10 MRCP Part 1 Questions Regarding Heart Failure – Part 3
This is Part 3 of our YouTube series 10 MRCP Part 1 Questions Regarding Heart Failure. Take the test and then watch the video on our YouTube Channel: The Health and Disease Blog Tube to find the answers along with explanations.
Link to the video: https://youtu.be/2LhGupXStkA

You will also find the other parts of this series and many other videos on MRCP and health related topics on our channel.
Link to the MRCP Heart Failure series: https://goo.gl/yQLoEW

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1. Which one of the following statements is true regarding pulsus alternans? *
1 point
2. A 35-year-old woman gives a history of progressive exertional dyspnoea and fatigue over the last year. Examination reveals features of right-sided heart failure with pulmonary hypertension, but there are no crackles to suggest fibrosis. Pulmonary function testing rules out obstructive airways disease. Lung perfusion scanning and pulmonary angiography fail to detect pulmonary thromboembolic disease. An echocardiogram shows enlarged right heart chambers. ANCA and HIV testing are negative.Which one of the following is the likely diagnosis? *
1 point
3. A 32-year-old man is recently diagnosed with ankylosing spondylitis. Echocardiogram shows a valvular abnormality.Which one of the following is the most likely diagnosis? *
1 point
4. A 63-year-old man with known chronic heart failure is admitted with symptoms at rest. Examination reveals pitting oedema to his knees, elevated jugular venous pressure, and basal crepitations. He is in sinus rhythm at 80 bpm and his blood pressure is 100/60 mmHg. Current medication is bisoprolol (10 mg, once daily), frusemide (80 mg, once daily) and ramipril (2.5 mg, twice daily). Blood tests reveal a sodium concentration of 133 mmol/l, potassium 4.9 mmol/l and creatinine of 169 μmol/l. The admitting doctor commences him on frusemide (80 mg, twice daily, iv) and increases his ramipril to 5 mg (twice daily).When you review him the following day, which other drug would be most appropriate to include? *
1 point
5. A 65-year-old man with chronic renal failure has a serum potassium level of 7.1 mmol/litre (normal 3.5–5.5 mmol/litre).What would be the most characteristic finding on ECG? *
1 point
6. You are asked to see a 67-year-old man who has been admitted overnight following a road traffic accident. He sustained extensive bruising to his chest from the steering wheel. The nurses are concerned as he has become hypotensive and tachycardic. There is a history of a previous inferior myocardial infarction some 7 years ago, but nil else of note. On examination his BP is 90/50 mmHg, pulse is 95/min and regular. He looks peripherally shut down. There are muffled heart sounds and pulsus paradoxus.Investigations – arterial blood gas - reveal: pH=7.29, pO2=11.9 kPa, pCO2=6.1 kPa, ECG=Widespread anterior T wave inversion. Which of the following is the most likely diagnosis? *
1 point
7. You are called urgently to review a 54-year-old man who has developed acute onset pulmonary oedema some 36 h after his myocardial infarction. On arrival you note that his blood pressure is 95/50 mmHg with a pulse of 110 bpm regular, and a pansystolic murmur is noted. There are crackles on auscultation of the chest consistent with heart failure.Which one of the following represents the next investigation of choice in this man?
1 point
8. A 52-year-old man is referred by his GP to the clinic with a systolic murmur. The GP suspects aortic stenosis.What factors in his history would make you expect a murmur of decreased intensity?
1 point
9. A patient with left ventricular failure undergoes echocardiography.Which one of the following is the correct formula for calculating the ejection fraction (EF)?
1 point
10. A 65-year-old woman with severe heart failure presents with increasing shortness of breath. Her current pharmacological treatment consists of an angiotensin-converting enzyme (ACE) inhibitor, loop diuretic and ß-blocker. There is only mild ankle swelling and bilateral basal crackles on auscultation of the chest. Her BP is 142/82 mmHg. Which one of the following is the most appropriate management?
1 point
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