RACP-Cardiology

Question 1

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- can cause reflex tachycardia
E. Inorganic nitrates

Answer 1

B- beta blocker

Question 2

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-

Answer 2

D. Syncope associated with carotid hypersensitivity

Question 3

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

Answer 3

B. Decrease function in sarcoplasmic reticulum Ca2+ ATP

Question 4

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

Answer 4

A. Implantable cardioverter-defibrillator

Question 5

A patient presents with aneurysmal subarachnoid haemorrhage. What is the rationale for treatment with nimodipine?

A. Prevent cerebral vasospasm
B. Reduce cerebral blood flow
C. Reduce cerebral oedema
D. Prevent aneurysm recurrence

Answer 5

A. Prevent cerebral vasospasm

Question 6

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

Answer 6

A) AV dissociation

S1 is the atrioventricular valves
Variable intensity can be due to: Mobitz type I heart block, digitalis toxicity, atrial fibrillation, and ventricular tachycardia with AV dissociation

Question 7

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

Answer 7

B) Obesity

BNP is biologically active  shorter half life
NT-proBNP is cleared passively by the body and not biologically active  longer half-life
Cleared by the kidneys
Obesity and BNP are inversely related

Question 8

7. 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

Answer 8

D) Valvular disorder

Carcinoid syndrome causes serotonin-mediated fibrosis, primarily affecting right-sided heart valves, leading to tricuspid regurgitation and pulmonary stenosis.

Question 9

8. Which of the following summarizes the relationship between cardiovascular events and blood pressure readings?

A) Linear
B) J curve
C) Exponential
D) U curve

Answer 9

B) J curve

Question 10

9. 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 10

B) Prolonged PR interval

Question 11

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

Answer 11

B) Beta blockers

Question 12

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 12

C. LVEF <50%

Question 13

Q30. What causes a capture beat on an ECG showing VT?
A similar image of an ECG with VT and a capture beat was given in the exam. You are told the diagnosis for the ECG
as part of the stem.
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 13

C. Sinus node firing causes ventricle to produce a normal QRS

Question 14

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 14

D. Surgical repair of VSD

Post-MI ventricular septal defect (VSD) typically requires urgent surgical repair, even if the patient is hemodynamically stable, to prevent rapid decompensation.

Question 15

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 15

C. LVEF <50%