MRCP Cardiology

Question 1

Dental procedure/dentition IE

Answer 1

Strep viridans

Question 2

Most common IE organism

Answer 2

Staph aureus

Question 3

IE IVDU

Answer 3

Staph aureus

Question 4

Indwelling lines/prosthetic valves IE

Answer 4

Staph epidermidis

Question 5

Colorectal cancer IE

Answer 5

Strep bovis

Question 6

SVT + asthma = ?treatment

Answer 6

Verapamil (not adenosine)

Question 7

Factors favouring RATE control in AF (2)

Answer 7

age >65, IHD

Question 8

Post-inferior MI + heart block = ?management

Answer 8

Conservative provided haemodynamically well

Question 9

Common s/e ACEi

Answer 9

Angioedema

Question 10

ESM louder on INSPIRATION

Answer 10

Pulmonary stenosis (increased venous return to right heart

Question 11

ESM louder on EXPIRATION

Answer 11

Aortic stenosis

Question 12

ESM + slow rising pulse

Answer 12

AS

Question 13

Aspirin mechanism of action

Answer 13

Non-specific COX inhibitor. Reduces formation of thromboxane A2

Question 14

Clopidogrel mechanism of action

Answer 14

Inhibits P2Y12 subtype of ADP receptor

Question 15

1st line investigation for stable cardiac chest pain

Answer 15

CT coronary angio

Question 16

Promote closure of PDA

Answer 16

Ibuprofen or indomethacin

Question 17

Pathophysiology of long QT

Answer 17

Blockage of potassium channels

Question 18

Heart with ‘egg-on-side’ appearance on CXR

Answer 18

Transposition of great arteries

Question 19

Atherosclerosis, bad renal fn on ACEi, flash pulmonary oedema, asymmetrical kidneys

Answer 19

Renal artery stenosis

Question 20

AF classification:

• Paroxysmal
• Persistent
• Permanent

Answer 20

Paroxysmal – self-terminates, usually <7 days
Persistent – doesn’t self-terminate (ie requires intervention), usually >7 days. (includes if recurs following successful cardioversion)
Permanent – cardioversion unsuccessful or deemed inappropriate

Question 21

Earliest & most consistent feature in restrictive pericarditis

Answer 21

Hepatomegaly

Question 22

Definitive treatment of atrial flutter

Answer 22

Ablation of tricuspid valve isthmus

Question 23

Deafness & long QT

Answer 23

Jervell and Lange-Nielsen syndrome

Question 24

First line treatment angina (excl GTN)

Answer 24

BB or CCB

Question 25

Commonest congenital heart defect in adults

Answer 25

ASD

Question 26

Common blood abnormality following cholesterol emboli

Answer 26

Eosinophilia

Question 27

Commonest genetic mutation in HOCM

Answer 27

Beta-myosin heavy-chain mutation

Question 28

Mid-systolic click. Which valvular abnormality?

Answer 28

Mitral valve prolapse

Question 29

Mode of action flecainide

Answer 29

Sodium channel blocker

Question 30

Mode of action amiodarone

Answer 30

Potassium channel blocker

Question 31

Urinary 5-HIAA associated with which condition

Answer 31

Carcinoid

Question 32

Early diastolic 'plop', changes with posture

Answer 32

Atrial myxoma (left more common)

Question 33

ECG diagnosis STEMI

Answer 33

>2mm in 2 contiguous chest leads | >1mm in 2 or more limb leads

Question 34

Hypertensive emergency (>180/120 & end organ damage). What should BP aim be within 1h?

Answer 34

Decrease in MAP by no more than 25%

Question 35

BNP is primarily released from which area of the heart

Answer 35

Ventricles

Question 36

Tetralogy of fallot mnemonic

Answer 36

``` DROP VENTRICULAR septal Defect Right ventricular hypertrophy Overriding aorta Pulmonary stenosis ```

Question 37

Site of ablation in paroxysmal AF

Answer 37

Pulmonary veins (where they join the atrium)

Question 38

Which tachyarrhythmia is verapamil CI in?

Answer 38

WPW | Broad complex

Question 39

Fact: Afro-Carribean people can have CK up to x4 normal limit

Answer 39

Yes this is true :)

Question 40

Cardiac complications of Marfans

Answer 40

Aortic root dilatation Aortic regurg Mitral valve prolapse Aortic dissection

Question 41

Primary pulmonary HTN absolute contraindication to pregnancy

Answer 41

True. Rapidly worsens in pregnancy

Question 42

Collapse, short period asystole afterwards, all investigations normal (incl Holter)

Answer 42

Carotid sinus syndrome

Question 43

Is endocarditis more common on left or right side of heart?

Answer 43

Left ie mitral, then aortic (regurgitation). | Right-sided more common in IVDU

Question 44

Heart sound abnormality signifying severe aortic stenosis

Answer 44

Quiet S2

Question 45

Mode of action of adenosine

Answer 45

G protein coupled receptor agonist

Question 46

4 stages of ECG changes seen in pericarditis

Answer 46

1. Concave ST elevation, PR depression 2. T wave flattening, ST segment normalises 3. T wave inversion 4. T wave normalises

Question 47

What is Beck's triad and what does it signify?

Answer 47

1. Raised JVP 2. Muffled heart sounds 3. Hypotension Signifies cardiac TAMPONADE

Question 48

ECG changes seen in: Transmural infarction Subendocardial infarction

Answer 48

Transmural: ST elevation (full occlusion) Subendocardial: ST depression (small area of occlusion in left ventricle, ventricular septum or papillary muscles)

Question 49

Symptoms of Dressler syndrome

Answer 49

1-8 weeks post MI | Malaise, fever, pericardial pain, raised ESR

Question 50

Management of Dressler syndrome

Answer 50

Aspirin 650mg QDS | other NSAID eg indomethacin can be used if aspirin not tolerated

Question 51

First line treatment for malignant hypertension

Answer 51

IV sodium nitroprusside

Question 52

First line treatment for pericarditis

Answer 52

Aspirin (NSAID) & colchicine

Question 53

Which coronary artery is involved in a posterior STEMI?

Answer 53

Right coronary artery

Question 54

ECG findings in Brugada syndrome

Answer 54

ST elevation V1-V3 with negative T waves, RBBB

Question 55

Most common genetic mutation associated with Brugada syndrome

Answer 55

SCN5A sodium channel

Question 56

Commonest cause of constrictive pericarditis worldwide?

Answer 56

TB pericarditis | - lymphocyte positive effusion fluid

Question 57

Diastolic murmur + bifid P wave

Answer 57

Mitral stenosis

Question 58

Prolonged QT interval + congenital deafness =

Answer 58

Jervel-Lange-Nielsen syndrome

Question 59

Aortic stenosis, anaemia, angiodysplasia =

Answer 59

Heyde's syndrome

Question 60

Explain ECG finding of electrical alternans and what it signifies

Answer 60

Consecutive QRS complexes alternate in height or direction. | Signifies cardiac tamponade as it represents movement of the heart in the fluid-filled pericardial sac

Question 61

Management of Brugada syndrom

Answer 61

ICD