2009 Module Exam

Question 1

In a patient who has a block in the anterior-interventricular septum, which is the area most susceptible to myocardial infarction?

Answer 1

Anterior 2/3 interventricular septum

Question 2

What is the component of the fatty streak?

a. Foam cells
b. Fibro-fatty plaque

Answer 2

a. Foam cells

Question 3

Where is the apex located?

Answer 3

5th intercostal space 9cm from midline

Question 4

A patient with chest pain that radiated to the left arm. What is the best way to treat his condition?

Answer 4

Nitrates, Ca++ channel blockers, β-blockers

Question 5

What are the sympathetic innervations of the heart?

Answer 5

T1-T6

Question 6

What is the mechanism of action of nitrates?

Answer 6

Increase relaxation of smooth muscle cells

Question 7

Weight gain is a side effect to clofibrate due to

Answer 7

Inhibiting lipolysis

Question 8

What is the best drug for increasing HDL levels?

Answer 8

Nicotinic acid

Question 9

What is a complication of myocardial infarctions in 3 days?

Answer 9

Arrhythmias

Question 10

What is the feature of the post-transition state?

What changes are seen in post 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 10

Low mortality, low fertility – chronic diseases

Question 11

How does glycosylation affect atherosclerosis?

Answer 11

Reduce LDL clearance

Question 12

An increase of perfusion pressure increases the blood flow. What mechanism is responsible for that?

a. Neural vasoconstriction
b. Metabolic vasodilation
c. Myogenic vasodilation

Answer 12

c. Myogenic vasodilation

Question 13

A patient has mitral stenosis due to an old rheumatic heart disease. What type of treatment is he given?

Answer 13

Diuretics & β-blockers

Question 14

Which enzyme is seen in pheochromocytoma?

Answer 14

VMA

Question 15

What is the mechanism of furosemide?

Answer 15

Inhibit Na/K/Cl pump

Question 16

What is the mechanism of digoxin?

Answer 16

Increase intracellular Ca++

Question 17

Kuwait is considered to have low hypertension percentage compared to western countries. Why is that?

Answer 17

Kuwait has a young population

Question 18

What drug is responsible for blocking angiotensin receptors?

Answer 18

Losartan

Question 19

What is the mechanism of action of α-methyldopa?

Answer 19

Stimulation of α2 receptors (agonists)

Question 20

What did the drug do?

Answer 20

Hypotension

Question 21

What is the likely cause of this condition?

a. Sympathetic dysfunction
b. Vasodilators

Answer 21

b. Vasodilators

Question 22

What is the most direct cause of cardiac death?

Answer 22

Cardiac arrhythmias

Question 23

What characterizes acute rheumatic fever?

Answer 23

Aschoff’s nodules

Question 24

Which causes acute myocardial infarction?

Answer 24

Rupture of plaque

Question 25

Which drug is responsible for blocking K+ channels?

Answer 25

Type III anti-arrythmatic drugs

Question 26

Which drug is responsible for blocking Na+ channels?

Answer 26

Quinidine

Question 27

What is the mechanism of action of Amodarone?

Answer 27

Prolongation of action potential duration

Question 28

Patient with MI would typically show

Answer 28

QT elongation

Question 29

What is the problem in the figure?

Answer 29

Aortic stenosis

Question 30

What would be seen in a post-mortem patient with 10-years history of hypertension?

Answer 30

Left ventricular hypertrophy

Question 31

A 3-month-infant is diagnosed with VSD, on birth he was diagnosed with a normal heart and no anomalies. What is the biological reason?

Answer 31

A decrease in pulmonary resistance

Question 32

What is the mechanism of blood flow in the inferior vena cava?

Answer 32

Negative pressure of the thoracic cavity

Question 33

A 41-year-old male developed sudden chest pain that radiated to the left arm. When he went to the hospital he collapsed. Whats the diagnosis?

Answer 33

Acute myocardial infarction

Question 34

VO2a = 20, VO2v = 12, MVO2 = 280, HR = 78, what’s the SV?

Answer 34

45

Question 35

A patient with breathlessness, increased creatinine, low Na, low albumin. What’s the diagnosis?

Answer 35

Heart failure

Question 36

A male with MI, aerobic exercise is done, which has the highest requirement of O2?

Answer 36

They will give you a table, and the answer is the highest (SBP x HR)

Question 37

The CO of a normal person is 5 L/min, when exercising it became 3 times more. What is the new venous return?

Answer 37

15 L/min

Question 38

Which is a potassium channel blocker?

Answer 38

Amiodarone

Question 39

Which shows a ventricular action potential?

Answer 39

Question 40

A patient with MI, his SV decreased from 88 to 46, what’s the reason? a. Decrease in contractility b. Increase in compliance c. Increase in pulmonary ridge

Answer 40

a. Decrease in contractility

Question 41

What is the complication of carotid artery occlusion?

Answer 41

Cerebrovascular event

Question 42

A 59-year-old male with angina on exertion and aortic stenosis. He is normotensive and coronary angiography is normal. What should we do? a. Increase VR b. Give diuretics c. Increase contractility d. Coronary angiogram

Answer 42

c. Increase contractility (or B)

Question 43

What is responsible for bypassing the liver in the fetal circulation?

Answer 43

Ductus venousus

Question 44

What changes are seen in a fetus after birth? a. Increase RA pressure b. Increase pulmonary pressure c. Swab of hepatic veins d. Blood flow in ductus arteriousus is reversed

Answer 44

d. Blood flow in ductus arteriousus is reversed

Question 45

A patient closes his nose and blow. (valvasa maneuver). What would it cause?

Answer 45

Increase in thoracic pressure

Question 46

An African American 45-year-old male with murmurs heard on both sides of the 2nd intercostal space is diagnosed with

Answer 46

Aortic stenosis

Question 47

What is the best way to adjust the volume-pressure relationship?

Answer 47

Adjusting contractility

Question 48

A patient was diagnosed with heart failure. What is the best combination of drugs?

Answer 48

Diuretics, β-agonists, digoxin, and ARBs

Question 49

A patient with blood pressure of 160/100. What’s the best treatment?

Answer 49

Diuretics, ACEI, and ARBs

Question 50

What is the mechanism by which CO increases?

Answer 50

Increase in venoconstriction

Question 51

There was a cross-sectional study and they made an Odds Ratio inference of 2.4, what do you think about the result?

Answer 51

Disagree. Temporal relationship not found

Question 52

A case-control study was made on the exercise and respiratory infections. The cases are from the hospital, and the controls are from the spa. What is your interference?

Answer 52

Case: Unbiased -- Control: Biased -- OR: increased

Question 53

Which nuclear medicine test is used to identify causes of heart failure?

Answer 53

Myocardial perfusion imaging

Question 54

What is the most factor that causes cardiac death? a. Smoking b. Illegal drugs c. Obesity d. Type-A-Behavior

Answer 54

a. Smoking

Question 55

Some impulses are not conducted through the AV, while others are conducted normally. What anomaly is this?

Answer 55

2nd degree AV block

Question 56

What sources are needed for HE/HP?

Answer 56

Sociodemographics/epidemiological

Question 57

What originates from aortic sinus?

Answer 57

Right coronary artery

Question 58

What supplies the pacemaker of the heart?

Answer 58

Nodal branch

Question 59

Patient with 90% stenosis of coronary artery with partial blockage?

Answer 59

Unstable angina

Question 60

Patient with 90% stenosis of coronary artery with complete occlusion?

Answer 60

Myocardial infarction

Question 61

What is the most prominent feature of arterioles?

Answer 61

Internal Elastic Lamina

Question 62

Which type of capillary is in the endocrine cells?

Answer 62

Fenestrated capillaries

Question 63

What is the best marker of cardiac failure?

Answer 63

BNP

Question 64

A patient came to the hospital after 6 hours of the onset of symptoms of myocardial infarction. What is the best diagnostic marker?

Answer 64

Troponin

Question 65

What is produced from the endothelial cells in response to high blood velocity?

Answer 65

Nitric Oxide

Question 66

What is a major vasoconstrictor agent?

Answer 66

Endothelin

Question 67

Where can you hear the murmur of mitral stenosis?

Answer 67

Diastolic murmur in 5th intercostal space

Question 68

Where can you hear the murmur of mitral regurgitation?

Answer 68

Systolic apical murmur

Question 69

Where can you hear the murmur of aortic stenosis?

Answer 69

2nd intercostal space right side systolic murmur

Question 70

Apo E polymorphism

Answer 70

Type III familial dysbetalipoproteinemia

Question 71

Lipoprotein lipase deficiency

Answer 71

Familial hyperchylomicronemia

Question 72

A patient with prosthetic valve was diagnosed with IE. Culture showed gram-positive cocci arranged in chains?

Answer 72

Streptococcus Viridans

Question 73

A patient with pain in the left leg. No pulses were found in the distal part of the leg. What's the diagnosis?

Answer 73

Peripheral arterial disease

Question 74

A 95-year-old patient with floppy mitral valve with friable vegetation. Diagnosis? a. Degenerative changes in valve leaflets b. Calcification of aortic valve

Answer 74

?

Question 75

A patient with senile vegetations. Diagnosis?

Answer 75

Limban sack endocarditis (all the other answers excluded) (\*pretty sure them meant sterile not senile)

Question 76

A patient with Gamine-Ghaneli bodies in the lab show. Diagnosis?

Answer 76

Congestive splenomegaly

Question 77

Which phase of the cardiac cycle you see the mitral valve opened, and the maximal volume?

Answer 77

Atrial contraction

Question 78

Which phase of the cardiac cycle you see maximal pressure?

Answer 78

Rapid ejection

Question 79

Vagal stimulation of the heart a. Alpha-1 b. Alpha-2 b. beta-1 c. beta-2 d. beta-3 e. M1 f. M2

Answer 79

f. M2

Question 80

Inotropic effect on the heart a. Alpha-1 b. Alpha-2 b. beta-1 c. beta-2 d. beta-3 e. M1 f. M2

Answer 80

b. beta-1

Question 81

Systemic vasoconstriction a. Alpha-1 b. Alpha-2 b. beta-1 c. beta-2 d. beta-3 e. M1 f. M2

Answer 81

a. Alpha-1

Question 82

Patient with asymmetric sub-aortic hypertrophy in interventricular septum. Diagnosis?

Answer 82

Hypertrophic cardiomyopathy

Question 83

Patient with transient decrease of blood flow. What mechanism is used to compensate?

Answer 83

Reactive hyperemia

Question 84

Which drug is used for supraventricular tachycardia?

Answer 84

Adenosine

Question 85

Which drug is exclusive for emergencies of ventricular arrhythmias?

Answer 85

Lidocaine

Question 86

Which drug affects PRARA-α?

Answer 86

Clofibrate

Question 87

Appropriate mechanism of tachycardia in hypervolemia

Answer 87

Sympathetic stimulation

Question 88

Sinus bradycardia. What would be the mechanism?

Answer 88

Decrease frequency of AP in SA node

Question 89

What’s responsible for developing partition in atria?

Answer 89

Septum primum

Question 90

What’s responsible for division of atrioventricular canal?

Answer 90

Endocardial cushions

Question 91

What’s responsible for the development of the infundibulum?

Answer 91

Bulbus cordis