cardio 1
Short Description
Download cardio 1...
Description
My Profile
Exam Revision Work Smart
Scores
Community
Work Hard
Group Learning
Sign Out
Help Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 49 of 50
Time taken: 55:59
Session Analysis
Recognised toxic effects of Amiodarone include: True / False i j k l m n
j k l m n
Hyperthyroidism
i j k l m n
j k l m n
Peripheral neuropathy
i j k l m n
j k l m n
Hepatitis
j k l m n
i j k l m n
Hypothyroidism
Incorrect answer selected
i j k l m n
j k l m n
Photosensitivity
Correct
Correct Correct
Correct
Amiodarone is a potent anti-arrhythmic useful in all forms of dysrhythmias. Caution is required in renal impairment and there is a risk of thyroid dysfunction with accumulation of iodine. It enhances the effects of Warfarin and increased Digoxin, Phenytoin and Cyclosporin levels. There is an increased risk of bradycardia and AV block and myocardial depression with betablockers and calcium channel blockers. Toxicity is increased if hypokalaemia occurs with diuretics. Reversible corneal microdeposits, optic neuritis, peripheral neuropathy
Score: Total Answered:
and myopathy, bradycardia and conduction disturbances, phototoxicity, and rarely a persistent slate grey discolouration, hypo and hyperthyroidism, diffuse pulmonary alveolitis in pneumonitis and fibrosis, disturbed liver function tests, jaundice, hepatitis and cirrhosis are all reported. Copyright © 2002 Dr Colin Melville Next question
Tag Question
Remove Tag
Remove question
Rate this question Leave question feedback
Related Articles (BMJ)
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Work Hard
Community
Sign Out
Help
Group Learning
Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 48 of 50
Time taken: 55:56
Session Analysis
An 18 month old girl presents with stridor at 1 am. She has had a cold for 48 hours, with low-grade fever, but went to bed as usual at 7.30pm. She awoke 4 hours later crying and distressed, with a barking cough. What is the most likely diagnosis? (Please select 1 option) j k l m n
Allergic rhinitis
j k l m n
Asthma
j k l m n
Croup
i j k l m n
Gastroesophageal reflux
j k l m n
Sinusitis
This is the correct answer Incorrect answer selected
Classical history of viral croup. Most of these episodes are one-off and settle rapidly without treatment or with dexamethasone orally.
Score: Total Answered:
Next question Tag Question
Remove Tag
Remove question
Rate this question Leave question feedback
Related Articles (BMJ)
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Work Hard
Community Group Learning
Sign Out
Help Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 47 of 50
Time taken: 54:18
Session Analysis
A 3-month-old infant presents with dyspnoea, cyanosis and poor feeding. On examination the pulse rate is 180 per minute, he has a grade 3/6 pansystolic murmur at the left sternal edge, basal crepitations and a liver measuring 4 cm below the right costal margin. Which of the following statements is/are true concerning this baby? True / False j k l m n
i j k l m n
Chest x ray would be likely to show a small cardiac shadow
i j k l m n
j k l m n
He requires a diuretic
j k l m n
i j k l m n
He should be digitalised with 50 ug/kg of digoxin given over 24 hours
j k l m n
i j k l m n
He should make a spontaneous recovery
i j k l m n
j k l m n
The most likely diagnosis is a ventricular septal defect
Correct
Correct Incorrect answer selected
Correct
Score:
Incorrect answer selected
Total Answered:
Ventricular septal defects cause shunting of oxygenated blood from the left ventricle to the right. Cyanosis is a later occurrence - following the development of Eisenmenger's syndrome, that is, shunt reversal.
Tag Question
Diuretics are required to offload pulmonary venous congestion. Digoxin has a positive inotropic effect.
Remove Tag
Cyanotic congenital heart disease requires surgical correction of vascular or shunt anomalies.
Remove question
The differential diagnosis of cyanosis and congestive cardiac failure in neonates includes
Rate this question Transposition of great vessels Total anomalous pulmonary venous drainage Hypoplastic left heart Single ventricle and Tricuspid valve abnormalities
Leave question feedback
and each is associated with cardiomegaly.
Related Articles (BMJ) Next question
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Work Hard
Community
Sign Out
Help
Group Learning
Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 46 of 50
Time taken: 53:15
Session Analysis
Which one of the following is/are true of sudden infant death syndrome? True / False i j k l m n
j k l m n
It is more common in low birth weight infants.
i j k l m n
j k l m n
It is more common in low socio-economic groups.
j k l m n
i j k l m n
It is the commonest cause of death in infants aged 1-2 months in this country. selected
j k l m n
i j k l m n
Post mortem shows asphyxia in over 80% of cases.
j k l m n
i j k l m n
There is a tenfold increased risk of sudden infant death to siblings of children with SIDS.
Correct Correct Incorrect answer
Correct Correct
SIDS is the commonest cause of death in this age group. Post mortem fails to reveal a cause of death.
Score:
There is a twice normal risk of SIDS in siblings and low birth weight/premature infants.
Total Answered:
Next question Tag Question
Remove Tag
Remove question
Rate this question Leave question feedback
Related Articles (BMJ)
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Work Hard
Community Group Learning
Sign Out
Help Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 42 of 50
Time taken: 48:49
Session Analysis
A 10-year-old boy is referred with heart murmur. He has collapsed on one occasion after energetic sport, but recovered quickly and has otherwise been well. Full term normal delivery with no neonatal complications. Immunisations up to date. There is no FH/SH of note. On examination he is well and on the 75% for height and weight. Respiratory rate is 15/min and pulse 85/min and blood pressure is 100/60 mmHg. Pulse volume is low, but equal in all 4 limbs. He has a carotid thrill and 3/6 ejection systolic murmur best heard at the upper sternum and conducted into the neck. No liver is palpable. What is the most likely diagnosis? (Please select 1 option) j k l m n
Aortic coarctation
i j k l m n
Aortic stenosis
j k l m n
Congenital heart block
Score:
j k l m n
Hypertrophic obstructive cardiomyopathy
Total Answered:
j k l m n
Simple faint
Correct
The history of collapse, plateau pulses and characteristic murmur all point to aortic stenosis as the diagnosis. This
Tag Question
requires detailed assessment with echocardiography, ECG and Chest X-ray. It may be amenable to balloon valvuloplasty, which may help delay the need for surgery until he is fully grown. Valve replacement is usually required in symptomatic
Remove Tag
cases. Antibiotic prophylaxis is essential to reduce the risk of endocarditis. Remove question Next question
Rate this question Leave question feedback
Related Articles (BMJ)
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Work Hard
Community Group Learning
Sign Out
Help Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 40 of 50
Time taken: 47:45
Session Analysis
A 9-year-old girl presents with throat discomfort and cough, particularly during the daytime. She has been well over the winter, with symptoms worsening in the Spring. Full term normal delivery with no neonatal complications. Immunisations up to date. There is no FH/SH of note. On examination she is apyrexial and well. She is constantly clearing her throat, and has a clear nasal discharge. She has no cervical lymphadenopathy. Her throat is minimally injected, and ear examination is normal. Select themost likely diagnosis? (Please select 1 option) i j k l m n
Asthma
j k l m n
Foreign body
j k l m n
Infectious mononucleosis
Score:
j k l m n
Paratonsillar abscess
Total Answered:
j k l m n
Postnasal drip
Incorrect answer selected
This is the correct answer
The history is of nasal discharge and cough, worse since Spring. This points to allergens rather than infection
Tag Question
as the underlying cause. A postnasal drip is the likely culprit for these symptoms, which may also disturb sleep because of cough. Treatment of the underlying problem with antihistamines and topical steroids is indicated.
Remove Tag
Remove question
© Colin Melville 2011
Rate this question Next question
Leave question feedback
Related Articles (BMJ)
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Work Hard
Community Group Learning
Sign Out
Help Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 39 of 50
Time taken: 46:22
Session Analysis
Theme: Apnoea A
Blood cultures
B
CSF culture
C
CT scan head
D
Drug screen on mother
E
EEG
F
Nasopharyngeal aspirate for viruses
G
Nasopharyngeal aspirate for pertussis
H
pH studies
I
Urine metabolic screen
For each scenario choose the most specific diagnostic investigation:
Score: A 5 day old girl presents to casualty following a brief apnoeic episode. On examination she is apyrexial, sweating, has a high-pitched cry and is difficult to settle.
Total Answered:
CSF culture
Incorrect - The correct answer is Drug screen on mother The 5day old presents with apnoea in the absence of fever or structural problem. The other symptoms point towards drug
Tag Question
Remove Tag
withdrawal, so a drug screen will be diagnostic. Remove question
A 4 month old girl presents with a 12 hour history of poor feeding and fever. She is rushed to hospital after she stops breathing. On examination she has an Oxygen saturation of 94%, and responds to pain. Serum glucose is 3.4 mmol/l. pH studies
Rate this question Leave question feedback
Incorrect - The correct answer is Blood cultures The 4 month old girl presents with a brief history of fever followed by apnoea. This suggests an infective cause. The decreased level of consciousness mean that LP should not be done yet. Blood cultures are likely to be the most helpful test.
A 5 month old boy has a 2 day history of coryza and poor feeding. On the day of admission he has a brief period of apnoea and is rushed to hospital. On examination he has 2 cm hepatomegaly and a blood glucose of 0.8 mmol/l. Urine metabolic screen
Correct The 5 month old presents with apnoea associated with mild infection and hypoglycaemia. This points to a metabolic cause, and a metabolic screen should be most helpful.
Related Articles (BMJ)
Apnoea can be caused by 3 main groups of conditions: infections, obstructions, or toxins/drugs.
Next question
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Work Hard
Community Group Learning
Sign Out
Help Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 38 of 50
Time taken: 43:41
Session Analysis
Are the following true regarding Marfan's syndrome? True / False j k l m n
i j k l m n
10% have hypercalcaemia
i j k l m n
j k l m n
Affected patients are prone to aortic dissection
i j k l m n
j k l m n
In about 50% it is the result of spontaneous mutations
i j k l m n
j k l m n
Subluxation of lens is a feature
j k l m n
i j k l m n
There is genetic anticipation
Correct Correct Incorrect answer selected
Correct Correct
Marfan's syndrome is a connective tissue disease with an autosomal dominant inheritance and an incidence of 4-6 per 100 000. Score: People with Marfan's syndrome used to have a life expectancy reduced by 50% but this is now changing because of improved treatment of cardiovascular abnormalities such as mitral valve prolapse and aortic
Total Answered:
dissection. In about 25% it is the result of spontaneous mutation.
Tag Question
Anterior subluxation of the lens is a feature. Remove Tag
Marfan syndrome Remove question Next question
Rate this question Leave question feedback
Related Articles (BMJ)
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Work Hard
Community Group Learning
Sign Out
Help Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 37 of 50
Time taken: 43:14
Session Analysis
In ventricular septal defect (VSD) which of the following statements is/are true? (Please select 1 option) j k l m n
Left-to-right shunting leads to increased risk of cerebral abscess
j k l m n
The smallest defects tend to produce the softest murmurs
j k l m n
The systolic murmur increases in intensity as pulmonary hypertension develops
j k l m n
There is no risk of bacterial endocarditis
i j k l m n
There may be a diastolic murmur at the apex
Correct
Large defects may be associated with soft murmurs; right to left shunting causes cerebral abscesses. Diastolic murmur occurs due to aortic incompetence (5%) or increased flow across the mitral valve and relative
Score:
mitral stenosis. Total Answered: Although pulmonary hypertension may occur in association with increased flow across the shunt, it may indicate decreased flow across the shunt and increased pulmonary vascular resistance in which case the murmur would be softer.
Tag Question
The risk of bacterial endocarditis is high in this lesion and even greater with haemodynamically trivial lesions. Remove Tag Next question Remove question
Rate this question Leave question feedback
Related Articles (BMJ)
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Work Hard
Community Group Learning
Sign Out
Help Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 34 of 50
Time taken: 42:42
Session Analysis
With regard to congenital heart disease True / False j k l m n
i j k l m n
Occurs in 3% of children under the age of 5 years
Correct
j k l m n
i j k l m n
Only 50% of cases present in the neonatal period
Incorrect answer selected
j k l m n
i j k l m n
Most babies with cyanotic congenital heart disease are small for gestational age
i j k l m n
j k l m n
Detection of pulmonary stenosis in a female child should be followed by karyotyping selected
j k l m n
i j k l m n
Heart failure is a common presentation in Fallot’s tetralogy
Correct Incorrect answer
Correct
Congenital heart disease occurs in 3-12 per thousand live births and many conditions such as ventricular septal defect and tetralogy of Fallot may present in infancy, with 50% presenting in infancy and the rest presenting later in life (sometimes in adulthood eg atrial septal defect). Growth failure is masked by fluid retention and reduced urine volume which leads to inappropriate weight gain. Pulmonary stenosis is associated
Score: Total Answered:
with Noonan's syndrome (chromosome 12q24.1 defect) but this will not show up on normal karyotyping; it also occurs in congenital Rubella, connective tissue disorders and William's syndrome-not chromosomal abnormalities. In females of XO karyotype coarctation and bicuspid aortic valve may occur. Fallots tetralogy
Tag Question
typically presents with hypercyanotic spells characterised by anxiety, air hunger and respiratory distress Remove Tag Next question Remove question
Rate this question Leave question feedback
Related Articles (BMJ)
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Work Hard
Community
Sign Out
Help
Group Learning
Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 33 of 50
Time taken: 42:09
Session Analysis
A small ventricular septal defect is associated with: True / False i j k l m n
j k l m n
A pansystolic murmur heard best at the lower left sternal edge
i j k l m n
j k l m n
A high risk of infective endocarditis
Correct
j k l m n
i j k l m n
Fixed splitting of the second sound
Correct
j k l m n
i j k l m n
Cyanosis
i j k l m n
j k l m n
A mid-diastolic murmur at the apex
Correct
Correct Incorrect answer selected
A small ventricular septal defect is classically associated with the holosystolic murmur at the left sternal edge. The risk of infective endocarditis is greater in haemodynamically insignificant defects. The second heart sound may be obscured by the murmur, but is normally split. Cyanosis occurs if there is Eisenmengers syndrome. A mid diastolic murmur at the apex is associated with a moderate sized shunt and increased flow through the left atrium. Next question
Score: Total Answered:
Tag Question
Remove Tag
Remove question
Rate this question Leave question feedback
Related Articles (BMJ)
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Work Hard
Community
Sign Out
Help
Group Learning
Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 32 of 50
Time taken: 41:37
Session Analysis
Supraventricular tachycardia: True / False j k l m n
i j k l m n
Often responds to Digoxin
i j k l m n
j k l m n
May be associated with structural cardiac defects
j k l m n
i j k l m n
In infancy is associated with maternal systemic lupus erythematosus
j k l m n
i j k l m n
Episodes are often difficult to document on ECG
i j k l m n
j k l m n
Can cause feeding problems in infants
Incorrect answer selected Correct Correct
Correct
Correct
Digoxin may be administered in all forms of supraventricular tachycardia in which the atrioventricular node is involved except in those with a pre excitation syndrome that are greater than 1-year-old. Supraventricular tachycardia though most commonly associated with a structurally normal heart with an accessory pathway, may be a feature of congenital heart disease. Transplacental passage of anti Ro SSA and anti La SSB antibodies in maternal systemic lupus erythematosus can result in neonatal lupus syndrome and associated cardiac rhythm
Score: Total Answered:
disturbances; most commonly complete heart block. Feeding difficulty is a common manifestation of cardiac insufficiency. Next question
Tag Question
Remove Tag
Remove question
Rate this question Leave question feedback
Related Articles (BMJ)
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Work Hard
Community Group Learning
Sign Out
Help Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 31 of 50
Time taken: 40:52
Session Analysis
In the management of congenital heart disease: True / False j k l m n
i j k l m n
Patients with ventricular septal defects require daily prophylactic ampicillin to prevent bacterial endocarditis Correct
i j k l m n
j k l m n
Ductus arteriosus that does not close by six months old will require surgical ligation
j k l m n
i j k l m n
All atrial septal defects have to be closed surgically
i j k l m n
j k l m n
Peripheral oedema is an uncommon finding in infants with heart failure
j k l m n
i j k l m n
Squatting is a typical description in patients with transposition of the great vessels
Correct
Correct Correct Correct
Prophylactic antibiotics are only required prior to dental procedures, surgery and other invasive procedures. If spontaneous closure of a patent ductus arteriosus does not occur, closure is recommended between six months to one year. This can be done surgically, or, more often these days, through the trans-catheter route.
Score: Total Answered:
Atrial septal defect may spontaneously close usually if less than 8 mm in size. Oedema and ascites and raised jugular venous pressure are uncommon signs of heart failure in infancy.
Tag Question
Squatting is a typical occurrence in an older child with tetralogy of Fallot. Remove Tag
Further reading: Congenital Heart Defects MedlinePlus Next question
Remove question
Rate this question Leave question feedback
Related Articles (BMJ)
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Work Hard
Community Group Learning
Sign Out
Help Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 29 of 50
Time taken: 39:38
Session Analysis
In congenital heart disease: True / False j k l m n
i j k l m n
A persistent patent ductus arteriosus is the commonest cardiology complication of Down syndrome Correct
j k l m n
i j k l m n
A ventricular septal defect may close spontaneously in less than 20% of cases
j k l m n
i j k l m n
Hepatosplenomegaly may be an important clue to diagnosis
i j k l m n
j k l m n
Transposition of great arteries is the commonest form of congenital heart disease causing cyanosis in the newborn period Correct
i j k l m n
j k l m n
When congenital heart disease is associated with congenital rubella it is commonly a persistent patent ductus arteriosus Correct
Correct
Incorrect answer selected
The rate of spontaneous closure for VSDs in over 50% of cases. Score: The most common form of cyanotic heart disease in the newborn period is transposition of the great arteries (remember that the newborn period is up to 28 days).
Total Answered:
Hepatosplenomegaly is a feature of congestive cardiac failure. Tag Question
Sequelae of patent ductus arteriosus are rubella pulmonary stenotic lesions atrial septal defect.
Remove Tag
Remove question
The commonest defect in Down syndrome is an endocardial cushion defect.
Rate this question Further reading: Types of Congenital Heart Defects Diseases and Conditions Index
Leave question feedback
Next question
Related Articles (BMJ)
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Work Hard
Community
Sign Out
Help
Group Learning
Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 26 of 50
Time taken: 35:05
Session Analysis
Cyanosis is a typical feature of which of the following conditions:
(Please select 1 option) j k l m n
Patent ductus arteriosus.
j k l m n
Ventricular septal defect.
i j k l m n
Total anomalous pulmonary venous drainage.
j k l m n
Atrial septal defect
j k l m n
Mitral atresia.
Correct
TAPVC is associated with cyanosis in the newborn. Total anomalous pulmonary venous connection (TAPVC) consists of an abnormality of blood flow in which all 4 pulmonary veins drain into systemic veins or the right atrium with or without pulmonary venous obstruction. Systemic and pulmonary venous blood mix in the right atrium. PDA, ASD and VSD are left to right shunts. Tricuspid atresia is typically associated with cyanosis rather than Mitral.
Score: Total Answered:
Next question
Tag Question
Remove Tag
Remove question
Rate this question Leave question feedback
Related Articles (BMJ)
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Community
Work Hard
Group Learning
Sign Out
Help Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 24 of 50
Time taken: 34:25
Session Analysis
A chest x-ray showing signs of increased pulmonary blood flow (increased pulmonary plethora) is compatible with a diagnosis of: True / False i j k l m n
j k l m n
Ventricular septal defect
Correct
i j k l m n
j k l m n
Patent ductus arteriosis
Correct
i j k l m n
j k l m n
Pulmonary tetralogy
j k l m n
i j k l m n
Fallot’s tetralogy
j k l m n
i j k l m n
Coarctation of the aorta
Incorrect answer selected Correct Correct
Ventricular septal defect will cause increased blood flow through the right ventricle and pulmonary trunk, as will patent ductus arteriosis which connects the left pulmonary artery and descending aorta. In fallots and pulmonary tetralogy there will be decreased flow due to infundibular stenosis. Coarctation, a narrowing of the aorta near the left subclavian vein is associated with normal pulmonary vasculature. Next question
Score: Total Answered:
Tag Question
Remove Tag
Remove question
Rate this question Leave question feedback
Related Articles (BMJ)
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Work Hard
Community
Sign Out
Help
Group Learning
Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 22 of 50
Time taken: 32:51
Session Analysis
An opening snap is found in:
True / False i j k l m n
j k l m n
mitral stenosis due to rheumatic heart disease
i j k l m n
j k l m n
congenital mitral stenosis
i j k l m n
j k l m n
mitral incompetence associated with a rigid posterior valve leaflet but a normal anterior leaflet
i j k l m n
j k l m n
left atrial myxoma
j k l m n
i j k l m n
severe aortic incompetence
Correct
Correct Correct
Correct Correct
d-10% of cases secondary to increasing left atrial pressure. Soft late snap - actually a 'tumour plop' that mimics the opening snap of Mitral Stenosis. (Wassermil M, Warkentin DL, Ravin A: Myxoma of the left atrium: Phonocardiographic study of three cases. Circulation 1962;25:50–56 )
Heart Sound reference
Score: Total Answered:
Next question Tag Question
Remove Tag
Remove question
Rate this question Leave question feedback
Related Articles (BMJ)
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Community
Work Hard
Group Learning
Sign Out
Help Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 21 of 50
Time taken: 32:28
Session Analysis
Cannon waves may be seen in the jugular veins in:
True / False i j k l m n
j k l m n
constrictive pericarditis
i j k l m n
j k l m n
first degree AV heart block
i j k l m n
j k l m n
tricuspid stenosis
j k l m n
i j k l m n
ventricular tachycardia
j k l m n
i j k l m n
ventricular pacing
Incorrect answer selected Incorrect answer selected
Incorrect answer selected Incorrect answer selected Incorrect answer selected
Canon waves are seen with unsynchronised closure of the tricuspid valve and right atrial contraction, i.e. when the right atrium contracts against a closed tricuspid valve. Giant V waves are seen with constrictive pericarditis. Tall a waves, but not cannon a waves, are seen with Tricuspid stenosis.
Next question
Score: Total Answered:
Tag Question
Remove Tag
Remove question
Rate this question Leave question feedback
Related Articles (BMJ)
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Work Hard
Community Group Learning
Sign Out
Help Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 19 of 50
Time taken: 32:03
Session Analysis
Which ONE of the following statements is true about the Austin Flint murmur? (Please select 1 option) j k l m n
It is associated with a loud first heart sound.
j k l m n
It is an early sign of aortic regurgitation
j k l m n
It can be distinguished from the murmur of mitral stenosis by absence of presystolic accentuation
i j k l m n
It is due to partial closure of the anterior leaflet of the mitral valve
j k l m n
It does not occur in aortic incompetence secondary to an aortitis
Correct
The Austin Flint murmur is a low frequency mid/late diastolic murmur which may show pre-systolic accentuation and is virtually indistinguishable from that of mitral stenosis. It is due to partial closure of the anterior leaflet of the mitral valve by the regurgitant jet. There is no correlation between presence of murmur and severity of AR, or aetiology. The first heart sound is normal but in severe cases, it may be absent.
Score: Total Answered:
Next question Tag Question
Remove Tag
Remove question
Rate this question Leave question feedback
Related Articles (BMJ)
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Work Hard
Community Group Learning
Sign Out
Help Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 18 of 50
Time taken: 31:29
Session Analysis
Which one of the following is associated with Marfan's syndrome? (Please select 1 option) j k l m n
Autosomal recessive inheritance
j k l m n
Increased upper:lower body ratio
j k l m n
Mental retardation
j k l m n
Pulmonary stenosis
i j k l m n
Retinal detachment
Correct
Marfan's syndrome is an autosomal dominant condition associated with ocular abnormalities such as upwards lens dislocation and retinal detachment ( Retinal detachment in Marfan syndrome: clinical characteristics and surgical outcome. Retina. 2002 Aug;22(4):423-8).
Score:
Aortic regurgitation may be a finding and aneurysmal dilatation is a feature.
Total Answered:
Upper to lower body ratio (head to symphysis pubis : symphysis pubis to toes) is decreased in Marfan's syndrome. Next question
Tag Question
Remove Tag
Remove question
Rate this question Leave question feedback
Related Articles (BMJ)
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Community
Work Hard
Group Learning
Sign Out
Help Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 17 of 50
Time taken: 30:59
Session Analysis
A left-to-right shunt is a feature in which of the following congenital heart defects: True / False j k l m n
i j k l m n
Eisenmenger’s syndrome
i j k l m n
j k l m n
Patent ductus arteriosus
i j k l m n
j k l m n
Tetralogy of Fallot
i j k l m n
j k l m n
Atrial septal defect
i j k l m n
j k l m n
Ventricular septal defect
Correct Correct
Incorrect answer selected Correct Correct
The commonest examples of a left-to-right shunt are an atrial septal defect (ASD), ventricular septal defect (VSD) and patent ductus arteriosus (PDA). Children with this defect are usually not cyanosed (providing there is no left ventricular failure or reversal of the shunt).
Score:
Fallot’s tetralogy is the commonest form of a right-to-left shunt and the children are cyanosed. Eisenmenger’s
Total Answered:
syndrome occurs when there is reversal of the left-to-right shunt (to a right-to-left shunt), due to irreversible pulmonary vessel disease. Tag Question Next question Remove Tag
Remove question
Rate this question Leave question feedback
Related Articles (BMJ)
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Work Hard
Community Group Learning
Sign Out
Help Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 15 of 50
Time taken: 29:54
Session Analysis
Which of the following statements are correct concerning hypertrophic cardiomyopathy? True / False i j k l m n
j k l m n
A Is associated with Friedreich's ataxia
i j k l m n
j k l m n
B Is best screened for by a 12-lead electrocardiogram
i j k l m n
j k l m n
C Is familial
i j k l m n
j k l m n
D May be usefully treated with nitrates
j k l m n
i j k l m n
E Treated with beta adrenergic blockers has a lower risk of sudden death
Correct Incorrect answer selected
Correct Incorrect answer selected Correct
Hypertrophic cardiomyopathy has a well recognised familial often dominant form of inheritance. A It is also associated with Pompe's disease and familial lentiginosis.
Score:
B ECHO is the best screening tool. The ECG has low sensitivity but high specificity for ventricular hypertrophy.
Total Answered:
C The penetrance is higher in males. D Nitrates and other vasodilators are best avoided. E Beta-blockers reduce the symptoms but not the risk of sudden death. Next question
Tag Question
Remove Tag
Remove question
Rate this question Leave question feedback
Related Articles (BMJ)
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Work Hard
Community Group Learning
Sign Out
Help Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 13 of 50
Time taken: 24:47
Session Analysis
In children with a ventricular septal defect:
True / False i j k l m n
j k l m n
it is the commonest congenital heart lesion
i j k l m n
j k l m n
closes spontaneously in up to 50% of cases
j k l m n
i j k l m n
of Maladie de Roger type is the most severe form
j k l m n
i j k l m n
is associated with pulmonary oligaemia
i j k l m n
j k l m n
with a large lesion is associated with biventricular hypertrophy
Correct Correct Correct
Correct Correct
VSDs are the commonest congenital heart defect with the vast majority being small often spontaneously closing and of no haemodynamic significance. Small residual VSDs may be picked up due to the loud murmur (Maladie de Roger) and VSDs are associated with increased pulmonary blood flow. Larger VSDs would be associated with biventricular hypertrophy associated with volume overload.
Score: Total Answered:
Next question
Tag Question
Remove Tag
Remove question
Rate this question Leave question feedback
Related Articles (BMJ)
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Community
Work Hard
Sign Out
Help
Group Learning
Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 12 of 50
Time taken: 23:37
Session Analysis
Hypertrophic obstructive cardiomyopathy is associated with:
True / False j k l m n
i j k l m n
a double apical impulse
i j k l m n
j k l m n
decreased left ventricular ejection fraction
i j k l m n
j k l m n
left ventricular diastolic dysfunction
i j k l m n
j k l m n
increased left ventricular outflow obstruction
j k l m n
i j k l m n
mitral regurgitation
Incorrect answer selected Incorrect answer selected
Correct Correct
Incorrect answer selected
Hypertrophic cardiomyopathy is defined as the unexplained, asymmetical or concentric hypertrophy of the undilated left ventricle. There is also hypertrophy of the right ventricle. It may be inherited as an autosomal dominant condition, but at least half of cases may be the result of sporadic mutation. Double apical impulse may be felt, with diastolic dysfunction being typical. Outflow obstruction develops over time associated with increasing hypertrophy and associated mitral regurgitation is common.
Score: Total Answered:
Echo parameters in HOCM. Next question
Tag Question
Remove Tag
Remove question
Rate this question Leave question feedback
Related Articles (BMJ)
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Work Hard
Community Group Learning
Sign Out
Help Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 11 of 50
Time taken: 22:57
Session Analysis
Which of the following are true regarding randomised controlled trials in single patients (n of 1 trials)? True / False i j k l m n
j k l m n
A. Need to be repeated in many patients to achieve significant results
i j k l m n
j k l m n
B. Can guide treatment in other patients
i j k l m n
j k l m n
C. Are useful where the patient doubts the effectiveness of a treatment
i j k l m n
j k l m n
D. Have an advantage in studying drugs with long half lives
j k l m n
i j k l m n
E. Do not normally require approval from ethics committees
Incorrect answer selected
Incorrect answer selected Correct
Incorrect answer selected Incorrect answer selected
A. In an n of 1 trial the treatment and placebo are given in random treatment periods in the same patient. B. The results are specific to the one drug and one patient studied and cannot usually be generalised. C. Or where the practitioner has doubts. They are also useful for dosing or working out if a symptom is a side
Score: Total Answered:
effect or not. D. Drugs with short effects are best as long wash-out periods need to be included for long-acting drugs. Tag Question
E. The studies are with single patients on or off a drug and do not normally require ethics committee approval. (DTB 1998;36(5):40) Next question
Remove Tag
Remove question
Rate this question Leave question feedback
Related Articles (BMJ)
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Work Hard
Community
Sign Out
Help
Group Learning
Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 10 of 50
Time taken: 22:09
Session Analysis
In mitral stenosis caused by rheumatic heart disease, prophylaxis against endocarditis is necessary in: True / False i j k l m n
j k l m n
cystoscopy
j k l m n
i j k l m n
dental scaling
i j k l m n
j k l m n
caesarean section
i j k l m n
j k l m n
cardiac catherization
j k l m n
i j k l m n
transesophageal echocardiogram
Incorrect answer selected Correct Incorrect answer selected Incorrect answer selected Correct
NICE guidelines in 2008 suggest that antibiotic prophylaxis is not required prior to any of the above procedures. A lack of evidence to support the administration of antibiotics in the prevention of infective endocarditis is cited, as well as the small risk of anaphylaxis associated with antibiotic use.
Score:
http://www.nice.org.uk/nicemedia/pdf/CG64PIEQRG.pdf
Total Answered:
Next question Tag Question
Remove Tag
Remove question
Rate this question Leave question feedback
Related Articles (BMJ)
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Work Hard
Community Group Learning
Sign Out
Help Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 9 of 50
Time taken: 12:26
Session Analysis
A loud first heart sound may be due to:
True / False i j k l m n
j k l m n
a long preceding diastolic interval
i j k l m n
j k l m n
mitral stenosis
j k l m n
i j k l m n
rupture of a papillary muscle
i j k l m n
j k l m n
increased systemic arterial pressure
j k l m n
i j k l m n
increrased pulmonary arterial pressure
Incorrect answer selected
Correct This is the correct answer Incorrect answer selected Correct
A loud first heart sound is due to abrupt closure of the mitral valve against a high left atrial pressure. MR occurs with papillary muscle rupture and thereby 1st heart sound is soft.A2 and P2 are loud in systemic HT and pulmonary hypertension respectively.
Next question
Score: Total Answered:
Tag Question
Remove Tag
Remove question
Rate this question Leave question feedback
Related Articles (BMJ)
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Work Hard
Community Group Learning
Sign Out
Help Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 8 of 50
Time taken: 12:23
Session Analysis
A 15-year-old female presents following a sore throat with chest pain, fever, and a skin rash. Examination reveals a diastolic murmur. Her ASO titre is elevated. Which of the following is a major criterion for the diagnosis of Rheumatic fever?
(Please select 1 option) j k l m n
Fever
j k l m n
Raised ESR
i j k l m n
Polyarthritis
j k l m n
Migratory erythema
j k l m n
Prolonged PR interval
Correct
Polyarthritis together with erythema marginatum, Sydenham's chorea, carditis and subcutaneous nodules constitute the major criteria associayed with Rheumatic fever. Minor criteria include raised ESR, Arthralgia, pyrexia and a prolonged PR interval. Migratory erythema is associated with a glucagonoma.
Score: Total Answered:
Next question
Tag Question
Remove Tag
Remove question
Rate this question Leave question feedback
Related Articles (BMJ)
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Work Hard
Community Group Learning
Sign Out
Help Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 7 of 50
Time taken: 12:16
Session Analysis
Theme: Congenital heart disease A
Ostium secundum atrial septal defect
B
Ventricular septal defect
C
Transposition of the great arteries
D
Total anomalous pulmonary venous drainage
E
Atrioventricular septal defect
F
Patent ductus arteriosus
G
Pulmonary valve stenosis
H
Coarctation of the aorta
I
Tetralogy of Fallot
J
Hypoplastic left heart syndrome
Which of the above is the most likely diagnosis in the following cases? Score: A 7-week-old infant presents with breathlessness on feeding and failure to thrive. On examination his femoral pulses are difficult to feel but present. Chest radiograph shows cardiomegaly and increased vascular markings. Coarctation of the aorta
Total Answered:
6 Tag Question
Correct Absent or weak femoral pulses suggest coarctation. Remember association with Turner's syndrome in females.
A 13-year-old girl is referred for evaluation of her short stature. She is pre-pubertal. On auscultation she has an ejection systolic murmur in the second and third left intercostal spaces radiating to the back, but is asymptomatic. Pulmonary valve stenosis
6
Remove Tag
Remove question
Rate this question Leave question feedback
Correct The murmur describes pulmonary stenosis which could also be a left peripheral pulmonary stenosis. She is short and has delayed puberty, and coupled with the cardiac findings, would suggest Noonan's syndrome.
Related Articles (BMJ) An infant is seen for his 6-week-check and found to have a loud ejection systolic murmur in the third left intercostal space and a single second heart sound on examination. There is no obvious cyanosis but a suggestion of mild desaturation. On the chest x ray there is a concavity on the left heart border and decreased pulmonary vascular markings. Tetralogy of Fallot
6
Correct Tetralogy of Fallot may present later than in the neonatal period. The ejection systolic murmur is from the infundibular stenosis. The desaturation results from the right to left shunt across the VSD.
Next question
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Work Hard
Community Group Learning
Sign Out
Help Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 4 of 50
Time taken: 05:59
Session Analysis
A newborn baby, one of twins born at term, is noted to be centrally cyanosed soon after birth. Which of the following is the most likely cause?
(Please select 1 option) j k l m n
Ventricular septal defect
i j k l m n
Transposition of great arteries
j k l m n
Patent ductus arteriosus
j k l m n
Coarction of the aorta
j k l m n
Tricuspid atresia
Correct
VSD and PDA are left to right shunts; coarctation of the aorta is not associated with cyanosis. Tricuspid atresia and transposition of the great arteries are both cyanotic congenital heart diseases and present in the immediate newborn period. Of the 2 transposition of the great arteries is more common and hence more likely to be the cause.
Score: Total Answered:
Next question
Tag Question
Remove Tag
Remove question
Rate this question Leave question feedback
Related Articles (BMJ)
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
My Profile
Exam Revision Work Smart
Scores
Work Hard
Community Group Learning
Sign Out
Help Saved Tests
Revision Advice
Tagged Questions
NOTE: Many features on this website require Javascript and cookies. You can enable both via your browser's preference settings.
Work Smart Session - MRCPCH Part 1 A / DCH Question: 1 of 50
Time taken: 03:59
Session Analysis
Theme: Childhood Hypertension. A
DMSA scan
B
Echocardiogram
C
Plasma renin and aldosterone
D
Renal angiography
E
Thyroid function tests
F
Urine catecholamines
G
Urine drug screen
H
U+Es, creatinine
I
Ultarsound KUB
For each scenario choose them most specific investigation:
A 15-year-old girl is brought to A+E having collapsed at a party. On examination she has a dry mouth, a heart rate of 110/min and blood pressure of 150/110 mmHg.
Score: Total Answered:
Urine drug screen
6
Correct In the 15-year-old girl there is acute hypertension, most likely related to drugs. The most common offender these days is
Tag Question
probably MDMA (ecstasy). A drug screen will confirm this. Remove Tag
A 6-year-old boy presents with headache on defaecation. On examination his blood pressure in the right arm is 140/100 mmHg and he has a 2/6 systolic murmur. Renal angiography
6
Remove question
Rate this question
Incorrect - The correct answer is Echocardiogram The 6-year-old boy has hypertension and a heart murmur. It is important to exclude coarctation. The murmur for this may
Leave question feedback
be loudest over the scapula. Four limb BPs are usually diagnostic, but echocardiography is will identify the precise structural lesion.
A 2 month old infant is found to have a blood pressure of 120/90 mmHg persistently. He was born at 25/40 gestation, was ventilated for 14 days and is still in oxygen. DMSA scan
6
Incorrect - The correct answer is Renal angiography The 2 month old infant is likely to have renal artery thrombosis complicating UAC insertion. Renal angiography will confirm this.
In evaluating raised blood pressure first decide whether it is acute or chronic. Second is it related to drugs. Third is it localised.
Next question
Related Articles (BMJ)
© 2011 BMJ Publishing Group Ltd . All rights reserved. Contact . Corporate . Terms and conditions & Privacy policy
View more...
Comments
