Your-Doctor Multiple Choice Questions (MCQ)

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Category: Cardiology--->Valvular heart disease and Endocarditis
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Question 1#Print Question

You review a 59-year-old man with long-standing hypertension in clinic. He has no other comorbidities. He complains of some breathlessness, but this does not limit his physical activity. A transthoracic echocardiogram demonstrates aortic root dilatation and severe aortic regurgitation.

Which one of the following is not an indication for surgery?

a. NYHA class II breathlessness
b. Aortic root disease with maximal diameter 49 mm
c. Patients undergoing CABG, valve surgery, or surgery of the ascending aorta
d. Asymptomatic with resting LVEF ≤50%
e. Asymptomatic with end-diastolic dimension > 70 mm


Question 2#Print Question

You are asked to review the echocardiogram of a 74-year-old woman with a loud pansystolic murmur. (following pic)

The following statements are all true, except:

a. The jet of regurgitation is anteriorly directed
b. The regurgitation is likely to be chronic
c. Using PISA to assess the severity of the regurgitant jet is more accurate than measuring the vena contracta
d. The MV inflow E-wave velocity is 1.6 m/s; this suggests severe MR
e. Systolic pulmonary vein flow reversal is not a sensitive measure of severe MR


Question 3#Print Question

You are reviewing a 65-year-old farmer in the post-PCI clinic. He had primary angioplasty to his RCA for an inferior STEMI 3 months previously. He reports exertional breathlessness but no chest pain. His current medications are aspirin 75 mg od, clopidogrel 75 mg od, ramipril 5 mg bd, bisoprolol 5 mg od, and atorvastatin 80 mg od. On examination his BP is 110/70 mmHg and his heart rate is 60 bpm. You hear a soft pan-systolic murmur at his apex. His chest is clear and there is no pedal oedema. His ECG shows atrial fibrillation. He manages only 3 minutes on the treadmill with no chest pain or ECG changes, stopping due to breathlessness. You request an urgent echocardiogram, which demonstrates mild LV systolic dysfunction. The inferior wall is akinetic, there is some tethering of the posterior mitral valve leaflet, and as a result some mitral regurgitation (ERO = 0.2 cm2 ).

What is the next appropriate step in his management?

a. Start dabigatran
b. Start eplerenone
c. Urgent repeat coronary angiography
d. Discharge patient with reassurance that he has reasonable LV function and no significant valve disease
e. Stress echocardiography


Question 4#Print Question

An 82-year-old retired solicitor presents to the ED with chest pain radiating to his jaw. He has hypertension treated with ramipril 5 mg bd but is otherwise normally fit and well. His admission ECG shows atrial fibrillation with a ventricular rate of 90 bpm, LVH, and widespread ST segment depression. His peak troponin is 110 ng/L (normal <30 ng/L). He is started on treatment for an acute coronary syndrome and listed for an inpatient angiogram. You are asked to perform a bedside echocardiogram as a systolic murmur is heard on the post-take ward round. Calculate the aortic valve area (using the continuity equation) from the following pics

a. 0.76 cm2
b. 0.80 cm2
c. 0.92 cm2
d. 1.02 cm2
e. 1.08 cm2


Question 5#Print Question

An 82-year-old retired solicitor presents to the ED with chest pain radiating to his jaw. He has hypertension treated with ramipril 5 mg bd but is otherwise normally fit and well. His admission ECG shows atrial fibrillation with a ventricular rate of 90 bpm, LVH, and widespread ST segment depression. His peak troponin is 110 ng/L (normal <30 ng/L). He is started on treatment for an acute coronary syndrome and listed for an inpatient angiogram. You are asked to perform a bedside echocardiogram as a systolic murmur is heard on the post-take ward round.

His coronary angiogram shows:

  • LMS: mild atheroma
  • LAD: severe (90%) proximal stenosis; good distal target
  • LCx: small vessel with diffuse distal atheroma
  • RCA: dominant; moderate (50–60%) mid-vessel focal stenosis.

Which one of the following statements is correct?

a. The patient should be referred for AVR and LIMA to LAD
b. His operative mortality is about 3%
c. Surgical ablation for AF may be considered
d. The patient should have PCI to LAD followed by TAVI
e. He should be managed conservatively with a beta-blocker and warfarin




Category: Cardiology--->Valvular heart disease and Endocarditis
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