MCQs GENERAL MEDICINE: CARDIOLOGY

Question 2. The differential diagnosis for chest pain includes: (a) Myocardial infarction. (True) (b) Oesophagitis. (True) (c) Pulmonary embolus. (True) (d) Cholecystitis. (True) (e) Aortic dissection. (True)

Question 3. The following are causes of acute life-threatening dyspnoea: (a) Myocardial infarction. (True) (b) Pulmonary embolus. (True) (c) Pneumothorax. (True) (d) Ventricular or supraventricular tachyarrhythmia. (True) (e) Bacterial endocarditis. (True)

Question 4. The following are clinical signs found in infective endocarditis: (a) Clubbing. (True) (b) Haematuria. (True) (c) Pyrexia. (True) (d) Rashes. (True)(e) Focal neurological defect. (True)

Question 5. The following are risk factors for ischaemic heart disease: (a) Hypertension. (True) (b) Moderate alcohol intake. (False) (c) Female sex. (False) (d) Hypercholesterolaemia. (True) (e) Increasing age. (True)

Question 6. The following are classical features of cardiac syncope: (a) Gradual onset. (False) (b) Warning symptoms. (False) (c) Rapid recovery. (True) (d) Residual neurological deficit. (False) (e) Precipitated by sudden turning of the head. (False)

Question 7. The following are causes of a pansystolic murmur: (a) Mitral regurgitation. (True) (b) Aortic regurgitation. (False) (c) Tricuspid regurgitation. (True) (d) Atrial septal defect. (False) (e) Aortic stenosis. (False)

Question 8. The following conditions require antibiotic prophylaxis before dental procedures: (a) Prosthetic aortic valve. (True) (b) Ventricular septal defect. (True) (c) Floppy mitral valve with coexistent mitral regurgitation. (True) (d) Enlarged left ventricle. (False) (e) A history of infective endocarditis in the past. (True)

Question 9. The following should be considered as possible signs of a positive exercise test: (a) ST segment depression. (True) (b) Exercise-induced hypotension. (True) (c) Exercise-induced ventricular tachycardia. (True) (d) Lack of adequate tachycardic response to exercise. (True) (e) Leg pain at peak exercise. (False)

Question 10. The following are indications for anticoagulating a patient who has atrial fibrillation with warfarin: (a) Age under 60 years. (False) (b) Associated mitral stenosis. (True) (c) Atrial fibrillation of more than 24 hours' duration. (True) (d) A history of cerebral thromboembolism. (True) (e) Associated left ventricular failure. (True)

Question 11. The following are true of ventricular tachycardia: (a) It is a life-threatening condition. (True) (b) It may be caused by myocardial ischaemia. (True) (c) It may be caused by hypokalaemia. (True) (d) Amiodarone may be used to prevent recurrent episodes of ventricular tachycardia. (True) (e) Acute ongoing ventricular tachycardia should be treated initially with drugs. (False)

Question 12. The following are signs of coarctation of the aorta: (a) Radiofemoral delay in the pulses. (True) (b) Rib notching. (True) (c) Bruits heard over the scapula. (True) (d) Ankle oedema. (False)(e) Atrial fibrillation. (False)

Question 13. Functions of the recovery position include: (a) To prevent the tongue from obstructing the airway. (True) (b) To prevent neck injury. (False) (c) To minimize the risk of aspiration of gastric contents. (True) (d) To maintain a straight airway. (True) (e) To enable cardiopulmonary resuscitation to be carried out. (False)

Question 14. Complications of prosthetic heart valves are as follows: (a) Thromboembolic events. (True) (b) Dehiscence of the valve ring. (True) (c) Increased risk of infective endocarditis. (True) (d) Failure of the valve 5 years after placement. (False) (e) Need for anticoagulation in patients who have porcine valves. (False)

Question 15. The following statements are true of thiazide diuretics: (a) They act at the level of the distal convoluted tubule. (True) (b) They may cause gout. (True) (c) Diabetic control may deteriorate. (True) (d) Hypokalaemia may occur. (True) (e) They cause ototoxicity. (False)

Question 16. The following are classified as high-output states: (a) Hypertension . (False) (b) Sepsis. (True) (c) Hypothyroidism. (False) (d) Pregnancy. (True) (e) Arteriovenous malformations. (True)

Question 17. The following statements are true of the apex beat: (a) It is the lowest and most lateral point at which the cardiac impulse can be felt. (True) (b) It is displaced downwards and laterally if the left ventricle is enlarged. (True) (c) It is thrusting in mitral stenosis. (False) (d) It is thrusting in aortic regurgitation. (True) (e) It is heaving in aortic stenosis. (True)

Question 18. Cardiac causes of clubbing are as follows: (a) Uncomplicated atrial septal defect. (False) (b) Chronic infective endocarditis. (True) (c) Atrial fibrillation. (False) (d) Acute endocarditis. (False) (e) Empyema. (False)

Question 19. The following leads represent the inferior myocardium: (a) I, AVL, and V6. (False) (b) V2, V3, and V4. (False) (c) AVR and V1. (False) (d) V1-V6. (False) (e) II, III, and AVF. (True)

Question 20. The following are possible causes of electromechanical dissociation: (a) Pulmonary embolus. (True) (b) Tension pneumothorax. (True) (c) Hypertension. (False) (d) Dehydration. (True) (e) Hypocalcaemia. (True)

Question 21. The following are characteristic of pericarditis: (a) The chest pain is dull in nature. (False) (b) There may be an associated pericardial effusion. (True) (c) The pericardial rub may come and go. (True) (d) The ECG usually shows regional ST elevation. (False) (e) The ST elevation is concave. (True)

Question 22. Secondary hypertension may be due to the following: (a) Renal artery stenosis. (True) (b) Renal cell carcinoma. (False) (c) Cushing's syndrome. (True) (d) Pregnancy. (True) (e) Oral contraceptive pill. (True)

Question 23. ECG changes due to myocardial infarction may include the following: (a) ST elevation. (True) (b) Sinus tachycardia. (True) (c) Ventricular tachycardia. (True) (d) Complete heart block. (True) (e) Q waves. (True)

Question 24. The following drugs are used in the treatment of hypertension: (a) Atenolol. (True) (b) Doxazocin. (True) (c) Enalapril. (True) (d) Bendrofluazide. (True) (e) Nicorandil. (False)

Question 25. Complications of myocardial infarction include: (a) Cardiac failure. (True) (b) Mitral regurgitation. (True) (c) Cerebrovascular event. (True) (d) Myocardial rupture. (True) (e) Gastrointestinal bleed. (False)

 

Question 1. The ECG: · The T wave corresponds to atrial contraction (False) · If the S wave is greater than the R wave in lead I, there is right axis deviation (True) · If the S wave is greater than the R wave in lead II, there is left axis deviation (True) · ST segment depression may be a sign of cardiac ischaemia (True) Explanation: It may also be a digoxin effect. · A tall R wave in V1 may be a sign of right ventricular hypertrophy (True) Explanation: It may also be a digoxin effect.

Question 2. Endocarditis: · It is important to take blood cultures over at least 24 hour period to make the diagnosis (False) · Transthoracic echocardiography is a sensitive means of making or confirming the diagnosis (False) · Most patients with Staphylococcus aureus bacteraemia have endocarditis (False) · Viral endocarditis leads to valvular abnormality (False) · In patients with a new stroke, endocarditis can be ruled out if the patient is afebrile (False)

Question 3. Treatment of endocarditis: · Intravenous antibiotics for 6 weeks are necessary to cure viridans type streptococcal endocarditis (False) · Staphylococcal endocarditis on the tricuspid valve in a drug addict is treated with flucloxacillin and valve replacement (False) · Large vegetations are an indication for surgery (True) Explanation: Flucloxacillin (with gentamicin or rifampicin) is the medical treatment of choice but valve replacement is not appropriate. Insertion of a prosthetic heart valve into a drug addict is very likely to lead to prosthetic valve endocarditis subsequently because of their continuing habit. · Combination antibiotic therapy is almost always appropriate for endocarditis (True) Explanation: For two reasons; first, the selected combinations are usually additive or synergistic. Second, to prevent the development of resistance. · If gentamicin is used for treatment, it should not be used for more than 2 weeks (False)

Question 4. Hypertension: · Treatment is of no proven benefit in patients over the age of 70 years (False) · The symptoms of phaeochromocytoma include headache, sweating and palpitations (True) Explanation: There is well-proven benefit, particularly in the prevention of stroke. · Oral treatment producing a fall in diastolic blood pressure of 20 mmHg over 24 hours might be regarded as successful treatment of accelerated hypertension (True) Explanation: There is well-proven benefit, particularly in the prevention of stroke. · ACE inhibitors are the drugs of choice for hypertension in pregnancy (False)
21. MCQs VIA WEB 2005 By A. H. · Addison's disease should be considered a possible cause in a hypertensive patient with hirsutism (False)

Question 5. Cardiac dysrhythmias: · Digoxin toxicity may cause supraventricular tachycardia (True) Explanation: Typically, paroxysmal atrial tachycardia. · A patient with a completely irregular pulse of 180 beats/min is likely to be in atrial fibrillation (True) Explanation: Typically, paroxysmal atrial tachycardia. · Complete heart block may be asymptomatic (True) Explanation: Particularly congenital complete heart block. · Digoxin is effective in preventing paroxysms of atrial fibrillation (False) · A QRS width less than 3 small squares on the ECG indicates that a tachycardia is supraventricular (True) Explanation: Digoxin slows the ventricular rate during paroxysms of atrial fibrillation but does not prevent them; sotalol or amiodarone may prevent them.

Question 6. Chronic bronchial sepsis: · Is an uncommon feature of cystic fibrosis (False) · Typically is caused by unusual, difficult-to-grow bacteria (False) · May lead to haemoptysis (True) Explanation: Haemoptysis is also seen with dry bronchiectasis, chronic bronchial sepsis and with aspergillomas. · Can usually be cured with oral antibiotics (False) · May lead to pulmonary fibrosis (True) Explanation: It produces a fibrotic reaction.

Question 7. In the small intestine: · If there is bile salt deficiency, micellar formation is reduced (True) Explanation: Bile salts are essential for micelle formation. · Long-chain triglycerides are transported from the gut in the lymph as chylomicrons (False) · There is no lymphatic tissue (False) · The entire mucosa is turned over every 2-3 weeks (False) · Is the site of most nutrient absorption (True)

Question 8. Colorectal cancer: · May arise from a metaplastic polyp (False) · Most often occurs in the rectum and sigmoid (True) Explanation: Metaplastic polyps have no malignant potential. · There are further polyps in most cases (False) · Involvement of local lymph nodes does not affect prognosis (False) · Obstruction is more common in right compared with left-sided lesions (False)

Question 9. Angiodysplasia of the colon: · Is more common in the caecum and ascending colon (True) Explanation: It usually occurs in the right side of the colon. · Is associated with a macrocytic anaemia (False) · Is best shown by barium enema (False) · Usually requires surgery (False) · Is a congenital lesion (False)

Question 10. Concerning HIV infection and AIDS: · Pneumocystis pneumonia is common in Africa (False) · Tuberculosis in AIDS presents like that in non-AIDS patients (False) · Oral candidiasis is a late feature of AIDS (False) · Toxoplasmosis is usually a cerebral disease (True)