2011 Module Exam Flashcards
Q's (1-11) anatomy Q's (12-19) biochemistry Q's (20-33) pharma Q's (34-58) clinical medicine Q's (59-64) microbiology Q's (65-86) pathology Q's (87-115) physiology Q's (116-)
1
Q
Which of the following arteries supplies the SA node?
A
Nodal artery
2
Q
Which of the following arteries arises from the ascending aorta?
A
Right coronary artery
3
Q
What embryological structure is responsible for separation of the Atrioventricular canal into the right and left Atrioventricular canals?
A
Endocardial cushions
4
Q
A coronary angiogram reveals the presence of a block in the anterior interventricular artery. Which of the following structures will most likely be affected?
A
Anterior 2/3 of the interventricular septum
5
Q
Which of the following components of the conduction system of the heart is located in the membranous part of the interventricular septum?
A
Bundle of His
6
Q
Which of the following carries the parasympathetic innervation to the heart?
A
Vagus nerve
7
Q
What is a prominent feature of veins?
A
Endothelial valves
8
Q
What structure is responsible for shunting blood from the right to left atrium in the fetal heart?
A
Foramen ovale
9
Q
Which of the following is a feature of sinusoids?
A
Discontinuous endothelium
10
Q
What is responsible for maintaining pressure in the ascending aorta?
A
Elastic lamellae
11
Q
What maintains the blood flow in the inferior vena cava?
A
Negative intrathoracic pressure
12
Q
What is impact of glycosylation on LDL?
A
Reduces the clearance of LDL
13
Q
Which of the following genes was found using quantitative trait loci and is related to an increased of MI and Stroke?
A
LOX
14
Q
Which of the following is responsible for lowering the concentration of IL-1β in high intracellular cholesterol concentrations?
A
LXR
15
Q
What energy producing pathway in the heart is predominant in a person who is fasting for 6 hours in Ramadan?
A
Fatty acids → TCA cycle
16
Q
What energy producing pathway in the heart is predominant after an injection of insulin?
A
Glucose →TCA cycle
17
Q
What is a main fuel that increases in importance for energy production during prolonged starvation?
A
Ketone bodies
18
Q
What is the main fuel used by the heart during normal oxygen conditions?
A
Fatty acids
19
Q
A person has dilated cardiomyopathy. What will be the main fuel used by his failing ischemic heart?
A
Glucose
20
Q
Which drug has anti-vagal activity resulting in sinus tachycardia?
A
Quinidine
21
Q
which of the following drugs is highly concentrated in the heart as compared to its plasma concentration?
A
Amiodarone
22
Q
Which of the following is an irreversible inhibitor of cyclooxygenase?
A
Aspirin
23
Q
Which of the following is a highly antigenic plasminogen activator?
A
Streptokinase
24
Q
Which drug is a reversible P2Y12 antagonist?
A
Ticagrelor
25
Which of the following is an angiotensin receptor blocker?
Losartan
26
A patient comes to the clinic suffering from atrial flutter. The doctor prescribes him lidocaine to manage his arrhythmia. After a few days, he returns to the clinic with no apparent improvement in his condition. What could be the cause?
Lidocaine has little or no effect on the action potential duration of atrial myocytes
27
which drug has multiple effects: decreasing the preload at high doses and increasing the blood flow in the coronary arteries?
Nitrates
28
What is the mechanism of weight gain in a patient receiving nicotinic acid?
Inhibition of lipolysis in lipid tissue
29
Which of the following drugs cannot be administered in angina?
Digoxin
30
Why is digoxin used to treat arrhythmias?
Because it decreases the speed of conduction in the AV node
31
Why is the effect of aspirin reversible of prostacyclin and irreversible of TXA2?
Because endothelial cells can regenerate cyclooxygenase
32
What drug inhibits renin activation?
Aliskirin
33
An asthmatic patient with a heart problem was given a drug. He came back a few days later and his asthma was exacerbated. Which of the following drugs he might have received?
Propranolol (beta-blocker)
34
Which drug is not used in heart failure?
Amlodipine (calcium channel blocker)
35
Which drug is used to terminate supraventricular tachycardias?
Adenosine
36
What is an irregularly irregular rhythm?
Atrial fibrillation
37
Which rhythm is associated with a high risk of thrombo-embolic events?
Atrial fibrillation
38
What characterizes the pain associated with biliary colic?
Right upper quadrant pain (or right hypochondriac pain, we don’t remember which was in the exam) that radiates to the right shoulder
39
What characterizes the pain associated with acute pericarditis?
Pain increased on inspiration and relieved by expiration
40
What is used for the treatment of ventricular tachyarrhythmia?
DC cardioversion (aka: DC shock)
41
In which of the following is the use of DC cardioversion contraindicated?
a-Third degree AV block
b-Supraventricular tachycardia
c-Ventricular tachycardia
d-Ventricular fibrillation
e-Ventricular flutter
a-Third degree AV block
42
A woman who is known to be hypotensive collapses on the floor after waiting in line for a long time at the airport. Which of the following is an appropriate initial therapy in this case?
a- Epinephrine injection
b- Raise her legs above her head
b- Raise her legs above her head
43
Which of the following is not known to cause pulmonary edema?
a-Crohn’s disease
b-Nephrotic syndrome
c-left ventricular failure
d-Hepatic failure
a-Crohn’s disease
44
What do you look for in an exercise stress test?
ST-depression on the ECG
45
What does the jugulo-venous pressure reflect?
Right-sided heart pressure
46
Which of the following represents ventricular contraction on the ECG?
QRS complex
47
What distinguishes a sinus rhythm from a non-sinus rhythm?
P-wave
48
When do you hear S3?
Systolic heart failure (dilated cardiomyopathy or ischemic heart disease)
49
Which of the following is least likely to be associated with sinus bradycardia?
a- Anemia
b- Hypothyroidism
a- Anemia
50
What is the best method to use in order to visualize calcification of the coronary arteries?
Computed tomography (CT scan)
51
A patient presents to you with burning chest pain that comes to him on exertion but not at rest. What is the best test to use to investigate his condition?
Exercise ECG
52
What is associated with aortic stenosis?
Bicuspid aortic valve
53
What is the apex beat?
The most infero-lateral (Inferior and lateral) palpable part of the heart
54
Which of the following is not found in mitral stenosis?
Left ventricular hypertrophy
55
What does ST-depression on an ECG indicate?
Unstable angina and non-ST-elevation myocardial infarction
56
What would you do if someone presented to you in the emergency department diagnosed with acute inferior wall MI?
a-give aspirin, clopidogrel, heparin, and fibrinolytics
b-do not give him anything and rush to the catheterization lab immediately
(?)
57
What would you find in a person with mitral regurge?
Pansystolic murmur heard at the apex
58
A patient with diabetes and heart failure undergoes pharmacological stressing and perfusion imaging which shows persistent ischemic areas. What is the most likely diagnosis?
Silent infarction
59
What would cause infective endocarditis in a person drinking raw unpasteurized milk?
Brucella abortus
60
A patient develops infective endocarditis 4 weeks after a valve replacement surgery. What is the most likely causative organism?
Staphylococcus epidermidis
61
What would most likely cause infective endocarditis in a woman undergoing a genitourinary exam?
Enterococcus feacalis
62
A patient presented with chest pain following a gastrointestinal surgery. Blood culture shows Gram positivecocci in short chains. What is the causative organism?
Enterococcus feacalis
63
What would cause splinter hemorrhages in infective endocarditis?
Small emboli
64
What would cause rheumatic fever after tonsillitis?
Streptococcus pyogenes
65
A person was diagnosed with Wegner’s granulomatosis involving the lungs. Which other organ would you think to investigate for involvement?
Kidney
66
A child presents with myocardial infarction, mucocutaneous lymphadenopathy, and inflammation of the oral mucosa Which of the following is the most likely diagnosis of his condition?
Kawasaki disease
67
What type of gangrene is caused by atherosclerosis?
Dry gangrene
68
A man suffered from MI. 4 days later his condition worsens and he dies shortly after. Post-mortem examination reveals hemopericardium. Which of the following will most likely be found in a microscopic examination of the heart muscle?
Necrotic tissue with neutrophilic infiltrate
69
A patient presents with a necrotizing disease involving the central nervous system, kidneys, heart, liver, and skeletal muscles. Upon further examination multiple microaneurysms in the vessel walls were found. What is this disease?
Polyarteritis nodosa
70
Which of the following is likely to be associated with marfan’s disease?
Dissecting aneurysm
71
What is associated with infective endocarditis?
Mycotic aneurysms
72
A patient presents to you with crushing sub-sternal chest pain that radiates to his left arm. What would most likely be the first step in the development of his condition?
Endothelial dysfunction
73
What would result from coronary artery atherosclerosis with athero- emboli?
a-Transient ischemic attack
b-stroke
(?)
74
A patient comes to you with peripheral edema and signs of shock. Upon examination of the spleen you found areas of fibrosis with calcification known as “gamna-gandy” bodies. What condition is associated with this histological finding?
Congestive splenomegaly
75
What is the most common genetic mutation associated with hypertrophic cardiomyopathy?
Single nucleotide polymorphisms
76
Which of the following is a drug whose dosage can be determined by genotyping polymorphisms in VKORC1 and CYP2C9?
Warfarin
77
Which of the following is most indicative of secondary hypertension?
Unilaterally small kidney with normal renal function
78
A patient suffers from myocardial infarction. On the following day, he was found to be hypotensive (90/50), pale, with tachypnea and cold, sweaty skin. What could be the cause of his presentations following the MI?
left ventricular failure (cardiogenic shock as a result of ventricular failure is one of the complications of MI)
79
Following a throat infection, a child came to the hospital complaining of pain and swelling in his joints, a peculiar rash on his arms and chest, and fever. What is your diagnosis?
Acute rheumatic fever
80
Something about "fusion of the commisures”
chronic rheumatic heart disease
81
What feature would you find in mitral valve prolapse?
Myxomatous degeneration
82
Which of the following is not an evidence of end organ damage in a hypertensive patient?
a-Wide QRS complex in an ECG
b-left ventricular hypertrophy
c-retinopathy
a-Wide QRS complex in an ECG
83
What is the earliest lesion of atherosclerosis?
Fatty streaks
84
A patient with coronary artery vasospasm will present with:
prinzmetal’s (variant) angina
85
What will a patient with 70% stenosis of the coronary artery present with?
Stable angina
86
What will a patient with 70% stenosis of the coronary artery with partial occlusion by thrombus present with?
Unstable angina
87
What would most likely be the cause of a loud carotid bruit in a 67- year-old female?
a-High velocity of blood
b-increased blood vessel diameter
a-High velocity of blood
(the high velocity of blood is due to narrowing of the carotid with atherosclerotic plaques)
88
In which phase of the cardiac cycle does the c-wave in the atrial pressure reading occur?
Isovolumic contraction
89
When do you hear S4?
Atrial systole
90
A 17 year old runner presented with a sudden onset of shortness of breath and chest discomfort. His bp is 88/56 mmHg. Chest x-ray showed pneumothorax. What is the cause of hypotension?
a- acidosis
b- cardiac tamponade
c- hypoxia
d- decreased venous return
d- decreased venous return
## Footnote
(In pneumothorax, the pressure in the thoracic cavity will be equal to the atmospheric pressure, thus it will compress the great vessels of the thorax and increase the CVP, resulting in a decrease in venous return, and reduced VR results in reduced CO, and this BP)
91
What results in elevated slope of end-diastolic pressure volume relationship in angina?
Reduced speed of relaxation
| (In angina, the heart has less ATP, thus the SERCA pump will not work as well in internalizing calcium and eliminating the contraction, resulting is reduced speed of relaxation and increased stiffness of the ventricle)
92
Which of the following substances will have an impact on hemodynamics as shown above?
a-Endothelin
b-Epinephrine
c-Nitric oxide
d-Prostacyclin
a-Endothelin
(We asked Dr.Turcani about this question. He said that it should be a substance that mimics the action of norepinephrine, aka a vasoconstrictor, and endothelin was the only choice that matched the description)
93
Given the above pressure volume loop, What is the ejection fraction?
50%
(100-50=50ml stroke volume. EDV= 100ml ! EF=SV/EDV=50%)
94
What results in a shift of the pressure volume loop from 1 to 2?
Increased inotropy and afterload, decreased preload
95
Upon physical examination, a patient was found to have a noticeably split second heart sound. What could result in that?
Increased right ventricular afterload
| (Dr.Turcani’s explanation: splitting of the second heart sound results from closure of the aortic valve before the pulmonary due to the delayed contraction of the right ventricle. So, splitting increases when the RV contraction is delayed, as with increased RV afterload)
96
What is a hemodynamic consequence of anemia?
Reduced peripheral vascular resistance
97
What is a hemodynamic consequence of a 37-year old female with thrombo-embolism?
We are not sure but it might be reduced blood flow velocity!! Again we are not sure but this is what the top students chose..
98
What would be affected in the ECG after administration of a drug that blocks fast sodium channels?
a-QRS complex
b-T-wave
c-ST segment
d-PR segment
e-R-R interval
a-QRS complex
## Footnote
(The photo above shows the ionic currents associated with each segment and wave (intervals are a combination of both). As you see, the only choice that was related to the fast sodium current was the QRS complex. R-R interval is wrong because it is the heart rate, and the heart rate is influenced by the rate of firing of the SA node. The rate of firing of the SA node is in turn influenced by HCN Na+ (NOT FAST Na+) channels and slow L-type calcium channels. Thus, the R-R interval is wrong because it only changes with changing heart rate, which changes when HCN channels and L-type calcium channels are affected. The others are wrong because they do not involve sodium channels as shown in the picture.)
99
Which of the following is the most likely mechanism of sinus bradycardia?
Muscarinic stimulation
100
Which of the following is found in aortic stenosis?
Increased pressure gradient across the aortic valve
101
What would increase the oxygen delivery to the heart?
Increased coronary blood flow
102
A medical student was taking the blood pressure of a patient when he accidentally elevated the pressure of the cuff to 180mmHg for 3 minutes. What would be expected to happen after deflation of the cuff?
Reactive hyperemia
(temporary increase on blood flow beyond the resting value following a period if no-flow (ischemia), which is what happened when BP cuff was inflated to 180 mmHg. The pressure collapsed the lumen of the brachial artery, impeding the blood flow to the arm and causing ischemia)
103
What will happen when the coronary perfusion pressure is increased from 100 mmHg to 120 mmHg?
Arteriolar vasoconstriction
| (autoregulatory response: when you increase the blood pressure, you will activate stretch channels that will result in vasoconstriction and increased resistance to maintain the blood flow)
104
A person suffers from long-term dilated cardiomyopathy. His ejection fraction is 40%. Which of the following is most likely to be found?
a-Sympatho-adrenal activation
b- low levels of atrial natriuretic peptide
a-Sympatho-adrenal activation
105
After administration of a drug, the rate of pressure generation (dP/dt) of a patient increased greatly. What is the mechanism of this drug in increasing dP/dt?
a- increase in the heart rate
b- Inhibition of Na/Ca channels
b- Inhibition of Na/Ca channels
106
What is the mechanism of post-extrasystolic potentiation in increasing the force of contraction?
Increased calcium induced calcium release
107
While doing an exercise test, the CO of the patient was 8.0L/min with a heart rate of 150. The intensity of the exercise was increased and the heart rate of the patient increased to 170, however his CO dropped to 6.5l/min. what would be the reason for the decrease in CO?
decreased left ventricular filling
108
What would cause light-headedness at high heart rates?
Reduced stroke volume
109
If the CO is doubled, and the systemic vascular resistance is halved, what would happen to the mean arterial pressure?
It will remain unchanged
| (MAP= CO X SVR)
110
How does sympathetic stimulation increase the mean arterial pressure?
By increasing the rate of firing of the SA node
111
calculate the total myocardial oxygen consumption when the arterial oxygen concentration is 0.2 ml O2/ml,the venous oxygen concentration is 0.08 ml O2/ml, and the coronary blood flow is 100ml/min/100g.
12 ml O2/min/100g
112
What is the consequence of increasing the afterload in a heart failure patient?
Decreased stroke volume
113
What would you find in the ECG of patient who suffered an anteroseptal MI 6 months ago?
Q waves in leads V2 and V3
114
What would you find in the ECG of a patient with acute inferior wall MI?
ST-elevation in leads II,III, and aVF
115
How would you prevent tachycardia in a patient with atrial flutter?
Increase the refractory period of the AV node
116
What is the measure of association used in a study where 435 cases of MI are matched to 435 people with no MI to study the association between family history and MI?
Odds ratio
117
A study was conducted to study chest pain in a population over a phone interview. Of the 3500 people called, only 700 responded. The people conducting the study strongly suspected that their results will be biased. Which of the following will be true regarding their results? Prevalence will
be biased upwards
118
What can be measured in a case-control study?
Prevalence
119
How much will the risk of CVD decrease after 1 year of smoking cessation?
50%
120
A patient comes to you with a BP measurement of 168/90. Which of the following is true regarding his risk of CVD?
His risk is twice as high as those with normal BP since systolic BP confers a greater risk than diastolic BP
121
How would you respond to the statement “Ischemic heart disease is not a major issue is females”?
False. Ischemic heart disease is the leading cause of death amongst women in the world
122
What increases the risk of death by 5-6 times following MI?
depression
| (This was a repeated question from past MCQs and wasn’t in our curriculum)
123
How would you define resistant hypertension?
Persistent hypertension above 140/90 despite a triple drug regime (This question was from the PBL)
