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Cardiology and Respiratory Flashcards

6 cards from real MRCP PART 1 practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 6 Cardiology and Respiratory flashcards as text

  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?

    Answer: Hypertrophic cardiomyopathy

    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.

  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?

    Answer: GOLD 3 — Severe

    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).

  3. Which ECG finding is most characteristic of hyperkalaemia?

    Answer: Tall tented T waves

    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.

  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?

    Answer: Life-threatening — indicates tiring and impending respiratory failure

    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.

  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?

    Answer: Idiopathic pulmonary fibrosis (usual interstitial pneumonia pattern)

    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).

  6. A patient with a mechanical mitral valve replacement presents with a new regurgitant murmur, fever, and splinter haemorrhages. Blood cultures grow Staphylococcus epidermidis. What is the most appropriate empirical antibiotic regimen whilst awaiting sensitivities?

    Answer: Vancomycin, gentamicin, and rifampicin

    Prosthetic valve endocarditis (PVE) with coagulase-negative staphylococci requires vancomycin (covering MRSE), gentamicin (synergistic bactericidal activity), and rifampicin (penetrates biofilm on prosthetic material). This is recommended by ESC and NICE guidelines for PVE.