2013 Module Exam Flashcards
Which of the following indicates fluid overload in a patient with heart failure?
A. Distended jugular veins
B. Loud second heart sound
C. Presence of a 4th heart sound
D. Heaving heart apex
A. Distended jugular veins
Which of the following is determined by using a patient’s risk score (Framingham and Q score)?
To calculate the risk of developing a cardiovascular event over a 10 years period
What causes an increase in stroke volume secondary (or in the next beat) to an extrasystolic beat?
A. decreased afterload
B. Increased contractility
C. Increased ESV
D. Frank-Starling mechanism
D. Frank-Starling mechanism
A young athlete experienced palpitations 2 hours after exercising and working out. His ECG showed sinus beats interpolated between premature ventricular complexes. What is the reason for these PVCs?
A. Bradycardia
B. Sympathetic effect of exercise
C. Delayed after depolarization
A. Bradycardia
What is true regarding secondary prevention?
A. Using aspirin in HF patients to prevent stroke
B. Using beta-blockers to prevent recurrence of heart failure
C. Using clopidogrel for Atrial fibrillation
D. IDC to prevent sudden death in patients with low ejection fraction
B. Using beta-blockers to prevent recurrence of heart failure
<40 Note: Both B and A were considered correct. The medical education staff removed choice “A”, so if this question came in the future, there would be only one correct answer, which is “B”.
Mendelian familial diseases are known to have high penetrance. What is the frequency of SNPs in high penetrance diseases?
A. 0.1
B. 0.2
C. 0.0001
D. 0.5
C. 0.0001
Which of the following statements is true regarding ejection fraction?
A. EF reflects the diastolic properties of the ventricle
B. EF is measured by subtracting diastolic volume from systolic volume
C. Normal EF 50-70%
D. People with increased EF have symptoms of heart failure
C. Normal EF 50-70%
How do you treat heart failure with reduced ejection fraction?
Inhibition of RAAS
Which of the following is decreased as a consequence of increased central venous pressure?
A. Venous return
B. Cardiac output
C. Venous compliance
D. Blood volume
E. Angiotensin II
A. Venous return
Note: Example: In heart failure, CO decreases due to loss of inotropy. This results in the activation of RAAS to increase total blood volume, together with venous constriction (in other words decreased venous compliance) by vasoconstrictor substances (e.g. angiotensin II, catecholamines) resulting in increased CVP. Whenever CVP increases, VR decreases and CO increases.
A 64 year old man presented with acute chest pain radiating to his left arm, his ECG leads showed ST elevation, what would be life-saving to manage his situation?
A. Administration of nitrates
B. Immediate revascularization by coronary catheterization
C. Administration of morphine
D. Administration of dual antiplatelet therapy with heparin
B. Immediate revascularization by coronary catheterization
What represents ventricular repolarization on ECG?
A. T wave
B. P wave
A. T wave
What is the suggestive prevention for a patient at risk of myocardial infarction because of his hypercholesterolemia?
A. Aspirin
B. Lovastatin
B. Lovastatin
In a patient with a previous myocardial infarction, which of the following is the most common complication?
A. Deep vein thromboembolism
B. Systemic embolism from the left atrium
C. Systemic embolism from the left ventricle
D. Pulmonary embolism
C. Systemic embolism from the left ventricle
What is the normal QRS duration on the ECG?
A. >0.21
B. >0.16
C. <0.12s
D. 0.12 -> 0.21
C. <0.12s
Which of the following is contraindicated in a patient with prinzmetal angina?
A. Lovastatin
B. Nitro-glycerine
C. Propranolol
C. Propranolol
The atrioventricular canal is separated into right and left atrioventricular canals by which structure?
A. Bulbar ridges
B. Endocardial cushions
C. Septum primum
D. Septum secondum
B. Endocardial cushions
What confirms Cardiac findings of Acute Rheumatic Disease?
A. Fibrinous pericarditis
B. Necrosis and fibrosis of myocardium
C. Aschoff nodule
D. vegetations on mitral valve
C. Aschoff nodule
What best describes the apical beat?
The 5th intercostal space midclavicular line
Which of the following passes in the interventricular septum?
A. AV node
B. Bundle of His
C. Pukinje fibers
B. Bundle of His
What does a patient with high CYP2C9 *1/*1 and VKORC1 GG Need?
A. Low dose warfarin
B. High dose warfarin
C. High dose clopidogrel
B. High dose warfarin
Activation of which nerve decreases ventricular muscle contraction?
A. phrenic
B. intercostal
C. great splanchnic
D. vagus
D. vagus
What increases myocardial oxygen consumption in aortic stenosis?
A. EDV
B. Stroke work
B. Stroke work
Note: In aortic stenosis, intraventricular pressure increases because a high pressure gradient is needed across the stenotic aortic valve to allow ejection. This results in an increase in ventricular wall stress (afterload) “#O2 demand. Keep in mind that stroke work is directly proportional to oxygen consumption.
Which of the following pathways provides the greatest amount of energy in the normal heart?
A. Fatty acids ➡TCA
B. Ketone bodies ➡TCA
C. Pyruvate➡TCA
D. Glucose ➡glycolysis
A. Fatty acids ➡TCA
What results from an increased pressure in the abdomen?
Ascites
What is the main thing that regulates blood flow in the veins?
A. Valves
B. Negative intrathoracic pressure
B. Negative intrathoracic pressure
Which drug is contradicted in patients with long QT syndrome?
Potassium channel blockers
What is responsible for depolarization from -40 to +1in this graph? (Picture of slow AP)
A. Activation of L-type calcium channels
B. Activation of fast sodium channels
A. Activation of L-type calcium channels
Which of the following inhibits Na/K ATPase and is used for the management of congestive heart failure?
A. Hydralazine
B. Digoxin
B. Digoxin
A study was conducted to assess the relationship between retinopathy and photosensitivity, knowing that the incidence was 4.3 per million. What kind of study was conducted?
A. Cross sectional study
B. Cohort study
C. Case control study
C. Case control study
What kind of valvular lesions is caused by Marfan syndrome?
A. Floppy mitral valve
B. Aortic stenosis
A. Floppy mitral valve
Wegener disease involves granulomatous inflammation of the respiratory tract and what?
A. Kidneys
B. Brain
A. Kidneys
What originates from the ascending aorta?
Right coronary artery
What causes a decrease in heart rate?
A. Hypocalcemia
B. Hyperkalemia
C. Alkalosis
B. Hyperkalemia
A patient with leg pain upon walking. His ABI was 0.9; what is true about Ankle brachial index (ABI)?
A. ABI=0.9 is abnormal
B. ABI is an indicator of cardiac events
C. ABI = systolic pressure in the ankle – systolic pressure of brachial artery
B. ABI is an indicator of cardiac events
What causes a negative inotropic effect?
A. Diastolic failure
B. Increased heart rate
C. Increased Afterload
D. Systolic failure
D. Systolic failure
Exercise Stress test (EST) is used to diagnose and manage suspected coronary artery disease. Which of these findings in the EST indicates ischaemia?
A. Dizziness
B. Fatigue
C. Rise of blood pressure in the test
D. Depression of ST segment at early stages
D. Depression of ST segment at early stages
A 45 year old hypertensive and diabetic smoker man comes to the hospital with excruciating chest pain that radiates to his back. The patient died and on autopsy they found blood in the thorax and pericardial and pleural cavities. What’s the INITIAL mechanism that triggered his arterial disease?
A. Elevated serum LDL
B. Elevated serum cTn
C. Vascular endothelial damage
D. Smooth muscle growth
C. Vascular endothelial damage
Note: This is a case of aortic dissection (dissecting aneurysm). It starts with a tear (weak point) in the wall of the aorta that will lead to blood leakage.
Which of the following is a biomarker of progressive heart failure?
BNP
Which drug activates PPARα?
A. Fibrates
B. Resins
A. Fibrates
What is the recommendation for weekly physical activity by American Heart association (AHA)?
A. 30 minutes walking 3 times a week
B. 10 minutes walking 5 times a week
C. 25 minutes jogging 3 times a week
D. 60 minutes walking 3 times a week
E. 45 minutes jogging 5 times a week
C. 25 minutes jogging 3 times a week
What is the most likely cause of clopidogrel resistance?
A. Reversible inhibition of ADP
B. Genetic polymorphisms
B. Genetic polymorphisms
Flecainamide is used to treat ventricular arrhythmias. It exerts its therapeutic action by affecting which phases of the ventricle AP? (AP graph was given)
A. Phase 0 and phase 4
B. Phase 0 and phase 2
C. Phase 3 and phase 4
A. Phase 0 and phase 4
What is found mostly in the tunica intima of blood vessels?
A. Collagen type 4
B. Collagen type 1
A. Collagen type 4