Your-Doctor Multiple Choice Questions (MCQ)

Category: Cardiology--->Adult Congenital Heart Disease and Pregnancy
Page: 1

Question 1#Print Question

You are reviewing a 27-year-old male in clinic for the first time. On a routine health check 12 months previously he was found to have a restrictive perimembranous VSD on his echocardiogram. The jet velocity was measured at 5 m/s. There was no evidence of left ventricular dilatation and pulmonary pressures are not raised. He is asymptomatic. The rest of his echocardiogram confirmed a structurally normal heart apart from mild aortic regurgitation. You repeat the echocardiogram in clinic and there has been no change. 

What is the most appropriate follow-up?

a. Advise him that this is an incidental finding which should not cause any problems and discharge him from clinic
b. Advise that there is an increased risk of endocarditis but based on the current guidance there is no role for antibiotic prophylaxis and discharge him from clinic
c. Arrange for follow-up with echocardiography in 12 months
d. Advise him that although there are no problems at the moment it is advisable to close the VSD to reduce the risk of progressive haemodynamic change and risk of endocarditis. This can usually be done transcatheter
e. Advise him that although there are no problems at the moment it is advisable to close the VSD to reduce the risk of progressive haemodynamic change and risk of endocarditis. This is usually done surgically


Question 2#Print Question

You are asked to review and explain the terminology on an echocardiogram report for a patient who has just returned to the ward having been admitted with stable but symptomatic AV block. The report states that there is A–V and V–A discordance. 

What is the underlying diagnosis?

a. Congenitally corrected transposition of the great arteries (ccTGA)
b. Transposition of the great arteries
c. An atrioventricular defect with lack of AV valve offset
d. Truncus arteriosus
e. None of the above—the term describes a characteristic m-mode pattern of the AV valves in complete heart block


Question 3#Print Question

You are asked to review a GUCH patient at 03:00 who has directly attended the ED with palpitations and breathlessness. On his arrival, the notes are available and document a diagnosis of tricuspid atresia with Fontan surgery. The patient appears anxious but well and tells you the symptoms started 8 hours previously whilst he was eating. He is well perfused with heart rate 130 bpm, BP 110/70 mmHg, and saturations of 97% on room air. There are no clinical signs of heart failure. The ECG is shown below.

The QRS morphology is consistent with baseline ECGs. The patient is on warfarin with an INR of 2.7.

What is your management strategy?

 

a. Support with O2 and IV fluids; look for underlying causes of tachycardia and especially sepsis; move to CCU and keep under close observation until morning
b. Give an adenosine bolus to diagnose the tachycardia; if an arrhythmia is proven, treat with oral beta-blocker and look for underlying causes
c. Give an adenosine bolus to diagnose the tachycardia; if an arrhythmia is proven, treat with intravenous amiodarone and look for underlying causes
d. It is likely that this represents a sinus tachycardia; reassure the patient; if routine bloods and CXR are normal, he can be discharged in the morning
e. This patient requires prompt DC cardioversion; adenosine can be attempted and IV fluids supplemented whilst making arrangements


Question 4#Print Question

You receive a letter from a GP asking if a patient requires follow-up in clinic. She is 35 years old and has not been seen since discharge from the paediatric cardiology services. She had a coarctation repair in childhood with no associated lesions. You have the surgical information, which documents a Dacron patch aortoplasty technique with excellent result and no residual stenosis. She is otherwise well with BP 120/80 mmHg. She has normal peripheral pulses and no murmurs. She has had two successful pregnancies.  What should you advise the GP?

a. She should have an echocardiogram and if this demonstrates normal structure and velocities in the descending aorta, based on normal blood pressure and clinical examination she does not require regular follow-up
b. She does not require follow-up but should be referred to the pregnancy clinic if she decides to have more children
c. She does not require any follow-up as surgical repair of coarctation has excellent long-term results
d. She will require long-term follow-up in a specialist clinic; an MRI will be the investigation of choice to document the previous repair and any associated problems
e. She should have an ambulatory blood pressure recording and if there is no evidence of hypertension there is no indication to explore any further; if there is evidence of hypertension she should have a CT scan to look for re-coarctation


Question 5#Print Question

A 33-year-old male has been admitted under the stroke physicians with an episode of transient left upper limb weakness, which lasted 1 hour after exercising at the gym. He has no prior medical history. He is a lifelong non-smoker with no important family history. He is very fit and plays competitive basketball. Blood tests reveal total cholesterol of 4.3 mmol/L. BP is 110/70 mmHg and ECG shows sinus rhythm with normal morphology. The stroke physicians arrange a CT head and echocardiogram. The CT head returns normal. You are asked to comment on the echocardiogram report which documents a structurally normal heart with no thrombus in the LA. The only finding is of an ‘aneurysmal’ intra-atrial septum. 

What should you advise the stroke team?

a. The patient should have a TOE as transthoracic echocardiography cannot rule out a cardiac source of thrombus
b. Aneurysmal intra-atrial septum is a common and benign finding in young adults and the rest of the echocardiogram is reassuring. No further cardiac investigations are required
c. They should arrange a Holter monitor to exclude a paroxysmal atrial arrhythmia which may have precipitated thrombus
d. A bubble contrast echocardiogram would be the next investigation of choice
e. Aneurysmal intra-atrial septums are associated with connective tissue disorders and he should have a CT aorta including neck vessels




Category: Cardiology--->Adult Congenital Heart Disease and Pregnancy
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