Multiple Choice Questions (MCQ)

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Category: Cardiology--->Arrythmias
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Question 1# Print Question

A 25-year-old man attends the ED because of palpitations of 1 hour in duration. They occurred suddenly when he was watching TV. He says his heart feels as if it is racing extremely fast. The patient has never had similar symptoms before. He denies chest pain or shortness of breath. He has had no loss of consciousness. Vital signs: Temperature 98.6° F (37.0° C), pulse 205 beats/min, BP 110/80 mm Hg, RR 17 breaths/min. Additional history: No medical history. No use of drugs, tobacco, or alcohol.

What is the most likely cause of his palpitations?

A. Stable tachycardia: AV nodal reentrant tachycardia
B. AV reciprocating tachycardia
C. Atrial flutter
D. Atrial fibrillation
E. Multifocal atrial tachycardia

Question 2# Print Question

A patient is diagnosed with long QT syndrome and has been commenced on beta-blockers with no symptoms and a QTc of 470 ms. No genetic testing has been performed. She has a 7-year-old daughter and asks about the risks for her child.
What is it appropriate to tell her?

A. The patient should be considered for genetic testing
B. The patient’s daughter should be considered for genetic testing
C. An ICD is likely to be the safest option
D. If her daughter has a normal ECG she can be reassured that she does not have long QT syndrome
E. No further investigation is necessary

Question 3# Print Question

A 61-year-old with a history of a myocardial infarction 2 years ago with a known ejection fraction of 25% presents to A&E with a 2 hour history of mild palpitations. He is otherwise fit and well.
His ECG monitoring shows a regular broad complex tachycardia at a rate of 170 bpm which self-terminated before a 12-lead ECG was performed. His U&Es are normal. The patient’s blood pressure was 130/90 mmHg during the tachycardia and he was not unduly distressed. He is transferred to CCU where a 12-lead ECG shows LBBB with a QRS duration of 100 ms.

A. He needs an ICD
B. He needs an urgent revascularization
C. He needs an EP study
D. He tolerated his tachycardia well; therefore it is likely to be an SVT with aberrancy
E. He should be commenced on flecainide

Question 4# Print Question

A patient with previous myocardial infarction, an ejection fraction of 25%, and a QRS duration of 140 ms, but no history of cardiac arrest, is seen in clinic and an ICD is recommended. She is concerned about driving. 
What is it appropriate to tell her?

A. She will need to stop driving for 6 months
B. She will need to stop driving for 1 month
C. If she has an appropriate shock she will need to stop driving for 6 months
D. A and C
E. B and C

Question 5# Print Question

Which one of the following features is least suggestive that a broad complex tachycardia is ventricular in origin (VT)?

A. P waves seen ‘walking through the tachycardia’
B. The QRS duration shortens as the patient goes from sinus rhythm to tachycardia
C. Capture beats
D. A right bundle branch block pattern with a small R wave and a large R' wave (i.e. rsR') in V1
E. Negative concordance in the chest leads

Category: Cardiology--->Arrythmias
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