Cardiology
Cardiology questions reward a disciplined sequence: symptoms and risk factors, ECG interpretation, then imaging and biomarkers. Candidates must read an ECG systematically: rate, rhythm, axis, intervals (PR, QRS, QT), ST-T changes, and Q waves. Know the criteria and immediate management of ST-elevation myocardial infarction, and the distinction between unstable angina/NSTEMI and STEMI. Understand heart failure phenotypes (reduced vs preserved ejection fraction), their different treatment priorities, and the role of natriuretic peptides. Master atrial fibrillation: rate vs rhythm control, and stroke risk scoring to decide anticoagulation. Know valvular lesion murmurs and the timing of intervention.
Traps: attributing chest pain to a benign cause without excluding acute coronary syndrome; misreading ST elevation in pericarditis or early repolarization; forgetting that normal troponin early does not exclude infarction; prescribing anticoagulants without checking bleeding risk and renal function.
Worked example: a patient with irregularly irregular pulse and no P waves on ECG has atrial fibrillation. The decision tree is: is the patient hemodynamically stable? If unstable, urgent synchronized cardioversion. If stable, assess stroke risk and bleeding risk, then choose rate or rhythm control. Anticoagulation is decided by stroke risk score, not by symptom severity.
Key concepts: systematic ECG reading, acute coronary syndrome pathways, heart failure phenotypes, arrhythmia management, and anticoagulation decisions.