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Cardio Flashcards

1
Q
  1. A 36/M consults for elevated blood pressure. His physical exam showed BMI 32 kg/m2, office BP 150/90; no other remarkable findings. What is the most likely mechanism underlying his hypertension?

a. Increased sympathetic outflow
b. Increased salt sensitivity
c. Diminished renin secretion
d. Decreased baroreceptor function

A

Increased sympathetic outflow

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2
Q

A large proportion of blood pressure is determined by peripheral vascular resistance. Which of the following anatomic vascular structures contribute most to systemic peripheral vascular resistance?

a. Capillaries
b. Small arteries and arterioles
c. Medium-sized arteries and venules
d. Large arteries (e.g., aorta) and veins

A

Small arteries and arterioles

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3
Q

25/M was rushed to the ER for severe headache and vomiting. On physical examination, he was drowsy with a BP 220/120; no focal neurologic signs. Drug screen was positive for methamphetamine. Nicardipine drip at 5 mg/hour was immediately started. During the initial resuscitative phase, what is the lowest blood pressure target for the patient within 4 hours?

a. 140/90
b. 150/90
c. 160/90
d. 170/90

A

170/90

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4
Q

Recommended criteria for a diagnosis of hypertension, based on 24-hour blood pressure monitoring:

a. Average awake BP ≥120/85 mmHg, average asleep BP ≥130/75 mmHg
b. Average awake BP ≥125/85 mmHg, average asleep BP ≥130/75 mmHg
c. Average awake BP ≥130/85 mmHg, average asleep BP ≥120/85 mmHg
d. Average awake BP ≥135/85 mmHg, average asleep BP ≥120/75 mmHg

A

Average awake BP ≥135/85 mmHg, average asleep BP ≥120/75 mmHg

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5
Q

According to the 2020 CPG for the Management of Dyslipidemia in the Philippines, the following are risk factors that provide compelling reason for initiating statin therapy for primary prevention in individuals with no prior atherosclerotic cardiovascular disease (ASCVD), EXCEPT:

a. Family history of hypertension
b. Postmenopausal woman
c. BMI of at least 25 kg/m2 or above
d. Presence of proteinuria

A

BMI of at least 25 kg/m2 or above

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6
Q
  1. A 52/M was referred by his employer for elevated blood pressure. During his last annual PE, his BP was 150/80. He was advised BP monitoring, with usual readings of 138 to 147/87 to 92, but was not yet started on any medications. His parents were diagnosed with hypertension beyond age 50. He denies intake of any other drugs or supplements. Review of systems and physical examination were unremarkable. Which of the following tests is recommended for the initial evaluation of his hypertension?

a. AST, ALT
b. HbA1c
c. TSH
d. Serum uric acid

A

TSH

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7
Q

What is the recommended limit on salt intake for Filipino patients with hypertension?

a. Less than 1000 mg/day
b. Less than 1500 mg/day
c. Less than 3000 mg/day
d. Less than 6000 mg/day

A

Less than 1500 mg/day

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8
Q

According to the 2020 CPG for the Management of Dyslipidemia in the Philippines, among individuals being treated with statin who have achieved their LDL-C goal, what can be used as an additional target to reduce cardiovascular events?

a. Apolipoprotein A-I
b. Apolipoprotein B-48
c. Apolipoprotein B-100
d. Apolipoprotein C-II

A

Apolipoprotein B-100

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9
Q

Which of the following is considered a moderate-intensity statin treatment and is associated with a 30 to 50% reduction in LDL-C?

a. Fluvastatin 40 mg
b. Rosuvastatin 20 mg
c. Atorvastatin 20 mg
d. Simvastatin 80 mg

A

Atorvastatin 20 mg

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10
Q

In which scenario is 2D echocardiography with Doppler NOT generally necessary?

a. 25/M with grade II continuous murmur
b. 20/M with grade II midsystolic murmur, asymptomatic
c. 20/M with grade II holosystolic murmur, asymptomatic
d. 45/M with grade II mid-diastolic murmur, asymptomatic

A

20/M with grade II midsystolic murmur, asymptomatic

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11
Q

Malar telangiectasia is a cutaneous manifestation of which cardiovascular disease?

a. Severe mitral stenosis
b. Malignant hypertension
c. Carney’s syndrome
d. Osler-Weber-Rendu syndrome

A

Severe mitral stenosis

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12
Q

A 30/F presents with episodes of palpitations and chest pains. She has no significant medical problems in the past. Initial PE revealed BP 100/60 HR 95, regular rhythm, RR 18, with a late systolic click and a late systolic “whooping” murmur on cardiac auscultation that is exaggerated upon standing. 12 lead ECG is normal. Which among the following is an appropriate treatment?

a. ACE-inhibitor therapy
b. Beta-blocker therapy
c. Low-dose aspirin
d. Antibiotic prophylaxis

A

Beta-blocker therapy

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13
Q

A 68/M with a history of hypertension and diabetes consulted because of chest pain. He described it as episodic and he usually experiences the pain every time he climbs up the footbridge going to the nearby market. He is able to do light activities without experiencing shortness of breath, fatigue or chest pain. Based on the New York Heart Association classification, what is his functional capacity?

a. Class I
b. Class II
c. Class III
d. Class IV

A

Class II

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14
Q

You appropriately prescribe guideline-directed medical therapy to the above patient, but he is non-adherent. On his follow-up, his left ventricle is 5.2 cm in diameter at end-diastole with an ejection fraction of 42%. However, he returns after 2 years (having not taken his medications) and echocardiogram reveals that his left ventricle is 7.2 cm in diameter at end-diastole and his ejection fraction is 28%. All of the following mechanisms are likely responsible for the remodeling of the left ventricle EXCEPT:

a. Abnormal myocardial energetics and metabolism
b. Alterations in the contractile properties of the myocyte
c.Increased β-adrenergic sensitization
d. Myocyte hypertrophy

A

Increased β-adrenergic sensitization

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15
Q

Which of the following disease processes can lead to heart failure with either reduced or preserved ejection fraction?

a. Chronic anemia
b. Sarcoidosis
c. Chronic aortic stenosis
d. Regurgitant valvular disease

A

Sarcoidosis

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16
Q

Which of the following statements is true regarding the clinical manifestations of heart failure?

a. Paroxysmal nocturnal dyspnea results from redistribution of fluid into the central circulation during recumbency
b. Rales are frequently present in patients with chronic heart failure
c. When pleural effusions occur unilaterally, they are usually on the left
d. Orthopnea can be caused by abdominal obesity

A

Orthopnea can be caused by abdominal obesity

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17
Q

What can explain the manifestation of early satiety with abdominal pain and fullness in a patient with early stage of heart failure?

a. Presence of ascites
b. Presence of hepatosplenomegaly
c. Presence of bowel wall edema
d. Increased levels of circulating estrogens

A

Presence of bowel wall edema

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18
Q

Which of the following findings in a patient admitted for acute decompensated heart failure portends a worse outcome?

a. Serum creatinine of 2.5 mg/dL
b. Systolic blood pressure of 110 mmHg
c. Resting heart rate of 115
d. BUN of 35 mg/dL

A

Systolic blood pressure of 110 mmHg

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19
Q

A 68/F with bronchial asthma consulted for worsening shortness of breath for the past two months, despite optimal medical management of her asthma. Which of the following physical signs is NOT compatible with cor pulmonale?

a. Apical holosystolic murmur
b. RV heave
c. Positive fluid wave test
d. Elevated jugular venous pressure

A

Apical holosystolic murmur

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20
Q

A 73/F with heart failure and diabetes comes for follow-up care. She feels helpless because of shortness of breath doing light physical activity. Her physical exam showed pallor, bibasal crackles and irregularly irregular heart sounds. Her latest labs showed Hemoglobin 9 g/L, serum creatinine 1.1 mg/dL, K 4.5 mmol/L, LDL 125 mg/dL and HbA1c 6.0%. Which of her comorbid problems will LEAST likely affect her prognosis?

a. Anemia
b. Arrhythmias
c. Diabetes
d. Dyslipidemia

A

Dyslipidemia

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21
Q

Which among the following survivors of acute myocardial infarction will benefit the most with an implantable cardioverter defibrillator?

a. 55/F, NYHA FC II, 2 days post-MI with LVEF 35%
b. 60/M, NYHA FC II, 5 days post-MI with LVEF 55%
c. 65/M, NYHA FC III, 2 months post-MI with LVEF 28%
d. 60/F, NYHA FC IV, 45 days post-MI with LVEF 30%

A

65/M, NYHA FC III, 2 months post-MI with LVEF 28%

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22
Q

Which of the following anti-arrhythmic medications is correctly matched to its primary mechanism of action?

a. Diltiazem: dihydropyridine calcium channel blockade
b. Dofetilide: sodium channel blockade
c. Sotalol: delayed rectifier potassium channel blockade
d. Verapamil: β-adrenergic receptor blockade

A

Sotalol: delayed rectifier potassium channel blockade

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23
Q

Which of the following activities is equivalent to more than 9 METs?

a. Rope jumping
b. Mountain climbing
c. Heavy shoveling
d. Rowing machine

A

Mountain climbing

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24
Q

Patients who have angina in cold or only during the few hours after awakening are classified under the Canadian Cardiovascular Society (CCS) as functional class:

a. I
b. II
c. III
d. IV

A

II

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25
Q

Ms. Vilma is a 65-year-old postmenopausal postal employee. While walking her mail route over the past 6 months, she routinely has chest pressure and dyspnea while climbing a certain steep hill. The pressure resolves when she rests for about 3 minutes. She has not missed any work due to these symptoms. You suspect she is experiencing angina. What term and Canadian Cardiovascular Society (CCS) functional class of angina are appropriate to describe her symptoms?

a. Stable angina—CCS class I
b. Stable angina—CCS class II
c. Stable angina—CCS class III
d. Unstable angina

A

Stable angina—CCS class II

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26
Q

Which of the characteristics of chest pain will most likely increase the probability of acute MI?

a. Associated with dyspnea
b. Associated with nausea and vomiting
c. Described as sharp
d. Described as pressure

A

Associated with nausea and vomiting

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27
Q

A 45/M complains of intermittent retrosternal chest pain after playing tennis, with a duration of 10 minutes, relieved by Isosorbide dinitrate. ECG done at rest showed left ventricular hypertrophy, premature atrial contractions, and ST segment depression in leads V5 and V6. What is recommended as the initial diagnostic and prognostic test for coronary artery disease for this patient?

a. Coronary angiography
b. Stress imaging study
c. Ambulatory (24-hour Holter) ECG monitoring
d. Coronary Computed Tomographic Angiography (CTA)

A

Stress imaging study

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28
Q

Which of the following drugs should be avoided in vasospastic angina?

a. Metoprolol
b. Verapamil
c. Amlodipine
d. Isosorbide mononitrate

A

Metoprolol

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29
Q

A 44/F consults at the ER with substernal chest pain radiating to the left arm. She has transient ST elevations in leads V1–V4 as well as I and aVL that occurred with the pain. Troponin biomarkers are mildly elevated. On coronary angiography, she has no atherosclerosis. However, during the procedure, when asked to hyperventilate, there is distinct vasospasm in the left anterior descending artery. All of the following are reasonable treatments for her EXCEPT:

a. Diltiazem
b. Aspirin
c. Atorvastatin
d. Long-acting oral nitrates

A

Aspirin

30
Q

The most common mechanism underlying non-ST elevation acute coronary syndrome is:

a. Atherothrombotic plaque rupture
b. Intracoronary plaque erosion
c. Intracoronary thrombus formation
d. Coronary arterial vasoconstriction

A

Atherothrombotic plaque rupture

31
Q

A 49/M came in due to chest pain. He denied dyspnea, no diaphoresis. Initial findings were 100/60, HR 96, RR 22, and clear breath sounds on auscultation. Initial labs showed ECG with ST-segment depression on leads V5-V6. Tests showed elevated troponins, normal CBC, and a computed eGFR of 70 mL/min/1.73 m2. When should an invasive strategy be initiated in this patient?

a. Within 2 hours
b. Within 24 hours
c. Within 25 to 72 hours
d. Elective angiography

A

Within 24 hours

32
Q

Which of the following statements is true about percutaneous coronary interventions?

a. Angiographic success is defined as a reduction of the stenosis to less than 50% narrowing.
b. Clinical restenosis is recognized by recurrence of angina or symptoms within 12 months of the procedure.
c. A proximal non-calcified subtotal lesion has a low probability of angiographic success.
d. Elective surgery requiring discontinuation of antiplatelet therapy should be postponed at least 2 months after the placement of a drug-eluting stent.

A

Clinical restenosis is recognized by recurrence of angina or symptoms within 12 months of the procedure.

33
Q

Which of the following is a clear contraindication to the use of tissue plasminogen activator (tPA) in ST-elevation myocardial infarction?

a. Hemorrhagic diabetic retinopathy
b. Known bleeding diathesis with INR of 3.5
c. Ischemic stroke within the past year
d. Active peptic ulcer disease

A

Ischemic stroke within the past year

34
Q

A 51/M complained of substernal chest pain, 5 minutes in duration, relieved by rest, occurring occasionally after playing badminton. He underwent a treadmill exercise test which was terminated when ST depression measuring 3 mm was seen on leads V1-V3. Which is the best next step in the management of this patient?

a. Obtain a coronary artery calcification score on electron beam computed tomography.
b. Perform coronary arteriography.
c. Do an ambulatory 24-hour Holter monitoring.
d. Perform two-dimensional echocardiography.

A

Perform two-dimensional echocardiography.

35
Q

A 54/M was admitted for progressive dyspnea associated 2-pillow orthopnea and fatigue. He has a history of pulmonary tuberculosis and uncontrolled hypertension. He was normotensive on admission, but tachycardic. Neck veins were distended, and chest findings revealed bibasal rales. Cardiac examination showed distinct S1 and S2, but absence of S3. Abdomen is distended, with a palpable liver edge, and fluid wave. Bilateral pedal edema was likewise noted. Work-up revealed: slight cardiomegaly on CXR; no electrical alternans on ECG; presence of pericardial calcification; normal RV size, no pericardial effusion on 2d-echo. Which of the following findings in this patient favor constrictive pericarditis over restrictive cardiomyopathy?

a. Absence of third heart sound
b. Absence of electrical alternans on ECG
c. Absence of pericardial effusion
d. Normal RV size

A

Absence of third heart sound

36
Q

Which of the following is the most appropriate secondary prevention strategy in an asymptomatic patient, newly diagnosed with first episode acute deep venous thrombosis of the right popliteal vein?

a. Anticoagulation with rivaroxaban
b. Vascular compression stockings
c. Inferior vena cava filter
d. Catheter-directed thrombolysis

A

Anticoagulation with rivaroxaban

37
Q

In which of the following patients that present to an emergency department reporting acute dyspnea would a positive D-dimer result prompt additional testing for a pulmonary embolism?

a. A 24/F who is 32 weeks pregnant
b. A 48/M with no past medical history who presents with calf pain following prolonged air travel; the alveolar-arterial oxygen gradient is normal
c. A 62/M who underwent hip replacement surgery 4 weeks previously
d. A 72/M who had an acute myocardial infarction 2 weeks ago

A

A 48/M with no past medical history who presents with calf pain following prolonged air travel; the alveolar-arterial oxygen gradient is normal

38
Q

Which of the following ankle-brachial index values is diagnostic of peripheral arterial disease?

a. 0.85
b. 0.90
c. 0.95
d. 1.35

A

0.85

39
Q

A 46/F with class II obesity consults for a non-healing wound on her right leg. Physical examination showed multiple dilated veins, ankle hyperpigmentation, and edema on both legs. Skin ulceration was noted on the right medial ankle area. All of the following are appropriate therapeutic steps EXCEPT:

a. Low dose aspirin
b. Frequent elevation of the lower extremities
c. Graduated compression stockings
d. All of the above are appropriate

A

Low dose aspirin

40
Q

A 24/F presents to the emergency room with a 2 month-history of fever. No cough, sore throat, dyspnea, orthopnea, weight loss or dysuria were noted. Sputum AFB was negative. She has no history of hospitalizations, surgeries, nor intravenous drug use. She was deemed hemodynamically stable based on clinical assessment. The attending physician is highly considering infective endocarditis. Which is TRUE of the diagnostic approach for this patient?

a. Three 2-bottle blood culture sets should be obtained immediately, at least 1 hour apart.
b. Obtaining blood culture sets from different venipuncture sites should be done over 48 hours.
c. Empiric antibiotics should be immediately started once blood cultures have been obtained.
d. If initial blood cultures remain negative after 48-72 hours, 2 to 3 blood culture sets should be obtained.

A

If initial blood cultures remain negative after 48-72 hours, 2 to 3 blood culture sets should be obtained.

41
Q

Which of the following etiologies present with indolent type of endocarditis?

a. Haemophilus species
b. Pneumococci
c. Staphylococcus aureus
d. Tropheryma whipplei

A

Tropheryma whipplei

42
Q

Which of the following cardiovascular abnormalities is a contraindication to pregnancy?

a. Mitral stenosis
b. Aortic stenosis
c. Bicuspid aortic valve with aortic diameter <45mm
d. Primary pulmonary hypertension

A

Primary pulmonary hypertension

43
Q

Which of the following statements is TRUE of cardiac involvement in acute rheumatic fever?

a. Isolated aortic valve involvement is rare.
b. Mitral valves, together with the tricuspid valve, are commonly affected.
c. The characteristic manifestation of carditis in previously unaffected persons is mitral stenosis.
d. Third-degree AV block is a common finding due to myocardial inflammation.

A

Isolated aortic valve involvement is rare.

44
Q

Which of the following is TRUE regarding monitoring of patients treated for acute rheumatic fever?

a. Inflammatory markers should be monitored monthly until normalization.
b. 2D Echocardiography should be repeated after 1 month to monitor progression of carditis.
c. Throat swab culture for Group A streptococcus should be repeated after completion of antibiotics.
d. If initial ECG shows PR prolongation, 12-lead ECG should be repeated weekly until with normal sinus rhythm.

A

2D Echocardiography should be repeated after 1 month to monitor progression of carditis.

45
Q

36/M presents with chest pain after suffering coryza, cough, fever, and muscle aches for the past week. He describes his pain as constant, exacerbated by lying flat and deep breaths, and radiating to his left shoulder. Examination reveals a rasping extra-cardiac sound present in three components per heartbeat. Troponin I levels are undetectable on presentation and 6 hours later. Blood pressure, heart rate and oxygen saturation are normal. What is the most appropriate next step?

a. Aspirin 81 mg daily, metoprolol 25 mg twice daily, and atorvastatin 80 mg daily
b. Aspirin 1 g every 8 hours with omeprazole 20 mg daily
c. Prednisone 40 mg daily for 2 weeks followed by a taper over the ensuing 2 months
d. Referral for transthoracic echocardiogram
e. Start IV heparin, give high-dose aspirin and clopidogrel, and refer for emergent coronary angiography.

A

Aspirin 1 g every 8 hours with omeprazole 20 mg daily

46
Q
  1. Which of the following statements is most accurate in describing in general hypertension in the elderly (beyond age of 60)
    a. Systolic blood pressures of men are higher than women, but diastolic pressures become lower with age creating a wide pulse pressure
    b. Diastolic blood pressures in general increases with age especially beyond age of 60, creating the pattern of diastolic hypertension among the elderly.
    c. Both systolic and diastolic blood pressure increase as age increases, with more prominent systolic elevation than diastolic especially beyond age 60 creating wide pulse pressure pattern.
    d. Among adults, diastolic blood pressures of women are higher than those of men, but it tends to decrease after the age of around 55 creating a widened pulse pressure beyond age 60.
A

d. Among adults, diastolic blood pressures of women are higher than those of men, but it tends to decrease after the age of around 55 creating a widened pulse pressure beyond age 60.

47
Q

Pre-hypertension is defined as:
a. BP 120-129/80-89
b. BP 120-139/80-89
c. BP 130-139/80-89
d. BP 140-159/80-89

A

b. BP 120-139/80-89

48
Q

Based on a 24-hour blood pressure monitoring, criteria for diagnosis of hypertension include:
a. Average awake blood pressure of > 135/85 mmHg and asleep blood pressure > 120/75 mmHg
b. Average awake blood pressure of > 130/90 mmHg and asleep blood pressure > 120/80 mmHg
c. Average awake blood pressure of > 140/90 mmHg and asleep blood pressure > 125/85 mmHg
d. Average awake blood pressure of > 140/85 mmHg and asleep blood pressure > 120/75 mmHg

A

a. Average awake blood pressure of > 135/85 mmHg and asleep blood pressure > 120/75 mmHg

49
Q

Possible cause of systolic hypertension with wide pulse pressure
a. Mitral regurgitation
b. Left Ventricular Dysfunction
c. Atrial Septal Defect
d. Atriovenous fistula

A

d. Atriovenous fistula

50
Q

A 31 year old female, CKD secondary to GN, not on dialysis, was referred to you by her hematologist due to increasing systolic and diastolic blood pressure despite her initial anti-hypertensive medication of Amlodipine 10mg. Among the her maintenance medications, what is the most possible secondary cause of her hypertension, aside from her CKD.
a. Paracetamol + Tramadol she takes as needed for her joint pains
b. Progestin pills she takes as OCP
c. Her insomnia pill Valium (Diazepam)
d. Erythropoeitin injection for her CKD

A

d. Erythropoeitin injection for her CKD

51
Q

A 20 year old male came in due to elevated blood pressure 180/100, palpitations, and headache. He has no known comorbidity and initial CBC Crea electrolytes SGOT lipid profile taken were normal. On physical examination you noticed axillary freckling and on the body there were irregular pigmented macules which he claimed to be present at birth but has increased since then. What would be your best initial impression
a. Primary hypertension, early onset
b. Secondary hypertension, to consider cushing’s syndrome, ectopic
c. Secondary hypertension, to consider pheochromocytoma and neurofibromatosis
d. Monogenic hypertension

A

c. Secondary hypertension, to consider pheochromocytoma and neurofibromatosis

52
Q

A classic hypertensive headache from severe hypertension is described as:
a. Tight band around the head, feels heavy associated with dizziness
b. Occurs in the morning and is localized in the occipital region
c. Pulsating usually in the entirety of the head upto the nape area
d. Severe headache almost blinding in the afternoon

A

b. Occurs in the morning and is localized in the occipital region

53
Q

Other nonspecific symptoms that maybe related to elevated to blood pressure that a physician should inquire when treating a hypertensive patient
a. Impotence
b. Blurring of the temporal side of vision
c. Memory lapses especially in the morning
d. Difficulty with pincer grasp and dexterity maneuvers

A

a. Impotence

54
Q

Central in the management of hypertension is lifestyle modification, which among the following is a correct management and advise:
a. Regular isometric exercises like brisk walking for 30/min/day (at least)
b. Dietary salt reduction of <2 g NaCL/day
c. Attain and maintain BMI <25 kg/m2 (for Asians <23.5 kg/m2)
d. Ketogenic Diet high in protein low in carbohydrates

A

c. Attain and maintain BMI <25 kg/m2 (for Asians <23.5 kg/m2)

55
Q

There are many anti-hypertensive medications, with different mechanisms of action. Which among the following is a direct vasodilator that defend arterial pressure, notably sympathetic nervous system, RAAS, and sodium retention. This drug has anti-oxidant and nitric oxide-enhancing actions, but may induce lupus-like syndrome.
a. Hydralazine
b. Methyldopa
c. Chlorthalidone
d. Aliskerin

A

a. Hydralazine

56
Q

This type of aneurysm affects the entire circumference of the segment of the vessel, resulting in a diffusely dilated artery
a. Saccular
b. Fusiform
c. Ectasia
d. Pseudoaneurysm

A

b. Fusiform

57
Q

The most common pathologic condition associated with degenerative aortic aneurysm is:
a. Atherosclerosis
b. Cystic Medial Necrosis
c. Plaque rupture
d. Spontaneous Dissection and thrombus formation

A

a. Atherosclerosis

58
Q

A patient came in due to incidental finding of widened mediastinum on her Chest Xray PA view as part of her pre-training assessment for military training. You ordered a CT Aortogram and showed an ascending aortic diameter of 4.5cm. She denies any symptoms and claims good functional capacity, no chest pain, and BP left and right are equal. Her echo is normal except for a moderate aortic regurgitation and a bicuspid aortic valve. What will you recommend next:
a. No clearance for training. Close observation of her aneurysm size with planned repeat CT Aortogram after 6 months.
b. Operative repair with graft and possible AVR with Bentall’s procedure (Aortic valve repair and graft), and no clearance for training.
c. Betablockers and maximize medical management, can be cleared for rigid military training but close ffup and CT Aortogram after 3 months
d. No need for intervention, she can be cleared for rigid military training

A

b. Operative repair with graft and possible AVR with Bentall’s procedure (Aortic valve repair and graft), and no clearance for training.

59
Q

This type of aortic dissection is described as intimal tear that occurs or originated in the ascending aorta and involves the descending aorta as well
a. Debakey Type I
b. Debakey Type II
c. Debakey Type III
d. Debakey Type IV

A

a. Debakey Type I

60
Q

Target vital signs for acute dissection as soon as diagnosis was made:
a. Heart Rate <50, BP < 100
b. Heart Rate <60, BP <110
c. Heart Rate <60, BP < 120
d. Heart Rate <70, BP <130

A

c. Heart Rate <60, BP < 120

61
Q

This inflammatory disease affects the ascending aorta and arch causing obstruction of aorta and its major arteries.
a. Giant Cell Arterities
b. Idiopathic Aortitis
c. Marfan’s Disease
d. Takayasu’s Arteritis

A

d. Takayasu’s Arteritis

62
Q

A diabetic 65 female, maintained on insulin, came in due to pain on her legs when walking normally just few meters around her house. She felt this pain since last year but noticed it to be more frequent in the last several months. Pain is not relieved when she elevates her legs, as prescribed by her daughter who is a nurse. In fact she feels less pain when her legs are dangling down from the bed. She denies any swelling in the legs. Your initial impression would be:
a. Acute to subacute limb ischemia, probably bilateral in the trifurcation level
b. Chronic DVT (Deep Vein Thrombosis)
c. Chronic Peripheral Arterial Occlusive Disease
d. Peripheral Neuropathy secondary to DM

A

c. Chronic Peripheral Arterial Occlusive Disease

63
Q

Arterial Brachial Index of 0.95 is interpreted as
a. Significant ABI: Diagnostic of PAD
b. Normal ABI
c. Borderline ABI
d. Noncompressible Arteries: probably calcified

A

c. Borderline ABI

64
Q

Aside from antiplatelet and statins, other medications can improve quality of life and increase claudication distance in PAD. Example of this drug is a xanthine derivative that increases blood flow to the microcirculation and enhances tissue oxygenation.
a. Cilostazol
b. Pentoxifylline
c. Prostaglandin
d. Trimetazidine

A

b. Pentoxifylline

65
Q
  1. This is also known as Buerger’s Disease
    a. Fibromuscular Dysplasia
    b. Thromboangiitis Obliterans
    c. Temporal Arterities
    d. Atheroembolism
A
66
Q

This is also known as Buerger’s Disease
a. Fibromuscular Dysplasia
b. Thromboangiitis Obliterans
c. Temporal Arterities
d. Atheroembolism

A

b. Thromboangiitis Obliterans

67
Q

Patients who are ACS suspects should have ECG done within how many minutes after arrival at the
ER.
a. Within 10 minutes
b. Within 30 minutes
c. Within 60 minutes
d. Within 90 minutes

A

a. Within 10 minutes

68
Q

Reperfusion Therapy for STEMI: According to latest ESC guidelines, patients with STEMI who arrived at the ER of a hospital that is PCI Capable like NKTI, (First MEdical contact) should be brought to the cathlab for primary PCI (FMC to Wiring time) for reperfusion within how many minutes.

a. Within 60 minutes
b. Within 90 minutes
c. Within 120 minutes
d. Within 12 hours

A

a. Within 60 minutes

69
Q

Reperfusion Therapy for STEMI: According to BRAUNWALD Figure 295-4, patients with STEMI who arrived at the ER of a hospital that is PCI Capable like NKTI, (First MEdical contact) should be brought to the cathlab for primary PCI (FMC to Wiring time) for reperfusion within how many minutes.
a. Within 60 minutes
b. Within 90 minutes
c. Within 120 minutes
d. Within 12 hours

A

b. Within 90 minutes

70
Q

Fibrinolysis is indicated to be given among patients without contraindications in hospital that is not PCI capable within 30minutes, especially if transfer to PCI capable hospital will be more than 120 minutes. These patients should be transferred to PCI capable hospital after fibrinolysis if:

a. All patients should be transferred still to PCI capable hospital regardless whether successful or failed fibrinolysis. If failed, they should be transferred urgently (ASAP), while successful therapy should be transferred within 3-24 hours for invasive strategy.

b. Those with Failed Fibrinolysis should be transferred within 3-24 hours to PCI capable hospitals. Successful fibrinolysis who remains stable can be managed conservatively/medically in the initial nonPCI capable hospital.

c. Any patients who underwent fibrinolysis need not be transferred to PCI capable hospital after fibrinolytic therapy has been given within 30minutes. They can be reassessed non-invasively after for risk stratification to determine who is high and very high risk that will benefit from invasive strategy, ideally within 24-72 hours.

d. Patients with STEMI who arrived in non PCI capable hospital should be transferred to PCI capable hospital without fibrinolysis even if transfer is more than 120 minutes, because this patients will be given heparin or antithrombotic in preparation for coronary angiogram and PCI.

A

a. All patients should be transferred still to PCI capable hospital regardless whether successful or failed fibrinolysis. If failed, they should be transferred urgently (ASAP), while successful therapy should be transferred within 3-24 hours for invasive strategy.

71
Q

A known hypertensive patient came in due to severe chest pain, sudden, and blood pressure awas relatively low at 90-100 (from his usual 140-150). He has beginning congestion, and heart rate was 110 sinus. ECG done showed deep ST depression in II, III, aVF, and 1 small box ST depression in V4, V5,V6, I and aVL. (A total of 11 ST depression in terms of millivolts). You called the attending and diagnosed patients as high risk NSTEMI. The attending cardiologists arrived and saw the ECG and diagnosed it as ST ELEVATION ACS, and activated the cathlab. What will you review again in the ECG and what do you think is the culprit during angiogram.

a. Look again at V1 and V2 (if there is beginning ST elevation) : Culprit is proximal Type III LAD

b. Do a Posterior and Right sided chest lead: Culprit probably is a proximal dominant RCA with RV and posterior involvement (explains hypotension)

c. Look at aVR: Culprit is Left main Artery

d. Look at high lateral walls I and AvL: patient has culprit left dominant LCX proximal segment

A

c. Look at aVR: Culprit is Left main Artery

I (12 decks)

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