Cardiology Flashcards
These can be heard in mitral stenosis, except for:
A) apical holosystolic murmur radiating towards the axilla
B) low-frequency apical diastolic murmur
C) opening snap
D) loud first heart sound
A) apical holosystolic murmur radiating towards the axilla
Part of the therapy of decompensated heart failure, except for:
A) mineralocorticoid-antagonists
B) diuretics
C) digoxin
D) parenteral volume expansion
E) ACE-inhibitors
D) parenteral volume expansion
Causes of acute left ventricle failure, except for:
A) asthma bronchiale
B) acute myocardial infarction
C) hypertensive crisis
D) severe aortic stenosis
A) asthma bronchiale
Characteristics of hypertrophic obstructive cardiomyopathy, except for:
A) might be combined 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
B) digoxin is important in the early stage
Features of atrial myxoma, except for:
A) the most common form of primary cardiac tumors
B) it can be diagnosed with echocardiography
C) it is often metastatic
D) it can mimic mitral stenosis during physical examination
C) it is often metastatic
Which one is true about the mechanism of action of digoxin?
A) it inhibits the Na-K-ATPase
B) it lowers intracellular Na+ concentration
C) it increases intracellular ATP levels
D) it enhances cAMP-production
E) it decreases Ca-release from the sarcoplasmic reticulum
A) it inhibits the Na-K-ATPase
All of the following statements about nitroglycerine are true, except for:
A) it increases intracellular cGMP levels
B) it is primarily metabolised in the liver
C) it can induce significant reflex tachycardia
D) it significantly prolongs AV-conduction
E) it can lead to postural hypotension
D) it significantly prolongs AV-conduction
The typical side effect of nitrates is:
A) hypertension
B) headache
C) bradycardia
D) sexual dysfunction
E) anaemia
B) headache
The typical feature 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
E) ST segment elevation during angina
Types of unstable angina pectoris, except for:
A) angina at rest
B) crescendo angina
C) effort angina
D) new-onset angina
C) effort angina
The most common pathology of myocardial infarction:
A) coronary embolism
B) rupture of an atherosclerotic plaque
C) dissection of coronary walls
D) growing of an atherosclerotic plaque
E) coronary inflammation
B) rupture of an atherosclerotic plaque
Normal mean electrical axis in the front plane, except for:
A) +60°
B) +90°
C) –45°
D) 0°
E) +45°
C) –45°
If acute myocardial infarction is suspected, the following diagnostic procedures should be carried out, except for:
A) ECG
B) blood tests (to measure CK-MB and troponin)
C) physical examination
D) cardiac stress test
E) echocardiography
D) cardiac stress test
Ischemic heart disease can present with, except for:
A) acute myocardial infarction
B) stable angina
C) deep vein thrombosis
D) sudden cardiac death
E) ischemic cardiomyopathy
C) deep vein thrombosis
The most important risk factor of atherosclerosis:
A) elevated serum LDL-cholesterol level
B) elevated serum HDL-cholesterol level
C) elevated serum triglyceride level
D) elevated serum cholesterol level
A) elevated serum LDL-cholesterol level
Risk factors of coronary artery disease, except for:
A) positive family history
B) diabetes mellitus
C) smoking
D) elevated serum HDL-cholesterol level
E) metabolic syndrome X
D) elevated serum HDL-cholesterol level
The ideal target value of serum LDL-cholesterol in a diabetic patient after myocardial infarction:
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
A 65-year-old patient with a history of smoking presents with sudden pain in his left leg. The limb feels cold, the toes are pale and peripheral pulse can not be palpated. What is the most likely diagnosis?
A) deep vein thrombosis
B) Buerger’s disease
C) embolism in the peripheral arteries
D) Raynaud’s disease
C) embolism in the peripheral arteries
Paramedics arrive to a 55-year-old patient with chest pain that started 3 hours ago. On the patient’s ECG they notice ST segment elevation in leads I, aVL, V5 and V6. What should they do?
A) transfer the patient to the regional Emergency Department
B) transfer the patient to the regional Coronary Care Unit
C) transfer the patient to the regional Cardiology Department for a troponin test and if it’s positive, transfer to a PCI center
D) transfer the patient directly to the nearest PCI center
D) transfer the patient directly to the nearest PCI center
Upon the physical examination of a 45-year-old man without any symptoms a soft systolic murmur and ejection click can be heard in 2L2. These have been known since he was a child. What is the most likely diagnosis?
A) patent ductus arteriosus
B) coarctation of the aorta
C) ventricular septal defect
D) Ebstein’s anomaly
E) pulmonary valve stenosis
E) pulmonary valve stenosis
Correct statements about aortic stenosis, except for:
A) it causes pulsus parvus et tardus
B) it can cause syncope
C) it can cause anginalike chest pain
D) Austin-Flint murmur can be heard upon auscultation
E) it causes concentric left ventricular hypertrophy
D) Austin-Flint murmur can be heard upon auscultation
Correct statements about aortic insufficiency, except for:
A) it causes pulsus celer et altus (Corrigan’s pulse).
B) it can be acute and chronic too.
C) it usually doesn’t lead to left ventricle dilation.
D) it can be congenital.
E) it predisposes to infective endocarditis.
C) it usually doesn’t lead to left ventricle dilation.
Accessory pathway-mediated reentry tachycardy (AVRT) can be terminated with, except for:
A) propafenone
B) adenosine
C) lidocaine
D) radiofrequency ablation
E) verapamil
C) lidocaine
A regular wide QRS complex tachycardia can not be:
A) ventricular tachycardia
B) supraventricular tachycardia with bundle branch block
C) atrial fibrillation with bundle branch block
D) antidromic atrioventricular reentry tachycardia (WPW-syndrome)
E) atrial flutter with bundle branch block
C) atrial fibrillation with bundle branch block
A patient was admitted to the Emergency Department because of a palpitation that started three hours earlier. On his ECG an atrial fibrillation with rapid (150 bpm) ventricular response was seen. His blood pressure was 130/90 Hgmm. In the patient’s history there wasn’t anything that indicated structural heart disease. What is the best first step in this situation?
A) pharmacological cardioversion
B) immediate electrical cardioversion
C) coronarography
D) immediate anticoagulation to prevent thromboembolism
E) cardiac stress test
A) pharmacological cardioversion
Which one is the most common permanent arrhythmia?
A) ventricular extrasystoles
B) atrial fibrillation
C) ventricular tachycardia
D) supraventricular tachycardia
E) junctional escape rhythm
B) atrial fibrillation
A patient who has been taking amiodarone for a long time was prescribed a fluoroquinolone antibiotic because 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 induced by the medications
B) torsade de pointes ventricular tachycardia induced by the medications
C) sinus bradycardia induced by the medications
D) her symptoms are not induced by her medications, it is just a coincidence
E) AV block induced by the medications
B) torsade de pointes ventricular tachycardia induced by the medications
These could be the first ECG findings in the acute phase of myocardial infarction, except for:
A) pathologic Q waves
B) inverted T waves
C) ventricular fibrillation
D) ST segment elevation
E) ST segment depression
A) pathologic Q waves
Pathologic Q wave in leads II, III and aVF with isoelectric ST segment and positive T waves indicate:
A) acute ischemia
B) acute phase of a progressing myocardial infarction
C) previous myocardial infarction
D) aneurysm after myocardial infarction
E) subendocardial ischemia
C) previous myocardial infarction
In the diagnostic workup of a 60-year-old patient with a history of smoking who has chest pain at exertion, the first step should be:
A) stress echocardiography
B) exercise test
C) stress perfusion scintigraphy
D) Holter ECG monitoring
E) stress MRI
B) exercise test
The best first-choice drug for bradycardia during myocardial infarction is:
A) isoproterenol
B) theophyllin
C) atropine
D) dobutamine
C) atropine
The most common side effect of ACE inhibitors is:
A) diarrhea
B) cough
C) vomiting
D) erythema
E) anasarca
B) cough
Which disease(s) cause(s) systolic hypertension?
1) aortic insufficiency
2) thyreotoxicosis
3) beriberi
4) atherosclerosis
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
E) All of the answers are correct
Aortic aneurysm can be caused by:
1) arteriosclerosis
2) Marfan’s syndrome
3) vascular syphilis
4) giant-cell arteritis
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
A) Answers 1, 2 and 3 are correct
The possible cause(s) of pericarditis:
1) uremia
2) transmural myocardial infarction
3) tuberculosis
4) metastatic cancer
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
E) All of the answers are correct
Secondary cardiomyopathy can be caused by:
1) hyperthyroidism
2) beriberi
3) amyloidosis
4) glycogenosis
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
E) All of the answers are correct
ACE inhibitors:
1) decrease blood pressure
2) decrease aldosterone levels
3) increase bradykinin levels
4) stop the deterioration of the left ventricle ejection fraction
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
E) All of the answers are correct
Which one(s) is/are correct?
1) Aspirin has no effect on the prostacyclin production of the endothelial cells.
2) According to multicenter trials aspirin reduces the chance of a second myocardial infarction.
3) It takes 24 hours for heparin to build up its anticoagulant effect.
4) Heparin and alteplase are treatment options in 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 of the answers are correct
C) Answers 2 and 4 are correct
Which diuretic side effect combination(s) is/are correct?
1) furosemide - hyperuricemia
2) chlortalidone – ototoxicity
3) spironolactone – gynecomasty
4) etacrynic acid - hyperuricemia
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
B) Answers 1 and 3 are correct
Risk factors of ischemic heart disease:
1) smoking
2) hypercholesterolemia
3) hypertension
4) family history
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
E) All of the answers are correct
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
E) All of the answers are correct
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 of the answers are correct
A) Answers 1, 2 and 3 are correct
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 of the answers are correct
B) Answers 1 and 3 are correct
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 of the answers are correct
A) Answers 1, 2 and 3 are correct
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 of the answers are correct
E) All of the answers are correct
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 of the answers are correct
E) All of the answers are correct
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
B) Answers 1 and 3 are correct
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
A) Answers 1, 2 and 3 are correct
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 of the answers are correct
A) Answers 1, 2 and 3 are correct
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 of the answers are correct
E) All of the answers are correct
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 of the answers are correct
A) Answers 1, 2 and 3 are correct
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 of the answers are correct
E) All of the answers are correct
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 of the answers are correct
E) All of the answers are correct
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 of the answers are correct
A) Answers 1, 2 and 3 are correct
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
C) Answers 2 and 4 are correct
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 of the answers are correct
D) Only answer 4 is correct
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 of the answers are correct
E) All of the answers are correct
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 of the answers are correct
C) Answers 2 and 4 are correct
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 of the answers are correct
E) All of the answers are correct
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 of the answers are correct
E) All of the answers are correct
Characteristic(s) 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 of the answers are correct
A) Answers 1, 2 and 3 are correct
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
A) Answers 1, 2 and 3 are correct
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 of the answers are correct
C) Answers 2 and 4 are correct
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 of the answers are correct
B) Answers 1 and 3 are correct
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 of the answers are correct
A) Answers 1, 2 and 3 are correct
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
E) All of the answers are correct
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 of the answers are correct
D) Only answer 4 is correct
It is true about long QT syndrome:
1) Long QT syndrome is most commonly the consequence of drug adverse reaction.
2) Long QT syndrome predisposes 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 of the answers are correct
E) All of the answers are correct
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 of the answers are correct
A) Answers 1, 2 and 3 are correct
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 of the answers are correct
E) All of the answers are correct
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 of the answers are correct
C) Answers 2 and 4 are correct
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 of the answers are correct
B. Answers 1 and 3 are correct
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
C. Answers 2 and 4 are correct
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
C) Answers 2 and 4 are correct
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 of the answers are correct
A) Answers 1, 2 and 3 are correct
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 of the answers are correct
C) Answers 2 and 4 are correct
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 of the answers are correct
B) Answers 1 and 3 are correct
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
79- D
80- C
81-A
82- B
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)
83- D
84- B
85- C
86- E
87- A
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
88- C
89- C
90- A
91- A
92- B
93- B
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
94- C
95- D
96- A
97- B
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
98- D
99- A
100- B
101- C
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) Both of them are correct, there is causal relationship between them
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
C) The first part is correct, the second one is wrong
Anticoagulant therapy isn’t required after myocardial infarction with left ventricular aneurysm because in this state the risk of intracardiac thrombus is low.
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) Both of them are incorrect
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) Both of them are correct, there is causal relationship between them
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) Both of them are correct, there is causal relationship between them
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 of them are correct, but there is no causal relationship between them
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 of them are correct, but there is no causal relationship between them
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) Both of them are correct, there is causal relationship between them
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) The first part is correct, the second one is wrong
When acute myocardial infarction occurs it is rightaway 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) The first part is wrong, the second one is correct
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) Both of them are correct, there is causal relationship between them
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) Both of them are correct, there is causal relationship between them
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) Both of them are incorrect
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 of them are correct, there is causal relationship between them
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) Both of them are incorrect
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) The first part is correct, the second one is wrong
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) The first part is correct, the second one is wrong
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) Both of them are incorrect
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) Both of them are correct, but there is no causal relationship between them
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) Both of them are incorrect
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) The first part is correct, the second one is wrong
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 of them are correct, there is causal relationship between them
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) The first part is correct, the second one is wrong
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) Both of them are incorrect
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) Both of them are correct, there is causal relationship between them
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) Both of them are incorrect
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) Both of them are correct, there is causal relationship between them
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) the statement is true, but the explanation is false;
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) the statement is false, but the explanation itself is true
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) the statement is false, but the explanation itself is true
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) the statement is false, but the explanation itself is true
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) both the statement and the explanation are false
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) the statement is true, but the explanation is false;
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) both the statement and the explanation are true and a causal relationship exists between them;
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 the statement and the explanation are false
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) the statement is false, but the explanation itself is true
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) the statement is false, but the explanation itself is true
What is the supposed diagnosis?
A 43-year-old man is admitted because of shortness of breath, ankle swelling at the evening and feels like a belt is tied around the liver. The complaints has grown up constantly in the last 6 months, in the anamnesis there has not been 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
Physical symptoms, which confirm the supposed diagnosis, except:
A 43-year-old man is admitted because of shortness of breath, ankle swelling at the evening and feels like a belt is tied around the liver. The complaints has grown up constantly in the last 6 months, in the anamnesis there has not been 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) loud diastolic thrill at the region of apex of the heart
Be in possession of anamnesis and physical examination the following device therapies are the most suitable to confirm the supposed diagnosis, except:
A 43-year-old man is admitted because of shortness of breath, ankle swelling at the evening and feels like a belt is tied around the liver. The complaints has grown up constantly in the last 6 months, in the anamnesis there has not been 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 at rest
What kind of therapic solution would NOT you choose?
A 43-year-old man is admitted because of shortness of breath, ankle swelling at the evening and feels like a belt is tied around the liver. The complaints has grown up constantly in the last 6 months, in the anamnesis there has not been 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
What is the diagnosis?
A 55-year-old man has hypertension in his anamnesis and he smokes. Half year ago he had suddenly a very strong pain behind the sternum which radiated into the left arm and into the mandible, moreover he had sweat. He was treated in hospital with anterior myocardial infarct. After his 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 can hear the sound of congestion in the lung, moreover scratchy sound while breathing. ECG: sinus rhythm. The axis is deviated into the left. I-II, aVL, V1-4 QS complex, ST-elevation. Some ventricular extrasystoles 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) left ventricular aneurysm after an extensive anterior myocardial infarct
What kind of conservative therapy would NOT you choose at the accurate diagnosis?
A 55-year-old man has hypertension in his anamnesis and he smokes. Half year ago he had suddenly a very strong pain behind the sternum which radiated into the left arm and into the mandible, moreover he had sweat. He was treated in hospital with anterior myocardial infarct. After his 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 can hear the sound of congestion in the lung, moreover scratchy sound while breathing. ECG: sinus rhythm. The axis is deviated into the left. I-II, aVL, V1-4 QS complex, ST-elevation. Some ventricular extrasystoles in different morphology.
A) ACE-inhibitor
B) diuretics
C) salicylate
D) statin
E) anticoagulants
F) nifedipine
F) nifedipine
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
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 echocardiography
What kind of examination would NOT you perform?
A 40-year-old woman with obesity had an accident and layed in her bed for 3 weeks. She has been coughing dry for 3 days. 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
Suggested therapy with the known diagnosis:
A 40-year-old woman with obesity had an accident and layed in her bed for 3 weeks. She has been coughing dry for 3 days. In the day of the examination she has bizarre mordant chest pain.
A) heparin
B) Venoruton (rutosid)
C) nitrate
D) ACE-inhibitor
A) heparin
ECG sign of pulmonary embolism:
A 40-year-old woman with obesity had an accident and layed in her bed for 3 weeks. She has been coughing dry for 3 days. 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
A) 1st, 2nd and 3rd answers are correct
What is (are) the most probable diagnosis after the previous medical records?
A patient arrives with fever and dyspnoe into the ambulance. By the 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
B) 1st and 3rd answers are correct
What kind of examination would you perform to certificate or exclude the diagnosis?
A patient arrives with fever and dyspnoe into the ambulance. By the 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
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 the 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
A) 1st, 2nd and 3rd answers are correct
In acute infective endocarditis what kind of examinations would you perform to make diagnosis, except:
A) Mantoux-test
B) CRP
C) transesophageal echocardiography
D) urine sludge
E) hemoculture and microbiological tests
A) Mantoux-test
The histological conformation of a vegetation presents:
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
E) all of the answers are correct
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. Which one can NOT be the acute therapy?
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) intravenous verapamil immediately
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
B) 1st and 3rd answers are correct
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 calcium channel blocker
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) ST-elevation at least two cohesive leads, chest pain
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) the first sign of a significant aortic stenosis
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 content of lipid, without infective cells
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 tachycardia
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) with big dosage of statins
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) percutan coronary intervention (PCI)
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
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 statement in one case
Acute, life threatening cases with chest pain, except:
A) acute coronary syndrome
B) pulmonary embolism
C) aortic dissection
D) pneumothorax
E) pericarditis acuta
E) pericarditis acuta
Imaging technique which helps to diagnose aortic dissection accurately:
A) chest X-ray
B) echocardiography
C) CT-angiography
D) coronarography
C) CT-angiography
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 tendineae rupture
It needs urgent surgical solution:
A) proximal aortic dissection
B) distal (descendent) aortic dissection
C) pulmonary embolism
D) endocarditis
A) proximal aortic dissection
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
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) hypertension
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) increased pulmonary pressure for example measured by echocardiography
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 of the ECG morphology, ejection fraction (EF) < 35%
B) left bundle branch block, symptomatic systolic heart failure with optimal medical treatment, ejection fraction (EF) < 35%
An 81-year-old man has been complaining about fatigue for few weeks, one time he had 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 pacemaker
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, sudden cardiac death of the parents
The function of the pacemaker, except:
A) hysteresis
B) sensitivity
C) basic frequency
D) antitachycardia pacing function
D) antitachycardia pacing function
Indication for pacemaker implantation, except:
A) third-degree atrioventricular block
B) first-degree atrioventricular block
C) bradyarrhythmia
D) carotis sinus hyperaesthesia
B) first-degree atrioventricular block
How treat you fast ventricular tachycardia which cause hemodynamic instability?
A) intravenous amiodarone
B) beta-blocker
C) sedation, electrical cardioversion
D) propafenon
C) sedation, electrical cardioversion
Antiplatelet pills, except:
A) Aspirin
B) Prasugrel
C) Ticagrelor
D) Cumarin
E) Clopidogrel
D) Cumarin
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) After myocardial infarct one year long combined acetylcalicilic acid (ASA) + Clopidogrel treatment is supposed.
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
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) it is the consequence of neointima proliferation
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 medical treatment
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 + heart rate > 70/min
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 (right coronary artery)
Where are you positioning the ICD electrode?
A) right atrium
B) right ventricle
C) left atrium
D) left ventricle
B) right ventricle
It causes the dilatation of aorta ascendens, except:
A) hypertension
B) chronic aortic valve insufficiency
C) Marfan-syndrome
D) myocardial infarct
D) myocardial infarct
