Cardiology Medicine 10 Single Best Answer (SBA)
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1. A 45-year-old man presents with dyspnoea, fatigue, and chest discomfort. On examination, his blood pressure is 90/60 mmHg, jugular venous pressure is elevated, and heart sounds are muffled. ECG shows low voltage QRS complexes. What is the most appropriate immediate management?
Answer: Perform pericardiocentesis
In cardiac tamponade, the pericardial fluid restricts ventricular filling. Pericardiocentesis is critical to decompress the pericardium and restore hemodynamics.
2. What is the primary electrophysiological mechanism underlying atrial flutter?
Answer: Re-entrant circuit within the atria
Atrial flutter is most often due to a macro–re-entrant circuit in the right atrium, classically around the tricuspid annulus.
3. A 70-year-old woman presents with palpitations, dyspnoea, and an irregularly irregular pulse. ECG confirms atrial fibrillation. What is the most appropriate initial investigation to assess stroke risk?
Answer: CHA₂DS₂-VASc score
In AF, stroke prevention is guided by the CHA₂DS₂-VASc score, which weighs factors like age, hypertension, and diabetes.
4. A 60-year-old man presents to the emergency department with palpitations and syncope. ECG shows monomorphic ventricular tachycardia. He is haemodynamically unstable with a blood pressure of 80/50 mmHg. What is the most appropriate next step?
Answer: Perform synchronized cardioversion
Unstable VT with a pulse is managed with immediate cardioversion. If pulseless, a defibrillation shock would be used.
5. ECG of a 75-year-old man shows a PR interval of 0.28 seconds with no dropped beats. What is the most likely diagnosis?
Answer: First-degree AV block
A first-degree AV block is diagnosed when every P wave conducts, but the PR interval is consistently prolonged (>200 ms).
6. A 65-year-old smoker complains of calf pain on walking that resolves with rest. What is the most appropriate next step to confirm the diagnosis?
Answer: Ankle-brachial pressure index (ABPI)
PAD often presents as intermittent claudication. The ABPI is a quick, reliable method for initial diagnosis.
7. What is the most significant complication of a newly diagnosed left bundle branch block (LBBB) in a patient with chest pain?
Answer: Myocardial infarction
A new LBBB in a patient with chest pain is highly suggestive of acute MI, which may obscure typical ST changes on ECG.
8. What is the most common cause of acute pericarditis in developed countries?
Answer: Viral infections
Viral or idiopathic pericarditis is the most common in developed countries, often attributed to enteroviruses like coxsackie.
9. A 68-year-old woman with atrial fibrillation refuses anticoagulation despite counselling. She later develops an arterial embolism. How should the healthcare team respond?
Answer: Reassess her capacity and provide urgent intervention
Following a new serious complication, the patient's capacity and wishes should be re-discussed. If she is competent and consents, start therapy; if she again refuses, respect that choice.
10. A 60-year-old man presents with chest pain at rest. ECG shows ST-segment depression and T-wave inversion. Troponin levels are normal. What is the next best step in management?
Answer: Administer aspirin and low molecular weight heparin
Unstable angina is managed as part of the acute coronary syndrome (ACS) spectrum. Antiplatelet and anticoagulant therapy is key.
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