MRCP Part 1 Cardiology 2

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?

Accepted Answer

Severe aortic stenosis

Answer

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?

Accepted Answer

Acute pericarditis

Answer

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?

Accepted Answer

IV magnesium sulphate

Answer

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?

Accepted Answer

Elevated intrapericardial pressure compressing all four chambers, reducing cardiac filling and output

Answer

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?

Accepted Answer

Amiodarone-induced pulmonary toxicity

Answer

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.

MRCP Part 1 Practice Test

MRCP Part 1 Practice Test

MRCP Part 1 Cardiology 2