2012 Module Exam

Question 1

Which drug causes leg edema?
a- Centrally-acting drugs
b- Spironolactone
c- CCB
d- B blockers
e- ACEI
f- ARBs
g- Steroids

Answer 1

c- CCB

“Calcium channel blocker (CCB)‐related edema is quite common in clinical practice”

Question 2

Infection 4 weeks after prosthetic aortic valve replacement?

Answer 2

Staphylococcus epidermidis

Question 3

Which statement is correct about hypertension?
a- Treatment is indicated once the systolic pressure is above 160
b- Is the person start treating it, it will be well controlled

Answer 3

SBP > 160 indicates Grade II HTN, where lifestyle changes are initiated for several weeks, THEN BP drugs are added targeting <140/90

Question 4

The patient has chest pain with ST elevation in the ECG in V3 to V6?

Answer 4

Anterior wall MI

V1-V2 are anteroseptal, V1-V4 are anterior (LAD), V4-V6 are anterolateral (LCX), which is in this case

Question 5

what are the drugs that cause these side effects?
1- HTN:
2- Leg edema:
3- Cough:

Answer 5

Steroids
CCB
ACEI

Question 6

Artery supplies SA node?

Answer 6

Nodal

Question 7

Artery that arises from ascending aorta?

Answer 7

RCA

right and left coronary arteries

Question 8

Mechanism of action of Aliskirin?

Answer 8

Renin inhibitor

Question 9

What best describes the apex beat?

Answer 9

Most inferiolateral palpable area

Question 10

What happens when the coronary perfusion pressure increases?

Answer 10

Arteriolar constriction

*Remember the myogenic mechanism to maintain blood flow (Q=dP/R so if P increases then R will increase by vasoconstriction to maintain Q)

Question 11

CO is doubled, SVR is halved. What happens to MAP?

Answer 11

It remains the same

MAP=CO*SVR

Question 12

What happens (to myocytes) when afterload increases?

Answer 12

Shortening of myocytes

*Afterload decreases the velocity of muscle fiber shortening with the same length of systole (in the first beat before interference of baroreceptors) longer myocytes at first beat

(The force of a muscle contraction declines with increasing velocity)

Question 13

Type of endothelium in splenic sinus?

Answer 13

Discontinuous basal lamina
*Fenestrated capillaries are present in GIT mucosa, endocrine glands, renal glomerular and peritubular capillaries, choroid plexus and ciliary body. Sinusoids (aka discontinuous capillaries) are found in liver, spleen, and bone marrow

Question 14

Histology of brachiocephalic?

Answer 14

Elastic lamella

Question 15

All arrhythmia drugs share one thing, which is?

Answer 15

Decrease Phase 4

Question 16

Which of the following does not increase JVP?

a. DVT
b. Cor pulmonale
c. Left side HF

Answer 16

c. Left side HF
* DVT could lead to pulmonary embolism→hypoxic pulmonary vasoconstriction→cor pulmonale. However, only large emboli (very rare, 5%) can cause acute right-sided HF not the small emboli (80%). Although the most common cause of right-sided HF is left- sided HF, but ISOLATED left-sided HF is well known NOT to raise JVP.

Question 17

What does macrophage apoptosis indicate?

Answer 17

Reduce cellularity in advanced lesions
*In early lesions, M1 macrophage apoptosis is anti-atherogenic because they will be cleared by efferocytes and hence reducing cellularity. In advanced lesions, apoptosis is due to other factors like free cholesterol loading where the defective efferocytosis will lead to secondary necrosis

Question 18

A palpable pulsating mass in a wall of a vessel that is subjected to rupture, thrombosis, or embolism?

Answer 18

Aortic aneurysm

Question 19

What is the pharmacological effect of prolonged use of chlorohydrothiazide in reducing BP?
a- Decreases production of angiotensin II
b- Decreases vascular resistance
c- Antagonism of angiotensin receptors
d- Increases vascular calcium

Answer 19

b- Decreases vascular resistance

Question 20

Which patient will benefit from DC shock?

Answer 20

Ventricular fibrillation

Question 21

Mechanism of action of Heparin?

Answer 21

Accelerated the action of antithrombin III

Question 22

Atrial contraction on ECG?

Answer 22

P wave

Question 23

Last addition of volume at end of diastole?

Answer 23

Atrial kick

Question 24

459 heart disease cases were selected and matched with 459 individuals with no history of heart disease. Cases were asked about their family history. What is the measure of association between heart disease and family history?

Answer 24

Odds ratio

Question 25

What best explains reduced cardiac output in mitral stenosis?

Answer 25

Reduced preload

Question 26

If EDV=140, ESV=70, and afterload=80, what is SV?

Answer 26

70

Question 27

What is the characteristic of ischemic chest pain?

Answer 27

On and off radiating to the left arm

Question 28

EMQ question: there were wave forms of aortic stenosis and aortic insufficiency

Answer 28

?

Question 29

Chronic severe mitral regurgitation? (heard as)

Answer 29

Pansystolic murmur heard on apex *Pansystolic murmur of mitral regurgitation (e.g. in IE, acute RF, chronic RHD if fibrosis in chordae tendinae) is best heart on left axilla

Question 30

Causative microorganism of IV drug addicts?

Answer 30

Candida

Question 31

Which feature of the aorta is responsible for maintaining the arterial blood pressure?

Answer 31

Internal elastic lamina

Question 32

What happens at the end of ventricular diastole?

Answer 32

Closure of mitral valve *Atrial kick concludes phase I of cardiac cycle not the closure of AV valves, which occurs in phase II in response to an increase in intraventricular pressure after QRS initiation

Question 33

What causes the 1st heart sound?

Answer 33

Mitral valve closure

Question 34

What is the hyperdynamic abnormality in severe anemia in a 35 year old? a- Decreased resistance b- Faster velocity

Answer 34

a- Decreased resistance Although an increased velocity may occur in anemia due to increased CO, i.e. v=CO/(πr2), the direct consequence of anemia is decreased viscosity which decreases resistance (R=8ηl/ πr4) in a young patient.

Question 35

What is the hyperdynamic abnormality in thrombo-embolus in a 47 year old woman?

Answer 35

Decreased diastole (??)

Question 36

A 45 year old patient presented with chest pain that radiates to his back. He died a few days later. On autopsy, there was blood in the thoracic cavity and pericardium?

Answer 36

Aortic dissection or cardiac tamponade *Cardiac tamponade common cause is chest trauma. It may also be caused by myocardial rupture and rarely by aortic dissection

Question 37

A 25 year old professional swimmer has been experiencing exertional dyspnea. He died suddenly and on autopsy showed enlarged heart with asymmetrical septal hypertrophy. Histology shows myocyte disarray. What is the underlying etiology?

Answer 37

Genetic mutation (it appears to be a case of HCM with is 100% genetic)

Question 38

A 35 year old asymptomatic woman with mid systolic murmur found on routine checkup. Echocardiogram shows hoody appearance and involvement of mitral valve?

Answer 38

Myxomatous degeneration

Question 39

``` Which of the following occurs during rapid ejection (phase III of cardiac cycle)? a- 1st heart sound b- T wave on ECG c- Mitral valve closure d- Decreased aortic blood flow e- Increased ventricular pressure ```

Answer 39

e- Increased ventricular pressure