Cardiology Module 5

A 65-year-old woman with a history of dyslipidemia and smoking is referred for a myocardial perfusion scan (MPS) to evaluate suspected coronary artery disease (CAD) based on her atypical chest pain and risk factors.

Which of the following is a limitation of myocardial perfusion scanning that could affect its diagnostic accuracy in this patient?

MPS has a high false-negative rate in patients with single-vessel disease.

Correct Incorrect Correct answer

MPS cannot differentiate between stable angina and acute coronary syndromes.

Correct Incorrect Correct answer

MPS is less sensitive in detecting endocardial ischemia.

Correct Incorrect Correct answer

MPS always requires hospitalization for administration.

Correct Incorrect Correct answer

MPS is less accurate in patients without a smoking history.

Correct Incorrect Correct answer

Which of the following hormone is responsible for growth promotion, vasoconstriction and sodium and water retention in heart failure patients?

Aldosterone

Correct Incorrect Correct answer

Atrial Natriuretic Peptide

Correct Incorrect Correct answer

Brain Natriuretic Peptide

Correct Incorrect Correct answer

Bradykinin

Correct Incorrect Correct answer

Nitric oxide

Correct Incorrect Correct answer

What is the most common cause of diastolic heart failure?

Hypertension

Correct Incorrect Correct answer

Hypertrophic cardiomyopathy

Correct Incorrect Correct answer

Ischaemia

Correct Incorrect Correct answer

Infiltration

Correct Incorrect Correct answer

Which of the following medication has been proven to reduce the risk of sudden cardiac death in patients with heart failure?

Carvedilol

Correct Incorrect Correct answer

Cilazapril

Correct Incorrect Correct answer

Aspirin

Correct Incorrect Correct answer

Frusemide

Correct Incorrect Correct answer

Diltiazem

Correct Incorrect Correct answer

What is the mechanism of action of Ivabradine?

selective sinus-node inhibitor

Correct Incorrect Correct answer

selective beta blocker

Correct Incorrect Correct answer

aldosterone antagonist

Correct Incorrect Correct answer

calcium channel blocker

Correct Incorrect Correct answer

sodium channel blocker

Correct Incorrect Correct answer

Which of the following advise should not be recommended for patients suffering from heart failure?

swimming exercises

Correct Incorrect Correct answer

reduce alcohol intake

Correct Incorrect Correct answer

smoking cessation

Correct Incorrect Correct answer

weight loss

Correct Incorrect Correct answer

sodium and fluid restriction

Correct Incorrect Correct answer

A patient with moderate to severe chronic heart failure treated with erythropoetin will most likely achieve:

improved exercise capacity

Correct Incorrect Correct answer

improved cardiac remodelling

Correct Incorrect Correct answer

reduction in orthopnea

Correct Incorrect Correct answer

improvement in survival

Correct Incorrect Correct answer

reduction in oxygen delivery

Correct Incorrect Correct answer

Which of the following inotropic agent is least likely to have arrythmogenic potential?

Levosimendan

Correct Incorrect Correct answer

Milrinone

Correct Incorrect Correct answer

Dobutamine

Correct Incorrect Correct answer

Noradrenaline

Correct Incorrect Correct answer

Adrenaline

Correct Incorrect Correct answer

Which of the following population group has the highest incidence of sudden cardiac death?

High risk post MI subgroups

Correct Incorrect Correct answer

previous coronary event

Correct Incorrect Correct answer

ejection fraction < 35%

Correct Incorrect Correct answer

cardiac arrest survivors

Correct Incorrect Correct answer

general adult population

Correct Incorrect Correct answer

The following interventions commenced within 7 days following a myocardial infarction reduces mortality in sudden cardiac death except?

Implantable cardioverter defibrillator (ICD)

Correct Incorrect Correct answer

beta blocker

Correct Incorrect Correct answer

ACE inhibitor

Correct Incorrect Correct answer

HMG-CoA reductase inhibitor

Correct Incorrect Correct answer

Aldosterone antagonist in patients with left ventricular EF <30%

Correct Incorrect Correct answer

A patient presents with an anterior non-ST elevation myocardial infarction with transient T-wave inversion in V3-6. There is a typical rise in CK-MB (creatine kinase myocardial tissue) (2 x URL at 12 hr and 5 x URL at 24 hrs) and Troponin T (2 x URL at 12 hr and 20 x URL at 24 hrs).

72 hours after the onset of the first episode, the patient experiences recurrent chest pain.

*Levels are expressed as a multiple of the upper reference limit (URL).

If present, which of the following BEST indicates that the patient has had a recurrent myocardial infarct?

CK-MB (creatine kinase myocardial tissue) = 5 x URL 12 hrs after recurrent pain.

Correct Incorrect Correct answer

The left anterior artery is occluded at angiography

Correct Incorrect Correct answer

Cardiac Troponin = 10 x URL 12 hrs after recurrent pain.

Correct Incorrect Correct answer

Pain duration and intensity is similar to the first event.

Correct Incorrect Correct answer

The ECG now shows deep T-wave inversion in V3-6.

Correct Incorrect Correct answer

A 70-year-old man presents to the emergency department with prolonged chest pain which is relieved by morphine and sublingual nitrates. He has a three-week history of frequent exertional and nocturnal chest pain. Three years ago he suffered an uncomplicated inferior myocardial infarction. Coronary angiography at that time revealed a 30% proximal left anterior descending artery stenosis, a long 90% right coronary artery stenosis and a 70% stenosis of the proximal circumflex artery.

As he was asymptomatic at that time, he was treated with aspirin, a beta-blocker and a hydroxy-methylglutarylcoenzyme A (HMG CoA) reductase inhibitor. He was also treated with an angiotensin converting enzyme (ACE) inhibitor for mild hypertension.

His current ECG shows Q waves in the inferior leads and 1 mm ST segment depression in leads V4-V6. A chest X-ray shows pulmonary venous congestion.

Emergency staff have initiated heparin therapy and have continued his usual medications. On review two hours later, he is asymptomatic, the ST changes have resolved and his serum troponin I level is 2.5 mg/L [<0.1].

Which one of the following management strategies would be most appropriate for this patient?

option E

Correct Incorrect Correct answer

option D

Correct Incorrect Correct answer

option C

Correct Incorrect Correct answer

option B

Correct Incorrect Correct answer

option A

Correct Incorrect Correct answer

A 65-year-old man with one hour of central chest pain returns to the same hospital where he had percutaneous coronary intervention performed four weeks ago. He had stopped clopidogrel one week earlier. He is hypotensive with 3mm ST elevation in antero-septal leads.

Which of the following is the most appropriate management?

Coronary angiography and revascularisation

Correct Incorrect Correct answer

Nitroglycerine infusion

Correct Incorrect Correct answer

Bolus and infusion of a glycoprotein IIb/IIIa inhibitor.

Correct Incorrect Correct answer

Intra-aortic balloon counter-pulsation

Correct Incorrect Correct answer

Thrombolysis

Correct Incorrect Correct answer

A patient presents to ED with central retrosternal chest pain. The onset of symptom was 16 hours ago.

His ECG shows 2mm ST elevation in lead II, III and aVF. His serum troponin is marginally raised.

However, he is now currently asymptomatic and hemodynamically stable.

What is the next step?

Commence aspirin and ticagrelor

Correct Incorrect Correct answer

Commence aspirin and clopidogrel

Correct Incorrect Correct answer

Coronary angiography and revascularisation

Correct Incorrect Correct answer

Urgent thrombolysis.

Correct Incorrect Correct answer

Intra-aortic balloon counter-pulsation

Correct Incorrect Correct answer

A patient presents to a rural hospital with an ST elevation MI and is thrombolysed with tenectaplase.

Which of the following medication should not be given as an adjuvant therapy with tenectaplase?

Abciximab

Correct Incorrect Correct answer

Aspirin

Correct Incorrect Correct answer

Clopidogrel

Correct Incorrect Correct answer

Simvastatin

Correct Incorrect Correct answer

Heparin

Correct Incorrect Correct answer

A patient develops an ST elevation MI and was urgently transferred to the cath lab for an urgent percutaneous coronary intervention. A drug eluting stent is placed over his left anterior descending artery and he was commenced on dual anti-platelet therapy.

Following stent placement, how long should the patient remain on clopidogrel if a single anti-platelet therapy is chosen?

Up to 12 months

Correct Incorrect Correct answer

Up to 1 month

Correct Incorrect Correct answer

Up to 3 months

Correct Incorrect Correct answer

Up to 6 months

Correct Incorrect Correct answer

Lifelong

Correct Incorrect Correct answer

A 48-year-old woman presents to the emergency department of a large rural hospital with severe chest pain. An ECG shows 3-4 mm ST elevation in the anteroseptal leads. The risk of major haemorrhage complicating thrombolysis therapy is greatest in a patient who:

minor facial trauma two weeks ago

Correct Incorrect Correct answer

active peptic ulcer disease

Correct Incorrect Correct answer

recent upper GI bleed 4 weeks ago.

Correct Incorrect Correct answer

currently menstruating

Correct Incorrect Correct answer

severe hypertension with systolic BP of 180mmHg.

Correct Incorrect Correct answer

You are working in a rural hospital where the percutaneous coronary intervention capable hospital is located 6 hours from your hospital. A paramedic faxes you an ECG showing 2mm ST elevation in lead V2 to V6 on a patient who presented with chest pain 1 hour ago. There is no contraindication to fibrinolytic therapy. They are currently one hour away from your hospital.

What would be the most appropriate advise?

Initiate thrombolysis in the ambulance.

Correct Incorrect Correct answer

Do not thrombolyse the patient in ambulance but direct the patient to hospital for thrombolysis

Correct Incorrect Correct answer

Commence aspirin monotherapy

Correct Incorrect Correct answer

Commence aspirin and ticagrelor

Correct Incorrect Correct answer

Give GTN spray.

Correct Incorrect Correct answer

In patients with significant left main coronary artery disease (>50% stenosis) along with high complexity coronary artery disease (SYNTAX score of >33), which of the following intervention is the most appropriate management strategy to improve their survival?

Coronary Artery Bypass Graft

Correct Incorrect Correct answer

Medical therapy only

Correct Incorrect Correct answer

Drug eluting stent

Correct Incorrect Correct answer

Sequential CABG-PCI

Correct Incorrect Correct answer

Percutaneous Coronary Intervention only

Correct Incorrect Correct answer

Which of the following intervention is the most definitive treatment in preventing sudden death in patients with Hypertrophic Cardiomyopathy?

ICD therapy

Correct Incorrect Correct answer

Beta blockers

Correct Incorrect Correct answer

Amiodarone

Correct Incorrect Correct answer

Calcium channel blockers

Correct Incorrect Correct answer

Diuretics

Correct Incorrect Correct answer

A patient undergoes urgent percutaneous cardiac intervention (PCI) with a drug eluting stent following an acute presentation with ACS. He has since made a good recovery from this.

What would be the most appropriate timing for an elective non-cardiac surgery to be performed after his PCI?

12 months

Correct Incorrect Correct answer

4 weeks

Correct Incorrect Correct answer

2 months

Correct Incorrect Correct answer

3 months

Correct Incorrect Correct answer

6 months

Correct Incorrect Correct answer

Which of the following is the strongest indication for stopping antiplatelet therapy prior to surgery in a patient with prior coronary artery stenting?

Intracranial surgery

Correct Incorrect Correct answer

Intraocular surgery

Correct Incorrect Correct answer

Dental surgery

Correct Incorrect Correct answer

Minor skin surgery

Correct Incorrect Correct answer

ENT surgery

Correct Incorrect Correct answer

Which of the following is inconsistent with the diagnosis of metabolic syndrome?

Low LDL cholesterol

Correct Incorrect Correct answer

Central obesity

Correct Incorrect Correct answer

High triglyceride levels

Correct Incorrect Correct answer

Low HDL cholesterol

Correct Incorrect Correct answer

Raised blood pressure

Correct Incorrect Correct answer

What is the mechanism of action of ezetimibe?

Inhibits gut absorption of cholesterol from food and also from bile.

Correct Incorrect Correct answer

Inhibit the rate-limiting step in cholesterol synthesis (HMG 6A reductase)

Correct Incorrect Correct answer

Bind bile acids in the gut

Correct Incorrect Correct answer

Activate peroxisome proliferator-activated nuclear receptors (esp. PPAR-alpha).

Correct Incorrect Correct answer

Inhibit lipid synthesis in the liver

Correct Incorrect Correct answer

You review a diabetic patient in your clinic. He is obese and has an LDL of 3.0mmol/L and TG of 3mmol/L.

Besides commencing him on statins, which of the following intervention should be added to reduce his cardiovascular risk ?

Lifestyle advice

Correct Incorrect Correct answer

Fenofibrate

Correct Incorrect Correct answer

Gemfibrozil

Correct Incorrect Correct answer

Ezetemibe

Correct Incorrect Correct answer

Nicotinic acid

Correct Incorrect Correct answer

Which one of the following feature is most suggestive of autosomal dominant familial hypercholesterolaemia rather than other causes of hypercholesterolaemia?

Tendon xanthomas

Correct Incorrect Correct answer

Corneal opacities

Correct Incorrect Correct answer

Lipaemia retinalis

Correct Incorrect Correct answer

Eruptive xanthomas

Correct Incorrect Correct answer

Recurrent pancreatitis

Correct Incorrect Correct answer

Which of the following provides the greatest rationale for the use of drug eluting stent?

Lower risk of In-stent restenosis

Correct Incorrect Correct answer

Lower risk of early in stent thrombosis

Correct Incorrect Correct answer

Lower risk of late in stent thrombosis

Correct Incorrect Correct answer

Ability to stent longer lesions

Correct Incorrect Correct answer

Longer lasting stent.

Correct Incorrect Correct answer

Which of the following is the most sensitive test of cardiac function?

cardiac output

Correct Incorrect Correct answer

stroke volume

Correct Incorrect Correct answer

stroke volume over end diastolic volume

Correct Incorrect Correct answer

stroke volume over cardiac output

Correct Incorrect Correct answer

end diastolic volume

Correct Incorrect Correct answer

Which of the following is not an anti-platelet agent?

Bivalirudin

Correct Incorrect Correct answer

Aspirin

Correct Incorrect Correct answer

Clopidogrel

Correct Incorrect Correct answer

Tirofiban

Correct Incorrect Correct answer

Abciximab

Correct Incorrect Correct answer

A 50-year-old man with fasting lipid profile A was started on lipid modifying treatment. Now, three months later, he has fasting lipid profile B with no other lifestyle change.

The treatment most likely to have been commenced was:

cholestyramine

Correct Incorrect Correct answer

gemfibrozil

Correct Incorrect Correct answer

nicotinic acid.

Correct Incorrect Correct answer

fish oil.

Correct Incorrect Correct answer

simvastatin.

Correct Incorrect Correct answer

A 36-year-old woman has a very strong family history of premature coronary disease. Physical examination is normal.

Her fasting lipid profile reveals:

Total cholesterol of 9.5 mmol/L [2.5-5.2]
High-density lipoprotein (HDL) cholesterol 1.5 mmol/L [0.9-1.8]
Triglycerides 2.00 mmol/L [0.10-1.85]

Which abnormality is most likely to be present?

Low-density lipoprotein (LDL) receptor defect

Correct Incorrect Correct answer

apoB 3500 mutation

Correct Incorrect Correct answer

Cholesteryl ester transfer protein (CETP) deficiency

Correct Incorrect Correct answer

Hypoalphalipoproteinaemia

Correct Incorrect Correct answer

Lecithin:cholesterol acetyltransferase (LCAT) deficiency.

Correct Incorrect Correct answer

A 25 year old man presents with recurrent syncope.His brother and uncle died suddenly in their 30’s. A 12 lead ECG is normal.However, signal averaged ECG shows late potentials in V1. The most likely diagnosis is:

Arrythmogenic right ventricular dysplasia

Correct Incorrect Correct answer

Hypertrophic cardiomyopathy

Correct Incorrect Correct answer

Brugada syndrome

Correct Incorrect Correct answer

Long QT2

Correct Incorrect Correct answer

Long QT3

Correct Incorrect Correct answer

In a patient presenting with chronic stable coronary artery disease following recent angiography showing 2 vessel disease (80% stenosis left circumflex,60% LAD) Currently on atorvastatin 10mg, metoprolol 47.5mg, aspirin 100mg and enalapril 10mg daily.

Which of the following intervention will likely improve cardiac event free survival?

Increase atorvastatin dose

Correct Incorrect Correct answer

Drug eluting stent to LAD

Correct Incorrect Correct answer

Bare metal stent to circumflex and LAD

Correct Incorrect Correct answer

CABG

Correct Incorrect Correct answer

Increase metoprolol dose

Correct Incorrect Correct answer

A 58-year-old woman presents to a Rural Centre with chest pain and vomiting. Her blood pressure is 80/50 mmHg. Her ECG is shown below.

What is the next step in management?

Temporary pacemaker

Correct Incorrect Correct answer

Intravenous isoprenaline

Correct Incorrect Correct answer

Intravenous atropine

Correct Incorrect Correct answer

Transfer for angiography.

Correct Incorrect Correct answer

Intravenous nitroglycerine

Correct Incorrect Correct answer

Which of the following feature is the most characteristic of Takotsubo cardiomyopathy?

apical ballooning akinesis on left ventriculography

Correct Incorrect Correct answer

raised serum troponin

Correct Incorrect Correct answer

ST-segment elevation on ECG

Correct Incorrect Correct answer

Angiography showing three vessel disease

Correct Incorrect Correct answer

QT-interval prolongation on ECG

Correct Incorrect Correct answer

Which one of the following medications is not considered an antihypertensive agent of choice in patients with bicuspid aortopathy?

Bendrofluazide

Correct Incorrect Correct answer

Metoprolol

Correct Incorrect Correct answer

Candesartan

Correct Incorrect Correct answer

Enalapril

Correct Incorrect Correct answer

A 50-year-old man with a BMI of 35 has a clinic blood pressure (BP) measurements of 148/90 mm Hg and 150/94 mm Hg. However, BP measurements at his local pharmacy have been consistently lower. You organized for him to a 24-hour ambulatory BP monitor which has now revealed an average blood pressure of 142/88 mm Hg. He remains asymptomatic.

At his current clinic visit, his BP is 142/90 mm Hg, and his heart rate is 75 beats per minute.

What is the next most appropriate step?

diagnose hypertension and initiate medical therapy

Correct Incorrect Correct answer

reassure the patient that the findings are normal

Correct Incorrect Correct answer

diagnose hypertension and recommend lifestyle modifications

Correct Incorrect Correct answer

repeat the ambulatory blood pressure monitoring

Correct Incorrect Correct answer

A 70 year old man with a known history of chronic heart failure presents to ED with acute angioedema. His ECHO from last year demonstrates a left ventricular ejection fraction of 30 percent. His current treatment includes cilazapril, carvedilol and spironolactone. In addition, he also informs that his GP had recently started him on Sacubitril-valsartan two days ago in an attempt to further improve his heart failure management.

You suspect that his angioedema is most likely due to the concomitant use of an ACE-inhibitor and an Angiotensin Receptor Neprilysin Inhibitor (ARNI).

What could have been done to prevent this adverse outcome?

Cilazapril should have been stopped at least 36 hours before commencing ARNI

Correct Incorrect Correct answer

Cilazapril dose should have been halved before commencing ARNI

Correct Incorrect Correct answer

Cilazapril should have been stopped at least 24 hours before commencing ARNI

Correct Incorrect Correct answer

Cilazapril and Spironolactone should have been stopped at least 36 hours before commencing ARNI

Correct Incorrect Correct answer

Cilazapril should have been stopped at least 12 hours before commencing ARNI

Correct Incorrect Correct answer

Average score
Your score

Cardiology Module 5

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

36. Question

37. Question

38. Question