Cardiology MCQs -Transmyocardial Revascularization ?

A 50 -year-old male with Type 2 DM and Ischaemic Heart Disease was browsing the Internet! He asks your opinion on Laser Transmyocardial Revascularisation. Which of the following statements regarding this technique is true?

1. This Procedure Avoids the need for Major Surgery
2. It can Damages the Endocardium
3. It can involve the Destruction of Coronary Stenoses
4. This technique is used severe proximal CAD
5. It can stimulate Collateral Vessel Formation

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Atrial Fibrillation ? (MRCP)

A female comes to the emergency with atrial fibrillation and later she is reverted back to  sinus rhythm. Under which one of the following conditions, the patient more likely to remain in sinus rhythm?

1. Age of the Patient more than 80 years 
2. Patient is on Warfarin
3. Size of Left Atrium more than 6 cm on ECHO
4. Short history of Atrial Fibrillation 
5. ventricular rate on presentation of 140 beats per minute

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USMLE - Some Points To remember about Brachial Plexus

If you are preparing for your USMLE Step 1 exams, ignoring studying Anatomy may be a wrong strategy as this is a branch that is sure to score you a few easy points. Don’t we know what difference a mere 5 or 7 points makes to your score? So instead of focusing just on Pharmacology and Pathology, spend time studying this branch as well. A very high yield USMLE Step 1 topic is the injuries that are related to the Brachial Plexus. Here are 4 injuries you should definitely know about.

1. The Median Nerve Injury: This is a kind of injury that occurs due fracture of the supracondyle of the humerus. What it results in is a loss of wrist flexion, thumb movements, finger flexion and forearm pronation. It may also result in the person losing his sensation in the lateral side of the palm and even the thumb.

 

2. The Ulnar Nerve Injury: This is a kind of injury that occurs when the medial epicondyle of the humerus is injured and may lead to the following troubles: impaired adduction of the thumb, the ulnar and two fingers and adduction of wrist and loss of flexion. The patient may also face loss of sensation to the medial half of the pinky and the ring finger as well as to the medial way of the palm.

 

3. The Radial Nerve Injury: This is a kind of injury which may result from the shaft of the humerus to be injured. It may cause the following problems: loss of carpi radialis longus, loss of brachioradialis reflex and loss of triceps reflex. Other than these, the patient may face something called the ‘wrist drop’ and the loss of sensation to posterior brachial cutaneous nerves and posterior antebrachial cutaneous.

 

4. The Axillary nerve Injury: This is a kind of injury that occurs due to two causes: firstly, if there is anterior dislocation of the shoulder or/and if the surgical neck of the shoulder gets injured. When this happens, the deltoid muscle loses its sensation and the movement of the deltoid muscle is completely lost.

 

The above is a basic idea about the 4 common injuries of the Brachial Plexus. 

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What should be next step in Management of this Patient ?

A 60-year-old male with multiple CAD risk factors presents with one year history
of DOE and exertional chest pain. He has had orthopnea and one episode of
PND.
■ Laboratory findings: serum potassium 4.8; creatinine 3.0
■ ECG shows nonspecific ST- T Changes
■ Echocardiography shows a mildly dilated Left Ventricle; Ejection Fraction 25%  -30%; global hypokinesis
■ CAG reveals an 80% stenosis of proximal LAD, 85% proximal
LFX, 90% mid-RCA

How to Manage this Patient ?

1. CTVS consultation for CABG
2. Rest thallium test with delayed imaging
3.  Initiation of Spironolactone therapy
4. All of the above

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Hypertensive Emergency

If a person comes to the emergency with a Blood Pressure of 180/120 mmHg. By what percentage the blood pressure should be reduced over an hour?

1. 10 %
2. 25 %
3. 30 %
4. 50 %

Which Drug Should be used first in the management of this Patient?

A 62 year-year-old man comes to you with progressive easy tiredness, moderate exertional breathlesness and  orthopnea of a one year duration. 
 On Examination BP 110/60 mm Hg, pulse 100/minutes and unlabored repirations at 22/min. Neck veins are engorged three cms above the clavicle at 30 degrees and the abdomino-jugular reflux is positive. The apical impulse is located 2 cms lateral to the left mid-clavicular line in the sixth interspace. Soft S3 and S4 gallops together with a grade 2/6 holosytolic murmur are heard at the apex. There are bibasilar inspiratory rales and pitting edema of the legs.
Chest x-ray PA view reveals moderate cardiomegaly with pulmonary congestion. ECG reveals a sinus mechanism with a left bundle branch block and frequent unifocal PVCs. Echocardiography reveals a left ventricular end-diastolic dimension of 60 mm with global hypokinesia, EF of 38%-40% and moderate Mitral Regurgitation. The IVC is moderately distended and demonstrates poor inspiratory collapse.


Which Drug Should be used first in the management of this Patient?

1. Digoxin
2. Ramipril
3. Amiodarone
4. Metoprolol

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What is the most likely diagnosis?

A 58 year old lady who had a significant history of alcohol abuse comes to you with diarrhoea and back pain one month after having a pacemaker insertion. On examination she had a fever of 40°C and her abdomen was soft and non-tender.

What is the most likely diagnosis?

1. Staphylococcal discitis
2. Ischemic colitis
3. Acute Pancreatitis
4. Pseudomembranous colitis
5. Diverticulitis

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Which of the following events is most likely to occur in this patient?

A 68 year old male has experienced substernal chest pain on slight exertion with increasing frequency over the past 8 months. An EKG reveals T wave inversion in the anterolateral leads at rest. He has a total serum cholesterol of 7.2 mmol/l. On Coronary Angiogram, he has an 80% narrowing of the LAD Artery.

Which of the following events is most likely to occur in this patient?

1. a systemic artery embolus from thrombosis in a peripheral vein
2. a systemic artery embolus from a left atrial mural thrombus
3. pulmonery embolism from a left ventricular mural thrombus
4. a systemic artery embolus from a left ventricular mural thrombus
5. pulmonary embolism from thrombosis in a peripheral vein

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What should be the next step in her case?

A 70-year-old female comes to the  with a Two-hour history of retrosternal chest pain, dyspnea, and sweating. The First  ECG shows ST elevation in anterior chest leads. Lady proceeds immediately to coronary angiography where a 100% proximal LAD artery occlusion is seen. The lesion is successfully opened with  the help of angioplasty followed by stent implantation, with resultant normal  TIMI III flow. An echocardiogram reveals a LV EF of 30% with RWMA along the  anterior and lateral walls. In ICU telemetry reveals frequent PVCs and infrequent episodes on nonsustained Ventricular Tachychardia (3–5 beats). What should be the next step in her case?


a. Conservative Treatment and implantation of an ICD


b. Conservative Treatment and implantation of an ICD if VT is induced


c. Conservative Treatment and implantation of an ICD if a signal averaged ECG is abnormal


d. Conservative Treatment and defer implantation of an ICD


e. Conservative Treatment and refer for radiofrequency ablation of the VT


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