MCQ - Internal Med

MCQ – Cardiology [Zerotofinals.
com]
1. You are asked by a nurse to review an ECG in a pre-operative 7. Other than atrial fibrillation, what can cause an irregularly
patient. You notice a thin vertical line before each P wave and irregular pulse?
each QRS complex.  Ventricular ectopics  can disappear when heart rate get over a
What is the most likely cause? certain threshold [exercise is used to differentiating AF from
VE]
a. Single-chamber pacemaker
b. Implantable cardioverter defibrillator
c. Amiodarone therapy
8. Most common cause of aortic stenosis
d. Dual-chamber pacemaker
 Idiopathic age related calcification [ejection systolic, high
e. Ventricular ectopics
pitched murmur, crescendo-decrescendo, radiate to carotid,
narrow pulse pressure, exertional syncope d/t difficulty
 Pacemaker ECG: sharp vertical line on all leads of ECG trace
maintaining good flow of blood to brain]
 Before P: for atria @ before QRS: for ventricle
2. You attend a crash call. The patient is unresponsive and no pulse

can be found. The team commences resuscitation according to 9. Cardiac diagnoses that cause hepatomegaly
the ALS protocol. You connect the defibrillator and assess the  Tricuspid regurgitation
rhythm.  Cor pulmonale [respiratory cause] – RHF – increased pressure
Select the rhythms below that would appropriate to shock in this in pulmonary arteries
scenario.
 Shockable rhythm: ventricular tachycardia, ventricular

10. You diagnose essential hypertension in a 45 year old black
fibrillation
female patient who has ambulatory blood pressure monitoring
 Non shockable rhythm: pulseless electrical activity [except VF/
demonstrating an average blood pressure of 156/89. She is
VT], sinus rhythm, asystole [no significant electrical activity] 
otherwise fit and well and has no known allergies. After
give epinephrine
discussing lifestyle interventions, you agree with the patient that
medication should be commenced.
3. A 64 year old presents complaining of shortness of breath,
What would be the most appropriate first line medication from
worse on exertion and when lying flat at night. He is known to
the list below?
have ischaemic heart disease and is on medication for angina.
 Amlodipine 5mg once daily
He has had two previous NSTEMIs. On auscultation you hear a
- Initially: <55 non black [A/B] ; black [CCB]
grade 3, pan-systolic murmur loudest at the apex.
- Stage 2: non black [A+C]
What is the most likely cause for his murmur?
 Mitral regurgitation [radiate to left axilla, result in congestive

HF – leaking valve reduced ejection fraction & backpressure] – 11. A 64 year old man who is known to have angina presents to
caused by IHD, infective endocarditis, RHD A+E by ambulance with chest pain. The pain started 2 hours ago
and came on at rest. It is similar to his normal angina pain
4. What valvular pathology would cause a murmur that radiates to (central, constricting, radiating to his jaw), however it has not
the carotids? settled with rest or with his GTN spray. It has been fluctuating
 Aortic stenosis in severity slightly since it started and the patient states it may
have improved a little since if first started. There are no changes
5. Which artery supplies the posterior aspect of the left ventricle on serial ECGs and serial troponin measurements are normal.
 Circumflex artery What is the most likely diagnosis?
 Inferior aspect: supplied by RCA  Unstable angina
 Anterior aspect: supplied by LAD  No ST elevation: not STEMI
 No changes in troponin: not NSTEMI
6. You are asked to review an 84 year old lady who has become
acutely short of breath. She was admitted 8 hours earlier with a 12. What would be an appropriate first line treatment for atrial
left basal pneumonia. On admission she was septic with a high fibrillation in a sedentary 78 year old lady with a new diagnosis
fever, hypotension and tachycardia. On admission her of atrial fibrillation who has no other health problems and no
saturations were 96% and her respiration rate as 18 per minute. allergies?
She was treated with the septic six, including IV tazocin and  Atenolol [rate control]
fluid resuscitation. She did not require oxygen on admission.
She is now requiring 4 litres of oxygen via facemask to maintain
saturations at 92%. She has a respiratory rate of 28 per minute. 13. You are counselling a patient with severe mitral regurgitation on
She is apyrexial, with a heart rate of 96 bpm and a blood the pros and cons of replacement heart valves.
pressure of 115/86. What is the most significant issue with mechanical heart valves
She looks unwell and is using her accessory muscles to breath. when compared to bioprosthetic valves?
She has bibasal crackles, worse on the left, a raised JVP, and an  Thrombus formation  need lifelong anticoagulant [target INR
ejection systolic murmur radiating to her carotids. 2.5-3.5]
What is the most likely diagnosis?
 Also risk for infective endocarditis, hemolysis causing anemia
 Acute LVF w pulmonary edema [secondary to underlying aortic

stenosis, sepsis, iatrogenic fluid overload]  give stat dose IV
furosemide to relieve fluid overload 14. A 48 year old white male patient presents with a dry cough since
starting treatment with ramipril 2 months ago to control his
essential hypertension. His blood pressure is controlled well on
the ramipril, but he is getting frustrated with the cough.
You decide he would benefit from changing his medication.
What would be the most appropriate replacement for his
ramipril?
 Candesartan 8mg once daily [ARB]
15. You are asked to review a patient with a heart rate of 160 bpm.
They are otherwise haemodynamically stable and you decide to
treat. The ECG reveals a regular, broad based tachycardia with
QRS complexes around 0.25 seconds.
What would be an appropriate initial intervention in this
scenario?
 IV Amiodarone 300mg
 In unstable patient : consider up to 3 synchronized shocks,
amiodarone
16. Best heard by auscultation using the stethoscope bell rather than
the diaphragm?
 Mitral stenosis [low pitched rumbling murmur]
17. You are asked by your consultant to examine a patient with a

murmur. She asks you to feel the patient’s carotid pulse. When
you feel the pulse, it feels as though the blood is shot up under
high pressure, then immediately disappears.
What valvular pathology would this stereotypical pulse
indicate?
 Aortic regurgitation [Corrigan’s pulse/ collapsing pulse – rapid
increasing & disappearing pulse at carotid]

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MCQ – Cardiology [Zerotofinals.

2. You attend a crash call. The patient is unresponsive and no pulse

 Shockable rhythm: ventricular tachycardia, ventricular

 Mitral regurgitation [radiate to left axilla, result in congestive

 Acute LVF w pulmonary edema [secondary to underlying aortic

17. You are asked by your consultant to examine a patient with a

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