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[OS 213] Q1 > Samplex 2017 > Flashcards

Samplex 2017 Flashcards

1
Q

True regarding the point of maximal impulse, except:

a. Location on the anterior chest wall where the apex of the heart is felt most strongly
b. It can be felt in 70% of individuals in the sitting/standing position of in the left lateral decubitus position
c. Normally 6 cm in diameter
d. None of the above

A

C

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2
Q

In a 55 year old male, the jugular venous pressure was measured at 4cm. What is his central venous pressure?

a. 6 cm H2O
b. 7 cm H2O
c. 8 cm H2O
d. 9 cm H2O

A

D

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3
Q

Tricuspid stenosis

a. Absent venous pulse
b. Giant a wave
c. Kussmaul’s sign (paradoxical venous filling)
d. Prominent v wave

A

B

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4
Q

Restrictive cardiomyopathy

a. Absent venous pulse
b. Giant a wave
c. Kussmaul’s sign (paradoxical venous filling)
d. Prominent v wave

A

C

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5
Q

In the Korotkoff sounds, which phase do the sounds usually become muffled?

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

A

D

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6
Q

True when performing auscultation, except:

a. Position the patient supine with the head of the table slightly elevated
b. Always examine from the patient’s right side
c. Listen with the diaphragm at the left 2nd intercostals space near the sternum (pulmonic area)
d. Listen with the diaphragm at the left 3rd, 4th, and 5h intercostals spaces near the sternum (mitral area)
e. None of the above

A

D

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7
Q

Paradoxical splitting of S2 is seen in the following conditions, except:

a. Complete left bundle branch block
b. Severe mitral regurgitation
c. Right ventricular apical placing
d. Severe aortic stenosis
e. None of the above

A

B

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8
Q

Which wave in the jugular venous pulse represents atrial emptying when the tricuspid valve is open?

a. a wave
b. x wave
c. v wave
d. y wave

A

D

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9
Q

true regarding the physical examination of patients with mitral regurgitation, except:

a. Loud S1 associated with an opening snap
b. Grade III/IV holosystolic murmur at apex and radiates to axilla
c. Apex beat displaced laterally
d. Systolic thrill at apex
e. None of the above

A

A

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10
Q

The murmur of mitral valve prolapsed (MVP) is best described as:

a. Systolic murmur with a non-ejection click
b. Diastolic murmur with a non-ejection click
c. Systolic murmur with an opening snap
d. Diastolic murmur with an opening snap
e. None of the above

A

A

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11
Q

Most common type of Atrial Septal Defect

a. Ostium primum
b. Ostium secundum
c. Muscular
d. Membranous

A

B

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12
Q

The following are examples of acyanotic heart diseases, except:

a. Atrial septal defect
b. Ventricular septal defect
c. Tetralogy of fallot
d. Patent ductus arteriosus

A

C

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13
Q

Which of the following explains the boot-shaped heart on radiographs of TOF?

a. Left ventricular hypertrophy
b. Aortic aneurysm
c. Right ventricular hypertrophy
d. Arterial notching

A

C

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14
Q

Which of the following occurs in Eisenmenger complex?

a. Decreased pulmonary blood flow volume and pressure
b. Left ventricular hypertrophy
c. Pulmonary artery vasodilation
d. Pulmonary vascular resistance increases to systemic levels

A

D

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15
Q

A ventriculoarterial discordance wherein the aorta rises from the right ventricle and the pulmonary artery emanates from the left ventricle is seen in which condition?

a. Transposition of Great Arteries
b. Total Anomalous Pulmonary Venous Connection
c. Coarctation of the Aorta
d. Tetralogy of Fallot

A

A

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16
Q

Which of the following is not a feature of Tetralogy of Fallot?

a. Ventricular septal defect
b. Obstruction of the left ventricular outflow tract
c. Overriding aorta
d. Right ventricular hypertrophy

A

B

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17
Q

Which of the following is not an indication for surgery in PDA?

a. Presence of respiratory distress
b. Small defects
c. Hemodynamically significant PDA
d. Failure of 2 courses of indomethacin

A

B

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18
Q

The following statements regarding Tetralogy of Fallot are true, except:

a. TOF can be managed medically
b. Surgery should be done before collaterals develop
c. Only 3% are alive by the age of 40 years old
d. Most children are not cyanotic at birth due to partial mixing of blood

A

A

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19
Q

In this congenital defect, the aorta arises from the RV and the pulmonary artery arises from the LV.

a. Tetralogy of Fallot
b. Transposition of the Great Arteries
c. Total Anomalous Pulmonary Venous Return
d. Tricuspid Valve Atresia

A

B

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20
Q

An infant presents with cyanosis at birth. Which of the following should first be considered?

a. ASD with eisenmengerizatioin
b. PDA
c. Transposition of the Great Arteries
d. TOF

A

C

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21
Q

Which of the following is a major criterion for heart failure?

a. Ankle edema
b. Night cough
c. Pleural effusion
d. Rales

A

D

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22
Q

Which of the following is an evidence for low perfusion in heart failure?

a. Orthopnea
b. Edema
c. Ascites
d. Cool extremities

A

D

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23
Q

A 58 year old male came in for dyspnea. This would be exaggerated even when he brushes his teeth, dresses up, and walks short distances. If your diagnosis is congestive heart failure, his functional class is grades as:

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

A

C

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24
Q

Stage of heart failure when symptoms are refractory?

a. Stage A
b. Stage B
c. Stage C
d. Stage D

A

D

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25
Q

Minor criterion of the Duke’s Criteria for the diagnosis of infective endocarditis, except:

a. Predisposing heart condition
b. Positive blood culture from 2 separate cultures
c. Vascular phenomena: emboli, infarcts, hges, Janeway lesions
d. Immunological phenomena: GN, Osler’s nodes, Roth spots

A

B

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26
Q

Most common symptom of infective endocarditis.

a. Dyspnea
b. Fever
c. Rashes
d. New onset murmur

A

B

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27
Q

A 25 year old male known to have mitral stenosis from rheumatic heart disease was admitted for a 1 month history of on and off fever. Physical examination showed a systolic murmur at the apex. 2D Echo showed an oscillating mass at the mitral valve. What is the diagnosis?

a. Acute myocardial infarction
b. Viral myocarditis
c. Constrictive pericarditis
d. Infective endocarditis

A

D

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28
Q

Which is part of the HACEK group?

a. Heikenella
b. Acinetobacter baumani
c. Corynebacterium
d. Escherichia
e. None of the above

A

E

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29
Q

Tender, erythematous papules found on the pulps of fingers or toes:

a. Osler’s nodes
b. Splinter haemorrhages
c. Janeway lesions
d. Roth papules
e. None of the above

A

A

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30
Q

The following conditions present with severe cyanosis:

a. Total anomalous pulmonary venous return
b. Truncus arteriosus
c. Pulmonic atresia
d. Pulmonic stenosis

A

C

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31
Q

What causes the fixed splitting of S2 in ASD?

a. Increased blood flow through the pulmonic valve causes its delayed closure
b. Increased blood flow through the tricuspid valve causes its delayed closure
c. Increased blood flow through the aortic valve causes its delayed closure
d. Increased blood flow though the mitral valve causes its delayed closure

A

A

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32
Q

What structure in the normal fetal circulation is required for the survival of a neonate with pulmonic atresia?

a. Patent ventricular septal defect
b. Patent ductus venosus
c. Patent foramen ovale
d. Patent ductus arteriosus

A

D

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33
Q

An 8 month old baby girl is brought to the ER for recurrent pneumonia. Inspection shows precordial bulge and Harrison’s groove with the apex beat at the 5th ICS left midclavicular line. She also has subcostal and intercostal retractions. You think you hear a systolic murmur but cannot clearly define it because of bilateral coarse crackles. You do note that the pulses are bounding on all extremities. Which of the following will you highly consider for this patient?

a. Ventricular septal defect
b. Patent ductus arteriosus
c. Atrial septal defect
d. Pulmonic stenosis

A

B

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34
Q

An 18 year old male presents with dyspnea and cyanosis. He says he was diagnosed with a large VSD when he was younger, but he was lost to follow up because his family moved to the province. On auscultation, you barely hear the systolic murmur but note a very loud second heart sound. He also has clubbing of his fingers. What do you think happened to this patient?

a. The patient now has Eisenmengerization, that is why the second heart sound is loud
b. The physician before made a mistake, the patient has Tetralogy of Fallot
c. The patient’s VSD is now closing, hence the decreased intensity of the murmur
d. There is not enough data to comment on the patient’s present state

A

A

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35
Q

A 10 month old boy was referred to Cardio service for clearance prior to congenital cataract extraction. Ophthalmology service is considering congenital rubella syndrome. You hear a systolic ejection murmur at the left upper sterna border with radiation to the back. What is the most likely diagnosis for this patient?

a. Aortic stenosis
b. Patent ductus arteriosus
c. Pulmonic stenosis
d. Patent foramen ovale

A

C

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36
Q

A newborn infant was noted to be cyanotic on the second day of life. Patient was brought to the NICU and was eventually intubated for persistent cyanosis. The patient was referred to Cardio service to rule out which of the following cardiac condition?

a. Tetralogy of Fallot
b. Coarctation of the aorta
c. Transposition of the great arteries
d. Ventricular Septal Defect

A

C

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37
Q

Systole occurs

a. When semilunar valves are open
b. When tricuspid valve is open
c. During ventricular relaxation
d. After aortic valve closes

A

A

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38
Q

Still’s murmur is characterized by:

a. Radiation to carotids
b. An associated thrill
c. Presence of suprasternal pulsation
d. Normal EKG and x-ray

A

D

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39
Q

Which is the etiologic agent causing rheumatic fever?

a. Streptococcus pyogenes
b. Streptococcus pneumonia
c. Group A α haemolytic strep
d. Group A β haemolytic strep

A

D

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40
Q

Which of the following is an exception to fulfilling Jones Criteria for the diagnosis of Rheumatic fever?

a. Truncal rash
b. Chorea
c. Subcutaneous nodule
d. Arthritis

A

B

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41
Q

A child with joint pains came into your clinic. She has had high-grade fever for 5 days and sore throat. On PE, you note that she has pharyngeal congestion and exudates. You treat her as a case of:

a. Rheumatic fever
b. Rheumatic heart disease
c. Influenza
d. Strep throat

A

D

42
Q

Most common heart disease in children.

a. ASD
b. VSD
c. TOF
d. Probe patent foramen ovale
e. NOTA

A

B

43
Q

No shunt is seen in:

a. PDA
b. Complete TGV
c. Anomalous PV drainage
d. NOTA

A

B

44
Q

With Eisenmengerization, the shunt is:

a. Left to right
b. Right to left
c. Both ways
d. Absent
e. NOTA

A

B

45
Q

Incomplete spiral septum partitioning results in:

a. PDA
b. Coarctation
c. Truncus
d. Anomalous veins
e. NOTA

A

C

46
Q

The boot-shaped heart on radiographs in TOF is due to:

a. LVH
b. Aortic aneurysm
c. RVH
d. Arterial notching
e. NOTA

A

C

47
Q

In Transposition of the Great Vessels (TGV):

a. Morphologic RA connects to morphologic LV
b. Morphologic LV gives rise to the aorta
c. Morphologic LA connects to the pulmonary veins
d. Morphologic RV gives rise to the pulmonary artery
e. NOTA

A

C

48
Q

The collateral circulation (intercostals) is prominent in:

a. TOF
b. PDA
c. Aortic stenosis
d. Coarctation of the aorta
e. NOTA

A

D

49
Q

Most common cause of isolated mitral stenosis is:

a. Congenital
b. Calcification
c. Rheumatic
d. Infection
e. NOTA

A

C

50
Q

Rheumatic fever may present as:

a. Pericarditis
b. Myocarditis
c. Endocarditis
d. All of the above
e. NOTA

A

D

51
Q

Rheumatic nodules are seen in the:

a. Pericardium
b. Myocardium
c. Endocardium
d. All of the above
e. NOTA

A

C

52
Q

Aschoff nodules are seen in the

a. Pericardium
b. Myocardium
c. Endocardium
d. All of the above
e. NOTA

A

B

53
Q

Main pathology of the valve in MV prolapsed

a. Fibrosis
b. Vascularisation
c. Myxoid degeneration
d. All of the above
e. NOTA

A

C

54
Q

Most common predisposing condition in children with infective endocarditis:

a. Rheumatic heart disease
b. Congenital heart disease
c. Maternal illness
d. Sepsis
e. NOTA

A

B

55
Q

Found in Libman-Sacks endocarditis:

a. Myxoid degeneration
b. Bacterial clumps
c. Fungi
d. Vegetations
e. NOTA

A

D

56
Q

Most common mortality in ASEAN countries.

A) Heart Disease
B) Pneumonia
C) Cancer
D) Diarrhea

A

A

57
Q

Which of the following is a risk factor for diabetes?

A. Low LDL
B. Low HDL
C. Low triglyceride
D. Low sugar

A

B

58
Q

72/F, diabetic, with chest pain during deepinspiration. She had a 1 week history of productive cough and low grade fever.

A. Typical angina
B. Gastroesophageal reflux
C. Pleuritic pain
D. Musculoskeletal pain

A

C

59
Q

68/F experienced severe chest pain after carrying her grandchild. Pain was aggravated by movement of her left arm and alleviated by anti-inflammatory drugs.

A. Typical angina
B. GERD
C. Pleuritic pain
D. Musculoskeletal pain

A

D

60
Q

56/M hypertensive smoker with mild chest heaviness when taking 2 flights of stairs and relieved by resting

A. Typical angina
B. Atypical angina
C. Pleuritic Pain
D. Musculoskeletal pain

A

A

61
Q

The usual location of typical or atypical
angina:

a. Suprasternal
b. Retrosternal
c. Left shoulder
d. Right shoulder

A

B

62
Q

Aside from angina, which chest pain is cured by nitrates?

A. Esophageal spasm
B. Peptic ulcer disease
C. Pleuritic pain
D. Musculoskeletal pain

A

A

63
Q

The 2 flaps of the mitral valve are called

A. Anterior and Posterior
B. Superior and Posterior
C. Inferior and Superior
D. Anterolateral and Posterior

A

A

64
Q

What is the normal mitral valve orifice?

A. 1-3 cm2
B. 2-4 cm2
C. 3-5 cm2
D. 4-6 cm2

A

D

65
Q

Findings in an ECG of pure mitral stenosis EXCEPT:

A. LAE
B. LVH
C. RAE
D. RVH

A

B

66
Q

Most sensitive and specific non-invasive method for diagnosis of MS

A. 2D echocardiogram
B. 12L electrocardiogram
C. Chest X-Ray
D. ASO titer

A

A

67
Q

Rationale for giving vasodilators during MR?

A. Decreases preload to augment CO
B. Decreases afterload to increase forward flow
C. Increases afterload to decrease regurgitant fraction
D. Increases preload to augment CO

A

B

68
Q

Where can you observe pulsus parvus et tardus?

A. Aortic Valve Stenosis.
B. Pulmonary valve atresia
C. Tricuspid regurgitation
D. Mitral stenosis

A

A

69
Q

An aortic regurgitation, a to and fro murmur
with femoral artery compression is called:

A. Demusset’s sign
B. Quincke’s sign
C. Traube’s sign
D. Durozier’s sign

A

D

70
Q

A 20 year old male comes in with dyspnea. PE reveals a diastolic rumble at apex with opening snap. What is the probable diagnosis?

A. Mitral Regurgitation
B. Mitral Stenosis
C. Aortic regurgitation
D. Aortic stenosis

A

B

71
Q

A 30 year old male comes in with findings typical of aortic regurgitation. On examination, he has long arms and arachnodactyly. Your diagnosis is:

A. Turner’s syndrome
B. Kleinfelter syndrome
C. Marfan’s syndrome
D. Any of the above

A

C

72
Q

Constrictive pericarditis (restrictive disease)

A. absent venous pulse
B. giant A wave
C. paradoxical venous filling
D. Prominent v wave

A

C

73
Q

RV failure, tricuspid stenosis

A. Absent venous pulse
B. Giant A wave
C. Kussmaul’s sign
D. Prominent v wave

A

B

74
Q

Disturbance of blood flow in the blood
vessels or peripheral arteries is called:

A. Bruit
B. Murmur
C. Thrill
D. Heave

A

A

75
Q

S1 (lub) sound is due to:

A: Opening of AV Valves
B. Opening of Semilunar valves
C. Closing of AV Valves
D. Opening of Semilunar valves

A

C

76
Q

Loud S1 in:

A. Late stages of MS
B. Beta adrenergic receptor blockade
C. Long PR interval (>200 ms)
D. Hyperkinetic state

A

D

77
Q

Paradoxical splitting can be seen in the ff.
conditions EXCEPT:

A. Complete left bundle branch block
B. Severe mitral regurgitation
C. Right ventricular apical pacing
D. Severe aortic stenosis

A

B

78
Q

28/M went for a general check-up. Upon auscultation, you heard a fixed splitting of S2. The patient has

A. Complete left bundle branch block
B. Complete right bundle branch block
C. ASD
D. Myocardial ischemia

A

C

79
Q

A clinical sign found in patients with tricuspid regurgitation. The holosystolic murmur found in this condition becomes louder during inspiration; this sign enables it to be distinguished from mitral regurgitation.

A. Austin- flint murmur
B. Carvallo’s sign
C. Gallavardin phenomenon
D. Graham steel murmur

A

B

80
Q

The murmur produced by a mitral valve prolapse is:

A. systolic nonejection click
B. diastolic nonejection click
C. systolic opening snap
D. diastolic opening snap

A

A

81
Q

Most common type of ASD

A. Ostium Primum
B. Ostium Secundum
C. Membranous
D. Muscular

A

B

82
Q

The following are usual physical findings in ASD except

A. Dilated MPA
B. Wide fixed split S2
C. Grade 2/6 systolic ejection murmur
D. Grade 3/5 holosystolic murmur at
2nd-4th ICS
A

D

83
Q

The pathophysiology of this congenital pathology is the atrialization of the RV inflow tract:

A. Ebstein’s anomaly
B. Tetralogy of Fallot
C. Lutembacher’s anomaly
D. Einstein’s anomaly

A

A

84
Q

What condition refers to hypertension of the upper extremities and relative hypotension of the lower extremities?

A. ASD
B. PDA
C. CoA (Coarctation of the aorta)
D. TOF

A

C

85
Q

Which of the following is not a feature of Tetralogy of Fallot?

A. Ventricular septal defect
B. Obstruction of the left ventricular outflow tract
C. Overriding aorta
D. Right ventricular hypertrophy

A

B

86
Q

Which of the following is not an indication for surgery in PDA:

A. Presence of respiratory distress
B. Small defects
C. hemodynamically significant PDA
D. Failure of 2 courses of indomethacin

A

B

87
Q

The following statements regarding Tetralogy of Fallot are true, EXCEPT:

A. TOF can be managed medically.
B. Surgery should be done before collaterals develop.
C. Only 3% are alive by the age of 40 years old.
D. Most children are not cyanotic at birth due to partial mixing of blood.

A

A

88
Q

In this congenital defect, the aorta arises from the RV and the pulmonary artery arises from the LV.

A. Tetralogy of Fallot
B. Transposition of the Great Arteries
C. Total anomalous pulmonary venous return
D. Tricuspid valve atresia

A

B

89
Q

An infant presents with cyanosis at birth. Which of the following should first be considered?

A. ASD with eisenmengerization
B. PDA
C. Transposition of the great arteries
D. Tetralogy of fallot

A

C

90
Q

Which of the following is more common in females?

A. Coarctation of aorta
B. Transposition of the great arteries
C. Tetralogy of fallot
D. Atrial septal defect

A

D

91
Q

The following are true statements EXCEPT:

a. ASD can cause right ventricular enlargement
b. Acyanotic congenital heart diseases usually result to increased vascular markings on chest x-ray
c. The most common left-to-right shunt is a ventricular septal defect
d. Congenital pulmonic stenosis will present with increased vascular markings on chest x-ray

A

D

92
Q

A 3 year old child was noted to have increased vascular markings on chest xray. You note left ventricular hypertrophy on examination and imaging. Your differentials for this include the following EXCEPT:

A. VSD
B. ASD
C. PDA
D. CAVSD

A

B

93
Q

A chest x-ray showing an egg-shaped appearance is suggestive of:

A. Tetralogy of Fallot
B. Partial Anomalous Pulmonary
Venous Return
C. Total Anomalous Pulmonary Venous
Return
D. Transposition of Great Arteries
A

D

94
Q

The following are usually present in congenital pulmonic stenosis, EXCEPT:

A. Right ventricular heave on PE
B. Right atrial enlargement on chest xray
C. Left ventricular hypertrophy on 2D echo
D. Right axis deviation on ECG

A

C

95
Q

A 5 year old child brought to the ER for severe distress. Tachycardic with distant heart sounds. You will request the following test:

A. Ekg will show sinus arrhytmia
B. Chest x-ray will show water bottle sign
C. Echocardiogram will show large VSD
D. CBC will show hemoglobin of 10gm%

A

B

96
Q

Systole occurs:

A. When semilunar valves are open
B. when tricuspid valves are open
C. During ventricular relaxation
D. After aortic valve closes

A

A

97
Q

Most common cyanotic heart disease in toddlers and older children

A. Tetralogy of Fallot
B. Hypoplastic left heart syndrome
C. Ebstein anomaly
D. Transposition of the Great Arteries

A

A

98
Q

A 6 month old premature infant presented with heart failure. Which cardiac finding will make you suspect that the heart failure was caused by PDA?

A. Continuous thrill at LUSB
B. LV heave
C. diastolic thrill at suprasternal area
D. RV heave

A

A

99
Q

13/F with an acyanotic heart disease presents with clubbing and dusty eyes. Which of the following will be expected in a patient with pulmonary hypertension?

A. Systolic ejection murmur
B. Bounding pulse
C. Loud S2
D. Widened pulse pressure

A

C

100
Q

Apart from poor lower extremity pulses, what findings will characterize severe coarctation of aorta with PDA?

A. A systolic ejection murmur at the L upper sternal border
b. bounding pulses at the R upper extremity
C. Dusky lips
d. clubbing of nailbeds of lower extremity

A

D

101
Q

In the Philippines, secondary prophylaxis for rheumatic fever is given as:

A. 600, 000 U, IM every 21 days
B. 1, 200, 000 U, IM every 21 days
C. 600, 000 U, IM every 28 days
D. 1, 200, 000 U, IM every 28 days

A

B

102
Q

Which is the etiologic agent causing rheumatic fever:

A. Strep. pyogenes
B. Strep. Pneumonia
C. Group A Alpha-hemolytic strep
D. Group A Beta-hemolytic strep

A

D

[OS 213] Q1 (6 decks)

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