2017 Module Exam Flashcards by Hessa Al Salem

A patient presented to the hospital with the previous ECG image. Which of the following is the best treatment option for this patient ?

A. Immediate primary PCI

B. immediate fibrinolytic therapy

C. Immediate nitrates

D. Immediate dual anti-platelet therapy

A. Immediate primary PCI

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Where is the AV-node located?

A. Upper part of crista terminalis

B. Triangle of Koch

C. Membranous part of the intraventricular septum

B. Triangle of Koch

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What best describes stable angina?

A. Chest pain that is predictable on exertion

B. Chest pain that occurs during rest and exertion

C. Chest pain that is stabbing in nature and radiates to the back

D. Right upper quadrant pain

A. Chest pain that is predictable on exertion

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A hypertensive patient is being treated for his condition. He was prescribed a medication that caused him to have wheezes and dyspnea. What is likely causative drug?

A. Amlodipine

B. Beta blockers

C. Isoprenaline

D. alpha 1 blockers

B. Beta blockers

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A. Atrial fibrillation

B. Atrial flutter

C. 1st degree AV block

D. WPW syndrome

E. 3rd degree AV block

A. Atrial fibrillation

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What is meant by “intermittent claudication”?

A. Pain when walking and it is relieved by rest

B. Transient Unstable angina

A. Pain when walking and it is relieved by rest

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Fibrinolytic therapy is absolutely contraindicated in which patients?

A. History of intracranial haemorrhage

B. Advanced liver disease

C. Use of warfarin in his 20s

D. Infective endocarditis

A. History of intracranial haemorrhage

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Which of the following may cause secondary hypertension?

A. Chronic use of Steroids

B. Diabetes

C. Liver cirrhosis

D. Aortic regurgitation

A. Chronic use of Steroids

D. Aortic regurgitation

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A 60 Y/O man with a history of DM and smoking for 40 years is also obese. Which of the following is most likely to develop?

A. Atherosclerosis

B. Mitral valve prolapse

C. Pericarditis

D. Fibromascular dysplasia

A. Atherosclerosis

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What is the common cause of bluish declaration of newborn lips and tips (cyanosis)?

A. Tetralogy of fallout

B. Transposition of the great vessels

C. Atrial septal Defect

D. Hypoalbuminemia

B. Transposition of the great vessels

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What best describes pleuritic chest pain?

A. The pain is relieved with leaning forward and increases with inspiration

B. The pain is relieved with expiration and recumbent position

C. Burning in nature

D. Associated with S3 heart sound

A. The pain is relieved with leaning forward and increases with inspiration

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Which of the following best describes the jugular venous pressure?

A. increases with high left atrial pressure

B. independent of the patient’s position

C. Increases with increased abdominal pressure

D. increases with compression at the root of the neck

C. Increases with increased abdominal pressure

D. increases with compression at the root of the neck

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What is a characteristic histological feature of the Inferior Vena Cava ?

A. Elastic lamellae in T. Media

B. T. Adventitia With smooth muscle cells

C. Festerated endothelium

D. Presence of thick layer of smooth muscles in T. Media

B. T. Adventitia With smooth muscle cells

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A patient with tachyarrhythmia is resistant to all anti-arrhythmic drugs expect for amiodarone. What is the mechanism of action of this drug?

A. Block potassium channels

B. Block sodium channels in the activated state

C. Inactivate adrenergic stimulation

A. Block potassium channels

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The action of the angiotensin AT1-receptor will generally cause which of the following ?

A. Vasodilation

B. Bradykinen release

C. Aldosterone release

D. Na/H exchanger activation

C. Aldosterone release

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An increase in mean arterial pressure is mediated by an increase in which of the following mechanisms?

A. Renal blood flow

B. Speed of ejection

C. HCN current in the SA node

D. Conduction velocity in the AV nod

C. HCN current in the SA node

D. Conduction velocity in the AV nod

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A 24 year old male patient with lymphoma, started combination chemotherapy that contains adriamycin (Doxorubicin). How can you monitor cardio toxicity ?

A. Coronary CT angiogram

B. Coronary angiography

C. Gated cardiac blood pool imaging

D. Stress/rest myocardial perfusion scan

C. Gated cardiac blood pool imaging

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Which of the following results in diastolic murmur?

A. Mitral valve prolapse

B. mitral regurgitation

C. Aortic stenosis

D. aortic insufficiency

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What represents increased dp/dtmax ( myocardial contractility index ) ?

A. heart failure

B. decreased intraventricular pressure

C. decreased pre-ejection time (PET)

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What disease is associated with MYH7 mutation?

A. Familial hypertrophic cardiomyopathy

B. Dilated cardiomyopathy

C. Restrictive cardiomyopathy

D. Familial hypercholesteremia

A. Familial hypertrophic cardiomyopathy

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A 55yr old male with poorly controled htn for a decade was found in the hospital to have 250/125 bp and high creatinine level Which vascular lesion is mostly present in his kidney?

A. Hyperplastic arteriolosclerosis

B. Polyarteritis nodosa

C. Leukocytoclastic vasculitis

A. Hyperplastic arteriolosclerosis

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What is the causative agent of rheumatic fever ?

A. Streptococcus pyogens

B. Streptococcus agalactiae

C. Streptococcus Equisimilis

D. Streptococcus Milleri

A. Streptococcus pyogens

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In a myocardial perfusion image study, what does a myocardial defect seen on both stress and test images suggest?

A. scar after infarction

B. myocardial ischemia

C. normal myocardium

D. cardiomyopathy

A. scar after infarction

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An acute myocardial infarction of the lateral wall of the heart is most likely due to an infarct in which artery?

A. Left Anterior artery

B. Circumflex

C. Posterior descending artery

D. Left coronary artery

B. Circumflex

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A 65 years old female with uncontrolled hypertension is likely to present with which of the following? A. HFrEF B. HFpEF C. Pulmonary embolism D. Right sided heart failure

B. HFpEF

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

What is most likely to cause hypertension in a 17 years old female? A. Coarctation of the aorta B. Aortic stenosis C. Liver Failure D.atherosclerosis

A. Coarctation of the aorta

What is the main fuel for the heart? A. FA B. glucose C. ketone bodies D. lactate

A. FA

Based on genotypes, a carrier of CYP2C9 1\*/1\* and VKORC1 GG, which of the following therapy options is suitable for these carriers ? A. High warfarin dose B. Low warfarin dose C. High clopidogrel dose D. Low clopidogrel dose E. Normal clopidogrel dose

A. High warfarin dose

In normal ECG what is duration of PR interval A) \>0.12 to \<0.21 ( three to five small squares) B) it depends on QT interval C) It is same of QRS D) \>0.44

A) \>0.12 to \<0.21 ( three to five small squares)

What is the ESV? A. 60 B.120 C.80 D. 65

A. 60

A 68 year old female presented with acute dyspnea, and on physical examination, she had an irregular pulse and a heart rate of 140 bpm, what is the heart rhythm? A. AV escape rhythm B. Sinus rhythm with Mobitz I C. Atrial Fibrillation D. Paroxysmal atrial tachycardia

C. Atrial Fibrillation

What is the structure responsible for right to left shunt in the fetal ? A. coronary sinus B. ductua venosus C. ductus arteriosus D. Umbilical vein

C. ductus arteriosus

A patient has a cardiovascular disease and he is being treated for it, after a while he develops bilateral angioedema. Which of the following drugs is likely cause for his presentation? A. Diurestics B. Digoxin C. Angiotensin converting enzyme inhibitors D. Hydralazine

C. Angiotensin converting enzyme inhibitors

A 62 years old man died 3 weeks ago following myocardial infarction what is the histology at autopsy? A. coagulative necrosis B. granulation tissue C. a dense fibrous scar D. many newly formed capillaries and macrophages

C. a dense fibrous scar

A 27 year old female patient presented to you with breathlessness and cough. She was found to have mitral stenosis. What applies to this patient? A. left atrial volume overload B. The patient must be advised against future pregnancy C. A diastolic murmur D. Increased ventricular volume

C. A diastolic murmur

What is used for the primary prevention of thromboembolism in atrial fibrillation ? A. Clopidogrel B. aspirin C. clopidogrel & aspirin D. depending on Cha2ds2-vasc score if \> 3

D. depending on Cha2ds2-vasc score if \> 3

What is the rate limiting step of angiotensin 2 production? A. Renin release B. Conversion of angiotensin 1-7 to angiotensin 9 C. Angiotensinogen release from the liver D. Conversion of angiotensin 1 to angiotensin 2 by ACE

A. Renin release

Which of the following is a characteristic of advanced atherosclerotic plaque? A. Smooth muscle cell migration and proliferation B. Matrix Metaloproteases C. Thick fibrous cap

B. Matrix Metaloproteases

Which of the following accompanies the left anterior descending artery and the circumflex artery to join the coronary sinus? A. Great cardiac vein B. Middle cardiac vein C. Small cardiac vein D. Anterior cardiac veins

A. Great cardiac vein

A 42 year old obese diabetic heavy smoker was admitted to the hospital experiencing severe chest pain radiating to the left arm. He has a history of hospital admission twice in the past 2 years for similar episodes. What is the initial triggering mechanism underlying his arterial disease ? A. Elevated serum level HDL B. Elevated serum level Troponin 1 C. Vascular endothelial dysfunction D. Smooth muscle proliferation

D. Smooth muscle proliferation

What is the structure that divides atrioventricular canal right and left? A. Endocardial cushions B. Bulbar ridges C. Inter-atrial septum

A. Endocardial cushions

A. 3rd degree AV block B. Atrial fibrillation C. Atrial flutter D. Sinus bradycardia E. 2nd degree AV block mobitz 2

A. 3rd degree AV block

What is the plateau of the cardiac output of a 24 y/o athletic male who weighs 80kg? A.13 B.5 C.20 D.25

C.20

A 27 y/o women develops palpitations. Her ECG shows supraventricular tachycardia. Her blood pressure is 120/80. What is the first choice of treatment? A. IV Adenosine B. IV BB C. IV Digoxin D. IV CCB

A. IV Adenosine

Tetralogy of Fallot includes Which of the following ? A. Pulmonary stenosis B. ostium secundum defect C. patent foramen ovale D. Left ventricular hypertrophy

A. Pulmonary stenosis [ventricular septal defect (VSD), pulmonary stenosis, a misplaced aorta and a thickened right ventricular wall (right ventricular hypertrophy)]

Which of these underlying conditions is associated with hyaline arteriosclerosis? A. syphilis B. henoch / schonlein purpura C. polyartritis nodosa D. systemic hypertension E. wegners’ granulomatosis

D. systemic hypertension

Volume overload is caused by which of the following valve pathology? A. Mitral valve prolapse B. Pulmonary valve stenosis C. Mitral valve stenosis D. Aortic valve regurgitation E. Aortic valve stenosis

D. Aortic valve regurgitatio

Which medicine is indicated for patient with HFrEF? A. Diltiazem B. Nitrates C. Aldosterone antagonist D. Amlodipine

C. Aldosterone antagonist

A 45 Y/O man has a cardiac output of 6 L/ min on echocardiography he was found to have the following measures : EDV - 150 ml ESV - 50 ml EF= 68% What is the patient’s heart rate ? A. 60 B. 120 C. 100 D. 80

A. 60

Which of the following conditions require immediate electrical cardioversion? A. atrial fibrillation B. SVT C. ventricular tachycardia D. complete heart block

C. ventricular tachycardia

Which of the following increases venous return? A. Decreased venous compliance B. Increased central venous pressure C. Increased urine production D. Decreased blood volume

A. Decreased venous compliance

A. Right bundle branch block B. Left bundle branch block C. Hypokalemia D. Left ventricular hypertrophy E. Subendocardial myocardial infarction

A. Right bundle branch block

What stimulates ADH secretion in patient withHFr-EF? A. Activated baroreceptor reflex B. Hyponatremia C. Atrial distension

A. Activated baroreceptor reflex

How would you assess the degree of ischemia in a chronic stable angina patient? A. Exercise ECG test B. Myocardial perfusion scan C. Stress Echociography

B. Myocardial perfusion scan

In an auscultation of a 54 y/o woman a murmur with a high pitch throughout the systole was heard. What is the most likely diagnosis? A. Mitral stenosis B. Mitral regurgitation C. Aortic regurgitation D. Patent ductus arteriosus

B. Mitral regurgitation

What characterises the metabolic profile of fetal life? A. Glucose B. Fatty acids

A. Glucose

Which of the following is true regrading atherosclerotic plaques? A. Macrophage apoptosis has a proinflammatory effect in the early lesion B. Macrophage apoptosis has an anti-inflammatory effect in the advanced lesion C. Increased efferocytosis D. Macrophage apoptosis contributes to the plaque rupture in the advanced lesions E. Free cholesterol crystals accumulate in the early leasions

D. Macrophage apoptosis contributes to the plaque rupture in the advanced lesions

Secretion of which hormone will be most likely elevated in response to an increase in arterial blood pressure? A. ANP B. Aldosterone C. Adrenaline D. Thyroxine

A. ANP

A 57 y/o woman with right heart faliure, which of the following is most likely to be associated with her condition ? A. Blurred vision B. Reduced diuresis C. Headache D. Right upper quadrant pain

D. Right upper quadrant pain

What is the mechanism of action of (dobutamine) in congestive heart failure disease? A. Beta 1 adrenergic agonist B. Phosphodiesterase Inhibitors C. Cardiac glycosides D. Beta 1 adrenergic blocker

A. Beta 1 adrenergic agonist

What is the mechanism of action of clofibrate? A. PPAR alpha agonist B. PPAR gamma agonist C. PPAR gamma antagonist D. HMG CoA reductase inhibitors

A. PPAR alpha agonist

A 35 year old female was doing a routine check up for health insurance. During the physical examination, a mid-systolic click was detected. She was found to have hooding of the mitral valve. What would be the cause of her condition ? A. Rheumatic heart disease B. Myxomatous degeneration C. Subacute infective endocarditis D. mitral annular stenosis

B. Myxomatous degeneration

What is the effect of co-administering digoxin and thiazlide ( diuretics ) ? A. ncreases toxicity of digoxin B. reduce the absorption of digoxin C. reduce vagal activity of digoxin

A. ncreases toxicity of digoxin

A patient who has undergone an aortic valve replacement surgery developed fever and a heart murmur one month after the surgery. What is the likely causative agent ? A. Staphylococcus epidermidis B. Coxiella burnetii C. Staphylococcus aureus D. Streptococcus viridans

A. Staphylococcus epidermidis

A 20 year old man was involved in a car accident. He passed away and postmortem autopsy was performed. Upon autopsy, the aorta was subject to traumatic burst and yellow lines were observed along the lumen. What is microscopic finding that correspond to this pathology? A. intimal foam cells B. Intimal endothelial injury C. Intimal fibrosis D. Intimal ulceration

A. intimal foam cells

Which of these nerves carry pain sensations from the heart? A. Vagus nerve B. Sympathetic nerves C. Intercostal neve D. Ventral rami of the spinal nerves T1-T4

B. Sympathetic nerves

A 56 year old man with a history of exertional chest pain for two years presented to the hospital with severe chest pain. He was diagnosed to have an acute MI. What is the likely mechanism? A. Severe coronary stenosis of more than 75% B. Occlusive thrombus of the coronaries due to a plaque rupture

B. Occlusive thrombus of the coronaries due to a plaque rupture

A 49 Y/O patient presented to the emergency department with a blood pressure of 165/95. Upon physical examination, he was to have reduced pulse in his left arm but his femoral pulse is normal. The patient was also complaining of acute chest pain , which was severe in nature. What is the likely diagnosis? A. Coarctation of the aorta B. Acute myocardial infarction C. Aortic dissection D. Pericarditis

C. Aortic dissection

A patient has undergone an analysis for his cardiac function and perfusion and was found to have a reduced signal in the images obtained during exercise only, what is the likely condition? A. Myocardial ischemia B. Myocardial infarction C. Cardiomyopathy D. normal myocardium

A. Myocardial ischemia

A 47 year old patient presented to the emergency department with chest. Upon further investigation he was found to have an old inferior wall mycocardial infarction. Which of the following changes are found to be present in the patient's ecg? A. ST elevation in leads II, III, aVF B. ST elevation in leads V2-V6 C. 3mm ST depression in leads V2-V3 D. Pathological Q waves in leads V2-V5

A. ST elevation in leads II, III, aVF

Which of the following is a major manifestation in patients with acute rheumatic fever? A. Leukocytosis B. First degree AV block C. Fever D. Arthralgia E. Pericarditis

E. Pericarditis

A. Right atrial hypertrophy B. Left atrial hypertrophy C. Premature atrial contractions D. Premature ventricular contractions

A. Right atrial hypertrophy

What is the most liklely mechanisim of blood flow decline in the figure? A. increased sympathetic activity B. myogenic regulation C. wash out of vasoconstrictory metabolites

B. myogenic regulation

Which of the following decreases the heart rate? A. thyroxine B. alkalosis C. acidosis D. Hypercalcemia

C. acidosis

A. Mobitz 1 B. 1st degree AV block C. 2nd degree AV block mobitz 2 D. Premature atrial contraction E. 3rd degree AV block

A. Mobitz 1

which of the following has the greatest effect on increasing the strength of contraction? A. Inhibition of the parasympathetic activity B. Sympathetic activation C. Catecholamines D. Thyroxine

A. Inhibition of the parasympathetic activity

Why doesn’t flecainide concentration correlate with its therapeutic action? A. highly bound to plasma proteins and does not dissociate easily B. excreted unchanged in urine C. strongly metabolized by oral administrations D. highly concentrated in cardiac muscle

D. highly concentrated in cardiac muscle

What mediates the adhesion of bacteria to the endocardium ? A. Dextran B. Lipoteichoic acid C. Peptidoglycan

A. Dextran

Which of the following inhibits HMG coA reductase? A. Statins B. Ezetimibe C. BCSK9 inhibitors D. Colestipol

A. Statins

What hemodynamic changes are expected in the case of an intracranial haemorrhage? A. hypotension and tachycardia B. hypotension and bradycardia C. hypertension and bradycardia D. Hypertension and tachycardia

C. hypertension and bradycardia

14) A 53-year old Female with cardiac murmur on examination and left ventricular hypertrophy on ECG. What is the most likely valve disease? A. Tricuspid Regurgitation B. Mitral Stenosis C. Mitral Regurgitation D. Aortic Stenosis

D. Aortic Stenosis

Which valve is auscultated in the left 2nd intercostal space? A. Pulmonary valve B. Mitral valve C. Tricuspid valve D. Aortic valve

A. Pulmonary valve