Best PP Flashcards by Elmar Lutz

What kinds of hemodynamic changes are characteristic in mitral valve stenosis? (2 correct)
a. Left atrial pressure increases
b. Left ventricular end diastolic pressure volume increases
c. Right ventricular systolic pressure increases
d. Annulus dilatation
e. Left arterial pressure decreases

a. Left atrial pressure increases

c. Right ventricular systolic pressure increases

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Chronic anticoagulation treatment is indicated after AMI in the following circumstances:
a. Left ventricular aneurysm
b. Atrial fibrillation
c. Left ventricular thrombus
d. Ventricular extrasystole
e. Right ventricular dilatation

a. Left ventricular aneurysm
b. Atrial fibrillation
c. Left ventricular thrombus

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Secondary indications of ICD implantation means (2 correct)
a. Patients with high risk of VF/VT
b. Patients with prior MI and low EF <35%
c. Patients with prior sudden cardiac death
d. Patients with LBBB and sinus bradycardia
e. Patient with prior ventricular tachycardia/VF

c. Patients with prior sudden cardiac death

e. Patient with prior ventricular tachycardia/VF

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High risk NSTE-ACS, Coronarography is indicated, except:
a. Persistent chest pain despite adequate therapy
b. Malignant ventricular arrhythmia
c. Dynamic motion of ST/T segments on ECG
d. Heart failure as a complication
e. Pulmonary emboli in anamnesis

e. Pulmonary emboli in anamnesis

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Acute life threatening condition with chest pain, except
a. ACS
b. Pulmonary emboli
c. Aortic dissection
d. Pneumothorax
e. Pericarditis

e. Pericarditis

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Diagnostic imaging method for aortic dissection
a. Chest x-ray
b. Echo
c. CT angio
d. Coronarography

c. CT angio

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Complications of aortic dissection except
a. STE-ACS
b. Tamponade
c. Aortic valve insufficiency
d. Rupture of the mitral valve string
e. Aortic rupture

d. Rupture of the mitral valve string

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Fibrinolysis may be indicated, except:
a. PE complicated with shock
b. Thrombosis of artificial valve
c. Stroke
d. NSTE-ACS
e. STE-ACS

d. NSTE-ACS

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Indicates urgent surgery
a. Proximal aortic dissection
b. Distal (descendent) aortic dissection
c. PE
d. Endocarditis

a. Proximal aortic dissection

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Risk for aortic dissection
a. Marfan syndrome
b. Chronic renal failure
c. Diabetes mellitus
d. Smoking
e. High cholesterol

a. Marfan syndrome

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Secondary prevention for myocardial infarction (drugs that decrease mortality and morbidity) (MCQ!)
a. Beta-blockers
b. Thrombocyte aggregation inhibitors
c. HMG-CoA reductase inhibitors
d. ACE-inhibitors

a. Beta-blockers
b. Thrombocyte aggregation inhibitors
c. HMG-CoA reductase inhibitors
d. ACE-inhibitors

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Which of the following diuretics - side effects pair is correct? (MCQ!)
a. Furosemide - hyperuricaemia
b. Chlorthalidon - ototoxicity
c. Spironolactone - gynecomastia
d. Ethacrynic acid - hyperuricaemia

a. Furosemide - hyperuricaemia

c. Spironolactone - gynecomastia

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Characteristics for Prinzmetal angina:(MCQ!)
a. The onset is specific in rest in the early morning
b. The ECG shows ST elevation during chest pain
c. Caused by coronary spasm
d. Ca2+-antagonists are recommended therapy

a. The onset is specific in rest in the early morning
b. The ECG shows ST elevation during chest pain
c. Caused by coronary spasm
d. Ca2+-antagonists are recommended therapy

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Risk factors for ischaemic cardiac disease: (MCQ!)
a. Smoking
b. Hypercholesterolemia
c. Hypertension
d. Genetics

a. Smoking
b. Hypercholesterolemia
c. Hypertension
d. Genetics

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The complaint for chest pain occurs (MCQ!)
a. Aortic stenosis
b. Mitral valve prolapse
c. Ulcus ventriculi
d. Morgagni syndrome

a. Aortic stenosis
b. Mitral valve prolapse
c. Ulcus ventriculi

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Complication of DVT in lower limb:
a. Pulmonary infarction
b. Ulcus cruris
c. PE
d. Raynaud syndrome

a. Pulmonary infarction
b. Ulcus cruris
c. PE

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May mimic ECG signs of MI (MCQ!)
a. Pericarditis
b. Pancreatitis
c. Myocarditis
d. PE

a. Pericarditis

c. Myocarditis

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Necro-enzymes relating to MI (MCQ!)
a. CK-MB
b. LDH
c. Troponin
d. ALP

a. CK-MB
b. LDH
c. Troponin
d. ALP

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The patient is on chronic amiodarone treatment and now takes fluoroquinolone AB for bronchitis. Has short unconscious episodes, no earlier similar symptoms. Most likely cause of syncope?
a. Hypotension due to combo of meds
b. TdP tachycardia due to combo of meds
c. Sinus bradycardia due to combo of meds
d. Not related to medication, accidental co-incidence
e. AV conduction block caused by combo of meds

b. TdP tachycardia due to combo of meds

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Typical chest pain occurs for 1 hour and ST elevation on ECG (>1mm, in two leads). What is to be done? (MCQ!)
a. Resting perfusion scintigraphy
b. Loading the patient to PCI centre
c. Measuring necro-enzyme levels from the serum to decide treatment algorithm
d. Monitoring to detect arrhythmias

b. Loading the patient to PCI centre

c. Measuring necro-enzyme levels from the serum to decide treatment algorithm

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Treatment of pulmonary oedema associated with MI (MCQ!)
a. Furosemide iv
b. Verapamil po
c. Oxygen inhalation
d. Nitroglycerine patch

a. Furosemide iv
c. Oxygen inhalation
d. Nitroglycerine patch

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Decrease the mortality of patient with heart failure
a. Nipedipine
b. ACEi
c. Diuretics
d. Beta-receptor blockers

b. ACEi
c. Diuretics
d. Beta-receptor blockers

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Trigger cause of LV failure
a. Untreated hypertension
b. Viral myocarditis
c. Aortic stenosis
d. DVT

a. Untreated hypertension

c. Aortic stenosis

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Match medications and side-effects!
a. Amiodarone
b. ACEi
c. Betablockers
i. Bronchoconstriction
ii. Cold extremities
iii. Fibrosis of the lungs
iv. Hyperthyreosis
v. Angioneurotic edema
vi. Dry coughing

i. Bronchoconstriction C
ii. Cold extremities CA
iii. Fibrosis of the lungs A
iv. Hyperthyreosis A
v. Angioneurotic edema B
vi. Dry coughing AB

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25. Symptoms and signs of acute aortic dissection (3correct) a. Syncope, neurologic deficit b. Decreased BP c. Polyuria d. Pulmonary edema e. Bigeminy

a. Syncope, neurologic deficit b. Decreased BP d. Pulmonary edema

26. Most frequent persistent arrhythmia is: a. Ventricular extrasystole b. Atrial fibrillation c. Ventricular tachycardia d. Supraventricular tachycardia e. Junctional rhythm

b. Atrial fibrillation

27. First registered ECG sign can be in acute myocardial infarction, except: a. Pathological Q-wave b. T-wave inversion c. Ventricular fibrillation d. ST elevation e. ST depression

a. Pathological Q-wave

28. Match the drugs used for ischemic heart disease with their characteristic properties a. Salicylate acids b. Beta blockers c. HMG-CoA inhibitors d. Nitrates i. Decrease HR and LV contractility ii. Decrease mainly preload iii. Inhibit thrombocyte aggregation iv. Decrease lipid levels and have pleiotropic effect

a. Salicylate acids iii b. Beta blockers i c. HMG-CoA inhibitors iv d. Nitrates ii i. Decrease HR and LV contractility B ii. Decrease mainly preload D iii. Inhibit thrombocyte aggregation A iv. Decrease lipid levels and have pleiotropic effect C

29. When do we call a mitral valve stenosis "sever"? (3 correct) a. When the mean diastolic pressure gradient across the valve is greater than 10mmHg b. When the mean systolic pressure gradient across the valve is greater than 40mmHg c. When the pulmonary artery systolic pressure is greater than 50mmHg d. When the mitral valve area is less than 3.0cm2 e. When the mitral valve area is less than 1.0cm2

a. When the mean diastolic pressure gradient across the valve is greater than 10mmHg c. When the pulmonary artery systolic pressure is greater than 50mmHg e. When the mitral valve area is less than 1.0cm2

30. What are the indications of chronic anticoagulation in mitral valve stenosis? (3correct) a. Atrial fibrillation b. Ectopic supraventricular beats c. In case of dyspnea d. If left atrial size is greater than 55mm e. Thrombus formation in the left atrium

a. Atrial fibrillation d. If left atrial size is greater than 55mm e. Thrombus formation in the left atrium

31. What kinds of interventions are possible in mitral valve stenosis?(3 correct) a. Commisurotomy b. Prosthetic valve implantation c. Balloon dilatation d. Stent implantation

a. Commisurotomy b. Prosthetic valve implantation c. Balloon dilatation

32. What are the most common etiologies of chronic mitral valve regurgitation? (3 correct) a. Rheumatic b. Ischaemic c. Mitral valve prolapse d. Austin-Flint mechanism e. Papillary muscle rupture

a. Rheumatic b. Ischaemic c. Mitral valve prolapse

33. True for aortic valve insufficiency except: a. Present with Corrigan type pulse (celer et altus) b. Acute and chronic types are known c. Significant left ventricle dilatation is not usual d. Congenital form is known e. Risk for infective endocarditis

c. Significant left ventricle dilatation is not usual

34. Regular, wide QRS tachycardia, except: a. Ventricular tachycardia b. Supraventricular tachycardia with bundle branch block c. Atrial fibrillation with bundle branch block d. Antidrom atrial-ventricular re-entry tachycardia e. Atrial flutter with bundle branch block

c. Atrial fibrillation with bundle branch block

35. Patient goes to ambulance because of severe palpitation for 3 hours. The ECG show atrial fibrillation (~150/min). BP is 130/90mmHg. No organic heart disease in the medical history. What to do first? a. Pharmacological cardioversion for sinus rhythm b. Electronic cardioversion immediately c. Coronarography for stating organic heart disease d. Setting chronic anticoagulant therapy to prevent thromboembolic complications e. Exercise test

a. Pharmacological cardioversion for sinus rhythm

36. What is the left ventricular ejection fraction in a healthy adult?(1 correct) a. 35% b. 100% c. 70% d. 50%

c. 70%

37. All of these can be an indication for exercise stress test (EST) except: (1correct) a. Suspected coronary artery disease b. After myocardial infarction (at least 4 days after) c. Recurrent symptoms after coronary revascularization d. Pulmonary embolism

d. Pulmonary embolism

38. All of these are contraindications for exercise stress test, except (1correct) a. Severe aortic stenosis b. Acute myocardial infarction (within 48-72 hours) c. Uncontrolled hypertension d. Prior CABG operation

d. Prior CABG operation

39. Which factors interfere with the interpretation of a stress test due to the baseline ECG abnormalities? (1correct) a. Complete left bundle branch block b. Ventricular pacing c. Baseline ST/T change d. Pre-excitation e. All of the above

e. All of the above

40. ECG shows the following characteristics in patients with NSTEMI, except: (1 correct) a. ST depression b. Normal c. ST elevation d. Deep inverted T-waves in corresponding leads

c. ST elevation

41. Transient ST-segment elevation with short episodes (less than 20 minutes) of chest pain is: (1 correct) a. Effort angina pectoris b. NSTEMI c. Prinzmetal's angina d. Crescendo angina pectoris

c. Prinzmetal's angina

42. Vasodilator medications used in the treatment of Prizmetal's angina are: (1 correct) a. Nitrates, beta-blockers, Ca-channel blockers b. Nitrates, Ca-channel blockers, Alpha-antagonists c. Nitrates, Ca-channel blockers d. Aspirin, Clopidogrel, GP IIb/IIIa antagonists

c. Nitrates, Ca-channel blockers

43. Signs of right ventricular infarction (3 correct) a. Hypotension b. Dilated right ventricle c. Bradycardia d. Increased IVC diameter

a. Hypotension b. Dilated right ventricle c. Bradycardia

44. Stress echocardiography is used: (3 correct) a. To provoke silent ischaemia when the patent cannot perform a treadmill test because of severe effort angina b. To assess viability in akinetic myocardial segments c. To indicate surgery in patients with symptomatic aortic stenosis d. To assess the severity of aortic stenosis in patients with impaired left ventricular function

a. To provoke silent ischaemia when the patent cannot perform a treadmill test because of severe effort angina b. To assess viability in akinetic myocardial segments d. To assess the severity of aortic stenosis in patients with impaired left ventricular function

45. Which of the following statements are true? (1 correct) a. Echocardiography is the gold standard for evaluating heart function b. Echocardiography is the appropriate test to diagnose ARVD c. Echocardiography is an appropriate diagnostic tool to assess systolic and diastolic left ventricular functions d. In the diagnosis of ST-elevation acute myocardial infarction echocardiography is superior to resting ECG

c. Echocardiography is an appropriate diagnostic tool to assess systolic and diastolic left ventricular functions

46. Corner stones for chronic heart failure therapy are, except: (2 correct) a. ACE-inhibitors b. Ca-channel blockers c. Beta-blockers d. Vitamin K antagonists e. Aldosterone antagonists

b. Ca-channel blockers | d. Vitamin K antagonists

47. Device therapy for chronic heart failure include (3 correct) a. Cardiac resynchronization therapy (CRT) b. Continuous veno-veno hemofiltration (CVVH) c. Left ventricular assist device (LVAD) d. Intraaortic balloon pump (IABP) e. DDD pacemaker

a. Cardiac resynchronization therapy (CRT) c. Left ventricular assist device (LVAD) d. Intraaortic balloon pump (IABP)

48. Biomarkers used for the guiding of chronic heart failure therapy include (3 correct) a. Creatinine b. NT proBNP c. Bilirubin d. C-reactive protein e. D-dimer

a. Creatinine b. NT proBNP c. Bilirubin

49. Life threatening diseases which can cause chest pain (3 correct) a. Musculoskeletal disorders b. Pulmonary embolism c. Acute coronary syndrome d. Aortic dissection e. Pericarditis

b. Pulmonary embolism c. Acute coronary syndrome d. Aortic dissection

50. Echocardiographic signs which can help in acute aortic dissection (3 correct) a. Membrane flap in the aorta b. Left ventricular dilatation c. Aortic valve regurgitation d. Right ventricular dysfunction e. Pericardial effusion

a. Membrane flap in the aorta c. Aortic valve regurgitation e. Pericardial effusion

51. Indication of biventricular pacemaker implantation a. 3rd degree AV block b. LBBB, symptomatic systolic heart failure despite optimal pharmacological therapy, EF<35% c. RBBB, diastolic heart failure d. Symptomatic systolic heart failure beside optimal pharmacological therapy, EF<35%, ECG pattern is not a criteria

b. LBBB, symptomatic systolic heart failure despite optimal pharmacological therapy, EF<35%

52. 81 years old male patient complains about feeling weak for some weeks, faint occurred a couple of times, ECG shows bradyarrythmia. Diabetes mellitus and hypertension is present in the anamnesis, the ejection fraction is 47%. Which type of device to choose? a. One-chambered ICD b. Biventricular pacemaker c. VVI pacemaker d. DDD pacemaker e. Biventricular ICD

c. VVI pacemaker

53. Indication of ICD implantation for primary prevention a. Good left ventricular function, 1st degree AV block b. Long QT syndrome, sudden cardiac death of parent c. Primer dilatative cardiomyopathy d. Hypertrophic obstructive cardiomyopathy e. Postinfarction state

b. Long QT syndrome, sudden cardiac death of parent

54. Function of pacemaker, except: a. Hysteresis b. Sensitivity c. Basal frequency d. Antitachycardic function

d. Antitachycardic function

55. The following drugs may increase serum potassium level (2 correct) a. Aldosterone antagonists b. Loop diuretics c. ACE-inhibitors d. Beta blocker e. Nitrates

a. Aldosterone antagonists | c. ACE-inhibitors

56. Predisposing risk factors for pulmonary emboli, except: a. Fracture of femoral collum b. Anticoncipients c. Hypertension d. Deep vein thrombosis in the anamnesis e. Malignant disease

c. Hypertension

57. Sign of high risk pulmonary emboli a. Positive D-dimer b. Increased pulmonary pressure measured by echocardiography c. Hemoptoe d. Pleural-type chest pain e. Tachycardia

b. Increased pulmonary pressure measured by echocardiography

58. Pathologic Q-wave, isoelectric ST and positive T-wave in leads STII-III and aVF refers to: a. Acute ischaemic signs b. Developing myocardial infarction c. Definitive myocardial infarction d. Aneurysm due to myocardial infarction e. Subendocardial ischaemia

c. Definitive myocardial infarction

59. 60 years old, smoking, male patient have chest pain during exercise activity. First diagnostic step: a. Exercise test with echocardiography b. Exercise test with ECG c. Exercise test with d. Holter monitoring e. Exercise test with cardiac MR

b. Exercise test with ECG

60. First medication for bradycardia in myocardial infarction a. Atropine b. Dobutamine c. Diaphylline d. __

a. Atropine

61. Most frequent side effect of ACE-inhibtors a. Diarrhoea b. Coughing c. Vomiting d. Erythema e. Anasarca

b. Coughing

62. First medication of myocardial infarction with ST elevation in the field (first examination with doctor) involves, except: a. Analgesia b. Short acting Ca2+-channel blockers c. Sublingual nitrate d. Aspirin e. Oxygen

b. Short acting Ca2+-channel blockers

63. 40 years old obese lady suffered injury and rested in bed for three weeks. She is dry coughing for three days now, and complains about atypical chest pain. a. Which diagnostic procedure to do, except i. ECG ii. D-dimer iii. Blood gas test iv. Pulmonary CT with angiography v. Exercise test with ECG vi. 2D echocardiography

v. Exercise test with ECG

63. 40 years old obese lady suffered injury and rested in bed for three weeks. She is dry coughing for three days now, and complains about atypical chest pain. b. Recommended therapy after the diagnosis i. Heparin ii. Venoruton (rutosid) iii. Nitrate iv. ACE-i

i. Heparin

63. 40 years old obese lady suffered injury and rested in bed for three weeks. She is dry coughing for three days now, and complains about atypical chest pain. What are the ECG signs of pulmonary emboli (may be more than one correct!) i. RBBB ii. S1Q3 complex iii. T wave inversion in lead II, aVF and V1-V4 iv. Left deviating R-vector

i. RBBB | ii. S1Q3 complex

64. What is the treatment of choice for cardiogenic shock during MI caused by ventricular septal rupture? (1 correct) a. Medical therapy alone b. Medical therapy + intraaortic balloon pump + surgical consultation c. Medical therapy + intraaortic balloon pump

b. Medical therapy + intraaortic balloon pump + surgical consultation

65. What are the typical clinical and ECG signs of symptomatic right ventricular infarction? (1 correct) a. Hypotension, elevated JVP and clear lung fields with ST-elevation in V4R b. Hypotension, low JVP, ST-elevation in V4-6 c. Hypotension, harsh pansystolic murmur

b. Hypotension, low JVP, ST-elevation in V4-6

66. What is the treatment of choice for right ventricular infarction?(1 correct) a. Fluid administration and if needed inotropic/IABP support b. Vasodilators to offload the right ventricle c. IV heparin to maintain patency of the right ventricular arteries

a. Fluid administration and if needed inotropic/IABP support

67. ICD-s are able to (3 correct) a. Terminate ventricular fibrillation with shock delivery b. Work as a pacemaker if necessary c. Terminate ventricular extrasystoles d. Terminate ventricular tachycardia with anti-tachycardia pacing e. Treat only tachycardia, no therapeutic options against bradycardia

a. Terminate ventricular fibrillation with shock delivery b. Work as a pacemaker if necessary d. Terminate ventricular tachycardia with anti-tachycardia pacing

68. "VVI" pacemaker means: (2 correct) a. One electrode in the ventricle b. One electrode in the atrium c. Two electrodes (atrium and ventricle) d. A sensed signal from the heart inhibits the pacemaker e. A sensed signal in the atrium may trigger a ventricular paced beat

a. One electrode in the ventricle | d. A sensed signal from the heart inhibits the pacemaker

69. Which is NOT indicative of an acute PE (one is correct) a. Acute tricuspid regurgitation b. Hypertrophic right ventricle c. Enlarged right ventricle d. Increased calculated pulmonary arterial systolic pressure

b. Hypertrophic right ventricle

70. The following conditions can cause pericardial effusion (2 correct) a. Chronic renal failure b. Dilated cardiomyopathy c. Neoplastic disease d. Acute VSD

a. Chronic renal failure | c. Neoplastic disease

``` 71. Etiology of acute tricuspid regurgitation might be (2 correct) a. Infective endocarditis b. Pericardial tamponade c. Acute pulmonary embolism d. Vena cava superior syndrome ```

a. Infective endocarditis | c. Acute pulmonary embolism

72. Aortic root dilatation might be caused by the following, but one:(1 correct) a. Marfan's syndrome b. Acute myocardial infarction c. Aneurysm d. Aortic dissection

b. Acute myocardial infarction

73. The following parameters are useful for follow-up of patients with dilated cardiomyopathy (3 correct) a. Pulmonary arterial systolic pressure b. Ejection fraction c. Number of akinetic myocardial segments d. Systolic blood pressure e. Severity of mitral regurgitation

a. Pulmonary arterial systolic pressure b. Ejection fraction e. Severity of mitral regurgitation

74. All of these conditions can contribute to symptoms of unstable angina, except: (1 correct) a. Fever b. Anaemia c. Thyrotoxicosis d. Well-controlled hypertension e. Stress

d. Well-controlled hypertension

75. Prognosis of patients with stable effort angina pectoris can be assessed by: (1 correct) a. Clinical evaluation b. Co-existing disease c. Stress-test d. Myocardial perfusion imaging or dobutamine stress echocardiography e. All of the above

e. All of the above

76. All of the following except ONE would suggest high risk in patients with stable effort angina (1 correct) a. Achieving 10 METS on stress test b. Depressed left ventricular ejection fraction (<35%) c. Large areas if ischaemia on perfusion imaging d. Hypotension during exercise stress test

a. Achieving 10 METS on stress test

77. Modifiable risk factors in patients with ischemic heart disease, except (1 correct) a. Hyperlipidemia b. Hypertension c. Smoking d. Male gender

d. Male gender

78. Which of the following conditions presents with systolic hypertension? a. Aortic insufficiency b. Thyrotoxicosis c. Beri-beri disease d. Atherosclerosis

a. Aortic insufficiency b. Thyrotoxicosis c. Beri-beri disease d. Atherosclerosis

79. Aortic aneurysm may develop: a. In atherosclerosis b. In Marfan disease c. In vascular syphilis d. In giant-cell arteritis

a. In atherosclerosis b. In Marfan disease c. In vascular syphilis

80. Possible explanation for pericarditis development: a. Uraemia b. Transmural infarction c. Tuberculosis d. Metastatic tumor

a. Uraemia b. Transmural infarction c. Tuberculosis d. Metastatic tumor

81. Results in secondary cardiomyopathy: a. Hyperthyreosis b. Beri-beri c. Amyloidosis d. Glycogenosis

a. Hyperthyreosis b. Beri-beri c. Amyloidosis d. Glycogenosis

82. Effects of ACE-inhibitors: a. Decrease blood pressure b. Decrease aldosterone level c. Increase bradykinin level d. Preserve ejection fraction

a. Decrease blood pressure b. Decrease aldosterone level c. Increase bradykinin level d. Preserve ejection fraction

83. The following are correct: a. Aspirin doesn't affect endothelial prostacyclin synthesis b. According to multicentre studies aspirin lowers the frequency of second myocardial infarction c. Heparin needs 24 hours for anticoagulant effect d. Possible treatments for pulmonary emboli are heparin and Alteplase

b. According to multicentre studies aspirin lowers the frequency of second myocardial infarction d. Possible treatments for pulmonary emboli are heparin and Alteplase

84. What is the most common arrhythmia in mitral valve stenosis? (1 correct) a. Sustained ventricular tachycardia b. Non-sustained ventricular tachycardia c. Atrial fibrillation d. 1st degree AV block e. Bigeminy

c. Atrial fibrillation

85. 55 years old male patient arrives to the ambulance by the ambulance service. He is complaining about suddenly developed wrecking chest pain. ST elevation is on the ECG. Possible diagnoses? a. Ulcus ventriculi b. Myocardial infarction c. Prolapse of the mitral valve d. Aortic dissection

b. Myocardial infarction

86. Refers to progressive obliterative vascular disease on the leg: a. Claudication b. Cold fingers c. In vertical position the leg is rather red, when moving up goes pale d. Sudden onset

a. Claudication

87. 70 years old male patient suffered anterior myocardial infarction 3 weeks ago. After a period of being asymptomatic, suddenly fever and chest pain develops. No new Q-wave presented on the ECG, the laboratory tests show CK-MB in the normal range. Possible diagnoses? a. Myocardial reinfarction b. Pulmonary emboli c. Lobar pneumonia d. Dressler syndrome

d. Dressler syndrome

88. Correct for mitral insufficiency: a. May result in dilatation of all heart chambers b. May be the complication of infective endocarditis c. Pulmonary vascular pressure may be increased beside adequate ejection fraction d. Severe form may need heart surgery treatment

a. May result in dilatation of all heart chambers b. May be the complication of infective endocarditis c. Pulmonary vascular pressure may be increased beside adequate ejection fraction d. Severe form may need heart surgery treatment

89. Correct for mitral stenosis a. Not risk factor for atrial fibrillation b. Risk factor for left atrial thrombus development c. Physical examination shows obtuse 1st sound and mesosystolic click d. Late complication of rheumatic fever

b. Risk factor for left atrial thrombus development | d. Late complication of rheumatic fever

90. Echocardiography parameters of aortic stenosis a. Left ventricular end-diastolic diameter is in the normal range b. Concentric left ventricular hypertrophy is common c. Left atrial diameter is higher than the normal d. Transvalvular gradient can be measured on the aortic valve by Doppler method

b. Concentric left ventricular hypertrophy is common c. Left atrial diameter is higher than the normal d. Transvalvular gradient can be measured on the aortic valve by Doppler method

91. Characteristic for mitral prolapse a. May go along with ventricular extrasystole b. May cause chest pain c. Common in Marfan syndrome d. Opening snap is characteristic

c. Common in Marfan syndrome

92. Leads to STE-ACS except: a. Rupture of the plaque b. Embolization c. Aortic dissection d. Significant aortic valve stenosis e. Vasospasm

d. Significant aortic valve stenosis

93. Characteristic for the so-called vulnerable plaque a. High calcium concentration b. High lipid concentration, inflammatory cells c. Cause >50% occlusion of the vessel d. Rough surface

b. High lipid concentration, inflammatory cells

94. Mechanical complications of myocardial infarction, except: a. Papillary muscle rupture b. Ventricular wall rupture c. Ventricular tachycardia d. Rupture of the intraventricular septum

c. Ventricular tachycardia

95. Regress atherosclerotic plaques: a. Statin therapy b. High dose statin c. Fibrate combined with statin d. Aspirin combined with fibrate e. High dose fibrate

b. High dose statin

96. First recommended, curative treatment for STE-ACS a. Fibrinolysis b. Percutaneous coronary intervention c. Intravenous anticoagulant d. Beta-receptor blocker e. Inhibition of thrombocyte aggregation

b. Percutaneous coronary intervention

97. What is the recommended, 95% effective therapy for such paroxysmal tachycardia (1 correct) a. Percutaneous coronary intervention b. Heart surgery c. Radiofrequency catheter ablation d. Pacemaker implantation e. ICD implantation

c. Radiofrequency catheter ablation

98. What is characteristic of AVRT (2 correct) a. Irregular rhythm b. Retrograde P-waves after the QRS-complex c. Re-entry tachycardia involving an accessory pathway d. Pseudo r' in lead V1 and pseudo s in inferior leads e. Life threatening arrhythmia

c. Re-entry tachycardia involving an accessory pathway | e. Life threatening arrhythmia

99. When do you find an elevated jugular venous pulse? (2 correct) a. Hypovolaemia b. Acute heart failure c. Hypervolemia d. Acute coronary syndrome e. Aortic valve regurgitation

b. Acute heart failure | c. Hypervolemia

100. What does NYHA III means? (1 correct) a. NYHA is a functional classification in angina pectoris. NYHA III means marked limitation - angina when walking at normal pace up one flight of stairs. b. NYHA is a grading system to estimate the disability due to heart disease. NYHA III means slight limitation during ordinary activity. c. NYHA is a grading system to estimate the disability due to heart disease. NYHA III means marked limitation of normal activities without symptoms at rest. d. NYHA III means when somebody is unable to undertake physical activity without symptoms and symptoms may be present at rest.

c. NYHA is a grading system to estimate the disability due to heart disease. NYHA III means marked limitation of normal activities without symptoms at rest.

101. Which are the three elements of typical angina pectoris? (3 correct) a. Location (retrosternal with typical radiation) b. Precipitant factors (effort, emotion) c. Associated symptoms (breathlessness, sweating) d. Relieving factors (rest, sublingual nitrate) e. Positive biomarkers

a. Location (retrosternal with typical radiation) b. Precipitant factors (effort, emotion) d. Relieving factors (rest, sublingual nitrate)

102. Which medications - mentioned below - can improve the symptoms in angina pectoris? (2 correct) a. Nitrates b. Diuretics c. Statins d. Proton pump inhibitors e. Calcium antagonists

a. Nitrates | e. Calcium antagonists

103. How high is the end diastolic pressure normally in the left ventricle? (1 correct) a. 0mmHg b. 5-12mmHg c. 70mmHg d. 120mmHg

b. 5-12mmHg

104. Which diseases may result in systemic thrombo embolisation? (3 correct) a. Aortic stenosis b. Atrial fibrillation c. Endocarditis d. Tricuspid regurgitation e. Left ventricular aneurysm

b. Atrial fibrillation c. Endocarditis e. Left ventricular aneurysm

105. How do you treat a fast ventricular tachycardia causing acute hemodynamic disability? (1 correct) a. Beta-blocker b. Amiodarone c. Catheter ablation d. Sedation e. Sedation (if necessary) and electrical cardioversion

e. Sedation (if necessary) and electrical cardioversion

106. ECG shows atrial fibrillation. The beginning of the arrhythmia is unknown. Average heart rate is 110 bpm. RR: 130/80 mmHg. Which strategies are good? (2 correct) a. Sedation and electrical cardioversion b. Effective anticoagulation for 4 weeks (INR 2-3) and then cardioversion c. Anticoagulation and rate control with beta-blockers d. Only propafenone or amiodarone therapy

b. Effective anticoagulation for 4 weeks (INR 2-3) and then cardioversion c. Anticoagulation and rate control with beta-blockers

107. Which diseases are associated often with ventricular tachycardia? (2 correct) a. Atrial fibrillation b. Myocardial infarction c. Diabetes mellitus d. Left ventricular aneurysm

b. Myocardial infarction | d. Left ventricular aneurysm

108. Which of the following are diagnostic signs of ventricular tachycardia? (3 correct) a. Fusion beat b. Regularity c. Irregularity d. VA (ventriculo-atrial) dissociation (ventricle faster than atrium) e. Capture beat

a. Fusion beat c. Irregularity d. VA (ventriculo-atrial) dissociation (ventricle faster than atrium) e. Capture beat

109. The patient had two myocardial infarctions. Left ventricular ejection fraction is 30%. How do you treat him after a documented fast monomorph ventricular tachycardia? (3 correct) a. Pacemaker implantation b. ICD implantation c. Beta-blocker therapy d. Digitalis e. Amiodarone

b. ICD implantation c. Beta-blocker therapy e. Amiodarone

110. Indications for pacemaker implantation, except: a. 1st degree AV block b. 2nd degree AV block c. Bradyarrhythmia d. Carotid sinus hyperesthesia

a. 1st degree AV block

111. Treatment of hemodynamically instable fast ventricular tachycardia a. Iv amiodarone b. Beta receptor blockers c. Sedation, electric cardioversion d. Propafenon

c. Sedation, electric cardioversion

112. Inhibitors of platelet aggregation, except: a. Aspirin b. Prasugrel c. Ticagrelol d. Kumarin e. Clopidogrel

d. Kumarin

113. Which statement is true? a. After MI combined medication stand by Aspirin + Clopidogrel for one year b. After MI medication stand by Clopidogrel monotherapy for one year c. After PCI every patient receive combined Aspirin + Clopidogrel therapy d. Aspirin monotherapy is enough after myocardial infarction

c. After PCI every patient receive combined Aspirin + Clopidogrel therapy

114. Alternative of coumarine in the treatment of chronic atrial fibrillation, except a. P.o. inhibitors of Xa factor b. Low molecular weight heparine c. Thrombin inhibitors d. Aspirin e. Iv Na-heparin

d. Aspirin

115. Characteristic for stent-thrombosis after PCI except a. Result of neotintimal proliferation b. Sudden event, always result in myocardial infarction c. Most common cause is ignoring combined thrombocyte aggregation-inhibitor medication d. Results in thrombotic occlusion e. Sign ST elevation on ECG

b. Sudden event, always result in myocardial infarction

116. Decrease the rate of instent restenosis, except: a. Implantation of drug-eluting stent b. Implantation of short-wide diameter stent c. Effective medication for inhibition of thrombocyte aggregation d. Right expandation of the stent during the implantation

b. Implantation of short-wide diameter stent

118. These abnormalities can cause a systolic murmur (3 correct) a. Hypertrophic cardiomyopathy b. Mitral valve stenosis c. Ventricular septal defect d. Atrial septal defect e. Tricuspid stenosis f. Aortic valve regurgitation

a. Hypertrophic cardiomyopathy c. Ventricular septal defect d. Atrial septal defect

119. Ivabradine is indicated a. Effort angina pectoris + heart rate > 70bpm b. Diastolic heart failure c. Rate control in atrial fibrillation d. 1st degree AV block, instead of beta-receptor blockers

a. Effort angina pectoris + heart rate > 70bpm

120. The affected coronary artery in inferior + right ventricle STE-ACS is a. LAD (left anterior descending) b. CX (circumflex) c. RCA (right coronary artery) d. None of these

c. RCA (right coronary artery)

122. What kind of arrhythmias can we treat with radiofrequency ablation? (3 correct) a. Atrial fibrillation b. Left bundle branch block c. WPW syndrome d. Ventricular extrasystole e. Mobitz II AV block

a. Atrial fibrillation c. WPW syndrome d. Ventricular extrasystole

123. What can cause paradoxical pulse? (2 correct) a. Anterior STEMI b. Congestive heart failure c. Pulmonary embolism d. Pericardial tamponade e. Aortic dissection

d. Pericardial tamponade | e. Aortic dissection

124. When can you find a difference in blood pressure between the upper and lower limbs? (2 correct) a. In aortic valve stenosis b. Possibly in aortic dissection c. In aortic coarctation d. In mitral valve stenosis e. In pericardial tamponade

b. Possibly in aortic dissection | c. In aortic coarctation

125. What is Dressler syndrome? a. Congenital valve disease b. Post-MI pericarditis c. Post-MI hepato-renal syndrome d. Pericarditis in renal insufficiency

b. Post-MI pericarditis

126. Indications of thrombolytic therapy (2 correct) a. Pulmonary embolism with hemodynamic compromise b. ST elevation MI within 12 hours c. Abdominal emboli d. Mitral valve rupture e. Left ventricular thrombi

a. Pulmonary embolism with hemodynamic compromise | b. ST elevation MI within 12 hours

127. How would you anticoagulate your 80yo diabetic patient who has chronic atrial fibrillation? (1 correct) a. With aspirin b. With clopidogrel+aspirin c. With warfarin d. With ticlopidine

c. With warfarin

128. These are indications of anticoagulant therapy (3 correct) a. Left ventricular thrombus b. Pulmonary embolism c. Aortic dissection d. Mechanical prosthetic valve implantation e. ICD implantation

b. Pulmonary embolism d. Mechanical prosthetic valve implantation e. ICD implantation

129. Which imaging tests are the most useful in the evaluation of pulmonary embolism? (3 correct) a. Radionuclide lung perfusion scan b. Pulmonary angiography c. Chest x-ray d. CT pulmonary angiography e. Contrast echocardiography

a. Radionuclide lung perfusion scan c. Chest x-ray d. CT pulmonary angiography

130. How is coarctation of the aorta detected? (1 correct) a. Place the thumb of one hand on the brachial pulse and the other one on the femoral pulse, and assess them simultaneously. Normally these pulses are equal in volume and timing. A delay in the femoral impulse or a reduction or absence strongly supports the diagnosis of coarctation. b. Place the thumb of one hand on the brachial pulse and the other on the femoral pulse, and assess the simultaneously. Normally these pulses are equal in volume and timing. A premature femoral impulse strongly supports the diagnosis of coarctation. c. A paradoxical femoral pulse on both side support the diagnosis of coarctation. d. Altering low and high volume beats (pulsus alternans) can be characteristic for aortic coarctation.

a. Place the thumb of one hand on the brachial pulse and the other one on the femoral pulse, and assess them simultaneously. Normally these pulses are equal in volume and timing. A delay in the femoral impulse or a reduction or absence strongly supports the diagnosis of coarctation.

131. Which of the following best describes Dressler's syndrome? (1 correct) a. Hypotension, elevated jugular pressure clear lung fields b. Pericardial and pleural fluid, elevated ESR, fever in a patient days or weeks after myocardial infarction c. Pericardial friction rub and pain while taking a deep breath 24 hours after suffering an anterior wall myocardial infarction d. Alternating RBBB and LBBB in a patient after suffering an anterior wall myocardial infarction

b. Pericardial and pleural fluid, elevated ESR, fever in a patient days or weeks after myocardial infarction

132. Types of re-entry arrhythmias are (3 correct) a. Right ventricular outflow tract tachycardia b. Atrial flutter c. WPW d. AV nodal/junctional re-entry tachycardia e. Atrial fibrillation

b. Atrial flutter c. WPW d. AV nodal/junctional re-entry tachycardia

133. Typical regular, narrow QRS tachycardias are (3 correct) a. AV nodal/junctional re-entry tachycardia b. Atrial flutter c. Ventricular tachycardia d. WPW (orthodrom) e. WPW (antidrom)

a. AV nodal/junctional re-entry tachycardia b. Atrial flutter d. WPW (orthodrom)

134. Regular wide QRS tachycardias are (2 correct) a. AV nodal/junctional re-entry tachycardia b. Atrial flutter c. Ventricular tachycardia d. WPW (orthodrom) e. WPW (antidrom)

c. Ventricular tachycardia | e. WPW (antidrom)

135. Pericarditis can be present (3 correct) a. In acute or chronic renal failure b. After myocardial infarction c. In hyperthyreoidism d. In young patients after upper airway infection e. In cerebral malignancy

a. In acute or chronic renal failure b. After myocardial infarction d. In young patients after upper airway infection

136. Which medication is preferred if hypertension is combined with diabetes mellitus? a. Beta blockers b. Loop diuretics c. ACEis d. Alpha blockers e. ARBs

c. ACEis | e. ARBs

137. Physical signs, symptoms related to chronic heart failure (3 correct) a. Orthopnoea b. Hydrothorax c. Signs of cerebral edema d. Lack of appetite e. Bronchospasm

a. Orthopnoea b. Hydrothorax d. Lack of appetite

138. What can be the etiology of acute aortic valve regurgitation? (3 correct) a. Chordal rupture b. Infective endocarditis c. Aortic dissection d. Bicuspid valve e. Trauma

b. Infective endocarditis c. Aortic dissection e. Trauma

139. What are the most frequent etiologies that can cause chronic aortic valve regurgitation? (3 correct) a. Degenerative b. Rheumatic c. Infective endocarditis d. Congenital e. Ischaemic heart disease

a. Degenerative b. Rheumatic d. Congenital

140. Major criteria for the diagnosis of infective endocarditis (2 correct) a. Fever b. Positive blood culture c. Vasculitic lesions d. Vegetation on echo e. History of IV drug abuse

b. Positive blood culture | d. Vegetation on echo

141. Surgery is indicated in patients, with infective endocarditis if: (3 correct) a. Severe cardiac failure is presented due to valvular compromise b. Relapse after optimal medical therapy c. In case of septical systemic embolism d. Mitral valve regurgitation is presented e. Pulmonary systolic pressure >50mmHg

a. Severe cardiac failure is presented due to valvular compromise b. Relapse after optimal medical therapy c. In case of septical systemic embolism

142. Myocardial perfusion stress testing can be used in: (3 correct) a. High clinical suspicion of aortic valve stenosis b. Resting ECG abnormalities preclude exercise stress test interpretation c. Culprit vessel identification in multivessel disease d. After PCI to evaluate stent restenosis e. All of the above

b. Resting ECG abnormalities preclude exercise stress test interpretation c. Culprit vessel identification in multivessel disease d. After PCI to evaluate stent restenosis

143. Causes that frequently can provoke acute heart failure in patients with chronic congestive heart failure (3 correct) a. Arrhythmias, especially atrial fibrillation b. NSAID abuse c. Fever d. Gastro-esophageal reflux e. Ventricular premature beats

a. Arrhythmias, especially atrial fibrillation b. NSAID abuse c. Fever

144. The most common cause of congestive heart failure (1 correct) a. Chronic anemia b. Volume overload c. Ischaemic heart disease d. Diabetes mellitus e. Chronic renal failure

c. Ischaemic heart disease

145. Patients with congestive heart failure have an increased risk of: (2 correct) a. Restless leg syndrome b. Ischaemic stroke c. Cardiac tamponade d. Sudden cardiac death e. Peripheral artery disease

b. Ischaemic stroke | d. Sudden cardiac death

146. These drugs are mandatory in patients suffering from chronic heart failure because these will increase life expectancy (3 correct) a. Digoxin b. ACEIs c. Verospiron d. Nitrates e. Beta-blockers

b. ACEIs c. Verospiron e. Beta-blockers

147. How do you treat isolated ventricular extrasystoles? Which statement is correct? (2 correct) a. It is not necessary to treat if there are no symptoms b. The first choice is beta blocker c. The first choice is amiodarone d. Coronarography is necessary to exclude coronary artery disease e. Calcium channel blocker plus beta blocker is a primary option

a. It is not necessary to treat if there are no symptoms | e. Calcium channel blocker plus beta blocker is a primary option

148. What does non-sustained VT means (2 correct) a. Duration of VT is not longer than 30sec b. Five ventricular beats come subsequently c. It can cause hemodynamic instability d. The time of the VT is longer than 30 minutes

a. Duration of VT is not longer than 30sec (b. Five ventricular beats come subsequently one of these, but I am not sure on this c. It can cause hemodynamic instability)

149. Which is not part of basic therapy of STEMI (1 correct) a. Acetylsalisylic acid b. O2 c. Clopidogrel d. Midazolam

d. Midazolam

150. What is the cause of reperfusional arrhythmias? (1 correct) a. The given medicines begin to activate b. The low concentration of endogenous morphins c. The liberation of toxic metabolites and perturbation of ionic balance d. The high blood sugar level

c. The liberation of toxic metabolites and perturbation of ionic balance

151. What does the Stanford classification describe? a. It is used in pulmonary embolism, it describes right ventricular overload. b. It is used in acute aortic dissection, it describes the involvement of the ascending aorta c. It is used in pulmonary embolism, it describes the involvement of the main pulmonary trunk d. It is used in pericardial tamponade, it describes the origin of the tamponade

b. It is used in acute aortic dissection, it describes the involvement of the ascending aorta

152. Choose the right answer/s: a. Serum troponin levels start to rise immediately after onset of chest pain and fall back to normal levels after pain relief b. In case of an AMI serum troponin levels start to rise within 3 hours and fall back to normal levels after a successful revascularization c. In case of AMI serum troponin levels start to rise within 4 hours and peak at 12-24 hours after onset. High troponin levels persist for 10-14 days. d. Serum troponin elevation is highly specific for myocardial infarction. It is not elevated in case of cardiomyopathy, myocarditis or pericarditis. e. If I treat a patient with STEMI, I have to wait for the troponin lab results to make the correct diagnosis. I send the patient just after that for primary PCI.

c. In case of AMI serum troponin levels start to rise within 4 hours and peak at 12-24 hours after onset. High troponin levels persist for 10-14 days.

153. The correct prehospital treatment of an AMI is (3 correct) a. O2 and ECG monitoring, IV access b. Proton pump inhibitor IV to prevent GI bleeding c. In case of severe chest pain 2mg morphine intravenously, repeated if necessary d. 300mg Aspirin e. Nitrate in all cases f. Warfarin in all cases

a. O2 and ECG monitoring, IV access d. 300mg Aspirin c. In case of severe chest pain 2mg morphine intravenously, repeated if necessary e. Nitrate in all cases MONA therapy, but I am not sure if Nitrates is correct in "ALL cases"

154. Possible non-cardiac causes of pulmonary edema (3 correct) a. Bleeding b. Cirrhosis hepatis c. Acute renal failure d. Sepsis e. Abdominal malignancy

b. Cirrhosis hepatis c. Acute renal failure d. Sepsis

155. What kind of adequate treatment do we have in case of massive pulmonary embolism? (3 correct) a. Aspirin and Clopidogrel combination b. Selective thrombolysis in the pulmonary artery c. Systemic thrombolytic therapy d. Permanent heparin infusion e. Nitroglycerin perfusion

b. Selective thrombolysis in the pulmonary artery c. Systemic thrombolytic therapy d. Permanent heparin infusion

156. What are the findings in case of pulmonary embolism? (3 correct) a. Bradycardia, LBBB b. Tachycardia, P pulmonale on ECG c. Functional tricuspid regurgitation d. Increased left ventricular pressure, without wall motion abnormalities e. Increased right ventricular pressure

b. Tachycardia, P pulmonale on ECG c. Functional tricuspid regurgitation e. Increased right ventricular pressure

157. Please choose the correct sequence of cardiac biomarkers in order of their change in serum level after AMI (1 correct) a. LDH -> troponin -> CK -> CK-MB -> GOT b. Troponin -> LDH -> CK -> CK-MB -> GOT c. LDH -> troponin -> GOT -> CK-MB -> CK d. Troponin -> CK-MB and CK -> LDH -> GOT e. Troponin -> CK-MB and CK -> GOT -> LDH

e. Troponin -> CK-MB and CK -> GOT -> LDH

158. What is the first therapeutic step if somebody suddenly collapse in front of you and you diagnose cardiac arrest? a. Give adrenaline b. Precordial thump c. Raise patients legs d. Open airways

b. Precordial thump

159. A 32-year old obese man arrived to your outpatient clinic with the following complaints: atypical chest pain related with breathing, dyspnea, sweating, he is pale. His medical history was negative. What would you do? (3 correct) a. Physical examination, perform an ECG, transport via ambulance to do CT scan b. Send for urgent Coronarography via ambulance to verify ACS c. Clear the character of the chest pain and urgent lab tests d. Systemic thrombolysis to open the artery e. Examine the lower extremities with Doppler echo in the outpatient clinic

a. Physical examination, perform an ECG, transport via ambulance to do CT scan c. Clear the character of the chest pain and urgent lab tests e. Examine the lower extremities with Doppler echo in the outpatient clinic

160. The laboratory parameters of a young female chronic smoker patient: WBC 12000/mL, RBC 4,4 T/L, Htc 43%, CRP 112mg/L, tropT 0,002, blood sugar 4,2 mmol/L, creatinine 102umol/L, GOT 26 U/L, GPT 32 U/L, D-dimer 4ug/mL (3 correct) a. I suggest her to quit smoking b. Give antibiotics for pneumonia c. Send for a CXR d. Perform echocardiography e. I schedule her for a diagnostic Coronarography

a. I suggest her to quit smoking b. Give antibiotics for pneumonia c. Send for a CXR

161. What are the most common etiologies of acute mitral valve regurgitation? (2 correct) a. Aortic dissection b. Pulmonary embolism c. Chordae tendinae rupture d. Papillary muscle rupture e. Infective endocarditis

c. Chordae tendinae rupture | d. Papillary muscle rupture

162. Which are the signs of hypertensive organ-damage in the heart? (2 correct) a. Left ventricular hypertrophy b. Diastolic dysfunction c. Aortic regurgitation d. Isolated septal hypertrophy e. Wall motion abnormality

a. Left ventricular hypertrophy | c. Aortic regurgitation

163. Possible ECG signs of pulmonary embolism (3 correct) a. II degree AV block b. Sinus tachycardia c. Right bundle branch block d. S1, QIII, T: inverted in III e. Ventricular extrasystoles

b. Sinus tachycardia c. Right bundle branch block d. S1, QIII, T: inverted in III

164. Clinical signs of pericardial tamponade: (3 correct) a. Oligo-anuria b. Low blood pressure c. Raised jugular pressure d. Left ventricular hypertrophy on ECG e. Ankle-brachial index >1

a. Oligo-anuria b. Low blood pressure c. Raised jugular pressure

165. Potentially reversible causes of EMD (electromechanical dissociation) (3 correct) a. Hypovolemia b. Hyperthermia c. Tension pneumothorax d. Pericardial tamponade e. Abdominal ischaemia

a. Hypovolemia c. Tension pneumothorax d. Pericardial tamponade

166. Drugs that may be useful in management of acute heart failure (3 correct) a. Beta blockers IV b. Loop diuretics IV c. Morphine IV d. Calcium antagonists IV e. Nitrates

a. Beta blockers IV b. Loop diuretics IV e. Nitrates Morphine could also be good though (MONA)

167. These lab test results are often found in chronic heart failure (3 correct) a. Polyglobulinemia b. Anemia c. Low Na-level d. High BNP-level e. High troponin-level

b. Anemia d. High BNP-level e. High troponin-level

168. Possible causes of dilatative cardiomyopathy (3 correct) a. Toxins, e.g. Adriamycin b. Myocarditis c. Hyperthyroidism d. COPD e. Chronic renal failure

a. Toxins, e.g. Adriamycin b. Myocarditis c. Hyperthyroidism

169. Consequences of aortic valve stenosis (3 correct) a. Left ventricular volume overload b. Left ventricular pressure overload c. Left ventricular hypertrophy d. Later left ventricular dilatation e. Early left ventricular dilatation

b. Left ventricular pressure overload c. Left ventricular hypertrophy d. Later left ventricular dilatation

170. Most frequent symptoms of significant aortic valve stenosis: (3 correct) a. Ventricular arrhythmias b. Effort angina pectoris c. Effort syncope d. Hypertension e. Heart failure

b. Effort angina pectoris c. Effort syncope e. Heart failure

171. Which symptom appearance will decrease life expectancy for 2 years in significant aortic valve stenosis? (1 correct) a. Ventricular tachycardia b. Heart failure c. Low blood pressure d. Effort angina pectoris e. Syncope

b. Heart failure

172. What are the typical physical signs of aortic valve stenosis? (3 correct) a. Mid diastolic murmur b. Mid systolic murmur c. Pulsus parvus et tardus d. Austin Flint murmur e. Palpable systolic thrill

b. Mid systolic murmur c. Pulsus parvus et tardus e. Palpable systolic thrill

173. Which of the following are parts of the re-entry circuit in AV nodal/junctional tachycardia? (2 correct) a. Left bundle branch b. AV node, slow pathway c. AV node, fast pathway d. Accessory pathway (Kent bundle) e. Ventricle

b. AV node, slow pathway | c. AV node, fast pathway

174. "AAI"; pacemaker means: (2 correct) a. One electrode in the ventricle b. One electrode in the atrium c. Two electrodes (atrium and ventricle) d. A sensed signal from the heart inhibits the pacemaker e. A sensed signal in the atrium may trigger a ventricular paced beat

b. One electrode in the atrium | d. A sensed signal from the heart inhibits the pacemaker

175. Possible mechanism of AMI (1 correct) a. Thrombus formation on a ruptured plaque b. Coronary embolism c. Coronary spasm d. Cocaine use e. All of the above

e. All of the above

176. Diagnosis of NSTEMI in the appropriate clinical settings require (1 correct) a. Elevation of cardiac biomarkers b. Segmental wall motion abnormalities on echocardiography c. Resting ECG changes d. Elevated LDH e. Ventricular premature beats on ECG

a. Elevation of cardiac biomarkers

177. In patients with unstable angina/NSTEMI the following medications are useful except (1 correct) a. Aspirin b. Clopidogrel c. Heparin d. Thrombolytics e. Statins

d. Thrombolytics

178. Indications of CRT (cardiac resynchronization therapy, atriobiventricular stimulation) (3 correct) a. Left ventricular EF <35% b. Left ventricular EF <45% c. Drug refractory heart failure, NYHA II functional stage d. Drug refractory heart failure, NYHA III-IV functional stage e. QRS > 130ms

a. Left ventricular EF <35% d. Drug refractory heart failure, NYHA III-IV functional stage e. QRS > 130ms

179. Typical causes of bradycardia (2 correct) a. Coronary artery disease b. Fever c. Fibrosis of the conduction system of the heart d. Hyperthyroidism e. WPW syndrome

a. Coronary artery disease | c. Fibrosis of the conduction system of the heart

180. Method to evaluate wall motion abnormalities except (1 correct) a. Cardiac MR b. Dobutamine stress echocardiography c. Exercise stress test d. Myocardial perfusion imaging

c. Exercise stress test

181. Which condition describes more accurately stable effort angina pectoris? (1 correct) a. 1 hour of chest pain after heavy exercise not relieved by rest b. 10 minutes of chest pain at rest which is relieved by nitroglycerin c. Chest pain occurring after walking 2 flights of stairs relieved by rest in the last 6 months d. Chest pain occurring after walking 20 meters in the last 2 weeks relieved by nitroglycerin

c. Chest pain occurring after walking 2 flights of stairs relieved by rest in the last 6 months

182. All of the following are risk factors for ischaemic heart disease except (1 correct) a. Smoking b. Hypertension c. Female gender before menopause d. Diabetes mellitus e. Hyperlipidemia

c. Female gender before menopause

183. Angina pain can radiate to these locations (1 correct) a. Left arm b. Jaw c. Neck d. All of the above e. None of the above

d. All of the above

184. What are the typical signs of chronic aortic valve regurgitation? (3 correct) a. Crescrendo-decrescendo systolic murmur b. High pulse amplitude c. Bobbing head d. Pulsus celer et altus (Corrigan's pulse) e. Pulsus parvus et tardus

b. High pulse amplitude c. Bobbing head d. Pulsus celer et altus (Corrigan's pulse)

185. Which cardiac symptoms are characteristic of hypertensive crisis? (3 correct) a. Pulmonary edema b. Syncope c. Chest pain d. Palpitation e. Left ventricular hypertrophy

a. Pulmonary edema b. Syncope c. Chest pain

186. Which endocrine disease can cause secondary hypertension? (3 correct) a. Polycystic renal disease b. Hypothyroidism c. Primary hyperaldosteronism d. Cushing's disease e. Acromegaly

a. Polycystic renal disease c. Primary hyperaldosteronism d. Cushing's disease

187. Which drugs can cause hypertension? a. NSAIDs b. Proton pump inhibitors c. Steroids d. Oral contraceptives e. Amiodarone

a. NSAIDs c. Steroids d. Oral contraceptives (e. Amiodarone this was on the past paper answer, but I really do not believe it is right)

188. What type of valve abnormality can be associated with Marfan's syndrome? (1 correct) a. Aortic valve stenosis b. Mitral regurgitation c. Tricuspid regurgitation d. Aortic valve regurgitation e. Pulmonary valve stenosis

d. Aortic valve regurgitation b. Mitral regurgitation seems much more like the correct answer because Marfan's is the main cause of Mitral valve prolapse and that is one of the main causes for mitral regurgitation.

189. The following describes the dominant coronary artery (left or right) (1 correct) a. The dominant coronary artery gives the obtuse marginal branch b. The dominant coronary artery gives the first diagonal branch c. The dominant coronary artery gives the interventricular posterior branch d. The dominant coronary artery gives the ramus intermedius

c. The dominant coronary artery gives the interventricular posterior branch

190. Which of the following plays a role in unstable angina/NSTEMI (1 correct) a. Plaque rupture b. Vasoconstriction c. Platelet activation d. Thrombus formation e. All of the above

e. All of the above

191. Which of the following increases the risk of restenosis after stent implantation? ( 4 correct) a. Smoking b. Long lesion c. Small vessel diameter d. Large vessel diameter e. Diabetes

a. Smoking b. Long lesion c. Small vessel diameter e. Diabetes

192. After drug eluting stent implantation the following medications are needed (1 correct) a. Warfarin and aspirin for 1 month, then aspirin alone b. Warfarin low dose and aspirin for one year, then aspirin alone c. Aspirin and clopidogrel for one month, then aspirin alone d. Aspirin and clopidogrel for at least 9-12 months, then aspirin or both

d. Aspirin and clopidogrel for at least 9-12 months, then aspirin or both

193. Risk factors for pulmonary embolization (2 correct) a. Taking Anticoncipients b. Diabetes mellitus c. Taking drugs d. Family anamnesis of positive thromboembolia e. Anamnesis of infarctus myocardi

a. Taking Anticoncipients | d. Family anamnesis of positive thromboembolia

194. The following deviations can suggest pulmonary embolism on echo (2 correct) a. Left ventricle dilatation b. Right ventricle dilatation c. Left ventricle wall motion disorder d. The paradox motion of the septum e. The increase of the aorta systolic gradient

b. Right ventricle dilatation | d. The paradox motion of the septum

195. What is forbidden in Torsades des Pointes VT? (2 correct) a. Cardioversion b. Starting amiodarone c. Starting sotalol treatment d. Pacemaker therapy e. To provide Mg-SO4 f. Sedation

b. Starting amiodarone | c. Starting sotalol treatment

196. A fixed (irreversible) perfusion defect on myocardial perfusion imaging is (1 correct) a. Decreased perfusion at rest, normal with exercise b. Decreased perfusion at rest and exercise c. Normal perfusion at rest, decreased at exercise d. Normal at rest and exercise

b. Decreased perfusion at rest and exercise

197. Drug-eluting stents were developed to overcome problems with (1 correct) a. Dissection during coronary angioplasty b. Restenosis after stent implantation c. Subacute stent thrombosis d. Late stent thrombosis

b. Restenosis after stent implantation

198. Where are the electrodes in atriobiventricuar system (CRT) (3 correct) a. Right atrium b. Left atrium c. Right ventricle d. Left ventricle, endocardial part e. Coronary sinus side branch for left ventricular pacing

a. Right atrium c. Right ventricle e. Coronary sinus side branch for left ventricular pacing

199. Effects of successful CRT (3 correct) a. Increase left ventricular EF b. Increase mitral stenosis c. Increase quality of life d. Decrease intraventricular dyssynchrony e. Increase left ventricular end-diastolic diameter

a. Increase left ventricular EF c. Increase quality of life d. Decrease intraventricular dyssynchrony

200. Characteristic clinical signs of cardiogenic shock except (2 correct) a. Low blood pressure <90mmHg b. Metabolic acidosis in ABG c. Oligo-anuria d. Low volume pulse, tachycardia e. Potassium level is high

b. Metabolic acidosis in ABG | e. Potassium level is high

201. Positive lab tests that can help in diagnosis of PE (3 correct) a. Increased LDH b. Positive D-dimer c. Hypoxaemia, hypocapnia in arterial blood sample d. Increased serum creatinine e. Hypoxemia, hypercapnia in arterial blood sample

a. Increased LDH b. Positive D-dimer c. Hypoxaemia, hypocapnia in arterial blood sample

202. What medication is contraindicated in severe aortic valve stenosis? (2 correct) a. Nitrates b. ACEis c. Calcium antagonists d. Beta blockers e. diuretics

b. ACEis | c. Calcium antagonists