PM ð« 161 TO 200
åé¡äžèŠ§
1
A 74-year-old woman presents to her general practitioner with breathlessness and leg swelling.
She has heart failure (ejection fraction 33%), rheumatoid arthritis and type 2 diabetes mellitus. Her
medications are 7.5mg bisoprolol once daily, 10mg lisinopril once daily, 20mg furosemide twice
daily, 500mg metformin three times daily and 1g paracetamol four times daily.
On examination, she has mild bibasal crackles, heart sounds are normal and there is bilateral
pedal pitting oedema. Heart rate is 72 beats per minute and regular, respiratory rate is 18 breaths
per minute, oxygen saturations are 94% on room air, blood pressure is 124/68mmHg and her
temperature is 36.2 C.
Bloods from an appointment two weeks previously
..
..
What is the most appropriate medication to start?
Spironolactone
2
A 73 year-old male has progressive exertional dyspnoea due to progressive systolic heart failure
with a left ventricular ejection fraction of 30%. What investigation is most useful in predicting
symptomatic response to cardiac resynchronisation therapy?
ECG
3
A patient with known heart failure has slight limitation of physical activity. She is comfortable at
rest but ordinary activities such as walking to the local shops results in fatigue, palpitations or
dyspnoea. What New York Heart Association class best describes the severity of their disease?
NYHA Class II
4
A patient who is intolerant of aspirin is started on clopidogrel for the secondary prevention of
ischaemic heart disease. Concurrent use of which one of the following drugs may make
clopidogrel less effective?
Omeprazole
5
You review a 60-year-old man who had a drug-eluting stent inserted 6 months ago for ischaemic
heart disease. His current medication includes aspirin, clopidogrel, atorvastatin, ramipril and
bisoprolol. He has developed an inguinal hernia and is keen for surgical repair. The cardiologists
plan was to continue clopidogrel for 12 months following stent insertion. What is the most
appropriate course of action?
Delay operation for 6 months
6
A 47-year-old man is admitted to hospital following an acute coronary syndrome. He has a history
peptic ulcer disease and his cardiologist decides to use clopidogrel. What is the mechanism of
action of clopidogrel?
Inhibits ADP binding to its platelet receptor
7
Which of the following conditions is least associated with coarctation of the aorta?
Prader-Willi syndrome
8
A 40-year-old woman who is being treated for refractory hypertension undergoes a coronary
angiogram after developing non-specific chest pains. The cardiologist takes a number of
measurements during the procedure:
..
..
The blood pressure in her left arm taking during the procedure was 188/74 mmHg. What is the
most likely underlying diagnosis?
Coarctation of the aorta
9
A 76-year-old man with a history of ischaemic heart disease and hypertension presents for review.
He had a myocardial infarction 20 years ago but has had no problems since. His current
medication is clopidogrel, atorvastatin, ramipril and bisoprolol. He has recently been feeling lightheaded an ECG shows atrial fibrillation.
What antithrombotic medication should he now be taking?
Switch to an oral anticoagulant
10
A 69-year-old man is reviewed on the Coronary Care Unit. He experienced an inferior ST-segment
elevation myocardial infarction (STEMI) two days previously, for which he underwent successful
percutaneous coronary intervention. A post-procedure echocardiogram showed normal valvular
function, with no obvious septal defects and a left ventricular ejection fraction of 50%.
His ECG report is as follows:
ECG
1mm ST-segment elevation in leads II, III and aVF. Heart rate 48 beats per minute. Complete
dissociation between P waves and QRS complexes
Given these findings, which of the following is most likely to be heard on auscultation?
Variable intensity S1
11
A 60-year-old man with known ischaemic heart disease presents following a collapse when out
walking. He is brought in by ambulance and reports an acute syncope episode without any pain.
Whilst in the emergency department he experiences several further syncope episodes and is
found to be hypotensive with a rate of 40 beats per minute.
An ECG is performed demonstrating no association between the P waves and QRS complexes.
What sign is most likely to be elicited in this patient?
Variable intensity of S1
12
A 76-year-old woman is admitted to the hospital following an episode of dizziness and
subsequent syncope while shopping with her family. She has no significant past medical history.
She has cannon waves on assessment of her jugular venous pressure.
Her heart rate is 34 bpm, and her blood pressure is 128/64 mmHg.
What is the most likely finding on cardiac auscultation?
Variable intensity of S1
13
A 72-year-old male is admitted to the Emergency Room following a collapse at church. ECG
reveals dissociation between the P and QRS complexes with a rate of 40 / minute. Which one of
the following clinical findings may also be found?
Variable intensity of S1
14
A 72-year-old man is admitted to the Emergency Department with chest pain. On initial
assessment he is noted to be pale, have a heart rate of 40/min and a blood pressure of 90/60
mmHg. Which one of the coronary arteries is most likely to be affected?
Right coronary
15
A 72-year-old man presents to the emergency department with lightheadedness. He has a past
medical history of hypertension and ischaemic heart disease. His medications include bisoprolol,
amlodipine, and aspirin.
Observations:
Heart rate 38 beats per minute
Blood pressure 96/54 mmHg
Respiratory rate 18/minute
Oxygen saturations 97% on room air
Temperature 37.1ºC
An ECG demonstrates a regular P-P interval and a regular R-R interval but there is no apparent
relationship between the P waves and the QRS complexes.
When auscultating this patient's heart sounds, what is an expected finding?
Variable intensity of S1
16
A 2-day-old baby girl is noted to become cyanotic whilst feeding and crying. A diagnosis of
congenital heart disease is suspected. What is the most likely cause?
Transposition of the great arteries
17
A 56-year-old man with a past history of ischaemic heart disease is admitted with central chest
pain radiating to his left arm associated with nausea. On arrival in the Coronary Care Unit he is
noted to be in complete heart block. Which coronary artery is likely to be affected?
Right coronary
18
A 64-year-old man is having a dual chamber pacemaker inserted. The ventricular lead is to be
inserted via the coronary sinus. Where does the coronary sinus drain into?
Right atrium
19
A 76-year-old man is brought to the emergency department following a fall. He recently had a hip
replacement and regularly takes atorvastatin, metformin, and dabigatran. CT imaging of the brain
has revealed a subdural haematoma.
What antidote should be administered?
Idarucizumab
20
A 74-year-old man presents to the emergency department with a fall after tripping over a step
outside his house. There were no preceding presyncopal symptoms. He sustained a head injury
but did not lose consciousness. His past medical history includes atrial fibrillation, hypertension
and type 2 diabetes. He takes dabigatran, amlodipine and metformin.
His observations on arrival were heart rate 84 beats per minute, blood pressure 132/77 mmHg,
respiratory rate 18/minute, oxygen saturations 96% on air and temperature 36.4ºC. He was alert
with a Glasgow coma scale of 15/15. A neurological examination was normal. There was evidence
of an external head injury with some bruising.
A CT head demonstrates a small subdural haematoma. There is no midline shift or mass effect.
What is the most appropriate medication to administer at this point?
Idarucizumab
21
A 65-year-old patient with chronic kidney disease is found to have a deficiency of antithrombin III
after he presented to emergency department with left leg pain and swelling.
A doppler-ultrasound scan of the leg confirms deep venous thrombosis (DVT). The patient is
started on dabigatran.
What is the mechanism of action of dabigatran?
Direct thrombin inhibitor
22
Your next patient is a 74-year-old woman who is known to have type 2 diabetes mellitus. Her
blood pressure has been borderline for a number of weeks now but you have decided she would
benefit from treatment. Her latest blood pressure is 146/88 mmHg, HbA1c is 58 mmol/mol and
her BMI is 25 kg/m^2. What is the most appropriate drug to prescribe?
Ramipril
23
An obese 45-year-old male, with known hyperlipidaemia and peripheral vascular disease, presents
with a right parietal ischaemic stroke. He reports trouble sleeping and laying flat at night that
began after a flu-like illness 3 months ago, and reports some exertional dyspnoea. Which of the
following investigations are most likely to find the cause of the stroke?
Echocardiogram
24
Which one of the following is least likely to cause dilated cardiomyopathy?
Wilson's disease
25
Dilated cardiomyopathy may be caused by deficiency of which one of the following:
Selenium
26
A 62-year-old male is admitted with right sided hemiplegia. An MRI confirms a diagnosis of a left
sided partial anterior circulating stroke. He is treated with high dose aspirin for 14 days. He is then
started on clopidogrel which he was unfortunately intolerant of. You therefore start him on dual
aspirin and dipyridamole.
What is the mechanism of action of dipyridamole?
Increases the effects of adenosine
27
A 66-year-old man is diagnosed with a transient ischaemic attack and commenced on clopidogrel.
He already takes a statin. After a week of treatment, he presents to his GP complaining of severe
diarrhoea. His GP suspects that clopidogrel is the cause and decides to switch him to combination
antiplatelet treatment. This includes modified-release dipyridamole.
What is the mechanism of action of this drug?
Phosphodiesterase inhibitor
28
A 72-year-old woman presents to a rapid access neurology clinic five days after a self-resolving
episode of weakness and sensory disturbance. She is diagnosed as having had a transient
ischaemic attack and is started on combined antiplatelets including modified-release
dipyridamole.
Which of the following best describes the mechanism of this medication?
A non-specific phosphodiesterase inhibitor that decreases cellular uptake of adenosine
29
A 72-year-old man is prescribed a dipyridamole in addition to aspirin following an ischaemic
stroke. What is the mechanism of action of dipyridamole?
Phosphodiesterase inhibitor
30
A 60-year-old heavy goods vehicle (HGV) driver with a one month history of ankle swelling and
orthopnoea presents to clinic for review. His departmental echocardiogram shows he has a left
ventricular ejection fraction (LVEF) of 35%. Which of the following statements most accurately
counsels this patient as regard to his driving?
An LVEF of < 40% bars him from driving a lorry, even if he becomes asymptomatic with treatment
31
You are a new speciality trainee in cardiology and in the middle of a busy outpatient clinic. Your
next patient is a 27-year-old female with Arrhythmogenic Right Ventricular Dysplasia (ARVD) who
is attending today for counselling/planning of prophylactic ICD insertion. She was diagnosed with
this condition following the sudden death of her brother 2 years ago but has no history of
problems herself.
Her echocardiogram (ECHO) done earlier today shows a moderately dilated and dyskinetic right
ventricle with a mildly reduced ejection fraction which is similar to her last ECHO done around 18
months ago.
She is concerned as she drives to work every day and wants to know if there will be any
restrictions to this.
What is the most appropriate thing to tell her?
She will have to stop driving for 1 month only
32
A 54-year-old man is admitted following a myocardial infarction associated with ST elevation. He
is treated with thrombolysis and does not undergo angioplasty. What advice should he be given
regarding driving?
Cannot drive for 4 weeks
33
How long should a patient stop driving for following an elective cardiac angioplasty?
1 week
34
A 68-year-old woman is admitted to hospital with complete heart block. After initially being
treated with a temporary pacing wire she goes on to have a permanent pacemaker fitted. How
soon after the procedure can she drive again?
1 week
35
A 54-year-old man is admitted to the Emergency Department (ED) after collapsing shortly after
complaining of palpitations. On arrival in the ED he is found to be in ventricular tachycardia and is
successfully cardioverted. Later investigations show that he has an underlying long QT syndrome.
A implantable cardioverter-defibrillator (ICD) is inserted. He works as a heavy goods vehicle (HGV)
driver. What is the most appropriate advice with regards to driving HGV vehicles?
Permanent bar
36
A 30-year-old woman presented to the acute medical department with shortness of breath. This
has been ongoing for the past 8 weeks and is worse on exertion. Palpitations are associated with
her shortness of breath. No chest pain was noted and she did not experience any episodes of
syncope/presyncope.
Physical examination revealed a holosystolic murmur that is best heard along the left sternal
border. The intensity of the murmur was increased with deep inspiration. Chest examination was
unremarkable. She was not obviously cyanosed and her JVP was unremarkable.
An ECG was performed and this showed a shortened PR interval, right bundle branch block and
delta waves throughout all leads. Chest X-ray was unremarkable with clear lung fields and normal
mediastinal contours.
What is the likely cause for her shortness of breath?
Ebstein's anomaly
37
A 16-year-old boy attends a cardiology clinic after referral from the general practitioner. He
reports a gradually worsening shortness of breath on exertion and fatigue over the past twoyears. With the general practitioner, an ECG demonstrated slurred upstrokes in the QRS
complexes.
On arrival, his vital signs are taken. These show a heart rate of 102/min but are otherwise normal.
Which murmur may be heard on auscultation?
Holosystolic, louder on inspiration
38
A 20-year-old man presents with episodes of palpitations and dyspnoea which occur at rest and
last from seconds to minutes at a time. He is normally fit and well and has no significant past
medical history. He drinks 8 units of alcohol per week and denies using any illegal drugs.
On examination, there is a pansystolic murmur which is worse on inspiration. His heart rate is
69/min with good peripheral pulses. His chest is clear, the jugular venous pressure is not elevated
and there is no peripheral oedema. Oxygen saturations are normal and there are no signs of
cyanosis.
An electrocardiogram revealed normal sinus rhythm with a delta wave pattern suggesting WolfParkinson-White syndrome.
What is the most likely underlying diagnosis?
Ebsteinâs abnormality
39
A 13-year-old girl presents with palpitations, fatigue and dyspnoea. She has had symptoms for
around a year. There is no history of syncope or chest pain. On examination she has a pan-systolic
murmur associated with giant V waves in the jugular venous pulse. Auscultation of the chest is
unremarkable. A resting ECG is normal but a 24 hour tape shows a short burst of supraventricular
tachycardia. What is the most likely diagnosis?
Ebstein's anomaly
40
A 36-year-old man presents to his general practitioner with six months of exertional shortness of
breath. He has no significant past medical history and is on no regular medications. He does not
smoke cigarettes or drink alcohol. His mother has bipolar affective disorder and took lithium
throughout her pregnancy.
On examination, there is an audible pansystolic murmur that is louder with inspiration.
Based on the clinical history, what is the most likely diagnosis from the options listed?
Ebstein's anomaly
PM 23 from 1 to 100 ð«
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PM 23 from 101 to 120 ð«
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PM ð« 121 to 160
Mohamed Ahmed · 40å · 1幎åPM ð« 121 to 160
PM ð« 121 to 160
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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 74-year-old woman presents to her general practitioner with breathlessness and leg swelling.
She has heart failure (ejection fraction 33%), rheumatoid arthritis and type 2 diabetes mellitus. Her
medications are 7.5mg bisoprolol once daily, 10mg lisinopril once daily, 20mg furosemide twice
daily, 500mg metformin three times daily and 1g paracetamol four times daily.
On examination, she has mild bibasal crackles, heart sounds are normal and there is bilateral
pedal pitting oedema. Heart rate is 72 beats per minute and regular, respiratory rate is 18 breaths
per minute, oxygen saturations are 94% on room air, blood pressure is 124/68mmHg and her
temperature is 36.2 C.
Bloods from an appointment two weeks previously
..
..
What is the most appropriate medication to start?
Spironolactone
2
A 73 year-old male has progressive exertional dyspnoea due to progressive systolic heart failure
with a left ventricular ejection fraction of 30%. What investigation is most useful in predicting
symptomatic response to cardiac resynchronisation therapy?
ECG
3
A patient with known heart failure has slight limitation of physical activity. She is comfortable at
rest but ordinary activities such as walking to the local shops results in fatigue, palpitations or
dyspnoea. What New York Heart Association class best describes the severity of their disease?
NYHA Class II
4
A patient who is intolerant of aspirin is started on clopidogrel for the secondary prevention of
ischaemic heart disease. Concurrent use of which one of the following drugs may make
clopidogrel less effective?
Omeprazole
5
You review a 60-year-old man who had a drug-eluting stent inserted 6 months ago for ischaemic
heart disease. His current medication includes aspirin, clopidogrel, atorvastatin, ramipril and
bisoprolol. He has developed an inguinal hernia and is keen for surgical repair. The cardiologists
plan was to continue clopidogrel for 12 months following stent insertion. What is the most
appropriate course of action?
Delay operation for 6 months
6
A 47-year-old man is admitted to hospital following an acute coronary syndrome. He has a history
peptic ulcer disease and his cardiologist decides to use clopidogrel. What is the mechanism of
action of clopidogrel?
Inhibits ADP binding to its platelet receptor
7
Which of the following conditions is least associated with coarctation of the aorta?
Prader-Willi syndrome
8
A 40-year-old woman who is being treated for refractory hypertension undergoes a coronary
angiogram after developing non-specific chest pains. The cardiologist takes a number of
measurements during the procedure:
..
..
The blood pressure in her left arm taking during the procedure was 188/74 mmHg. What is the
most likely underlying diagnosis?
Coarctation of the aorta
9
A 76-year-old man with a history of ischaemic heart disease and hypertension presents for review.
He had a myocardial infarction 20 years ago but has had no problems since. His current
medication is clopidogrel, atorvastatin, ramipril and bisoprolol. He has recently been feeling lightheaded an ECG shows atrial fibrillation.
What antithrombotic medication should he now be taking?
Switch to an oral anticoagulant
10
A 69-year-old man is reviewed on the Coronary Care Unit. He experienced an inferior ST-segment
elevation myocardial infarction (STEMI) two days previously, for which he underwent successful
percutaneous coronary intervention. A post-procedure echocardiogram showed normal valvular
function, with no obvious septal defects and a left ventricular ejection fraction of 50%.
His ECG report is as follows:
ECG
1mm ST-segment elevation in leads II, III and aVF. Heart rate 48 beats per minute. Complete
dissociation between P waves and QRS complexes
Given these findings, which of the following is most likely to be heard on auscultation?
Variable intensity S1
11
A 60-year-old man with known ischaemic heart disease presents following a collapse when out
walking. He is brought in by ambulance and reports an acute syncope episode without any pain.
Whilst in the emergency department he experiences several further syncope episodes and is
found to be hypotensive with a rate of 40 beats per minute.
An ECG is performed demonstrating no association between the P waves and QRS complexes.
What sign is most likely to be elicited in this patient?
Variable intensity of S1
12
A 76-year-old woman is admitted to the hospital following an episode of dizziness and
subsequent syncope while shopping with her family. She has no significant past medical history.
She has cannon waves on assessment of her jugular venous pressure.
Her heart rate is 34 bpm, and her blood pressure is 128/64 mmHg.
What is the most likely finding on cardiac auscultation?
Variable intensity of S1
13
A 72-year-old male is admitted to the Emergency Room following a collapse at church. ECG
reveals dissociation between the P and QRS complexes with a rate of 40 / minute. Which one of
the following clinical findings may also be found?
Variable intensity of S1
14
A 72-year-old man is admitted to the Emergency Department with chest pain. On initial
assessment he is noted to be pale, have a heart rate of 40/min and a blood pressure of 90/60
mmHg. Which one of the coronary arteries is most likely to be affected?
Right coronary
15
A 72-year-old man presents to the emergency department with lightheadedness. He has a past
medical history of hypertension and ischaemic heart disease. His medications include bisoprolol,
amlodipine, and aspirin.
Observations:
Heart rate 38 beats per minute
Blood pressure 96/54 mmHg
Respiratory rate 18/minute
Oxygen saturations 97% on room air
Temperature 37.1ºC
An ECG demonstrates a regular P-P interval and a regular R-R interval but there is no apparent
relationship between the P waves and the QRS complexes.
When auscultating this patient's heart sounds, what is an expected finding?
Variable intensity of S1
16
A 2-day-old baby girl is noted to become cyanotic whilst feeding and crying. A diagnosis of
congenital heart disease is suspected. What is the most likely cause?
Transposition of the great arteries
17
A 56-year-old man with a past history of ischaemic heart disease is admitted with central chest
pain radiating to his left arm associated with nausea. On arrival in the Coronary Care Unit he is
noted to be in complete heart block. Which coronary artery is likely to be affected?
Right coronary
18
A 64-year-old man is having a dual chamber pacemaker inserted. The ventricular lead is to be
inserted via the coronary sinus. Where does the coronary sinus drain into?
Right atrium
19
A 76-year-old man is brought to the emergency department following a fall. He recently had a hip
replacement and regularly takes atorvastatin, metformin, and dabigatran. CT imaging of the brain
has revealed a subdural haematoma.
What antidote should be administered?
Idarucizumab
20
A 74-year-old man presents to the emergency department with a fall after tripping over a step
outside his house. There were no preceding presyncopal symptoms. He sustained a head injury
but did not lose consciousness. His past medical history includes atrial fibrillation, hypertension
and type 2 diabetes. He takes dabigatran, amlodipine and metformin.
His observations on arrival were heart rate 84 beats per minute, blood pressure 132/77 mmHg,
respiratory rate 18/minute, oxygen saturations 96% on air and temperature 36.4ºC. He was alert
with a Glasgow coma scale of 15/15. A neurological examination was normal. There was evidence
of an external head injury with some bruising.
A CT head demonstrates a small subdural haematoma. There is no midline shift or mass effect.
What is the most appropriate medication to administer at this point?
Idarucizumab
21
A 65-year-old patient with chronic kidney disease is found to have a deficiency of antithrombin III
after he presented to emergency department with left leg pain and swelling.
A doppler-ultrasound scan of the leg confirms deep venous thrombosis (DVT). The patient is
started on dabigatran.
What is the mechanism of action of dabigatran?
Direct thrombin inhibitor
22
Your next patient is a 74-year-old woman who is known to have type 2 diabetes mellitus. Her
blood pressure has been borderline for a number of weeks now but you have decided she would
benefit from treatment. Her latest blood pressure is 146/88 mmHg, HbA1c is 58 mmol/mol and
her BMI is 25 kg/m^2. What is the most appropriate drug to prescribe?
Ramipril
23
An obese 45-year-old male, with known hyperlipidaemia and peripheral vascular disease, presents
with a right parietal ischaemic stroke. He reports trouble sleeping and laying flat at night that
began after a flu-like illness 3 months ago, and reports some exertional dyspnoea. Which of the
following investigations are most likely to find the cause of the stroke?
Echocardiogram
24
Which one of the following is least likely to cause dilated cardiomyopathy?
Wilson's disease
25
Dilated cardiomyopathy may be caused by deficiency of which one of the following:
Selenium
26
A 62-year-old male is admitted with right sided hemiplegia. An MRI confirms a diagnosis of a left
sided partial anterior circulating stroke. He is treated with high dose aspirin for 14 days. He is then
started on clopidogrel which he was unfortunately intolerant of. You therefore start him on dual
aspirin and dipyridamole.
What is the mechanism of action of dipyridamole?
Increases the effects of adenosine
27
A 66-year-old man is diagnosed with a transient ischaemic attack and commenced on clopidogrel.
He already takes a statin. After a week of treatment, he presents to his GP complaining of severe
diarrhoea. His GP suspects that clopidogrel is the cause and decides to switch him to combination
antiplatelet treatment. This includes modified-release dipyridamole.
What is the mechanism of action of this drug?
Phosphodiesterase inhibitor
28
A 72-year-old woman presents to a rapid access neurology clinic five days after a self-resolving
episode of weakness and sensory disturbance. She is diagnosed as having had a transient
ischaemic attack and is started on combined antiplatelets including modified-release
dipyridamole.
Which of the following best describes the mechanism of this medication?
A non-specific phosphodiesterase inhibitor that decreases cellular uptake of adenosine
29
A 72-year-old man is prescribed a dipyridamole in addition to aspirin following an ischaemic
stroke. What is the mechanism of action of dipyridamole?
Phosphodiesterase inhibitor
30
A 60-year-old heavy goods vehicle (HGV) driver with a one month history of ankle swelling and
orthopnoea presents to clinic for review. His departmental echocardiogram shows he has a left
ventricular ejection fraction (LVEF) of 35%. Which of the following statements most accurately
counsels this patient as regard to his driving?
An LVEF of < 40% bars him from driving a lorry, even if he becomes asymptomatic with treatment
31
You are a new speciality trainee in cardiology and in the middle of a busy outpatient clinic. Your
next patient is a 27-year-old female with Arrhythmogenic Right Ventricular Dysplasia (ARVD) who
is attending today for counselling/planning of prophylactic ICD insertion. She was diagnosed with
this condition following the sudden death of her brother 2 years ago but has no history of
problems herself.
Her echocardiogram (ECHO) done earlier today shows a moderately dilated and dyskinetic right
ventricle with a mildly reduced ejection fraction which is similar to her last ECHO done around 18
months ago.
She is concerned as she drives to work every day and wants to know if there will be any
restrictions to this.
What is the most appropriate thing to tell her?
She will have to stop driving for 1 month only
32
A 54-year-old man is admitted following a myocardial infarction associated with ST elevation. He
is treated with thrombolysis and does not undergo angioplasty. What advice should he be given
regarding driving?
Cannot drive for 4 weeks
33
How long should a patient stop driving for following an elective cardiac angioplasty?
1 week
34
A 68-year-old woman is admitted to hospital with complete heart block. After initially being
treated with a temporary pacing wire she goes on to have a permanent pacemaker fitted. How
soon after the procedure can she drive again?
1 week
35
A 54-year-old man is admitted to the Emergency Department (ED) after collapsing shortly after
complaining of palpitations. On arrival in the ED he is found to be in ventricular tachycardia and is
successfully cardioverted. Later investigations show that he has an underlying long QT syndrome.
A implantable cardioverter-defibrillator (ICD) is inserted. He works as a heavy goods vehicle (HGV)
driver. What is the most appropriate advice with regards to driving HGV vehicles?
Permanent bar
36
A 30-year-old woman presented to the acute medical department with shortness of breath. This
has been ongoing for the past 8 weeks and is worse on exertion. Palpitations are associated with
her shortness of breath. No chest pain was noted and she did not experience any episodes of
syncope/presyncope.
Physical examination revealed a holosystolic murmur that is best heard along the left sternal
border. The intensity of the murmur was increased with deep inspiration. Chest examination was
unremarkable. She was not obviously cyanosed and her JVP was unremarkable.
An ECG was performed and this showed a shortened PR interval, right bundle branch block and
delta waves throughout all leads. Chest X-ray was unremarkable with clear lung fields and normal
mediastinal contours.
What is the likely cause for her shortness of breath?
Ebstein's anomaly
37
A 16-year-old boy attends a cardiology clinic after referral from the general practitioner. He
reports a gradually worsening shortness of breath on exertion and fatigue over the past twoyears. With the general practitioner, an ECG demonstrated slurred upstrokes in the QRS
complexes.
On arrival, his vital signs are taken. These show a heart rate of 102/min but are otherwise normal.
Which murmur may be heard on auscultation?
Holosystolic, louder on inspiration
38
A 20-year-old man presents with episodes of palpitations and dyspnoea which occur at rest and
last from seconds to minutes at a time. He is normally fit and well and has no significant past
medical history. He drinks 8 units of alcohol per week and denies using any illegal drugs.
On examination, there is a pansystolic murmur which is worse on inspiration. His heart rate is
69/min with good peripheral pulses. His chest is clear, the jugular venous pressure is not elevated
and there is no peripheral oedema. Oxygen saturations are normal and there are no signs of
cyanosis.
An electrocardiogram revealed normal sinus rhythm with a delta wave pattern suggesting WolfParkinson-White syndrome.
What is the most likely underlying diagnosis?
Ebsteinâs abnormality
39
A 13-year-old girl presents with palpitations, fatigue and dyspnoea. She has had symptoms for
around a year. There is no history of syncope or chest pain. On examination she has a pan-systolic
murmur associated with giant V waves in the jugular venous pulse. Auscultation of the chest is
unremarkable. A resting ECG is normal but a 24 hour tape shows a short burst of supraventricular
tachycardia. What is the most likely diagnosis?
Ebstein's anomaly
40
A 36-year-old man presents to his general practitioner with six months of exertional shortness of
breath. He has no significant past medical history and is on no regular medications. He does not
smoke cigarettes or drink alcohol. His mother has bipolar affective disorder and took lithium
throughout her pregnancy.
On examination, there is an audible pansystolic murmur that is louder with inspiration.
Based on the clinical history, what is the most likely diagnosis from the options listed?
Ebstein's anomaly