Multiple Choice Questions MCQ

Question 24# Print Question

A patient with severe LVSD and LBBB undergoes MPS. The following report is available to you in clinic. ‘Adenosine stress (40 micrograms/ kg/min) used over 6 minutes. 400 Mbq of 99mTc-sestamibi was injected after 4 minutes. Further dose of 800 MBq injected at rest. Line source attenuation corrected imaging also undertaken. Reduced septal counts noted on both studies. Probable anteroapical hypoperfusion noted on stress images. Normal counts elsewhere. Dilated LV cavity with global hypokinesia and LVEF 32%.’

Which one of the following statements is correct?

A. This patient has undergone adequate stress

B. This patient has a dilated cardiomyopathy

C. Coronary angiography is not required

D. There is evidence of a myocardial infarct

E. Diaphragmatic attenuation accounts for some of the findings

Question 21# With regard to equilibrium radionuclide ventriculography (RNV), which one of the following is true?
A. Although RNV provides an accurate estimate of the LVEF it is poorly reproducible
B. Only LVEF can be measured using RNV as the RV is too posterior and crescentic in shape to be imaged accurately
C. RNV relies on the clear definition of the endocardial border and this is its main limitation in clinical practice
D. Unlike myocardial perfusion scintigraphy (MPS), no radiation is used in RNV studies
E. Poorly controlled atrial fibrillation limits the accuracy of an RNV study
RNV provides very reproducible data. New techniques allow the RVEF to be assessed. RNV is independent of endocardial border detection as it images radiolabelled red cell passage through the LV. It is a nuclear-based technique. AF will limit the accuracy, as gating will be less regular.

Question 22# With regard to positron emission tomography (PET), which one of the following is true?
A. PET scanning is a cheap and widely available investigation
B. PET compares poorly with CMR imaging when used to determine myocardial viability
C. PET scanning uses thallium as the isotope of choice
D. One of the major limitations of PET for cardiac perfusion has been that, until recently, the isotope needed to be produced on site in a cyclotron
E. PET scanning utilizes changes in the metabolism of carbon to detect abnormalities of cardiac perfusion
This answer is correct, although rubidium-based isotopes may change this. PET remains a costly and specialist procedure. It uses glucose metabolism to detect abnormalities.

Question 23# The following patients have sound evidence-based reasons to undergo an MPS study, based on the NICE 200 guidelines for the assessment of chest pain. Choose the single best answer.
A. A woman age 60 years with an intermediate risk of cardiac pain
B. A patient with chest pain and ST elevation on their ECG
C. A bilateral amputee, with a recent MI and brittle asthma
D. A patient with a massive pulmonary embolism in whom the RV strain is to be quantified
E. A 62-year-old diabetic with unstable anginal symptoms
Scenario B needs emergency angiography. Scenario C is unsuitable for current vasodilator stress agents; however, new selective A2A agents which have much less bronchospasm (e.g. regadenoson) will soon be available. Scenario D should have echocardiography as the first line. Scenario E should be offered angiography in the first incidence.

Question 25# What would you do based on your interpretation of the MPS study shown in Figure below?
A. Revascularization to LAD
B. Revascularization to RCA
C. DSE
D. Medical therapy
E. CTCA
This is a high-risk study confirming significant anterior and anteroseptal ischaemia. There is a large ischaemic burden with LV cavity dilatation with stress. Revascularization to the LAD should be attempted.

Question 24# A patient with severe LVSD and LBBB undergoes MPS. The following report is available to you in clinic. ‘Adenosine stress (40 micrograms/ kg/min) used over 6 minutes. 400 Mbq of 99mTc-sestamibi was injected after 4 minutes. Further dose of 800 MBq injected at rest. Line source attenuation corrected imaging also undertaken. Reduced septal counts noted on both studies. Probable anteroapical hypoperfusion noted on stress images. Normal counts elsewhere. Dilated LV cavity with global hypokinesia and LVEF 32%.’ Which one of the following statements is correct?
A. This patient has undergone adequate stress
B. This patient has a dilated cardiomyopathy
C. Coronary angiography is not required
D. There is evidence of a myocardial infarct
E. Diaphragmatic attenuation accounts for some of the findings
No information is given as to the size of the left ventricle. The report suggests ischaemia and therefore coronary angiography is required. The septal hypoperfusion is probably due to an LBBB artefact rather than a myocardial infarction. No inferior wall pathology is identified, which is sometimes masked by diaphragmatic attenuation.

Your-Doctor Multiple Choice Questions (MCQ)

Your-Doctor
Multiple Choice Questions (MCQ)