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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.