MRCP Part 1 Cardiology and Respiratory 2

Question 1

A 28-year-old woman presents with syncope during exercise. Echocardiography shows asymmetric septal hypertrophy with systolic anterior motion of the mitral valve. What is the most likely diagnosis?

Accepted Answer

Hypertrophic cardiomyopathy

Answer

Hypertrophic cardiomyopathy (HCM) characteristically shows asymmetric septal hypertrophy (ASH) and systolic anterior motion (SAM) of the mitral valve on echocardiography. Exertional syncope is a concerning feature suggesting left ventricular outflow tract obstruction.

Question 2

A 65-year-old smoker has an FEV1 of 45% predicted after bronchodilator. According to GOLD classification, what is the severity of his COPD?

Accepted Answer

GOLD 3 — Severe

Answer

GOLD classification is based on post-bronchodilator FEV1: GOLD 1 (mild) >=80%, GOLD 2 (moderate) 50-79%, GOLD 3 (severe) 30-49%, GOLD 4 (very severe) <30%. An FEV1 of 45% predicted falls into GOLD 3 (severe).

Question 3

Which ECG finding is most characteristic of hyperkalaemia?

Accepted Answer

Tall tented T waves

Answer

Tall, peaked (tented) T waves are the earliest ECG change in hyperkalaemia, typically appearing when potassium exceeds 5.5-6.0 mmol/L. Progressive hyperkalaemia leads to widened QRS, loss of P waves, and eventually a sine wave pattern preceding cardiac arrest.

Question 4

A patient with known asthma presents with acute breathlessness. Arterial blood gas shows pH 7.35, PaCO2 5.5 kPa, PaO2 8.0 kPa. What does the PaCO2 suggest about the severity of this exacerbation?

Accepted Answer

Life-threatening — indicates tiring and impending respiratory failure

Answer

In acute asthma, patients typically hyperventilate, producing a low PaCO2. A normal or rising PaCO2 (5.5 kPa) in acute asthma is a sinister sign indicating respiratory muscle fatigue and inability to maintain the hyperventilatory response. This is classified as a feature of life-threatening asthma by BTS/SIGN guidelines.

Question 5

A 50-year-old man presents with progressive exertional breathlessness and fine bibasal inspiratory crackles. HRCT shows honeycombing and traction bronchiectasis predominantly in the lower lobes. What is the most likely diagnosis?

Accepted Answer

Idiopathic pulmonary fibrosis (usual interstitial pneumonia pattern)

Answer

The combination of progressive breathlessness, bibasal crackles, and HRCT showing honeycombing with traction bronchiectasis in a subpleural, basal distribution is the classic pattern of usual interstitial pneumonia (UIP), the hallmark of idiopathic pulmonary fibrosis (IPF).

MRCP Part 1 Practice Test

MRCP Part 1 Practice Test

MRCP Part 1 Cardiology and Respiratory 2