MCQ past papers Flashcards
(132 cards)
1
Q
Which of the following is NOT indicated in angina pectoris patients?
A b-blockers
B nitrates
C alpha-blockers
D aspirin
E clopidogrel
A
C. alpha-blockers
2
Q
What is the recommended treatment for diabetic patients with hypertension?
A b-blockers
B heparin
C ACE-I
D alpha-blockers
E ARB (angiotensin receptor blocker)
A
C. ACE-I
E. ARB (angiotensin receptor blocker)
3
Q
A fixed perfusion defect means:
A. the defect appears at rest but disappears in stress test
B. the defect appears both at rest and the stress test
C. the defect appears at stress test but not in rest
A
B. the defect appears both at rest and the stress test
4
Q
To diagnose a right MI on ECG we need:
A. ST elevations waves in V1-V6
B. deep Q waves in V1-V4
C. ST elevation on R-V4 (this is a precordial lead on the right)
D. RVH signs
A
C. ST elevation on R-V4 (this is a precordial lead on the right)
5
Q
Which of these arrhythmias are focal?
A atrial tachycardia B AVRT C AVNRT D WPW E right ventricular flow tachycardia
A
A. atrial tachycardia
E. right ventricular flow tachycardia
6
Q
In case of right MI best treatment is:
A give the patient fluids and IABP if needed
B give the patient vasodilators in order to off load the right ventricle
C perform PCI
A
C. Perform PCI
7
Q
To diagnose a right MI on ECG we need:
A. ST elevations waves in V1-V6
B deep Q waves in V1-V4
C. ST elevation on R-V4 (this is a precordial lead on the right)
D. RVH signs
A
C. ST elevation on R-V4 (this is a precordial lead on the right)
8
Q
Which of these arrhythmias are focal?
A. atrial tachycardia
B. AVRT
C. AVNRT
D. WPW
E. right ventricular flow tachycardia
A
A. atrial tachycardia
E. right ventricular flow tachycardia
9
Q
In a case of an inferior wall MI we should perform an urgent echo to exclude:
A. mitral valve rupture
B. vetricular septal rupture
C. free wall rupture
A
A. mitral valve rupture
10
Q
In the case of ventricular extrasystole:
A. amiodarone is the first option
B. it is benign and doesn’t require any treatment
C. verapamil is the treatment of choice
A
B. it is benign and doesn’t require any treatment
11
Q
In supraventricular tachycardia we treat with:
A. Carotid massage B. Valslva maneuver C. Verapamil D. Amiodarone E. Metoprolol
A
A. Carotid massage
B. Valslva maneuver
C. Verapamil
12
Q
Difference in BP between upper and lower body can be present in:
A. Aortic coarctation
B. Malignant HT
C. Leukemia
D. Aortic valve stenosis
E. Aortic dissection
A
A. Aortic coarctation
E. Aortic dissection
13
Q
The following arrhythmias can be indications for cardioversion:
A. Atrial fibrillation B. WPW C. Atrial tachycardia D. AVRT E. AVNRT
A
A. Atrial fibrillation
D. AVRT
14
Q
A cardiac echo is indicated:
A. before PCI where symptoms don’t fit the presumed diagnosis
B. before heart surgery for evaluation
C. always in atrial fibrillation
A
B. before heart surgery for evaluation
C. always in atrial fibrillation
15
Q
An anemic patient can present:
A. pallor B. tachycardia C. systolic murmur D. flush E. diastolic murmur
A
A. Pallor
B. Tachycardia
C. Systolic murmur
16
Q
When we hear a harsh, holosystolic murmur over the chest in a post-MI patient we
immediately suspect:
A. cardiac tamponade B. PE C. pericarditis D. papillary muscle rupture E. ventricular septal rupture
A
E. ventricular septal rupture
17
Q
Pulsus paradoxus is a sign of:
A. aortic stenosis
B. aortic regurgitation
C. cardiac tamponade
D. severe air way obstruction
A
C. Cardiac temponade
D. Severe air way obstruction
18
Q
How do you treat isolated ventricular extrasystoles?
A. It’s not necessary to treat if there are no symptoms
B. The first choice is B-blocker
C. The first choice is amiodarone
D. Coronarography is necessary to exclude coronary artery disease
E. Calcium channel blocker plus B-blocker is a primary option
A
A. It’s not necessary to treat if there are no symptoms
B. The first choice is B-blocker
19
Q
What does non-sustained VT means?
A. Duration of VT isn’t longer than 30 sec
B. Five ventricular beats come subsequently
C. It can cause hemodynamic instability
D. The time of the VT is longer than 30 min
A
A. Duration of VT isn’t longer than 30 sec
B. Five ventricular beats come subsequently
20
Q
Which disease may result in systemic thromboemoblism?
A. Aortic stenosis B. Atrial fibrillation C. Endocarditis D. Tricuspid regurgitation E. Left ventricular aneurysm
A
B. Atrial fibrillation
C. Endocarditis
E. Left ventricular aneurysm
21
Q
The patient had two MIs. EF= 30%. How do you treat him after a documented fast
monomorph ventricular tachycardia?
A. Pacemaker implantation
B. ICD implantation
C. B-blocker therapy
D. Digitalis
E Amiodarone
A
B. ICD implantation
C. B-blocker therapy
E. Amiodarone
22
Q
ICDs are able to:
A. Terminate ventricular fibrillation with shock delivery
B. Work as a pacemaker if necessary
C. Terminate ventricular extrasystoles
D. Terminate ventricular tachycardia with antitachycardia pacing
E. Treat only tachycardias, no therapeutic options against bradycardias
A
A. Terminate ventricular fibrillation with shock delivery
B. Work as a pacemaker if necessary
D. Terminate ventricular tachycardia with antitachycardia pacing
23
Q
VVI pacemaker means:
A. One electrode in the ventricle
B. One electrode in the atrium
C. Two electrodes (atrium and ventricle)
D. A sensed signal from the heart inhibits the pacemaker
E. A sensed signal in the atrium may trigger a ventricular paced beat
A
A. One electrode in the ventricle
D. A sensed signal from the heart inhibits the pacemaker
24
Q
Causes that frequently provoke acute heart failure in patients with chronic congestive
heart failure:
A. Arrhythmias, especially AF B. NSAIDs C. Fever D. GERD E. Ventricular premature beats
A
A. Arrhythmias, especially AF
B. NSAIDs
C. Fever
25
The most common cause of congestive heart failure:
```
A. Chronic anemia
B. Volume overload
C. Ischemic heart disease
D. Diabetes mellitus
E. Chronic renal failure
```
C. Ischemic heart disease
26
Patients with congestive heart failure have increased risk of:
```
A. Restless leg syndrome
B. Ischemic stroke
C. Cardiac tamponade
D. Sudden cardiac death
E. Peripheral artery disease
```
B. Ischemic stroke
D. Sudden cardiac death
27
These drugs are mandatory in patients suffering from chronic heart failure, because
they will increase life expectancy:
```
A. Digoxin
B. ACEi
C. Verospiron (spironolactone)
D. Nitrates
E. B-blockers
```
B. ACEi
C. Verospiron (spironolactone)
E. B-blockers
28
Physical signs and symptoms related to heart failure:
```
A. Orthopnea
B. Hydrothorax
C. Signs of cerebral edema
D. Lack of appetite
E. Bronchospasm
```
A. Orthopnea
B. Hydrothorax
D. Lack of appetite
29
What can be the etiology of acute aortic valve regurgitation?
```
A. Chordal rupture
B. Infective endocarditis
C. Aortic dissection
D. Bicuspid valve
E. Trauma
```
B. Infective endocarditis
C. Aortic dissection
E. Trauma
30
What are the most frequent etiologies that can cause chronic aortic valve
regurgitation?
```
A. Degenerative
B. Rheumatic
C. Infective endocarditis
D. Congenital
E. Ischemic heart disease
```
A. Degenerative
B. Rheumatic
D. Congenital
31
Major criteria for the diagnosis of infective endocarditis:
```
A. Fever
B. Positive blood culture
C. Vasculitic lesions
D. Vegetation on echo
E. History of IV drug abuse
```
B. Positive blood culture
D. Vegetation on ECHO
32
Surgery is indicated in patients with infective endocarditis if:
```
A. Severe cardiac failure is presented due to valvular compromise
B. Relapse after optimal medical therapy
C. In case of septic systemic embolism
D. Presentation of mitral regurgitation
E. Pulmonary systolic pressure > 50 mmHg
```
A. Severe cardiac failure due to valvular compromise
B. Relapse after optimal medical therapy
C. In case of septic systemic embolism
33
Myocardial perfusion testing can be useful in:
A. High clinical suspicion of aortic stenosis
B. Resting ECG abnormalities preclude exercise stress test interpretation
C. Culprit vessel identification in multi-vessel disease
D. After PCI, to evaluate stent restenosis
E. All of the above
B. Resting ECG abnormalities preclude exercise stress test interpretation.
C. Culprit vessel identification in multiple-vessel disease.
D. After PCI, to evaluate stent restenosis.
34
How is coarctation of the aorta detected?
A. Place the thumb of one hand on the brachial pulse and the other on the femoral
pulse, and assess the simultaneously. Normally these pulses are equal in volume and
timing. A delay in the femoral pulse or a reduction or absence strongly supports the
diagnosis of coarctation
B. Place the thumb of one hand on the brachial pulse and the other on the femoral
pulse, and assess the simultaneously. Normally these pulses are equal in volume and
timing. A premature femoral impulse strongly supports the diagnosis of coarctation
C. A paradoxical femoral pulse on both sides supports the diagnosis of coarctation
D. Alternating low and high volume beats (pulsus alternans) can be characteristic for
aortic coarctation
A. Place the thumb of one hand on the brachial pulse and the other on the femoral
pulse, and assess the simultaneously. Normally these pulses are equal in volume and
timing. A delay in the femoral pulse or a reduction or absence strongly supports the
diagnosis of coarctation
35
When do you find an elevated JVP?
```
A. Hypovolemia
B. Acute heart failure
C. Hypervolemia
D. ACS
E. Aortic valve regurgitation
```
B. Acute heart failure
C. Hypervolemia
36
Which of the following best describes Dressler's syndrome?
A. Hypotension, elevated JVP, clear lung fields
B. Pericardial and pleural fluid, elevated ESR, and fever days to weeks after MI
C. Pericardial friction rub and pain while taking a deep breath 24 hours after anterior
MI
D. Alternating RBBB and LBBB after anterior MI
B. Pericardial and pleural fluid, elevated ESR, and fever days to weeks after MI
37
Typical re-entry arrhythmias are:
A. Right ventricular outflow tract tachycardias
B. Atrial flutter
C. WPW
D. AV nodal/ junctional re-entry tachycardia
E. Atrial fibrillation
B. Atrial flutter
C. WPW
D. AV nodal /junctional re-entry tachycardia
38
Typically regular narrow QRS tachycardias are:
```
A. AV nodal/ junctional re-entry tachycardia
B. Atrial flutter
C. Ventricular tachycardia
D. WPW (orthodrom)
E. WPW (antidrom)
```
A. AV nodal/junctional re-entry tachycardia
B. Atrial flutter
D. WPW (orthodromic)
39
Pericarditis can be present in:
```
A. in chronic or acute renal failure
B. After MI
C. In hyperthyroidism
D. In young patients after upper airway infection
E. In cerebral malignancy
```
A. In chronic or acute renal failure
B. After MI
D. In young patients after upper airway infection
40
Which medication is preferred if hypertension is combined with diabetes mellitus?
```
A. B-blockers
B. Loop diuretics
C. ACEi
D. Alpha blockers
E. ARBs
```
C. ACE i
E. ARBs
41
This ECG is typical in:
```
A. Aortic stenosis
B. Anemia
C. Hypertrophic cardiomyopathy
D. Hypertension
E. Mitral regurgitatiom
```
A. Aortic stenosis
C. Hypertrophic cardiomyopathy
D. Hypertension
42
How would you anticoagluate your 80 yo diabetic patient who has chronic atrial
fibrillation?
A. Aspirin
B. Clopidogrel and aspirin
C. Warfarin
D. Ticlopidine
C. Warfarin
43
These are indications of anticoagulant therapy:
```
A. Left ventricular thrombus
B. PE
C. Aortic dissection
D. Mechanical prosthetic valve implantation
E. ICD implantation
```
A. Left ventricular thrombus
B. PE
D. Mechanical prosthetic valve implantation
44
Which imaging tests are the most useful in the evaluation of PE?
```
A. Radionuclide lung perfusion scan
B. Pulmonary angiography
C. Chest X-ray
D. CT pulmonary angiography
E. Contrast ECHO
```
A. Radionuclide lung perfusion scan
B. Pulmonary angiography
D. CT pulmonary angiography
45
Indications of thrombolytic therapy:
```
A. PE with hemodynamic compromise
B. ST elevation MI within 12 hours
C. Abdominal emboli
D. Mitral valve rupture
E. Left ventricular thrombi
```
A. PE with hemodynamic compromise
B. ST elevation MI within 12 hours
46
37 yo man had palpitations without chest pain and syncope. It started abruptly and
lasted for 2 hours. He experienced these tachycardic episodes 5 times during the
previous year. He is hypertensive, a smoker and obese. This is his ECG during
tachycardia. What would you do in order to stop the arrhythmia?
```
A. Carotid massage
B. Adenosine IV
C. Verapamil IV
D. Amiodarone IV
E. Direct current cardioversion
```
C. Varapamil IV
D. Amiodarone IV.
E. Direct current cardioversion
47
According to the ECG, symptoms and history what is the likely diagnosis?
```
A. Atrial tachycardia
B. Atrial fibrillation
C. AVRT
D. AVNRT
E. Ventricular tachycardia
```
A. Atrial tachycardia
D. AVNRT
E. Ventricular tachycardia
48
After such documented tachycardia what kind of examinations are recommended in
order to reveal the underlying mechanism:
```
A. 24 hour Holter monitoring
B. Treadmill test
C. Echo
D. Electrophysiology
E. Coronarography
```
D. Electrophysiology
49
What is the recommended and 95% effective therapy for such paroxysmal
tachycardia?
```
A. PCI
B. Heart surgery
C. RFCA
D. Pacemaker implantation
E. ICD implantation
```
C. RFCA
= Radiofrequency catheter ablation; used to eliminate tachyarrhythmia
50
What is characteristic of AVRT?
A. Irregular rhythm
B. Retrograde p waves after the QRS complex
C. Re-entry tachycardia involving an accessory pathway
D. Pseudo r’ in lead V1 and pseudo s in inferior leads
E. Life threatening arrhythmia
B. Retrograde p waves after the QRS complex
C. Re-entry tachycardia involving an accessory pathway
51
What kind of arrhythmias can we treat with RFCA?
```
A. AF
B. LBBB
C. WPW
D. Ventricular extrasystole
E. Mobitz II AV block
```
A. AF
C. WPW
D. Ventricular extrasystole
52
What can cause paradoxical pulse?
```
A. Anterior STEMI
B. Congestive heart failure
C. PE
D. Pericardial tamponade
E. Aortic dissection
```
C. PE
D. Pericardial temponade
53
When can you find a difference in BP between the upper and lower limbs?
```
A. Aortic stenosis
B. Possibly in aortic dissection
C. Aortic coarctation
D. Mitral stenosis
E. Pericardial tamponade
```
B. Possibly in aortic dissection
C. Aortic coarctation
54
What is Dressler’s syndrome?
A. Congenital valve disease
B. Post MI pericarditis
C. Post MI hepato-renal syndrome
D. Pericarditis in renal insufficiency
B. Post MI pericarditis
55
Risks for atrial fibrillation:
```
A. mitral stenosis
B. Hyperlipidemia
C. IHD
D. COPD
E. Pulmonary embolism
```
A. mitral stenosis
C. IHD
D. COPD
E. Pulmonary embolism
56
Male with many IHD risk factors had an anterior wall MI, 3 days later vomited and
was bradycardic without ST changes in the ECG. What is the best next step in the
care of this patient?
A. To do an ECG to check if there is a new MI
B. To perform CXR to check PTX
C. To continue with the medical therapy
D. To perform an echo to check for cardiac tamponade
D. To perform an ECHO to check for cardiac tamponade
57
What causes transient ST elevation for 20 min?
A. Prinzmetal angina
...
58
Vasodilators medicines in case of Prinzmetal angina:
A. NO, Ca channel blockers, alpha blockers
B. NO, Ca channel blockers
C. NO, Ca channel blockers, beta blockers
B. NO, Ca-channel blockers
59
When do you anticoagulate:
A. AF
B. Aortic stenosis
C. Left ventricular aneurysm
D. Right ventricular dilatation
E. Left ventricular thrombus
A. AF (atrial fibrillation)
C. Left ventricular aneurysm
E. Left ventricular thrombus
60
In every infarction we see changes in the ECG:
- True
- False
False
61
How can you asses a specific kind of arrhythmia
Electrophysiology
62
CRT (cardiac resynchronization therapy):
- Increases life expectancy
- Increases ejection fraction
- Decreases intraventricular dysynchronization
63
The most reliable marker for IHD:
Troponin
| IHD = Ischemic heart disease
64
The most common cause of heart failure:
IHD (ischemic heart disease)
65
What is typical to angina? (3)
- Location (substernal)
- Precipitators (emotional stress, physical activity)
- What relives pain (nitroglycerin, rest)
66
What can aortic dissection cause?
A. LV hypertrophy
B. RV dilatation
C. Pericardial effusion
D. Aortic regurgitation
C. Pericardial effusion
| D. Aortic regurgitation
67
The most common etiologies of mitral regurgitation?
A. Rheumatic fever
B. Degenerative process
C. Infective endocarditis
A. Rheumatic fever
C. Infective endocarditis
68
# Choose the correct sentence:
A. VF within the first 48 hours after MI increase mortality in the long run
B. VF after the first 48 after MI increase mortality in the long run
C. Idioventricular tachycardia the first 48 hours after MI increase mortality in the long
run
D. Idioventricular tachycardia after the first 48 after MI increase mortality in the long
run
B. VF after the first 48 hours after MI increases mortality in the long run
69
75 years old diabetic female typical angina for 2 hours with ST depression on ECG,
not relieved after medication what should you do?
A. wait for biomarkers if positive coronarography
B. wait for biomarkers if positive thrombolysis
C. urgent coronarography
D. thrombolysis
C. Urgent coronarography
70
Cardiogenic shock symptoms, except:
A. metabolic alkalosis
B. anuria- oliguria
C. hyperkalemia
D. low blood pressure
A. metabolic alkalosis
C. hyperkalemia
71
Which of the following are not considered to be mechanical post-MI complications?
```
A. Papillary rupture
B. Ventricular free wall rupture
C. Aortic regurgitation
D. Atrial fibrillation
E. Septal rupture
```
C. Aortic regurgitation
D. Atrial fibrillation
72
DDD:
A. electrode in ventricle sensed in atrium
B. 2 electrodes (a\v)
C. sensed signal from the heart does not inhibit the pacemaker
D. a sensed signal from the atrium may trigger a ventricular beat
E. can pace atrium and ventricles
B. 2 electrodes (a/v)
E. Can pace atrium and ventricles
73
Late complications (>1 week) of MI:
A. aneurysm
B. Dressler syndrome
C. VF
D. acute heart failure
A. Aneurysm
B. Dressler syndrome
74
What are the most common etiologies of mitral valve stenosis?
```
A. Rheumatic fever
B. Congenital
C. Infective endocarditis
D. Marfan
E. Cushing
```
A. Rheumatic fever
B. Congenital
C. infective endocarditis
75
Contraindicated in aortic stenosis:
```
A. ACEi
B. Nitrate
C. Ca blockers
D. B-blockers
E. diuretics
```
Contraindicated = meaning a drug that should not be used in the case of aortic stenosis
A. ACEi
B. Nitrate
76
What are the most common complications of mitral valve stenosis?
```
A. sustained ventricular tachycardia
B. non-sustained ventricular tachycardia
C. AF
D. Third degree AV block
E. Bigeminy
```
A. Sustain ventricular tachycardia
C. AF
D. Third degree AV block
77
What can be the etiology of acute aortic valve regurgitation?
```
A. chorda tendinae rupture
B. infective endocarditis
C. aortic dissection
D. bicuspid valve
E. trauma
```
B. Infective endocarditis
C. Aortic dissection
E. Trauma
78
What is the indication of catheterization before valve replacement surgery?
A. When the findings of the echo are inconclusive
B. when the echo findings are discordant with the clinical findings
C. when the patient has AF
D. when the patient has congenital valve disease
E. always in case of aortic valve regurgitations
D. When the patient has congenital valve disease
E. Always in case of aortic valve regurgitations
79
What kind of valvular abnormalities are connected to Marfan?
```
A. AS
B. AR
C. MR
D. TR
E. PS
```
B. AR
= Aortic regurgitation
Marfan syndrome (MFS) is a disease in which connective tissue becomes weak secondary to fibrillin-1 mutations, resulting in aortic dilatation, aneurysm formation, aortic dissection, aortic regurgitation and mitral valve prolapse
80
What is true for severe mitral stenosis?
```
A. The area of the orifice is 1.0 cm2
B. The area of the orifice is 3.0 cm2
C. The pressure in the LA is 10mmHg.
D. The pressure in the LA is 50 mmHg
E. There is also mitral regurgitation
```
A. The area of the orifice is 1,0 cm2
C. The pressure in the LA is 10 mmHg
The two in red are correct but the last one wasn’t the actual choice on the test...it was
something along the lines of the pulmonary pressure being more than 50.
81
Which branches can cause inferior MI?
```
A. inferior ventricular posterior artery (IVP) (aka left marginal)
B. septal branch
C. diagonal branch
D. circumflex branch
E. RCA
```
A. Inferior ventricular posterior artery (IVP) (aka left marginal)
D. Circumflex branch
E. RCA
82
Hypertensive, diabetic 50 yo male develops hypotension during stress testing with 2
mm horizontal ST depression in the anterior leads; this can be due to:
```
A. significant left main disease
B. severe triple vessel disease
C. significant proximal LAD lesion
D. significant proximal RCA lesion
E. significant lesion in the proximal part of IVP
```
A. Significant left main disease
B. Severe triple vessel disease
C. Significant proximal LAD lesion
83
Which endocrine disease can cause hypertension?
```
A. Hypothyroidism
B. Polycystic renal disease
C. Primary hyperaldosteronism
D. Cushing’s syndrome
E. Acromegaly
```
B. Polycystic renal disease
C. Primary hyperaldosteronism
C. Cushing's disease
84
Which drugs can cause hypertension?
```
A. Oral contraceptives
B. NSAIDs
C. Proton pump inhibitors
D. Steroids
E. Amiodorone
```
A. Oral contraceptives
B. NSAIDs
D. Steroids
85
Which of the followings are a part of the whole complete circuit of WPW?
```
A. SA node
B. AV node
C. Atrium
D. Ventricle
E. Bundle of Kent
```
B. AV node
C. Atrium
D. Ventricle
E. Bundle of Kent
86
Which of the following can describe best effort stable angina?
A. Localization: substernal pain
B. Accompanied by Sweating
C. Relief by taking sublingual nitrate or by resting
D. The pain is increased by physical activity
A. Localization: substernal pain
C. Relief by taking sublingual nitrate or by resting
D. The pain is increased by physical activity
87
Which of the following is considered to be a modifiable risk factor?
A. smoking
B. hypertension
C. high cholesterol
D. male gender
A. Smoking
88
75 years old, chest pain for 2 hours. Now she’s without pain and her ECG is normal,
what would you do?
A. Urgent coronarography
B. Coronarography in 72 hours
C. Coronarography in the future (when ever she can)
B. Coronarography in 72 hours
89
Treatment of AF with unknown beginning, HR-110, BP 130\80:
A. Immediate cardioversion
B. Only amiodarone
C. 4 weeks anticoagulation and then cardioversion
D. Beta blockers and rate control drugs
C. 4 weeks anticoagulation and then cardioversion
D. Beta blockers and rate control drugs
90
In anterior MI which coronary artery might be involved?
```
A. RCA
B. IVP
C. LAD
D. CX
E. Diagnoal
```
C. LAD
91
Patient with untreated inferior MI develops hypotension and new murmur; what
happened
A. right MI
B. septal rupture
C. papillary muscle rupture
D. mitral valve regurgitation
D. mitral valve regurgitation
92
Treatment of VT:
A. sedation
B. sedation (if needed) and cardioversion
C. amiodarone
C. Amiodarone
93
What can increase the risk for endocarditis?
A. Mixed valvular disease
B. Permanent pacemaker
C. Mitral valve prolapse without significant regurgitation
D. Mitral valve lesion
A. Mixed valvular disease
D. Mitral valve lesion
94
Lab tests which can be positive in pulmonary embolism are:
A. LDH
B. Creatinine
C. D-dimer
D. Hypoxia (low O2) and hypocapnia (low CO2) in the arterial blood
E. Hypoxia (low O2) and hypercapnia (high CO2) in the arterial blood
A. LDH
C. D-dimer
D. Hypoxia (low O2) and hypocapnia (low CO2) in the aterial blood
95
Indications for thrmobolytic therapy in pulmonary embolism are:
A. PE + sinus tachycardia
B. PE + dyspnea
C. PE + DVT
D. PE + cardiogenic shock
B. PE + dyspnea
96
An increased JVP will be seen in these conditions:
```
A. Acute heart failure
B. Acute coronary syndrome
C. Left atrial increased pressure
D. Aortic regurgitation
E. End diastolic pressure increment on the RV
```
A. Acute heart failure
E. End diastolic pressure increment on the RV
97
Hemodynamic changes in MS include:
A. RV pressure increases
B. LA end diastolic pressure volume increase
C. Annular dilatation
D. LA systolic pressure increases
E. Formation of a polar body in the left ventricle
B. LA end diastolic volume increase
D. LA systolic pressure increase
98
Causes of pericarditis may be:
```
A. Upper airway infection in young people
B. Prosthetic valve
C. Chronic renal failure
D. Cerebral malignancy
E. Hyperthyroidism
```
A. Upper airway infection in young people
B. Prosthetic valve
C. Chronic renal failure
99
Which of the following can lead to pulmonary embolism?
```
A. DVT
B. Toxic hepatopathy
C. Hip joint replacement
D. Abdominal malignancy
E. Familial thrombophilia
```
A. DVT
C. Hip joint replacement
D. Abdominal malignancy
E. Familial thrombophilia
100
Diastolic murmurs can be heard in the following conditions:
```
A. ASD
B. MR
C. AR
D. MS
E. TR
```
C. AR (aortic regurgitation)
D. MS (mitral stenosis)
101
The following conditions are considered major risk factors for IE except:
```
A. Mixed valve disease
B. Cyanotic congenital disease
C. MPS without regurgitation
D. Permanent pacemaker
E. Prosthetic heart valve
```
B. Cyanotic congenital disease
C. MPS without regurgitation
(E. Prosthetic heart valve)
IE = infective endocarditis
102
All of these can be an indication for exercise tolerance test except:
A. Suspected coronary artery disease
B. After MI (at least 4 days after)
C. Recurrent symptoms after coronary revascularization
D. Pulmonary embolism
D. Pulmonary embolism
103
Myocardial perfusion stress testing can be used in:
A. High clinical suspicion of aortic valve stenosis
B. Resting ECG abnormalities preclude exercise stress test interpretation
C. Culprit vessel identification in multivessel disease
D. After PCI to evaluate stent restenosis
E. All of the above
B. Resting ECG abnormalities preclude exercise stress test interpretation
C. Culprit vessel identification in multivessel disease
D. After PCI to evaluate stent restenosis
104
Regular wide QRS tachycardias are:
```
A. AV nodal/ junctional re-entry tachycardia
B. Atrial flutter
C. VT
D. WPW (orthodrom)
E. WPW (antidrom)
```
C. VT
E. WPW (antidrom)
105
These are indications of anticoagulant therapy:
```
A. Left ventricular thrombus
B. Pulmonary embolism
C. Aortic dissection
D. Mechanical prosthetic valve implantation
E. ICD implantation
```
A. Left ventricular thrombus
B. Pulmonary embolism
D. Mechanical prosthetic valve implantation
106
These abnormalities can cause a systolic murmur:
A. Hypertrophic cardiomyopathy
B. Mitral valve stenosis (diastolic)
C. Ventricular septal defect
D. Atrial septal defect
E. Aortic valve regurgitation (diastolic)
A. Hypertrophic cardiomyopathy
C. Ventricular septal defect
D. Atrial septal defect
107
What does NYHA III mean?
A. NYHA is a functional classification in angina pectoris. NYHA III means marked
limitation- angina when walking at normal pace one flight of stairs
B. NYHA is a grading system to estimate disability due to heart disease. NYHA III
means slight limitation during ordinary activity
C. NYHA is a grading system to estimate disability due to heart disease. NYHA III
means marked limitation of normal activities without symptoms at rest
D. NYHA III is when someone is unable to undertake physical activity without
symptoms and symptoms may be present
C. NYHA is a grading system to estimate diability due to heart disease. NYHA III. means marked limitation of normal activities without symptoms at rest
108
Which medications, mentioned below, can improve the symptoms in angina pectoris?
```
A. Nitrates
B. Diuretics
C. Statins
D. Proton pump inhibitors
E. Calcium Ants
```
A. Nitrates
E. Calcium ants.
109
Which factors interfere with the interpretation of a stress test due to baseline ECG
abnormality?
```
A. Complete LBBB
B. Ventricular pacing
C. Baseline ST/T changes
D. Pre-excitation
E. All of the above
```
C. Baseline ST/T changes
110
Methods to evaluate wall motion abnormalities except:
A. Cardiac MRI
B. Dobutamine stress echocardiography
C. Exercise stress test
D. Myocardial perfusion imaging
C. Exercise stress test
111
Which condition describes more accurately stable effort angina pectoris?
A. One hour of chest pain after heavy exercise not relieved by stress
B. 10 minutes of chest pain at rest which is relieved by nitroglycerine
C. Chest pain occurring after walking up two flights of stairs relived by rest in the last
6 months
D. Chest pain occurring after walking 20 meters in the last two weeks relieved by
nitroglycerine
C. Chest pain occurring after walking up two flights of stairs relived by rest in the last 6 months
112
All of the following are risk factors for ischemic heart disease except:
```
A. Smoking
B. Hypertension
C. Female gender before menopause
D. Diabetes mellitus
E. Hyperlipidemia
```
C. Female gender before menopause
113
Anginal pain can radiate to these locations:
```
A. Left arm
B. Jaw
C. Neck
D. All of the above
E. None of the above
```
D. All of the above
114
Suddenly developing sharp chest pain with dyspnea which is increased by taking a
deep breath is typical of:
```
A. Angina pectoris
B. Pulmonary embolism
C. GERD
D. Peptic ulcer
E. None of the above
```
B. Pulmonary embolism
115
ECG shows the following characteristics in patients with NSTEMI except:
A. ST depression
B. Normal
C. ST elevation
D. Deep inverted T waves in corresponding leads
C. ST elevation
116
All of these conditions can contribute to the symptoms of unstable angina except:
```
A. Fever
B. Anemia
C. Thyrotoxicosis
D. Well controlled hypertension
E. Stress
```
D. Well controlled hypertension
117
Possible mechanisms of acute MI:
```
A. Thrombus formation on a ruptured plaque
B. Coronary embolism
C. Coronary spasm
D. Cocaine use
E. All of the above
```
E. All of the above
118
Diagnosis of NSTEMI in the appropriate clinical setting requires:
```
A. Elevation of cardiac biomarkers
B. Segmental wall motion abnormalities on echocardiography
C. Resting ECG changes
D. Elevated LDH
E. Ventricular premature beats on ECG
```
A. Elevation of cardiac biomarkers
119
In patients with unstable angina/ NSTEMI the following medications are useful
except:
```
A. Aspirin
B. Clopidogrel
C. Heparin
D. Thrombolytics
E. Statins
```
D. Thrombolytics
120
A 55 yo male, diabetic, smoking patient present to the ER with typical anginal pain at
rest on the day of admission which lasted 1 hour and started 6 hours prior to
admission. Troponin T is elevated, ECG shows 2 mm ST depression in the anterior
leads. You start medications (NGL, aspirin, clopidogrel, IV heparin). During
evaluation the patient develops ventricular fibrillation. After defibrillation he is
hemodynamically stable, you should:
A. Administer thrombolytics
B. Continue with the medications and schedule for a stress test
C. Send for urgent coronary angiography
C. Send for urgent coronary angiography
121
Indications of cardiac resynchronization therapy:
A. EF < 45%
B. EF < 35%
C. Drug refractory heart failure, NYHA II functional stage
D. Drug refractory heart failure, NYHA III-IV functional stage
E. QRS > 130 ms
B. EF < 35%
D. Drug refractory heart failure, NYHA III-IV functional stage
E. QRS > 130 ms
122
Typical causes of bradycardias
```
A. Coronary artery disease
B. Fever
C. Fibrosis of the conduction system of the heart
D. Hyperthyroidism
E. WPW
```
A. Coronary artery disease
C. Fibrosis of the conduction system of the heart
123
Which of the following are parts of the re-entry circuit in AV nodal/ junctional re-entry tachycardia?
```
A. Left bundle branch
B. AV node, slow pathway
C. Accessory pathway, Kent bundle
D. AV node, fast pathway
E. Ventricle
```
B. AV node, slow pathway
D. AV node, fast pathway
124
AAI pacemaker means:
A. One electrode in the ventricle
B. One electrode in the atrium
C. Two electrodes (atrium and ventricle)
D. A sensed signal from the heart inhibits the pacemaker
E. A sensed signal in the atrium may trigger a ventricular paced beat
B. One electrode in the atrium
D. A sensed signal from the heart inhibits the pacemaker
125
Drugs which may be useful in the management of acute heart failure:
```
A. B-blockers
B. Loop diuretics
C. Morphine
D. Calcium Ants
E. Nitrates
```
B. Loop diuretics
C. Morphine
E. Nitrates
126
These lab results are often found in chronic heart failure:
```
A. Polyglobulinemia
B. Anemia
C. Low Na level
D. High BNP level
E. High troponin level
```
C. Low Na level
D. High BNP level
E. High troponin level
127
Possible causes of dilated cardiomyopathy:
```
A. Toxins, e.g. adriamycin
B. Myocarditis
C. Hyperthyroidism
D. Chronic renal failure
E. COPD
```
A. Toxins, e.g. adriamycin
B. Myocarditis
C. Hyperthyroidism
128
What are the consequences of aortic stenosis in the heart?
```
A. Left ventricular volume overload
B. Left ventricular pressure overload
C. Left ventricular hypertrophy
D. Later left ventricular dilation
E. Early left ventricular dilation
```
B. Left ventricular pressure overload
C. Left ventricular hypertrophy
D. Later left ventricular dilation
129
What are the most frequent symptoms of significant aortic stenosis?
```
A. Ventricular arrhythmias
B. Effort angina pectoris
C. Effort syncope
D. Hypertension
E. Heart failure
```
B. Effort angina pectoris
C. Effort syncope
E. Heart failure
130
The appearance of which symptom will decrease the life expectancy by 2 two years in
significant aortic stenosis?
```
A. VT
B. Heart failure
C. Low blood pressure
D. Effort angina pectoris
E. Syncope
```
B. Heart failure
131
What are the typical physical signs of aortic valve stenosis?
```
A. Mid diastolic murmur
B. Mid systolic murmur
C. Pulsus parvus et tardus
D. Austin Flint murmur
E. Palpable systolic thrill
```
B. Mid systolic murmur
C. Pulsus parvus et tardus
E. Palpable systolic thrill
132
What are the indications for chronic anticoagulation in mitral valve stenosis?
```
A. AF
B. Ectopic supraventicular beats
C. Dyspnea
D. Left atrial size > 55 mm
E. Thrombus formation in left atrium
```
A. AF
D. Left atrial size > 55 mm
E. Thrombus formation in left atrium
