61- A 27 year old woman complained of palpitations, breathlessness and chest pain, radiating to the left arm. These symptoms had developed six weeks previously, after she had witnessed her father dying from a myocardial infarction. In the past 10 years she had been investigated for abdominal pain, headaches, joint pains, and dyspareunia, without serious cause being found for these symptoms.
What is the most likely diagnosis?
1) Depressive episode
2) Factitious disorder
3) Generalized anxiety disorder
4) Hypochondriasis
5) Somatization disorder
Answer-5
62- A 35-year-old healthy woman has a faint systolic murmur on physical examination. An echocardiogram is performed, and she is found to have a bicuspid aortic valve. In explaining the meaning of this finding to her, the most appropriate statement is that?
1) An aortic valve prosthesis may eventually need to be placed
2) Other family members may have the same condition
3) She should be treated with a cholesterol-lowering agent
4) The problem resulted from past injection drug usage
5) This is one manifestation of an underlying autoimmune disease process
Answer-1
Bicuspid aortic valve is perhaps the most common form of congenital heart disease in adults. Bicuspid valves have a propensity to wear out and calcify with aging.
Bicuspid aortic valve tends to be a sporadic.
63- Which of the following findings is the most specific for a diagnosis of myocardial infarction?
1) an akinetic area of LV wall motion on ECHO
2) elevated cardiac enzymes
3) evolution of Q waves on ECG
4) history of severe chest pain
5) ST elevation on ECG
Answer-3
64- A 15 year old female presents following a sore throat with chest pain, fever, and a skin rash. Examination reveals a diastolic murmur. Her ASO titre is elevated. Which of the following is a major criterion for the diagnosis of Rheumatic fever?
1) Fever
2) Raised ESR
3) Polyarthritis
4) Migratory erythema
5) Prolonged PR interval
Answer-3
65- A 55-year-old man with Type 2 Diabetes Mellitus and Ischaemic Heart Disease has been researching the Internet! He asks your opinion on Laser Transmyocardial Revascularisation. Which of the following statements about this technique is true?
1) avoids the need for major surgery
2) damages the endocardium
3) involves destruction of coronary stenoses
4) is of particular use in severe proximal coronary artery disease
5) stimulates collateral vessel formation
Answer-2
66- On auscultation of the heart of a 30 year old female a loud first heart sound is heard. Which of the following may be responsible for thsi auscultatory feature?
1) a long preceding diastolic interval
2) Atrial premature beat
3) increrased pulmonary arterial pressure
4) increased systemic arterial pressure
5) rupture of a papillary muscle
Answer-2
67- A 64-year-old man is admitted with a right femoral neck fracture following a fall. Also seen in the radiograph of the pelvis are several prominent calcified vessels. What is the most appropriate next step in management of this finding?
1) anticoagulate with heparin
2) Ignore it
3) Order a pulmonary ventilation-perfusion scan
4) Request a serum troponin test
5) Start the patient on a nitrate infusion
Answer-2
68- A 59-year-old man who was active all his life develops sudden severe anterior chest pain that radiates to his back. Within minutes, he is unconscious. He has a history of hypertension, but a recent treadmill test had revealed no evidence for cardiac disease. Which of the following is the most likely diagnosis?
1) Acute myocardial infarction
2) Group A streptococcal infection
3) Pulmonary embolus
4) Right middle cerebral artery embolus
5) Tear in the aortic intima
Answer-5
The history is typical of aortic dissection. All the others could cause sudden collapse but not with acute chest pain radiating to the back in the presence of a
recent normal exercise test. Acute MI is possible but not the most likely.
69- Which ONE of the following statements is true about the diastolic Austin Flint murmur?
1) It is associated with a loud first heart sound.
2) It is an early sign of aortic regurgitation
3) It can be distinguished from the murmur of mitral stenosis by absence of presystolic accentuation
4) It is due to partial closure of the anterior leaflet of the mitral valve
5) It does not occur in aortic incompetence secondary to an aortitis
Answer-4
The Austin Flint murmur is a low frequency mid/late diastolic murmur which may show pre-systolic accentuation which is virtually indistinguishable from that of
mitral stenosis. There is no correlation between presence of murmur and severity of AR, or aetiology. The first heart sound is normal but in severe cases, it may be
absent.
70- A 28-year-old man who is known to have Hypertrophic Cardiomyopathy has an out of hospital cardiac arrest and is successfully resuscitated. What is the most appropriate mode of treatment?
1) Alcohol Septal Ablation
2) Amiodarone
3) Beta Blocker
4) Implantable Defibrillator
5) Myomectomy
Answer-4
Patients with HCM are at increased risk of sudden cardiac death due to VF/VT. Implantable Cardio Defibrillators (ICD) are superior to Amiodarone or Beta
Blockers for preventing this. Reducing outflow tract obstruction with myomectomy or Alcohol Septal Ablation does not reduce the risk of SCD.
What is the most likely diagnosis?
1) Depressive episode
2) Factitious disorder
3) Generalized anxiety disorder
4) Hypochondriasis
5) Somatization disorder
Answer-5
62- A 35-year-old healthy woman has a faint systolic murmur on physical examination. An echocardiogram is performed, and she is found to have a bicuspid aortic valve. In explaining the meaning of this finding to her, the most appropriate statement is that?
1) An aortic valve prosthesis may eventually need to be placed
2) Other family members may have the same condition
3) She should be treated with a cholesterol-lowering agent
4) The problem resulted from past injection drug usage
5) This is one manifestation of an underlying autoimmune disease process
Answer-1
Bicuspid aortic valve is perhaps the most common form of congenital heart disease in adults. Bicuspid valves have a propensity to wear out and calcify with aging.
Bicuspid aortic valve tends to be a sporadic.
63- Which of the following findings is the most specific for a diagnosis of myocardial infarction?
1) an akinetic area of LV wall motion on ECHO
2) elevated cardiac enzymes
3) evolution of Q waves on ECG
4) history of severe chest pain
5) ST elevation on ECG
Answer-3
64- A 15 year old female presents following a sore throat with chest pain, fever, and a skin rash. Examination reveals a diastolic murmur. Her ASO titre is elevated. Which of the following is a major criterion for the diagnosis of Rheumatic fever?
1) Fever
2) Raised ESR
3) Polyarthritis
4) Migratory erythema
5) Prolonged PR interval
Answer-3
65- A 55-year-old man with Type 2 Diabetes Mellitus and Ischaemic Heart Disease has been researching the Internet! He asks your opinion on Laser Transmyocardial Revascularisation. Which of the following statements about this technique is true?
1) avoids the need for major surgery
2) damages the endocardium
3) involves destruction of coronary stenoses
4) is of particular use in severe proximal coronary artery disease
5) stimulates collateral vessel formation
Answer-2
66- On auscultation of the heart of a 30 year old female a loud first heart sound is heard. Which of the following may be responsible for thsi auscultatory feature?
1) a long preceding diastolic interval
2) Atrial premature beat
3) increrased pulmonary arterial pressure
4) increased systemic arterial pressure
5) rupture of a papillary muscle
Answer-2
67- A 64-year-old man is admitted with a right femoral neck fracture following a fall. Also seen in the radiograph of the pelvis are several prominent calcified vessels. What is the most appropriate next step in management of this finding?
1) anticoagulate with heparin
2) Ignore it
3) Order a pulmonary ventilation-perfusion scan
4) Request a serum troponin test
5) Start the patient on a nitrate infusion
Answer-2
68- A 59-year-old man who was active all his life develops sudden severe anterior chest pain that radiates to his back. Within minutes, he is unconscious. He has a history of hypertension, but a recent treadmill test had revealed no evidence for cardiac disease. Which of the following is the most likely diagnosis?
1) Acute myocardial infarction
2) Group A streptococcal infection
3) Pulmonary embolus
4) Right middle cerebral artery embolus
5) Tear in the aortic intima
Answer-5
The history is typical of aortic dissection. All the others could cause sudden collapse but not with acute chest pain radiating to the back in the presence of a
recent normal exercise test. Acute MI is possible but not the most likely.
69- Which ONE of the following statements is true about the diastolic Austin Flint murmur?
1) It is associated with a loud first heart sound.
2) It is an early sign of aortic regurgitation
3) It can be distinguished from the murmur of mitral stenosis by absence of presystolic accentuation
4) It is due to partial closure of the anterior leaflet of the mitral valve
5) It does not occur in aortic incompetence secondary to an aortitis
Answer-4
The Austin Flint murmur is a low frequency mid/late diastolic murmur which may show pre-systolic accentuation which is virtually indistinguishable from that of
mitral stenosis. There is no correlation between presence of murmur and severity of AR, or aetiology. The first heart sound is normal but in severe cases, it may be
absent.
70- A 28-year-old man who is known to have Hypertrophic Cardiomyopathy has an out of hospital cardiac arrest and is successfully resuscitated. What is the most appropriate mode of treatment?
1) Alcohol Septal Ablation
2) Amiodarone
3) Beta Blocker
4) Implantable Defibrillator
5) Myomectomy
Answer-4
Patients with HCM are at increased risk of sudden cardiac death due to VF/VT. Implantable Cardio Defibrillators (ICD) are superior to Amiodarone or Beta
Blockers for preventing this. Reducing outflow tract obstruction with myomectomy or Alcohol Septal Ablation does not reduce the risk of SCD.
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