Multiple Choice Questions (MCQ)

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Category: Cardiology--->Pulmonary Hypertension And Pericardium
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Question 1# Print Question

A GP contacts you about a young woman in whom a formal diagnosis of pulmonary hypertension has been made. He has not yet received her discharge summary but tells you that she has had a ‘range’ of tests.

Which one of the following would have to have been true in order for the diagnosis to be made?

A. An echocardiogram demonstrated a dilated right heart
B. During an exercise echocardiogram, the estimated RV systolic pressure (derived from the jet of tricuspid regurgitation) was >30 mmHg at peak exercise
C. A CT pulmonary angiogram demonstrated bilateral pulmonary emboli
D. Mean pulmonary artery pressure at rest was ≥25 mmHg on a right heart catheterization
E. During right heart catheterization, the pulmonary wedge pressure was normal

Question 2# Print Question

You are asked by one of the echocardiography technicians to review an echocardiogram for an elderly patient who presents with breathlessness. Estimated RV systolic pressure, as judged by the velocity of the tricuspid regurgitant jet, is moderately elevated.

In terms of an aetiology of the pulmonary hypertension, which one of the following is true?

A. The presence of normal atrial size in the setting of diabetes and hypertension, in particular, point to a left heart cause
B. Lung disease is an uncommon cause
C. Thrombus seen in the proximal pulmonary arteries means that chronic thromboembolic disease has to be the explanation for the pulmonary hypertension
D. The fact that the referral has come from a rheumatologist helps shed light on the cause
E. Echocardiographic evidence of an old myocardial infarction is unlikely to be related

Question 3# Print Question

You admit a middle-aged woman on the acute take who has been investigated for breathlessness for several years. Pulmonary hypertension is suspected.

What should you do?

A. Start sildenafil
B. Give warfarin in patients with pulmonary hypertension but no thromboembolic disease
C. Withhold diuretics in the setting of overt right heart failure
D. Give an ACE inhibitor to benefit the right ventricle
E. Give an angiotensin receptor blocker

Question 4# Print Question

A 70-year-old woman with a history of proven recurrent pulmonary emboli but no other comorbidities presents with breathlessness over a number of months. She is in NYHA class III. Her INR has been within the therapeutic range. Serial echocardiograms demonstrate persistent features of pulmonary hypertension.

Which one of the following is the most important measure?

A. Persist with warfarin; the clot will resolve eventually
B. Immediately work up for advanced oral therapies
C. Refer her for consideration of pulmonary end-arterectomy
D. Change her anticoagulant
E. Refer her for a balloon atrial septostomy

Question 5# Print Question

You have been contacted by the infectious diseases team about a man with HIV who has become progressively more breathless over a series of months. He has had a CT pulmonary angiogram which has excluded clots. You discuss the scan with the radiologist.

What else would you like to know about the CT?

A. The size of the right ventricle—if it is normal, this excludes pulmonary hypertension as a cause for his symptoms
B. The position of the interventricular septum as this indicates the balance of pressures between right and left atrium
C. Whether there is reflux of contrast into the superior vena cava since this suggests elevated right atrial pressures
D. The size of the pulmonary arteries—if these are dilated, it suggests that pulmonary hypertension might be present
E. A pericardial effusion is not in keeping with pulmonary hypertension and should trigger a search for malignancy

Category: Cardiology--->Pulmonary Hypertension And Pericardium
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