MRCP Part 1 Cardiology and Respiratory — Questions and Answers
Question 1: A 62-year-old man presents with acute chest pain. His ECG shows ST elevation in leads II, III, and aVF with reciprocal changes in I and aVL. Which coronary artery is most likely occluded?
- Right coronary artery (Correct answer)
- Left anterior descending artery
- Left circumflex artery
- Left main stem
Correct answer: Right coronary artery
ST elevation in leads II, III, and aVF indicates an inferior myocardial infarction. The right coronary artery (RCA) supplies the inferior surface of the heart in approximately 85% of patients (right-dominant circulation).
Question 2: A patient with heart failure has the following spirometry: FEV1 2.8L (predicted 3.5L), FVC 3.2L (predicted 4.2L), FEV1/FVC ratio 87.5%. What pattern does this show?
- Restrictive pattern (Correct answer)
- Obstructive pattern
- Mixed obstructive and restrictive
- Normal spirometry
Correct answer: Restrictive pattern
The FEV1/FVC ratio is preserved (>70%) but both FEV1 and FVC are reduced, indicating a restrictive pattern. Heart failure causes pulmonary congestion and reduced lung compliance, leading to restriction.
Question 3: Which valvular lesion classically produces an early diastolic murmur best heard at the left sternal edge with the patient sitting forward?
- Aortic regurgitation (Correct answer)
- Mitral stenosis
- Pulmonary stenosis
- Tricuspid regurgitation
Correct answer: Aortic regurgitation
Aortic regurgitation produces a high-pitched early diastolic decrescendo murmur best heard at the left sternal edge with the patient sitting forward and in held expiration. This position brings the aortic root closer to the chest wall.
Question 4: A 70-year-old woman with atrial fibrillation has a CHA2DS2-VASc score of 4. According to NICE guidelines, what is the recommended anticoagulation strategy?
- Direct oral anticoagulant (DOAC) (Correct answer)
- Aspirin alone
- Aspirin plus clopidogrel
- No anticoagulation required
Correct answer: Direct oral anticoagulant (DOAC)
NICE recommends anticoagulation with a DOAC (apixaban, dabigatran, edoxaban, or rivarelbana) as first-line for stroke prevention in AF when CHA2DS2-VASc score is 2 or more. Aspirin alone is no longer recommended for stroke prevention in AF.
Question 5: A patient presents with pleuritic chest pain, haemoptysis, and breathlessness. D-dimer is elevated and CTPA shows a filling defect in the right lower lobe pulmonary artery. What is the most appropriate initial treatment?
- Low molecular weight heparin and arrange DOAC (Correct answer)
- Intravenous thrombolysis with alteplase
- Inferior vena cava filter
- Oral warfarin alone
Correct answer: Low molecular weight heparin and arrange DOAC
For a confirmed pulmonary embolism without haemodynamic instability, initial treatment is anticoagulation with LMWH (or fondaparinux) followed by transition to a DOAC. Thrombolysis is reserved for massive PE with haemodynamic compromise.
Question 6: In which condition would you expect to find bilateral hilar lymphadenopathy on chest X-ray with a raised serum ACE level?
- Sarcoidosis (Correct answer)
- Tuberculosis
- Small cell lung cancer
- Lymphoma
Correct answer: Sarcoidosis
Bilateral hilar lymphadenopathy (BHL) with a raised serum angiotensin-converting enzyme (ACE) level is characteristic of sarcoidosis. The ACE is produced by epithelioid cells within the non-caseating granulomas. While BHL occurs in other conditions, the combination with raised ACE is most suggestive of sarcoidosis.
MRCP Part 1 Cardiology and Respiratory
A 62-year-old man presents with acute chest pain.
His ECG shows ST elevation in leads II, III, and aVF with reciprocal changes in I and aVL.
Which coronary artery is most likely occluded?