients with heart failure the medication that has an evidence base to reduce mortality is:

A. Frusemide

B. Hydralazine

C. Bisoprolol

D. Verapamil

E. Allopurinol

Answer 24

C. Bisoprolol