PM 23 from 101 to 120 ð«
åé¡äžèŠ§
1
A 17-year-old male is taken to the Emergency Department due to alcohol intoxication. On
examination he is noted to be tachycardic with a rate of 140bpm. An ECG shows atrial fibrillation.
The following morning he is noted to be in sinus rhythm. What is the most appropriate
management?
Discharge
2
A 55-year-old man presents with a 2-hour history palpitations. He has no other history of note
and is generally fit and well. An ECG confirms fast atrial fibrillation with a rate of 140/min. He has a
fear of sedation and requests pharmacological cardioversion. Which one of the following agents is
most likely to cardiovert him into sinus rhythm?
Flecainide
3
A 62-year-old female with no past medical history is admitted to hospital with a left-sided
hemiparesis. Examination reveals that she is in atrial fibrillation. CT scan of her brain shows a
cerebral infarction. What is the most appropriate anticoagulation strategy for this patient?
Aspirin started immediately switching to life-long warfarin after 2 weeks
4
Which one of the following agents is most useful in the maintenance of sinus rhythm in patients
with atrial fibrillation?
Amiodarone
5
A 72-year-old man presents with lethargy and palpitations for the past four or five days. On
examination his pulse is 123 bpm irregularly irregular, blood pressure is 118/70 mmHg and his
chest is clear. An ECG confirms atrial fibrillation. What is the appropriate drug to control his heart
rate?
Bisoprolol
6
In patients with atrial fibrillation (AF), which one of the following factors would make a rate control
strategy, rather than rhythm control, more suitable?
Age > 65 years
7
A 75-year-old woman is brought to the Emergency Department by her family. She has been
getting more short-of-breath over the last 6 weeks and says her energy levels are low. An ECG on
arrival shows atrial fibrillation at a rate of 114 / min. Blood pressure is 128/80 mmHg and a chest
x-ray is unremarkable. What is the appropriate drug to control the heart rate?
Bisoprolol
8
A 71-year-old woman presents with palpitations and 'lightheadedness'. An ECG shows that she is
in atrial fibrillation with a rate of 130 / min. Her blood pressure is normal and examination of her
cardiorespiratory system is otherwise unremarkable. Her past medical history includes well
controlled asthma (salbutamol & beclomethasone) and depression (citalopram). Her symptoms
have been present for around three days. What is the most appropriate medication to use for rate
control?
Diltiazem
9
A 68-year-old man presents with a 4-day history of palpitations and increased breathlessness on
exertion. An ECG shows atrial fibrillation with a rate of 118 beats per minute.
His past medical history includes brittle asthma, hypertension and congestive cardiac failure and
his recent echocardiogram showed a left ventricular ejection fraction of 32%.
What is the most appropriate medication to control the heart rate in this man?
Digoxin
10
A 65-year-old man is admitted with palpitations. The ECG shows a ventricular rate of 150/min with
an underlying atrial rate of 300/min. A diagnosis of atrial flutter is suspected. What is the
treatment of choice to permanently restore sinus rhythm?
Radiofrequency ablation of the tricuspid valve isthmus
11
A 70-year-old woman is brought to the Emergency Department by her relatives. For the past two
hours she has experienced palpitations and 'tightness' in her chest. An ECG taken on arrival shows
baseline atrial activity of around 300/min with a ventricular rate of 150/min. What is the most
likely diagnosis?
Atrial flutter
12
Where is the most common site for primary cardiac tumours to occur in adults?
Left atrium
13
Each one of the following is associated with atrial myxoma, except:
'J' wave on ECG
14
A 25-year-old female is found to have a left hemiparesis following a deep vein thrombosis. An
ECG shows RBBB with right axis deviation. What is the most likely underlying diagnosis?
Ostium secundum atrial septal defect
15
Which of the following physiological effects would be expected following administration of
atropine?
Tachycardia + mydriasis
16
Where is B-type natriuretic peptide mainly secreted from?
Ventricular myocardium
17
A 71-year-old woman is admitted with acute dyspnoea to the Emergency Department. Oxygen
saturations are 94% on 28% supplementary oxygen and her respiratory rate is 30/min. A rapid Btype natriuretic peptide (BNP) assay is reported as follows:
BNP
62 pg/ml
What is the best interpretation of this result?
Heart failure is unlikely to be the cause of her dyspnoea
18
Which one of the following statements regarding B-type natriuretic peptide is incorrect?
The positive predictive value of BNP is greater than the negative predictive value
19
A 79-year-old man is admitted with congestive cardiac failure. Bloods on admission show:
BNP
354 pg/ml
Which one of the following would result from elevated BNP levels?
Inhibition of the renin-angiotensin-aldosterone system
20
Which of the following is not true regarding B-type natriuretic peptide?
Acts as a vasoconstrictor
PM 23 from 1 to 100 ð«
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Mohamed Ahmed · 40å · 1幎åPM 23 from 1 to 40 ð«
PM 23 from 1 to 40 ð«
40å ⢠1幎ååé¡äžèŠ§
1
A 17-year-old male is taken to the Emergency Department due to alcohol intoxication. On
examination he is noted to be tachycardic with a rate of 140bpm. An ECG shows atrial fibrillation.
The following morning he is noted to be in sinus rhythm. What is the most appropriate
management?
Discharge
2
A 55-year-old man presents with a 2-hour history palpitations. He has no other history of note
and is generally fit and well. An ECG confirms fast atrial fibrillation with a rate of 140/min. He has a
fear of sedation and requests pharmacological cardioversion. Which one of the following agents is
most likely to cardiovert him into sinus rhythm?
Flecainide
3
A 62-year-old female with no past medical history is admitted to hospital with a left-sided
hemiparesis. Examination reveals that she is in atrial fibrillation. CT scan of her brain shows a
cerebral infarction. What is the most appropriate anticoagulation strategy for this patient?
Aspirin started immediately switching to life-long warfarin after 2 weeks
4
Which one of the following agents is most useful in the maintenance of sinus rhythm in patients
with atrial fibrillation?
Amiodarone
5
A 72-year-old man presents with lethargy and palpitations for the past four or five days. On
examination his pulse is 123 bpm irregularly irregular, blood pressure is 118/70 mmHg and his
chest is clear. An ECG confirms atrial fibrillation. What is the appropriate drug to control his heart
rate?
Bisoprolol
6
In patients with atrial fibrillation (AF), which one of the following factors would make a rate control
strategy, rather than rhythm control, more suitable?
Age > 65 years
7
A 75-year-old woman is brought to the Emergency Department by her family. She has been
getting more short-of-breath over the last 6 weeks and says her energy levels are low. An ECG on
arrival shows atrial fibrillation at a rate of 114 / min. Blood pressure is 128/80 mmHg and a chest
x-ray is unremarkable. What is the appropriate drug to control the heart rate?
Bisoprolol
8
A 71-year-old woman presents with palpitations and 'lightheadedness'. An ECG shows that she is
in atrial fibrillation with a rate of 130 / min. Her blood pressure is normal and examination of her
cardiorespiratory system is otherwise unremarkable. Her past medical history includes well
controlled asthma (salbutamol & beclomethasone) and depression (citalopram). Her symptoms
have been present for around three days. What is the most appropriate medication to use for rate
control?
Diltiazem
9
A 68-year-old man presents with a 4-day history of palpitations and increased breathlessness on
exertion. An ECG shows atrial fibrillation with a rate of 118 beats per minute.
His past medical history includes brittle asthma, hypertension and congestive cardiac failure and
his recent echocardiogram showed a left ventricular ejection fraction of 32%.
What is the most appropriate medication to control the heart rate in this man?
Digoxin
10
A 65-year-old man is admitted with palpitations. The ECG shows a ventricular rate of 150/min with
an underlying atrial rate of 300/min. A diagnosis of atrial flutter is suspected. What is the
treatment of choice to permanently restore sinus rhythm?
Radiofrequency ablation of the tricuspid valve isthmus
11
A 70-year-old woman is brought to the Emergency Department by her relatives. For the past two
hours she has experienced palpitations and 'tightness' in her chest. An ECG taken on arrival shows
baseline atrial activity of around 300/min with a ventricular rate of 150/min. What is the most
likely diagnosis?
Atrial flutter
12
Where is the most common site for primary cardiac tumours to occur in adults?
Left atrium
13
Each one of the following is associated with atrial myxoma, except:
'J' wave on ECG
14
A 25-year-old female is found to have a left hemiparesis following a deep vein thrombosis. An
ECG shows RBBB with right axis deviation. What is the most likely underlying diagnosis?
Ostium secundum atrial septal defect
15
Which of the following physiological effects would be expected following administration of
atropine?
Tachycardia + mydriasis
16
Where is B-type natriuretic peptide mainly secreted from?
Ventricular myocardium
17
A 71-year-old woman is admitted with acute dyspnoea to the Emergency Department. Oxygen
saturations are 94% on 28% supplementary oxygen and her respiratory rate is 30/min. A rapid Btype natriuretic peptide (BNP) assay is reported as follows:
BNP
62 pg/ml
What is the best interpretation of this result?
Heart failure is unlikely to be the cause of her dyspnoea
18
Which one of the following statements regarding B-type natriuretic peptide is incorrect?
The positive predictive value of BNP is greater than the negative predictive value
19
A 79-year-old man is admitted with congestive cardiac failure. Bloods on admission show:
BNP
354 pg/ml
Which one of the following would result from elevated BNP levels?
Inhibition of the renin-angiotensin-aldosterone system
20
Which of the following is not true regarding B-type natriuretic peptide?
Acts as a vasoconstrictor