DUMES Cardiology Questions

Mr Taylor (age 60) has his BP measured by his practice nurse during a routine check-up. It is 152/105. Ambulatory BP monitoring is arranged which showed a BP of 140/93. He has a PMH of diet-controlled type 2 diabetes and depression. Which is the most appropriate medication to commence?

• A) Lisinopril
• B) Losartan
• C) Nifedipine
• D) Bendroflumethiazide
• E) Atenolol

Miss Green (45 years old) presents to AMU with a fever and rigors. Her observations are HR 110, BP 89/60, resp rate 22, O2 sats 98%, temp 38.7. Her PMH of note includes a DVT and cellulitis. On examination, a pansystolic murmur is heard over the tricuspid region. You perform an ABCDE assessment and are asked to prescribe antibiotic treatment. Which antibiotic(s) would be most appropriate to prescribe?

• A) Amoxicillin IV
• B) Flucloxacillin IV
• C) Gentamicin IV
• D) Vancomycin IV
• E) Amoxicillin IV & Gentamicin IV
• F) Vancomycin IV & Gentamicin IV & Rifampicin PO

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Patient is brought in to A&E with palpatations. On examination her pulse appears regular and examination reveals no abnormalities. An ECG is performed and reveals a PR interval of 0.24s and QRS duration of 0.08s. A QRS complex follows every P wave.

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What does this describe?

a) Complete heart block

b) Mobitz type I heart block

c) Mobitz type II heart block

d) First degree heart block

e) Pulsus paradoxus

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Anne Smith is a 76 year old female. She has no significant past medical history and is otherwise fit and well. She had a routine ECG done as part of an annual check up. You have been asked to review her ECG. Given the likely diagnosis, what is the most important intervention you would suggest for the patient.

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1. Amiodarone
2. Adenosine
3. Anticoagulant
4. Antiplatelet
5. Beta blockade
6. Furosemide
7. Pacing
8. ICD
9. No intervention

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Which intervention is most appropriate given the following ECG.

1. Amiodarone
2. Adenosine
3. Anticoagulant
4. Antiplatelet
5. Beta blockade
6. Furosemide
7. Pacing
8. ICD
9. No intervention

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A 64 year old male presents to the GP with fatigue and difficulty breathing. There are coarse crackles heard on auscultation of both lungs. Which of the following would support a diagnosis of dilated cardiomyopathy

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1. Thickened ventricles on ECHO
2. Family history of autoimmune disease
3. History of alcohol abuse
4. Evidence of left heart failure

Mr Smith, 67, suffered an MI a month previously and is now in to discuss measures for secondary prevention. Which of the following would contraindicate prescription of propranolol?

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1. Would always be contraindicated
2. Allergy to peanuts
3. Asthma
4. Renal impairment

Mrs Smith is started on Lisinopril for high blood pressure and is in for her 14-day review since starting the medication. She complains of a very irritable dry cough. What would you advise?

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1. Paracetamol and ibuprofen
2. Decreasing the dose of the medication
3. Switching to Nefedipine
4. Switching to Losartan

Select the response which best fits each question...

1. Mitral valve
2. Aortic valve
3. Tricuspid valve
4. Pulmonary valve

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Answers:

1. Mitral valve - A. 2 cusps
2. Aortic valve - B. Blood from the left ventricle next passes through here
3. Tricuspid valve - C. shutting of this valve causes a biphasic wave form in the jugular vein
4. Pulmonary valve - E. best heard in the right 2nd intercostal space, close to the sternal edge

Name the structures labelled

1

2

3

4

Name the structures labelled

1

2

3

4

Answers:

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1. C - Right atrium
2. J - Carina
3. H. Arch of aorta
4. B. Left ventricle

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Where does the thoracic duct drain into?

1. Right lymphatic duct
2. Right venous angle
3. Left venous angle
4. Cisterna chyli

Where does the thoracic duct drain into?

Answer: C. left venous angle

1. Right lymphatic duct - right duct doesn’t drain into left duct
2. Right venous angle - right lymphatic duct drains into right venous angle
3. Left venous angle - right!
4. Cisterna chyli - this is the swollen beginning of the thoracic duct below the diaphragm

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What event predominates in each of these phases of the myocyte action potential?

1. Phase 0
2. Phase 1
3. Phase 2
4. Phase 3
5. Phase 4

What event predominates in each of these phases of the myocyte action potential?

Ans:

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1. Phase 0 - B. Na influx
2. Phase 1 - A. K efflux
3. Phase 2 - D. K efflux & Ca influx
4. Phase 3 - A. K efflux
5. Phase 4 - F. resting potential

Which of these does not happen during isovolumetric ventricular contraction?

1. Ventricle is closed off on both sides
2. Aortic pressure exceeds ventricular pressure
3. Ventricular pressure exceeds atrial pressure
4. S1 sounds is heard
5. AV valves shut

Which of these does not happen during isovolumetric ventricular contraction?

Ans: B. aortic pressure exceeds ventricular pressure

1. Ventricle is closed off on both sides - true
2. Aortic pressure exceeds ventricular pressure - this happens in isovolumetric ventricular RELAXATION
3. Ventricular pressure exceeds atrial pressure - true
4. S1 sounds is heard - true
5. AV valves shut - true, this is same as D

Where is angiotensin converting enzyme produced?

1. Kidneys
2. Lungs
3. Liver
4. Heart
5. Muscle

Where is angiotensin converting enzyme produced?

Ans: B. lungs

1. Kidneys - produce renin
2. Lungs - yup
3. Liver - produces angiotensinogen
4. Heart
5. Muscle

Match the words to their correct definitions

1. Stroke volume
2. Mean arterial blood pressure
3. End diastolic volume
4. Ejection fraction

Match the words to their correct definitions

Ans:

1. Stroke volume - C. EDV-ESV
2. Mean arterial blood pressure - J. [(2xdiastolic) + systolic]/3
3. End diastolic volume - E. max. Vol in ventricle before contraction
4. Ejection fraction - F. SV/end diastolic volume

Which of these blood vessels has the highest systemic vascular resistance?

1. Artery
2. Vein
3. Capillary
4. Venule
5. Arteriole

Which of these blood vessels has the highest systemic vascular resistance?

Ans: E. arteriole

Which of these improves mortality rates in a patient with heart failure?

1. Spironolactone
2. Digoxin
3. Entresto
4. Ramipril
5. Statin

Which of these improves mortality rates in a patient with heart failure?

Ans: D. Ramipril (ACEi)

ACEi & ARBs reduce morbidity & mortality, the others are for symptomatic management

Which of these is the most common cause of heart failure?

1. Valvular disease
2. Cardiomyopathy
3. Chronic lung disease
4. Congenital heart defect
5. Atherosclerosis

Which of these is the most common cause of heart failure?

Ans: E. Atherosclerosis

All others are also causes but the most common cause is atherosclerosis

1. 65 year old man complains of light-headedness on exertion. He has an ejection systolic murmur radiating to the neck.
2. 45 year old woman complains of increasing shortness of breath on exertion. She has a mid-diastolic murmur best heard at the apex of the heart with the patient in the left lateral position.
3. 52 year old man has a displaced apex beat and a pan-systolic murmur at the apex of the heart radiating to the axilla.

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a) Aortic regurgitation f) Pulmonary stenosis

b) Aortic stenosis g) Tricuspid regurgitation

c) Mitral regurgitation h) Tricuspid stenosis

d) Mitral stenosis i) Ventricular septal defect

e)Pulmonary regurgitation j) Patent ductus arteriosus

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1. Aortic stenosis (b)

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• Mitral stenosis (d)

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• Mitral regurgitation (c)

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A previously well 55-year-old-man presents with increasing shortness of breath on exertion. �

You notice he has a low volume pulse at 60 beats per minute. It is slow rising. Upon auscultation you hear a systolic crescendo-decresendo murmur.

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a. Aortic regurgitation

b. Pulmonary regurgitation

c. Mitral stenosis

d. Aortic stenosis

e. Aortic regurgitation

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Answer= D

• Aortic stenosis.
• Ejection systolic murmur that radiates to the neck

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• Mr Allen is a 65-year-old man who has been admitted with central crushing chest pain and is diagnosed as having an MI. His ECG shows ST elevation in leads I, V5 and V6. Which coronary artery has been occluded?
1. Left anterior descending artery
2. Right coronary artery
3. Left coronary artery
4. Circumflex artery

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Mrs Brown is a 70-year-old lady. As she is walking up a hill to the shops, she feels a tightness in the centre of her chest. She stops to take a rest. What medication should she be prescribed on a PRN basis to relieve these symptoms?

1. ACE inhibitor
2. Statin
3. Glyceryl trinitrate
4. Isosorbide mononitrate
5. Beta blocker

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Mr Anderson is a 55-year-old lorry driver who presents to the A and E department with central chest pain that radiates down his arm. It has been going on for 30 minutes and has not gone away with his GTN spray. His drug history includes lisinopril, atenolol, GTN spray and atorvastatin. An ECG is done, and no ST elevation is seen. What single investigation should be requested next?

1. Serum creatinine kinase
2. CT pulmonary angiogram
3. Serum urea and electrolytes
4. Duplex USS abdomen
5. Serum troponin

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Mrs Lyon is a 30-year-old lady who has presented to A and E with acute shortness of breath. She says this came on suddenly and is worse when she breaths in. She also reports having a hot swollen left calf for the past 2 days. She has very little past medical history and takes the combined oral contraceptive pill. What investigation would be the diagnostic test for her condition?

1. CTPA
2. D dimer
3. Chest X ray
4. ECG
5. V/Q perfusion scan

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• Mr Smith is a 75 year old man who is admitted to A and E with abdominal pain radiating to his back and iliac regions. His blood pressure is 90/40 and on palpation of his abdomen you detect an expansile mass. What is the most likely diagnosis?
• Aortic dissection
• Coarctation of the aorta
• Bowel ischaemia
• Ruptured abdominal aortic aneurysm
• Cholecystitis
• Renal stone

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Match the following statements with the anatomical structure related to fetal circulation? 

1. Connects the iliac arteries to the placenta

2. Allows blood to move from the right atrium to the left atrium

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1. Ductus arteriosus
2. Umbilical vein
3. Placental vein
4. Ductus venousus
5. Foramen ovale
6. Ligamentum arteriosum
7. Umbilical artery

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