Weitzman Prize Examination in Cardiology – Past

Exam Questions
INSTRUCTIONS TO CANDIDATE

1. You are required to answer 4 Questions Only

2. No scrap paper is allowed
3. You are allowed 3 hours to complete this examination

Questions from 2002/2003

Question 1
A 45 year old man presents to the Accident and Emergency Department with unstable
angina. Discuss his management during the first 24 hours.

Question 2
A 73 year old woman presents to the out-patient clinic with palpitation. The
electrocardiogram reveals atrial fibrillation with a ventricular rate response of 137 beats per
minute. Discuss her immediate and long-term management.

Question 3
A general practitioner refers a 23 year old woman with a 3 year history of syncope.
Discuss the cardiology assessment.

Question 4
Discuss the pharmacological treatment of a 69 year old man with chronic heart failure.

Question 5
Discuss the clinical assessment and management of a 76 year old man presenting with
shortness of breath and who is found to have severe aortic valve stenosis.

Question 6
A 49 year old man presents to the Accident and Emergency Department with an anterior
myocardial infarction. Discuss in outline his management during the first 7 days.

Questions from 2003/2004

Question 1
A 50 year old man presents to the Accident and Emergency Department with a myocardial
infarction. Discuss his management.

Question 2
Discuss the management of atrial fibrillation in a 65 year old patient.

Question 3
Discuss the treatment of a 70 year old man with chronic heart failure.
Question 4
A 65 year old woman presents with shortness of breath on exertion. On examination she
is in atrial fibrillation and has the heart sounds and murmurs of mitral stenosis.
Discuss her investigation and treatment.

Question 5
A 70 year old man presents to the Accident and Emergency Department with chest pain
and sudden onset shortness of breath. The ECG shows an anterior myocardial infarction.
The chest x-ray reveals pulmonary oedema. Discuss his management immediately and
over the first 24 hours

Questions from 2004/2005

Question 1
A 50 year old man presents to the Accident and Emergency Department with unstable
angina. Discuss his management.

Question 2
A 72 year old man is found to have the heart sounds and murmurs of aortic stenosis at a
routine medical examination with his general practitioner. He denies any symptoms.
Discuss his management.

Question 3
A 70 year old woman with new onset exertional angina is referred by her general
practitioner to the cardiology outpatient clinic. Discuss her management.

Question 4
Discuss the management of a 23 year old woman who has hypertrophic cardiomyopathy.

Question 5
A 70 year man has two blackouts. A primary neurological cause has been excluded.
Which cardiological causes would you consider? How would you investigate him?

Questions from 2005/2006

Question 1
Write notes on
a) Drug eluting stents
b) The use of stem cells in cardiology
c) B-type natriuretic peptide.

Question 2
A 55-year-old man presents with breathlessness and ankle swelling to his GP. The GP
suspects heart failure. Describe the investigations he will initiate and the treatment he will
commence if the diagnosis is correct.

Question 3
Write notes on
a) Beta-blockers and their use in left ventricular dysfunction
b) Amiodarone
c) Biventricular pacing and resynchronisation therapy
Question 4
A 68-year-old man presents with palpitations and is found to be in atrial fibrillation.
Describe his management.

Question 5
A 55-year-old man presents to the Accident and Emergency department with an acute
anterior myocardial infarction. The nearest cardiothoracic facilities are 25 miles away.
Describe his management within the first 24 hours.

Questions from 2006/2007

Question 1
Write notes on
a) Pericarditis
b) Hypertrophic cardiomyopathy
c) Ventricular septal defects

Question 2
A 65 year old man presents with exertional chest pain consistent with angina. His
cholesterol is 5.1 mmol/l and blood pressure 150/90mmHg. Describe his initial
investigations and subsequent management.

Question 3
Write notes on
a) Primary percutaneous intervention (angioplasty and stenting) in acute myocardial
infarction
b) Amiodarone
c) The clinical signs and of mitral stenosis

Question 4
A 65-year-old man with an old anterior myocardial infarction presents with exertional
breathlessness, orthopnoea and PND, but no chest pain. His BNP is 950 pmol/l (NR
<150). He has left bundle branch block on an ECG. An echo shows an akinetic anterior
wall of the left ventricle with an ejection fraction of approximately 25%. A thallium scan
does not show any reversible ischaemia. Describe his treatment.

Question 5
Discuss the important investigation and management decisions in a 68-year-old man who
presents with palpitations, and is found to have atrial fibrillation with a heart rate of
120bpm. He has co-existing controlled hypertension
Questions from 2007/2008

Question 1
Write notes on:
a) Myocarditis
b) The treatment of a total cholesterol of 6.5mmol/l, LDL cholesterol of 3.5mmol/l and
HDL cholesterol of 1.5mmol/l in a 50 year old man with no evidence of
cardiovascular disease (CVD). His only other risk factor for CVD is a father with an
MI at the age of 45 years.
c) Beta blockers in the treatment of hypertension.

Question 2
A 65 year old man with a previous history of myocardial infarction presents with a syncopal
episode. His ECG shows complete heart block with ventricular rate of 50 bpm. His
blood pressure is 110mmHg systolic. An echocardiogram shows a large segment of
akinesia anteriorly with poor overall function of the left ventricle. Angiography shows
an occluded left anterior descending artery without any significant lesions in the right
or circumflex coronary arteries.

Discuss:
a) Immediate management
b) Further investigation
c) The optimal pacemaker device
d) Long term medical management of this patient

Question 3
Writes notes on:
a) Marfans Syndrome
b) Heart transplantation
c) Biventricular or ‘resynchronisation’ pacing

Question 4
Discuss the important investigations and management decisions in a 68-year-old man who
has an incidental finding of atrial fibrillation at an insurance medical. His heart rate is
120bpm and blood pressure 160/95mmHg.

Question 5
A 65 year old man calls an ambulance after 4 hours of central chest pain which he thought
was indigestion. The ECG in the ambulance shows 2mm of ST elevation in leads V1
to V4. Describe his optimum management in the first 24 hours.

Questions from 2008/2009

Question 1
Write notes on:

a) Cardiac syncope
b) Hypertrophic cardiomyopathy
c) Pericarditis
Question 2
A 58yr old Polish man is referred for cardiological assessment of exertional dyspnoea. The
symptoms had been worsening over a 6 month period and were occasionally associated
with central chest discomfort. He was a non-smoker with no history of hypertension or
dyslipidaemia, and there was no family history of premature coronary disease. There was
no history of serious illness and he was on no regular medication. Indeed, he had only
once previously had a medical examination when, as a child, he had been told he had a
soft heart murmur “of no significance”. On examination he was in regular rhythm with a
blood pressure of 130/80. Auscultation revealed a moderately loud (3/6) ejection systolic
murmur at the base of the heart with a slow upstroke to the carotid pulse. There were no
signs of heart failure. The 12 lead ECG confirmed sinus rhythm with exaggerated QRS
voltage deflexions. The chest x-ray showed a normal sized heart, clear lung fields and
minor dilatation of the aortic root.

a) What is the diagnosis?

b) What single investigation is needed to confirm the diagnosis?
c) What are the treatment options?

Question 3
Write notes on:

a) Causes of heart failure

b) Complete heart block
c) Investigation of suspected endocarditis

Question 4
Describe your management of a 50 year old man presenting to A+E with non-ST elevation
myocardial infarction.

Question 5
Discuss the extended role played by renin-angiotensin system inhibition in the
management of cardiovascular disease.