Download Cardiology Board Exam - Palestine Medical Council

Palestine medical council
Cardiology Board Examination(proposed)
Multiple choice questions
Candidate’s name: ……………………………………………..Date:……………
Answer the following multiple choice questions by writing T for true and F for false
opposite each statement.
1. Atrial fibrillation is commonly associated with:
…..A: valvular heart disease.
…..B: cerebrovascular accident.
…..C: obesity.
…..D:hypothyroidism.
…..E: chronic lung disease.
2. Supraventricular tachycardia:
…..A: is mostly due to re-entry mechanism incorporating an anomalous AV pathway.
…..B: may be caused by excess tea or coffee.
…..C: always aborts spontaneously.
…..D: may respond to carotid sinus massage.
…..E: may need electrophysiological studies and radiofrequency ablation.
3. Ventricular fibrillation:
…..A: may need prophylactic insertion of cardioverter defibrillator.
…..B: usually presents by sudden cardiac death.
…..C: may complicate acute myocardial infarction.
…..D: mouth to mouth breathing is never needed.
…..E: may complicate other arrhythmias.
4. Ventricular tachycardia:
…..A: can be sustained or non– sustained.
…..B: commonly associated with hyperkalaemia.
…..C: may be treated with beta-blockers.
…..D: always needs direct current shock.
…..E: incessant VT needs further evaluation.
5. When treating arrhythmias:
…..A: always start by drugs.
…..B: carotid sinus massage can abort some arrhythmias.
…..C: Valsalva technique is of no benefit at all.
…..D: adenosine is useful to differentiate supraventricular from ventricular tachycardia.
…..E: rhythm monitoring is not necessary.
6. When choosing an antiarrhythmic drug:
…..A: it is important to know few alternatives.
…..B: some drugs have broader spectrum than others.
…..C: all drugs have similar effect on the refractory period.
…..D: any drug can freely combined with another.
…..E: some can be given orally or intravenously or via an endotracheal tube.
7. Embolic events in relation to arrhythmias:
…..A: have not been recognized.
…..B: atrial fibrillation is a common precipitating factor.
…..C: can be successfully prevented.
…..D: can cause sudden loss of vision.
…..E: anticoagulation is not necessary with atrial fibrillation.
8. Bradyarrythmias:
…..A: may be drug- induced.
…..B: always needs permanent pacemaker implantation.
…..C: may complicate myocardial infarction.
…..D: may cause no symptoms.
…..E: carotid sinus hypersensitivity can cause dizziness while eating.
9. Cardiopulmonary arrest:
…..A: loss of consciousness alone is enough to make the diagnosis.
…..B: may occur without warning.
…..C: 100% of cases are due to ventricualr tachycardia or ventricular fibrillation.
…..D: may be complicated by acid-base imbalance.
…..E: the prognosis for all cases is similar.
10. When managing cardiopulmonary arrest:
…..A: very important to maintain an airway and breathing.
…..B: electrocardiographic monitoring is useful to determine cardiac rhythm and deliver
treatment.
…..C: calcium can be given intravenously to any patient.
…..D: any arrhythmia can be drug resistant.
…..E: endotracheal dosages of epinephrine, lidocaine, and atropine are identical to
intravenous route.
11. As
regards heart failure:
…..A: the most common causes are hypertension and ischaemic heart disease.
…..B: both systolic and diastolic function must be altered to produce heart failure.
…..C: remodeling happens as a compensatory mechanism to maintain cardiac function.
…..D: lemon and non-drug compliance can worsen the condition.
…..E: licorice can be freely consumed.
12. The following are some features of heart failure:
.....A: NYHA classification depends on both the physical and mental status.
…..B: right ventricular dysfunction may present by abdominal pain and distention.
…..C: fatigue is a common symptom of heart failure of any aetiology.
…..D: the absence of lower limb oedema rules out fluid retention.
…..E: cough productive of frothy sputum may be a manifestation of heart failure.
13. On treating acute heart failure:
…..A: dopamine should be used in relatively small doses.
…..B: dobutamine has more arrhythmogenic effect than dopamine.
…..C: nitroprusside can be used for long periods.
…..D: phosphdiesterase inhibitors are of doubtful benefit.
…..E: nitroglycerine may be needed in increasing doses.
14. Angiotensin converting enzyme inhibitors:
…..A: cause both arterial and venous dilatation.
…..B: significantly improved mortality alone in clinical heart failure studies.
…..C: should be considered in the recovery phase of myocardial infarction.
…..D: first dose effect on blood pressure can be serious.
…..E: electrolytes should be monitored.
15. Diuretics:
…..A: concurrent nonsteroidal anti- inflammatory drugs block the prostaglandinmediated increase in renal blood flow.
…..B: hypokalaemia and hypomagnesaemia are serious metabolic complications.
…..C: dosages are titrated according to symptoms and body weight.
…..D: resistance to diuretic therapy may be encountered.
…..E: can be given for both acute and chronic heart failure.
16. Beta- blockers for heart failure:
…..A: are contraindicated.
…..B: can be given with other therapeutic agents of heart failure.
…..C: upregulate beta 1 receptors in the myocardium.
…..D: provide the extra benefit of antiarrhythmic action.
…..E: standard dosage regimen should be followed.
17. As regards primary hypertension:
…..A: constitutes not less than 90% of the cases of hypertension.
…..B: can only raise systolic blood pressure.
…..C: interaction between autonomic nervous system and other systems is an important
predisposing factor.
…..D: never complicated by end organ damage.
…..E: blood pressure reading may fluctuate between normal and abnormal readings.
18. Secondary hypertension may be caused by the following:
…..A: chronic renal disease.
…..B: coarctation of the aorta.
…..C: nonsteroidal anti- inflammatory drugs.
…..D: pneumonia
…..E: cephalosporines.
19. Target organ damage in hypertension may involve:
…..A: the brain
…..B: the retina
…..C: the urinary bladder
…..D: the left ventricle
…..E: the spleen
20. Hypertensive patients should have the following routine tests:
…..A: chest X- ray.
…..B: echocardiographic examination.
…..C: electroencephalogram.
…..D: abdominal ultrasound.
…..E: cardiac catheterization.
21. Follow up of hypertensive patients:
…..A: should be conducted periodically.
…..B: blood pressure measurement needs special atmosphere.
…..C: physical status and diet need not be discussed each visit.
…..D: blurred vision is an emergency.
…..E: no need for blood tests if the patient is compliant.
22. Initial treatment of hypertension:
…..A: should involve strict advice about sugar intake even the patient is not diabetic.
…..B: the nurse usually gives non- drug advice.
…..C: smoking few cigarettes is allowed.
…..D: other concurrent conditions may affect drug choice.
…..E: racial variations are important to consider.
23. When treating hypertension:
…..A: loop diuretics should be to all patients.
…..B: a diuretic can be added to any other antihypertensive.
…..C: spironolactone is generally avoided with angiotensin converting enzyme inhibitors.
…..D: thiazide diuretics can cause hyperkalaemia, hyperuricaemia, and hypoglycaemia.
…..E: diabetic patients need special attention.
24. Side effects of antihypertensive drugs:
…..A: methyl- dopa can result in salt and water retention.
…..B: centrally acting drugs may cause depression.
…..C: any drug can cause dizziness.
…..D: any drug can cause hyperlipidaemia.
…..E: some useful drugs can cause headache and worsen anginal pains.
25: Beta- blockers in hypertension:
…..A: useful in hypertensives with fast atrial fibrillation.
…..B: acebutolol (with intrinsic sympathetic activity) is absolutely contraindicated with
bradycardia.
…..C: selective beta 1 blockers are not contraindicated in patients with mild bronchial
asthma.
…..D: may aggravate intermittent claudications.
…..E: do not produce impotence.
26. Angiotensin converting enzyme inhibitors for hypertension:
…..A: cough and reversible change in taste have been well known side effects.
…..B: serious haematological and renal side effects are rare.
…..C: have extra protective effect in patients with either heart failure or diabetes mellitus.
…..D: hyperkalaemia is primarily seen in patients with renal failure or diabetes.
…..E: several preparations are available with different half-lives.
27. Calcium channel blockers in hypertension:
…..A: are preferred in an asthmatic with angina.
…..B: contraindicated with angiotensin II receptor antagonists.
…..C: do not cause electrolyte imbalance.
…..D: short acting nifedipine is better to be avoided.
…..E: some can be used in hypertensives with heart failure as well.
28. In hypertensive emergencies:
…..A: precipitous drop in blood pressure may lead to serious end organ damage.
…..B: long- acting intravenous vasodilators are recommended.
…..C: better to avoid sublingual nifedipine.
…..D: nitroprusside is free of serious side effects.
…..E: does not happen in pregnant women.
29. Myocardial oxygenation status depends on:
…..A: heart rate, contractility, and intramyocardial wall tension.
…..B: double product of cantractility and wall tension.
…..C: may be affected by coronary obstruction and spasm.
…..D: flow reserve afforded by R2 intrmyocardial arteries and arteriols is useful to a
certain extent.
…..E: coronary reserve is diminished at about 50% obstruction of a main coronary artery.
30. The diagnosis of coronary artery disease:
…..A: encouraged by certain features of chest pain.
…..B: may be concluded from an exercise tolerence test.
…..C: can be ruled out if echocardiographic examination is normal.
…..D: severity should be related to risk factors.
…..E: cardiac catheterization is useful for diagnostic, therapeutic, and prognostic
implications.
31. On treating ischaemic heart disease:
…..A: patient’s education about risk factors is of paramount importance.
…..B: beta- blockers should be considered for all patients.
…..C: beta- blockers reduce oxygen demand but may cause coronary spasm.
…..D: beta-blockers are safe in patients with stable or unstable symptoms.
…..E: beta- blockers can be withdrawn at any time.
32. Nitrate therapy for angina:
…..A: contraindicated if patients have right sided heart failure as well.
…..B: can be given through more than two routes.
…..C: reduce wall tension, dilate atherosclerosed coronary arteries, but do not relief
spasm.
…..D: nitrate- free interval is required to avoid tolerance.
…..E: sublingual nitroglycerine rarely produces profound hypotension.
33. When treating unstable angina:
…..A: aspirin, clopidogrel, and low molecular weight heparin should be considered for
every patient.
…..B: monitoring in a coronary care unit is not essential.
…..C: glycoprotein IIb / IIIa receptor antagonists are contraindicated.
…..D: i.v. nitroglycerine dosage is titrated according to the patient’s symptoms regardless
of blood pressure.
…..E: diltiazem has been shown to reduce refractory angina and re- infarction.
34. Development of myocardial infarction:
…..A: commonly results from thrombus formation due to rupture of atheromatous
plaque.
…..B: the direct cause of plaque rupture is still largely unknown.
…..C: Q- wave MI (STEMI) involves the full thickness of the infarcted myocardium.
…..D: non-Q- wave MI (NSTEMI) does not warrant further investigations.
…..E: inflammation propagates thrombotic lesion formation.
35. When diagnosing acute myocardial infarction:
…..A: early normal cardiac enzymes rules out the diagnosis.
…..B: raised troponin for several days.
…..C: CK- MB shows rapid rise and rapid fall.
…..D: electrocardiographic recording is needed for both diagnosis and monitoring
progression.
…..E: Diabetics can have silent MI.
36. When treating myocardial infarction:
…..A: morphine sulphate is contraindicated.
…..B: fibrinolytic therapy should be considered without delay.
…..C: repeat electrocardiographic recording is not necessary post streptokinase if the
patient is pain free.
…..D: nitroglycerine infusion for 48 hours may reduce the risk of early death post MI.
…..E: beta- blocker therapy is protective in the setting of acute MI.
37. In cases of post myocardial infarction unstable angina:
…..A: clopidogrel or ticlopidine should be given.
…..B: aspirin is contraindicated with clopidogrel.
…..C: low molecular weight heparin is contraindicated if the patient was given
thrombolytic therapy.
…..D: glycoprotein IIb / IIIa receptor antagonists can be given with heparin.
…..E: angioplasty may be needed urgently.
38. As regards shock:
…..A: results in circulatory failure to deliver sufficient Oxygen to the brain alone.
…..B: any excessive source of fluid loss may precipitate shock.
…..C: multisystem organ failure may follow and is of worse prognosis.
…..D: stress gastritis can be simply prevented.
…..E: kidneys are resistant to hypoperfusion.
39. Shock is commonly associated with:
…..A: sinus tachycardia, hypotension, and oliguria.
…..B: less than 2.2L/min/m2 cardiac index is pathognomonic for the diagnosis of any
shock.
…..C: increased urinary sodium.
…..D: deranged liver enzymes.
…..E: increased serum lactate concentration.
40. When treating shock:
…..A: oxygen should be given only to patients with cardiogenic shock.
…..B: oxygen dosage is similar via nasal canula or via face mask.
…..C: crystalloids have the advantage of ease of administration and compatibility with
most drugs.
…..D: blood products may be used but may lead to hypothermia.
…..E: lactate Ringer’s solution is unlikely to cause hyperchloraemic metabolic acidosis.
41. Colloids:
…..A: results in increased intravascular retention time.
…..B: albumin is usually given in smaller amounts than normal saline.
…..C: hetastarch can cause pancreatitis.
…..D: dextran is free of complications.
…..E: bleeding may occur in some patients receiving certain colloids.
42. When treating cerebrovascular accident:
…..A: the recommended dosage of aspirin is 100 mgs/day.
…..B: mannitol is commonly used to reduce intracranial pressure.
…..C: corticosteroids are no longer recommended but still widely used.
…..D: antiplatelet and anticoagulants should be discontinued when alteplase is given.
…..E: aspirin or dipyridamole may be given with warfarin to some patients with
prosthetic valves.
43. the following factors play a role in the development of deep vein thrombosis:
…..A: prolonged bed rest especially post orthopaedic surgery.
…..B: pregnancy.
…..C: urinary tract infection.
…..D: hypertonic glucose.
…..E: angina.
44. As a consequence of deep vein thrombosis or pulmonary embolism the following
may happen:
…..A: chronic venous insufficiency.
…..B: recurrent pulmonary embolisation.
…..C: pneumonia.
…..D: acute or chronic right ventricular failure.
…..E: recurrent chest pain.
45. When diagnosing a thrombo- embolic event:
…..A: serial Doppler testing is necessary for deep vein thrombosis.
…..B: an early positive Doppler is diagnostic of DVT.
…..C: venography for legs and lungs may be necessary.
…..D: D-Dimer test is a good negative test.
…..E: spiral CT scan with contrast is a useful diagnostic tool.
46. When treating a thromboembolic event;
…..A: anticoagulation is only recommended after proving the diagnosis.
…..B: heparin allows the endogenous thrombolytic system to eradicate a clot.
…..C: heparin is contraindicated with leg cellulitis.
…..D: heparin is given as a standard dose to all patients.
…..E: heparin but not warfarin can cause skin changes.
47. Low molecular weight heparins have the following features:
…..A: have better bioavailability than unfractionated heparin but short duration of action.
…..B: associated with lower incidence of thrombocytopaenia and its paradoxical
thrombotic effects.
…..C: no bleeding complications at all.
…..D: serial anti- Xa should be measured for monitoring response to treatment.
…..E: once or twice daily doses are required.
48. Warfarin have the following features:
…..A: inhibits only vit. K dependent coagulant proteins.
…..B: an overlap period is needed with heparin.
…..C: is given indefinitely to all patients with deep vein thrombosis.
…..D: all side effects are dose related.
…..E: warfarin is contraindicated during lactation.
49. Prevention policy of thromboembolic disorders:
…..A: thrombolytics may be necessary.
…..B: operative implantation of a filter may be necessary.
…..C: patients should lie still in bed.
…..D: heparin is contraindicated during pregnancy.
…..E: Danaparoid is a useful alternative to heparin in certain cases.
50. The development of atherosclerosis:
…..A: may result from mechanical injury to the endothelium.
…..B: arterial wall LDL- C recruits monocytes and macrophages to accelerate its own
oxidation.
…..C: oxidation alone provokes the development of atherosclerosis.
…..D: LDL- C degeneration via unknown receptors protects against atherosclerosis.
…..E: is not affected by drugs.
51. the following are associated with hyperlipidaemia:
…..A: abdominal pain.
…..B: myxoedema.
…..C: life style.
…..D: insulin.
…..E: some neurogenic disorders.
52. When diagnosing hyperlipidaemia:
…..A: periodic measurement in adult population is necessary for primary prevention.
…..B: associated cardiac history alone is evaluated.
…..C: case finding and management should be based on LDL- C.
…..D: LDL- C can be calculated in all cases of hyperlipidaemia regardless of the level of
triglycerides.
53. When treating hyperlipidaemia:
…..A: strict diet control is mandatory with or without drug therapy.
…..B: strict diet alone is necessary for urgent cardiac conditions.
…..C: the extent of lipid reduction with drug treatment is different between males and
females.
…..D: exercise is necessary in all patients.
…..E: antioxidant diet is as important as low fat diet.
54. Drug treatment of hyperlipidaemia:
.....A: is based on good clinical evidence.
…..B: can be generalised to all patients.
…..C: gemfibrozil may enhance gall stone formation.
…..D: clofibrate has numerous side effects.
…..E: combination therapy is free of side effects.
55. Statins:
…..A: their effect is receptor dependent.
…..B: reduce LDL- C by reducing its synthesis and enhancing its catabolism.
…..C: are tolerated like niacin.
…..D: of similar efficacy in familial and non- familial forms of hypercholesterolaemia.
…..E: their benefit is beyond lipid lowering extent.
56. Normal depolarization of the ventricles:
…..A: the endocardium depolarizes before the outside of the heart.
…..B: equal current quantities flow in all directions.
…..C: the apex remains positive during most of depolarization with respect to the base.
…..D: mean QRS vector represents both atrial and ventricular average vectors.
…..E: Q wave represents the depolarization of the septum, which normally starts from the
right side.
57. Normal repolarization of the heart:
…..A: the predominant vector of ventricular repolarization is from the base to the apex.
…..B: the slow repolarization of the ventricular endocardium is independent of the blood
pressure inside the ventricles.
…..C: ventricular repolrazation is normally represented by a positive, negative, or
biphasic T waves in the bipolar limb leads.
…..D: the pattern of atrial repolarization is similar to that of ventricular repolarization.
…..E: the atrial T wave is totally obscured by the large ventricular QRS complex.
58. Mean QRS complex:
…..A: can be shifted in some normal people.
…..B: may vary according to the patient’s posture.
…..C: is shifted in the same direction of the hypertrophied ventricle.
…..D: right axis deviation due to right bundle branch block is associated with normal
configuration of the QRS complex.
…..E: may be influenced by some congenital heart disease.
59. Current of injury:
…..A: happens due to a state of persistent depolarization in the injured myocardium.
…..B: arises only from ischaemic myocardium.
…..C: emits positive charges to the surroundings.
…..D: always causes ST shift in the same direction in all leads.
…..E: helps to detect the site of myocardial injury.
60. Mean QRS axis:
…..A: can be predicted from either limb leads or chest leads.
…..B: +30 is of normal axis.
…..C: +90 is of right axis.
…..D: left bundle branch block can be associated with -50.
…..E: pulmonary stenosis can be associated with +120.
61. The sinoatrial node:
…..A: is the site of impulse generation in children and adults.
…..B: is influenced by both sympathetic and vagal reflexes.
…..C: responds to raised temperature by producing bradycardia.
…..D: sinus arrhythmia is not a serious condition.
…..E: can be overdriven by another pacemaker.
62. Atrioventricular block:
…..A: may reflect the severity of a heart disease.
…..B: is always irreversible.
…..C: second degree is always associated with dropped beats.
…..D: Stokes- Adams syndrome may cause variable fainting up to 30 minutes.
…..E: no P waves are generated with complete heart block.
63. Premature contractions:
…..A: may be of atrial origin only.
…..B: All result in the same QRS morphology.
…..C: are always benign.
…..D: may not be palpable by radial pulse.
…..E: some premature ventricular contractions can lead to ventricular fibrillation.
64. Ventricular tachycardia:
…..A: can be of serious consequences.
…..B: may be drug induced.
…..C: always needs antiarrhythmic drugs.
…..D: is mostly regular.
…..E: considerable ischaemia needs to be considered in most cases.
65. Ventricular fibrillation:
…..A: is as serious as atrial fibrillation.
…..B: may lead to unconsciousness within 5 minutes.
…..C: always starts by low- voltage irregular waves.
…..D: dilated ventricles are more prone to this arrhythmia.
…..E: may begin again after successful electrical cardioversion.
66. Moderate cardiac failure due to an acute myocardial infarction;
…..A: results only from damming of venous return.
…..B: early compensatory sympathetic reflexes strengthen the pumping action of the
heart but do not affect the venous return.
…..C: doubling the systemic filling pressure helps the blood to flow back to the heart.
…..D: a prolonged semichronic compensation starts after 24 hours.
…..E: fluid retention by the kidneys can increase the venous return to entirely normalize
the cardiac output at rest.
67. Recovery after myocardial infarction:
…..A: infarcted myocardium and undamaged portions are usually involved in the
recovery process.
…..B: collateral blood supply usually promotes early functional recovery.
…..C: cardiac reserve is not reduced in compensated heart failure.
…..D: fluid retention helps to abate symptoms due to sympathetic stimulation such as
pallor and tachycardia.
…..E: recovery is independent of the size of the myocardial infarction.
68. Decompensated heart failure due to a large myocardial infarction:
…..A: marginal reduction in cardiac output can be detrimental.
…..B: fluid retention can be fatal by producing pulmonary oedema.
…..C: the patient can survive up to a month as the myocardium can resist overstretching.
…..D: digitalis and diuretics are useless in cases of decompensation.
…..E: achieving fluid balance is an important prophylactic measure.
69. Pathogenesis of oedema in patients with severe heart failure:
…..A: pulmonary oedema precedes peripheral oedema in most cases of acute left
ventricular failure.
…..B: pulmonary oedema is independent of systemic arterial and capillary pressures.
…..C: peripheral oedema is independent of fluid retention by the kidney.
…..D: fluid retention by the kidney is due to renal and extra renal causes.
…..E: atrial natriuretic factor raised level prevents the development of peripheral oedema.
70. Cardiac reserve:
…..A: is roughly the same in failing and non- failing heart.
…..B: is influenced by myocarditis.
…..C: is not influenced by chronic ischaemia.
…..D: can be uncovered by physical and chemical exercise tests.
…..E: can be affected by either low or high output heart failure.
71. As regards circulatory shock:
…..A: can affect patients with previously normal hearts.
…..B: always associated with hypotension but normal urine output.
…..C: always reversible.
…..D: all degrees of shock can result from haemorrhage.
…..E: progression depends on volume of blood loss and degree of hypotension regardless
of the duration.
72. Hypovolaemic shock:
…..A: affects cardiac output to a greater extent then blood pressure.
…..B: blood loss of 500 mls can be compensated without blood transfusion.
…..C: sympathetic reflex compensations are of the same importance like other
compensations.
…..D: if untreated can lead to cardiac arrest.
…..E: dextran is an adequate colloid as a plasma expander.
73. Sympathetic reflex compensation in cases of shock:
…..A: both peripheral and central reflexes are essential.
…..B: makes arterial blood pressure response identical to cardiac output curve.
…..C: coronary autoregulation is excluded from sympathetic reflexes so long as blood
pressure is above a certain level.
…..D: may result in bradycardia.
…..E: other mechanisms may contribute in raising peripheral vascular resistance.
74. Progressive shock:
…..A: some positive feedbacks breed more shock.
…..B: patchy punctate necrotic areas are proportional to blood supply.
…..C: release of tissue toxins happens only with septic shock.
…..D: corticosteroids therapy may offer some cellular protection.
…..E: glucose metabolism is increased.
75. Shock complications:
…..A: any shock can be fatal.
…..B: disseminated intravascular coagulopathy may be associated with bleeding and
thrombotic complications in the same time.
…..C: increased capillary permeability and cellular depletion of high-energy compounds
are usually irreversible.
…..D: anaphylactic shock is always due to a delayed antigen- antibody reaction.
…..E: the liver is excluded from the cellular deterioration in progressive shock due to its
rich blood supply.
76. In congenital heart disease:
…..A: VSD may close spontaneously.
…..B: ASD presents only in children.
…..C: patent foramen ovale may need surgical closure.
…..D: PDA is the commonest congenital heart disease following maternal rubella.
…..E: balloon angioplasty is suitable for restenosis post surgical resection of
coarctation of the aorta.
77. Pure mitral stenosis may present by:
…..A: haemoptysis.
…..B: infective endocarditis.
…..C: angina with normal coronaries.
…..D: chronic bronchitis.
…..E: Ortner’s syndrome.
78. Valver aortic stenosis:
…..A: commonly associated with bicuspid valve.
…..B: never calcific .
…..C: has been caused by inflammation.
…..D: lipid lowering may hold its progression.
…..E: sudden death may occur without severe ECG changes.
79. Prosthetic valves follow up:
…..A: good warfarin control can still be associated with embolic events.
…..B: aortic prosthetic endocarditis is worse than mitral if caused severe
incompetence.
…..C: transthoracic echocardiography is reliable to detect vegetations.
…..D: vegetations may muffle prosthetic sounds.
…..E: redo valve replacement is not a risky operation.
80. Cardiomyopathy:
…..A: dilated cardiomyopathy may be familial.
…..B: hypertrophic cardiomyopathy is only serious in the presence of obstruction.
…..C: AF can cause rapid deterioration.
…..D: the right ventricle is never involved by restrictive cardiomyopathy.
…..E: automatic cardioverter defibrillator may be needed.
81. Hypertrophic cardiomyopathy can be associated with:
…..A: angina.
…..B: dyspnoea.
…..C: syncope.
…..D: infective endocarditis.
…..E: double or tipple apex.
82. Cardiac syndrome X may be associated with:
…..A: low pain threshold due to central pathology.
…..B: normal epicardial coronaries.
…..C: never with abnormal systolic function.
…..D: abnormal diastolic function.
…..E: slow flow of dye down epicardial coronaries.
83. Inflammatory markers:
…..A: detected in acute coronary syndrome.
…..B: irrelevant to post PCI restenosis.
…..C: is a worse prognostic factor in MI.
…..D: is independent of other ischaemic risk factors.
…..E: tumor necrosis factor is the only detectable marker.
84. Acute coronary syndrome:
…..A: requires clopidogrel therapy for as long as 9 months.
…..B: does not always require cool-down period prior to PCI.
…..C: low molecular weight heparin is not superior to unfractionated heparin.
…..D: lipid lowering is a necessary measure.
…..E: is of similar risk in diabetics.
85. Cardiac enzymes:
…..A: are useful to monitor progress of MI.
…..B: troponin is useful to detect early reinfarction.
…..C: CK-MB is not excusive to MI.
…..D: LDH is raised only with Q wave MI
…..E: SGOT is only raised when there is liver congestion.
86. Primary PCI for MI:
…..A: is of proved benefit.
…..B: is contraindicated in diabetics.
…..C: is associated with lower risk of intracranial bleeding.
…..D: is not useful in inferior MI
…..E: is successful in reducing reinfarction and death.
87. Potential risk factors for reinfarction:
…..A: silent ischaemia.
…..B: normal heart rate variability.
…..C: ventricular tachycardia.
…..D: normal left ventricular function.
…..E: diabetes mellitus.
88. Myocardial infarction with normal coronaries:
…..A: may be due to coronary spasm.
…..B: never documented.
…..C: could be due to recanalisation with thrombolytic.
…..D: may happen in women on the pill.
…..E: warrants evaluation for hypercoagulable state.
89. Thrombolytic therapy:
…..A: should be considered for all early MI.
…..B: is contraindicated above 80 years old.
…..C: contraindicated in both aortic and left ventricular aneurysm with thrombus
formation.
…..D: streptokinase may be reversed by tranexamic acid if major bleeding occurs.
…..E: t-PA is preferred in the presence of hypotension.
90. Lipid lowering:
…..A: is useful in acute coronary syndrome.
…..B: not very useful in elderly.
…..C: as useful in females as males.
…..D: may be useful in patients with normal lipid profile according to heart
protection study.
…..E: contained in the polypill.
91. Heart failure:
…..A: can be ruled out if brain natriuretic peptide is normal.
…..B: brain natiruretic peptide is not prognostically useful.
…..C: testosterone can be helpful.
…..D: anaemia is an independent prognostic factor.
…..E: is of higher mortality in male patients.
92. Digoxin:
…..A: acts by inhibiting sodium pump.
…..B: its inotropic effect is independent of calcium handling.
…..C: dosage should be reduced with amiodarone.
…..D: children need relatively larger per weight dosage.
…..E: useful in heart failure without AF.
93. Permanent pacemakers:
…..A: DDDR is more physiologic than VVIR.
…..B: bipolar system is more resistant to external stimulation.
…..C: shows larger spike with unipolar systems.
…..D: for hear failure is useful only in the presence of severe MR.
…..E: has been documented to be useful in patients with hypertrophic
cardiomyopathy.
94. Antiarrhythmic therapy:
…..A: quinidine therapy needs monitoring of QRS duration.
…..B: disopyramide effect is independent of the vagal tone.
…..C: lignocaine is less effective in hypokalaemia.
…..D: vasopressin may be useful in asystole.
…..E: excretion of quinidine and mexiletine is reduced in alkaline urine.
95. Infective endocarditis:
…..A: is not ruled out if there is no murmur.
…..B: is ruled out with normal ESR.
…..C: needs combination chemotherapy.
…..D: may need treatment for life with Coxiella burneti.
…..E: recurrent fever may be due to non bacterial causes.
96. Chronic pulmonary hypertension;
…..A: may be caused by recurrent pulmonary embolisation.
…..B: does not cause secondary thrombosis.
…..C: is associated with intimal thickening, medial hypertrophy and endothelial
proliferation.
…..D: may be treated by calcium antagonists.
…..E: prostacycline inhaler is contraindicated.
97. Thyroid induced cardiac disease:
…..A: cardioversion is relatively contraindicated.
…..B: may need non-selective beta blocking therapy.
…..C: may result in permanent cardiac damage.
…..D: is associated with coronary heart disease.
…..E: may need permanent pacemaker insertion despite correction of hypothyroid
status.
98. Pericardial pathology:
…..A: in tamponade raised venous pressure varies with breathing.
…..B: right atrial compression and right venrtricular diastolic collapse are neither
specific nor sensitive enough to diagnose tamponade.
…..C: pulsus paradoxus is absent in uraemic patients with tamponade.
…..D: can be associated with other serositis.
…..E: may be drug induced.
99. the use of thrombolytic therapy in the setting of angioplasty for unstable angina is:
…..A: strongly indicated because thrombus is frequently seen in acute coronary
syndrome.
…..B: indicated only in cases where dissection and thrombus are evident on
angiography.
…..C: Not indicated because of increased incidence of bleeding when given with
heparin.
…..D: not generally indicated because of poorer outcome.
100. In the cardiac catheterization laboratory the following are true except:
…..A: radiation scatter is increased when the angle of the tube is set obliquely.
…..B: Acrylic shields reduce the amount of scattered radiation.
…..C: fluoroscopy generates one fifth of the x-ray exposure of cineangiography.
…..D: the source of radiation in the cath lab is the image intensifier.