2013 Module Exam Flashcards by Hessa Al Salem

Which of the following indicates fluid overload in a patient with heart failure?

A. Distended jugular veins

B. Loud second heart sound

C. Presence of a 4th heart sound

D. Heaving heart apex

A. Distended jugular veins

How well did you know this?

Not at all

Perfectly

Which of the following is determined by using a patient’s risk score (Framingham and Q score)?

To calculate the risk of developing a cardiovascular event over a 10 years period

How well did you know this?

Not at all

Perfectly

What causes an increase in stroke volume secondary (or in the next beat) to an extrasystolic beat?

A. decreased afterload

B. Increased contractility

C. Increased ESV

D. Frank-Starling mechanism

How well did you know this?

Not at all

Perfectly

A young athlete experienced palpitations 2 hours after exercising and working out. His ECG showed sinus beats interpolated between premature ventricular complexes. What is the reason for these PVCs?

A. Bradycardia

B. Sympathetic effect of exercise

C. Delayed after depolarization

A. Bradycardia

How well did you know this?

Not at all

Perfectly

What is true regarding secondary prevention?

A. Using aspirin in HF patients to prevent stroke

B. Using beta-blockers to prevent recurrence of heart failure

C. Using clopidogrel for Atrial fibrillation

D. IDC to prevent sudden death in patients with low ejection fraction

B. Using beta-blockers to prevent recurrence of heart failure

<40 Note: Both B and A were considered correct. The medical education staff removed choice “A”, so if this question came in the future, there would be only one correct answer, which is “B”.

How well did you know this?

Not at all

Perfectly

Mendelian familial diseases are known to have high penetrance. What is the frequency of SNPs in high penetrance diseases?

A. 0.1

B. 0.2

C. 0.0001

D. 0.5

C. 0.0001

How well did you know this?

Not at all

Perfectly

Which of the following statements is true regarding ejection fraction?

A. EF reflects the diastolic properties of the ventricle

B. EF is measured by subtracting diastolic volume from systolic volume

C. Normal EF 50-70%

D. People with increased EF have symptoms of heart failure

C. Normal EF 50-70%

How well did you know this?

Not at all

Perfectly

How do you treat heart failure with reduced ejection fraction?

Inhibition of RAAS

How well did you know this?

Not at all

Perfectly

Which of the following is decreased as a consequence of increased central venous pressure?

A. Venous return

B. Cardiac output

C. Venous compliance

D. Blood volume

E. Angiotensin II

A. Venous return

Note: Example: In heart failure, CO decreases due to loss of inotropy. This results in the activation of RAAS to increase total blood volume, together with venous constriction (in other words decreased venous compliance) by vasoconstrictor substances (e.g. angiotensin II, catecholamines) resulting in increased CVP. Whenever CVP increases, VR decreases and CO increases.

How well did you know this?

Not at all

Perfectly

A 64 year old man presented with acute chest pain radiating to his left arm, his ECG leads showed ST elevation, what would be life-saving to manage his situation?

A. Administration of nitrates

B. Immediate revascularization by coronary catheterization

C. Administration of morphine

D. Administration of dual antiplatelet therapy with heparin

B. Immediate revascularization by coronary catheterization

How well did you know this?

Not at all

Perfectly

What represents ventricular repolarization on ECG?

A. T wave

B. P wave

A. T wave

How well did you know this?

Not at all

Perfectly

What is the suggestive prevention for a patient at risk of myocardial infarction because of his hypercholesterolemia?

A. Aspirin

B. Lovastatin

How well did you know this?

Not at all

Perfectly

In a patient with a previous myocardial infarction, which of the following is the most common complication?

A. Deep vein thromboembolism

B. Systemic embolism from the left atrium

C. Systemic embolism from the left ventricle

D. Pulmonary embolism

C. Systemic embolism from the left ventricle

How well did you know this?

Not at all

Perfectly

What is the normal QRS duration on the ECG?

A. >0.21

B. >0.16

C. <0.12s

D. 0.12 -> 0.21

C. <0.12s

How well did you know this?

Not at all

Perfectly

Which of the following is contraindicated in a patient with prinzmetal angina?

A. Lovastatin

B. Nitro-glycerine

C. Propranolol

How well did you know this?

Not at all

Perfectly

The atrioventricular canal is separated into right and left atrioventricular canals by which structure?

A. Bulbar ridges

B. Endocardial cushions

C. Septum primum

D. Septum secondum

B. Endocardial cushions

How well did you know this?

Not at all

Perfectly

What confirms Cardiac findings of Acute Rheumatic Disease?

A. Fibrinous pericarditis

B. Necrosis and fibrosis of myocardium

C. Aschoff nodule

D. vegetations on mitral valve

C. Aschoff nodule

How well did you know this?

Not at all

Perfectly

What best describes the apical beat?

The 5th intercostal space midclavicular line

How well did you know this?

Not at all

Perfectly

Which of the following passes in the interventricular septum?

A. AV node

B. Bundle of His

C. Pukinje fibers

B. Bundle of His

How well did you know this?

Not at all

Perfectly

What does a patient with high CYP2C9 *1/*1 and VKORC1 GG Need?

A. Low dose warfarin

B. High dose warfarin

C. High dose clopidogrel

B. High dose warfarin

How well did you know this?

Not at all

Perfectly

Activation of which nerve decreases ventricular muscle contraction?

A. phrenic

B. intercostal

C. great splanchnic

D. vagus

How well did you know this?

Not at all

Perfectly

What increases myocardial oxygen consumption in aortic stenosis?

A. EDV

B. Stroke work

Note: In aortic stenosis, intraventricular pressure increases because a high pressure gradient is needed across the stenotic aortic valve to allow ejection. This results in an increase in ventricular wall stress (afterload) “#O2 demand. Keep in mind that stroke work is directly proportional to oxygen consumption.

How well did you know this?

Not at all

Perfectly

Which of the following pathways provides the greatest amount of energy in the normal heart?

A. Fatty acids ➡TCA

B. Ketone bodies ➡TCA

C. Pyruvate➡TCA

D. Glucose ➡glycolysis

A. Fatty acids ➡TCA

How well did you know this?

Not at all

Perfectly

What results from an increased pressure in the abdomen?

Ascites

How well did you know this?

Not at all

Perfectly

What is the main thing that regulates blood flow in the veins? A. Valves B. Negative intrathoracic pressure

B. Negative intrathoracic pressure

Which drug is contradicted in patients with long QT syndrome?

Potassium channel blockers

What is responsible for depolarization from -40 to +1in this graph? (Picture of slow AP) A. Activation of L-type calcium channels B. Activation of fast sodium channels

A. Activation of L-type calcium channels

Which of the following inhibits Na/K ATPase and is used for the management of congestive heart failure? A. Hydralazine B. Digoxin

B. Digoxin

A study was conducted to assess the relationship between retinopathy and photosensitivity, knowing that the incidence was 4.3 per million. What kind of study was conducted? A. Cross sectional study B. Cohort study C. Case control study

C. Case control study

What kind of valvular lesions is caused by Marfan syndrome? A. Floppy mitral valve B. Aortic stenosis

A. Floppy mitral valve

Wegener disease involves granulomatous inflammation of the respiratory tract and what? A. Kidneys B. Brain

A. Kidneys

What originates from the ascending aorta?

Right coronary artery

What causes a decrease in heart rate? A. Hypocalcemia B. Hyperkalemia C. Alkalosis

B. Hyperkalemia

A patient with leg pain upon walking. His ABI was 0.9; what is true about Ankle brachial index (ABI)? A. ABI=0.9 is abnormal B. ABI is an indicator of cardiac events C. ABI = systolic pressure in the ankle – systolic pressure of brachial artery

B. ABI is an indicator of cardiac events

What causes a negative inotropic effect? A. Diastolic failure B. Increased heart rate C. Increased Afterload D. Systolic failure

D. Systolic failure

Exercise Stress test (EST) is used to diagnose and manage suspected coronary artery disease. Which of these findings in the EST indicates ischaemia? A. Dizziness B. Fatigue C. Rise of blood pressure in the test D. Depression of ST segment at early stages

D. Depression of ST segment at early stages

A 45 year old hypertensive and diabetic smoker man comes to the hospital with excruciating chest pain that radiates to his back. The patient died and on autopsy they found blood in the thorax and pericardial and pleural cavities. What’s the INITIAL mechanism that triggered his arterial disease? A. Elevated serum LDL B. Elevated serum cTn C. Vascular endothelial damage D. Smooth muscle growth

C. Vascular endothelial damage **Note:** **This** **is** **a** **case** **of** **aortic** **dissection** **(dissecting** **aneurysm).** **It** **starts** **with** **a** **tear** **(weak** **point)** **in** **the** **wall** **of** **the** **aorta** **that** **will** **lead** **to** **blood** **leakage.**

Which of the following is a biomarker of progressive heart failure?

BNP

Which drug activates PPARα? A. Fibrates B. Resins

A. Fibrates

What is the recommendation for weekly physical activity by American Heart association (AHA)? A. 30 minutes walking 3 times a week B. 10 minutes walking 5 times a week C. 25 minutes jogging 3 times a week D. 60 minutes walking 3 times a week E. 45 minutes jogging 5 times a week

C. 25 minutes jogging 3 times a week

What is the most likely cause of clopidogrel resistance? A. Reversible inhibition of ADP B. Genetic polymorphisms

B. Genetic polymorphisms

Flecainamide is used to treat ventricular arrhythmias. It exerts its therapeutic action by affecting which phases of the ventricle AP? (AP graph was given) A. Phase 0 and phase 4 B. Phase 0 and phase 2 C. Phase 3 and phase 4

A. Phase 0 and phase 4

What is found mostly in the tunica intima of blood vessels? A. Collagen type 4 B. Collagen type 1

A. Collagen type 4

What is the _most prominent_ component on the tunica media of the aorta? A. Collagen type 3 B. Elastin

B. Elastin

What is the mechanism of action of amrinone in increasing cardiac contractility in heart failure? A. Na/K ATPase inhibitor B. Phosphodiesterase inhibitor

B. Phosphodiesterase inhibitor

Which of the following causes vasodilation? A. Endothelin B. Valsalva manoeuvre C. Carotid artery occlusion by a thrombus D. Lying down

D. Lying down **Note:** **When** **a** **person** **is** **lying** **down,** **sympathetic** **activation** **of** **systemic** **vasculature** **is** **reduced,** **which** **causes** **systemic** **vascular** **resistance** **to** **fall** **as** **the** **resistance** **vessels** **dilate.**

What’s the first drug of choice in treating supraventricular tachycardia?

Adenosine

In an unmatched case control study, 58% of the cases are moderate smokers compared to 31% of controls. What is the odds ratio? A. 1- 1.5 B. 2- 2.5 C. 3- 3.5

C. 3- 3.5 Note: Don’t divide 58 over 31! You need to draw a 2x2 table. OR= (58x69)/(31x42)= 3.07

A patient with angina is treated with beta blockers and now has improved exercise tolerance. Why? A. Decreased HR B. Increased filling time

A. Decreased HR

What is meant by the genetic risk score?

The total effect of several SNPs in genes associated with the disease

How do bacteria bind to a thrombus on the valve?

Dextran

What is the characteristic of an advanced atherosclerosis plaque? A. Increased efferocytosis B. Decreased apoptosis C. production of metalloproteases D. Increased emigration of macrophages

C. production of metalloproteases

What is the effect of a sudden increase in norepinephrine on heart rate? A. Increases heart rate because norepinephrine has a positive inotropic effect B. decreases heart rate

A. Increases heart rate because norepinephrine has a positive inotropic effect

A patient presented with chest pain of 30-minute duration. What will you do to confirm the diagnosis of MI? A. Check troponin B. Cardiac angiography C. ECG D. Chest X-ray

C. ECG **N****ote:****This****is****the****correct****answer****according****to****medical****education****department.****Troponin****is****released****within****4****to****6****hours.**

What prolongs QT on the ECG? A. Quinidine (or class IA anti-arrythmatics) B. Hypercalcemia C. Calcium channel blockers D. K+ channel blockers E. Hypokalemia

D. K+ channel blockers

What would you find in the pathological specimen of a patient with symptoms of congestive heart failure?

Hemosideren laden macrophages

What is the first gross evidence of an atheromatous plaque A. Fatty streaks B. Raised plaque C. Calcification D. Ulceration

A. Fatty streaks

Which artery supplies the primary pacemaker of the heart?

Nodal artery

In which disease does the blood flow causes splitting in the arterial wall layers and forms a false lumen?

Aortic dissection

Increase in which of the following diminishes the pulse pressure? A. Stroke volume B. Speed of ejection C. Aortic compliance D. Heart rate E. LV dp/dt

D. Heart rate Note: The correct answer in our exam was heart rate. However, many students put aortic compliance because it was mentioned in the table that we had in one of the seminars. I discussed the question with Dr. Fawzi and Dr. Turcani and both of them said it is correct as well.

Which of the following blocks potassium channels? ## Footnote A. Lidocaine B. Amiodarone C. Quinidine

B. Amiodarone

Which drug requires activation and undergoes enterohepatic circulation? A. Lidocaine B. Amiodarone C. Quinidine

B. Amiodarone

Positive dromotropic effect of exercise A. Activation of Nicotinic K+ channels B. Activation of HCN channels C. Inactivation of L-type Ca channels D. Hyperpolarization of the SA node

B. Activation of HCN channels

Which drug is found in the cardiac tissue many more times than the blood? A. Lidocaine B. Amiodarone C. Quinidine

B. Amiodarone

Negative chronotropic effect of diving A. Activation of Nicotinic K+ channels B. Activation of HCN channels C. Inactivation of L-type Ca channels D. Hyperpolarization of the SA node

D. Hyperpolarization of the SA node

Its normal duration is 0.12-0.2 A. PR interval B. QT segment

A. PR interval

Polarization of M1 macrophages A. IL-12 B. IL-13 C. INF-λ D. IL-4 E. MCSF F. MCP-1

C. INF-λ

Attracts monocytes to the site of the atherosclerotic plaque A. IL-12 B. IL-13 C. INF-λ D. IL-4 E. MCSF F. MCP-1

F. MCP-1

Inflammation and thrombosis (with segmental necrosis) of medium and small vessels of the upper and lower extremities in a young heavy smoker male A. Giant cell vasculitis B. Kawasaki disease C. Polyarteritis nodosa D. Buerger disease

D. Buerger disease

Necrotizing arteritis of coronary, hepatic, renal, mesenteric, and skin small and medium sized vessels leading to micro aneurisms A. Giant cell vasculitis B. Kawasaki disease C. Polyarteritis nodosa D. Buerger disease

C. Polyarteritis nodosa

Large vessel vasculitis in the elderly and causes blindness if not treated A. Giant cell vasculitis B. Kawasaki disease C. Polyarteritis nodosa D. Buerger disease

A. Giant cell vasculitis

What increases with temporal increase in aortic pressure? A. ESV B. SV C. Afterload

C. Afterload **N****ote:****Temporal****here****means****that****they****increase****simultaneously****that’s****why****the****answer****is****afterload****not****ESV.**

Indicated to prevent the deterioration of the left ventricular function after myocardial infraction A. Angiotensin converting enzyme inhibitor B. Nitrate C. Secondary prevention

A. Angiotensin converting enzyme inhibitor

Pain in the hips, thighs, or calves upon walking and is relieved by rest

Intermittent claudication

What increases in the initial phase of Valsalva manoeuvre? A. Venous return B. Heart rate C. Peripheral venous pressure D. Arterial blood pressure E. ESV F. Stroke volume

D. Arterial blood pressure

A measure of the total blood flow through the pulmonary circulation A. Stroke volume B. Cardiac output C. Viscosity D. Resistance E. Systolic blood pressure

B. Cardiac output Note: CO is basically what gives the blood flow.

In the pathological specimen of a patient who is known to be a case of SLE, whitish vegetations were found on the mitral and aortic valves A. Non-bacterial thrombotic endocarditis B. Infective endocarditis C. Rheumatic endocarditis D. Libman-Sacks endocarditis

D. Libman-Sacks endocarditis Note: Though it wasn’t mentioned in the notes, Libman-Sacks endocarditis (LSE) is known to be the most characteristic cardiac manifestation seen in patients with SLE. It most commonly affects mitral and aortic valves but all valves can be affected.

This condition is treated by Renin-angiotensin system modulation A. Hypertension –induced heart failure B. Pulmonary hypertension C. Cor-pulmonale

C. Cor-pulmonale

Results in heart failure with preserved ejection fraction A. Hypertension –induced heart failure B. Pulmonary hypertension C. Cor-pulmonale

A. Hypertension –induced heart failure

What is indicated in every patient with previous MI? A. Aspirin B. ACEI

A. Aspirin

Presynaptic α2-agonist

clonidine

Treatment of pregnancy-induced hypertension

methyldopa

If coronary arteries are affected by 50% stenosis, which of the following statements is correct? A. Resting blood flow will be reduced by 16-fold B. Resting blood flow will be reduced by 8-fold C. Coronary arteries will no longer be able to autoregulate D. Maximal coronary capacity will be reduced E. Arterioles will constrict

D. Maximal coronary capacity will be reduced **Note:** **The** **resting** **flow** **doesn’t** **change** **with** **narrowing** **of** **the** **coronaries.**

What is a direct sign of left-sided heart failure? A. Ascites B. Orthopnoea

B. Orthopnoea

What causes heart failure with reduced ejection fraction? A. Hypertrophy B. Multiple infarcts

B. Multiple infarcts

Which of the following is true regarding RAAS in heart failure? A. Using angiotensin II receptor blockers decrease aldosterone B. Aldosterone causes diuresis C. It must be blocked in heart failure with reduced ejection fraction D. Aldosterone causes potassium retention

C. It must be blocked in heart failure with reduced ejection fraction

What is the gross appearance of benign hypertensive nephrosclerosis?

Fine granular outer surface

If total peripheral resistance (TPR) in a subject was 22mmHg/L/min at the sea level. He climbed hills and the new amplitude is 4000m above the sea. If blood viscosity has increased by 15%, what is the new TPR? A. 19 B. 22 C. 25 D. 33

C. 25 **Resistance** **is** **directly** **proportional** **to** **viscosity** **(n)**"**so** **15%** **increase** **in** **viscosity** **will** **result** **in** **15%** **increase** **in** **TPR**"**15%** **x** **22** **=** **3.3**"**3.3** **+** **22** **=** **25.3** **mmHg/L/min**

What type of aneurysm occurs following massive MI? A. Dissecting aneurysm B. Syphilitic aneurysm C. Mycotic aneurysm D. Cardiac aneurysm

D. Cardiac aneurysm

Which letter represents the maximum coronary blood flow in the left coronary artery? A. A B. B C. C D. D E. E

Notice that this graph represents ventricular blood volume where B is pointing to the _beginning of isovolumic relaxation_. During systole, coronary resistance is very high due to the compression that is caused by muscular contraction, and thus there’s almost no flow. Towards the end of reduced ejection, coronary flow starts to increase and reaches its maximum in isovolumic relaxation by reactive hyperaemia (a period of flow following a period of no flow).

What is palpable mass in a blood vessel that might rupture and cause a thrombus or an embolus?

Aneurysm

Which structures will NOT be affected by a block in the anterior interventricular artery? A. SA node B. AV bundle

A. SA node

A patient with blood pressure of 170/90 experiences exertional dyspnea, why? A. Presence of arrhythmia B. Presence of coronary artery disease C. Presence of left ventricular diastolic dysfunction

C. Presence of left ventricular diastolic dysfunction

What is the best treatment for a patient with chronic stable angina? A. Diuretics B. Performing coronary angiography before medications C. Administering Amplodipine

C. Administering Amplodipine

Most common cause of abdominal aortic aneurysm A. Syphilitic aneurysm B. Mycotic aneurysm C. Atherosclerotic aneurysm D. Berry aneurysm E. Dissecting aneurysm

C. Atherosclerotic aneurysm

Aneurysm in a 45 year old woman who is known to be a case of Marfan’s syndrome A. Syphilitic aneurysm B. Mycotic aneurysm C. Atherosclerotic aneurysm D. Berry aneurysm E. Dissecting aneurysm

E. Dissecting aneurysm

Aneurysm in a case with cystic medial necrosis A. Syphilitic aneurysm B. Mycotic aneurysm C. Atherosclerotic aneurysm D. Berry aneurysm E. Dissecting aneurysm

E. Dissecting aneurysm

What characterizes the murmur heard in aortic stenosis?

Starts softly and peaks in midsystole

Which of the following has a positive effect on cardiomyocyte contraction? A. ATP-induced Ca++ release B. Phosphalamban activation C. Ryanodine receptor activation D. L type inactivation

C. Ryanodine receptor activation

What does this ECG show? A. Atrial tachycardia B. Sinus tachycardia C. Ventricular fibrillation D. Atrial fibrillation

D. Atrial fibrillation In the ECG we had in the exam, the ventricular response was slow, which means that if you calculated the ventricular rate it would be around 40. This doesn’t exclude AF.

What is the immediate treatment for a patient with the following ECG? ## Footnote A. Revascularization by catheterization B. Administration of fibrinolytic therapy C. Dual antiplatelet therapy with heparin D. Warfarin

C. Dual antiplatelet therapy with heparin **The** **heart** **rate** **in** **the** **ECG** **was** **very** **fast** **(around** **220)**

What does this ECG show?

ST segment elevation

What does this ECG show? A. Multifocal atrial tachycardia B. Ventricular fibrillation C. Respiratory arrhythmia D. Atrial fibrillation E. Sinus tachycardia

D. Atrial fibrillation **Note:** **The** **waves** **that** **are** **shown** **are** **T** **waves** **not** **P** **waves.**

What is the condition caused by partial occlusion of coronary arteries by a plaque causing 50% stenosis? A. Stable angina B. Unstable angina C. MI

A. Stable angina

What is the condition caused by 50% occlusion of coronary by a thrombus following plaque rupture? A. Stable angina B. Unstable angina C. MI

B. Unstable angina

What causes IE in IV drug users? A. S. aureus B. S. epidermidis

A. S. aureus

Which of the following is a cause of secondary hypertension? A. Chronic use of NSAIDs B. Presence of diabetes C. Hepatic cirrhosis

A. Chronic use of NSAIDs

If neglected, what would cause left ventricular dilatation and sings and symptoms of left-sided heart failure? A. Mitral stenosis B. Mitral regurgitation C. Tricuspid stenosis D. Aortic stenosis

B. Mitral regurgitation