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FRACP PAST PAPERS - CARDIOVASCULAR - page 4 / 17

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E) Phosphorylation of myosin

Question 6

A 90 year old man with a history of hypertension, acute myocardial infarction ten years ago and total knee replacement 4 years ago presents for an elective inguinal herniorraphy. He has not had a history of recent angina pectoris. On examination you note a 2/4 ejection systolic murmur at the base of the heart which radiates to the carotids. His BP is 170/103. The surgical resident enquires whether this man is fit for surgery. An ABG shows a pH of 7.4, PO2 70 and PCO2 40. Your advice would be:

A)Postpone surgery until hypoxia is investigated

B)Treat hypertension as this increases risk of intraoperative comlpications

C)This man needs preoperative subcutaneous heparin to prevent DVT

D)Postpone operation and perform an exercise stress test and arrange a cardiology consult

Question 7

A man is awaiting an elective cholecystectomy. He is said to have been in previously good health. Physical examination reveals a 2/6 ejection systolic murmur in the aortic area and radiates to the carotids. An ECG is shown and said to demonstrate sinus rhythm and left ventricular hypertrophy and right bundle branch block. Which of the following investigations is likely to be most helpful.

A)TTE

B)carotid doppler

C)Coronary angiogram

Question 8

A 35 year old man presents with a 24 hour history of palpitations. No haemodynamic compromise. BP 105/65. On examination systolic murmur and click in the mitral area. ECG show atrial flutter with a 3:1 block. Management:

A)Immediate electrical cardioversion

B)TOE before cardioversion

C)Cardiovert within 24 hours

D)Cardiovert if haemodynamically stable

E)Warfarin for 3 weeks then cardiovert

FRACP 1998

1.  Most likely to decrease VLDL, LDL and increase HDL:

a.Cholestyramine

b.Nicotinic acid

c.Simvastatin

d.Gemfibrozil

e.Oestrogens

2.  Most likely cause of prolonged QT:

a.Verapamil

b. Decreased potassium

c.  Increased calcium

d.  Flecainide

e.Propanolol

3.  Both Marfan's syndrome and homocysteinaemia have similar clinical features.  Which is most likely in homocystemia which differentiates it from Marfan's?

a.Ectopia lentis

b.Intellectual impairment

c.Autosomal dominant inheritance

d.Long limbs/arms/fingers

e.Absence of arterial thrombosis

4. What is most likely to be present in a patient with a triglyceride concentration >25 mmol/l.

a.Tendon xanthomata

b.Reversible memory defect

c.Paraesthesia of hand and feet

d.

Abdominal pain

5.  64 year old man, story about AS, peak gradient 90 mmHg, pulmonary oedema refractory to diuretics. Therapy:

a.Valve replacement

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