Cardiology Flashcards
(112 cards)
1
Q
Which of the following requires a 2D echo for diagnosis?
A. MVP B. Hypertrophic cardiomiopathy C. CHF D. Cardiac Tamponade E. ASD
A
Hypertrophic cardiomyopathy
2
Q
In which scenario is 2D echo with DS NOT generally necessary
(a) 25 year old man with grade 2 continous murmur
(b) 45 year old woman with grade 2 mid-diastolic murmur
(c) 20 year old woman with grade 2 mid-systolic murmur but asymptomatic
(d) 50 year old man with grade 3 late systolic murmjr
(e) 20 year old man with grade 2 holosystolic murmur but ASYMPTOMATIC
A
(e) 20 year old woman with grade 2 mid-systolic murmur but asymptomatic
3
Q
Malar telangiectasia is cutaneous manifestationnof which cardiovascular disease?
■ Severe mitral stenosis ■ Significant CAD ■ Malignant hypertension ■ Osler- Weber-Rendu syndrome ■ Carney syndrome
A
Severe mitral stenosis
4
Q
Presence of peripheral edema in the setting of a normal venous pressure
■ Constrictive Pericarditis ■ Venous insufficiency ■ Cardiac tamponade ■ severe CHF ■ severe atherosclerosis
A
Venous insufficiency
5
Q
Patient seen at the ER in respiratory distress with a notable drop in his blood pressure from 110/80 to 90/70 on inspiration. Which is the most likely cause?
■ severe aortic stenosis ■ dilated cardiomyopathy ■ restrictive cardiomyopathy ■ cardiogenic shock ■ pericardial effusion
A
Pericardial effusion
6
Q
Patient seen at the ER in respiratory distress with a notable drop in his blood pressure from 110/80 to 90/70 on inspiration. Which is the most likely cause?
■ severe aortic stenosis ■ dilated cardiomyopathy ■ restrictive cardiomyopathy ■ cardiogenic shock ■ pericardial effusion
A
Pericardial effusion
7
Q
An anacrotic pulse with shrill is mostly lilely due to
■ aortic stenosis ■ hypertrophic cardiomyopathy ■ advanced aortic regurgitation ■ severe dilates cardiomyopathy ■ premature ventricular contractions
A
Aortic stenosis
8
Q
60 year old diabetic man with persistent chest discomfort consults at your clinic. On checking his blood pressure, BP in the right arm is 140/80 while his left arm BP is 120/80. What caused the above finding?
■ Aortic dissection ■ Essential Hypertension ■ Aortic regurgitation ■ Large AV fistula ■ normal finding for age group
A
Aortic dissection
9
Q
Reversed split S1
■ Complete RBBB ■ Complete LBBB ■ RA myxoma ■ Normal in young ■ ASD
A
Complete LBBB
10
Q
Wide split S2
■ Pulmonary Hypertension ■ Severe Aortic stenosis ■ RBBB ■ Hypertrophic cardiomyopathy ■ Acute MI
A
RBBB
11
Q
Which of the following is the systolic sound
■ click murmur complex ■ Opening snap ■ Pericardial knock ■ Tumor Plop of atrial myxoma ■ 4th heart sound
A
Click murmur complex
12
Q
A 28 y/o female, White patient presents to the ER with the following: recent onset hypertension of 200/120, maintained on Losartan 50mg OD and Amlodopine 10mg ODHS, abdominal bruit heard on auscultation. Patient is also known to have fibromuscular dysplasia. This patient most likely is diagnosed to have:
■ Essential hypertension ■ Renal Artery Stenosis ■ Renal parenchymal disease ■ Coarctation of aorta ■ Hyperaldosteronsim
A
Renal artery stenosis
13
Q
35 yo male patient came in the ER due to hypertension of 190/100. History reveals refractory hypertension for 1 week now despite medications. There was associated polyuria and muscle weakness. There was no vomiting or diarrhea. Laboratory results revealed hypokalemia, 2.7meq/L. The hypertension is most likely due to: *
1/1
■ Essential hypertension ■ Renal Artery Stenosis ■ Secondary hypertension due renal parenchymal disease ■ Coarctation of aorta ■ Hyperaldosteronsim
A
Hyeraldosteronism
14
Q
Systolic hypertension with wide pulse pressure include the ff except: *
■ aortic stenosis ■ thyrotoxicosis ■ fever ■ AV fistula ■ PDA
A
Aortic stenosis
15
Q
Class I indication for pacemaker implantation, except?
■ Atrial fibrillation with bradycardia and pauses >5 s
■ SA node dysfunction with symptomatic bradycardia or sinus pause
■ Mildly symptomatic patients with waking chronic heart rates <40 beats/min
■ Symptomatic SA node dysfunction as a result of essential long-term drug therapy
A
Mildly symptomatic patients with waking chronic heart rates <40 beats/min
16
Q
The patient complained of palpitations and was brought to the ER. BP reading was 80/60. She was hooked to cardiac monitor with a reading of atrial fibrillation in fast ventricular response. What is the most appropriate initial management?
■ Carotid massage
■ Amiodarone 150mg slow IV bolus
■ Adenosine 6mg IV bolus
■ Cardiovert with 200J
A
Cardiovert with 200J
17
Q
Patient AB, a 45 years old male, came in due to chest pain, with stable vital signs, suddenly presented with the ECG reading Vtach What is your next step?
■ Adenosine 6 mg IV
■ Defibrillate 360 J
■ Verapamil 2.5 mg IV
■ Amiodarone 150 mg IV
A
Amiodarone 150 mg IV
18
Q
Coronary angiography revealed 1-vessel disease with total occlusion of the proximal to mid LAD. Patient underwent subsequent PCI of the culprit vessel. Angiographic success occurs in 95-99% of patients undergoing PCI and is defined by reduction of the stenosis to less than how many percent of the diameter narrowing?
■ 10%
■ 20%
■ 30%
■ 50%
A
20%
19
Q
The following are Non-Cardiac / Systemic Causes of Elevated Troponin Reflecting Myocardial Damage Other Than Spontaneous Myocardial Infarction (Type 1), EXCEPT
■ Pulmonary Embolism
■ Sepsis, shock
■ Rhabdomyolysis
■ Amyloidosis
A
Amyloidosis
20
Q
A state-of-the art blood test has been developed for the rapid, noninvasive diagnosis of CAD. The assay has a 90% sensitivity and 90% specificity for the detection of at least one coronary stenosis of greater than 70%. In which of the following scenarios is the blood test likely to be of the most value to the clinicians?
■ A 29 year old man with exceptional chest pain, he has no cardiac risk factors.
■ A 41 year old asymptomatic premenopausal woman.
■ A 78 year old diabetic woman with exertion chest pain who underwent 2-vessel coronary stunting 6 weeks ago.
■ A 62 year old man with exertion chest pain; he has HPN, dyslipidemia, and a 2-pack per day smoking history.
■ A 68 year old man with chest discomfort at rest accompanied by 2 mm of ST segment depression in the inferior leads on the ECG.
A
A 62 year old man with exertion chest pain; he has HPN, dyslipidemia, and a 2-pack per day smoking history.
21
Q
Unequal upper extremity arterial pulsations are commonly found in each of the following disorders except: *
■ Aortic dissection ■ Takayasu disease ■ Supravalvular aortic stenosis ■ Subclavian artery atherosclerosis ■ Subvalvular aortic stenosis
A
Subvalvular aortic stenosis
22
Q
Which of the following ECG features is typical of left anterior fascicular block? *
■ Q waves in the inferior leads
■ Mean QRS axis between 0 and -30 degrees
■ QRS duration >0.12 msec
■ rS pattern in the inferior leads and qR pattern in lateral leads
■ Marked right axis deviation
A
rS pattern in the inferior leads and qR pattern in lateral leads
23
Q
All of the following statements about pulses paradoxes are true except:
■ A reduction in systolic arterial pressure of up to 8 mmHg during inspiration is normal.
■ Pulsus paradoxus is observed frequently in cardiac tamponade
■ Pulsus paradoxus is observed in patients with pulmonary disease associated with wide swings in intrathoracic pressure.
■ In the presence of aortic regurgitation, pulsus paradoxus is less likely to develop, despite the presence of tamponade.
■ Pulsus paradoxus is typically present in patients with HCM.
A
Pulsus paradoxus is typically present in patients with HCM.
24
Q
The timing of an “innocent” murmur is usually: *
■ Early systolic ■ Presystolic ■ Midsystolic ■ Holosystolic ■ Early diastolic
A
Midsystolic
25
Each of the following statements regarding auscultatory findings of mitral stenosis is correct except: *
■The opening snap is an early diastolic sound
■ A long A2-OS interval implies severe MS
■ In AF, the A2-OS interval varies with cycle length
■The "snap" is generated by rapid reversal of the position of the anterior mitral valve
■ The presence of an opening snap implies a mobile body of the anterior mitral leaflet
A long A2-OS interval implies severe MS
26
Digitalis is of potential benefit in all of the following conditions except: *
■ Mitral stenosis with atrial fibrillation and normal RV function
■ Dilated cardiomyopathy with LV EF of 25% and normal sinus rhythm
■ Hypertrophic cardiomyopathy with LV EF of 70% and AF
■ Mitral stenosis with normal sinus rhythm and normal RV function
Mitral stenosis with normal sinus rhythm and normal RV function
27
The following statement is true regarding the cardiac cycle. *
■ The third heart sound corresponds to the rapid early diastolic filling of the ventricles.
■ The presence of the a wave on the right atrial pressure is typical of atrial fibrillation.
■The QRS complex corresponds to the initiation of the isovolumic relaxation.
■ The mitral valves opens in systole when the left ventricular pressure falls below the left atrial pressure.
The mitral valves opens in systole when the left ventricular pressure falls below the left atrial pressure.
28
All of the following conditions are associated with high-output heart failure except: *
■ Iron overload
■ Hyperthyroidism
■ Systemic arteriovenous fistulas
■ Thiamine deficiency
■ Paget's disease
Thiamine deficiency
29
Which of the following is associated with increased left ventricular preload? *
```
■ Sepsis
■ Right ventricular infarction
■ Mitral regurgitation
■ Dehydration
■ Pulmonary embolism
```
Mitral regurgitation
30
The most common cause of heart failure is: *
A. Regurgitant valvular heart disease
B. Viral infection
C. Drug-induced
D. Coronary artery disease
CAD
31
A 60 year old male patient was complaining of 1 month history of dyspnea, easy fatigability and edema. You started him on Furosemide, Losartan and Carvedilol with subsequent improvement. A 2DED was done revealing global hypokinesia with an ejection fraction of 30%. What stage of heart failure does he belong? *
A. Stage A
B. Stage B
C. Stage C
D. Stage D
Stage C
32
Patients with a low-to-moderate likelihood of DVT or PE should undergo initial diagnostic evaluation with d-dimer testing alone without obligatory imaging tests. The S1Q3T3 is relatively specific but insensitive.
a. Both statements are true.
b. Only the first statement is true.
c. Only the second statement is true.
d. Both statements are incorrect.
A. Both statements are True
33
Patients with venous thromoboembolism in the setting of suspected heparin-induced thrombocytopenia, one may utilize the following parenteral direct thrombin inhibitors EXCEPT *
a. Dabigatran
b. Argatroban
c. Bivalirudin
d. None of the above
A.
34
What is the second line diagnostic test for pulmonary embolism?
a. Chest CT angiography
b. Ultrasonography
c. Lung scanning
d. Echocardiography
C. Lung Scanning
35
Intraarterial thrombolytic therapy with recombinant tissue plasminogen activator in the following conditions except *
a. If arterial occlusion is one week and caused by thrombus in an arterial bypass graft
b. If arterial occlusion is 30 days and caused by a thrombus in an occluded stent
c. If arterial occlusion is two weeks and caused by a thrombus in an atherosclerotic vessel
d. None of the above
c. If arterial occlusion is two weeks and caused by a thrombus in an atherosclerotic vessel
36
Compression of a large arteriovenous fistula may cause reflex slowing of the heart rate. *
a. Nicoladoni-Branham sign
b. Bernouli-Pasteori sign
c. Charley-Budd sign
d. Bamm-Harley sign
A. Nicoladoni-Branham sign
37
Which of the following drugs are thought to increase the duration of exercise in several placebo-controlled studies but not yet confirmed in clinical trials, among patients diagnosed to have peripheral arterial disease. *
a. Cilostazol
b. Vasodilator prostaglandins
c. Pentoxifylline
d. Apixaban
c. Pentoxifylline
38
Patients with claudication are advised to exercise regularly, prolong walking distance, at what duration and frequency? *
a. 15-20 min sessions, 5 times per week for at least 12 weeks
b. 20-30 min sessions, 3-5 times per week for at least 12 weeks
c. 30-45 min sessions, 3-5 times per week for at least 12 weeks
d. 45 min sessions, 3 times per week for at least 2 months
c. 30-45 min sessions, 3-5 times per week for at least 12 weeks
39
19-year-old previously healthy hockey player is defending the goal when he is hit in the left chest with a hockey puck. He immediately collapses to the ice. His coach runs to his side and finds him unresponsive and without a pulse. Which of the following is most likely responsible for this syndrome? *
```
A. Aortic rupture
B. Cardiac tamponade
C. Commotio cordis
D. Hypertrophic cardiomyopathy
E. Tension pneumothorax
```
Blunt, nonpenetrating trauma such as that described here can result in commotio cordis, which occurs when the trauma impacts the heart during the susceptible phase of repolarization just before the peak of the T wave and results in ventricular fibrillation.
40
A 32-year-old female is seen in the emergency department for acute shortness of breath. A helical CT shows no evidence of pulmonary embolus, but incidental note is made of dilatation of the ascending aorta to 4.3 cm. All the following are associated with this finding EXCEPT: *
```
A. Syphilis
B. Takayasu’s arteritis
C. Giant cell arteritis
D. Rheumatoid arthritis
E. Systemic lupus erythematosus
```
E. Systemic lupus erythematosus
41
A 35-year-old woman with a history of tobacco abuse presents to the emergency department because of severe chest pain radiating to both arms. The pain began 8 hours ago and is worse with inspiration. She has been unable to lie down as this markedly exacerbates the pain, but she feels better with sitting forward. Examination is notable for a heart rate of 96 beats/min, blood pressure of 145/78 mmHg, and oxygen saturation of 98%. Lungs are clear and a friction rub with three components is audible and is best heard at the left lower sternal border. Which of the following are most likely to be found on her ECG? *
A. Diffusely inverted T waves in the precordial leads
B. PR elevation in leads II, III, and aVF
C. Sinus tachycardia
D. ST-segment elevation in I, aVL, and V2–V6 with upward concavity and reciprocal depressions in aVR
E. ST-segment elevation V1–V6 with convex curvature and reciprocal depressions in aVR
D. ST-segment elevation in I, aVL, and V2–V6 with upward concavity and reciprocal depressions in aVR
The patient has a classic presentation for acute pericarditis with constant or pleuritic chest pain, exacerbated by lying flat and alleviated by sitting forward. Serum biomarkers may show mild evidence of myocardial injury from myocardial inflammation, but are generally not substantially elevated. Friction rub is frequently present, has three components, and is best heard while the patient is upright and leaning forward. In the acute stages, ECG classically shows ST-segment elevation with upward concavity in two or three standard limb leads and V2 through V6 with reciprocal changes in aVR. Convex curvature is more commonly found in acute myocardial infarction. PR depression may be found. After several days, the ST changes resolve and T waves become inverted. After weeks to months, the ECG returns to normal
42
Granulomatous vasculitis of the upper and lower respiratory tracts together with glomerulonephritis lower respiratory tracts together with glomerulonephritis
```
A. Lupus Vasculitis
B. Wegeners Granulomatosis
C. PAN
D. Systemic sclerosis
E. Takayasus arteritis
```
B. Wegeners Granulomatosis
43
Microvasculopathy, Immune dysregulation, Fibrosis
```
A. Lupus Vasculitis
B. Wegeners Granulomatosis
C. PAN
D. Systemic sclerosis
E. Takayasus arteritis
```
D. Systemic Sclerosis
44
Multisystem, necrotizing vasculitis of small- and medium-sized muscular arteries in which involvement of the renal and visceral arteries is characteristic , with sparing of the pulmonary arteries
```
A. Lupus Vasculitis
B. Wegeners Granulomatosis
C. PAN
D. Systemic sclerosis
E. Takayasus arteritis
```
C. PAN
45
Inflammatory and stenotic disease of mediumand large-sized arteries characterized by a strong predilection for the aortic arch and its branches. (Most commonly affected branch would be the Subclavian Arteries)
```
A. Lupus Vasculitis
B. Wegeners Granulomatosis
C. PAN
D. Systemic sclerosis
E. Takayasus arteritis
```
E. Takayasus Arteritis
46
Characterized by asthma, peripheral and tissue eosinophilia, extravascular granuloma formation, and vasculitis of multiple organ systems
A. Churg Strauss
B. Wegeners granulomatosis
C. PAN
D. Lupus nephritis
A. Churg strauss
47
In asymptomatic patient with aneurysms that are too small to justify surgery, non-invasive testing with either contrast-enhance CT or MRI should be performed at least every: *
a. 3-6 months
b. 4 months
c. 6-12 months
d. 10 months
e. 12-24 months
c. 6-12 months
48
Each of the following statements regarding oral anti-platelets is correct except: *
(A) Aspirin's principal mode of action is via inhibition of cyclooxyrgenase
(B) Ticlopidine and clopidogrel reversibly affect platelet aggregation
(C) NSAID's may inhibit the effect of aspirin
(D) Cilostazol's mechanism of action is via inhibition of platelet phosphodiesterase-3
(B) Ticlopidine and clopidogrel reversibly affect platelet aggregation
49
Binds directly to thrombin, independent of antithrombin III, and least likely to trigger Type II Heparin0induced thrombocytopenia
A. Bivalirudin
B. UFH and Bivalirudin
C. LMWH and Bivalirudin
D. none
B. Bivalirudin
50
Dose(s) should be adjusted if creatinine clearance is <30 ml/min
A. Bivalirudin
B. UFH and Bivalirudin
C. LMWH and Bivalirudin
D. none
C. LMWH and Bivalirudin
51
Degree if anticoagulation can be monitored using the APTT
A. Bivalirudin
B. UFH and Bivalirudin
C. LMWH and Bivalirudin
D. none
B. UFH and Bivalirudin
52
A 67 year old woman comes to your office complaint of rapid heart rate, fatigue, weight loss and swelling of both ankles. She also complains of a sensation of fullness in her neck. She has been in apparent good health for all her life until the last 6 month. she is taking no medications except for Furosemide. Examination discloses clear lungs, an irregular pulse, prominent jugular veins, a pan systolic murmur that exhibits respiratory variation in intensity and marked peripheral edema. There are no cardiac heaves or lifts. She also tells you that she has recurrent episodes id flushing and diarrhea. A lily cause of her illness is: *
```
A. Subacute bacterial endocarditis
B. Carcinoid syndrome
C. Ebstein's anomaly
D. Chronic pulmonary embolism
E. Marfan's syndrome
```
B. Carcinoid syndrome
53
A 76 year old man presents to the emergency room with aphasia and a dense right hemiplegia. HIs wife reposts that he had experienced intermittent fever and chills over the previous 2 weeks. Cardiac examination showed a grade 2/6 systolic ejection murmur at etc upper right sternal border and grade 1/4 early diastolic murmur at the same position. Blood culture grew Satphylococcus aureus. 2DED showed normal LV contractile function and mild AS. No vegetations are seen. A CT scan of the head showed a non-hemorrhagic stroke in the territory of the left middle cerebral artery. Which of the following statement in true? *
(A) Endocarditis is not present because valvular vegetations are absent by 2DED.
(B) Endocarditis caused by S. aureus is an absolute contraindication for surgery.
(C) In patients with endocarditis, a vegetation >10 mm in diameter represents an absolute contraindication for surgery.
(D)The likelihood of subsequent embolic events will decrease with appropriate antibiotic therapy.
(E) Even if intractable heart failure develops, corrective valve surgery should be postponed until well after blood cultures have become sterile.
(D)The likelihood of subsequent embolic events will decrease with appropriate antibiotic therapy.
54
The organism most commonly associate with prosthetic valve endocarditis during the first 60 days following surgical valve replacement is: *
```
A. Staphylococcus aureus
B. Escherichia coli
C. Candida albicans
D. Staphylococcus epidermidis
E. Streptococcus bovis
```
D. Staphylococcus epidermidis
55
Each of the following statements regarding risk factors for sudden cardiac death in HCM is true except: *
(A) The severity of the outflow tract gradient correlates consistently with the risk of SCF.
(B) A family history of HCM with SCD identifies a very high-risk patient.
(C) Specific mutations have been identified that portend a higher risk of SCD.
(D) The absence of non-sustained VT on an ambulatory monitor is a good prognostic indicator.
(E) The degree of symptoms and functional limitation does not correlate with the risk of SCD.
The severity of the outflow tract gradient correlates consistently with the risk of SCF
56
Which of the following primary hyper coagulable states is most frequent among patients who present with DVT? *
A. Protein C deficiency
B. Activated protein C resistance
C. Anti-thrombin III deficiency
D. Protein S deficiency
C. Activated protein C resistance
57
A 65 year old man comes to the clinic because if episodic palpitations. His other symptoms include paroxysmal nocturnal dyspnea, nocturnal enuresis and mild angina. His wife says that he snores loudly. There is a history of several auto accidents. On examination, his BP is 190/100 and he is mildly overweight. Laboratory examination showed an Hct of 58%. The most likely cardiac finding is: *
```
A. Mitral stenosis
B. Aortic stenosis
C. Right ventricular hypertrophy
D. Pulmonic stenosis
E. Atrial septal defect
```
C. Right ventricular hypertrophy
58
In the present of which f the following situations would be appropriate to administer antimicrobial prophylaxis prior to invasive dental procedures? *
A. An isolated ASD osmium secundum type
B. Prior CABG surgery
C. An implanted permanent pacemaker
D. Prior repair of an osmium secundum ASD (without a patch) more than a year ago
E. ventriculoatrial shunt for hydrocephalus
E. ventriculoatrial shunt for hydrocephalus
59
A 50 y/o male came in for check up due to chest discomfort . He was given several medications. Which among his medications causes venodilation with concomitant reduction in left ventricular end diastolic volume and pressure. *
A. Isosorbide mononitrate
B. Metoprolol
C. Perindopril
D. Diltiazem
A. Isosorbide mononitrate
60
In the treatment of dyslipidemia in diabetic patients, what is the target LDL cholesterol? *
A. 130mg/dl
B. 100mg/dl
C. 70mg/dl
D. Less than 70mg/dl
D. Less than 70mg/dl
61
The antiplatelet that inhibits irreversibly the platelet cyclooxygenase thus interfering with platelet activation is: *
A. Aspirin
B. Clopidogrel
C. Cilostazol
D. Sulodexide
A. Aspirin
62
What is the condition wherein ischemic damage to the left ventricular myocardium caused no symptom before the development of heart failure? *
A. Prinzmetal angina
B. Dilated cardiomyopathy
C. Ischemic cardiomyopathy
D. Hypertrophic cardiomyopathy
D. Hypertrophic cardiomyopathy
63
Typically, ECG reveals a right bundle branch block morphology with ST segment elevation in the anterior precordial leads.
A. Jervell and Lange-Nielsen Syndrome
B. Romano-Ward Syndrome
C. Right ventricular outflow tract ventricular tachycardia
D. Brugada syndrome
D. Brugada Syndrome
64
A 40 year old female is complaining of bilateral leg heaviness for more than 2 months already more pronounce when standing for long periods of time. There was no history of trauma or infection. Physical examination revealed bilateral edema of both legs. A venous duplex scan of both lower extremities showed reflux disease involving the bilateral common femoral veins, popliteal veins, anterior-tibial veins and peroneal veins. Based on the CEAP classification, patient is classified as:
```
A. C3EcAsPr
B. C3EpAdPr
C. C3EpAsPo
D. C2EcAdPr
```
B. C3EpAdPr
65
66. All of the following needs an ABI measurement in clinical practice except? (ESC Guidelines on PAD)
A. A 45 year old patient with family history of lower extremity artery disease.
B. 40 year old patient with Chronic kidney disease.
C. 70 year old patient with no leg symptoms.
D. 50 year old patient with aortic aneurysm.
A. A 45 year old patient with family history of lower extremity artery disease.
66
This is the most common congenital heart valve defect:
A. Mitral valve prolapse
B. Rheumatic mitral stenosis
C. Pulmonic stenosis
D. Bicuspid aortic valve
D. Bicuspid aortic valve
67
A 25 years old female was brought to the emergency room because of severe retrosternal chest pain after an emotional outburst. She had a history of frequent headache and palpitation. She is a nonsmoker, nonalcoholic drinker, but with frequent visits to the emergency room for chest pain after emotional outburst. On Physical examination, BP=200/150, CR = 120 bmp, RR = 26/min. BMI = 30. Which of the following test will help you clinch your diagnosis? *
(a) 24 hours cortisol and creatinine levels
(b) Renal Duplex scan
(c) Plasma Renin levels
(d) Metanephrine leves
d. Metanephrine levels
The above patient is the diagnosed case of Pheochromocytoma and the diagnostic of choice is metanephrine levels
68
A 35 year old female was brought to the emergency room because of hemoptysis. On physical examination, BP = 90/60 CR = 75 bmp, irregularly, irregular, faint pulses, with a grade3/6 diastolic rumble at the apex. What is the most likely diagnosis? *
a. Pulmonary hypertension
b. Pulmonary Tuberculosis
c. Aortic stenosis
d. Mitral Stenosis
d. Mitral Stenosis
Hemoptysis is a pulmonary manifestation of pulmonary hypertension, pulmonary tuberculosis. Pulmonary hypertension can be due to a lot of causes including mitral stenosis which is considered when a murmur of MS is heard - diastolic murmur at the apex of the heart
69
A 60 year old male consulted at the OPD because of BP readings of 180/100 on 3 readings, and a result of fasting blood sugar of 200 mg/dl. What is your drug of choice?
a. diuretics
b. betablockers
c. calcium channel blockers
d. ACE inhibitors
d. ACE inhibitors
the above patient is a diabetic and the drug of choice is ACE inhibitors for diabetic patient with hypertension.
70
. A 60 year old male smoker complained of effort-related chest pain and leg cramps on walking cramps. What is the ideal drug to relieve the chest pain and and leg cramps if the BP = 120/80, and HR = 90 beats per minute? *
a. Captopril
b. Isosorbide dinitrate
c. amlodipine
d. carvedilol
carvedilol
71
A 35 year old male is a diagnosed case of chronic kidney disease stage V, but not yet undergoing hemodialysis. The ideal target blood pressure according to the 2020 Clinical Practice Guideline on the management of hypertension will be achieved using.
(a) Calcium channel blockers + Diuretics for volume dependent hypertension
(b) Calcium channel blockers + ARB for Renin dependent hypertension
(c) All of the above
(d) none of the above
(a) Calcium channel blockers + Diuretics for volume dependent hypertension
72
A 22 y/o female with mitral stenosis and regurgitation was admitted at the ICU due to dyspnea with 3 pillow orthopnea. No previous history of antibiotic treatment. BP was 80/50 mmHg, CR was 110 which was irregularly irregular. 2 d echo revealed a large mobile echogenic density at the anterior mitral valve leaflet. Three 2- bottle blood culture sets separated from one another by 2 hours was obtained from different sites. The culture was negative after 48 - 72 hours. What is then next step in the management of this patient?
(a) Two or 3 additional blood culture sets should be obtained.
(b) The laboratory should be consulted regarding the result.
(c) Pending culture results, empirical antibiotic therapy should be withheld initially.
(d) Empirical antibiotic treatment should be given immediately.
Empirical antibiotic treatment should be given immediately.
Patients with acute endocarditis or with deteriorating hemodynamics who may require urgent surgery should receive empirical treatment immediately after 3 sets of blood cultures are obtained over several hours.
73
A 20 y/o female went to the OPD for check up. On PE, there was high pitched blowing decrescendo diastolic murmur heard best in the 3rd ICS along the left sternal border. There was also an Austin Flint murmur. What is the most likely diagnosis of this patient? *
(a) Mitral valve prolapse
(b) Aortic stenosis
(c) Aortic regurgitation
(d) Pulmonic stenosis
(c) Aortic regurgitation
74
A 25 y/o male diagnosed with hypertrophic cardiomyopathy sought consult due to palpitations. 12 leads ECG revealed atrial fibrillation. Which medications below should NOT be given to the patient?
(a) Metoprolol
(b) Verapamil
(c) Disopyramide
(d) Digoxin
(d) Digoxin
75
A 50 y/o male weighing 60kg sought consult due to chest pain. On PE, he had friction rub. On ECG, there was widespread upward concavity of the ST segment and PR segment depression below the TP segment. How will you manage this patient? *
(a) Aspirin 2 grams per day
(b) Ibuprofen 600 mg 1 tablet 3 x a day
(c) Omeprazole 40 mg 1 tablet 30 min to 1 hour before breakfast
(d) All of the above
(d) All of the above
76
A 60 y/o male diagnosed to have severe mitral stenosis(MS) who underwent valvotomy 10 years ago went to the ER due to shortness of breath on climbing 3 steps of stairs. 2 d echo revealed MS with severe MR. He is on optimal medical therapy. What is the treatment of choice for this patient? *
(a) Repeat mitral valvotomy
(b) Maximize diuretic therapy
(c) Increase digoxin dose
(d) Mitral valve replacement
(d) Mitral valve replacement
77
In normal adult, the normal aortic valve orifice is:
a. 4-6 cm2
b. 2-4 cm2
c. 1.5-2.5 cm2
d. 1-2 cm3
b. 2-4 cm2
78
A 50 y/o male alcoholic patient developed dilated cardiomyopathy. He asked his doctor what his prognosis is. Which of the following statement/s is/are correct regarding his question? *
(a) He needs implantable defibrillator to prolong his survival.
(b) He will improve within 3 - 6 months of abstinence from alcohol and also his EF.
(c) He may improve in 3 - 6 months of abstinence but not his EF.
(d) He will not improve even if he will abstain from alcohol for 3 to 6 months if his EF is severe
Chapter 254 CMP and myocarditis pp. 1788.
Even with severe disease, marked improvement can occur within 3-6 months of abstinence. Implantable defibrillators are generally deferred until an adequate period of abstinence, after which they may not be necessary if the EF has improved.
79
What gene is implicated in the heredity basis for Marfan's syndrome *
a. TGF-β
b. ACTA
c. Fibrillin
d. MYLK
c. Fibrillin
80
A 30 year old Filipino male, who appears to be unusually tall and lanky came in at the emergency room due to sudden chest pain, ripping in character. BP on both arms is 90/60. On CT Aortogram, there was noted involvement of the ascending aorta extending up to the descending aorta. What is the classification? *
(a) Stanford Type A Dissection, De Bakey I
(b) Stanford Type A Dissection ,De Bakey II
(c) Stanford Type B Dissection, De Bakey I
(d) Stanford Type B Dissection, De Bakey II
(a) Stanford Type A Dissection, De Bakey I
81
A 58 year old smoker, hypertensive and non-diabetic consulted at your clinic due to intermittent claudication. He started to have his symptoms 3 months ago after walking about 300 meters, and it was reproducible every time he walks the same distance. What is the Fontaine Classification? *
(a) I-1
(b) II-A
(c) II-2
(d) II-b
(b) II-A
82
Based on a meta-analysis, which of the following interventions is known to improve quality of life in patients with PAD, and is associated with a 50% increase in maximal walking distance? *
(a) Cilostazol
(b) Clopidogrel
(c) Atorvastatin
(d) Apixaban
(a) Cilostazol
83
What supports the diagnosis of ventricular septal rupture versus papillary muscle rupture? *
(a) S3
(b) rales
(c) thrills
(d) hypotension
thrills
84
A 20 years old male was admitted in the Covid Ward for a confirmed COVID 19 infection - mild. Electrocardiogram findings suggestive of acute injury. Troponin was requested and was elevated at 10. What is your consideration? *
(a) Possible Subclinical Acute Myocarditis
(b) Probable Acute myocarditis
(c) Definite Myocarditis
(d) Acute ST elevation myocardial Infarction
(e) Acute Myocardial infarction, Non ST elevation
a. Possible Subclinical Acute Myocarditis
85
What valvular lesion most likely to cause death during pregnancy due to increase in blood volume, cardiac output and tachycardia? *
(a) aortic stenosis
(b) mitral stenosis
(c) aortic regurgitation
(d) mitral regurgitation
Aortic stenosis
86
The stroke volume increases during pregnancy. This increases the cardiac output by: *
(a) 20%
(b) 30%
(c) 40%
(d) 50%
c. 40%
87
A 25/M was rushed to the ER for severe headache and vomiting. On physical examination, he was drowsy with a BP 220/120; no focal neurologic signs. Drug screen was positive for methamphetamine. Nicardipine drip at 5 mg/hour was immediately started. During the initial resuscitative phase, what is the lowest blood pressure target for the patient within 4 hours?
a. 140/90
b. 150/90
c. 160/90
d. 170/90
170/90
88
A 36/M consults for elevated blood pressure. His physical exam showed BMI 32 kg/m2, office BP 150/90; no other remarkable findings. What is the most likely mechanism underlying his hypertension?
a. Increased sympathetic outflow
b. Increased salt sensitivity
c. Diminished renin secretion
d. Decreased baroreceptor function
a. Increased sympathetic outflow
89
Recommended criteria for a diagnosis of hypertension, based on 24-hour blood pressure monitoring:
a. Average awake BP ≥120/85 mmHg, average asleep BP ≥130/75 mmHg
b. Average awake BP ≥125/85 mmHg, average asleep BP ≥130/75 mmHg
c. Average awake BP ≥130/85 mmHg, average asleep BP ≥120/85 mmHg
d. Average awake BP ≥135/85 mmHg, average asleep BP ≥120/75 mmHg
d. Average awake BP ≥135/85 mmHg, average asleep BP ≥120/75 mmHg
90
According to the 2020 CPG for the Management of Dyslipidemia in the Philippines, the following are risk factors that provide compelling reason for initiating statin therapy for primary prevention in individuals with no prior atherosclerotic cardiovascular disease (ASCVD), EXCEPT:
a. Family history of hypertension
b. Postmenopausal woman
c. BMI of at least 25 kg/m2 or above
d. Presence of proteinuria
c. BMI of at least 25 kg/m2 or above
Risk factors:
Male
Smoking
BP ≥ 140/90
BMI >25 kg/m2
Proteinuria
Postmenopausal women
Family history of premature CAD
LVH
91
A 52/M was referred by his employer for elevated blood pressure. During his last annual PE, his BP was 150/80. He was advised BP monitoring, with usual readings of 138 to 147/87 to 92, but was not yet started on any medications. His parents were diagnosed with hypertension beyond age 50. He denies intake of any other drugs or supplements. Review of systems and physical examination were unremarkable. Which of the following tests is recommended for the initial evaluation of his hypertension?
a. AST, ALT
b. HbA1c
c. TSH
d. Serum uric acid
TSH
92
What is the recommended limit on salt intake for Filipino patients with hypertension?
a. Less than 1000 mg/day
b. Less than 1500 mg/day
c. Less than 3000 mg/day
d. Less than 6000 mg/day
b. Less than 1500 mg/day
93
According to the 2020 CPG for the Management of Dyslipidemia in the Philippines, among individuals being treated with statin who have achieved their LDL-C goal, what can be used as an additional target to reduce cardiovascular events?
a. Apolipoprotein A-I
b. Apolipoprotein B-48
c. Apolipoprotein B-100
d. Apolipoprotein C-II
c. Apolipoprotein B-100
94
In which scenario is 2D echocardiography with Doppler NOT generally necessary?
a. 25/M with grade II continuous murmur
b. 20/M with grade II midsystolic murmur, asymptomatic
c. 20/M with grade II holosystolic murmur, asymptomatic
d. 45/M with grade II mid-diastolic murmur, asymptomatic
b. 20/M with grade II midsystolic murmur, asymptomatic
95
Malar telangiectasia is a cutaneous manifestation of which cardiovascular disease?
a. Severe mitral stenosis
b. Malignant hypertension
c. Carney’s syndrome
d. Osler-Weber-Rendu syndrome
a. Severe mitral stenosis
96
Which of the following disease processes can lead to heart failure with either reduced or preserved ejection fraction?
a. Chronic anemia
b. Sarcoidosis
c. Chronic aortic stenosis
d. Regurgitant valvular disease
b. Sarcoidosis
97
Which of the following statements is true regarding the clinical manifestations of heart failure?
a. Paroxysmal nocturnal dyspnea results from redistribution of fluid into the central circulation during recumbency
b. Rales are frequently present in patients with chronic heart failure
c. When pleural effusions occur unilaterally, they are usually on the left
d. Orthopnea can be caused by abdominal obesity
d. Orthopnea can be caused by abdominal obesity
98
Which of the following findings in a patient admitted for acute decompensated heart failure portends a worse outcome?
a. Serum creatinine of 2.5 mg/dL
b. Systolic blood pressure of 110 mmHg
c. Resting heart rate of 115
d. BUN of 35 mg/dL
b. Systolic blood pressure of 110 mmHg
WORSE OUTCOMES in Heart Failure
- BUN >43 mg/dL
- Creatinine >2.75mg/dL
- BP of <115mmHg
- Elevated Trop I
99
A 68/F with bronchial asthma consulted for worsening shortness of breath for the past two months, despite optimal medical management of her asthma. Which of the following physical signs is NOT compatible with cor pulmonale?
a. Apical holosystolic murmur
b. RV heave
c. Positive fluid wave test
d. Elevated jugular venous pressure
a. Apical holosystolic murmur
Cor Pulmonale clinical features:
• Dyspnea, the most common symptom,
• murmur of tricuspid regurgitation, an S3 gallop
• RV heave palpable along the left sternal border can be appreciated
• Elevated jugular venous pressures with prominent v waves
• Cyanosis is a late finding in cor pulmonale and is secondary to a low cardiac output (i.e., cardiogenic shock), systemic vasoconstriction, and hypoxemia.
100
A 73/F with heart failure and diabetes comes for follow-up care. She feels helpless because of shortness of breath doing light physical activity. Her physical exam showed pallor, bibasal crackles and irregularly irregular heart sounds. Her latest labs showed Hemoglobin 9 g/L, serum creatinine 1.1 mg/dL, K 4.5 mmol/L, LDL 125 mg/dL and HbA1c 6.0%. Which of her comorbid problems will LEAST likely affect her prognosis?
a. Anemia
b. Arrhythmias
c. Diabetes
d. Dyslipidemia
Dyslipidemia
101
Which of the following anti-arrhythmic medications is correctly matched to its primary mechanism of action?
a. Diltiazem: dihydropyridine calcium channel blockade
b. Dofetilide: sodium channel blockade
c. Sotalol: delayed rectifier potassium channel blockade
d. Verapamil: β-adrenergic receptor blockade
c. Sotalol: delayed rectifier potassium channel blockade
102
Which of the following activities is equivalent to more than 9 METs?
a. Rope jumping
b. Mountain climbing
c. Heavy shoveling
d. Rowing machine
b. Mountain climbing
103
Which of the characteristics of chest pain will most likely increase the probability of acute MI?
a. Associated with dyspnea
b. Associated with nausea and vomiting
c. Described as sharp
d. Described as pressure
The correct answer is: Associated with nausea and vomiting
104
Ms. Vilma is a 65-year-old postmenopausal postal employee. While walking her mail route over the past 6 months, she routinely has chest pressure and dyspnea while climbing a certain steep hill. The pressure resolves when she rests for about 3 minutes. She has not missed any work due to these symptoms. You suspect she is experiencing angina. What term and Canadian Cardiovascular Society (CCS) functional class of angina are appropriate to describe her symptoms?
a. Stable angina—CCS class I
b. Stable angina—CCS class II
c. Stable angina—CCS class III
d. Unstable angina
b. Stable angina—CCS class II
105
A 44/F consults at the ER with substernal chest pain radiating to the left arm. She has transient ST elevations in leads V1–V4 as well as I and aVL that occurred with the pain. Troponin biomarkers are mildly elevated. On coronary angiography, she has no atherosclerosis. However, during the procedure, when asked to hyperventilate, there is distinct vasospasm in the left anterior descending artery. All of the following are reasonable treatments for her EXCEPT:
a. Diltiazem
b. Aspirin
c. Atorvastatin
d. Long-acting oral nitrates
ASPIRIN
• Nitrates and calcium channel blockers are the main therapeutic agents.
• Aspirin may actually increase the severity of ischemic episodes, possibly as a result of the sensitivity of coronary tone to modest changes in the synthesis of prostacyclin.
• Statin therapy has been shown to reduce the risk of major adverse events, although the precise mechanism is not established.
• Beta blocker's response is variable.
• Coronary revascularization may be helpful in patients who also have discrete, flow-limiting, proximal fixed obstructive lesions.
• Implantable cardioverter defibrillator: Patients who have had ischemia-associated ventricular fibrillation despite maximal medical therapy
106
49/M came in due to chest pain. He denied dyspnea, no diaphoresis. Initial findings were 100/60, HR 96, RR 22, and clear breath sounds on auscultation. Initial labs showed ECG with ST-segment depression on leads V5-V6. Tests showed elevated troponins, normal CBC, and a computed eGFR of 70 mL/min/1.73 m2. When should an invasive strategy be initiated in this patient?
a. Within 2 hours
b. Within 24 hours
c. Within 25 to 72 hours
d. Elective angiography
Within 24 hours
107
Which of the following statements is true about percutaneous coronary interventions?
a. Angiographic success is defined as a reduction of the stenosis to less than 50% narrowing.
b. Clinical restenosis is recognized by recurrence of angina or symptoms within 12 months of the procedure.
c. A proximal non-calcified subtotal lesion has a low probability of angiographic success.
d. Elective surgery requiring discontinuation of antiplatelet therapy should be postponed at least 2 months after the placement of a drug-eluting stent.
The correct answer is: Clinical restenosis is recognized by recurrence of angina or symptoms within 12 months of the procedure.
108
A 54/M was admitted for progressive dyspnea associated 2-pillow orthopnea and fatigue. He has a history of pulmonary tuberculosis and uncontrolled hypertension. He was normotensive on admission, but tachycardic. Neck veins were distended, and chest findings revealed bibasal rales. Cardiac examination showed distinct S1 and S2, but absence of S3. Abdomen is distended, with a palpable liver edge, and fluid wave. Bilateral pedal edema was likewise noted. Work-up revealed: slight cardiomegaly on CXR; no electrical alternans on ECG; presence of pericardial calcification; normal RV size, no pericardial effusion on 2d-echo. Which of the following findings in this patient favor constrictive pericarditis over restrictive cardiomyopathy?
b. Absence of electrical alternans on ECG
c. Absence of pericardial effusion
d. Normal RV size
a. Absence of third heart sound
Third heart sound
- Rapid ventricular filling
- chordae tendinae "Twang"
109
A 46/F with class II obesity consults for a non-healing wound on her right leg. Physical examination showed multiple dilated veins, ankle hyperpigmentation, and edema on both legs. Skin ulceration was noted on the right medial ankle area. All of the following are appropriate therapeutic steps EXCEPT:
a. Low dose aspirin
b. Frequent elevation of the lower extremities
c. Graduated compression stockings
d. All of the above are appropriate
The correct answer is: Low dose aspirin
110
24/F presents to the emergency room with a 2 month-history of fever. No cough, sore throat, dyspnea, orthopnea, weight loss or dysuria were noted. Sputum AFB was negative. She has no history of hospitalizations, surgeries, nor intravenous drug use. She was deemed hemodynamically stable based on clinical assessment. The attending physician is highly considering infective endocarditis. Which is TRUE of the diagnostic approach for this patient?
a. Three 2-bottle blood culture sets should be obtained immediately, at least 1 hour apart.
b. Obtaining blood culture sets from different venipuncture sites should be done over 48 hours.
c. Empiric antibiotics should be immediately started once blood cultures have been obtained.
d. If initial blood cultures remain negative after 48-72 hours, 2 to 3 blood culture sets should be obtained.
The correct answer is: If initial blood cultures remain negative after 48-72 hours, 2 to 3 blood culture sets should be obtained.
111
Which of the following cardiovascular abnormalities is a contraindication to pregnancy?
a. Mitral stenosis
b. Aortic stenosis
c. Bicuspid aortic valve with aortic diameter <45mm
d. Primary pulmonary hypertension
d. Primary pulmonary hypertension
112
36/M presents with chest pain after suffering coryza, cough, fever, and muscle aches for the past week. He describes his pain as constant, exacerbated by lying flat and deep breaths, and radiating to his left shoulder. Examination reveals a rasping extra-cardiac sound present in three components per heartbeat. Troponin I levels are undetectable on presentation and 6 hours later. Blood pressure, heart rate and oxygen saturation are normal. What is the most appropriate next step?
a. Aspirin 81 mg daily, metoprolol 25 mg twice daily, and atorvastatin 80 mg daily
b. Aspirin 1 g every 8 hours with omeprazole 20 mg daily
c. Prednisone 40 mg daily for 2 weeks followed by a taper over the ensuing 2 months
d. Referral for transthoracic echocardiogram
e. Start IV heparin, give high-dose aspirin and clopidogrel, and refer for emergent coronary angiography.
b. Aspirin 1 g every 8 hours with omeprazole 20 mg daily
