Cardio Flashcards
1
Q
these can be heard in mitral stenosis, except for
a) apical holosystolic murmur radiating o the axilla
b) low freq apical diastolic murmur
c) opening snap
d) loud first heart sound
A
a) apical holosystolic murmur radiating o the axilla
holosystolic radiating to axilla is typical of mitral regurgitation
2
Q
Part of the therapy of decompensated heart failure, except for
a) mineralocorticoid-antagonists
b) diuretics
c) digoxin
d) parenteral volume expansion
e) ACE inhibitors
A
d) parenteral volume expansion
in chr decomp HF the body is in a state of fluid overload so diuretics and mineralocorticoid antagonists are essential. Digoxin should be given bc its a positive inotrope and negative chronotrope while ACEIs help long term survival. parenteral fluids (aka infusions) should be avoided
3
Q
Cause of acute LVF, except for
a) bronchial asthma
b) AMI
c) hypertensive crisis
d) severe aortic stenosis
A
asthma bronchial
bronchial asthma puts strain on the RV not the L
4
Q
Characteristic of hypertrophic obstructive cardiomyopathy, except for
a) might be combo with mitral insufficiency
b) digoxin is important in the early stage
c) it often shows a familial distribution
d) diastolic dysfunction is common
e) syncope is a common symptom
A
digoxin is important in the early stages
it is not recommended in either early or late stages unless the disease has reached its ‘burnout’ dilated phase
5
Q
features of atrial myxoma, except for
a) the most common form of primary cardiac tumors
b) can be diagnosed with echo
c) often metastatic
d) can mimic mitral stenosis during physical exam
A
it’s often metastatic
since it’s benign and in situ, mets are rare
6
Q
which one is true about the mechanism of action of digoxin
a) inhibits intracellular Na/K-ATPase
b) it lowers intracellular Na conc
c) inc ATP levels
d) enhances cAMP production
e) dec Ca release from sarcoplasmic reticulum
A
it inhibits the Na/K ATPase
this causes a temp rise in intracellular Na levels which inc intracellular Ca via the Na-Ca exchanger. As result the high Ca level inc myocardium contractility and has positive inotropic effect
7
Q
All of the following statements about NTG are true, except for
a) inc intracellular cGMP levels
b) primarily metabolised in the liver
c) can induce significant reflex tachycardia
d) significantly prolongs AV conduction
e) can lead to postural hypotension
A
significantly prolongs AV conduction
nitrates don’t alter AV conduction
8
Q
the typical side effect of nitrates are
a) HTN
b) headache
c) bradycardia
d) sexual dysfunction
e) anemia
A
headache
should resolve in a few days so they shouldn’t give up on it right away
9
Q
The typical features of Prinzmetal angina
a) ST segment depression during angina
b) negative T waves during angina
c) pathologic Q waves during angina
d) elevated necroenzymes
e) ST segment elevation during angina
A
ST segment elevation during angina
Prnzmtl is a type of coronary artery spasm with ST elevation indicating subepi or transmural ischemia. ST depression is seen in subendocardial ischemia.
10
Q
Types of unstable angina pectoris, except for
a) angina at rest
b) crescendo angina
c) effort angina
d) new onset angina
A
effort angina
new onset counts as unstable, and crescendo too (inc in freq, severity, and duration), and can dev at rest. effort means it’s the same level of stress that causes it each time
11
Q
The most common pathology of MI
a) coronary embolism
b) rupture of an ATH plaque
c) dissection of coronary walls
d) growing of ATh plaque
e) coronary inflamm
A
rupture of ATH plaque
it’s usually the rupture of the plaque the following thrombus. soft plaques are usually worse
12
Q
normal mean electrical axis in the front plane, except for
a) +60
b) +90
c) -45
d) 0
e) +45
A
-45
0 to +90 is thought to be normal range while -45 is LAD
13
Q
if AMI is suspected, the following diagnostic procedures should be carried out except for
a) ECG
b) blood test to see CK-MB and troponin
c) physical exam
d) cardiac stress test
e) echo
A
cardiac stress test
don’t do it stupid they’re already stressed
14
Q
IHD can present with , except for
a) AMI
b) stable angina
c) DVT
d) sudden cardiac death
e) ischemic cardiomyopathy
A
DVT
isn’t directly connected with thrombotic processes in coronary circulation
15
Q
The most important risk factor of ATH
a) high seLDL
b) high seHDL
c) high seTG
d) high seCholesterol
A
high seLDL
chronic high cholesterol and changes to the LDL/HDL ratio are key factors in the pathomech of ATH since its the toxic metabolites of oxidation that leads to plaque. high TGs are less significant compared to LDL.
16
Q
risk factors for CAD except for
a) positive family history
b) DM
c) smoking
d) high seHDL
e) metabolic syndrome X
A
high seHDL
HDL is protective against the dev of ATH
17
Q
The ideal target value of seLDL in a DM patient after an MI
a) < 1.8 mmol/L
b) > 2.6 mmol/L
c) < 3.5 mmol/L
d) > 3.5 mmol/L
A
< 1.8 mmol/L
target value in very high risk pt is lower than primary prevention
18
Q
A 65 pt with a history of smoking presents with sudden pain in his left leg. The limb feels cold and the toes are pale and peripheral pulse can’t be felt.
a) DVT
b) Buerger’s disease
c) embolism in the peripheral arteries
d) Raynauds disease
A
embolism in the peripheral arteries
symptoms developed quickly unlike in DVT which would have a pulse. Buerger’s is also slow.
19
Q
Paramedics arrive to a 55yo pt with chest pain that started 3h ago. On the ECG there’s elevations in I, aVL, V5, and V6. What should they do?
a) transfer the pt to the regional ER
b) transfer the pt to the regional coronary care unit
c) transfer the pt to the regional cardio dept for a troponin test and if positive transfer to a PCI center
d) transfer the pt to the closest PCI center
A
transfer to the closest PCI center
they have a STEMI which is almost always bc of coronary occlusion and PCI is the best way to fix it so don’t delay at all
20
Q
Upon physical exam of a 45yo man w/o symptoms of a soft systolic murmur and ejection click can be heard in 2L2. This has been known since he was a child so what was the diagnosis?
a) patent DA
b) coarctation of the aorta
c) ventricular septal defect
d) Ebstein’s anomaly
e) pulmo valve stenosis
A
pulmonary valve stenosis
organic heart disease since childhood without any symptoms is likely pulmo stenosis. patent DA causes continuous murmur, coarctation causes high BP in the upper limbs, VSD causes very loud systolic murmur,
21
Q
Correct statement about aortic stenosis, except for
a) it causes pulus parvus et tardus
b) it can cause syncope
c) it can cause angina like chest pain
d) Austin-Flint murmur can be heard upon auscultation
e) it causes concentric left ventricular hypertrophy
A
Austin-Flint murmur
AF murmur can be heard in aortic regurgitation, not stenosis
22
Q
Correct statements about aortic insufficiency, except for
a) it causes pulsus celer et altus (Corrigan’s pulse)
b) it can be acute and chronic
c) usually doesn’t lead to LV dilation
d) can be congenital
e) it predisposes to infective endocarditis
A
it doesn’t usually lead to LV dilation
it does lead to LV dilation due to volume overload
23
Q
Accessory pathway-mediated reentry tachycardia (AVRT) can be terminated with, except for
a) propafenone
b) adenosine
c) lidocaine
d) RF ablation
e) verapamil
A
lidocaine
lidocaine cannot delay the conduction in the AV node or in the bundles that can carry signal
24
Q
A regular wide QRS complex tachycardia can not be
a) ventricular tachycardia
b) SVT with BBB
c) Afib with BBB
d) antidromic AV reentry tachycardia (WPW)
e) Aflutter with BBB
A
Atrial fibrillation with BBB
Afib might have narrow and wide QRS complex but they’re always regularly irregular
25
A pt was admitted to the ED bc of palpitation that started 3h ago. On ECG an Afib with rapid (150bpm) ventricular response was seen. His BP was 130/90. In the pts history there wasn't anything that indicated structural heart disease. What's the best first step in this situation?
a) pharma conversion
b) immediate electrical cardioversion
c) coronarography
d) immediate anticoag to prevent TE
e) cardiac stress test
pharma cardioversion
they are hemodynamicallys table so they don't need electro tx and long term anticoag isn't needed if it's only a few hrs old.
26
Which one is the most common permanent arrhythmia
a) ventricular extrasystoles
b) atrial fibrillation
c) ventricular tachycardia
d) SVT
e) junctional escape rhythm
afib
depending on the age prevalence is 0.4-14% with permanent meaning 30s+ (excluding ventricular extrasystoles)
27
A pt who has been taking amiodarone for a long time was prescribed a fluoroquinolone AB bc of a respiratory infection. She had recurring, short-term syncopes that had never occurred before. Which one is the most likely cause of the syncopes?
a) hypotension bc of the meds
b) torsade de pointes VT bc of the meds
c) sinus bradycardia bc of the meds
d) symptoms aren't linked, they're just a coincidence
e) AV block induced by the meds
TdP bc of the meds
both class III antiarrhythmic agents and fluoroquinolone can prolong the QT interval and inc the chances of TdP. if you get symptoms then remove the meds
28
These could be the first ECG findings in an acute phase of MI, except for
a) pathological Q wave
b) inverted T waves
c) ventricular fibrillation
d) ST segment elevation
e) ST segment depression
pathological Q waves
patho Q waves take hours to days to show up
29
PAtho Q waves in leads II, III, and aVF with isoelectric ST segments and positive T waves indicate
a) acute ischemia
b) acute phase of a progressing MI
c) previous MI
d) aneurysm after MI
e) subendocardial ischemia
previous MI
patho Q waves are indicative of an old infarct and ST changes +/- T wave inversions are more for acute MIs. Aneurysms show elevated ST segments 2-3 weeks after the onset of symptoms
30
In the diagnostic workup of a 60yo pt with a history of smoking who has chest pain at exertion the first step should be
a) stress echo
b) exercise test
c) stress perfusion scintigraphy
d) holter ECG
e) stress MRI
exercise test
most likely caused by CAD and so stress test should be next step
31
The best first choice drug for bradycardia during MI is
a) isoproterenol
b) theophylllin
c) atropine
d) dobutamine
atropine
32
Most common side effect of ACEIs is
a) diarrhea
b) cough
c) vomiting
d) erythema
e) anasarca
cough
result of high bradykinin conc (its metabolism is inhibited)
33
Which disease causes systolic hypertension
1 aortic insufficiency
2 thyreotoxicosis
3 beriberi
4 ATH
a) 1 2 3
b) 1 3
c) 2 4
d) only 4
e) all
all
34
Aortic aneurysm can be caused by
1 arterioscleorsis
2 Marfans
3 vascular syphilis
4 giant cell arteritis
a) 1 2 3
b) 1 3
c) 2 4
d) only 4
e) all
1 2 3
they can call damage the arterial tunica media and that leads to its weakening, the loss of elastic elements, and resulting dilation. GCA usually leads to throbbing pain of temporal arteries
35
Possible causes of pericarditits
1 uremia
2 transmural MI
3 TB
4 metastatic cancer
a) 1 2 3
b) 1 3
c) 2 4
d) only 4
e) all 4
all
transmural MI is a less common cause but still valid
36
Secondary CMP can be caused by
1 hyperthyroidism
2 beriberi
3 amyloidosis
4 glycogenesis
a) 1 2 3
b) 1 3
c) 2 4
d) only 4
e) all 4
all
hyperthyroidism and beriberi can cause dilated CMP, amyloidosis can come before restrictive infiltrative CMP, and glycogenosis can lead to hypertropic restrictive secondary CMP
37
ACEIs
1 dec BP
2 dec aldosterone
3 inc bradykinin
4 stop deterioration of LVEF
a) 1 2 3
b) 1 3
c) 2 4
d) 4
e) all
all
38
Which ones are correct
1 aspirin has no effect on prostacyclin production of the endothel cells
2 according to multicenter trials aspirin dec the chance of a second MI
3 takes 24h for heparin to build up its anticoag effect
4 heparin and alteplase are tx options in pulmo embolism
a) 1 2 3
b) 1 3
c) 2 4
d) 4
e) all
2 4 are correct
aspirin blocks cyclooxygenase enzyme that makes prostacyclin and both subQ and IV heparin have rapid onset and fibrinolytics (alteplase) are used to dissolve fibrin bound thrombin
39
Which diuretic side effect combo is/are correct
1 furosemide - hyperuricemia
2 chlortalidone - ototoxicity
3 spirinolactone - gynecomasty
4 etacrynic acid - hyperuricemia
a) 1 2 3
b) 1 3
c) 2 4
d) 4
e) all
1 and 3
furosemide (and chlortalidone) dec uric acid secretion leading to gout and spirinolactone can cause gynecomasty bc of its antialdosterone effect
40
RFs for ischemic heart disease
1 smoking
2 hypercholesterolemia
3 hypertension
4 fam hx
a) 1 2 3
b) 1 3
c) 2 4
d) 4
e) all
all
41
Treatments that reduce morbidity and mortality after myocardial infarction (secondary prevention):
1) beta-blockers
2) antiplatelet drugs
3) HMG-CoA reductase inhibitors
4) ACE inhibitors
a) Answers 1, 2 and 3 are correct
b) Answers 1 and 3 are correct
c) Answers 2 and 4 are correct
d) Only answer 4 is correct
e) All of the answers are correct
all
42
Diagnostic options to determine myocardial viability:
1) low-dose dobutamine stress test
2) positron-emission tomography
3) stress perfusion scintigraphy with Tl-201 reinjection
4) Doppler ultrasound
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All four answers are correct
```
1 2 3
43
Contraindications of cardiac exercise tests:
1) acute myocardial infarction
2) chronic heart failure
3) unstable angina
4) beta-blocker therapy
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All four answers are correct
```
1 and 3
44
Diagnostic tests with the ability to detect asymptomatic angina pectoris (silent ischemia):
1) dobutamine stress echocardiogram
2) Holter ECG monitoring
3) exercise test
4) ABPM
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All four answers are correct
```
1 2 3
ambulatory BP monitoring won't detect anything useful
45
Early and late complications of acute myocardial infarction:
1) ventricular fibrillation
2) left ventricular aneurysm formation
3) cardiogenic shock
4) pericardial effusion
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All four answers are correct
```
all
Vfib and shock can be acute complication while LV aneurysm and pericardial effusion are seen as late and very late complications (like weeks)
46
Treatment option(s) of heart failure:
1) pharmacotherapy
2) heart transplant
3) mechanical circulatory support devices
4) cardiac resynchronization therapy
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All four answers are correct
```
all
47
Risk factors of atherosclerosis:\
1) stress
2) AV-nodal reentry-tachycardia
3) smoking
4) hypotension
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
```
1 and 3
48
Drugs that lower serum cholesterol level:
1) rosuvastatin
2) ezetimibe
3) atorvastatin
4) ivabradine
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
```
1 2 3
statins dec cholesterol levels
ezetimibe dec serum cholesterol by blocking the absorption of cholesterol in the small intestine
49
Drugs that lower serum triglyceride levels:
1) special diet
2) niacin
3) fibrates
4) alcohol
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All four answers are correct
```
1 2 3
50
Characteristic features of Prinzmetal angina:
1) it usually occurs at dawn during rest
2) ST segment elevation can be seen during angina
3) it is caused by coronary spasm
4) it should be treated with calcium-channel blockers
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All four answers are correct
```
all
51
Possible complication(s) of deep vein thrombosis:
1) pulmonary infarction
2) crural ulcer
3) pulmonary embolism
4) Raynaud’s syndrome
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All four answers are correct
```
1 2 3
Raynauds has vasospastic attacks and its not a TE disease
52
Possible complication(s) of atherosclerosis:
1) dry gangraena of the feet
2) aortic aneurysm
3) myocardial infarction
4) stroke
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All four answers are correct
```
all
53
Might mimic the ECG findings of myocardial infarction:
1) pericarditis
2) pancreatitis
3) myocarditis
4) pulmonary embolism
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All four answers are correct
```
all
54
Enzyme(s) that is/are elevated in myocardial infarction:
1) creatine kinase (CK-MB)
2) lactate dehydrogenase
3) troponin
4) alkaline phosphatase
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All four answers are correct
```
1 2 3
high ALP is seen in GI, bone, or blood diseases
55
A 55 year old patient with a history of hypertension has been rushed to the emergency room because of severe chest pain and ST segment elevation. Possible diagnosis/diagnoses:
1) peptic ulcer
2) acute myocardial infarction
3) mitral valve prolapse
4) aortic dissection
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
```
2 4
peptic ulcers and mitral valve prolapse both cause chest pain but no ST elevations
56
A 70-year-old patient had an anterior wall myocardial infarction three weeks ago. He suddenly develops a fever and complains of chest pain. On his ECG there are no new Q waves and his CK-MB level is normal. What is/are the most likely diagnose(s)?
1) myocardial reinfarction
2) pulmonary embolism
3) lobar pneumonia
4) Dressler’s syndrome
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All four answers are correct
```
4
Dresslers syndrome (pericarditis) starts usually 3 weeks after an MI and presents with recurring chest pain with normal cardiac markers
57
Correct statements about mitral insufficiency:
1) it leads to the dilation of all heart chambers
2) it might be the complication of infective endocarditis
3) left atrial pressure can be elevated even when the ejection fraction is preserved
4) its severe form requires surgical treatment.
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All four answers are correct
```
all
58
Correct statements about mitral stenosis:
1) it doesn’t increase the risk of atrial fibrillation
2) it predisposes to left atrial thrombus formation
3) during auscultation a muffled first heart sound and a mesosystolic click can be heard
4) it might be a late complication of rheumatic fever
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All four answers are correct
```
2 4
loud first heart sound and opening snap can be heard in pts with MV stenosis
59
Echocardiographic findings of aortic stenosis:
1) the end-diastolic diameter of the left ventricle is not significantly enlarged
2) concentric left ventricle hypertrophy can often be seen
3) the left atrial diameter can be abnormally large
4) a pathologic transvalvular gradient can be measured at the level of the aortic valve with Doppler ultrasound
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All four answers are correct
```
all
60
Echocardiographic findings of isolated mitral stenosis:
1) large left atrial diameter
2) the unidirectional movement of the anterior and posterior leaflets in M-mode
3) an abnormal transvalvular gradient can be measured in diastole at the level of the mitral valve with continuous wave Doppler ultrasound
4) the calcification of the whole mitral valve can be visualised with 2D-echocardiography
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All four answers are correct
```
all
61
Characteristic of mitral valve prolapse:
1) it can cause ventricular extrasystoles
2) it can present with chest pain
3) it is common in Marfan’s syndrome
4) an opening snap can be heard during auscultation of the heart
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All four answers are correct
```
1 2 3
62
Hypertrophic cardiomyopathy:
1) is caused by genetic mutations.
2) can cause dynamic left ventricle outflow obstruction.
3) can cause sudden cardiac death.
4) should not be treated with beta-blockers.
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
```
1 2 3
63
The treatment of ventricular extrasystoles:
1) All cases must be treated with antiarrhythmic agents.
2) Frequent, symptomatic extrasystoles require antiarrhythmic pharmacological therapy.
3) Class Ic agents have been proven to be the best choice.
4) In most cases antiarrhythmic treatment is not required.
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All four answers are correct
```
2 4
64
In the differential diagnosis of wide QRS complex tachycardia helps:
1) Knowing the organic status of the heart
2) Frequency of tachycardia
3) Physical or ECG signs of atrioventricular dissociation
4) Hemodynamic instability of the tachycardia
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All four answers are correct
```
1 3
65
Principles of the treatment of wide QRS complex tachycardia:
1) If we are not sure in the mechanism, we should treat it as ventricular tachycardia.
2) Carotid sinus massage should be tried first before the medical treatment.
3) Immediate synchronized cardioversion is required in case of hemodynamic instability.
4) Always start the treatment with group 1/C agent.
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All four answers are correct
```
1 2 3
66
Etiologic factors of atrial fibrillation:
1) Hyperthyroidism
2) Mitral valve disease
3) Cardiomyopathy
4) Ischemic heart disease
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
```
all
67
It’s true about the proarrhythmic effect of antiarrhythmic drugs:
1) Organic heart disease does not have influence on the proarrhythmic risk
2) Dangerous proarrhythmia is most commonly caused by beta blockers
3) Chinidin has the least proarrhythmic potential
4) Antiarrhythmic drugs in some cases cause different type, often worse arrhythmia than the arrhythmia which made the use of these types of drugs reasonable. This effect is called proarrhythmia.
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All four answers are correct
```
4
68
It is true about long QT syndrome:
1) Long QT syndrome is most commonly the consequence of drug adverse reaction.
2) Long QT syndrome predispose to the development of potentially lethal arrhythmia.
3) Beta blockers are appropriate for the treatment of long QT syndrome if necessary with pacemaker implantation.
4) Congenital long QT syndrome can be associated with deafness.
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All four answers are correct
```
all
69
It is true about ventricular tachycardia:
1) The prognosis of ventricular tachycardia is defined by possible organic heart disease and by the function of left ventricle.
2) Ventricular tachycardia is most common in ischemic heart disease, after myocardial infarction.
3) The origin point of ventricle tachycardia can be deduced based on the type of bundle branch block which is seen on 12-lead ECG and on the frontal plane axis.
4) Digitalis is the most important drug in the medical treatment of ventricular tachycardia.
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All four answers are correct
```
1 2 3
70
Myocardial infarction could have the following symptoms:
1) Back pain
2) Chest pain
3) Sweating
4) Epigastric pain
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All four answers are correct
```
all
71
To do in case of typical infarction chest pain is present for longer than one hour and ST-elevation of more than 1 mm is detected between two ECG-leads:
1) To take rest myocardial perfusion scintigraphy
2) Send the patient to hospital where percutaneous coronary intervention can be performed
3) To determine the next action diagnosticate serum-necroenzym level
4) Strict monitoring to detect arrhythmia
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All four answers are correct
```
2 4
72
The following can be used in the treatment of pulmonary edema which is associated with myocardial infarction:
1) Intravenous furosemide
2) Oral verapamil
3) Inhale of oxygen
4) Nitroglycerin transdermal patch
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All four answers are correct
```
1 3
73
The use of the following decreases the patient’s mortality in heart failure:
1) Nifedipine
2) ACE inhibitor
3) Diuretic
4) Beta-blockers
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
```
2 4
74
The following could be the cause of a left sided heart failure:
1) Untreated hypertension
2) Viral myocarditis
3) Aortic stenosis
4) Deep vein thrombosis
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All four answers are correct
```
1 2 3
75
Symptoms of heart failure:
1) Paralytic ileus
2) Edema of legs
3) Joint pain
4) Dyspnoea
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All four answers are correct
```
2 4
76
Symptoms of heart failure:
1) Nocturia
2) Paresis of lower extremity
3) Tachycardia
4) Trophic disorders of the skin of upper extremities
```
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All four answers are correct
```
1 3
77
Pair the symptoms and the therapies.
A) Hypertensive crisis
B) Third-degree atrioventricular block
C) Edema of the pulmonary- and systemic circulation
D) Ventricular sustained tachycardia with reduced left ventricular function
INT - 1.79 - amiodarone
INT - 1.80 - furosemide
INT - 1.81 - urapidil (Ebrantil)
INT - 1.82 - pacemaker therapy
amiodarone - D
furosemide - C
urapidil - A
pacemaker therapy - B
78
Match the clinical aspects with the related tests.
```
A) Transesophageal echocardiography
B) Heart muscle biopsy
C) Cardiac MRI
D) 2D, color Doppler-echocardiography
E) 24-hour Holter monitoring (EKG)
```
INT - 1.83 - Mitral valve prolapse
INT - 1.84 - Detect of rejection after heart transplantation
INT - 1.85 - Post myocardial infarction, detection of viability
INT - 1.86 - Sick sinus syndrome
INT - 1.87 - Suspected intracardiac thrombus (for example underlying chronic embolisation)
mitral valve prolapse - 2D colour doppler echo
detection of rejection after transplant - muscle biopsy
post MI detection of viability - cardiac MRI
sick sinus syndrome - 24h holter monitor
suspected intracardiac thrombus - TEE
79
Match the side-effects with each medicine!
A) amiodarone
B) ACE-inhibitor
C) β - blocker
```
INT - 1.88 - Bronchoconstriction
INT - 1.89 - Cold extremities
INT - 1.90 - Pulmonary fibrosis
INT - 1.91 - Hyperthyroidism
INT - 1.92 - Angioneurotic edema
INT - 1.93 - Dry cough
```
bronchoconstriction and cold extremities - b blocker
pulmo fibrosis and hyperthyroidism - amiodarone
angioneurotic edema and dry cough - ACEI
80
Match the medicines which are used in the therapy of ischemic heart disease with their characteristic properties:
A) Salicylates
B) HMG CoA reductase inhibitors
C) Beta-blockers
D) Nitrates
INT - 1.94 - Reduction of the frequency and the left ventricular contractility
INT - 1.95 - Mainly reducing the preload
INT - 1.96 - Inhibiting the platelets aggregation
INT - 1.97 - They have lipid reducing and pleiotropic effect
Reduction of the frequency and the left ventricular contractility - C)
Mainly reducing the preload - D)
Inhibiting the platelets aggregation - A)
They have lipid reducing and pleiotropic effect - B)
81
Match the effect with the right medicine.
A) Platelet ADP-receptor inhibitor
B) Ivabradine
C) Rivaroxaban
D) Dronedarone
INT - 1.98 - Antiarrhythmic effect
INT - 1.99 - Platelet aggregation inhibiting effect
INT - 1.100 - „funny” Na-K-channel inhibitor
INT - 1.101 - Anticoagulant effect
Antiarrhythmic effect - D)
Platelet aggregation inhibiting effect - A)
„funny” Na-K-channel inhibitor - B)
Anticoagulant effect - C)
82
The aortic stenosis cause increased left ventricle load, because of that the consequence is left ventricular hypertrophy.
A) Both of them are correct, there is causal relationship between them
B) Both of them are correct, but there is no causal relationship between them
C) The first part is correct, the second one is wrong
D) The first part is wrong, the second one is correct
E) Both of them are incorrect
A
83
Some of the diuretics which are used in the treatment of heart failure may lead to hypokalemia, therefore diuretics should always be given with potassium supplementation.
A) Both of them are correct, there is causal relationship between them
B) Both of them are correct, but there is no causal relationship between them
C) The first part is correct, the second one is wrong
D) The first part is wrong, the second one is correct
E) Both of them are incorrect
E
84
For patients who had myocardial infarction aspirin and beta-blockers treatments are required, because these agents in secondary prevention have positive effect on the mortality which was proven in multicenter studies.
A) Both of them are correct, there is causal relationship between them
B) Both of them are correct, but there is no causal relationship between them
C) The first part is correct, the second one is wrong
D) The first part is wrong, the second one is correct
E) Both of them are incorrect
A
85
ACE-inhibitors are required in the treatment of chronic heart failure because multicenter studies have proven the positive effect on the mortality.
A) Both of them are correct, there is causal relationship between them
B) Both of them are correct, but there is no causal relationship between them
C) The first part is correct, the second one is wrong
D) The first part is wrong, the second one is correct
E) Both of them are incorrect
A
86
Sudden cardiac death is common during heart failure, because the predisposition of malignant ventricular arrhythmia can’t be predisposed in every case even with electrophysiological study.
A) Both of them are correct, there is causal relationship between them
B) Both of them are correct, but there is no causal relationship between them
C) The first part is correct, the second one is wrong
D) The first part is wrong, the second one is correct
E) Both of them are incorrect
B both are correct with no relation
87
The abnormally prolonged QT-interval predisposes to severe ventricular arrhythmia because the normal length of QT interval physiologically depends from the ventricular frequency.
A) Both of them are correct, there is causal relationship between them
B) Both of them are correct, but there is no causal relationship between them
C) The first part is correct, the second one is wrong
D) The first part is wrong, the second one is correct
E) Both of them are incorrect
B both correct but with no relation
88
The usage of fast-acting nitrates decrease the oxygen demand of the myocardium, because their vasodilator effect reduces the ventricular pre-load.
A) Both of them are correct, there is causal relationship between them
B) Both of them are correct, but there is no causal relationship between them
C) The first part is correct, the second one is wrong
D) The first part is wrong, the second one is correct
E) Both of them are incorrect
A
89
The Prinzmetal angina is also called vasospastic angina because all the arteries have increased spasmodism.
A) Both of them are correct, there is causal relationship between them
B) Both of them are correct, but there is no causal relationship between them
C) The first part is correct, the second one is wrong
D) The first part is wrong, the second one is correct
E) Both of them are incorrect
C first is correct but second isn't
just the coronaries
90
When acute myocardial infarction occurs it is right away indicated by CK (creatinine phos) enzyme because the CK-MB fraction is specific for the detection of the damage of cardiomyocytes.
A) Both of them are correct, there is causal relationship between them
B) Both of them are correct, but there is no causal relationship between them
C) The first part is correct, the second one is wrong
D) The first part is wrong, the second one is correct
E) Both of them are incorrect
D first is wrong but second is correct
CK rises 3hrs after
91
Silent ischemia should be treated in the same way as angina pectoris because the prognosis is similar to symptomatic angina pectoris
A) Both of them are correct, there is causal relationship between them
B) Both of them are correct, but there is no causal relationship between them
C) The first part is correct, the second one is wrong
D) The first part is wrong, the second one is correct
E) Both of them are incorrect
A
92
Transesophageal echocardiography could be required before the cardioversion of atrial fibrillation because diagnosing left atrial thrombus with transesophageal echocardiography could make the cardioversion necessary to be postponed.
A) Both of them are correct, there is causal relationship between them
B) Both of them are correct, but there is no causal relationship between them
C) The first part is correct, the second one is wrong
D) The first part is wrong, the second one is correct
E) Both of them are incorrect
A
93
Transesophageal and transthoracic echocardiography have equal value in the diagnosis of infectious endocarditis because the mostly significant structural differences caused by infectious endocarditis can be detected easily with both of the procedures.
A) Both of them are correct, there is causal relationship between them
B) Both of them are correct, but there is no causal relationship between them
C) The first part is correct, the second one is wrong
D) The first part is wrong, the second one is correct
E) Both of them are incorrect
E neither
1. TEE is more sensitive and specific to IE
2 TEE has better quality and resolution bc of low absorption
94
Transesophageal echocardiography has an important role in the diagnosis of aortic dissection because most part of the thoracic aorta can be visualized with good resolution.
A) Both of them are correct, there is causal relationship between them
B) Both of them are correct, but there is no causal relationship between them
C) The first part is correct, the second one is wrong
D) The first part is wrong, the second one is correct
E) Both of them are incorrect
A both are correct with relation
95
The laboratory diagnostic of infectious endocarditis doesn’t require to take series of hemoculture because the pathogen usually breed from the first hemoculture despite of previous antibiotic treatment.
A) Both of them are correct, there is causal relationship between them
B) Both of them are correct, but there is no causal relationship between them
C) The first part is correct, the second one is wrong
D) The first part is wrong, the second one is correct
E) Both of them are incorrect
E neither is correct
96
For patients with hemodynamically significant aortic stenosis the presence of angina pectoris and syncope are bad prognostic signs because in this clinical situation even cardiac surgery doesn’t change the long-term clinical course of the disease.
A) Both of them are correct, there is causal relationship between them
B) Both of them are correct, but there is no causal relationship between them
C) The first part is correct, the second one is wrong
D) The first part is wrong, the second one is correct
E) Both of them are incorrect
C first is correct but second isn't
97
Biological valve replacement can be required in fertile women who have acquired valvular heart disease because mechanical prosthetic valves could cause fetal damage by autoimmune mechanism.
A) Both of them are correct, there is causal relationship between them
B) Both of them are correct, but there is no causal relationship between them
C) The first part is correct, the second one is wrong
D) The first part is wrong, the second one is correct
E) Both of them are incorrect
C first is correct but second isn't
biologics don't need anticoags (mechs do but last forever) but the coumarin tx in 1st trimester can damage the fetus
98
Beta blockers are not recommended in case of hypertrophic cardiomyopathy because these drugs could increase the left ventricle outflow tract obstruction.A) Both of them are correct, there is causal relationship between them
B) Both of them are correct, but there is no causal relationship between them
C) The first part is correct, the second one is wrong
D) The first part is wrong, the second one is correct
E) Both of them are incorrect
E neither are correct
99
Eosiniphilia in the bloodstream is often observed in Löffler type of endocarditis because this type of endocarditis can cause restrictive cardiomyopathy.
A) Both of them are correct, there is causal relationship between them
B) Both of them are correct, but there is no causal relationship between them
C) The first part is correct, the second one is wrong
D) The first part is wrong, the second one is correct
E) Both of them are incorrect
B - correct but no relation
100
Most types of diuretics require potassium supplementation because most of them increase the potassium excretion with urine.
A) Both of them are correct, there is causal relationship between them
B) Both of them are correct, but there is no causal relationship between them
C) The first part is correct, the second one is wrong
D) The first part is wrong, the second one is correct
E) Both of them are incorrect
E all incorrect
101
Long-term use of ACE-inhibitors reduce the left ventricle hypertrophy because their use decreases the serum bradykinin level.
A) Both of them are correct, there is causal relationship between them
B) Both of them are correct, but there is no causal relationship between them
C) The first part is correct, the second one is wrong
D) The first part is wrong, the second one is correct
E) Both of them are incorrect
C first part is correct but second is wrong
102
Radiofrequency ablation is the first choice treatment of the symptomatic paroxysmal supraventricular tachycardia, because success rate is 90% and complications occur only in 1-2%.
A) Both of them are correct, there is causal relationship between them
B) Both of them are correct, but there is no causal relationship between them
C) The first part is correct, the second one is wrong
D) The first part is wrong, the second one is correct
E) Both of them are incorrect
A both are correct with relation
103
Implantable cardioverter defibrillator can be used as the treatment of arrhythmia because these devices can cure the underlying disease which caused the arrhythmia.
A) Both of them are correct, there is causal relationship between them
B) Both of them are correct, but there is no causal relationship between them
C) The first part is correct, the second one is wrong
D) The first part is wrong, the second one is correct
E) Both of them are incorrect
C first is correct but second isn't
104
Sporadic ventricular extrasystole for healthy patients without significant complaints also require antiarrhythmic treatment because antiarrhythmic medication clearly improve the survival.
A) Both of them are correct, there is causal relationship between them
B) Both of them are correct, but there is no causal relationship between them
C) The first part is correct, the second one is wrong
D) The first part is wrong, the second one is correct
E) Both of them are incorrect
E neither are correct
105
The anticoagulant treatment of atrial fibrillation is based on the CHADS2-VASc2 Score because the thromboembolic risk increasing effect of atrial fibrillation depends on the patient’s other clinical features.
A) Both of them are correct, there is causal relationship between them
B) Both of them are correct, but there is no causal relationship between them
C) The first part is correct, the second one is wrong
D) The first part is wrong, the second one is correct
E) Both of them are incorrect
A
106
Paroxysmal supraventricular tachycardia is a mostly lethal arrhythmia therefore these patients require combined antiarrhythmic treatment.
A) Both of them are correct, there is causal relationship between them
B) Both of them are correct, but there is no causal relationship between them
C) The first part is correct, the second one is wrong
D) The first part is wrong, the second one is correct
E) Both of them are incorrect
E
107
In case of acute myocardial infarction, the use of beta blockers is preferred if there is no contraindication because beta blockers reduce the oxygen demand of the myocardium.
A) Both of them are correct, there is causal relationship between them
B) Both of them are correct, but there is no causal relationship between them
C) The first part is correct, the second one is wrong
D) The first part is wrong, the second one is correct
E) Both of them are incorrect
A
108
In stabil angina pectoris permanent dosage of small dose of acetylsalicylic acid has a favourable effect, because the drug block the determining step of acute coronary syndrome, the fast drift of white blood cells into the intima.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false
C
109
In every coronary occlusion surgical revascularization is justified, because the movement disorder of the distal myocardium fields of the occluded coronary arteries after the cease of occlusion can improve.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false
D - 1 is wrong but 2 is right
110
In acute myocardial infarct the use of narcotic analgesic is contraindicated, because with the reduction of pain these drugs decrease the sympathetic tone of the human body.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false
D - 1 is wrong but 2 is right
111
In the first 24-hour of a myocardial infarct the permanent ECG-monitoring of patients is not necessary, because the incidence of ventricular fibrillation is the biggest in the cases which are complicated with heart failure.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false
D - 1 is wrong but 2 is right
112
In the first week of an outstanding myocardial infarct every patient require lying in bed strictly, because with this method the incidence of thromboembolic complications can be decreased.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false
E neither
start mobilization ASAP
mobilization and anticoags dec TE incidence
113
The use of ACE inhibitors decrease the serum level of angiotensin II, because the drug block the transformation of angiotensinogen- angiotensin I.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false
C - 1 is right but 2 is wrong
AT-I into AT-II is blocked
114
The use of ACE inhibitors improve the endothel function, because they decrease the level of the vascular oxigenas-activator angiotensin II.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false
A
115
The use of calcium channel blockers in heart failure is forbidden, because every calcium channel blocker have a negative inotropic effect next to therapic concentration.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false
E both are wrong
116
Every dihidropiridin type calcium channel blocker adaptable in heart failure, because every drug in this farmacological group command vasoselectivity.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false
D - first is wrong and 2nd is true
117
What is the supposed diagnosis?
Beta-blockers are unadaptable in heart failure, because they have negative inotropic effect.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false
D - first is wrong but 2nd is correct
118
43- year old man is admitted because the shortness of breath, ankle swelling at the evening and feels like a belt is tied around the liver. The complaints grow up constantly in the last 6 months, in the anamnesis there was any rheumatic arthritis. He does not have neither diabetes mellitus, nor hypertension. He does not smoke, but he drinks every day 1-2 dl short drinks and 1/2-1 liter wine.
```
A) congenital vitium
B) alcoholic myocardium laesion
C) asymmetrical septal hypertrophy
D) cor pulmonale chronicum
E) ischaemic heart disease
```
B) alcoholic myocardium laesion
119
Physical symptoms, which confirm the supposed diagnosis, except:
43- year old man is admitted because the shortness of breath, ankle swelling at the evening and feels like a belt is tied around the liver. The complaints grow up constantly in the last 6 months, in the anamnesis there was any rheumatic arthritis. He does not have neither diabetes mellitus, nor hypertension. He does not smoke, but he drinks every day 1-2 dl short drinks and 1/2-1 liter wine.
A) the relative dullness of heart reach the anterior axillary line
B) galopp rhythm
C) hepatomegaly, ankle edema
D) loud diastolic thrill at the region of apex of the heart
E) cyanosis on lips and fingers
D) diastolic thrill at apex region
you should hear a systolic thrill bc of dilated LV with dilated mitral annulus with complicated mitral regurg
120
Be in possession of anamnesis and physical examination the following device therapies are the most suitable to confirm the supposed diagnosis, except:
43- year old man is admitted because the shortness of breath, ankle swelling at the evening and feels like a belt is tied around the liver. The complaints grow up constantly in the last 6 months, in the anamnesis there was any rheumatic arthritis. He does not have neither diabetes mellitus, nor hypertension. He does not smoke, but he drinks every day 1-2 dl short drinks and 1/2-1 liter wine.
A) ECG
B) chest X-ray + bidirectional record from the heart
C) echocardiography
D) tallium perfusion scintigraphy at rest
D) tallium perfusion scintigraphy
not needed bc it shows prior MI
121
What kind of therapic solution would you choose, except:
43- year old man is admitted because the shortness of breath, ankle swelling at the evening and feels like a belt is tied around the liver. The complaints grow up constantly in the last 6 months, in the anamnesis there was any rheumatic arthritis. He does not have neither diabetes mellitus, nor hypertension. He does not smoke, but he drinks every day 1-2 dl short drinks and 1/2-1 liter wine.
```
A) use of loop diuretics
B) 'saving' lifestyle
C) ACE-inhibitor therapy
D) thrombolysis
E) alcohol prohibition
F) aldosterone antagonist
```
D) thrombolysis
122
What is the diagnosis?
A 55-year old man has hypertension in his anamnesis and he is smoking. Half year ago he had suddenly a very strong pain behind the sternum which radiate into the left arm and into the mandible, moreover he had sweat. He was treated in hospital with anterior myocardial infarct. After the departure he was well for a while, but then he had symptoms again: shortness of breath, weak leg swelling, tightness in the region of the liver. He needed diuretics and digitalis. Tachycard heart movement, galopp rhythm. Above the diaphragm we could hear the sound of congestion in the lung, moreover scratchy sound while breathing. ECG: sinus rhythm. The axis deviated into the left. I-II, aVL, V1-4 QS complex, ST-elevation. Some ventricular extrasystole in different morphology.
```
A) decompensated aorta vitium
B) left ventricular aneurysm after an extensive anterior myocardial infarct
C) primer dilatative cardiomyopathy
D) tricuspidal valve insufficiency
E) stent thrombosis
F) left atrial myxoma
```
B) LV aneurysm after extensive anterior MI
123
What kind of conservative therapy would you like to choose at the accurate diagnosis, except:
A 55-year old man has hypertension in his anamnesis and he is smoking. Half year ago he had suddenly a very strong pain behind the sternum which radiate into the left arm and into the mandible, moreover he had sweat. He was treated in hospital with anterior myocardial infarct. After the departure he was well for a while, but then he had symptoms again: shortness of breath, weak leg swelling, tightness in the region of the liver. He needed diuretics and digitalis. Tachycard heart movement, galopp rhythm. Above the diaphragm we could hear the sound of congestion in the lung, moreover scratchy sound while breathing. ECG: sinus rhythm. The axis deviated into the left. I-II, aVL, V1-4 QS complex, ST-elevation. Some ventricular extrasystole in different morphology.
```
A) ACE-inhibitor
B) diuretics
C) salicylate
D) statin
E) anticoagulants
F) nifedipine
```
F) nifedipine
it worsens the systolic function of the LV by negative inotropic effect and causes tachycardia
124
What is the diagnosis?
One month ago the patient had suddenly sore throat, fatigue, pain in limbs, subfebrility, chest pain and coughed. Actually the main symptoms of the patient are dyspnoe, stretching in the region of the liver, tachycardia. He can take some rest if he underpins his head. Physical status: moderate cyanosis in lips. The wings of the nose are used while breathing. Jugular vein distension both sides, tachycardia, third heart sound above the apex,, soft heart sounds. Heart: relative size reaches the lateral chest wall. Pulmonary crepitation. Liver is bigger with 4 cm. Spleen is untouchable. Pulse of the peripheral arteries is good. Blood pressure: 120/70 Hgmm. ECG: sinus tachycardia, low-voltage. Left deviated R-axis. Diffuse depressed T-waves. Chest X-ray: cor bovinum. In the heart contour inert pulsation. Labor parameters: ESR 30 mm/h, AST 120 E, SGOT, GPT, ALP: normal. Sample from the pharynx: bacteria + resistency negative.
A) prior pulmonary embolism
B) left ventricular aneurysm after a myocardial infarct
C) pericarditis exsudativa after a virus infection, with a lot of pericardial fluid, with threatening of cardiac tamponade
D) combined mitral vitium
E) rheumatic carditis
C) pericarditis exsudativa after a virus infection, with a lot of pericardial fluid, with threatening of cardiac tamponade
125
If you know the right diagnosis, what kind of acute therapy would you like to use?
One month ago the patient had suddenly sore throat, fatigue, pain in limbs, subfebrility, chest pain and coughed. Actually the main symptoms of the patient are dyspnoe, stretching in the region of the liver, tachycardia. He can take some rest if he underpins his head. Physical status: moderate cyanosis in lips. The wings of the nose are used while breathing. Jugular vein distension both sides, tachycardia, third heart sound above the apex,, soft heart sounds. Heart: relative size reaches the lateral chest wall. Pulmonary crepitation. Liver is bigger with 4 cm. Spleen is untouchable. Pulse of the peripheral arteries is good. Blood pressure: 120/70 Hgmm. ECG: sinus tachycardia, low-voltage. Left deviated R-axis. Diffuse depressed T-waves. Chest X-ray: cor bovinum. In the heart contour inert pulsation. Labor parameters: ESR 30 mm/h, AST 120 E, SGOT, GPT, ALP: normal. Sample from the pharynx: bacteria + resistency negative.
```
A) salicylate, rest, steroids
B) antibiotics
C) digitalis
D) anticoagulants
E) pericardiac punction guided by echocardiography
```
E) pericardiac punction guided by echo
126
What kind of examination would you perform, except:
40-year old woman with obesity had an accident and lying in bed 3 weeks. 3 days ago she cough dry. In the day of the examination she has bizarre mordant chest pain.
```
A) ECG
B) D-dimer
C) Blood gases
D) pulmonary CT-angiography
E) treadmill exercise test
F) 2D- echocardiography
```
E) treadmill exercise test
you don't do it if there's a chance of pulmo embolism
127
Suggested therapy with the known diagnosis:
40-year old woman with obesity had an accident and lying in bed 3 weeks. 3 days ago she cough dry. In the day of the examination she has bizarre mordant chest pain.
A) heparin
B) Venoruton (rutosid)
C) nitrate
D) ACE-inhibitor
A) heparin
128
ECG sign of pulmonary embolism:
40-year old woman with obesity had an accident and lying in bed 3 weeks. 3 days ago she cough dry. In the day of the examination she has bizarre mordant chest pain.1) right bundle branch block
2) S1Q3- complex
3) T-wave inversion in III., aVF and V1-4
4) frontal line R-vektor with left deviation
```
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
```
1 2 3
129
What is (are) the most probable diagnosis after the previous medical records?
A patient arrives with fever and dyspnoe into the ambulance. By a physical examination they observe, that the heart is bigger in the left side. During the chest X-ray they do not see the pulsation of the contour of the heart. By auscultation we can hear soft systolic murmur above the apex.
1) dilatative cardiomyopathy with catarrh at upper respiratory tract
2) severe, decompensated aorta insufficienty
3) pericarditis with pericardial fluid
4) hyperkinetic circulation
```
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
```
1 3
big silent heart + fever is typical for pericarditis
DCM is another option
130
What kind of examination would you perform to certificate or exclude the listed diagnosis?
A patient arrives with fever and dyspnoe into the ambulance. By a physical examination they observe, that the heart is bigger in the left side. During the chest X-ray they do not see the pulsation of the contour of the heart. By auscultation we can hear soft systolic murmur above the apex.
A) test-punction and bacterial examination
B) chest X-ray
C) transthoracic echocardiography
D) transesophageal echocardiography
C) transthoracic echocardiography
131
If you find significant pericardial fluid, what kind of physical signs would you search for to award cardiac tamponade?
A patient arrives with fever and dyspnoe into the ambulance. By a physical examination they observe, that the heart is bigger in the left side. During the chest X-ray they do not see the pulsation of the contour of the heart. By auscultation we can hear soft systolic murmur above the apex.
1) distended jugular veins
2) tachycard heart beats
3) pulsus paradoxus
4) laterally displaced apical impulse
```
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
```
1 2 3
132
In acute infective endocarditis what kind of examinations would you perform to make diagnosis, except:
A patient arrives with fever and dyspnoe into the ambulance. By a physical examination they observe, that the heart is bigger in the left side. During the chest X-ray they do not see the pulsation of the contour of the heart. By auscultation we can hear soft systolic murmur above the apex.
```
A) Mantoux-test
B) CRP
C) transesophageal echocardiography
D) urine sludge
E) hemoculture and microbiological tests
```
A) Mantoux test
133
The histological conformation of a vegetation presents:
A patient arrives with fever and dyspnoe into the ambulance. By a physical examination they observe, that the heart is bigger in the left side. During the chest X-ray they do not see the pulsation of the contour of the heart. By auscultation we can hear soft systolic murmur above the apex.
1) bacteria
2) fibrin
3) platelets
4) white blood cells
```
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
```
all
134
By the physical examination there are tachycardia, blood pressure: 170/100 Hgmm and above the basal part of the lung on both side can we hear statis. The acute therapy, except:
A 64-year old man has had hypertension in his anamnesis for decades, he does not take any pills. He started smoking when he was 21 years old. He has been short of breath because of charging for 3 months. He has had urine several times at night for a month. Both of his legs have been swollen by the evening for a week. He has been taken to the internal medicine department at night because of strong shortness of breath during sleeping.
A) Tensiomin (captopril) immediate use orally
B) intravenosus diuretics immediately
C) intravenous verapamil immediately
D) oxygen therapy
C) IV verapamil immediately
verapamil is specifically negatively inotropic
135
To confirm the diagnosis what kind of device examination should we perform:
A 64-year old man has had hypertension in his anamnesis for decades, he does not take any pills. He started smoking when he was 21 years old. He has been short of breath because of charging for 3 months. He has had urine several times at night for a month. Both of his legs have been swollen by the evening for a week. He has been taken to the internal medicine department at night because of strong shortness of breath during sleeping.
1) echocardiography
2) treadmill exercise test
3) ECG
4) pulmonary scintigraphy
```
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
```
1 3
136
The primary local treatment (first medical contact) at STE- ACS, except:
```
A) aspirin 250mg
B) painkiller (morphin)
C) short-acting calcium channel blocker
D) oxygen
E) nitroglycerin sublingual
```
C) short acting CCB
can provoke unwanted hypotension and HF
137
To diagnose STE-ACS we need the following:
A) chest pain, biomarker positivity
B) ST-elevation at least two cohesive leads, echocardiography shows dysfunction in wall movement
C) ST-elevation at least two cohesive leads, chest pain
D) chest pain, coronarography which proves the occlusion
C) STE in at least 2 leads and chest pain
138
It drives to the development of STE-ACS, except:
A) plaque rupture
B) embolization
C) it can develop as the complication of aortic dissection
D) the first sign of a significant aortic stenosis
E) vasospasm
D) first sign of aortic stenosis
nothing to do with coronary arteries
139
It is typical for the vulnerable plaque:
A) high content of whitewash
B) high content of lipid, without infective cells
C) it causes 50% or more than 50% occlusion in lumen
D) plaque with irregular surface
B) high lipid content without infective cells
high fat content, inflamm cells, and a thin fibrotic cap
140
The mechanical complication of myocardial infarct, except:
A) papillary muscle rupture
B) rupture of a free ventricular wall
C) ventricular tachycardia
D) rupture of the interventricular septum
C) ventricular tachy
it's not mechanical since it's an arrthymia
141
A successful plaque regression could achieve:
A) with use of statin
B) with big dosage of statins
C) with the combination of fibrate + statin
D) with the combination of aspirin + fibrate
E) with big dosage of fibrates
B) big dose of statins
142
The primary choose curative therapy in STE-ACS:
```
A) fibrinolysis
B) percutan coronary intervention (PCI)
C) intravenous anticoagulant therapy
D) beta-blocker therapy
E) antiplatelet therapy
```
B) PCI
143
Fibrinolysis is indicated, except:
A) pulmonary embolism with the complication of shock
B) mechanical valve thrombosis
C) stroke
D) NSTE-ACS
E) STE-ACS, if primary PCI is not available in two hours
D) NSTE-ACS
144
NSTE-ACS with high risk, when urgent coronarography is indicated:
```
A) persistent chest pain despite of optimal medical therapy
B) malignant ventricular arrhythmia
C) dynamical ST-T movement on ECG
D) heart failure as a complication
E) all statement in one case
```
E) all statements in one case
all justify the urgent angiography
145
Acute, life threatening cases with chest pain, except:
```
A) acute coronary syndrome
B) pulmonary embolism
C) aortic dissection
D) pneumothorax
E) pericarditis acuta
```
E) acute pericarditis
146
Imaging technique which helps to diagnose aortic dissection accurately:
A) chest X-ray
B) echocardiography
C) CT-angiography
D) coronarography
C) CT angio
147
The complication of aortic dissection, except:
```
A) STE-ACS
B) cardiac tamponade
C) aortic valve insufficiency
D) mitral valve chordae tendineae rupture
E) aortic rupture
```
D) mitral valve chordae tendinae rupture
148
It needs urgent surgical solution:
A) proximal aortic dissection
B) distal (descendent) aortic dissection
C) pulmonary embolism
D) endocarditis
A) prox aortic dissection
needs urgent surgical care while distal can be managed with controlled hypotension
149
It is disposed to aortic dissection:
```
A) Marfan- syndrome
B) chronic renal failure
C) diabetes mellitus
D) smoking
E) high cholesterin level
```
A) Marfan syndrome
150
Predisposition factors in pulmonary embolism, except:
```
A) fractura in the neck of femur
B) taking contraceptive pills
C) hypertension
D) deep venous thrombosis in anamnesis
E) malignancy
```
C) HTN
151
Sign of pulmonary embolism with high risk:
```
A) positive D-dimer
B) increased pulmonary pressure for example measured by echocardiography
C) haemaptoe
D) pleural like chest pain
E) tachycardia
```
B) inc pulmo pressure via echo
the others can be symptoms as well but alone aren't prognostic
152
The indication of a biventricular pacemaker implantation:
A) third-degree atrioventricular block
B) left bundle branch block, symptomatic systolic heart failure with optimal medical treatment, ejection fraction (EF) < 35%
C) right bundle branch block + diastolic heart failure
D) symptomatic systolic heart failure with optimal medical treatment independently from the ECG morphology, ejection fraction (EF) < 35%
B) LBB + symptomatic sys HF + optimal HF, EF < 35%
153
The 81-year old man complain about fatigue few weeks ago, one time syncope and collapse. ECG: bradyarrhythmia. In the anamnesis there are diabetes mellitus, hypertension, EF (ejection fraction):47%. Which device would you choose?
```
A) one chamber pacemaker
B) biventricular pacemaker
C) VVI pacemaker
D) DDD pacemaker
E) biventricular ICD
```
C) VVI
154
It could be the indication of a primary prevention ICD:
A) good left ventricular function, first-degree atrioventricular block
B) long QT-syndrome, sudden cardiac death of the parents
C) primary dilatative cardiomyopathy
D) hypertrophic obstructive cardiomyopathy
E) postinfarct status
B) long QT syndrome + SCD in parents
155
The function of the pacemaker, except:
A) hysteresis
B) sensitivity
C) basic frequency
D) antitachycardia pacing function
D) antitachycardia pacing function
156
Indication for pacemaker implantation, except:
A) third-degree atrioventricular block
B) first-degree atrioventricular block
C) bradyarrhythmia
D) carotis sinus hyperaesthesia
B) first degree AV block
157
How treat you fast ventricular tachycardia which cause hemodynamic instability?
A) intravenous amiodarone
B) beta-blocker
C) sedation, electrical cardioversion
D) propafenon
C) sedation and electrical cardioversion
158
Antiplatelet pills, except:
```
A) Aspirin
B) Prasugrel
C) Ticagrelor
D) Cumarin
E) Clopidogrel
```
D) cumarin
it's an anticoag not an antiplatelet
159
Which statement is true?
A) After myocardial infarct one year long combined acetylcalicilic acid (ASA) + Clopidogrel treatment is supposed.
B) After myocardial infarct one year long Clopidogrel monotherapy is supposed.
C) For every post- PCI patient combined ASA+ Clopidogrel treatment is necessary in the first year.
D) ASA in itself is sufficient treatment after myocardial infarct.
A) ASA + clopidogrel for 1 year
160
In the treatment of chronic atrial fibrillation it can be the alternative of cumarin, except:
```
A) Xa-inhibitor orally
B) low molecular weight heparin
C) some thrombin inbitor
D) Aspirin
E) Na-heparin intravenous
```
D) aspirin
an antiplatelet drug isn't effective enough
161
It is typical for stent-trombosis after PCI, except:
A) it is the consequence of neointima proliferation
B) sudden appearant event, which always causes myocardial infarct
C) the most often cause is the quitting of double anti-platelet treatment
D) it causes thrombotic occlusion
E) on the ECG you can see ST-elevation
A) consequence of neointimal prolif
neointima prolif is responsible for the instent restenosis and presents in the first 6mo after stent implantation
162
It decreases the appearance of instent restenosis, except:
A) drug eluting stent implantation
B) short stent implantation with big caliber
C) effective anti-platelet medical treatment
D) sufficient stent expandation during the implantation
C) effective anti platelet med tx
antiplatelet tx doesn't have an impact on stopping restenosis
163
The use of ivabradin with accepted indication:
A) in effort angina pectoris + heart rate > 70/min
B) in diastolic heart failure
C) in the heart rate control of atrial fibrillation
D) in first-degree atrioventricular block, instead of beta-blocker
A) in effort angina pectoris + HR 70+ bpm
ivabradin works to slow the HR specifically the SA node
164
In the case of acute inferior + right ventricular STE-ACS the responsible vessel is:
A) LAD (left anterior descendent)
B) CX (circumflexus)
C) RCA (right coronary artery)
D) none of them
C) RCA
RCA feeds RV as well as the posterior intraventricular area
165
Where are you positioning the ICD electrode?
A) right atrium
B) right ventricle
C) left atrium
D) left ventricle
B) right ventricle
166
It causes the dilatation of aorta ascendens, except:
A) hypertension
B) chronic aortic valve insufficiency
C) Marfan-syndrome
D) Myocardial infarct
D) MI
