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TitleExplained Mcqs in Cardiology
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Given this clinical history, this patient has a diagnosis of hypertrophic obstructive cardiomyopathy. He has

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non-sustained ventricular tachycardias and is at significant risk of sudden death. While myomectomy will impact on
symptoms, it won’t affect the risk of arrhythmia. Management in the past would have been medical therapy with
amiodarone, but recent studies have demonstrated superior efficacy for implantable cardioverter defibrillators (I CDs).
Given that long-term use of amiodarone is associated with significant morbidity, ICDs are taking over as management of
choice.

A 72-year-old man presents for an extraction of three teeth under local anaesthesia. He has a past history of rheumatic
heart disease. Mitral stenosis has been identified but the rotten teeth are being removed before valve replacement. He is
allergic to penicillin.

Which of the following would be the most appropriate antibiotic regime for him?

Amoxicillin 3 g po 1 hour before procedure

No prophylaxis necessary

Vancomycin 1 g po 1 hour before procedure

Ciprofloxacin 1 g po 1 hour before procedure

Augmentin 1 g po before procedure

A 72-year-old man presents for an extraction of three teeth under local anaesthesia. He has a past history of rheumatic
heart disease. Mitral stenosis has been identified but the rotten teeth are being removed before valve replacement. He is
allergic to penicillin.

Which of the following would be the most appropriate antibiotic regime for him?

Amoxicillin 3 g po 1 hour before procedure

No prophylaxis necessary Your answer

Vancomycin 1 g po 1 hour before procedure

Ciprofloxacin 1 g po 1 hour before procedure

Augmentin 1 g po before procedure

After an extensive evidence review, the most recent NICE guidelines do not recommend antibiotic prophylaxis for a
number of routine procedures including dental extraction. Their conclusion is based on the fact that they were unable to
determine any evidence which suggested that antibiotic prophylaxis prevented the development of endocarditis.

A 45-year-old man attends for review. He has been suffering increasing shortness of breath over the past few years. He is a
non-smoker who drinks 20 units per week of alcohol and has no significant past cardiovascular history. Now he presents
with what seems to have been a transient ischaemic attack (TI A), with weakness and co-ordination problems affecting his
left side, which have resolved over the past 24 hours. On examination blood pressure is 142/95 mmHg and he is in sinus
rhythm. There is no opening snap, but a diastolic murmur is heard which changes in character according to posture. Bloods
are unremarkable, including C-reactive protein (CRP), which is in the normal range.

Which of the following diagnoses fit best with this clinical picture?

Right atrial myxoma

Left atrial myxoma

Aortic stenosis

Mitral stenosis

Mitral regurgitation

A 45-year-old man attends for review. He has been suffering increasing shortness of breath over the past few years. He is a
non-smoker who drinks 20 units per week of alcohol and has no significant past cardiovascular history. Now he presents
with what seems to have been a transient ischaemic attack (TI A), with weakness and co-ordination problems affecting his
left side, which have resolved over the past 24 hours. On examination blood pressure is 142/95 mmHg and he is in sinus
rhythm. There is no opening snap, but a diastolic murmur is heard which changes in character according to posture. Bloods
are unremarkable, including C-reactive protein (CRP), which is in the normal range.

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Amiodarone

Atenolol

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DC shock

Mitral valve replacement

Percutaneous mitral valvotomy

A 52-year-old woman, with a prior history of rheumatic fever, presents with shortness of breath on strenuous exertion while
working as a landscape gardener. She is in permanent atrial fibrillation and is on long-term warfarin and digoxin (125 µg
once daily). Clinical examination reveals her to be in atrial fibrillation at a rate of around 150 bpm. Echo demonstrates

preserved left ventricular function, a heavily calcified mitral valve with moderate mitral stenosis (mitral valve area 1.5 cm
2

and moderate mitral regurgitation. Her left atrium is dilated.

What is the most appropriate initial treatment option?

Amiodarone

Atenolol Correct answer

DC shock

Mitral valve replacement Your answer

Percutaneous mitral valvotomy

This woman has moderate, mixed mitral valve disease and therefore surgery is not currently indicated. It may however
be required later if features of left heart failure progress. Even if the mitral stenosis were to be severe the presence of
heavy calcification of the valve and concomitant mitral regurgitation would preclude percutaneous valvotomy. She is in
permanent atrial fibrillation and as such, by definition, sinus rhythm cannot be restored (as opposed to persistent or
paroxysmal). Better rate control is required. Digoxin on its own may not control catecholamine-driven tachycardia (eg
during exertion). Amiodarone, while effective, would not be the first choice for this young patient working outdoors
because of its side-effect profile.

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