How to Pass the FRACP Written Examination. Jonathan Gleadle
obesity, OSA, and permanent AF. On examination, there are clinical signs consistent with CCF. Her troponin level is normal, but NT‐pro BNP level is elevated. Her echocardiogram demonstrates a left ventricular ejection fraction of 55%, left ventricular end‐diastolic volume index (LVEDI) <97 mL/m2 and the ratio of mitral early diastolic inflow velocity to mitral early annular lengthening velocity (E/e')>15.Which one of the following treatments will reduce mortality for this patient?Angiotensin‐converting enzyme inhibitor.No pharmacological treatment proven to reduce mortality.Phosphodiesterase‐5 inhibitor.Selective sinus node If sodium channel inhibitor.
18 18. In a 28‐year‐old man with known hypertrophic cardiomyopathy (HOCM) who has had one episode of syncope at work, which one of the following treatments should be instituted?Amiodarone.Anticoagulation.Atenolol.Implantable cardioverter–defibrillator.
19 19. A 56‐year‐old man presents to emergency department with severe headaches and blurred vision. He is known to have IgA nephropathy but has no regular follow up for this. His BP is 210/110 mmHg. You have performed a fundoscopic examination which is shown below:What does the fundoscopy show?Keith‐Wagener (KG) grade 3 hypertensive retinopathy.Keith‐Wagener (KG) grade 4 hypertensive retinopathy.Retinal artery occlusion.Retinal vein occlusion.
20 20. Which one of the following patients DOES NOT have an indication for an implantable cardioverter defibrillator (ICD) implantation?A 20‐year‐old man with congenital long QT syndrome with recurrent syncope who cannot tolerate beta‐blockers.A 65‐year‐old woman with haemodynamically unstable ventricular tachycardia not due to reversible causes.A 59‐year‐old man with ischaemic cardiomyopathy with a myocardial infarction two weeks ago with left ventricular ejection fraction of 30%.A 22‐year‐old asymptomatic female with hypertrophic cardiomyopathy, unexplained syncope but no family history of sudden cardiac death.
21 21. A 56‐year‐old man with a background history of type 2 diabetes, hypertension, and hyperlipidaemia presents with unexplained syncope and palpitations that happen around 6‐monthly. His previous cardiac investigations, including repeated 12‐lead ECG and 24‐hour Holter monitoring, are normal.What is the appropriate next step to investigate palpitations?Three‐day Holter monitoring.Seven‐day Holter monitoring.Wearable device.Implantable loop recorder.
22 22. Which one of the following lipid‐lowering agents acts by blocking the inhibition of lysosomal degradation of low‐density lipoprotein (LDL) receptors, thereby increasing the body's ability to sequester LDL?Evolocumab.Ezetimibe.Mipomersen.Rosuvastatin.
23 23. A 65‐year‐old man presents with dizziness and syncope. His ECG shows a QTc interval of 520 ms. Review of medical history, family history, medications, electrolytes, and echocardiogram did not find a reversible cause of the condition.What is the first‐line treatment for this patient?Amiodarone.Beta‐blockers.Implantable cardioverter defibrillator (ICD).Left cardiac sympathetic denervation (LCSD).
24 24. A 25‐year‐old Aboriginal and Torres Strait Islander woman presents with a 3‐month history of exertional dyspnoea. She has had an unproductive cough but no fevers, chest pain or other illnesses. She takes no medication. On examination, BP is 120/70 mmHg, HR 90/min and regular, there is a 2/6 diastolic murmur and a 3/6 systolic murmur, chest is clear, there is pitting oedema of both ankles. Echocardiogram reveals mitral stenosis with a mean transvalvular gradient of 14 mmHg and moderate mitral regurgitation. The left atrium is enlarged. There is normal biventricular size and function, as well as pulmonary hypertension with a pulmonary arterial pressure of 50 mmHg.Which of the following is the most appropriate management?Balloon mitral valvuloplasty.Commence ACE inhibitor and repeat echocardiogram in 6 months.Mitral valve open commissurotomy.Mitral valve replacement.
25 25. A 65‐year‐old man suffers from ischaemic heart disease, chronic AF, insulin‐dependent type 2 diabetes, stage 3 CKD, peripheral vascular disease with chronic claudication. He is taking multiple medications and is asking your advice about taking omega‐3 fish oil supplements.Which one of the following pieces of advice regarding omega‐3 fish oil supplements for this patient is correct?It is associated with a statistically significant reduction on all‐cause mortality.It has a beneficial effect on glycaemic control and increased fasting insulin levels.It can improve walking distance, ankle brachial pressure index, and angiographic findings.It can reduce serum triglycerides and raise HDL and LDL levels.
26 26. A 55‐year‐old man presents with repeated clinic blood pressure measurements of around 150/90 mmHg, after six months of therapy with perindopril, amlodipine, and hydrochlorothiazide at maximal doses. He is compliant with his medications and is engaging actively with lifestyle modifications.Which one of the following additional agents is most likely to be beneficial?Atenolol.Doxazosin.Hydralazine.Spironolactone.
27 27. A 50‐year‐old woman with haemochromatosis presents with dyspnoea. She undergoes an echocardiogram. Which of the echocardiogram findings is most commonly seen in patients with early‐stage restrictive cardiomyopathy?Left ventricular dilatation with reduced left ventricular ejection fraction <45%.Left ventricular outflow tract obstruction.Normal ventricular size and systolic function with a restrictive ventricular filling pattern.Regional wall motion abnormality in a non‐coronary distribution.
28 28. Which of the following statements is correct regarding acute rheumatic fever (ARF) in Aboriginal and Torres Strait Islander (ATSI)?It is usually associated with Group B streptococcal infection.Secondary prophylaxis following rheumatic fever should be oral doxycycline.The highest rates of ARF in ATSI are between the ages 34 to 45.The major manifestations of ARF include carditis and chorea.
29 29. A 60‐year‐old woman presents with epigastric pain, nausea, vomiting, and shortness of breath. She has a HR of 58 bpm and a BP of 90/60 mmHg. Her ECG is shown below:The occlusion of which coronary artery is likely to have produced this presentation.Circumflex.Left anterior descending.Left marginal.Right.
30 30. A 55‐year‐old man is referred by his GP because of bradycardia with a heart rate as low as 45 bpm at night. He has hypertension for which he is taking amlodipine 5 mg daily. An ECG performed today shows a sinus bradycardia 55/min and he is asymptomatic.Which one of the following statements is correct?Nocturnal bradycardia is an indication for permanent pacing.Sinus node dysfunction is most likely due to ischaemic heart disease.Sleep apnoea is not associated with nocturnal bradycardia.There is no minimum heart rate or pause duration for which permanent pacing is recommended in sinus node dysfunction.
31 31. A 38‐year‐old woman is admitted to intensive care unit because of septic shock due to meningococcal septicaemia. She complains of increased dyspnoea on day 3 when she is discharged to the ward. She has a medical history of asthma and chronic back pain. She has been experiencing depressive symptoms since her husband passed away one year ago. Her ECG shows ST depression in the lateral leads. Initial Troponin I level is 54 ng/L [<29], N‐terminal pro‐B‐type brain natriuretic peptide (NT‐proBNP) level is 5400 ng/L [0–124]. Her echocardiogram shows ballooning of the left ventricular apex.Which of the following medications will improve her survival at one year?Angiotensin‐receptor blockers.Beta‐blockers.Calcium channel blockers.Digitalis glycosides.
32 32. Which of the following statements is correct regarding transcatheter aortic valve implantation (TAVI) in inoperable and high‐risk elderly patients?Patients should be anticoagulated with a novel oral anticoagulant (NOAC) for 3 months post implantation.Patients should be anticoagulated with dual antiplatelet therapy for 3 months post implantation.Patients with asymptomatic severe aortic stenosis at intermediate surgical risk should be offered TAVI.The need for permanent pacemaker insertion due to bradyarrhythmias post TAVI is about 30%.
33 33. A 62‐year‐old man presents with vague chest discomfort for 6 hours. He is known to have insulin‐dependent type 2 diabetes, hypertension, hyperlipidaemia, stage 3A CKD with serum creatinine 150 μmol/L [60–110] and psoriatic arthritis treated with adalimumab. His ECG is shown below. His coronary artery angiography shows 50% stenosis of the left main, 75% stenosis of the left circumflex, 70% stenosis of the proximal left anterior descending artery, and 50% stenosis of the right coronary artery. Left ventricular systolic function is reduced with an ejection fraction of 40%.Which one of the following is the best management option?Coronary artery bypass graft surgery (CABG).Infarct‐related artery (IRA)‐only revascularisation in