2015 Module Exam Flashcards by Hessa Al Salem

A 33-year-old female experienced calf pain followed by shortness of breath, cough, and hemoptysis. What could be the problem?

pulmonary thromboembolism

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A 13-year-old Brazilian football player suddenly collapse d during training. Chest x-ray showed moderate cardiomegaly and pulmonary edema with history of difficulty swallowing and dilated esophagus. What’s the etiology of myocarditis?

a) Giant cell myocarditis
b) TB myocarditis
c) Chagas myocarditis
d) viral myocarditis
e) toxoplasma myocarditis
f) bacterial myocarditis
g) diphtheria myocarditis

c) Chagas myocarditis

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A 35-year-old diabetic woman on hydrochlorothiazide was shown to have eosinophilic infiltrate upon heart biopsy. What could be the cause?

a) TB myocarditis
b) Giant cell myocarditis
c) viral myocarditis
d) toxoplasma myocarditis
e) bacterial myocarditis
f) diphtheria myocarditis

a) TB myocarditis

(another exam said diptheria)

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A 45-year-old man complained of leg pain upon walking. Ankle-brachial index (ABI) was 0.9, what is true?

a) 0.9 is normal
b) Indicates risk of cardiovascular events

b) Indicates risk of cardiovascular events

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What increases as a consequence of the Valsalva maneuver?

a) pulmonary veins compression
b) pulmonary edema
c) pulmonary capillary pressure

a) pulmonary veins compression (MABP wasn’t a choice)

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What decreases if lusitropy decreases?

Stroke Work

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What happens as compensation if CVP drops to 0?

a) VR increases to 7
b) PVP increases to 4
c) VR increases to 2

a) VR increases to 7

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What severe problem can an overdose of beta blockers cause?

a) 3rd degree heartblock
b) sinus bradycardia
c) sinus tachycardia

a) 3rd degree heartblock

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A case-control study was done to assess the relation between taking a certain drug having a MI attack in hypertensive people. The scientists reached the following statement: “From our 500 patients, we conclude that taking this drug is protective against MI in hypertensive patients”. What is the type of this statement?

a) Assumption
b) inference
c) analysis

b) inference

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A group of scientists asked patients with hypertension about their myocardial infarction history. They reached the following conclusion: “People with HTN are 2.3 times more likely to suffer an MI. What is your evaluation of this statement?

a) False because you cannot determine causality in cross sectional studies
b) True

a) False because you cannot determine causality in cross sectional studies

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The tunica media of the common carotid artery is made mainly from?

a) Collagen III
b) Collagen IV
c) Collagen I
d) Elastin

d) Elastin

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What is shown in this graph to the right?

a) Partial depolarization
b) NCX activation

a) Partial depolarization

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Which receptor mediates unregulated uptake of LDL?

CD36 (SRA wasn’t a choice)

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What is the receptor that is responsible for unregulated lipid uptake?

a) Cd36
b) SR-B

a) Cd36

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the ligation of which receptor causes foam cell formation?

SRA

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A woman was found to have bilateral pulmonary edema because of group A streptococci throat infection. Which valves are more likely to be affected?

a. Aortic and mitral
b. Mitral and pulmonary

a. Aortic and mitral

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What characterizes fatty streak formation in atherosclerosis?

a) Raised fibro-fatty growth
b) Intimal foam cells

b) Intimal foam cells

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A 45-Year-old man with blood pressure of 155/95 is asymptomatic, has negative family history, and is not known to be hypertensive before. What is the cause?

a. Catecholamine producing tumor
b. Increased renal retention of sodium
c. Genetic defect in aldosterone metabolism
d. Fibromuscular dysplasia

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What is a characteristic of mitral stenosis?

a) diastolic murmur
b) systolic murmur
c) S3
d) loud s1

a) diastolic murmur

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What is a characteristic of Aortic stenosis?

a) diastolic murmur
b) systolic murmur
c) S3
d) loud s1

b) systolic murmur

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A woman had an acute heart failure and developed exertional dyspnea a short while after. There was consolidation in the lung seen in the chest x-ray. What is the mechanism causing this?

a) Pulmonary congestion
b) Pulmonary edema

b) Pulmonary edema

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What is the issue if there is low perfusion or defect at stress, but it is corrected at rest?

a) Scar
b) Ischemia
c) normal

b) Ischemia

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What is this pulse to the right?

a) Normal pulse
b) Pulsus Alternans
c) Pulsus Bispherans

b) Pulsus Alternans

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What is the diagnosis based on this ECG above?

a) Anterior STEMI
b) Inferior STEMI
c) NSTEMI

a) Anterior STEMI

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What is the most prominent feature on this ECG above? a) ST depression b) ST elevation c) Pathological Q

a) ST depression

What is the diagnosis based on the ECG above? a) Supraventricular tachycardia b) Ventricular tachycardia c) Atrial fibrillation

a) Supraventricular tachycardia

What supplies blood to the pacemaker of the heart?

Nodal artery

What branches from the ascending aorta?

Right coronary artery

If 67% of people are right dominant pattern, what will be spared if there is a thrombus in the left anterior descending artery?

SA node

A person with a myocardial infarction underwent perfusion testing that showed low perfusion in the apex. Which of the following arteries is mostly involved? a) nodal artery b) LAD c) RCA d) circumflex

b) LAD

blood pressure of a patient changed from 130/80 to 150/80. What most likely occurred? a) increased SV b) decreased compliance c) increased compliance d) decreased ejection speed

a) increased SV the PP increased because of an increase in SP, while DP was normal

What increases blood flow and diameter of blood vessels? a) aldosterone b) BNP c) Angiotensin II d) NO

d) NO

what increases salt and water excretion? a) BNP b) NO c) Angiotensin II d) aldosterone

a) BNP

What increases dromotropy when SNS is stimulated?

phosphorylation of L type calcium channels

What causes bradycardia if there is increased in pressure? a) Hyperpolarization b) Acetylcholine on muscarinic receptors

b) Acetylcholine on muscarinic receptors

What could be the issue if a patient’s blood pressure did not decrease when he was given ACE-I but it did with ARB?

He synthesizes angiotensin II from another pathway

A drug is used to interfere with the first step of synthesis of angiotensin II? a) aliskiren b) captopril c) losartan

a) aliskiren

What is the mechanism of action of amrinone?

Phosphodiesterase inhibitor

What is the treatment of a patient with ST depression? a) PCI b) Dual antiplatelet, heparin, and fibrinolytic c) Dual antiplatelet and heparin

c) Dual antiplatelet and heparin

What is the best method to diagnose right heart failure? a) Echocardiography b) ECG

a) Echocardiography

If a patient came in with chest pain of 30 minutes duration, what would we do to confirm the diagnosis of an MI? a) Electrocardiography b) Cardiac troponins

a) Electrocardiography

What happens in Diastolic failure?

low ventricular filling

What happens in cardiac tamponade?

Low ventricular filling

What is the most common complication 24 hours following acute MI? a) Mural thrombus b) Ventricular embolism c) Ventricular fibrillation d) Rupture of papillary muscles e) Rupture of plaque f) Ventricular aneurysm

c) Ventricular fibrillation

What is the most common complication 4-7 days following acute MI? a) Cardiac tamponade b) Mural thrombus

a) Cardiac tamponade

What is true about HF with preserved EF? a) Low EDV b) Normal in adults c) Dilated LV

a) Low EDV

In which of the following conditions there will be an increased myocardial demand? a) Anemia b) Hypertrophic heart

b) Hypertrophic heart

A 55-year-old male has developed a fusiform abdominal aortic aneurysm. What is the underlying process?

Atherosclerosis

A patient had bilateral renal artery stenosis and concentric cardiac hypertrophy. What could be the cause?

Systemic hypertension

A 55-year old man with long-standing (10 years) untreated hypertension of 180/125. What could be seen histologically in his kidneys?

Hyperplastic arteriolitis

Tree barking aneurysm was found on the upper part of the ascending aorta of a patient. What is true when testing his blood sample? a) High ESR \>100 b) Patient will have antibodies to Treponema pallidum

b) Patient will have antibodies to Treponema pallidum

High pressure gradient = high coronary blood flow by which method?

Autoregulation

Patient with tachycardia because of a drug, what increases blood flow to coronary arteries? a) Myogenic response b) Metabolic response

b) Metabolic response

What happens in severe aortic regurgitation?

Low coronary blood flow

A 38-year-old female had an echocardiogram which revealed a 4 chamber dilation and mitral and tricuspid incompetence. What is the pathological reason of this? a) acute viral endocarditis b) inherited disorder of collagen synthesis c) inherited disorder of cardiac myocyte d) chronic rheumatic heart disease

c) inherited disorder of cardiac myocyte

Stenosis occurred in the deep popliteal and femoral arteries, what hemodynamic effect is seen? a. Decreased flow to calf b. Increased vasoconstriction of calf and thigh arteries c. Increased flow to internal iliac

what is a compensatory hemodynamic mechanism in heart failure? a) Increased JVP b) Increased renal perfusion c) Sinus tachycardia d) Thrombocytosis

c) Sinus tachycardia

In which stage of atherosclerosis does M2 macrophage "interfere"? a) rupture b) initiation c) resolution

c) resolution

a drug was given to a patient and it only affected vascular smooth muscles and not the cardiac muscle contractility. Where does this drug act? a) Troponin b) Calmodulin c) L-type calcium channels d) B-adrenergic e) PKA

b) Calmodulin

What increases vascular tone? a) K channel activation b) Phospholipase C c) PDE inhibition d) Ca channel inhibition

b) Phospholipase C

Inhibition of what would cause increased free cholesterol in cells? a) LDLR b) LCAT c) ACAT d) SRA e) SR-B1 f) CETP g) LPL h) Cholesterol esterase

c) ACAT

What is a characteristic of Frank-starling mechanism? a) Increased efficiency b) Decreased oxygen consumption c) Decreased wall stress d) Increased ejection fraction

d) Increased ejection fraction

What should we monitor when administering digoxin? a) zinc b) Calcium c) Sodium d) Chloride e) Potassium

e) Potassium

What is affected if lusitropy decreases? a) Stroke work b) Stroke volume

a) Stroke work

Which of the following is part of the treatment of unstable angina?

Heparin

What is true about the fetal heart?

Uses glucose more, less oxidative phosphorylation

During a Cross-sectional study of smoking in women, what measure could decrease since there is a stigma associated with women smoking?

Prevalence

What measure of burden or association could be found in case-control study? a) Prevalence b) Odds ratio

b) Odds ratio

What microorganism infects farmers who drink unpasteurized milk?

Brucella

A women had a mitral valve replacement 3 weeks ago. What’s the organism that may cause infective endocarditis now?

S. epidermidis

A whitish growth was found on the heart valve of a patient with SLE. What could be the problem? a) Libmann sacks b) NBTE

a) Libmann sacks

Large friable vegetation was found the valve of drug abuser. What could it be? a) Infective endocarditis b) NBTE

a) Infective endocarditis

What could be found grossly in heart of a patient with viral myocarditis?

Flabby appearance with patchy areas of hemorrhage

Upon biopsy examination, brown pigmentation, extensive fibrosis, and eosinophil infiltration were found in the heart of a congestive heart failure patient. What is the diagnosis? a) Myocardial fibrosis b) Loeffler’s fibroelastosis c) Hemosiderosis

c) Hemosiderosis

What is a characteristic of metabolism activity in heart failure? a) Increased glycolysis b) Decreased ketone bodies c) Increased pentose phosphate pathway

a) Increased glycolysis

What anti-anginal drug is used after all other drugs have been proven to be ineffective?

Ranolazine

What characterizes stable angina? a) heart burn in the epigastrium b) SOB during sleep c) severe crushing chest pain for more than 20 minutes in duration d) chest pain that increases with exertion or emotional stress e) chest pain at rest

d) chest pain that increases with exertion or emotional stress

What drug should be carefully monitored as it has a narrow therapeutic index?

Digoxin

Which of the following, if changed, causes the ventricle to operate on another Frank-Starling curve?

Troponin sensitivity

Which of the following, if changed, causes the ventricle to move along a single Frank-Starling curve?

Sarcomere length

What mediates bacterial adhesion to the valves to form a vegetation?

Dextran

What do you tell people who claim that CHD is only important in males?

False, CHD is the leading cause of death in females

What contributes to the formation of the intra-atrial septum?

Septum primum

What does Septum primum give rise to?

Fossa ovalis

What happens if the communication between the left and right atrium does not close?

Patent foramen ovale

What is the phenomena in which the intracellular calcium is increased due to increased HR? a) Treppe b) Extrasystole c) pause

a) Treppe

A patient had an old MI. What will you see in the ECG? a) Q waves b) ST depression

a) Q waves

A kidney of a patient was found to have a fine granular surface. What happened?

Benign nephrosclerosis

A question about Malignant HTN?

Fibroid necrosis and thrombosis of renalarteriols

What causes separation of the left and right atrioventricular canal?

endocardial cushions

What is found mostly in tunica intima of aorta? a) Collagen type IV b) Collagen type I c) Elastin

a) Collagen type IV

What is true about point A? a) 0 tension because of complete myofilament overlap b) 0 tension because of no myofilament overlap

a) 0 tension because of complete myofilament overlap

What increases when the venous compliance decreases?

resistance

Which drug has less hormonal effect because it binds specifically to aldosterone receptors? a) Eplerenone b) Spironolactone

a) Eplerenone

What makes weight gain aside effect of nicotinic acid?

It inhibits lipolysis in adipose tissue

What will increase in response to AL increase? a) SV b) ESV c) Speed of ejection d) Shortening of myocyte

b) ESV

The heart depends on which of the following in starvation? a) amino acids b) ketone bodies c) glucose d) fat

b) ketone bodies

Which one if these originate from the aortic sinus? a) right coronary artery b) left anterior descending artery

a) right coronary artery

What is true about patient with HFpEF? a) s4 b) the EDP is low

a) s4

On expense of which parameter does the ESV increase when increasing the afterload? a) SV b) preload c) EDV

a) SV

What is the cause of rheumatic heart disease? a) S. aureus b) S. pyogenes c) S. epidermidis

b) S. pyogenes

After 10 years, the BP od a patient changed from 131/80 to 151/60. What could be the reason? a) Increase SV b) Increase HT c) Increase compliance d) Decrease compliance

d) Decrease compliance

Which of the following is true about magnesium sulfate in treatment of arrhythmia? a) effective treatment of ventricular arrhythmia in children b) drug of choice for fatal arrhythmias such as torsade de pointes c) action enhanced by co- administration of dipyridamole d) increase synthesis of c-GMP

b) drug of choice for fatal arrhythmias such as torsade de pointes

Which of the following is a class 1B Na blocker? a) Phenytoin b) Flecainide

a) Phenytoin

Which of the following is a selective angiotensin II antagonist? a) propranolol b) captopril c) losartan d) hydrochlorothiazide e) clonidine f) prazosin

c) losartan

When preload and contractility are kept constant and the afterload was increased, what parameter continues to decrease in the first and second heartbeat? a. Stroke volume b. End diastolic volume c. Ejection fraction d. Stroke work e. End systolic volume f. End diastolic pressure g. Aortic pressure f. Fractional shortening

c. Ejection fraction

Which necrotizing arteritis involves the hepatic and renal artery as well as show multiple coronary microaneurysms? a. Giant Cell Arteritis b. Takayasu Arteritis c. Beurger Disease d. Polyarteritis Nodosa e. Wegener Granulomatosis f. Churg Strauss syndrome g. Kawasaki disease h. Leukocytoclastic Vasculitis

d. Polyarteritis Nodosa

Which of those happen in heart failure? A. Increased Compliance B. Increased heart rate

B. Increased heart rate

What do we use to know the frequency of a disease in a cross-sectional study? A. Prevalence B. Relative Risk

A. Prevalence

Decrease of which will increase the preload? A. Ventricular compliance B. Afterload C. Speed of ejection

C. Speed of ejection