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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 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?

    Answer: Right coronary artery

    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).

  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?

    Answer: Restrictive pattern

    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.

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

    Answer: Aortic regurgitation

    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.

  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?

    Answer: Direct oral anticoagulant (DOAC)

    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.

  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?

    Answer: Low molecular weight heparin and arrange DOAC

    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.

  6. In which condition would you expect to find bilateral hilar lymphadenopathy on chest X-ray with a raised serum ACE level?

    Answer: Sarcoidosis

    Bilateral hilar lymphadenopathy (BHL) with a raised serum angiotensin-converting enzyme (ACE) level is characteristic of sarcoidosis. The ACE is produced by epithelioid cells within the non-caseating granulomas. While BHL occurs in other conditions, the combination with raised ACE is most suggestive of sarcoidosis.