2016 Module Exam

Question 1

What mechanism explains increased systolic pressure?

a. Increased SV
b. Increased HR
c. Increased arterial compliance
d. Increased cardiac output with decreased vascular resistance (simultaneous)
e. Increased arterial compliance with increased speed of ejection (simultaneous)

Answer 1

a. Increased SV

Question 2

What mechanism explains unchanged MAP?

a. Increased SV
b. Increased HR
c. Increased arterial compliance
d. Increased cardiac output with decreased vascular resistance (simultaneous)
e. Increased arterial compliance with increased speed of ejection (simultaneous)

Answer 2

d. Increased cardiac output with decreased vascular resistance (simultaneous)

(or c)

Question 3

which of these has the slowest spontaneous diastolic depolarization?

1. SA node
2. AV node
3. AV bundle
4. terminal end of purkinje
5. ventricular myocyte

Answer 3

b. AV node

(or D)

Question 4

Which decreases CO?

a) increased central venous pressure
b) decreased peripheral venous pressure
c) increased HR to below 150bpm

Answer 4

b) decreased peripheral venous pressure

Question 5

a 54 yr old woman with a resting cardiac output of 6000ml/min. Using the PV loop, calculate the heart rate.

1. 50 BPM
2. 70 BPM
3. 100 BPM
4. 120 BPM
5. 140 BPM

Answer 5

c. 100 BPM

CO=HR • SV

Question 6

Also in same pic, calculate the EF

1. 60%
2. 50%
3. 30%
4. 25%

Answer 6

b. 50%

Question 7

This figure shows arterial blood pressure during Valsalva maneuver. What is the most likely cause of the arterial pressure increase in late phase 2?

1. Increase in VR
2. Increase in Afterload

Answer 7

a. Increase in VR

Question 8

Bulging of the tricuspid valve occurs in which number(green) in pic?

Answer 8

2

Question 9

opening of the mitral valve occurs in which number(green) in pic?

Answer 9

3

Question 10

What causes blood movement during the slow ejection phase?

Answer 10

Energy of blood movement

Question 11

what doesn’t cause an increase in pulse pressure?

A) increase in compliance

B) increase in heart rate

C) increase in sv

D) simultaneous increase in compliance and speed of ejection

Answer 11

B) increase in heart rate

Question 12

what is the plateau of the cardiac output of a 24 yr old male who weighs 80kg?

1. 25
2. 13
3. 3

Answer 12

b. 13

(this was the model answer but since he was an athlete the dr said A is also correct)

Question 13

Answer 13

ST elevation

Question 14

A hemodynamically stable person was sitting then he got up, what remains reduced?

Answer 14

SV

Question 15

what does T-wave represent on action potential curve?

1. Phase1
2. Phase2
3. Phase3
4. Phase4

Answer 15

c. Phase3

Question 16

A man wearing a shirt with a tight collar, when he was shaving, he turned his head and felt dizzy, what is the reason for that?

Answer 16

Decreased slope of phase 4

Question 17

a person with fever of 38°C and he has bradycardia, what is the cause?

a. Hyperkaliemia surrounding the SA node
b. Sympathetic activation deactivates HCN channel
c. Vagal tone increases reducing the peak

Answer 17

a. Hyperkaliemia surrounding the SA node

Question 18

What is responsible for cardiac relaxation?

a- phospholamban C activation

b- ATP induced calcium release

c- IP3 activation

Answer 18

a- phospholamban C activation

Question 19

Which arrythmia results from this abnormality?

Answer 19

Ventricular Polymorphic Tachycardia

Question 20

What contribute to blood flow in “Z” green highlighted?

a- Increase in adenosine

b-Increase in adenosine triphosphate

c-Decrease carbon dioxide

Answer 20

a- ​Increase in adenosine

Question 21

Which of the following is involved in excitation-contraction coupling?

A- K(atp) channels

B- phospholamban

C- L-type ca channel

D- cl- channel

Answer 21

C- L-type ca channel

Question 22

Secretion of which hormone will be most likely elevated in response to an increase in atrial blood pressure?

Answer 22

ANP

Question 23

what is responsible for increasing the SV in the second beat in case of a high afterload?

a. high ESV
b. high EDV

Answer 23

b. high EDV

Question 24

17 cm/sec velocity, ?? HR, ?? MAP, 23 mm descending aorta diameter. Calculate BF for descending aorta.

Answer 24

4.5 L/min

Question 25

A coronary angiogram of 65 years old male who experienced MI showed LAD occlusion, which of the following will be depleted from oxygen? a- Posterior 1/3 of the atria b- Anterior 1/3 of the interventricular septum c- Anterior 2/3 of the interatrial septum d- Anterior 2/3 of the interventricular septum

Answer 25

d- Anterior 2/3 of the interventricular septum

Question 26

A 60 yrs old male presented with previous myocardial infarction and hemopericadial, what is the source of blood in pericardial cavity? a. Coronary artery rupture b. Ruptured aortic artery c. Ruptured pulmonary veins d. Perfusion myocyte

Answer 26

d. Perfusion myocyte

Question 27

A patient with cardiac tamponade, chest pain that radiates to the shoulders, which nerve is responsible for that? 1. Subclavian 2. Supraclavicular

Answer 27

a. Supraclavicular

Question 28

What is present in the tunica media of common carotid artery? 1. Elastin 2. Actin 3. Collagen 2 4. Collagen 3 5. Collagen 4

Answer 28

a. Elastin

Question 29

what is more prominent in tunica intima of arteries? 1. Elastin 2. Actin 3. Collagen 2 4. Collagen 3 5. Collagen 4

Answer 29

a. Collagen 4

Question 30

A microdissection study is done to follow the SA node artery until it ends; where does this artery end in the surface of epicardium? A- inferior end of sulcus terminalis B- superior end of sulcus terminalis C- right of left atrium D- left of SVC entry

Answer 30

B- superior end of sulcus terminalis

Question 31

What congenital disorder causes blue lips and tips? A- transposition B- Pulmonary Stenosis

Answer 31

A- transposition

Question 32

Which Microorganism infects those who drink unpasteurized milk?

Answer 32

brucella Melintes

Question 33

which microorganism was found in a patient who had an aortic valve replacement 6 months back? 1. Viridians streptococci 2. Kingella kingae 3. Ekinella carrdens 4. Coxiella burneti

Answer 33

a. Viridians streptococci

Question 34

an intravenous drug addict. Which does he most likely have? 1. Candida albicans 2. Staph epidermis 3. Brucella melitenisis 4. Enterocouss faecalis 5. Coxiella brutini

Answer 34

a. Candida albicans

Question 35

The most important fuel when insulin is high a- Glucose b- Glycogen c- Triglycerides d- Fatty acids e- Ketone bodies

Answer 35

a- Glucose

Question 36

The most important fuel in both starvation and heart failure a- Glucose b- Glycogen c- Triglycerides d- Fatty acids e- Ketone bodies

Answer 36

e- Ketone bodies

Question 37

M2 macrophages are involved in which phase of atherosclerosis? A. Initiation B. Resolution

Answer 37

B. Resolution

Question 38

Which is the main source of energy for adult heart? a- Fatty acids b- Glucose c- Pyruvate d- Ketone bodies

Answer 38

a- Fatty acids

Question 39

what is a prominent change in cardiac metabolism during heart failure but A) increased fatty acid oxidation B) increased glycolysis C)decreased ketone bodies D)increased lactate oxidation

Answer 39

B) increased glycolysis

Question 40

What receptor that is responsible for unregulated lipid uptake?

Answer 40

CD36

Question 41

An autopsy was performed on a 39-year-old male that showed inter ventricular septum of 27 mm, left ventricle of 15 mm, right ventricle of 7 mm and the heart weighed 500g. What is the diagnosis? A) hypertrophic cardiomyopathy B) dilated cardiomyopathy C) restrictive cardiomyopathy D) amyloid deposited E) right ventricular arrhythmic cardiomyopathy

Answer 41

A) hypertrophic cardiomyopathy

Question 42

skin rash in rheumatic heart disease is called?

Answer 42

Erythema marginatum

Question 43

liquefactive necrosis in brain

Answer 43

lacunar infarct

Question 44

What is intermittent claudication?

Answer 44

Leg pain while walking and relieved by rest

Question 45

An autopsy was performed on a 39-year-old male that showed inter ventricular septum of 27 mm, left ventricle of 15 mm, right ventricle of 7 mm and the heart weighed 500g. What is the diagnosis?

Answer 45

?

Question 46

restrictive cardiomyopathy most common in? a- multiple myeloma b- eosinophilic infiltrate

Answer 46

a- multiple myeloma

Question 47

Long standing old hypertensive patient found to have small kidneys.

Answer 47

Benign hypertension

Question 48

Cardiac biopsy of 32 years old male was done, and he has a family history of cardiac disease. Biopsy shows interstitial fibrosis, myocyte disarray and enlarged cardiomyocytes. A) Dilated cardiomyopathy B) Hypertrophied cardiomyopathy C) Restricted cardiomyopathy

Answer 48

B) Hypertrophied cardiomyopathy

Question 49

left ventricular hypertrophy caused by

Answer 49

aortic stenosis

Question 50

Patient with 90% occlusion with thrombus, what is the diagnosis?

Answer 50

transient ischemia (no unstable angina)

Question 51

A 15-year-old male died in a car accident, postmortem autopsy revealed yellowish streaks in the abdominal aorta. What could this be? A. Intimal foam cells B. Endothelial injury C. Intimal fibro-fatty elevation

Answer 51

B. Endothelial injury (or its A, aka fatty streak)

Question 52

Volume overload is caused by which of the following valve pathology? 1. Mitral valve stenosis 2. Aortic valve regurgitation 3. Pulmonary valve stenosis 4. Mitral valve prolapse

Answer 52

b. Aortic valve regurgitation

Question 53

what disease is associated with MYH7 mutation?

Answer 53

hypertrophic cardiomyopathy

Question 54

match the diagnosis with this hypertension complication: fibrinoid necrosis w/thrombus in renal arterioles

Answer 54

malignant hypertension

Question 55

Which of the following cause systemic HTN? A- coarctation of aorta B-Hepatic disease C- diabetic

Answer 55

A- coarctation of aorta

Question 56

Hyaline arteriosclerosis in the renal arterioles is seen in which condition? 1. Systemic HTN 2. Polyarteritis nodosa

Answer 56

a. Systemic HTN

Question 57

A 22 y/o female with myocarditis died, on autopsy do we see?

Answer 57

flappy heart

Question 58

Familial Hypertrophic cardiomyopathy are known to have high penetrate. What is the frequency of SNP in high penetrance disease? a) .0001 b) .1 c) .5

Answer 58

a) .0001

Question 59

63 yr old man had an MI and died after 3 weeks. What do you expect to see in his heart autopsy? 1. Fibrosis 2. High vascularization

Answer 59

a. Fibrosis

Question 60

Dosage of which drug should be monitored due to narrow therapeutic index?

Answer 60

Digoxin

Question 61

Patient with heart failure you give him A drug and he comes to you with irritation throat and cough which of the drugs cause this? A-ACEI B- BB C-Diuretics D- digoxin derivatives

Answer 61

A-ACEI

Question 62

Which drug is contraindicated with sildenafil?

Answer 62

GTN

Question 63

Which drugs causes excessive hair growth?

Answer 63

Minoxidil

Question 64

What is given to a pt with high risk of MI due to hypercholesteremia?

Answer 64

Statins

Question 65

What selectively binds to mineralocorticoid receptors?

Answer 65

Eplerenone

Question 66

Which of the following is concentrated in the heart? a. flecainide b. amrinone

Answer 66

a. flecainide

Question 67

Antivagal effect drug

Answer 67

Quinidine

Question 68

Which of the following have no effect on action potential duration in atria? 1. Lidocaine 2. class IA 3. beta blockers

Answer 68

a. Lidocaine

Question 69

what phase is affected in antiarrhythmic drugs? a. phase 1 b. phase 2 c. phase 3 d. phase 4

Answer 69

d. phase 4

Question 70

Which of the following drugs can prevent platelet aggregation and thrombosis in treatment of unstable angina pectoris? 1. clopidogrel 2. clonidine 3. metoprolol 4. isosorbide nitrate 5. aliskiren

Answer 70

a. Clopidogrel

Question 71

What drug is contraindicated in patients with variant angina

Answer 71

? | (beta 1-receptor Antagonists)

Question 72

Which drug has less hormonal effect because it binds specifically to aldosterone receptors? 1. Eplerenone 2. Spironolactone

Answer 72

a. Eplerenone

Question 73

Which drug inhibits HMG coA reductase?

Answer 73

Statins

Question 74

which one describe the mechanism of dobutamine? 1-activation of aldosterone receptor 2-inhibition of Ace 3-activation of B1 receptor 4-release of nitric oxide

Answer 74

3-activation of B1 receptor

Question 75

what drug is administered sublingually and achieve a therapeutic blood level rapidly?

Answer 75

Nitroglycerin

Question 76

overdose of which drug causes severe nausea and bradycardia? 1. Digoxin 2. calcium channel blockers 3. beta blockers

Answer 76

a. Digoxin | (they put them all correct)

Question 77

what produces bradycardia as a side effect?

Answer 77

Atenolol

Question 78

which of the following is AT1-R antagonist? A) captopril B) Losartan C) verapamil

Answer 78

B) Losartan

Question 79

enzyme for clopidogrel?

Answer 79

CYP2C19

Question 80

HfpEF is associated with what?

Answer 80

patients with LVH/HTN

Question 81

Which of the following statements is true? (when are ACE drugs given?)

Answer 81

ACE is are given to asymptomatic pts with HF and EF \<35

Question 82

An overdose of which of the following results bradycardia and nausea? 1. Digoxin 2. Beta blocker 3. CCB

Answer 82

? this is Dr. Zubaid’s fav question bc every year most of the students get it wrong, CCBs and Beta blockers can cause these side effects but in their NORMAL THERUBITIC DOSE, digoxin only causes them with overdose

Question 83

what is a manifestation of right heart failure? 1. RUQ pain 2. Blurred vision 3. Decreased urine execration 4. Headache

Answer 83

This is one of dr. zubaid’s fav questions too, RUQ pain is the answer bc what do we have in the RUQ? Liver, in RHF we will have hepatomegaly resulting in RUQ pain

Question 84

In a myocardial perfusion image study, what does a myocardial defect seen on both stress and rest images suggest? A) Scar after infarction B) Myocardial ischemia C) Cardiomyopathy D) Normal myocardium

Answer 84

A) Scar after infarction

Question 85

Patient with ventricular tachycardia with low BP and dizziness, what’s the treatment? A) Digoxin B) dc shock C) adenosine D) carotid massage E) beta blocker

Answer 85

B) dc shock

Question 86

A condition, if not treated immediately, will affect the patient's life.

Answer 86

Ventricular Fibrillation

Question 87

A condition that predisposes to thrombo-embolitic event.

Answer 87

Atrial Fibrillation

Question 88

What is true regarding EF? A) it measures end diastolic volume B) it measures diastolic function C) it's considered abnormal if it's less than 60% D) it's normal in hypertensive patients

Answer 88

D) it's normal in hypertensive patients

Question 89

Treatment of HTN w diabetic nephropathy?

Answer 89

ARBs

Question 90

lymphoma patient is being treated with doxorubin (something like this) what test should be done to monitor the cardio toxicity?

Answer 90

Pool test

Question 91

stiff heart /not filling means what kind of failure?

Answer 91

diastolic failure

Question 92

which is true about JVP? 1. increases with increase in abdominal pressure 2. it reflects left atrial pressure 3. its independent of the patient’s position 4. increases with increased pressure at the root of the neck fat

Answer 92

a. increases with increase in abdominal pressure jugular venous pressure (JVP)

Question 93

Patient presented with left sided heart failure secondary to reduced ejection fraction. Which signs would this patient show? A-Bradycardia B-SOB when lying flat C-Absence of S3 sound D-Presence of ejection systolic murmur

Answer 93

B-SOB when lying flat

Question 94

Fibrinolytic therapy is absolutely contraindicated in which patients?

Answer 94

History of intracranial hemorrhage

Question 95

You diagnose a patient with HF-rEF. What of the following medication is indicated for her? 1. Nitrates 2. amlodipine 3. Aldosterone antagonist 4. Diltiazem 5. Amiodarone

Answer 95

c. Aldosterone antagonist

Question 96

what happened to CVD rate in US and Europe between 1960 to 2000 a) increase by 25% b) no change c) increase by 60% d) decrease by 60% E) decrease by 25%

Answer 96

d) decrease by 60%

Question 97

If they tell u that they want to assess the risk of heart diseases using smoking as exposure, and they tell u that 58% of cases were MI patients wo have been smoking, and 31% of controls were smoking, what is the odds ratio?

Answer 97

-3.9

Question 98

A case control study was done to check the correlation btw physical inactivity and CVD, cases are recently diagnosed pts with MI, controls were taken from walking thrills, which of the following is true? a- Cases are unbiased, controls are biased, odds ratio is upwards biased b- Cases are unbiased, controls are unbiased, odds ratio is upwards biased c- Cases are unbiased, controls are biased, odds ratio is downwards biased d- Cases are biased, controls are biased, odds ratio is upwards biased

Answer 98

a- Cases are unbiased, controls are biased, odds ratio is upwards biased