Cardiology Module 2

A 55-year-old Māori male, Mr. T, is admitted to the hospital with a diagnosis of acute coronary syndrome. He is prescribed clopidogrel as part of his treatment plan. However, his cardiologist notes that Mr. T’s platelet aggregation studies show a reduced response to clopidogrel.

Which of the following genetic variations is most likely responsible for this reduced response in Mr. T?

CYP2C19*2 polymorphism

Correct Incorrect Correct answer

ABCB1 gene variant

Correct Incorrect Correct answer

PON1 Q192R polymorphism

Correct Incorrect Correct answer

COX-1 gene mutation

Correct Incorrect Correct answer

SLCO1B1 gene variant

Correct Incorrect Correct answer

A 55-year-old man presents to the emergency department with a 2-hour history of chest pain. The pain is described as a squeezing sensation in the center of his chest, radiating to his left arm. He has a history of hypertension and hyperlipidemia.

During periods when he is pain free, his ECG shows:

Biphasic T-waves in V2-V3
NO ST elevation (<1 mm)
NO loss of R-wave progression

What is the most likely diagnosis and significance of the ECG findings in this patient?

Wellens syndrome, indicating a high-grade stenosis of the LAD coronary artery, with a high risk of impending anterior wall MI.

Correct Incorrect Correct answer

Acute myocardial infarction (MI) with ST-elevation in the anterior leads, indicating occlusion of the left anterior descending (LAD) coronary artery.

Correct Incorrect Correct answer

Non-ST elevation MI (NSTEMI) with subendocardial ischemia in the anterior leads.

Correct Incorrect Correct answer

Left ventricular hypertrophy (LVH) with repolarization abnormalities.

Correct Incorrect Correct answer

Pericarditis with diffuse ST-elevation.

Correct Incorrect Correct answer

Regarding Transcatheter Edge-to-Edge Repair (TEER) for mitral valve regurgitation, which of the following statements is most accurate?

TEER can significantly improve symptoms and quality of life in patients with functional mitral regurgitation who are not suitable candidates for surgery.

Correct Incorrect Correct answer

TEER is the first-line treatment for all patients with mitral regurgitation regardless of their surgical risk profile.

Correct Incorrect Correct answer

The MitraClip device used in TEER is designed to reposition the aortic valve leaflets to reduce regurgitation.

Correct Incorrect Correct answer

Patients undergoing TEER typically require anticoagulation therapy for life to prevent thromboembolic events.

Correct Incorrect Correct answer

TEER is contraindicated in patients with left ventricular ejection fraction (LVEF) greater than 60%.

Correct Incorrect Correct answer

A 32-year-old male presents to the clinic with recurrent episodes of severe abdominal pain, accompanied by nausea and vomiting. He mentions that these episodes often occur after consuming fatty meals. Physical examination reveals hepatosplenomegaly and multiple eruptive xanthomas over his buttocks and back.

His fasting lipid profile shows severely elevated triglycerides. His family history is significant, with similar symptoms noted in his father and a paternal uncle.

Which of the following is the most appropriate initial management approach for this patient?

Implementation of a strict low-fat diet comprising less than 20 grams of fat per day.

Correct Incorrect Correct answer

Administration of high dose omega-3 fatty acids supplements.

Correct Incorrect Correct answer

Prescribe subcutaneous insulin therapy.

Correct Incorrect Correct answer

Initiate niacin to reduce triglyceride synthesis.

Correct Incorrect Correct answer

Initiate treatment with Olezarsen.

Correct Incorrect Correct answer

A 52-year-old male patient with no previous history of cardiovascular disease (CVD) presents to your clinic for a routine health check-up. He has been smoking for 30 years, has a systolic blood pressure of 140 mmHg, total cholesterol of 220 mg/dL, and uses no antihypertensive or statin medications. He is not diabetic and his estimated glomerular filtration rate (eGFR) is 90 mL/min/1.73m².

You decide to assess his absolute risk of CVD using the American Heart Association Predicting Risk of CVD EVENTs (PREVENT) equations.

Based on the PREVENT study findings, which additional predictor could you consider adding to the base model to potentially enhance the precision of his CVD risk prediction?

Urine albumin-to-creatinine ratio

Correct Incorrect Correct answer

Left ventricular ejection fraction

Correct Incorrect Correct answer

Erythrocyte sedimentation rate (ESR)

Correct Incorrect Correct answer

C-reactive protein (CRP) level

Correct Incorrect Correct answer

Body Mass Index (BMI)

Correct Incorrect Correct answer

In patients with non-valvular atrial fibrillation with prior stroke, TIA or CHA2DS2-VASC score of more than 2, the recommended oral anticoagulants include all of the following except?

aspirin

Correct Incorrect Correct answer

warfarin

Correct Incorrect Correct answer

dabigatran

Correct Incorrect Correct answer

rivaroxaban

Correct Incorrect Correct answer

apixaban

Correct Incorrect Correct answer

Which of the following is not part of the recommended Mediterranean diet?

honey roasted nuts on every meal

Correct Incorrect Correct answer

extra virgin olive oil on every meal

Correct Incorrect Correct answer

herbs and spices on every meal

Correct Incorrect Correct answer

fish and seafood at least twice a week

Correct Incorrect Correct answer

limiting red meat to no more than a few times a month

Correct Incorrect Correct answer

A 56 year old man comes in to your hypertension clinic for a review. He is an ex-smoker of 40 pack years, hyperlipidemia, hypertension but no history of diabetes. His BMI is 42.

What should his initial target systolic blood pressure be to help reduce his risk of having a major cardiovascular event in the future?

Between 110 to 120 mmHg

Correct Incorrect Correct answer

Between 90 to 100 mmHg

Correct Incorrect Correct answer

Between 100 to 110 mmHg

Correct Incorrect Correct answer

Between 120 to 130 mmHg

Correct Incorrect Correct answer

Between 130 to 140 mmHg

Correct Incorrect Correct answer

Flecainide is a class Ic antiarrhythmic agent used to prevent and treat tachyarrhythmias. However the drug has a narrow therapeutic index.
Which of the following would not be a compatible sign of cardiac toxicity related to this drug?

Prolonged PR interval with a normal QRS duration

Correct Incorrect Correct answer

QT prolongation

Correct Incorrect Correct answer

Prolonged PR interval with widening QRS complex

Correct Incorrect Correct answer

Torsades de pointes

Correct Incorrect Correct answer

Overt heart failure

Correct Incorrect Correct answer

What is the most common symptom of mitral stenosis?

Dyspnea

Correct Incorrect Correct answer

Haemoptysis

Correct Incorrect Correct answer

Thromboembolism

Correct Incorrect Correct answer

Chest pain

Correct Incorrect Correct answer

Hoarseness

Correct Incorrect Correct answer

What is the most likely diagnosis?

Ventricular tachycardia

Correct Incorrect Correct answer

Supraventricular tachycardia

Correct Incorrect Correct answer

Torsades de Pointes

Correct Incorrect Correct answer

Sinus tachycardia

Correct Incorrect Correct answer

Atrial flutter

Correct Incorrect Correct answer

What is the underlying rhythm?

Ventricular fibrillation

Correct Incorrect Correct answer

Ventricular tachycardia

Correct Incorrect Correct answer

Atrial flutter

Correct Incorrect Correct answer

Atrial fibrillation

Correct Incorrect Correct answer

Torsades de Pointes

Correct Incorrect Correct answer

Which of the following medication is contraindicated in systolic heart failure?

Diltiazem

Correct Incorrect Correct answer

ACE-inhibitors

Correct Incorrect Correct answer

Digoxin

Correct Incorrect Correct answer

Spironolactone

Correct Incorrect Correct answer

Frusemide

Correct Incorrect Correct answer

What is the mechanism of action of Tirofiban?

Reversible non peptide receptor antagonist against Glycoprotein IIB/IIIA

Correct Incorrect Correct answer

ADP receptor blocker

Correct Incorrect Correct answer

Direct thrombin inhibitor

Correct Incorrect Correct answer

Indirect thrombin inhibitor

Correct Incorrect Correct answer

Irreversible monoclonal antibody against Glycoprotein IIB/IIIA receptor

Correct Incorrect Correct answer

What is the most common cause of sudden cardiac death in young competitive athletes?

hypertrophic cardiomyopathy

Correct Incorrect Correct answer

aberrant coronary arteries

Correct Incorrect Correct answer

arrhythmogenic right ventricular dysplasia

Correct Incorrect Correct answer

ruptured aortic aneurysm

Correct Incorrect Correct answer

restrictive cardiomyopathy

Correct Incorrect Correct answer

A 64-year-old man presents to hospital seven hours after onset of severe chest pain. His ECG shows 4-5 mm ST elevation in leads II, III and aVF, and complete heart block with a ventricular rate of 50/minute. His blood pressure is 115/60 mmHg which falls transiently to 90/50 mmHg with the administration of streptokinase, before returning to 120/55 mmHg.

Four hours later, he is reviewed in the coronary care unit. His heart rate is 50/minute and his blood pressure is 85/60 mmHg. His jugular venous pressure is 4 cm with cannon waves. A third sound is audible but there are no murmurs. Breath sounds are normal. The patient complains of mild chest pain which is relieved by sitting up.

The ECG remains unchanged. Urine output has declined to 5 mL/h for the last two hours

What is the most appropriate next step in management?

Increase intravenous fluid administration

Correct Incorrect Correct answer

Insert a temporary pacing wire to increase the heart rate to about 80/minute

Correct Incorrect Correct answer

Organise immediate rescue percutaneous transluminal coronary angioplasty (PTCA).

Correct Incorrect Correct answer

Commence an intravenous dobutamine infusion

Correct Incorrect Correct answer

Insert a Swan-Ganz catheter for haemodynamic monitoring

Correct Incorrect Correct answer

What is the most common cause of mitral stenosis?

Rheumatic heart disease

Correct Incorrect Correct answer

Congenital mitral stenosis

Correct Incorrect Correct answer

Infective endocarditis

Correct Incorrect Correct answer

Mitral annular calcification

Correct Incorrect Correct answer

Atrial myxoma

Correct Incorrect Correct answer

About half of all patients with Hypertrophic Cardiomyopathy (HCM) have a positive family history compatible with autosomal dominant transmission.

What is the most common mutation?

cardiac myosin binding protein c

Correct Incorrect Correct answer

cardiac beta-myosin heavy chain gene on chromosome 14.

Correct Incorrect Correct answer

cardiac alpha myosin heavy chain

Correct Incorrect Correct answer

cardiac troponin C

Correct Incorrect Correct answer

myosin light chain

Correct Incorrect Correct answer

What is the most important predisposing factor for acute aortic dissection in the elderly population?

Systemic hypertension

Correct Incorrect Correct answer

Preexisting aortic aneurysm.

Correct Incorrect Correct answer

Presence of vasculitis

Correct Incorrect Correct answer

Family history of dissection

Correct Incorrect Correct answer

Marfan syndrome

Correct Incorrect Correct answer

With regards to valvular heart disease, which of the following cases is valve surgery most appropriate?

Mitral valve repair in a patient with asymptomatic severe mitral regurgitation secondary to posterior leaflet prolapse,a LVEF of 55% and a LV end systolic dimension of 4.8cm

Correct Incorrect Correct answer

Aortic valve replacement in a patient undergoing CABGs and with mild aortic stenosis

Correct Incorrect Correct answer

Aortic valve replacement in a patient with severe asymptomatic aortic regurgitation, a LVEF of 55% and LV end diastolic dimension of 6.0cm

Correct Incorrect Correct answer

Mitral valve replacement for symptomatic severe functional MR in a patient with LVEF of 15%

Correct Incorrect Correct answer

Tricuspid valve replacement in an IVDU with a 10mm vegetation on the tricuspid valve.

Correct Incorrect Correct answer

Which of the following is the strongest indication for an ICD placement in a patient with Hypertrophic Obstructive Cardiomyopathy (HOCM)?

Left ventricular wall thickness equal to or more than 30 mm.

Correct Incorrect Correct answer

LV apical aneurysm without late gadolinium enhancement (LGE).

Correct Incorrect Correct answer

Family history of sudden death attributable to HCM in ≥1 second-degree relatives ≤50 years of age

Correct Incorrect Correct answer

Left ventricular ejection fraction between 55 to 60 percent.

Correct Incorrect Correct answer

Vasovagal syncope following intense exercise

Correct Incorrect Correct answer

Which of the following drugs have not been shown to improve survival in patients with heart failure with reduced ejection fraction (HFrEF)?

Frusemide

Correct Incorrect Correct answer

ACE inhibitors

Correct Incorrect Correct answer

Beta-blockers

Correct Incorrect Correct answer

Spironolactone

Correct Incorrect Correct answer

Angiotensin Receptor Neprilysin Inhibitor

Correct Incorrect Correct answer

What is the most likely diagnosis based on the ECG below?

Wolff-Parkinson-White syndrome.

Correct Incorrect Correct answer

AV junctional re-entrant tachycardia

Correct Incorrect Correct answer

Lown-Ganong-Levine syndrome

Correct Incorrect Correct answer

Atrial tachycardia

Correct Incorrect Correct answer

Atrial fibrillation

Correct Incorrect Correct answer

Which of the following drugs causes gynaecomastia?

Spironolactone

Correct Incorrect Correct answer

ACE inhibitors

Correct Incorrect Correct answer

Beta blockers

Correct Incorrect Correct answer

Digoxin

Correct Incorrect Correct answer

Frusemide

Correct Incorrect Correct answer

What is the mechanism of action of eplerenone?

Selective aldosterone antagonist

Correct Incorrect Correct answer

Aldosterone agonist

Correct Incorrect Correct answer

direct thrombin inhibitor

Correct Incorrect Correct answer

ADP receptor blocker

Correct Incorrect Correct answer

beta-1 and beta-2 antagonist.

Correct Incorrect Correct answer

Which of the following is NOT true regarding digoxin?

Reduces vagal activity

Correct Incorrect Correct answer

Inhibits Sodium-potassium ATPase

Correct Incorrect Correct answer

Sensitize cardiopulmonary baroreceptors

Correct Incorrect Correct answer

Reduces sympathetic outflow

Correct Incorrect Correct answer

Reduces activation of the renin-angiotensin system.

Correct Incorrect Correct answer

The following drugs should be avoided in patients with congestive heart failure, except?

Beta blockers

Correct Incorrect Correct answer

Non-dihydropyridine calcium channel blocker

Correct Incorrect Correct answer

Tricyclic antidepressants

Correct Incorrect Correct answer

NSAIDs

Correct Incorrect Correct answer

TNF blocker

Correct Incorrect Correct answer

What is the most characteristic feature of Hypertrophic Cardiomyopathy on ECHO?

a ratio of septal to posterior wall thickness greater than 1.3: 1.0

Correct Incorrect Correct answer

systolic anterior motion of mitral valve

Correct Incorrect Correct answer

late systolic closure of aortic valve

Correct Incorrect Correct answer

left ventricular outflow tract obstruction

Correct Incorrect Correct answer

abnormal doppler mitral inflow pattern

Correct Incorrect Correct answer

What is the mechanism of action of Abciximab?

Glycoprotein IIb/IIIa receptor antagonist

Correct Incorrect Correct answer

ADP receptor blocker

Correct Incorrect Correct answer

COX inhibitor

Correct Incorrect Correct answer

Direct thrombin inhibitor

Correct Incorrect Correct answer

Indirect thrombin inhibitor

Correct Incorrect Correct answer

In apparently healthy persons without hyperlipidemia but with elevated high-sensitivity C-reactive protein levels,which medication significantly reduced the incidence of major cardiovascular events?

Rosuvastatin

Correct Incorrect Correct answer

Cilazapril

Correct Incorrect Correct answer

Frusemide

Correct Incorrect Correct answer

Aspirin

Correct Incorrect Correct answer

Metoprolol

Correct Incorrect Correct answer

An 88 year old man has a background of atrial fibrillation, hypertension, diabetes and chronic renal failure with a baseline serum creatinine of 210 umol/l (eGFR <20). His current medications include cilazapril, glipizide and aspirin.

He enjoys drinking a glass of wine each night after dinner. His BP is 150/80 and cardiovascular examination is unremarkable. His friend had told him that a drug called Rivaroxaban is helpful in preventing stroke in patients with chronic AF, so now he asks you if he should be on Rivaroxaban.

Which of the following patient factors would make you decide against the use of Rivaroxaban in this man?

Age, chronic renal failure and aspirin use.

Correct Incorrect Correct answer

Age alone

Correct Incorrect Correct answer

Age, diabetes and hypertension

Correct Incorrect Correct answer

Age, alcohol intake and hypertension

Correct Incorrect Correct answer

Age, alcohol intake and diabetes

Correct Incorrect Correct answer

In patients with severe aortic stenosis who are not candidates for surgical replacement of the aortic valve, which of the following treatment significantly reduces mortality?

Transcatheter aortic-valve implantation (TAVI)

Correct Incorrect Correct answer

Balloon aortic valvuloplasty

Correct Incorrect Correct answer

ACE-inhibitors

Correct Incorrect Correct answer

Frusemide

Correct Incorrect Correct answer

Spironolactone

Correct Incorrect Correct answer

What is the most likely diagnosis based on the ECG below?

Lown-Ganong-Levin syndrome

Correct Incorrect Correct answer

Wolff Parkinson White syndrome

Correct Incorrect Correct answer

Brugada syndrome

Correct Incorrect Correct answer

Atrial fibrillation

Correct Incorrect Correct answer

AV nodal re-entrant tachycardia

Correct Incorrect Correct answer

A 50 year old woman presents with acute onset left sided chest pain radiating to her neck and down her left arm. Her ECG shows 2mm ST elevation in V2-V4.

An urgent angiography subsequently shows a spontaneous coronary artery dissection involving her left anterior descending artery.

Which of the following intervention is least likely to be helpful?

Statins

Correct Incorrect Correct answer

Beta-blocker

Correct Incorrect Correct answer

Calcium channel blocker

Correct Incorrect Correct answer

Aspirin

Correct Incorrect Correct answer

Angiotensin receptor blocker

Correct Incorrect Correct answer

Which of the following risk factor has the highest odds ratio for myocardial infarction?

Stress

Correct Incorrect Correct answer

Dyslipidemia

Correct Incorrect Correct answer

Diabetes

Correct Incorrect Correct answer

Hypertension

Correct Incorrect Correct answer

Regular alcohol consumption

Correct Incorrect Correct answer

Average score
Your score

Cardiology Module 2

Quiz Summary

Information

Results

Results

Categories

1. Question

2. Question

3. Question

4. Question

5. Question

6. Question

7. Question

8. Question

9. Question

10. Question

11. Question

12. Question

13. Question

14. Question

15. Question

16. Question

17. Question

18. Question

19. Question

20. Question

21. Question

22. Question

23. Question

24. Question

25. Question

26. Question

27. Question

28. Question

29. Question

30. Question

31. Question

32. Question

33. Question

34. Question

35. Question