Cardiology Question Bank

Read the Cardiology Question Bank sample questions

1. 1.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 testingCorrect
   • 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

   Why: In long QT syndrome, asymptomatic first-degree relatives must be screened because the condition is autosomal dominant with variable penetrance; an affected gene carrier can have a normal-appearing ECG. Genetic and clinical evaluation of family members is standard, so the daughter should be assessed rather than reassured. The patient here is well controlled on beta-blockers and does not need genetic testing redirected away from the family.

2. 2.A 60-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 70 bpm which self-terminated before a 2-lead ECG was performed. His U&Es are normal. The patient's blood pressure was 30/90 mmHg during the tachycardia and he was not unduly distressed. He is transferred to CCU where a 2-lead ECG shows LBBB with a QRS duration of 00 ms

   • A.He needs an ICDCorrect
   • 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

   Why: This patient has had a haemodynamically significant ventricular tachycardia (sustained VT) with a prior MI and EF of 25%. This constitutes secondary prevention of sudden cardiac death, for which an ICD is clearly indicated. Revascularization or EP study would not substitute for definitive ICD protection in this high-risk substrate.

3. 3.A patient with previous myocardial infarction, an ejection fraction of 25%, and a QRS duration of 40 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.B and CCorrect
   • C.She will need to stop driving for month
   • D.A and C

   Why: With prior MI, EF 25% and a very narrow QRS (40 ms, i.e. no conduction delay), she meets primary-prevention ICD criteria but not CRT criteria (which require broad QRS). Driving restrictions apply after device implant. The combined answer (B and C) correctly captures the relevant driving restrictions.

4. 4.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 VCorrect

   Why: P waves dissociated from the QRS (AV dissociation), capture/fusion beats, and concordance all strongly favour VT. A typical RBBB morphology with a normal axis is the LEAST specific for VT, as it can occur in SVT with aberrancy. Hence option d is least suggestive of VT.

5. 5.A 37-year-old man presents to A&E with pneumonia and a temperature of 39°C. He has no chest pain but a routine ECG is performed and is shown in Figure

   • A.He should be referred for primary angioplasty
   • B.His temperature may have exacerbated his ECG changesCorrect
   • C.He should be treated with ajmaline
   • D.He needs an ICD

   Why: This febrile patient shows a type 1 Brugada ECG pattern unmasked by fever. Fever is a well-recognized trigger that exacerbates the Brugada phenotype and arrhythmic risk. Management is fever control and risk stratification, not primary angioplasty; ajmaline is a diagnostic provocation drug, not treatment here.

6. 6.Which one of the following would not be considered a high-risk marker for sudden cardiac death in hypertrophic cardiomyopathy?

   • A.Family history of sudden cardiac death
   • B.Non-sustained VT on cardiac monitoring
   • C.LV septal thickness of 2.3cmCorrect
   • D.Drop in blood pressure on ETT

   Why: Recognized high-risk markers in HCM include family history of SCD, non-sustained VT, abnormal BP response on exercise, unexplained syncope, and massive LV thickness (typically ≥30 mm). A septal thickness of 2.3 cm (23 mm) is below the high-risk wall-thickness threshold, so it is not considered a high-risk marker.

7. 7.A 26-year-old patient presents to A&E with the rhythm strip shown in Figure 2. He is complaining of palpitations and chest pain. His blood pressure is 80/60 mmHg. What should the initial management be?

   • A.IV adenosine
   • B.IV amiodarone
   • C.Urgent cardioversionCorrect
   • D.IV beta-blocker

   Why: This young patient with pre-excitation (WPW) who develops a rapid, broad, irregular tachycardia (pre-excited AF) and is symptomatic with chest pain is at risk of degeneration to VF. AV-nodal blocking drugs (adenosine, beta-blockers) are dangerous. Urgent DC cardioversion is the safest definitive treatment.

8. 8.The ECG shown in Figure 1.2 is diagnostic of which one of the following rhythms? following rhythms?

   • A.AF with aberrancy
   • B.AF with pre-excitationCorrect
   • C.VT
   • D.AVNT—orthodromic

   Why: An irregularly irregular broad-complex tachycardia with varying QRS widths/morphology is characteristic of atrial fibrillation conducting down an accessory pathway (AF with pre-excitation). This distinguishes it from monomorphic VT (regular) and orthodromic AVNRT (narrow, regular).

9. 9.Which one of these drugs does not prolong the QT interval?

   • A.Amiodarone
   • B.Erythromycin
   • C.CarbemazpineCorrect
   • D.Methadone

   Why: Amiodarone, erythromycin (a macrolide) and methadone all prolong the QT interval. Carbamazepine is an enzyme-inducing anticonvulsant that does not typically prolong QT, so it is the correct answer.

10. 10.What does the the box plot in Figure 1.3 show?

    • A.An inappropriate shock for AF
    • B.Inappropriate ATP for AF
    • C.Appropriate shock for VT
    • D.Appropriate ATP for VTCorrect

    Why: The device tracing demonstrates antitachycardia pacing (ATP) that successfully terminated a ventricular tachycardia, i.e. appropriate ATP for VT. This is the intended, appropriate device therapy.