MRCP Part 1 Cardiology 2 — Questions and Answers
Question 1: A 70-year-old man with known aortic stenosis has a systolic murmur that radiates to the carotids, a slow-rising pulse, and a narrow pulse pressure. What severity does this indicate?
- Mild aortic stenosis
- Moderate aortic stenosis
- Severe aortic stenosis (Correct answer)
- Aortic sclerosis without obstruction
Correct answer: Severe aortic stenosis
Severe aortic stenosis features include: slow-rising (anacrotisch) pulse, narrow pulse pressure, sustained apex beat, late-peaking murmur, absent A2, and the clinical triad of syncope, angina, and heart failure. These findings together indicate haemodynamically significant stenosis.
Question 2: Which condition is associated with a 'saddle-shaped' ST elevation pattern across multiple leads without reciprocal changes?
- STEMI
- Prinzmetal angina
- Acute pericarditis (Correct answer)
- Left bundle branch block
Correct answer: Acute pericarditis
Acute pericarditis classically causes diffuse, saddle-shaped ST elevation across multiple leads without the reciprocal ST depression seen in STEMI. It is accompanied by PR depression (especially in limb leads) and is caused by inflammation of the pericardium.
Question 3: A patient presents with collapse. ECG shows torsades de pointes. What is the immediate pharmacological treatment?
- Lignocaine
- Amiodarone
- IV magnesium sulphate (Correct answer)
- Adenosine
Correct answer: IV magnesium sulphate
Torsades de pointes is a polymorphic ventricular tachycardia associated with prolonged QTc. IV magnesium sulphate is the first-line treatment regardless of the patient's magnesium level. It stabilises the cardiac membrane and suppresses early afterdepolarisations.
Question 4: Which of the following best describes the pathophysiology of cardiac tamponade?
- Increased left ventricular preload from fluid accumulation
- Elevated intrapericardial pressure compressing all four chambers, reducing cardiac filling and output (Correct answer)
- Left ventricular systolic dysfunction from ischaemia
- Aortic regurgitation causing volume overload
Correct answer: Elevated intrapericardial pressure compressing all four chambers, reducing cardiac filling and output
Cardiac tamponade occurs when fluid accumulates in the pericardium, raising intrapericardial pressure above right atrial pressure, impeding cardiac filling. The result is reduced stroke volume, hypotension, and compensatory tachycardia. Beck's triad: hypotension, raised JVP, muffled heart sounds.
Question 5: A 55-year-old woman on amiodarone presents with new dyspnoea. CXR shows bilateral infiltrates. What is the most likely complication?
- Amiodarone-induced hepatotoxicity
- Amiodarone-induced pulmonary toxicity (Correct answer)
- Amiodarone-induced thyrotoxicosis
- Amiodarone-induced neuropathy
Correct answer: Amiodarone-induced pulmonary toxicity
Amiodarone pulmonary toxicity is a well-recognised serious adverse effect, presenting with progressive dyspnoea, bilateral infiltrates on CXR, and reduced DLCO on pulmonary function testing. It can be fatal. Regular monitoring and dose reduction or cessation are required.
Question 6: In heart failure with reduced ejection fraction (HFrEF), which drug combination has been shown to reduce all-cause mortality?
- Beta-blocker + calcium channel blocker
- ACE inhibitor (or ARNI) + beta-blocker + MRA + SGLT2 inhibitor (Correct answer)
- ARB + diuretic + aspirin
- Digoxin + warfarin + diuretic
Correct answer: ACE inhibitor (or ARNI) + beta-blocker + MRA + SGLT2 inhibitor
The four pillars of HFrEF treatment with mortality benefit are: ACE inhibitor/ARB/ARNI (sacubitril-valsartan), beta-blocker, mineralocorticoid receptor antagonist (spironolactone/eplerenone), and SGLT2 inhibitor (dapagliflozin/empagliflozin). Each class independently reduces mortality.
MRCP Part 1 Cardiology 2
A 70-year-old man with known aortic stenosis has a systolic murmur that radiates to the carotids, a slow-rising pulse, and a narrow pulse pressure.
What severity does this indicate?