2008 Module Exam

Question 1

What is best used to identify a recessive monogenic disorder predisposing to (heart disease?)?

a. whole genome sequencing for all unaffected family members
b. whole genome sequencing for each family member
c. karyotyping
d. SNPB based linkage analysis
e. SNP based association approach

Answer 1

e.SNP based association approach

Question 2

what psychological factor increase the risk of mortality by 5-6 times (after 1 year of having) MI?

a. depression
b. anxiety
c. type A behavior
d. social isolation

Answer 2

a. depression

Question 3

In post epidemiologic transition countries

A) Low mortality, high fertility, infectious diseases

B) Low Mortality, low fertility, and chronic diseases

C) High mortality, low fertility, chronic diseases

D) High mortality, high fertility. Infectious diseases

Answer 3

B) Low mortality, low fertility, and chronic diseases

Question 4

to which level the blood pressure should be lowered in a patient with hypertension and diabetes mellitus

a. 140/90
b. 139/89
c. 130/90
d. 130/80

Answer 4

d. 130/80

Question 5

a male who experiences syncopal attack when pressure is applied to his neck

Answer 5

Vagal bradycardia due to carotid sinus hypersensitivity

Question 6

what should paramedics do to a patient who is unconscious and have pulseless tachycardia?

a. CD Cardioversion
b. medications

Answer 6

a. CD Cardioversion

Question 7

when a thrombolytic drug is used?

a. stable angina
b. unstable angina
c. old MI
d. acute MI

Answer 7

d. acute MI

(same question in other exams is B)

Question 8

treatment of a patient with chest pain (symptoms of angina)

Answer 8

Beta-blocker, nitrate, and CCB

Question 9

Which chamber receives blood from coronary sinus?

Answer 9

Right atrium

Question 10

which fetal vessel allow the blood from placenta to bypass the liver?

Answer 10

Ductus venosus

Question 11

which defect is caused by unequal separation of truncus arteriosus?

Answer 11

Pulmonary atresia

Question 12

which congenital defect is associated with separation of sternum?

Answer 12

Ectopia cordis

Question 13

mechanism of action of thiazide?

Answer 13

Bind to Cl site in Na/Cl co-transport system

Question 14

mechanism of action of digoxin?

Answer 14

Inhibit Na/k ATPase

Question 15

a consequence of using a drug that prevents the absorption of cholesterol into the gastrointestinal tract like cholestyramine?

Answer 15

Increase the density of LDL receptors

(not sure)

Question 16

which drug has negative effects on the heart after using it for a long time for heart failure?

a. Digoxin
b. beta-blocker
c. beta-agonist
d. ACEI

Answer 16

c. beta agonist

Question 17

dobutamine effect?

a. increase cAMP
b. activate β2 receptors

Answer 17

a. increase cAMP

Question 18

angiotensin receptor blocker:

Answer 18

Losartan

Question 19

a drug that blocks Na channels and reduce the slope of phase 4

Answer 19

Quinidine

Question 20

weight gain when using clofibrate is due to:

Answer 20

Inhibiting lipolysis

Question 21

angiotensin-converting enzyme inhibiter:

Answer 21

Captopril

Question 22

a molecule with antithrombotic and vasodilatory effects

Answer 22

Nitric oxide

Question 23

10-year-old boy fainted when playing football, systolic ejection murmur was heard in the right intercostal space and the murmur radiates to the neck. Diagnosis?

Answer 23

Aortic stenosis

Question 24

full term neonate has cyanotic congenital heart defect, his aortic O2 saturation was 60 and pulmonary artery saturation 98%

a. tetralogy of Fallot
b. transposition of great artereies
c. persistent fetal circulation
d. tricuspid atresia

Answer 24

b. transposition of great artereies

Question 25

apical pansystolic murmur means

Answer 25

Mitral regurgitation

Question 26

what characterizes sinus rhythm?

Answer 26

Upstroke p wave followed by QRS complex | (not sure about question)

Question 27

Otherwise healthy elderly developed isolated systolic blood pressure. What is most likely the cause?

Answer 27

Aortic rigidity

Question 28

patient was admitted to the hospital after 5 days of onset of acute MI. best biomarker used is:

Answer 28

Troponin I

Question 29

patient 60 pack of cigarettes/year experienced pain in his left calf when walking for 200m. ankle-brachial index was 0.6 and one of his legs was cooler than the other one:

Answer 29

Peripheral arterial disease

Question 30

Question about rheumatic heart disease:

Answer 30

Aschoff nodules in endocardium

Question 31

artery occlusion 90% Developed a thrombus that caused partial occlusion? a. cerebrovascular event b. unstable angina c. acute MI

Answer 31

b. unstable angina

Question 32

artery occlusion 90%. Developed a thrombus that caused total occlusion? a. cerebrovascular event b. unstable angina c. acute MI

Answer 32

c. acute MI

Question 33

effect of pulmonary embolism a. right ventricle failure b. pulmonary oedema c. dilated right ventricle

Answer 33

a.right ventricle failure

Question 34

What is the complication of carotid artery occlusion? a. cerebrovascular event b. unstable angina c. acute MI

Answer 34

a. cerebrovascular event

Question 35

effect of aortic regurgitation: a. decreased perfusion of coronary arteries b. prominent S2

Answer 35

a. decreased perfusion of coronary arteries

Question 36

what is the pulmonary resistance if Mean pulmonary pressure = 30mmgh Mean right atrium pressure=1 Mean left atrium pressure=4 CO=5.6

Answer 36

?

Question 37

what is the minimum HR that a 45-year-old male should reach to enhance his aerobic performance when performing aerobic exercise?

Answer 37

**123** **\*\*How to calculate it:** **220+45= 175** **175****×70/100**

Question 38

why does the diastolic blood pressure increases during isometric exercise?

Answer 38

Increased resistance

Question 39

What causes closure of ductus arteriosus : a. Increased O2 in aorta b. increased prostaglandins

Answer 39

a. Increased O2 in aorta

Question 40

young female had an accident, which resulted in massive bleeding. What is the initial response ( reflex?) a. total peripheral vasodilation b. vagal over activity c. decreased sympathetic outflow d. reflex tachypnea

Answer 40

d. reflex tachypnea hemorrhage causes hypoxia → response by chemoreceptors

Question 41

What is the compliance of vessels? a. 1000 b. 100 c. 10

Answer 41

b. 100 | (3500-2500)⁄(20-10)

Question 42

Q about accident and bleeding. what’s maintaining coronary blood flow? a. autoregulation b. sympathetic activation

Answer 42

a. autoregulation | (not sure)

Question 43

what is the cause of edema in a female with liver disease?

Answer 43

Decreased capillary oncotic pressure

Question 44

What stimulates NO?

Answer 44

Velocity of blood (= shear stress)

Question 45

what stimulates thirst center in a person who is deprived from water intake?

Answer 45

Angiotensin ΙΙ

Question 46

what is the physiological cause of S2 splitting?

Answer 46

Prolonged ventricular ejection (not sure about the Q) (one of the ventricles has a high afterload, causing it to get out of sync with the other ventricle. They close at different times and that causes the S2 splitting)

Question 47

what decreases stroke volume and ejection fraction in an angina patient? a. increased central venous pressure b. decreased arteriolar diameter c. Increased heart rate d. increased end-systolic volume

Answer 47

angina→decreased myocardial contractility →more volume of blood is left→increased"ESV)

Question 48

what estimates stroke volume? a. pulse pressure b. pulmonary wedge pressure c. systolic blood pressure

Answer 48

a. pulse pressure

Question 49

which current differentiate between atrial and ventricular action potential? a. fast Na b. L-type Ca c. inward rectifier K d. transient outward K channel

Answer 49

d. transient outward K channel the atrial action potential is triangular, while the action potential of the ventricle is quadrilateral→the difference"is"in"repolarization→K channels

Question 50

Answer 50

decrease contractility

Question 51

which point represent end-systolic pressure volume relationship?

Answer 51

**F**

Question 52

at which point the isovolemic relaxation ends?

Answer 52

Question 53

At which phase of the cardiac cycle the blood flow from the ventricles is highest?

Answer 53

Rapid ejection

Question 54

the slowest spontaneous depolarization? a. Purkinjie b. atrial myocytes

Answer 54

a. Purkinjie (b=although these can act as an ectopic pacemaker, but normally the pacemakers are SA node, AV node, and Purkinje fibers)

Question 55

a. sinus tachycardia b. atrial flatter c. atrial fibrillation

Answer 55

a. sinus tachycardia

Question 56

what represents AV node depolarization?

Answer 56

PR segment

Question 57

absolute refractory period is caused by:

Answer 57

Inactivation of Na channels

Question 58

young female with yellow streaks. What's the histological evaluation of the yellow streaks? a. fibro fatty b. inflammatory c. foam cells

Answer 58

c. foam cells

Question 59

the initial step of atherosclerosis?

Answer 59

Vascular endothelial damage

Question 60

patient with sterile vegetation and died from prostate cancer:

Answer 60

Marantic endocaditis

Question 61

what would you find in renal artery of a patient with mild controlled hypertension for 20 years?

Answer 61

Hyaline areriolitis

Question 62

what would a biopsy of the temporal artery of 70 year old lady with right side ( headache?) and visual disturbance shows?

Answer 62

Granulamatous panarteritis

Question 63

female with dilated cardiomyopathy developed left hemiplegia, what's the cause of the hemiplegia? a. DVT in left leg b. thrombophlebitis c. embolization of Mural thrombus in the left (ventricle/atrium)

Answer 63

c. embolization of Mural thrombus in the left (ventricle/atrium)

Question 64

young female collapsed while jogging, and she had asymmetrical interventricular septum and (fibrous?) disarray:

Answer 64

Hypertrophic cardiomyopathy

Question 65

a heart with endomyocardial fibrosis

Answer 65

Restrictive cardiomyopathy

Question 66

what is the function of ATP binding cassette?

Answer 66

Efflux of cholesterol

Question 67

what's the effect of glycosylation on LDL?

Answer 67

Impair its clearance from circulation

Question 68

receptor expressed on vascular endothelium that can recognize oxidized LDL? a. LOX1 b. Scavenger"Receptor

Answer 68

a. LOX1 (probably this, but unsure)

Question 69

what valve prevent blood from going back from the right ventricle to the right atrium during systole OR (Defect in which structure would let the blood leak into the right atrium??)

Answer 69

tricuspid valve

Question 70

a patient with mitral regurgitation (mitral systolic murmur?). No calcification was found on the leaflets of the valve. What may be the pathogenesis?

Answer 70

Calcification of mitral annulus

Question 71

a question about a case African American + mumur radiates to the neck area

Answer 71

**aortic stenosis**

Question 72

when one’s age is (55/more than 55?) what is his risk of developing hypertension?

Answer 72

\>75%

Question 73

a drug that causes elevated liver enzymes as a side effect

Answer 73

Lovastatin (they also mention that it is a statin)

Question 74

a drug that inhibits intestinal absorption of cholesterol?

Answer 74

Ezetimap

Question 75

physiology question about calculating fluid movement

Answer 75

Question 76

physiology question about calculation cardiac index (stroke volume, heart rate, body surface area were given)

Answer 76

?

Question 77

blood pressure changes (values given) (I remember that the systolic increases by 5, while the diastolic by 10) what is the mechanism for blood pressure increase)

Answer 77

\*\*we don’t remember the number, but the doctor told us that the actual numbers are critical; you must calculate MAP before the administration of the drug, and then calculate MAP after the administration of the drug, and then compare MAP1 with MAP2 to see if MAP increased/decreased/unchanged and answer accordingly!!

Question 78

a previously sedentary man is exercising. What parameter increases?

Answer 78

stroke volume

Question 79

what receptor mediates vasodilation in exercising skeletal muscles?

Answer 79

beta 2 receptor

Question 80

physiology question. A curve that indicates decreased luisotropy. What may be the cause?

Answer 80

ventricular fibrosis

Question 81

a patient with (symptoms of infective endocarditis) after (2 months?) of a valve replacement surgery. The culture showed gram-positive bacteria arranged in clusters?

Answer 81

**staphylococcus epidermidis**

Question 82

a patient with symptoms of infective endocarditis) + showed gram positive bacteria arranged in (……..) ![]()

Answer 82

**viridian streptococci**

Question 83

patient with symptoms of rheumatoid fever

Answer 83

staphylococcus pyogens (I know this does not make any sense, but this is the way it was written!!!)

Question 84

a patient with intracranial tumor. What is the mechanism of high blood pressure?

Answer 84

**Cushing reflex**

Question 85

a cuff was used to press on someone's arm and then was released. What's the mechanism of the increased blood flow?

Answer 85

**Reactive hyperemia**

Question 86

the cause of atrial fibrillation in a female:

Answer 86

Increase in left atrial pressure

Question 87

What contributes to the cyanosis associated with Eisenmenger’s syndrome?

Answer 87

**R****i****gh****t****t****o** **l****e****ft** **s****hun****t**

Question 88

What would result from AV block?

Answer 88

**Prolongation of PR**

Question 89

How does sympathetic activation affect action potential?

Answer 89

**Phosphorylation of L+type calcium channels**

Question 90

What is the side effect of ACEI?

Answer 90

**Cough**

Question 91

Why is the prevalence of hypertension in Kuwait misleading?

Answer 91

**Because Kuwait is a relatively young population**

Question 92

What is the difference between arterial pulsation and jugular venous pressure?

Answer 92

Arterial pulsation has a single upstroke

Question 93

Heavy neutrophilic infiltrate is the answer

Answer 93

??

Question 94

Continuous murmur

Answer 94

**Pa****t****en****t****d****uc****t****us** **a****r****t****er****i****o****s****us**

Question 95

What structure allows the blood to flow from the aorta to the pulmonary trunk in the embryo?

Answer 95

Ductus arteriosus

Question 96

How does sympathetic stimulation affects action potential?

Answer 96

Positive dromotropy

Question 97

How do statins work?

Answer 97

Inhibition of HMG+Co reductase ​