Your-Doctor Multiple Choice Questions (MCQ)

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Category: Cardiology--->Adult Congenital Heart Disease and Pregnancy
Page: 3

Question 11#Print Question

You are approached by one of the adult congenital specialist nurses for advice regarding a patient with tetralogy of Fallot (ToF) who has contacted them directly. The patient, who is now 24 years old, had total surgical repair in childhood and has remained well since, but has recently been experiencing palpitations with associated presyncope. The symptoms are transient and there has been no syncope. There are no other relevant symptoms or reduction in exercise capacity. The echocardiogram from clinic a year previously showed moderate–severe PR and moderate RV dilatation. The nurse has performed an ECG which shows SR with first-degree AV block and RBBB (QRS 190 ms).

What is the most appropriate advice?

a. The patient is at risk of malignant arrhythmias and sudden cardiac death; urgent haemodynamic assessment and consideration of an ICD is appropriate
b. It is likely that the patient is experiencing paroxysmal SVTs or symptomatic ectopics; arrange an outpatient 24-hour tape
c. It is common for patients with ToF repair to develop non-sustained RVOT arrhythmias at the site of the surgical scar, and beta-blockers are the initial treatment of choice for symptoms
d. It is possible that the symptoms represent haemodynamic deterioration; an echocardiogram should be arranged to document progression of PR and RV dilatation
e. High degrees of AV block/sinus node dysfunction are probably due to the scar from the VSD patch; the best investigation is an implantable loop recorder with a view to a permanent pacemaker


Question 12#Print Question

One of the stroke physicians asks your advice regarding a 45-year-old man admitted with a stroke. The patient is overweight with known hypertension and raised lipids. He is a non-smoker. Carotid Doppler scans show no atheroma. The stroke physicians have performed a 24-hour tape which has shown clear runs of asymptomatic paroxysmal AF. They have also requested a bubble contrast echo which has demonstrated complete opacification of the left heart with Valsalva release. The heart is structurally normal apart from moderate LVH and a left atrial area of 30 cm2 . The patient is currently on antiplatelet therapy, but they are keen to know what the immediate strategy would be from the cardiac point of view.

a. There is a large PFO which represents a significant risk factor for recurrent stroke; once the patient has recovered, inpatient transcatheter PFO closure is indicated
b. There is clear evidence of paroxysmal AF: in the context of stroke and cardiovascular risk factors, we would recommend anticoagulation once beyond the acute risk of haemorrhagic transformation; no further treatment for the PFO is required whilst on anticoagulation
c. The patient is young and should have pulmonary vein isolation and a flutter ablation with transcatheter left atrial appendage closure and PFO closure
d. TOE is the next step to confirm the presence and anatomy of the shunt
e. Short episodes of AF can be seen in the context of an acute illness: the patient should have aggressive cardiovascular risk factor modification and BP control with ACE inhibitors; further ambulatory ECGs should be peformed when he has recovered as


Question 13#Print Question

One of the medical students asks you what a Fontan operation consists of.

What is your answer?

a. A palliative procedure when a biventricular surgical repair is not possible: the systemic venous blood is directly routed into the pulmonary arteries bypassing the ventricle
b. When a biventricular surgical repair is not possible the systemic venous blood is directly routed into the pulmonary arteries bypassing the ventricle; life expectancy is near normal
c. It is a procedure for the treatment of transposition of the great arteries but is no longer performed; the systemic venous blood is routed via baffles to the morphological left ventricle (subpulmonary ventricle) and the pulmonary venous blood is routed to the morphological RV (systemic ventricle)
d. It consists of an SVC-to-PA shunt to increase pulmonary blood flow in congenital cyanotic heart disease when pulmonary flow is low
e. It consists of a subclavian-to-PA shunt to increase pulmonary blood flow in congenital cyanotic heart disease when pulmonary flow is low


Question 14#Print Question

You are following up a 33-year-old male in clinic who was referred by the GP for increasing breathlessness and intermittent palpitations. A transthoracic echocardiogram was performed which revealed moderate right heart dilatation but no abnormality of the right-sided valves. Right ventricular systolic pressure was estimated at 30 mmHg. He has no respiratory problems and is a lifelong non-smoker. He is slim with good echocardiogram images, and careful interrogation of the intra-atrial and ventricular septum shows no evidence of a colour flow. 

What is a likely differential diagnosis?

a. ASD
b. VSD
c. PFO
d. Primary respiratory disease with right heart changes
e. PDA


Question 15#Print Question

You are following up a 28-year-old male in clinic who was referred by his GP for increasing breathlessness and intermittent palpitations. He has come back for the result of his TOE which has shown evidence of a superior sinus venosus ASD with normal pulmonary venous drainage and moderate right heart dilatation.

He asks you about the likely treatment.

a. Transcatheter ASD device closure
b. Surgical ASD closure
c. ACE inhibitor treatment to reduce the shunt and protect the right heart
d. Monitoring in clinic for signs of severe right heart dilatation
e. Stenting of the SVC to commit blood into the RA




Category: Cardiology--->Adult Congenital Heart Disease and Pregnancy
Page: 3 of 20