500 Single Best Answers In Medicine - MU-medical

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SECTION 1:CARDIOVASCULARQuestions1. Myocardial infarction2. Heart failure (1)3. Valve lesion signs4. CHAD2 score5. Chest pain (1)6. Shortness of breath (1)7. Murmurs (1)8. Chest pain (2)9. Chest pain management10. Ventricular tachyarrhythmia11. Jugular venous pressure12. Heart failure (2)13. First degree heart block14. Mitral stenosis15. Hypertension (1)16. Palpitations17. Murmurs (2)18. Postmyocardial infarction (1)19. Hypertension (2)20. Mid-systolic murmur21. Ventral septal defect22. Microscopic haematuria23. Retrosternal chest pain24. Pulmonary embolism management25. Mid-diastolic murmur33344455566677788899910101011

1CARDIOVASCULAR26. Severe chest pain27. Decrescendo diastolic murmur28. Supraventricular tachycardia29. Chest pain (3)30. Shortness of breath (2)31. Hypertension (3)32. Chest pain (4)33. Constrictive pericarditis34. Visual disturbance35. Weight loss36. Postmyocardial infarction (2)37. Mitral valve prolapse complication38. Mitral valve prolapse39. Paroxysmal atrial fibrillation40. Hypertension managementAnswers11111212121313131414141515151617

Questions 3QUESTIONS1. Myocardial infarctionA 65-year-old man presents with central crushing chest pain for the first time. Heis transferred immediately to the closest cardiac unit to undergo a primarypercutaneous coronary intervention. There is thrombosis of the left circumflexartery only. Angioplasty is carried out and a drug-eluding stent is inserted. Whatare the most likely changes to have occurred on ECG during admission?A.B.C.D.E.ST depression in leads V1–4ST elevation in leads V1–6ST depression in leads II, III and AVFST elevation in leads V5–6ST elevation in leads II, III and AVF2. Heart failure (1)A 78-year-old woman is admitted with heart failure. The underlying cause isdetermined to be aortic stenosis. Which sign is most likely to be present?A.B.C.D.E.Pleural effusion on chest x-rayRaised jugular venous pressure (JVP)Bilateral pedal oedemaBibasal crepitationsAtrial fibrillation3. Valve lesion signsA patient is admitted with pneumonia. A murmur is heard on examination. Whatfinding points to mitral regurgitation?A.B.C.D.E.Murmur louder on inspirationMurmur louder with patient in left lateral positionMurmur louder over the right 2nd intercostal space midclavicular lineCorrigan’s signNarrow pulse pressure

4 Section 1: Cardiovascular4. CHAD2 scoreA 79-year-old woman is admitted to the coronary care unit (CCU) with unstableangina. She is started on appropriate medication to reduce her cardiac risk. She ishypertensive, fasting glucose is normal and cholesterol is 5.2. She is found to be inatrial fibrillation. What is the most appropriate treatment?A.B.C.D.E.Aspirin and clopidogrelDigoxinCardioversionAspirin aloneWarfarin5. Chest pain (1)A 55-year-old man has just arrived in accident and emergency complaining of 20minutes of central crushing chest pain. Which feature is most indicative ofmyocardial infarction at this moment in time?A.B.C.D.E.Inverted T wavesST depressionST elevationQ wavesRaised troponin6. Shortness of breath (1)A 66-year-old woman presents to accident and emergency with a 2-day history ofshortness of breath. The patient notes becoming progressively short of breath aswell as a sharp pain in the right side of the chest which is most painful when takinga deep breath. The patient also complains of mild pain in the right leg, though thereis nothing significant on full cardiovascular and respiratory examination. Heartrate is 96 and respiratory rate is 12. The patient denies any weight loss or long haulflights but mentions undergoing a nasal polypectomy 3 weeks ago. The most likelydiagnosis is:A.B.C.D.E.Muscular strainHeart failurePneumothoraxAnginaPulmonary embolism

Questions 57. Murmurs (1)A 59-year-old man presents for a well person check. A cardiovascular, respiratory,gastrointestinal and neurological examination is performed. No significant findingsare found, except during auscultation a mid systolic click followed by a late systolicmurmur is heard at the apex. The patient denies any symptoms. The most likelydiagnosis is:A.B.C.D.E.Barlow syndromeAustin Flint murmurPatent ductus arteriosusGraham Steell murmurCarey Coombs murmur8. Chest pain (2)A 60-year-old man presents to accident and emergency with a 3-day history ofincreasingly severe chest pain. The patient describes the pain as a sharp, tearingpain starting in the centre of his chest and radiating straight through to his backbetween his shoulder blades. The patient looks in pain but there is no pallor, heartrate is 95, respiratory rate is 20, temperature 37 C and blood pressure is155/95 mmHg. The most likely diagnosis is:A.B.C.D.E.Myocardial infarctionMyocardial ischaemiaAortic dissectionPulmonary embolismPneumonia9. Chest pain managementA 49-year-old man is rushed to accident and emergency complaining of a 20-minutehistory of severe, crushing chest pain. After giving the patient glyceryl trinitrate(GTN) spray, he is able to tell you he suffers from hypertension and type 2 diabetesand is allergic to aspirin. The most appropriate management arin

6 Section 1: Cardiovascular10. Ventricular tachyarrhythmiaWhile on call you are called by a nurse to a patient on the ward complaining oflight headedness and palpitations. When you arrive the patient is not conscious buthas a patent airway and is breathing with oxygen saturation at 97 per cent. You tryto palpate a pulse but are unable to find the radial or carotid. The registrar arrivesand after hearing your report of the patient decides to shock the patient whorecovers. What is the patient most likely to have been suffering?A.B.C.D.E.Torsades de PointesVentricular fibrillationSustained ventricular tachycardiaNon-sustained ventricular tachycardiaNormal heart ventricular tachycardia11. Jugular venous pressureA 67-year-old man presents to accident and emergency with a 3-day history ofshortness of breath. On examination you palpate the radial pulse and notice thatthe patient has an irregular heart beat with an overall rate of 140 bpm. You requestan electrocardiogram (ECG) which reveals that the patient is in atrial fibrillation.Which of the following would you expect to see when assessing the JVP?A.B.C.D.E.Raised JVP with normal waveformLarge ‘v waves’Cannon ‘a waves’Absent ‘a waves’Large ‘a waves’12. Heart failure (2)A 78-year-old woman is admitted to your ward following a 3-day history ofshortness of breath and a productive cough of white frothy sputum. On auscultationof the lungs, you hear bilateral basal coarse inspiratory crackles. You suspect thatthe patient is in congestive cardiac failure. You request a chest x-ray. Which of thefollowing signs is not typically seen on chest x-ray in patients with congestivecardiac failure?A.B.C.D.E.Lower lobe diversionCardiomegalyPleural effusionsAlveolar oedemaKerley B lines

Questions 713. First degree heart blockA 56-year-old man presents to your clinic with symptoms of exertional chesttightness which is relieved by rest. You request an ECG which reveals that thepatient has first degree heart block. Which of the following ECG abnormalities istypically seen in first degree heart block?A.B.C.D.E.PR interval 120 msPR interval 300 msPR interval 200 msPR interval 200 msPR interval 120 ms14. Mitral stenosisYou see a 57-year-old woman who presents with worsening shortness of breathcoupled with decreased exercise tolerance. She had rheumatic fever in heradolescence and suffers from essential hypertension. On examination she has signswhich point to a diagnosis of mitral stenosis. Which of the following is not aclinical sign associated with mitral stenosis?A.B.C.D.E.Malar flushAtrial fibrillationPan-systolic murmur which radiates to axillaTapping, undisplaced apex beatRight ventricular heave15. Hypertension (1)A 48-year-old woman has been diagnosed with essential hypertension and wascommenced on treatment three months ago. She presents to you with a dry coughwhich has not been getting better despite taking cough linctus and antibiotics. Youassess the patient’s medication history. Which of the following antihypertensivemedications is responsible for the patient’s thiazideFrusemideAtenolol

8 Section 1: Cardiovascular16. PalpitationsA 62-year-old male presents with palpitations, which are shown on ECG to be atrialfibrillation with a ventricular rate of approximately 130/minute. He has mildcentral chest discomfort but is not acutely distressed. He first noticed these about 3hours before coming to hospital. As far as is known this is his first episode of thiskind. Which of the following would you prefer as first-line therapy?A.B.C.D.E.Anticoagulate with heparin and start digoxin at standard daily doseAttempt DC cardioversionAdminister bisoprolol and verapamil, and give warfarinAttempt cardioversion with IV flecainideWait to see if there is spontaneous reversion to sinus rhythm17. Murmurs (2)A 76-year-old male is brought to accident and emergency after collapsing at home.He has recovered within minutes and is fully alert and orientated. He says this isthe first such episode that he has experienced, but describes some increasingshortness of breath in the previous six months and brief periods of central chestpain, often at the same time. On examination, blood pressure is 115/88 mmHg andthere are a few rales at both bases. On ECG there are borderline criteria for leftventricular hypertrophy. Which of the following might you expect to find onauscultation?A.B.C.D.E.Mid-diastolic murmur best heard at the apexCrescendo systolic murmur best heard at the right sternal edgeDiastolic murmur best heard at the left sternal edgePan-systolic murmur best heard at the apexPan-systolic murmur best heard at the left sternal edge18. Postmyocardial infarction (1)A 63-year-old male was admitted to accident and emergency 2 days after dischargefollowing an apparently uncomplicated MI. He complained of rapidly worseningshortness of breath over the previous 48 hours but no further chest pain. He wastachypnoeic and had a regular pulse of 110/minute, which proved to be sinustachycardia. The jugular venous pressure was raised and a pan-systolic murmurwas noted, maximal at the left sternal edge. Which of the following is the mostlikely diagnosis?A.B.C.D.E.Mitral incompetenceVentricular septal defectAortic stenosisDressler’s syndromeFurther myocardial infarction

Questions 919. Hypertension (2)A 57-year-old male is admitted complaining of headaches and blurring of vision.His blood pressure is found to be 240/150 mmHg and he has bilateral papilloedema,but is fully orientated and coherent. He had been known to be hypertensive forabout five years and his blood pressure control had been good on three drugs.However, he had decided to stop all medication two months before this event.Which of the following would be your preferred parenteral medication at thispoint?A.B.C.D.E.Glyceryl trinitrateHydralazineLabetalolSodium nitroprussidePhentolamine20. Mid-systolic murmurA 16-year-old male is referred for assessment of hypertension. On average, hisblood pressure is 165/85 mmHg, with radiofemoral delay. There is a mid-systolicmurmur maximal at the aortic area, and radiating to the back. Clinical findings andthe ECG are compatible with left ventricular hypertrophy. What is the most likelyunderlying pathology?A.B.C.D.E.Hypertrophic obstructive cardiomyopathyCongenital aortic stenosisCoarctation of the aortaPatent ductus ateriosusAtrial septal defect21. Ventral septal defectA 16-year-old boy is diagnosed with a small ventricular septal defect, having beenscreened by echocardiography because of a family history of hypertrophicobstructive cardiomyopathy. He is entirely asymptomatic, plays several sportsregularly and has no growth retardation. The echocardiogram also confirms a smallleft to right shunt, with pulmonary to systemic flow ratio only just above one.Which of the following is the most likely to be a significant complication of hiscondition?A.B.C.D.E.Pulmonary hypertensionHeart failureDysrhythmiasEndocarditisShunt reversal (right to left flow)

10 Section 1: Cardiovascular22. Microscopic haematuriaA 52 year-old woman has been treated for several years with amlodipine andlisinopril for what has been presumed to be primary hypertension. She is seen byher GP having complained of persistent left loin pain. Her BP is 150/95 mmHg. Sheis tender in the left loin and both kidneys appear to be enlarged. On urine dipsticktesting, there is microscopic haematuria. Which of the following is likely to be themost appropriate investigation at this point?A.B.C.D.E.Urinary tract ultrasoundAbdominal and pelvic computed tomography (CT) scanMicroscopy of the urine (microbial and cytological)Renal biopsyIntravenous urogram23. Retrosternal chest painA 61-year-old man presents with a 2-hour history of moderately severe retrosternalchest pain, which does not radiate and is not affected by respiration or posture. Hecomplains of general malaise and nausea, but has not vomited. His ECG shows STsegment depression and T wave inversion in the inferior leads. Troponin levels arenot elevated. He has already been given oxygen, aspirin and intravenous GTN; heis an occasional user of sublingual GTN and takes regular bisoprolol for stableangina. What would be the most appropriate next step in his management?A.B.C.D.E.IV low-molecular weight heparinThrombolysis with alteplaseIV nicardapineAngiography with stentingOral clopidogrel24. Pulmonary embolism managementA 41-year-old woman is referred for assessment after suffering a second pulmonaryembolus within a year. She has not been travelling recently, has not had anysurgery, does not smoke and does not take the oral contraceptive pill. She is notcurrently on any medication as the diagnosis is retrospective and she is nowasymptomatic. What should be the next step in her management?A.B.C.D.E.Initiation of warfarin therapyECGThrombophilia screenInsertion of inferior vena cava filterDuplex scan of lower limb veins and pelvic utrasound

Questions 1125. Mid-diastolic murmurA 32-year-old woman attends her GP for a routine medical examination and isnoted to have a mid-diastolic murmur with an opening snap. Her blood pressure is118/71 mmHg and the pulse is regular at 66 beats per minute. She is entirelyasymptomatic and chest x-ray and ECG are normal. What would be the mostappropriate investigation at this point?A.B.C.D.E.ECGAnti-streptolysin O titreCardiac catheterizationThallium radionuclide scanningColour Doppler scanning26. Severe chest painA 46-year-old man develops sudden severe central chest pain after lifting heavycases while moving house. The pain radiates to the back and both shoulders but notto either arm. His BP is 155/90 mmHg, pulse rate is 92 beats per minute and the ECGis normal. He is distressed and sweaty, but not nauseated. What would you considerthe most likely diagnosis?A.B.C.D.E.PneumothoraxMIPulmonary embolismAortic dissectionMusculoskeletal pain27. Decrescendo diastolic murmurA 49-year-old woman presents with increasing shortness of breath on exertiondeveloping over the past three months. She has no chest pain or cough, and hasnoticed no ankle swelling. On examination, blood pressure is 158/61 mmHg, pulseis regular at 88 beats per minute and there are crackles at both lung bases. There isa decrescendo diastolic murmur at the left sternal edge. What is the most likelydiagnosis?A.B.C.D.E.Aortic regurgitationAortic stenosisMitral regurgitationMitral stenosisTricuspid regurgitation

12 Section 1: Cardiovascular28. Supraventricular tachycardiaA 21-year-old man is on his way home from a party when he experiences the suddenonset of rapid palpitations. He feels uncomfortable but not short of breath and hasno chest pain. He goes to the nearest accident and emergency department, where heis found to have a supraventricular tachycardia (SVT) at a rate of 170/minute. Carotidsinus massage produced transient reversion to sinus rhythm, after which thetachycardia resumed. What wou

500 Single Best Answers in. First published in Great Britain in 2011 by . MCQs have largely been abandoned in favour of extending matching questions (EMQs) and more recently the single best answer (SBA) question format. EMQs and SBAs ov