Multiple Choice Questions (MCQ)

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Category: Cardiology--->Heart Failure
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Question 1# Print Question

A 55 year old man with known heart failure and LVEF of 37% is reviewed in the outpatient clinic with breathlessness. He is NYHA class III with no signs of fluid overload on examination. His BP is 110/60 mmHg, and his heart rate is 55 bpm. He is on bisoprolol 5 mg od and ramipril 10 mg od.

His U&E tests reveal:

  • Na 137 mmol/L 
  • K 4.5 mmol/L
  • urea 7 mmol/L
  • creatinine 85 µmol/L

Which one of the following medications will you chose next?

A. Furosemide 40 mg od
B. Spironolactone 25 mg od
C. Digoxin 62.5 micrograms od
D. Hydralazine 37.5 mg and isosorbide dinitrate 20 mg od
E. Candesartan 4 mg od

Question 2# Print Question

An 80 year old woman is admitted with acute pulmonary oedema on a background of progressive shortness of breath with exertional chest pain for 6 months. She has a history of renal impairment with an eGFR of 40 mL/min. She is initially commenced on IV furosemide with good effect. An echocardiogram reveals LVEF 40% with severe aortic stenosis (AS) with an estimated valve area of 0.7 cm2 .

What would you do next?

A. Add a beta-blocker
B. Perform angiography with a view to aortic valve replacement (AVR)/transcatheter aortic valve implantation
C. Add an ACE inhibitor
D. Implant a CRT-D
E. A and B

Question 3# Print Question

You review a 60-year-old man with NHYA class II heart failure in clinic. He has LVEF 35%, BP 110/50 mmHg, and heart rate 80 bpm (sinus rhythm). Current medications are bisoprolol 1.25 mg and ramipril 7.5mg.

What medication alteration would you recommend to the GP?

A. Add ivabradine
B. Add spironolactone 25 mg od
C. Add digoxin 62.5 micrograms od
D. Titrate up bisoprolol
E. Add candesartan 4 mg

Question 4# Print Question

A 35 year old man presents to the medical take with acute heart failure. He has a 2 week history of progressive breathlessness. Past medical history includes type II diabetes mellitus. An echocardiogram subsequently shows an EF of 25% with anterior, septal, and lateral wall motion defects. He is stabilized on medication with furosemide, spironolactone, bisoprolol, and ramipril.

What would be your next course of investigation?

A. Endomyocardial biopsy
B. Angiogram
C. Viral titres
D. Exercise tolerance test
E. Lung function tests

Question 5# Print Question

A 65 year old woman with ischaemic cardiomyopathy and LVEF 30% comes for review in the outpatient clinic. She is NYHA class II and has been optimally revascularized. Her current heart failure medications are bisoprolol 10 mg od, ramipril 10 mg od, ivabradine 7.5 mg bd, and spironolactone 25 mg. Her ECG shows sinus rhythm, left bundle branch block (QRS duration 135 ms), left axis deviation, and PR interval 180 ms.

Which one of the following managements would you recommend next?

A. Refer for transplant assessment
B. Refer for ICD
C. Refer for CRT-D
D. Refer for CRT-P
E. Perform a dyssynchrony echocardiogram

Category: Cardiology--->Heart Failure
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