MRCP Part 1 Cardiology and Respiratory

Question 1

A 62-year-old man presents with acute chest pain. His ECG shows ST elevation in leads II, III, and aVF with reciprocal changes in I and aVL. Which coronary artery is most likely occluded?

Accepted Answer

Right coronary artery

Answer

ST elevation in leads II, III, and aVF indicates an inferior myocardial infarction. The right coronary artery (RCA) supplies the inferior surface of the heart in approximately 85% of patients (right-dominant circulation).

Question 2

A patient with heart failure has the following spirometry: FEV1 2.8L (predicted 3.5L), FVC 3.2L (predicted 4.2L), FEV1/FVC ratio 87.5%. What pattern does this show?

Accepted Answer

Restrictive pattern

Answer

The FEV1/FVC ratio is preserved (>70%) but both FEV1 and FVC are reduced, indicating a restrictive pattern. Heart failure causes pulmonary congestion and reduced lung compliance, leading to restriction.

Question 3

Which valvular lesion classically produces an early diastolic murmur best heard at the left sternal edge with the patient sitting forward?

Accepted Answer

Aortic regurgitation

Answer

Aortic regurgitation produces a high-pitched early diastolic decrescendo murmur best heard at the left sternal edge with the patient sitting forward and in held expiration. This position brings the aortic root closer to the chest wall.

Question 4

A 70-year-old woman with atrial fibrillation has a CHA2DS2-VASc score of 4. According to NICE guidelines, what is the recommended anticoagulation strategy?

Accepted Answer

Direct oral anticoagulant (DOAC)

Answer

NICE recommends anticoagulation with a DOAC (apixaban, dabigatran, edoxaban, or rivarelbana) as first-line for stroke prevention in AF when CHA2DS2-VASc score is 2 or more. Aspirin alone is no longer recommended for stroke prevention in AF.

Question 5

A patient presents with pleuritic chest pain, haemoptysis, and breathlessness. D-dimer is elevated and CTPA shows a filling defect in the right lower lobe pulmonary artery. What is the most appropriate initial treatment?

Accepted Answer

Low molecular weight heparin and arrange DOAC

Answer

For a confirmed pulmonary embolism without haemodynamic instability, initial treatment is anticoagulation with LMWH (or fondaparinux) followed by transition to a DOAC. Thrombolysis is reserved for massive PE with haemodynamic compromise.

MRCP Part 1 Practice Test

MRCP Part 1 Practice Test

MRCP Part 1 Cardiology and Respiratory