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Question 1 of 40
1. Question1 point(s)
What valvular pathology would cause a murmur that radiates to the carotids?CorrectIncorrect
Question 2 of 40
2. Question1 point(s)
Which artery supplies the posterior septal area of the heart?CorrectIncorrect
Question 3 of 40
3. Question1 point(s)
Select the cardiac diagnoses that may cause hepatomegaly.CorrectIncorrect
Question 4 of 40
4. Question1 point(s)
Which artery supplies the posterior aspect of the left ventricleCorrectIncorrect
Question 5 of 40
5. Question1 point(s)
Which coronary artery supplies the inferior aspect of the left ventricle?CorrectIncorrect
Question 6 of 40
6. Question1 point(s)
Which artery supplies the left atrium?CorrectIncorrect
Question 7 of 40
7. Question1 point(s)
What blood test is most important in a patient who is starting and ACE inhibitor?CorrectIncorrect
Question 8 of 40
8. Question1 point(s)
Which of the following medication do NOT have a role in the treatment of uncomplicated angina?CorrectIncorrect
Question 9 of 40
9. Question1 point(s)
A 64 year old man who is known to have angina presents to 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 (central, constricting, radiating to his jaw), however it has not settled with rest or with his GTN spray. It has been fluctuating in severity slightly since it started and the patient states it may have improved a little since if first started.
There are no changes on serial ECGs and serial troponin measurements are normal.
What is the most likely diagnosis?CorrectIncorrect
Question 10 of 40
10. Question1 point(s)
A 76 year old lady presents to the accident and emergency department complaining of central crushing chest pain. This came on at rest whilst she was eating breakfast 30 minutes ago. She rates this as 8/10 and is associated with anxiety. It radiates to her left shoulder and arm.
She is a smoker and is known to have severe COPD with frequent exacerbations (and is on a host of inhalers for her COPD), is on atorvastatin 20mg at night for high cholesterol, and has osteoarthritis for which she takes simple analgesia. She doesn’t have any allergies.
She has normal heart sounds, scattered wheezes throughout her chest with no crackles, and is haemodynamically stable. Her observations are as follows:
- Heart rate 87.
- Respiratory rate 16.
- Blood pressure 113/84.
- Oxygen saturations 93%.
- Temperature 36.8C.
Her ECG shows ischaemic changes but no ST elevation and she has a significantly raised troponin. ABG shows a chronic obstructive picture with a raised CO2, although she has compensated metabolically and is not acidotic. She is slightly hypoxic at pO2 of 9.2.
A diagnosis of NSTEMI is made.
Select the appropriate medications from the list below for the immediate management of this patient.CorrectIncorrect
Question 11 of 40
11. Question1 point(s)
You are the oncall surgical FY1. You are called to see a 65 year old female patient who is post op day 2 after a laparoscopic right hemicolectomy. She started complaining of central crushing chest pain scoring 9/10 only 10 minutes ago.
On examination she looks unwell, is sweating, clammy and tachycardic at 105 beats per minutes. Her blood pressure is stable at 142/87. She is apyrexial, with saturations at 98% and respiratory rate of 18 / minute.
You perform an ECG that shows ST elevation in leads 1 aVL, V5 and V6.
What is the most appropriate initial management?CorrectIncorrect
Question 12 of 40
12. Question1 point(s)
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 left basal pneumonia. On admission she was septic with a high fever, hypotension and tachycardia. On admission her saturations were 96% and her respiration rate as 18 per minute.
She was treated with the septic six, including IV tazocin and 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. She is apyrexial, with a heart rate of 96 bpm and a blood pressure of 115/86.
She looks unwell and is using her accessory muscles to breath. She has bibasal crackles, worse on the left, a raised JVP, and an ejection systolic murmur radiating to her carotids.
What is the most likely diagnosis?CorrectIncorrect
Question 13 of 40
13. Question1 point(s)
What blood investigation will be most helpful in diagnosing chronic heart failure?CorrectIncorrect
Question 14 of 40
14. Question1 point(s)
What is the normal cardio-thoracic ratio?CorrectIncorrect
Question 15 of 40
15. Question1 point(s)
Select from the list the medication that would be considered first line in chronic heart failure.CorrectIncorrect
Question 16 of 40
16. Question1 point(s)
What point on the chest is the best overall position for listening for the third and fourth heart sounds?CorrectIncorrect
Question 17 of 40
17. Question1 point(s)
What would be the best position on the chest wall to listen for aortic stenosis?CorrectIncorrect
Question 18 of 40
18. Question1 point(s)
What would be the best position on the chest wall to listen for mitral stenosis?CorrectIncorrect
Question 19 of 40
19. Question1 point(s)
Select the pathology from the list below that would be best heard by auscultation using the stethoscope bell rather than the diaphragm?CorrectIncorrect
Question 20 of 40
20. Question1 point(s)
What valvular pathology may cause a murmur that radiates to the left axilla?CorrectIncorrect
Question 21 of 40
21. Question1 point(s)
What statement would best describe a grade 3 murmur?CorrectIncorrect
Question 22 of 40
22. Question1 point(s)
What is the most common cause of aortic stenosis?CorrectIncorrect
Question 23 of 40
23. Question1 point(s)
A 64 year old presents complaining of shortness of breath, worse on exertion and when lying flat at night.
He is known to have ischaemic heart disease and is on medication for angina. He has had two previous NSTEMIs.
On ausculatation you hear a grade 3, pan-systolic murmur loudest at the apex.
What is the most likely cause for his murmur?CorrectIncorrect
Question 24 of 40
24. Question1 point(s)
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?CorrectIncorrect
Question 25 of 40
25. Question1 point(s)
You are clerking a patient on the acute medical take. She tells you she had surgery on her heart replacement three years ago and has been on warfarin ever since.
She is unsure what the surgery was, and what her normal dose of warfarin is.
On examination you notice a midline sternotomy scar, and hear a subtle click instead of S1, loudest over the apex.
What target INR would be most appropriate for this patient?CorrectIncorrect
Question 26 of 40
26. Question1 point(s)
You are counselling a patient with severe mitral regurgitation on the pros and cons of replacement heart valves.
What is the most significant issue with mechanical heart valves when compared to bioprosthetic valves?CorrectIncorrect
Question 27 of 40
27. Question1 point(s)
Other than atrial fibrillation, what can cause an irregularly irregular pulse?CorrectIncorrect
Question 28 of 40
28. Question1 point(s)
What would be an appropriate first line treatment for atrial fibrillation in a sedentary 78 year old lady with a new diagnosis of atrial fibrillation who has no other health problems and no allergies?CorrectIncorrect
Question 29 of 40
29. Question1 point(s)
What would be an appropriate first line treatment for atrial fibrillation in a sedentary 78 year old lady with a new diagnosis of atrial fibrillation who has no other health problems and no allergies? She is normotensive and has no evidence of heart failure.CorrectIncorrect
Question 30 of 40
30. Question1 point(s)
What is the normal duration of a QRS complex?CorrectIncorrect
Question 31 of 40
31. Question1 point(s)
What ventricular rate would you expect in atrial flutter?CorrectIncorrect
Question 32 of 40
32. Question1 point(s)
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.CorrectIncorrect
Question 33 of 40
33. Question1 point(s)
What is the most important thing to consider prior to administering amiodarone?CorrectIncorrect
Question 34 of 40
34. Question1 point(s)
Match the following AV node abnormalities with the appropriate description
- Delayed atrioventricular conduction
- Wenckebach's phenomenon
- Intermitted AV conduction interuption
- QRS after every second P wave
- Dissociation between P waves and QRS complexes
First degree heart block
Mobitz Type 1
Mobitz Type 2
2:1 AV block
Third Degree Heart Block
Question 35 of 40
35. Question1 point(s)
Select the antiarrythmic medication with a role in treating bradycardias from the list below.CorrectIncorrect
Question 36 of 40
36. Question1 point(s)
You attend a crash call. The patient is unresponsive and no pulse can be found. The team commences resuscitation according to the ALS protocol. You connect the defibrillator and assess the rhythm.
Select the rhythms below that would appropriate to shock in this scenario.CorrectIncorrect
Question 37 of 40
37. Question1 point(s)
You are asked by a nurse to review an ECG in a pre-operative patient.
You notice a thin vertical line before each P wave and each QRS complex.
What is the most likely cause?CorrectIncorrect
Question 38 of 40
38. Question1 point(s)
You diagnose essential hypertension in a 45 year old black female patient who has ambulatory blood pressure monitoring demonstrating an average blood pressure of 156/89. She is otherwise fit and well and has no known allergies.
After discussing lifestyle interventions, you agree with the patient that medication should be commenced.
What would be the most appropriate first line medication from the list below?CorrectIncorrect
Question 39 of 40
39. Question1 point(s)
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?CorrectIncorrect
Question 40 of 40
40. Question1 point(s)
Match the confirmed hypertensive patient with the most appropriate medication.
- Ramipril plus amlodipine
84 year old woman
76 year old diabetic man
43 year old black diabetic women
65 year old black man already on amlodipine with persistently uncontrolled hypertension
74 year old woman with uncontrolled diabetes already on amlodipine and ramipril