Total collection Flashcards

Question 1

Q

FOG-2
The location of the oral orifice of the Stenon’s duct (parotid gland’s duct):

A) in the vestible at the upper premolars’ region
B) in the cavum oris proprium( oral cavity) at the second upper molars
C) in the vestible at the upper canines’ region
D) in the vestible at the upper second molars
E) in the vestible at the upper first molars’ region

Answer

A

D) in the vestible at the upper second molars

EXPLANATION
The Stenon’s duct is the duct of the parotid gland it enters into the vestibule of the oral cavity at the upper second molars, creating a small nodule named as Caruncula

Question 2

Q

FOG - 3

Which drug’s characteristic side effect is the dry mouth syndrome (Xersotomia)

A) Lidocain (lidocainium chloratum anhydricum)
B) Troparin (papaverinium sulfuricum + methylhomatropinum bromatum)
C) Papaverinum (papaverinium chloratum)
D) Eunoctin (nitrazepamum)
E) Tarivid (ofloxacinum)

Answer

A

B) Troparin (papaverinium sulfuricum + methylhomatropinum bromatum)

EXPLANATION
The Troparine’s side effect is the xerostomia ( see also FOG 27) The other listed drugs have no effect on the salivation

Question 3

Q

FOG - 4

The leading sign of the chronic osteomyelitis is:

A) sequestration
B) leukopenia
C) fibrinous exsudate
D) high fever
E) mostly associated with rheumatic complains

Answer

A

A) sequestration

EXPLANATION
The leading sign of the chronic osteomyelitis is the sequestration, the body’s chronic response. The other symptoms are characteristic to acute inflammation and or the inflammation of the cortical bone

Question 4

Q

FOG - 5
Which is a precancerous lesion?

A) fibromatosis gingivae
B) lingua pilosa nigra
C) Fordyce’s granules
D) geographic tongue
E) leukoplakia

Answer

A

E) leukoplakia

EXPLANATION
The leukoplakia (white plaque) is a premalignant lesion and the prevalence of malignant transformation is ranging between 2-6% (see also FOG.93) The other entities are not premalignant conditions

Question 5

Q

FOG - 6
The management of an abscess developed at deciduous teeth

A) immediate extraction
B) access cavity preparation with open therapy
C) access cavity preparation and putting a filling afterwards
D) the abscess is eliminated with a Volkmann curette
E) access cavity preparation and the abscess is drained and excavated

Answer

A

E) access cavity preparation and the abscess is drained and excavated

EXPLANATION
It is no use to extract the deciduous molars – because of their space maintaining rolls. The filling is an inadequate therapy . The access cavity preparation or the drainage of the parulis will not solve the case. A comprehensive therapy should be performed.

Question 6

Q

FOG - 7

The consequence of the use of pacifier soaked in candy :

A) caries at the upper and lower central incisors
B) gingivitis
C) periodontitis
D) circular caries on the four upper deciduous incisors
E) all of them

Answer

A

D) circular caries on the four upper deciduous incisors

EXPLANATION
The pacifier soak in candy or the very sweet tea given from a bottle thru a nipple can cause very characteristic lesion- the so called circular caries. It is located on the upper deciduous incisors. A dark brown lesion develops around the cervical area of the crown, later a real decay is formed and can lead to crown fracture.

Question 7

Q

FOG - 8
It is a characteristic disease located on the soft palate:

A) aphthous stomatitis
B) herpangina
C) flue
D) morbilli ( measles)
E) pertussis (whooping cough )

Answer

A

B) herpangina

EXPLANATION
Only the vesicles of herpangina are located solely on the soft palate. The oral lesion associated with Morbilli (see FOG-1). The common flue and pertussis (whooping cough) have no characteristic oral symptoms. The aphthous stomatitis does not cause vesicle, it is an ulcer located on the lip, buccal mucosa the tongue or soft palate.

Question 8

Q

FOG - 9
The optimal fluoride intake at the age of one year :

A) should not be given
B) 0,05 mg
C) 0,3 mg
D) 0,1 mg
E) 1,0 mg

Answer

A

C) 0,3 mg

EXPLANATION
In a non fluoride supplemented environment the optimal dose that has caries protective effect, and does not damage the enamel and has no systemic side effects or poisoning effects is 0,3 mg. the 0,15-0,2x of the adult dose.

Question 9

Q

FOG - 10
According to the Miller’s caries theory:

A) Adenylphosfate is provided by the saliva for the fermentation of carbohydrate in the dental plaque
B) The initial caries is caused by the bacterial penetration into the enamel
C) Lactic acid is produced in the dental plaque
D) A caries is mainly caused by anaerobic microorganisms
E) The protein content of the tooth is a decisive factor in the development of dental caries

Answer

A

C) Lactic acid is produced in the dental plaque

EXPLANATION
The father of the modern caries theory is Miller, according to this the cause of disease is the low acidic pH. Int he dental plaque the Streptococcus mutans, sanguis, salivarius ferment the sugar and create lactic acid, as a consequence the plaque become acidic and the acids will solve- demonetize the enamel prism.

Question 10

Q

FOG - 11
What is characteristic of the so called cariogenic plaque?

A) It can develop on any tooth surface
B) its dominant bacterial flora is organized from lactobacilli and acidifying streptococci
C) it is bacterium-free
D) its pH is always above 6.3
E) in can be recognized by naked eye

Answer

A

B) its dominant bacterial flora is organized from lactobacilli and acidifying streptococci

EXPLANATION
Cariogenic plaque can only be formed on the so called non self-cleaning tooth surfaces. The plaque contains several different microbial species that sometimes can only be detected by plaque disclosing agents (see –also FOG 110)

Question 11

Q

FOG - 14
The optimal fluoride content of table salt

A) 1,25 mg/kg
B) 250 mg/kg
C) 25 mg/kg
D) 50 mg/kg
E) 150 mg/kg

Answer

A

B) 250 mg/kg

EXPLANATION
In the Hungarian cuisine 250mg/kg fluoridated table salt has an equivalent protective effect like a 1mg/l fluoridated water. The 150mg/kg content is only a supplement and the lower doses have no caries protective effects.

Question 12

Q

FOG - 15
What is the cause of the gingival enlargement in leukaemia ?

A) infiltration by malignant cells
B) reactive fibrosis
C) haemangioma
D) capillary rigidity
E) neither of them

Answer

A

A) infiltration by malignant cells

EXPLANATION
The early sign of acute leukemia is the swelling of the interdental gingiva, the spontaneously bleeds ,and finally necrotized creating ulcers. (see also FOG-1) It is caused by the infiltrating malignant hematological cells.

Question 13

Q

FOG - 16
The management of pregnancy gingivitis :

A) gingivoplasty
B) topical metronidazole application
C) broad spectrum antibiotics
D) improved oral hygiene
E) neither of them

Answer

A

D) improved oral hygiene

EXPLANATION
The gingivitis was considered as one of the physiological symptoms of the pregnancy hormonal changes. After delivery and the finish of lactation it well recede but only the prefect oral hygiene can cure the disease. Medication or surgery is contraindicated. The best remedy is the perfect oral hygiene even during pregnancy.

Question 14

Q

FOG - 17
The characteristic sign of pulpal hyperemia :

A) cold water will alleviate pain
B) the tooth is sensitive to percussion
C) it is a reversibly phenomenon
D) it is an irreversibly phenomenon
E) it is caused by antihypertensive drugs

Answer

A

C) it is a reversibly phenomenon

EXPLANATION
The inflammatory hyperemia leads to the elevation of the blood pressure in the pulp chamber, this irritates the cells. The very sudden sharp pain can spontaneously recede. If it frequently returns it sooner or later will progress to pulpitis. It is the irreversibly damage of the dental pulp. The thermal insults can aggravate the process, sensitivity to percussion is not experienced.

Question 15

Q

FOG - 18
The salivary flow will not enhanced :

A) Sjögren’s syndrome
B) acute heavy metal poisoning
C) during dental treatment
D) trigeminal neuralgia
E) in epileptic attack

Answer

A

A) Sjögren’s syndrome

EXPLANATION.
The mechanical, chemical and neurogenic stimuli can enhance the salivation. In this way the B,C.D are associated with elevated flow rate. The Sjogren’s disease , the autoimmune disease of the major salivary glands is associated with severe xresotomia. In this disease the mouth is totally dry and salivation cannot be stimulated.

Question 16

Q

FOG - 19
The biological effect of vitamin-A on the oral mucosa :

A) inflammation
B) increased keratinization
C) atrophy
D) hyperplasa
E) angular cheilitis

Answer

A

B) increased keratinization

EXPLANATION
In vitamin-A deficiency –the is considered as an epithelial protective vitamin increased mucous membrane keratinization occurs. The other lesions listed are not directly associated with the vitamin-A deficiency.

Question 17

Q

FOG - 20
It is not characteristic of ostitis alveolaris (dry socket):

A) oral malodor
B) inflammation around the alveolar socket
C) severe pain at the day of extraction
D) general malaise
E) fever

Answer

A

C) severe pain at the day of extraction

EXPLANATION
The dry socket (alveolar ostitis) develops a couple of days after the extraction. Its main cause is the early degradation of the blood clot or the insufficient blood clot formation in the socket.

Question 18

Q

FOG - 21
Usually the nearest tooth to the basis of the maxillary sinus is:

A) the upper wisdom tooth
B) the palatal root of the upper first premolar
C) the upper second molar
D) the distal root of the upper second premolar
E) the upper first molar

Answer

A

C) the upper second molarEXPLANATIONUsually in 45% of the cases the upper second molars’ roots are in the nearest position to the alveolar recess of the maxillary sinus. Sometimes the sinus floor protrudes into the interradicular area between the mesial and palatal roots. The next is the first molar (30%) and followed by the wisdom tooth (27%) according to the approximation. It is very rare that the sinus protrudes until the apex of the first premolar

Question 19

Q

FOG - 22
What does it mean „ the completion of the dental arch” ?

A) the eruption of the wisdom tooth
B) the eruption of a mesiodens
C) the eruption of a supernumeraly tooth
D) the eruption of the lower first permanent molar
E) all of them

Answer

A

D) the eruption of the lower first permanent molar

EXPLANATION
During the eruption of the first permanent molars the dental arch built up of 5 teeth by quadrants will be completed, in this way those teeth will not be exploited or changed and any damage on those teeth will be irreversible. Therefore those teeth need more attention and care from the dentist and parents.

Question 20

Q

FOG - 23
The characteristic sing of periodontal abscess :

A) develops after the obturation of the orifice of the pocket
B) strong pulsating pain
C) the involved tooth has vital sign
D) a putrid charge from the sulcus
E) all of them

Answer

A

E) all of them

EXPLANATION
All the symptoms are characteristic of periodontal abscesses. The pyogenic exudates in the closed pocket will increase the pressure and this leads to acute pain and many ties can mimic the symptoms of the periapical abscess. On the other hand the tooth is vital . With pressing the pocket wall puss can be discharged from the sulcus. The location of the periodontal abscess helps the differential diagnosis, to differentiate from the acute periapical abscess. It is closer to the gingival margin than to the apex. It is usually smaller and can be drained thru the sulcus.

Question 21

Q

FOG - 24
The oral signs and symptoms of AIDS :

A) Kaposi-sarcoma
B) severe progressing periodontitis
C) leukoplakia
D) candidiasis
E) all of them

Answer

A

E) all of them

EXPLANATION
All the listed conditions might associate with AIDS, their cause is the severely compromised immune status of the patient.

Question 22

Q

FOG - 25
The lidocain cartridge/ampoule commercially delivered for dental anesthesia as

A) Inj. Lidocain 1% – Adrenalin 0,01%
B) Inj. Lidocain 2% – Adrenalin 0,1%
C) Inj. Lidocain 2% – Adrenalin 0,01%
D) Inj. Lidocain 2% – Adrenalin 0,001%
E) Inj. Lidocain 1% – Adrenalin 0,02%

Answer

A

D) Inj. Lidocain 2% – Adrenalin 0,001%

EXPLANATION
For dental infiltration and block anesthesia –unless the administration of adrenalin (epinephrine) contraindicated the proper anesthesia can be achieved with injections containing 2% lidocain (xilocain) +0,001% adrenalin. The commercial unit dose is 2 ml in brown ampoule. In general surgery 1 and 2% lidocain is used without epinephrine., but this has no adequate analgesic effect is dentistry . It can only be used for superficial soft tissue anesthesia for a short period of time. The reason is the special vascularisation of the oral tissues and the compact bony structure .

Question 23

Q

FOG - 26
salivary enzymes
1) proteases
2) maltase
3) lipase
4) amylase

A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only the 4. answer is correct
E) all the answers are correct

Answer

A

C) 2. and 4. answers are correct

EXPLANATION
In the oral cavity the fermentation of the carbohydrates are started by the salivary enzymes. If a carbohydrate containing foodstuff - like bread stays in the oral cavity for a relatively long time due to the fermentation it will be sweet. The metabolism of fat and proteins starts only in the deeper part of the GI system.

Question 24

Q

FOG - 27
Drugs decreasing salivary flow rate

1) homatropine
2) scopolamine
3) atropine
4) noscapine

A) if 1., 2. and 3. are correct
B) if 1. and 3. are correct
C) if 2. and 4. are correct
D) only the 4th answer is correct
E) if all the answers are correct

Answer

A

A) if 1., 2. and 3. are correct

EXPLANATION
The tropeins ( a structure made up by the condensation of a pyridine and pirolidine ring) even in therapeutic dose cause xerostomia, dray through, thirst and mydriasis. This sometimes can be used for the transitory inhibition of the salivation. This is very useful during impression taking or special oral exams.

Question 25

Q

FOG - 28
What can cause chronic glossitis ?

1) candidasis
2) diabetes mellitus
3) avitaminosis
4) hemophilia

A) if 1., 2. and 3. are correct
B) if 1. and 3. are correct
C) if 2. and 4. are correct
D) only the 4th answer is correct
E) if all the answers are correct

Answer

A

A) if 1., 2. and 3. are correct

EXPLANATION
The chronic glossitis is much more common than the acute one. Associated with systemic diseases the glossitis cannot be cured without controlling the background disease. The most common causes are: pernicious anemia, vitamin-B deficiency, gastrointestinal ailments candidiasis and diabetes mellitus.

Question 26

Q

FOG - 29
The characteristics of Pierre–Robin-syndrome

1) glossoptosis
2) micrognathia
3) palatoschisis
4) coarctatio aortae

A) if 1., 2. and 3. are correct
B) if 1. and 3. are correct
C) if 2. and 4. are correct
D) only the 4th answer is correct
E) if all the answers are correct

Answer

A

A) if 1., 2. and 3. are correct

EXPLANATION
The Pierre Robin syndrome (palatoschisis, micrognathia and glossoptosis) is a congenital hereditary condition. Its typical sign is the gothic palate, which frequently associated with palatourano-staphyloschisis . The lower jaw is underdeveloped and the tongue is in a retro position .

Question 27

Q

FOG - 30
Which can be a permanent trism ?

1) myogen
2) ankylosis
3) spastic
4) osteogen

A) if 1., 2. and 3. are correct
B) if 1. and 3. are correct
C) if 2. and 4. are correct
D) only the 4th answer is correct
E) if all the answers are correct

Answer

A

C) if 2. and 4. are correct

EXPLANATION
The myogenic and spastic trismus (lockjaw) might suddenly develops and usually transitory and reversible. The ankylosis and osteogenic trismus slowly develops . The most common causes: The juvenile injuries can cause hematoma in the joint that can later maturate and finally ossifys.. In extreme cases a typical bird like face develops. In adulthood the chronic rheumatoid arthritis or other degenerative diseases like Marie—Stümpfell-spondylitis can lead to irreversible trismus .

Question 28

Q

FOG - 31
The characteristic sign of amelogenesis imperfecta

1) a disturbed enamel development
2) many times the total enamel coverage is missing on the crown of the tooth
3) this affects both the disturbed matrix formation and the calcification
4) it occurs only in the permanent teeth

A) if 1., 2. and 3. are correct
B) if 1. and 3. are correct
C) if 2. and 4. are correct
D) only the 4th answer is correct
E) if all the answers are correct

Answer

A

A) if 1., 2. and 3. are correct

EXPLANATION
The amelogenesis imperfecta is a developmental disease the affects only the structure of the enamel and not the form of the crown. It is characteristic that the developing enamel is porous, soft, matt. It warns down easily and turns to brown.

Question 29

Q

FOG - 33
The characteristic signs of Down-syndrome

1) hyper salivation
2) microglossia
3) small teeth
4) very wide upper dental arch

A) if 1., 2. and 3. are correct
B) if 1. and 3. are correct
C) if 2. and 4. are correct
D) only the 4th answer is correct
E) if all the answers are correct

Answer

A

B) if 1. and 3. are correct

EXPLANATION
Down’s syndrome is a chromosomal aberration. Its general syndromes associate with characteristic facial features. Macroglossia, hypopastic teeth, and at least in 90% orthodontic abnormalities -like open bite, cross bite occur

Question 30

Q

FOG - 36
It is characteristic of the forceps used for the removal of an upper fractured root

1) the beaks closely approximate each other
2) the beaks are a straight continuation of the hinge
3) the beaks set in a wide angle to the hinge
4) the width of the beaks are divided and pointed

A) if 1., 2. and 3. are correct
B) if 1. and 3. are correct
C) if 2. and 4. are correct
D) only the 4th answer is correct
E) if all the answers are correct

Answer

A

E) if all the answers are correct

EXPLANATION
The beaks of the root tip forceps meet the tip. For upper front teeth the beaks are symmetrical and placed in the same line as the handle. For molars the beaks are at the wide angle to the handle. The size of the beaks are variable according to the diameter of the root.

Question 31

Q

FOG - 37
The symptoms of dental caries at a vital tooth :

1) sensitive to cold
2) softened dentine
3) it is sensitive to osmotic attack
4) sensitive to percussion

A) if 1., 2. and 3. are correct
B) if 1. and 3. are correct
C) if 2. and 4. are correct
D) only the 4th answer is correct
E) if all the answers are correct

Answer

A

A) if 1., 2. and 3. are correct

EXPLANATION
The caries depending of its progression shows different symptoms . The early sign of the enamel caries is the sensitivity to osmotic and thermal (cold, hot) stimuli. The dentin caries due to the further demineralisation affects the decalcified structures. Although the pathology involving only the hart tissues of the teeth will not lead to sensitivity to percussion.

Question 32

Q

FOG - 38
Drugs causing gingival hyperplasia

1) major tranquilizer drugs
2) penicillin group
3) minor tranquilizer drugs
4) dilantin –hydantoin group

A) if 1., 2. and 3. are correct
B) if 1. and 3. are correct
C) if 2. and 4. are correct
D) only the 4th answer is correct
E) if all the answers are correct

Answer

A

D) only the 4th answer is correct

EXPLANATION
Gingival hyperplasia can be side effects of many different drugs. One of them the dilantine (hydantoin) groups given to patients with epilepsy. After one or two months administration might cause gingival enlargement, The fibrotic tissues with minimal tendency to bleed sometime might cover the whole crows interfering with chewing. The proper oral hygiene in this case is very important.

Question 33

Q

FOG - 40
The symptoms of sinus apertus:

1) when the patient rinses the mouth the water flows out through the nose
2) strong arterial bleeding
3) when blowing the patient’s nose the air flows through the perforation into the oral cavity creating a whistling noise
4) an extensive hematoma

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

Answer

A

B) 1st and 3rd answers are correct

EXPLANATION
The characteristic feature of the sinus apertus is the antro-oral communication – the water/air pathological communication between the to cavities. The air can enter into the oral cavity from the nose, and the water from the oral cavity into the nose. Hematoma is not a common characteristic sign.

Question 34

Q

FOG - 41
The symptoms of Arthrosis temporomandibularis

1) compromised opening movement
2) swollen joints
3) terminal crepitation
4) deviation towards the diseased joint

A) if 1., 2. and 3. are correct
B) if 1. and 3. are correct
C) if 2. and 4. are correct
D) only the 4th answer is correct
E) if all the answers are correct

Answer

A

B) if 1. and 3. are correct

EXPLANATION
The degenerative processes associated with swelling. The opening of the mouth is compromised and the forced opening movement leads to pain. Histologically the destruction of the cartilage, calcification and sever other structural destructions can be detected. The crepitation is the most prominent early morning.

Question 35

Q

FOG - 43
It is characteristic to the central midface bone fracture:

1) diplopia
2) swollen face
3) nasal bleeding
4) liquour discharge

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

Answer

A

A) 1st, 2nd and 3rd answers are correct

EXPLANATION
The Le Fore II mid-facial fracture usually involves the bones of the orbital basis , the bones move caudally and therefore diplopia develops. The soft tissue injury leads to sudden swelling of the face, because the mimic muscle have no fascia sheets. The nasal bleeding is also a common sing. This fracture does not involves the cranial bones. The liquour discharge is not common-

Question 36

Q

FOG - 46
The characteristic sign of mandibular fracture

1) diplopia
2) the dental arch continuity is broken
3) xerostomia
4) traumatic occlusion

A) if 1., 2. and 3. are correct
B) if 1. and 3. are correct
C) if 2. and 4. are correct
D) only the 4th is correct
E) if all the answers are correct

Answer

A

C) if 2. and 4. are correct

EXPLANATION
In case of mandibular fractures the bones due to the muscle pull will be partially or totally dislocated. Characteristic the traumatic occlusion caused by the vertical displacement of the bones and the deformation of the dental arch due to the horizontal movement of the fractured bones. Diplopia and xersotomia does not occur as a side effect of mandibular fractures.

Question 37

Q

FOG - 48
The characteristic sign of acute periodontitis

1) the pain is exacerbated when the patient goes to bed
2) sensitivity to percussion
3) a sudden swelling around the tooth
4) when closing the mouth a sharp pain evoked when occluding the teeth

A) if 1., 2. and 3. are correct
B) if 1. and 3. are correct
C) if 2. and 4. are correct
D) only the 4th answer is correct
E) if all the answers are correct

Answer

A

C) if 2. and 4. are correct

EXPLANATION
The acute periapical periodontitis is sensitive to percussion and also to occlusal contact. The inflammatory exudates elevates the root from the alveolar socket ant the patients feels the involved tooth erupted. The mechanism of the pain sensation is that if the root is pressed into the inflamed tissue it reacts with severe pain. The pain occurring when the patient is a laid down position is the consequence of the pulpal hyperemia and acute pulpits. It is cause by the elevated blood pressure. The sudden swelling around tooth is a characteristic sing of periodontal inflammation

Question 38

Q

FOG - 49
In case of a closed pulpitis the anatomical situation are very disadvantageous from the inflammation point of view

1) The volume of the closed pulp cannot be expanded and one of the leading sign of any inflammations is the swelling
2) In inflammation in a closed system the inflammatory swelling leads to a pressure increase in the tissues
3) the active hyperemia is followed by a passive venous hyperemia that leads to increased pressure and finally stasis in the pulp
4) the stasis arrest the circulation in the pulp that finally results in tissue necrosis

A) if 1., 2. and 3. are correct
B) if 1. and 3. are correct
C) if 2. and 4. are correct
D) only the 4th answer is correct
E) if all the answers are correct

Answer

A

E) if all the answers are correct

EXPLANATION
An inflammation process in a closed space by the concomitant swelling will evidently lead to tissue pressure increase. The listed signs are all the causative factors or the consequences of this mechanism

Question 39

Q

FOG-51-53
Join the given words marked with letters to the proper numbers below.

A) enamel
B) dentin
C) both of them
D) neither of them

FOG - 51 - It continuously growth throughout the life
FOG - 52 - Its major histological component is the hydroxyapatite.
FOG - 53 - Its structure is highly vascularised .

Answer

A

FOG - 51 - It continuously growth throughout the life - B)
FOG - 52 - Its major histological component is the hydroxyapatite. - A)
FOG - 53 - Its structure is highly vascularised . - D)

Question 40

Q

FOG-54-57
Join the given words marked with letters to the proper numbers below.

A) periodontitis apicalis acuta
B) periodontitis apicalis chronica
C) all of them
D) neither of themFOG - 54 - It can be symptom less for a long period of time

FOG - 55 - The affected tooth is erupted from the alveolar socket
FOG - 56 - Characteristic the severe pain occurring in intermittent attacks
FOG - 57 - It can be attributed to the a consequence of dental caries

Answer

A

FOG - 54 - It can be symptom less for a long period of time - B)
FOG - 55 - The affected tooth is erupted from the alveolar socket - A)
FOG - 56 - Characteristic the severe pain occurring in intermittent attacks - D)
FOG - 57 - It can be attributed to the a consequence of dental caries - C)

Question 41

Q

FOG-58-61
Join the given words marked with letters to the proper numbers below.

A) caries media
B) caries penetrans
C) both of them
D) neither of them

FOG - 58 - It occurs only in the enamel .
FOG - 59 - It affects the pulp chamber .
FOG - 60 - It affects both the enamel and dentin
FOG - 61 - It affects only the dentin .

Answer

A

FOG - 58 - It occurs only in the enamel . - D)
FOG - 59 - It affects the pulp chamber . - B)
FOG - 60 - It affects both the enamel and dentin - A)
FOG - 61 - It affects only the dentin . - D)

Question 42

Q

FOG-62-67
Join the given words marked with letters to the proper numbers below.

A) fixed dentures (restorations)
B) partial removable dentures
C) both of them
D) neither of them

FOG - 62 - The restoration occupies more space in the oral cavity than natural teeth
FOG - 63 - In can be made without the damage of the natural teeth (the preparation of tooth structure)
FOG - 64 - It is fixed on the remaining natural teeth .
FOG - 65 - In can be made even in the case of total edentulousness .
FOG - 66 - It can be cleaned easily .
FOG - 67 - It can also be made in case of patient with a tendency to seizures

Answer

A

FOG - 62 - The restoration occupies more space in the oral cavity than natural teeth - B)
FOG - 63 - In can be made without the damage of the natural teeth (the preparation of tooth structure) - B)
FOG - 64 - It is fixed on the remaining natural teeth . - C)
FOG - 65 - In can be made even in the case of total edentulousness . - D)
FOG - 66 - It can be cleaned easily . - B)
FOG - 67 - It can also be made in case of patient with a tendency to seizures - A)

Question 43

Q

FOG-68-70
Join the given words marked with letters to the proper numbers below.

A) periapical abscess
B) periodontal abscess
C) both of them
D) neither of themFOG - 68 - Increased tooth mobility.

FOG - 69 - It can develop only from periodontal pockets
FOG - 70 - It develops after the necrosis of the dental pulp .

Answer

A

FOG - 68 - Increased tooth mobility. - C)
FOG - 69 - It can develop only from periodontal pockets - D)
FOG - 70 - It develops after the necrosis of the dental pulp . - A)

Question 44

Q

FOG-71-74
Join the given words marked with letters to the proper numbers below.

A) It is characteristic of pregnancy gingivitis
B) It is characteristic of acute ulcerative gingivitis
C) both of them
D) neither of them

FOG - 71 - It can be cured by restoring proper oral hygiene.
FOG - 72 - It theoretically can develop without the presence of dental plaque .
FOG - 73 - In its patomechanism the embolisation of the small blood vessels plays important role
FOG - 74 - If it is not treated on time it will lead to irreversible tissue defect

Answer

A

FOG - 71 - It can be cured by restoring proper oral hygiene. - C)
FOG - 72 - It theoretically can develop without the presence of dental plaque . - D)
FOG - 73 - In its patomechanism the embolisation of the small blood vessels plays important role - B)
FOG - 74 - If it is not treated on time it will lead to irreversible tissue defect - B)

Question 45

Q

FOG-75-78
Join the given words marked with letters to the proper numbers below.

A) rhinogenic sinusitis
B) odontogenic sinusitis
C) both of them
D) neither of them

FOG - 75 - Usually both extends to the both side of the maxillary sinus
FOG - 76 - It gives a positive radiological image
FOG - 77 - Its characteristic syndrome is the severe facial swelling .
FOG - 78 - Touching the area of the infraorbital nerves in the infraorbital foramen can provoke pain attacks

Answer

A

FOG - 75 - Usually both extends to the both side of the maxillary sinus - A)
FOG - 76 - It gives a positive radiological image - C)
FOG - 77 - Its characteristic syndrome is the severe facial swelling . - D)
FOG - 78 - Touching the area of the infraorbital nerves in the infraorbital foramen can provoke pain attacks - D)

Question 46

Q

FOG-79-82
Join the given words marked with letters to the proper numbers below.

A) acute osteomyelitis
B) chronic osteomyelitis
C) both of them
D) neither of them

FOG - 79 - Characteristic radiological findings .
FOG - 80 - Patient has a severe malaise .
FOG - 81 - The shivering and septic fever are very common .
FOG - 82 - Antibiotics should be administered.

Answer

A

FOG - 79 - Characteristic radiological findings . - B)
FOG - 80 - Patient has a severe malaise . - A)
FOG - 81 - The shivering and septic fever are very common . - A)
FOG - 82 - Antibiotics should be administered. - C)

Question 47

Q

FOG-83-86
Join the given words marked with letters to the proper numbers below.

A) gingival hyperplasia
B) granuloma fissuratum
C) both of them
D) neither of them

FOG - 83 - It belongs to the fibrous hyperplasia group of diseases
FOG - 84 - It is the sign of systemic disease .
FOG - 85 - Its frequent cause is the irritating effect of the ill fitting denture .
FOG - 86 - It is frequently associated with hydantoin derivates used in the therapy of epilepsy

Answer

A

FOG - 83 - It belongs to the fibrous hyperplasia group of diseases - C)
FOG - 84 - It is the sign of systemic disease . - D)
FOG - 85 - Its frequent cause is the irritating effect of the ill fitting denture . - B)
FOG - 86 - It is frequently associated with hydantoin derivates used in the therapy of epilepsy - A)

Question 48

Q

FOG-87-90
Join the given words marked with letters to the proper numbers below.

A) dental implant
B) natural root
C) both of them
D) neither of them

FOG - 87 - It is anchored in the jawbones.
FOG - 88 - It is an abutment of fixed restorations.
FOG - 89 - it is an anchoring element.
FOG - 90 - it is fixed by connective tissue.

Answer

A

FOG - 87 - It is anchored in the jawbones. - C)
FOG - 88 - It is an abutment of fixed restorations. - C)
FOG - 89 - it is an anchoring element. - D)
FOG - 90 - it is fixed by connective tissue. - C)

Question 49

Q

FOG - 91
The diabetes is a risk factor in periodontal disease BECAUSE it can cause odontoblast resorption

A) Both the statement and the reason are true, and the reason verifies the statement.
B) Both the statement and the reason are true ,but there is no relation between them
C) The statement is true the reason is false
D) The statement is false the reason is true
E) Both the statement and the reason are false

Answer

A

C) The statement is true the reason is false

EXPLANATION
The diabetic patients are more susceptibly to infections because of a decreased immune resistance. One of the cause of the different oral lesions and periodontitis is the microvasculopathy and the other is the dehydration of the tissues. The resorption of the odontoblastic cells are not causative factors and this does not occur at all.

Question 50

Q

FOG - 92
The cholinesterase inhibitors enhance the salivation, BECAUSE it will cause acetylcholine accumulation at the parasympathetic nerve endings

A) both the statement and the reason are true, and the reason verifies the statement
B) both the statement and the reason are true ,but there is no relation between them
C) the statement is true the reason is false
D) the statement is false the reason is true
E) both the statement and the reason are false

Answer

A

A) both the statement and the reason are true, and the reason verifies the statement

EXPLANATION
The parasympathetic response enhances the salivary secretion. The sympatholythic drugs, such as the cholinestherase inhibitors enhances the acetylcholine accumulation and in this way can stimulate the salivation.

Question 51

Q

FOG - 93
The leukoplakia is a precancerous lesion on the oral mucosa THERFORE it treatment is mandatory in any cases

A) both the statement and the reason are true, and the reason verifies the statement.
B) both the statement and the reason are true ,but there is no relation between them
C) the statement is true the reason is false
D) the statement is false the reason is true
E) both the statement and the reason are false

Answer

A

A) both the statement and the reason are true, and the reason verifies the statement.

EXPLANATION
One of the white lesions of the oral cavity , the leukoplakia –depending of its clinical type and histology can lead to cancer formation (3-36%) (the average incidence is 2-6%). Therefore they should be treated by specialists .

Question 52

Q

FOG - 94
The juvenile periodontal disease can be managed BECAUSE it is always caused only by local etiologic factors .
A) Both the statement and the reason are true, and the reason verifies the statement.
B) both the statement and the reason are true ,but there is no relation between them
C) the statement is true the reason is false
D) the statement is false the reason is true
E) both the statement and the reason are false

Answer

A

C) the statement is true the reason is false

EXPLANATION
In childhood the juvenile periodontitis is mostly associated with severe systemic diseases but the local causative factors (dental plaque bacteria) are also important factors in the aetiology. Depending of the systemic background disease its management and therapy can be successful

Question 53

Q

FOG - 95
During the mix dentition period even the symptom less non vital deciduous teeth are maintained BECAUSE its space maintenance role is important in the development of the permanent dental arch .

A) both the statement and the reason are true, and the reason verifies the statement.
B) both the statement and the reason are true ,but there is no relation between them
C) the statement is true the reason is false
D) the statement is false the reason is true
E) both the statement and the reason are false

Answer

A

A) both the statement and the reason are true, and the reason verifies the statement.

EXPLANATION
In case of the deciduous tooth’s preterm extraction due to the migration and shifting of the neighbouring teeth the erupting permanent teeth cannot fit properly in the dental arch. Gamed crowding dentition is formed and the tooth erupts either in extra-or intraocclusal position. Therefore in the period of mixed dentition space maintenance appliance should be used.

Question 54

Q

FOG - 96
The incipient carious lesion can heal by” restitution ad integrum” after topical fluorid therapies BECAUSE the initial demineralization is reversible

A) both the statement and the reason are true, and the reason verifies the statement.
B) both the statement and the reason are true ,but there is no relation between them
C) the statement is true the reason is false
D) the statement is false the reason is true
E) both the statement and the reason are false

Answer

A

A) both the statement and the reason are true, and the reason verifies the statement.

EXPLANATION
The incipient caries is a superficial demineralisation on the surface of enamel. If the saliva contains sufficient substrates ( calcium, phosphate and fluoride) and the pH in the local environment is beneficial for remineralisation the lesion can heal with “restitution ad integrum” (See also FOG-50)

Question 55

Q

FOG - 97
The dental caries is a fluoride deficiency disease BECAUSE the fluoride integrated into dental enamel can increase the acid resistance .

A) both the statement and the reason are true, and the reason verifies the statement.
B) both the statement and the reason are true ,but there is no relation between them
C) the statement is true the reason is false
D) the statement is false the reason is true
E) both the statement and the reason are false

Answer

A

D) the statement is false the reason is true

EXPLANATION
The caries is definitely not the consequence of the fluoride ion deficiency . Although the fluoride ions incorporated into the hydroxyapatite can facilitate the acid resistance by decreasing the acid solubility of the crystals (this is the so called dispositional prophylaxis)

Question 56

Q

FOG - 98
Even the extraction of a single tooth can lead to severe discrepancy in the articulation BECAUSE the contact point system is disrupted

A) both the statement and the reason are true, and the reason verifies the statement.
B) both the statement and the reason are true ,but there is no relation between them
C) the statement is true the reason is false
D) the statement is false the reason is true
E) both the statement and the reason are false

Answer

A

A) both the statement and the reason are true, and the reason verifies the statement.

EXPLANATION
Excepting the extraction of the wisdom teeth (no 8) even a single missing tooth can upset the harmonious occlusion leading to a disturbed articulation. One of the reason of this phenomena is the disruption of the contact point system (the contacts between the interproximal tooth surfaces) and the concomitant tooth migration, tilting and over eruption of the involved tooth.

Question 57

Q

FOG - 99
The small arteriole on the dental pulp do not form an anastomosis THEREFOR they are functionally terminal arteriole .

A) both the statement and the reason are true, and the reason verifies the statement.
B) both the statement and the reason are true ,but there is no relation between them
C) the statement is true the reason is false
D) the statement is false the reason is true
E) both the statement and the reason are false

Answer

A

D) the statement is false the reason is true

EXPLANATION
The pulpal blood vessels of multi-rooted teeth can anastamose in the pulp chamber. Because functional collateral circulation does not exist in the pup if one of the arteriole gets blocked none of the other can substitute and restore the circulation. In this way the pulpal arteriole are considered as terminal arteriole.

Question 58

Q

FOG - 100
The dental caries is a fluoride deficiency disease THEREFOR the fluoridation has a caries protective role

A) both the statement and the reason are true, and the reason verifies the statement.
B) both the statement and the reason are true ,but there is no relation between them
C) the statement is true the reason is false
D) the statement is false the reason is true
E) both the statement and the reason are false

Answer

A

D) the statement is false the reason is true

EXPLANATION
The caries is definitely not the consequence of the fluoride ion deficiency . Although the fluoride ions incorporated into the hydroxyapatite can facilitate the acid resistance by decreasing the acid solubility of the crystals (this is the so called dispositional prophylaxis)

Question 59

Q

FOG - 101
The sorbit is a tooth protective carbohydrate BECAUSE it facilitate the adhesion of the oral microorganisms

A) both the statement and the reason are true, and the reason verifies the statement.
B) both the statement and the reason are true ,but there is no relation between them
C) the statement is true the reason is false
D) the statement is false the reason is true
E) both the statement and the reason are false

Answer

A

C) the statement is true the reason is false

EXPLANATION
The fermentation of the sugar-alcohols (sorbit, xilit) is not so rapid in the oral cavity than the saccharose, therefore those are considered as tooth protective sugars. The plaque forming capacity is also limited and therefore will not facilitate the adhesion of the plaque forming bacteria.

Question 60

Q

FOG - 102
The tooth with a fistula will never cause swelling in the face BECAUSE the excaudate can be drained through the fistula tract .

A) both the statement and the reason are true, and the reason verifies the statement.
B) both the statement and the reason are true ,but there is no relation between them
C) the statement is true the reason is false
D) the statement is false the reason is true
E) both the statement and the reason are false

Answer

A

D) the statement is false the reason is true

EXPLANATION
The derange thru the fistula tract can be influenced by several factors, in this way the nature of the inflammatory exudates, the consistency of the pus and its viscosity. The direction of the progression and spread of disease and the spontaneous discharge or the development and the size of the facial oedema are essentially determined by the tissue pressures

Question 61

Q

FOG - 103
The dental restorations cause irritation in the oral cavity THEREFORE all dental restorations should be changed after a certain period of time

A) both the statement and the reason are true, and the reason verifies the statement.
B) both the statement and the reason are true ,but there is no relation between them
C) the statement is true the reason is false
D) the statement is false the reason is true
E) both the statement and the reason are false

Answer

A

B) both the statement and the reason are true ,but there is no relation between them

EXPLANATION
The dental restorations can be chemical, mechanical and electrochemical irritativ factors even immediately at insertion or later during its use. The amortisation of the restoration or the continuous change of the morphology of the biological base make it necessary to periodically change the dentures even if it actually does not cause any harm to the patients .

Question 62

Q

FOG - 104
Even the loss of a single tooth can lead to severe secondary consequences THEREFORE all missing teeth should be completed

A) both the statement and the reason are true, and the reason verifies the statement.
B) both the statement and the reason are true ,but there is no relation between them
C) the statement is true the reason is false
D) the statement is false the reason is true
E) both the statement and the reason are false

Answer

A

C) the statement is true the reason is false

EXPLANATION
Even the lack of a single tooth – i.e. upper incisor - can cause severe functional and psychological disturbances ( like speech disorder, or aesthetics). A tooth missing from the lateral dental arch can cause other type of functional problems (see- FOG 98). Nevertheless the missing wisdom tooth will not create and disturbances in the occlusion. Even the missing second molars can be accepted and do not indicate any prosthodontic rehabilitation

Question 63

Q

FOG - 105
The forceps used for the extraction of the upper molars are in pairs (left and right) because the maxillary first and second molars have two buccal roots

A) both the statement and the reason are true, and the reason verifies the statement.
B) both the statement and the reason are true ,but there is no relation between them
C) the statement is true the reason is false
D) the statement is false the reason is true
E) both the statement and the reason are false

Answer

A

A) both the statement and the reason are true, and the reason verifies the statement.

EXPLANATION
The maxillary molars have three roots one of them located palatally and the two other buccally. Consequently the buccal beaks of crown forceps are divided and tipped. It is because of the symmetry we need a left and a right upper molar forceps.

Question 64

Q

FOG - 106
The caries is a disease that occurs on certain predilection areas on the teeth THREFOR it very infrequently develops the self-cleaning tooth surfaces .

A) both the statement and the reason are true, and the reason verifies the statement.
B) both the statement and the reason are true ,but there is no relation between them
C) the statement is true the reason is false
D) the statement is false the reason is true
E) both the statement and the reason are false

Answer

A

A) both the statement and the reason are true, and the reason verifies the statement.

EXPLANATION
The development of dental caries is caused by massive plaque accumulation. On the so called self cleansing tooth surfaces where the saliva flushing effect , and the continuous abrasion by the foodstuff anticipate the pathogenic plaque formation practically no carious lesions develop. (see also FOG-11)

Answer 65

A

D) the statement is false the reason is true

EXPLANATION
The interdental embrasure spaces, the approximal smooth surfaces are really non self-cleansing surfaces and its mechanical cleaning is also difficult. Despite of these facts in young individuals the pit and fissure caries is more frequent and the approximal caries is more common in young adults.

Answer 66

A

A) both the statement and the reason are true, and the reason verifies the statement.

EXPLANATION
The ameloblast cells during the development of enamel are calcified and totally embedded into the enamel prisms. The fully matured enamel shows only certain physico-chemical “metabolisms” (demineraisation-remineralsation) It is also called as “bradytop tissue” It cannot be repaired by any other type of tissues

Answer 67

A

D) the statement is false the reason is true

EXPLANATION
The retentive factors of the upper full dentures – the adhesion, suction, anatomical retention usually enhance the stability and stabilization of the restoration In case of a lower full denture the possibilities of the retentive beneficial factors are limited . The gravity is naturally acts against the stability and adhesion but the denture plates made of acrylic is very light and do not act against the stability .

Answer 68

A

A) both the statement and the reason are true, and the reason verifies the statement.

EXPLANATION
If the dental debris is transitory and the foodstuffs do not cause any discoloration in the plaque its visual detection is complicated. Therefore some plaque disclosing agents – like erythrosine or basic fuchsine tablets or liquids are used to detect plaque. This not only helps plaque diagnosis but also assists the patients to control the proper oral hygiene and improve tooth-brushing techniques.

Answer 69

A

B) Langerhans cell

Answer 70

A

E) All of the above

Answer 71

A

D) topical glucocorticoids

Answer 72

A

E) atopic dermatitis

Answer 73

A

E) angiography

Answer 74

A

E) They are inborn skin lesions

Answer 75

A

B) which do not change over many years

Answer 76

A

B) Lupus erythematosus

Answer 77

A

C) psoriasis

Answer 78

A

B) usually mild symptoms

Answer 79

A

E) green discoloration of urine

Answer 80

A

D) erythema multiforme

Answer 81

A

E) All answers are correct.

Answer 82

A

E) All answers are correct.

Answer 83

A

E) All answers are correct.

Answer 84

A

A) Answers 1, 2 and 3 are correct.

Answer 85

A

A) Answers 1, 2 and 3 are correct.

Answer 86

A

A) Answers 1, 2 and 3 are correct.

Answer 87

A

C) Answers 2 and 4 are correct.

Answer 88

A

A) Answers 1, 2 and 3 are correct.

Answer 89

A

E) All answers are correct.

Answer 90

A

E) All answers are correct.

Answer 91

A

A) Answers 1, 2 and 3 are correct.

Answer 92

A

A) Answers 1, 2 and 3 are correct.

Answer 93

A

C) Answers 2 and 4 are correct.

Answer 94

A

E) All answers are correct.

Answer 95

A

D) Only answer 4 is correct.

Answer 96

A

A) Answers 1, 2, 3 and 4 are correct

Answer 97

A

A) Answers 1, 2 and 3 are correct

Answer 98

A

A) Answers 1, 2 and 3 are correct

Answer 99

A

BOR - 40 -
It results in usually a superficial mycosis of the scalp and trunk. If the scalp is affected, systemic antimycotic treatment is indicated. On the trunk, it is characterized by red, annular, oval or round plaques with scaling edges. - B)
BOR - 41 - It leads to a chronic dermatitis of the scalp which typically heals with scarring alopecia. - A)
BOR - 42 - It affects typically animals such as cows; in humans, it causes usually a deep tinea of the scalp (also called kerion Celsi) and tinea barbae. - D)
BOR - 43 - This is the most common pathogenic dermatophyte in Central Europe including Hungary. - C)

Answer 100

A

BOR - 44 - Pemphigus vulgaris - E)
BOR - 45 - Porphyria cutanea tarda - C)
BOR - 46 - Dermatitis herpetiformis - D)
BOR - 47 - Epidermolysis bullosa simplex - A)
BOR - 48 - Toxic epidermal necrolysis - B)

Answer 101

A

BOR - 49 - Atopic dermatitis - E)
BOR - 50 - SLE - A)
BOR - 51 - Allergic contact dermatitis - B)
BOR - 52 - Hereditary angioedema - D)
BOR - 53 - Cholinergic urticaria - C)

Answer 102

A

BOR - 54 - IgE-mediated hypersensitivity reaction - B)
BOR - 55 - Non-necrotizing granuloma formation - C)
BOR - 56 - Hypersensitivity reaction of delayed type - A)
BOR - 57 - Immune complex reaction - D)

Answer 103

A

BOR - 59 - Cat scratch disease - C)
BOR - 60 - Pustula maligna - E)
BOR - 61 - Ulcus molle - A)
BOR - 62 - Swimming pool granuloma - D)
BOR - 63 - Lupus vulgaris - B)

Answer 104

A

A) The statements in both clauses are correct, and they are causally related to each other.

Answer 105

A

B) The statements in both clauses are correct, but they are not causally related to each other.

Answer 106

A

A) The statements in both clauses are correct, and they are causally related to each other.

Answer 107

A

A) The statements in both clauses are correct, and they are causally related to each other.

Answer 108

A

E) The statements in both clauses of the sentence are false.

Answer 109

A

A) The statements in both clauses are correct, and they are causally related to each other.

Answer 110

A

E) The statements in both clauses of the sentence are false.

Answer 111

A

A) The statements in both clauses are correct, and they are causally related to each other.

Answer 112

A

C) The statement in the first clause of the sentence is true, but the second one is false.

Answer 113

A

A) The statements in both clauses are correct, and they are causally related to each other.

Answer 114

A

D) The statement in the first clause of the sentence is false, but the second one is true.

Answer 115

A

C) The statement in the first clause of the sentence is true, but the second one is false.

Answer 116

A

B) Nodular malignant melanoma

Answer 117

A

A) Surgical excision of the primary tumor

Answer 118

A

B) Dacarbazine

Answer 119

A

A) apical holosystolic murmur radiating towards the axilla

EXPLANATION
Holosystolic heart murmurs that radiate towards the axilla and are best heard at the apex are characteristic of mitral regurgitation, therefore they cannot be heard in mitral stenosis. Severe mitral stenosis might be accompanied by tricuspidal insufficiency that can cause a holosystolic, apical murmur, but it never radiates towards the axilla. The pathomechanism behind the low-frequency, diastolic murmur is the fast, turbulent flow through the stenotic mitral valve. The opening snap (o.s.) is heard as the mitral leaflets buckle in their attempt to open and it cannot be heard when the valve is severely calcified. The loud, tapping first heard sound is especially easy to notice when the heart is in sinus rhythm and when it is introduced by a presystolic murmur.

Answer 120

A

D) parenteral volume expansion

EXPLANATION
In chronic decompensated heart failure the body is in a state of fluid overload. Treatment with diuretics and mineralocorticoid-antagonists is essential. Digoxin should be given because of its positive inotropic and negative chronotropic effects, while ACE-inhibitors improve long-term survival. Parenteral administration of fluids (infusions) is contraindicated as it increases the preload on the left atrium and the left ventricle and worsens the symptoms. Acute left ventricle failure might be caused by acute myocardial infarction, hypertensive crisis or severe aortic stenosis as well since these all strain the left ventricle while bronchial asthma exerts the right ventricle.

Answer 121

A

A) asthma bronchiale

EXPLANATION
Acute left ventricle failure might be caused by acute myocardial infarction, hypertensive crisis or severe aortic stenosis as well since these all strain the left ventricle while bronchial asthma exerts the right ventricle.

Answer 122

A

B) digoxin is important in the early stage

EXPLANATION
Hypertrophic cardiomyopathy has a genetic background in most of the cases, so it is usually familial. Characteristic symptoms include syncope and it is often accompanied by mitral insufficiency because the mitral valve is primarily damaged. The valve has functional damage, too: because of the Venturi effect its anterior leaflet moves toward or contacts the interventricular septum (it is called systolic anterior motion: SAM) and the valve doesn’t close completely during systole which can result in severe mitral insufficiency (these changes can be diagnosed with echocardiography). As the hypertrophic myocardium’s ability to relaxe is damaged, the diastolic filling decreases which leads to diastolic dysfunction. Digitalis (Digoxin) is not recommended either in early or in late stages unless the disease reaches its „burn-out”, dilated phase.

Answer 123

A

C) it is often metastatic

EXPLANATION
Left atrial myxoma is the most common benign, primary neoplasm in the heart. It can be diagnosed with echocardiography because of its pathognomic features. As it is a benign, in situ tumor, metastases are extremely rare. It can mimic the auscultation characteristics of mitral stenosis by protruding into the mitral orifice and causing an obstruction during diastole.

Answer 124

A

A) it inhibits the Na-K-ATPase

EXPLANATION
Digoxin inhibits the Na/K-ATPase. This causes a temporary rise in intracellular sodium levels, which increases intracellular calcium concentration through the sodium-calcium exchanger. Consequently, it is the elevated intracellular calcium level that increases myocardium contractility and has a positive inotropic effect.

Answer 125

A

D) it significantly prolongs AV-conduction

EXPLANATION
Nitrates don’t alter atrioventricular conduction.

Answer 126

A

B) headache

EXPLANATION
The most common adverse effect of nitrate therapy is headache. In severe cases it could result in the discontinuation of the therapy but most of these headaches resolve in a few days, therefore it is recommended to continue the treatment for a few days.

Answer 127

A

E) ST segment elevation during angina

EXPLANATION
Prinzmetal angina is a unique type of angina pectoris that is caused by coronary spasm which can affect healthy and stenotic arteries, too. Chest pain is accompanied by ST segment elevation indicating subepicardial or transmural ischemia. ST segment depression during chest pain means subendocardial ischemia, while negative T waves are non-specific features. Pathologic Q waves and elevated necroenzymes are signs of myocardial infarction.

Answer 128

A

C) effort angina

EXPLANATION
Unstable angina pectoris could be defined as a new-onset angina (it presents for the first time), or it might occur with a crescendo pattern (increase in frequency, severity and duration), and it could develop at rest or sometimes during minimal exertion. Contrarily, stable or effort angina pectoris is usually provoked by the same level of exertion in the same circumstances.

Answer 129

A

B) rupture of an atherosclerotic plaque

EXPLANATION
The pathomechanism behind acute myocardial infarction is usually the rupture of an atherosclerotic plaque of a coronary artery and the following thrombus formation. The so-called soft plaques are more prone to rupture because their lipid-rich core is only covered by a thin, vulnerable fibrous cap. Coronary endarteritis is a rare cause of acute myocardial infarction.

Answer 130

A

C) –45°

EXPLANATION
The mean electrical axis is considered normal between 0° and +90° in the frontal plane. 0° leftward axis can be physiological, while a +90° axis is common in young people. A -45° axis means distinct left axis deviation, a typical feature in left anterior fascicular block.

Answer 131

A

D) cardiac stress test

EXPLANATION
Cardiac stress test is contraindicated if acute myocardial infarction is suspected. The other choices could be diagnostic steps in NSTEMI.

Answer 132

A

C) deep vein thrombosis

EXPLANATION
Deep vein thrombosis isn’t directly connected to the thrombotic processes in the coronary circulation.

Answer 133

A

A) elevated serum LDL-cholesterol level

EXPLANATION
Chronic hypercholesterolemia and changes in the LDL/HDL ratio play key roles in the pathomechanism of atherosclerosis. LDL is released into the bloodstream and the toxic metabolites of its oxidation propagate the mechanism that eventualy leads to plaque formation. Elevated LDL concentration is the most significant proatherogenic risk factor. HDL cholesterol has protective qualities. Elevated triglyceride levels are less significant but they are proatherogenic, too.

Answer 134

A

D) elevated serum HDL-cholesterol level

EXPLANATION
Risk factors are variables that are associated with the later development of atherosclerosis in healthy people. The risk factors of coronary heart disease are (among other things) stress, lack of physical exercise, elevated cholesterol, diabetes, obesity, male sex, age, smoking and family history. Metabolic syndrome X is a cluster term for several of these risk factors (impaired glucose tolerance, dyslipidemia, obesity, hypertension) and it significantly inreases the risk of atherosclerosis. Elevated HDL-cholesterol levels have a protective role against the devlopment of atherosclerosis.

Answer 135

A

A) < 1,8 mmol/l

EXPLANATION
Total serum cholesterol and HDL/LDL ratio are main factors of atherosclerosis. The target level of LDL in very high-risk patients is below 1.8 mmol/l, lower than in primary prevention.

Answer 136

A

C) embolism in the peripheral arteries

EXPLANATION
These symptoms indicate embolism as they developed quickly. Deep vein thrombosis doesn’t present suddenly, the arterial pulse is palpable and has different symptoms. In Raynaud’s syndrome the tip of the fingers are cold on both sides and it resolves spontaneously. Buerger’s disease has a gradual onset, too.

Answer 137

A

D) transfer the patient directly to the nearest PCI center

EXPLANATION
The patient has an ST Segment Elevation Myocardial Infarction (STEMI). In most of the cases this is caused by a complete coronary occlusion. The opening of the occlusion by percutaneous coronary intervention (PCI) is a life-saving procedure, any unnecessary delay increases the rate of mortality.

Answer 138

A

E) pulmonary valve stenosis

EXPLANATION
An organic heart disease that has been known since childhood and doesn’t cause any symptoms is most likely a mild pulmonary stenosis. Based on the physical examination and the mild signs and symptoms patent ductus arteriosus (its typical feature is a continuous murmur), coarctation of the aorta (elevated blood pressure on the upper limbs), ventricular septal defect (very loud systolic murmur) or the very rare Ebstein’s anomaly are highly unlikely diagnoses.

Answer 139

A

D) Austin-Flint murmur can be heard upon auscultation

EXPLANATION
The patients’ pulse in aortic stenosis is usually parvus et tardus (slow-rising and anacrotic). A hemodynamically significant aortic stenosis might cause exercise-related syncope. The chest pain that is typically associated with ischemic heart disease might occur in significant aortis stenosis. The increased preload of the heart induces concentric left ventricular hypertrophy. Its severity can be measured with echocardiography. Severe left ventricle might cause strain signs on the ECG. The Austin-Flint murmur can be heard in aortic regurgitation and not in aortic stenosis.

Answer 140

A

C) it usually doesn’t lead to left ventricle dilation.

EXPLANATION
The patients’ pulse in aortic insufficiency is usually celer et altus (rapidly increasing and suddenly collapsing). It might have a rapid onset (e.g. infective endocarditis, aortic dissection), but its chronic form is the most common. In young adults it is usually predisposed to by congenital bicuspid aortic valve. Aortic regurgitation increases the risk of infective endocarditis because the blood forcefully, turbulently regurgitates from the aorta into the left ventricle. Hemodynamically significant, chronic aortic insufficiency leads to substantial left ventricle dilation through volume overload.

Answer 141

A

C) lidocaine

EXPLANATION
Drugs that delay the conduction in the AV node or in the bundle are able to terminate an AVRT. Lidocaine doesn’t have this effect. Ablation can be done during tachycardia (e.g. incessant AVRT).

Answer 142

A

C) atrial fibrillation with bundle branch block

EXPLANATION
Atrial fibrillation might have narrow and wide QRS complexes, too, but it is always an irregular rhythm. Monomorphic ventricular tayhcardia (most common in patients after myocardial infarction) has a regular rhythm with wide QRS complexes. Antidromic atrioventricular tachycardia has a regular rhythm, too. The ventricular activation happens through an accessory pathway which results in pre-excited, wide QRS complexes. Supraventricular tachycardia with (either right or left) bundle branch block always creates wide QRS complexes and has a regular rhythm. Atrial flutter might appear as regular tachycardia if it has a fixed conduction or as an irregular rhythm if the AV-block is variable.

Answer 143

A

A) pharmacological cardioversion

EXPLANATION
The patient is hemodynamically stable, doesn’t require immediate electrical cardioversion and long-term anticoagulation is not needed in atrial fibrillation that is only a few hours old. Exercise testing and coronarography are later diagnostic steps if ischemic heart disease is suspected. Pharmacological cardioversion is the logical first step.

Answer 144

A

B) atrial fibrillation

EXPLANATION
The prevalence of atrial fibrillation is 0.4-14% depending on the age, which means that it the most common permanent (longer than 30 seconds) arrhythmia. Everyone has ventricular extrasystoles but they are not permanent. The other arrhythmias aren’t nearly as common as atrial fibrillation.

Answer 145

A

B) torsade de pointes ventricular tachycardia induced by the medications

EXPLANATION
Both Class III antiarrhythmic agent amiodarone and fluoroquinolone antibiotics can prolong the QT interval (long QT syndrome). Their concomitant administration increases the chance of polymorphic ventricular tachycardia (torsade de pointes), syncope because of ventricular arrhythmia and sudden cardiac death. At the onset of these symptoms the therapy or therapies should be immediately discontinued.

Answer 146

A

A) pathologic Q waves

EXPLANATIONS
T segment elevation with lasting chest pain are characteristic of ST Segment Elevation Myocardial Infarction. However, in Non-ST-Segment Myocardial Infarction the ECG findings range from ST segment depression to T wave inversion. Sometimes the first ECG recording of a severe myocardial infarction already shows ventricular fibrillation. The manifestation of pathologic Q waves takes hours, sometimes days.

Answer 147

A

C) previous myocardial infarction

EXPLANATION
The typical ECG findings of acute myocardial ischemia are ST segment elevations and depressions. ST segment depression and T wave abnormalities (changes in amplitude, inversion) indicate subendocardial ischemia. During the progression of a myocardial infarction these changes are accompanied by a decrease in R wave amplitude, the appearing of pathologic Q waves and T wave inversion. In the recovery phase of the myocardial infarction the ST segment becomes isoelectric and in most cases the T wave normalizes, too. The pathologic Q wave is permanent. If the ST segment stays elevated for more than 2-3 weeks after the onset of the symptoms, a left ventricle aneurysm is likely.

Answer 148

A

B) exercise test

EXPLANATION
The patient’s symptoms are most likely to be caused by significant coronary artery disease. Unless stress testing is contraindicated, an exercise test should be the next step. If significant ST segment changes appear during the test, then an invasive diagnostic procedure is necessary. If the results of the stress test are questionably or the symptoms are atypical, diagnostic imaging tests (echocardiography, coronary CT angiography) or stress tests with imaging (stress echocardiography, stress MRI) should be considered. Holter ECG is not suitable to detect significant coronary artery disease, this test is only recommended if we need additional information (e.g. the duration of ischemic burden, possibility of Prinzmetal angina).

Answer 149

A

C) atropine

EXPLANATION
Myocardial infarction, especially posterior wall infarction often induces bradycardia. These usually respond well to atropine since they are partially caused by an increase in vagal tone. Sympathomimetic drugs should be avoided because they raise the myocardial oxygen demand which is unfavorable in ischaemia. Although diaphyllin elevates the heart rate but it should be avoided in myocardial infarction because of its proarrhythmogenic effect.

Answer 150

A

B) cough

EXPLANATION
The most common side effect of ACE inhibitor therapy is cough (5-10%). It is a consequence of the elevated bradykinin concnentration (its metabolism is inhibited). All of the other side effects are rare or non-existent.

Answer 151

A

E) All of the answers are correct

EXPLANATION
Patients with aortic insufficiency have increased cardiac output because of the regurgitated volume. In thyreotoxicosis the thyroid hormone accelerates the circulation which also leads to a higher cardiac output. Beriberi (vitamin B1 deficiency) can induce a special form of dilated cardiomyopathy with extremely high cardiac output, so all of these conditions can lead to systolic hypertension. Arteriosclerosis causes systolic hypertension through the increased vascular resistance.

Answer 152

A

A) Answers 1, 2 and 3 are correct

EXPLANATION
Arteriosclerosis, Marfan’s snydrome and vascular syphilis can all cause aortic aneurysm. All of these diseases damage the arterial wall’s tunica media that leads to its weakening, the loss of its elastic elements and the consequent dilation (aneurysm). Aneurysm formation is unusual in giant-cell arteritis, its characteristic feature is the throbbing pain of the temporal arteries.

Answer 153

A

E) All of the answers are correct

EXPLANATION
The most common causes of pericarditis are tuberculosis, uremia, metastatic cancer and (less frequently) transmural myocardial infarction.

Answer 154

A

E) All of the answers are correct

EXPLANATION
Secondary or specific cardiomyopathies can be caused by endocrine disorders, e.g. hyperthyroidism (dilated cardiomyopathy); deficiency diseases, e.g. beriberi (vitamin B1 deficiency) might induce dilated cardiomyopathy while amyloidosis can precipitate restrictive infiltrative cardiomyopathy; and metabolic (storage) diseases, like glycogenosis can lead to hypertrophic-restrictive secondary cardiomyopathy.

Answer 155

A

E) All of the answers are correct

EXPLANATION
Due to the inhibition of the ACE the serum level of angiotensin II decreases in parallel with an increase in the production of bradykinin and a reduction in blood pressure. In heart failure the increased pre- and afterload lead to the gradual dilation and remodeling of the left ventricle and its ejection fraction progressively deteriorates. Treatment with ACE-inhibitors decelerates this process.

Answer 156

A

C) Answers 2 and 4 are correct

EXPLANATION
Aspirin works by inhibiting the cyclooxigenase enzyme and by blocking the synthesis of prostacyclin. Several multicenter trials proved that low-dose aspirin reduces cardiovascular mortality. Heparin enhances the activity of antithrombin-III and thus has an anticoagulant effect by inhibiting the fibrinogen-thrombin reaction. Both intravenous and subcutaneous heparin have a rapid onset of action. Fibrinolytics (e.g. alteplase) are used to dissolve fibrin-bound thrombin.

Answer 157

A

B) Answers 1 and 3 are correct

EXPLANATION
Furosemide and chlortalidone can occasionally provoke gout by reducing uric acid excretion. Spironolactone can cause gynecomasty through its antialdosterone effect. Etacrynic acid (and furosemide) therapy can lead to temporary, and in some cases permanent hearing loss.

Answer 158

A

E) All of the answers are correct

EXPLANATION
The risk factors of ischemic heart disease are variables that have a positive correlation with the development and progression of atherosclerosis. These are: smoking, lack of physical exercise, obesity, hyperlipidemia (hypercholesterolemia, hypertriglyceridemia), diabetes mellitus, hypertension, age, male sex, family history (a history of coronary heart disease or its risk factors in the family).

Answer 159

A

E) All of the answers are correct

EXPLANATION
Heart-rate-lowering beta-blockers reduce both mortality and (through their antiarrhythmic effect) the risk of sudden cardiac death in patients after acute myocardial infarction. They also reduce the oxygen demand of the myocardium, decrease myocardial ischaemia and are especially recommendatory in cases of hypertension and ventricular arrhythmias. It has also been proven that inhibition of platelet aggregation has a favorable effect on survival, microcirculation, vasoconstriction and atherogenesis. Inhibition of HMG-CoA reductase: by lowering serum cholesterol statins mitigate and even reverse atherogenesis. Several clinical trials proved that reducing serum total cholesterol, LDL and triglycerides (all major risk factors of ischaemic heart disease) improve the survival and quality of life of patients suffering from coronary artery disease. 4S (Scandinavian Simvastatin Survival Study) was the first large-scale (n=4444) clinical trial to prove their favorable effect on survival: mortality decreased by 30%, coronary-mortality by 42% and myocardial infarction by 37% during the 8-year follow-up. ACE inhibitors: their most important effect is to stop the postinfarction remodeling, therefore (unless contraindicated) all patients who have suffered a myocardial infarction should be given ACE inhibitors as soon as possible.

Answer 160

A

A) Answers 1, 2 and 3 are correct

EXPLANATION
Methods to measure the metabolism of the myocardium in vivo: positron-emission tomography (PT) and thallium-201 myocardial perfusion scintigraphy. Low-dose dobutamine stress helps the motion of the viable myocardium walls through its positive inotropic effect. PET is highly sensitive and specific in detecting perfusion-metabolism mismatches. Myocardial perfusion scintigraphy using Tl-201 reinjection is highly sensitive but it is less specific while dobutamin stress testing is very specific but has a slightly lower sensitivity. Conventional Doppler ultrasound isn’t suitable for determining myocardial viability, but the newer tissue Doppler ultrasound seems to be promising.

Answer 161

A

B) Answers 1 and 3 are correct

EXPLANATION
The 1. and 3. answers are absolute contraindications of exercise stress tests. In chronic heart failure symptom-limited exercise testing is a safe and optimal way to measure the patient’s current condition. Beta-blocker treatment (an essential medication of ischemic heart disease) doesn’t contraindicate exercise stress testing but it limits the maximum achievable heart rate and might prevent the appearance of repolarization abnormalities and arrhythmias.

Answer 162

A

A) Answers 1, 2 and 3 are correct

EXPLANATION
The first-line diagnostic test of ischemic heart disease is exercise testing. If the results are questionable or if the test is contraindicated then the next step is stress echocardiography using dobutamine. Ischemic signs (ST segment depression or wall motion abnormalities) without any symptoms indicate silent ischemia. Holter ECG monitor can be used to detect episodes of angina to determine a silent/symptomatic ratio. Ambulatory Blood Pressure Monitoring, a 24-hour measurement of blood pressure is obviously unable to detect silent ischemia.

Answer 163

A

E) All of the answers are correct

EXPLANATION
Cardiogenic shock can be an early complication of acute myocardial infarction. Ventricular fibrillation can be an early ischemic complication and because of the ischemic scarring it can present in the later stages, too. Left ventricular aneurysm is considered a late complication. Pericardial effusion typically develops 4 to 6 weeks after the infarction and it is a consequence of pericarditis (Dressler’s syndrome).

Answer 164

A

E) All of the answers are correct

EXPLANATION
Early stages of heart failure are treated conservatively with medication. However, in severe heart failure non-pharmacologic treatment options (in addition to pharmacotherapy) have recently been given a more important role. Examples are cardiac resynchronization therapy, mechanical circulatory support devices and as a final option, heart transplant.

Answer 165

A

B) Answers 1 and 3 are correct

EXPLANATION
Stress and smoking are well-known risk factors of atherosclerosis. AV-nodal reentry tachycardia doesn’t have a role in the development of atherosclerosis, but if it presents frequently and for longer durations, it might cause tachycardia-induced cardiomyopathy. Hypotension, unlike hypertension, is not an atherosclerotic risk factor.

Answer 166

A

A) Answers 1, 2 and 3 are correct

EXPLANATION
Statins can reduce serum cholesterol levels. They work by inhibiting the HMG-COA reductase and the intracellular cholesterol production. Currently the most effective statins are rosuvastatin and atorvastatin. Ezetimibe lowers serum cholesterol levels by blocking the absorption of cholesterol in the small intestine. They are mostly used in combination with statins. Ivabradine acts by blocking the If (funny) Na-K channel, it is used to decrease resting sinus heart rate in ischemic heart disease.

Answer 167

A

A) Answers 1, 2 and 3 are correct

EXPLANATION
Elevated serum triglyceride levels were considered to be the risk factors solely of pancreatitis but recently it has been recognized as a risk factor of coronary heart disease. It can be lowered by diet, fibrates and niacin. Statins (with a few exceptions) only have a modest effect on triglyceride levels. Moderate to heavy alcohol intake raises triglyceride levels.

Answer 168

A

E) All of the answers are correct

EXPLANATION
Prinzmetal angina is caused by coronary vasospasm that can affect healthy and stenotic arteries, too. The symptoms usually present in the early morning at rest and temporary ST segment elevation can be seen on the ECG.

Answer 169

A

A) Answers 1, 2 and 3 are correct

EXPLANATION
Blood clots that break off from deep vein thrombi can cause pulmonary embolism and infarction. Crural ulcers are local complications. Raynaud’s syndrome consists of vasospastic attacks, it is not a thromboembolic disease.

Answer 170

A

E) All of the answers are correct

EXPLANATION
Atherosclerosis can cause a wide range of symptoms depending on which vessels are affected.

Answer 171

A

E) All of the answers are correct

EXPLANATION
ST segment elevation in the precordial leads is not exclusive for myocardial infarction. Pericarditis and myocarditis can cause ST elevation (sometimes in every lead), too. Acute pancreatitis might present with aspecific ST segment and T wave abnormalities. Pulmonary embolism can mimic the ECG findings of a posterior wall myocardial infarction.

Answer 172

A

A) Answers 1, 2 and 3 are correct

EXPLANATION
CK-MB, troponin and LDH serum levels can be used in the diagnostic workup of myocardial damage. Elevated alkaline phosphatase levels indicate gastrointestinal, bone or hematologic diseases.

Answer 173

A

C) Answers 2 and 4 are correct

EXPLANATION
Chest pain with ST elevation might be the sign of myocardial infarction and aortic dissection, too. Peptic ulcers and mitral valve prolapse can both cause chest pain but they don’t cause ST segment elevation.

Answer 174

A

D) Only answer 4 is correct

EXPLANATION
The onset of Dressler’s syndrome is typically three weeks after myocardial infarction and it presents with recurring chest pain and fever but cardiac marker levels are usually normal. In reinfarctions and pulmonary embolism cardiac enzymes are often elevated. Although lobar pneumonia can not be ruled out, in the combination of the above-mentioned findings you should always think of Dressler’s syndrome at first instead of other, less likely diagnoses.

Answer 175

A

E) All of the answers are correct

EXPLANATION
Significant mitral regurgitation can lead to the dilation of every heart chamber because of the substantial volume overload. A number of acute mitral regurgitations are caused by infective endocarditis through the destruction of the valve. In hemodynamically significant mitral regurgation the left atrial pressure can be notably elevated. The left ventricle ejection fraction might be preserved for a long time because during the ventricular systole the left ventricle empties itself quite easily into the left atrium. Symptomatic cases with significant left ventricle dilation might require surgical solutions.

Answer 176

A

C) Answers 2 and 4 are correct

EXPLANATION
Mitral stenosis increases the risk of thrombus formation in the left atrium. It can be a late complication of rheumatic fever. The narrowing of the mitral valve predisposes to atrial fibrillation. Muffled first heart sound and mesosystolic click are not characteristic auscultation findings of mitral stenosis. A loud first heart sound and an opening snap can be heard in patients with mitral valve stenosis.

Answer 177

A

E) All of the answers are correct

EXPLANATION
During the echocardiographic assessment of isolated aortic stenosis the left ventricle has a normal size, but concentric left ventricle hypertrophy can be visualised. The parasternal diameter of the left atrium is often abnormally large. The pathologic transvalvular gradient can be measured in four chamber view at the level of the aortic valve.

Answer 178

A

E) All of the answers are correct

EXPLANATION
During the echocardiographic assessment of isolated mitral stenosis the following signs are characteristic: increased left atrium end-systolic diameter and the unidirectional movement of the anterior and posterior leaflets in M-mode. A pathologic transvalvular gradient can be measured at the level of the mitral valve during diastole. In 2D-echo the mitral calcification can be visualised.

Answer 179

A

A) Answers 1, 2 and 3 are correct

EXPLANATION
Mitral valve prolapse syndrome is quite common in Marfan’s syndrome and it can cause chest pain and ventricular extrasystoles. The opening snap cannot be heard, as it can be evidence of mitral and tricuspidal stenosis, too.

Answer 180

A

A) Answers 1, 2 and 3 are correct

EXPLANATION
Point mutations of the genes that code different parts of the sarcomer (beta-myosin heavy chain, troponin T, tropomyosin, myosin-binding protein C) can be detected in most cases of hypertrophic cardiomyopathy. Septal hypertrophy can cause left ventricle outflow obstruction and a systolic gradient. The sudden cardiac deaths of hypertrophic cardiomyopathy patients are most likely caused by ventricular arrhythmias. Beta-blockers are the recommended first-line therapy because with the right dosage they decrease ventricular contractility and they can reduce the outflow obstruction. In addition to this they have antiarrhythmic potential, too.

Answer 181

A

C) Answers 2 and 4 are correct

EXPLANATION
Basically everyone has ventricular extrasystoles. They are considered important only if they accompany organic heart diseases, especially after myocardial infarction. So far no medication has been proven to improve survival by decreasing the number of ventricular extrasystoles and a few of them (Class Ic agents) worsened mortality. Ventricular extrasystoles that present without any symptoms and/or without organic heart disease don’t require any treatment, but in cases of frequent, symptomatic, monomorphic extrasystoles ablation therapy should be considered to prevent tachycardia-incuded cardiomyopathy and to improve quality of life.

Answer 182

A

B) Answers 1 and 3 are correct

EXPLANATION
Ventricular tachycardia occurs as wide QRS-complex tachycardia or supraventricular tachycardia in case of bundle branch block or accessorius pathway conduction. The more common mechanism is ventricular tachycardia, this is especially true in organic heart disease, primarily in post-infarction state, this helps in the differential diagnosis based on probability. The sure sign of ventricular tachycardia is atrioventricular dissociation. Dissociated p-waves and QRS-complexes, fusion and capture beats can be observed on the ECG, the Cannon-wave on the jugular pulse can be seen during physical examination and the I. sound (cannon sound) with varying intensity can be heard during auscultation which indicate the atrioventricular asynchrony. The frequency of the tachycardia and the hemodynamic status of the patient doesn’t help to differentiate.

Answer 183

A

A) Answers 1, 2 and 3 are correct

EXPLANATION
If we have doubts about the mechanism of the wide QRS tachycardia, we make less of a mistake if we treat as ventricle tachycardia, because the medicines (amiodarone, procainamide, lidocaine) used in the treatment of ventricle tachycardia is effective as well in some cases of supraventricular tachycardia, but at least do not worsen the patient’s state. Contrary to this, the intravenous Verapamil which is most commonly used as the treatment of supraventricular tachycardia may cause immediate circulatory collapse in case of ventricle tachycardia. Carotid-sinus massage can terminate the supraventricular tachycardia which involve the AV-node, in case of ventricle tachycardia it doesn’t help, but doesn’t worsen the patient’s state. In case of hemodynamic instability any kind of tachycardia (regular or irregular, narrow or wide QRS-complex) require cardioversion with synchronized DC-shock. Echocardiography is a basic test method for evaluation of the organic heart status in any kind of arrhythmia, but not during acute treatment, but rather after it.

Answer 184

A

E) All of the answers are correct

EXPLANATION
Atrial fibrillation could be associated with all the listed disease. The most common etiologic factor is the ischemic heart disease and hypertension which is not listed here.

Answer 185

A

D) Only answer 4 is correct

EXPLANATION
The 4th point contains the correct definition of pro-arrhythmia. The risk of pro-arrhythmia partly depends on the patient and partly depends on the medication used. Bad left ventricular function, active ischemia increases the risk of pro-arrhythmia. Among the medicines chinidin has the largest, beta blockers have the smallest pro-arrhythmic potential.

Answer 186

A

E) All of the answers are correct

EXPLANATION
All the listed answers are correct. In the congenital form the most important element of the clinical picture is the recurrent syncope (physical and psychic load), mostly in childhood, caused by polymorph tachycardia and sudden death, which show familiar accumulation. The more common form is the autosomal dominant inherited Romano-Ward syndrome, less common is the recessive inherited, deafness associated Jervell-Lange-Nielsen syndrome.

Answer 187

A

A) Answers 1, 2 and 3 are correct

EXPLANATION
Digitalis is not appropriate for treating ventricular tachycardia. The statements in the first three point are true.

Answer 188

A

E) All of the answers are correct

EXPLANATION
Although left chest pain is typical during myocardial infarction, primarily the infarction of the posterior wall often begins with epigastric and back pain. Hemodynamic changes during the infarction (transient cardiac output decrease) are usually experienced by the patient as sweating.

Answer 189

A

C) Answers 2 and 4 are correct

EXPLANATION
Persistent chest pain unresponsive to nitrate and associated with ST-elevation is an indication of percutaneous coronary intervention. Additional tests will only delay the launch of this therapy, therefore they are causeless. During all acute ischemic cases strict observation is required in order to remedy all possible arrhythmia.

Answer 190

A

B) Answers 1 and 3 are correct

EXPLANATION
During acute myocardial infarction decreased cardiac output often leads to pulmonary circulation edema, pulmonary edema. The first choice drug to treat this, is fast acting diuretic, which should be supplemented with oxygen enrichment of the breathed air. Nitrate may be beneficial for reducing the pre-load but instead of the difficult to control transdermal route, intravenous infusion should be chosen. Beta-blocker should be used carefully in myocardial infarction. It is contraindicated to use in case of heart failure, bradyarrhythmia or hypotension.

Answer 191

A

C) Answers 2 and 4 are correct

EXPLANATION
Big clinical trials proved the mortality reducing effects of ACE-inhibitors and beta-blockers in heart failure. Despite the good symptomatic effect of the diuretics, they do not affect mortality, furthermore nifedipine worsens the mortality in the same group of patient.

Answer 192

A

A) Answers 1, 2 and 3 are correct

EXPLANATION
In case of untreated hypertension or aortic stenosis the excessive loading of the left ventricle musculature, in case of viral myocarditis the reduced contractility due to ventricular dysfunction (inflammation) could be the cause of heart failure. Deep vein thrombosis doesn’t affect directly the left ventricle performance.

Answer 193

A

C) Answers 2 and 4 are correct

EXPLANATION
Because of the right-sided heart failure peripheral edema (for example leg edema), and because of the left-sided heart failure pulmonary edema and consequential dyspnoe can occur.

Answer 194

A

B) Answers 1 and 3 are correct

EXPLANATION
Nocturia might occur for a patient with heart failure, as the insufficient circulation can reduce and empty the edema at nighttime rest. The increase in adrenergic hormone levels as the consequence of peripheral hypoperfusion causes tachycardia. The heart then provides the required cardiac output not by the pulse volume, but by the increasing heart rate.

Answer 195

A

INT - 1.79 - amiodarone - D)
INT - 1.80 - furosemide - C)
INT - 1.81 - urapidil (Ebrantil) - A)
INT - 1.82 - pacemaker therapy - B)

Answer 196

A

INT - 1.83 - Mitral valve prolapse - D)
INT - 1.84 - Detect of rejection after heart transplantation - B)
INT - 1.85 - Post myocardial infarction, detection of viability - C)
INT - 1.86 - Sick sinus syndrome - E)
INT - 1.87 - Suspected intracardiac thrombus (for example underlying chronic embolisation) - A)

Answer 197

A

INT - 1.88 - Bronchoconstriction - C)
INT - 1.89 - Cold extremities - C)
INT - 1.90 - Pulmonary fibrosis - A)
INT - 1.91 - Hyperthyroidism - A)
INT - 1.92 - Angioneurotic edema - B)
INT - 1.93 - Dry cough - B)

Answer 198

A

INT - 1.94 - Reduction of the frequency and the left ventricular contractility - C)
INT - 1.95 - Mainly reducing the preload - D)
INT - 1.96 - Inhibiting the platelets aggregation - A)
INT - 1.97 - They have lipid reducing and pleiotropic effect - B)

Answer 199

A

INT - 1.98 - Antiarrhythmic effect - D)
INT - 1.99 - Platelet aggregation inhibiting effect - A)
INT - 1.100 - „funny” Na-K-channel inhibitor - B)
INT - 1.101 - Anticoagulant effect - C)

Answer 200

A

A) Both of them are correct, there is causal relationship between them

EXPLANATION
Both parts of the sentence are correct. In aortic stenosis the left ventricle has an increased load, under the narrow aortic valve in the left ventricle there is a greater pressure which leads to left ventricle hypertrophy. The left ventricle hypertrophy can be most easily and accurately established with echocardiography.

Answer 201

A

C) The first part is correct, the second one is wrong

EXPLANATION
Most of the diuretics used during heart failure treatment cause hypokalemia, therefore the laboratory monitoring of serum electrolytes (se-K,-Na) is recommended, during the treatment potassium replacement can be necessary. Other diuretics, called „potassium sparing” such as Verospiron, Aldacton, Triamteren doesn’t cause hypokalemia, but awareness of serum electrolyte levels is also recommended (possible hyperkalemia!).

Answer 202

A

E) Both of them are incorrect

EXPLANATION
After myocardial infarction associated with left ventricular aneurysm, it’s necessary to adjust anticoagulant therapy due to risk of developing intracardial thrombus.

Answer 203

A

A) Both of them are correct, there is causal relationship between them

EXPLANATION
In patients who have undergone a myocardial infarction, the use of aspirin and β-blockers significantly reduces the mortality (explanation translated via google)

Answer 204

A

A) Both of them are correct, there is causal relationship between them

EXPLANATION
The SOLVD Study proved in mild and moderate, the CONSENSUS Trial proved the decrease of mortality in case of severe heart failure and therefore the use of ACE inhibitors is indicated also in NYHA I-IV. stage.

Answer 205

A

B) Both of them are correct, but there is no causal relationship between them

EXPLANATION
Life-threatening arrhythmias are common in heart failure, it can lead to sudden death, but also with electrophysiological examination can’t always predict the predisposition to sudden cardiac death. There is no correlation between the two statements.

Answer 206

A

B) Both of them are correct, but there is no causal relationship between them

EXPLANATION
Abnormal prolongation of the QT-interval can be caused by drugs or in the congenital forms can be caused by Na- and K-channel dysfunction. The prolonged QT-interval is really predisposing to the “torsades de pointes” type (potentially lethal) ventricular tachycardia. The second part of the sentence is also true, but there is no cause and effect relation between the two.

Answer 207

A

A) Both of them are correct, there is causal relationship between them

EXPLANATION
The systemic use of nitrates primarily causes the small veins expansion, their arterial effect rather develop at intracoronary delivery. Based on this, with their pre-load reducing effect they can reduce the myocardium oxygen demand in angina pectoris.

Answer 208

A

C) The first part is correct, the second one is wrong

EXPLANATION
The angina pectoris which was first described by Prinzmetal is called vasospastic or variant angina (1959). The cause is the large coronary arteries spasm, which occurs during resting (often at dawn-in a variant manner), when there is no load. It has been clinically not proven that all the arteries have increased spasticity, but it could be developed due to general endothelial dysfunction

Answer 209

A

D) The first part is wrong, the second one is correct

EXPLANATION
The level of CK starts to elevate 3 hours after the myocardial infarction. The significance of this is that the indication of thrombolysis is beyond the optimum. The situation is similar with the recently used troponin T-, and troponin I-level measurements, though they show slightly earlier and more sensitively the myocardial necrosis.

Answer 210

A

A) Both of them are correct, there is causal relationship between them

EXPLANATION
Silent ischemic and symptomatic angina practically don’t differ from each other in pathology and prognosis, so they should be treated in the same way.

Answer 211

A

A) Both of them are correct, there is causal relationship between them

EXPLANATION
We often indicate TEE before cardioversion of atrial fibrillation to exclude atrial thrombus. If we detect thrombus during this that could require the postponement of the cardioversion and the indication of immediate anticoagulant.

Answer 212

A

E) Both of them are incorrect

EXPLANATION
In the diagnostic of infectious endocarditis transesophageal and transthoracic echocardiography doesn’t equal to each other, because TEE is more sensitive and more specific in this disease. The reason for this is that TEE examines the heart more closely, and during its application there is very little absorption and diffusion medium between the heart and the transducer probe, so the image quality and resolution is much better. The two methods examine the heart from different directions.

Answer 213

A

A) Both of them are correct, there is causal relationship between them

EXPLANATION
TEE has a prominent role in the diagnosis of aortic dissection. With this test method, most part of the thoracic aorta can be examined from the esophagus with good resolution. Another advantage of this method is that it is less invasive than angiography.

Answer 214

A

E) Both of them are incorrect

EXPLANATION
The laboratory diagnostic of infectious endocarditis requires to take series of hemoculture. Antibiotic treatment can be initiated when the breeding results two identical pathogens. Once in a while only from some of the hemocultures can the pathogen be bred, the other results may be negative. Previous antibiotic treatment could significantly reduce the chances of detection of the pathogens.

Answer 215

A

C) The first part is correct, the second one is wrong

EXPLANATION
In hemodynamically significant aortic stenosis the presence of angina pectoris and syncope are bad prognostic signs. This group of patients have high mortality without surgery. The surgical solution also has a good influence on the long-term pathology of the disease at this stage, angina pectoris is not a contraindication of the surgery.

Answer 216

A

C) The first part is correct, the second one is wrong

EXPLANATION
For fertile women who have acquired valvular heart disease, biological valve replacement can be indicated, which doesn’t require long-term anticoagulant therapy. Mechanical prosthetic valve replacement requires anticoagulant therapy. In the first trimester of pregnancy coumarin anticoagulant treatment may cause fetal damage. Mechanical prosthetic valves do not cause fetal damage by autoimmune mechanism.

Answer 217

A

E) Both of them are incorrect

EXPLANATION
Beta blockers are the first choice medications in the treatment of hypertrophic cardiomyopathy. Applying these medications in a correct dose decreases the outflow tract obstruction of the left ventricle and improves clinical symptoms.

Answer 218

A

B) Both of them are correct, but there is no causal relationship between them

EXPLANATION
Eosinophilia in the bloodstream is often observed in Löffler type of endocarditis. Substances released from the eosinophilic granules first lead to endocardial necrosis, which is followed by the thrombotic and endocardial fibrotic phase. This last disorder causes restrictive type of myocardial dysfunction. The statement and the explanation are correct, but there is no direct cause and effect relationship between them.

Answer 219

A

E) Both of them are incorrect

EXPLANATION
There is no need for potassium supplementation in all type of diuretics, because the use of so-called „potassium sparing” diuretics (spironolactones, triemteren) usually do not justify potassium supplementation. Potassium excretion with urine is reduced when using the same group of medication.

Answer 220

A

C) The first part is correct, the second one is wrong

EXPLANATION
Long-term use of ACE-inhibitors reduce the left ventricle hypertrophy. As the effect of the same group of drugs, serum bradykinin level is increased as these agents inhibit bradykinin degradation. 5-10% of treated patients develop hacking cough which is explained by higher bradykinin levels.

Answer 221

A

A) Both of them are correct, there is causal relationship between them

EXPLANATION
Radiofrequency ablation results definitive healing in case of accessory pathway driven arrhythmia, AV-nodal reentry tachycardia, atrial flutter or atrial tachycardia. In case of atrial fibrillation AV-node ablation is a palliative, ventricular rate reducing intervention. In practice, despite of this the first usual therapy is medication, due to the limitations of the possibility of the interventional treatment, if this is fails or in case of arrhythmias with hemodinamic collapse then occurs radiofrequency ablation.

Answer 222

A

C) The first part is correct, the second one is wrong

EXPLANATION
Implantable cardioverter defibrillator is able to automatically detect arrhythmias and eliminate it with low or high energy DC-shock with a set algorythm. It can’t prevent arrhythmia or treat the underlying disease.

Answer 223

A

E) Both of them are incorrect

EXPLANATION
Asymptomatic ventricular extrasystole in healthy patients don’t require treatment. None of the currently available medicines has proven to improve the survival in ventricular extrasystole.

Answer 224

A

A) Both of them are correct, there is causal relationship between them

EXPLANATION
Young patient’s lone atrial fibrillation does not have higher thromboembolic risk. In contrary to this there is higher thromboembolic risk during bad left ventricle function, dilated heart chambers, valvular disease, hypertension and diabetes associated with atrial fibrillation, and in these cases the most important in the treatment is the adequately adjusted anticoagulant. CHA2DS2-VASc Score is appropriate for measuring the risk of thromboembolism and for setting the indication of anticoagulant treatment for patients with atrial fibrillation.

Answer 225

A

E) Both of them are incorrect

EXPLANATION
Supraventricular arrhythmias are very rare and only in less than 17 % of the cases are lethal. Combined antiarrhythmic treatment usually doesn’t improve the effectiveness but increases the chance of the side effect of the drugs. In drug refractory cases transcatheter ablation is an effective and safe alternative of the pharmacotherapy.

Answer 226

A

A) Both of them are correct, there is causal relationship between them

EXPLANATION
During myocardial infarction it is desirable to reduce oxygen demand of the myocardium, therefore negative inotropic and chronotropic beta-blockers are preferred to use.

Answer 227

A

C) the statement is true, but the explanation is false;

EXPLANATION
In the procession of coronary atherosclerosis the developing myocardial infarct because of the sudden occlusion of the vessel is life threatening for the patient. The initial step is the rupture of the lipid plaque of the wall of the vessel, which is followed by the developing of thrombus because the platelets hit each other. This process is attended by the urgent stenosis of the vessel. The antiplatelet drug, the acetylsalicylic acid plays an important role to slow down this thrombotic procedure.

Answer 228

A

D) the statement is false, but the explanation itself is true

EXPLANATION
From the severe occlusion distal located myocardium area, which is alive beacuse of the minimal perfusion, the movement capacity can get better after reperfusion. The preoperative recognition of these areas are executed by examination methods (18-FDG-PET, dobutamin-echocardiography, perfusion myocardium scintigraphy at rest). As the result of the examinations there is any chance to the postoperative function improvement in the movement disorder areas, the reperfusion therapy means more risk than gain, that is why the completion is not explainable.

Answer 229

A

D) the statement is false, but the explanation itself is true

EXPLANATION
In acute myocardial infarct the severe pain provoke sympathicotony, which worsen the status of the patient because of the increase of oxygen demand. That is why using painkillers is justified. The use of opiate painkillers in cardiac diseases are not contraindicated, most of the time we use these painkillers.

Answer 230

A

D) the statement is false, but the explanation itself is true

EXPLANATION
In the first 48 hours after a myocardial infarct the continuos ECG-monitoring of the patient is justified because we need to treat malignant arrhythmias promptly. The incidence is quite high in cases which are complicated by heart failure.

Answer 231

A

E) both the statement and the explanation are false

EXPLANATION
In myocardial infarct we need to start mobilization immadiately. A patient with myocardial infarct without any complication after 24 hours can wash hisself/herself, in the second/third day the patient can move limited in the room. The early mobilisation and the anticoagulants therapy can decrease the risk of thromboembolic complications.

Answer 232

A

C) the statement is true, but the explanation is false;

EXPLANATION
ACE.inhibitors are inhibiting the activity of ACE (angiotensin converting enzyme). This enzyme is catalising the transformation of angiotensin I into angiotensin II (that is why the second part of the statement is false), the inhibiting decrease the serum level of angiotensin II. (first part of the statement is true).

Answer 233

A

A) both the statement and the explanation are true and a causal relationship exists between them;

EXPLANATION
The ACE-inhibitors are inhibiting the activity of ACE (angiotensin converting enzyme). This enzyme is catalising the transformation of angiotensin I into angiotensin II, that is why the inhibiting decrease the serum level of angiotensin II, which can effectively activating the vascular oxigenase (second part of the statement is true). The increase in the activity of the vascular oxigenase worsen the endothelfunction because of the decrease of the tissue NO-level, that is why the inhibition of this enzyme cause the progress of the endothelfunction (first part of the statement is true, there is connection between the two statements).

Answer 234

A

E) both the statement and the explanation are false

EXPLANATION
Not every calcium channel blockers are prohibited in heart failure (for example: we can use amlodipine) and not every calcium channel blocker have a negative inotropic effect in therapic concentration (vasoselective calcium channel blocker), that is why any part of the sentence are true.

Answer 235

A

D) the statement is false, but the explanation itself is true

EXPLANATION
Dihidropiridin type calcium channel blockers are not suggestible in heart failure without a few exception (for example the basic molecule, nifedipine is unadaptable), that is why first part of the statement is false. But, all of these molecules have different degree of vasoselectivity, that is why the second part of the statement is true.

Answer 236

A

D) the statement is false, but the explanation itself is true

EXPLANATION
In acute circumstances beta-blockers have a negative inotropic effects (second part of the sentence is true), to start in small dose, to increase the dose continuesly prove the survival of the patients in heart failure after long-term clinical trials, that is why as far as possible we should use them (first part of the sentence is false).

Answer 237

A

B) alcoholic myocardium laesion

EXPLANATION
The patient has pulmonary and body circulation decompensation symptoms, the patient drinks regularly alcoholic beverages. He/She has not got any risk factors for coronary atherosclerotic disease. There are any signs for hereditary cardiac disease, asymmetrical septal hypertrophy has different symptoms (e.g. angina, syncope, etc.). First of all we can think about alcoholic myocardium lesion or alcoholic cardiomyopathy after the sypmtoms and signs.

Answer 238

A

D) loud diastolic thrill at the region of apex of the heartEXPLANATIONThe suspected diagnosis, alcoholic cardiomyopathy (with left and right ventricular dysfunction) are veryfied by the following physical signs: cardiomegaly, gallop rythm, dyspnoe. Hepatomegaly and ankle swelling might be the physical signs of the decompensation of the body circulation with lips and finger cyanosis without drumstick fingers. The loud diastolic thrill at the region of apex of the heart is not typical as a physical sign, mostly it could be a systolic thrill because of the dilatated left ventricular and the dilatated mitral annulus with the complicated mitral regurgitation.

Answer 239

A

D) tallium perfusion scintigraphy at rest

EXPLANATION
To diagnose alcoholic cardiomyopathy the most important device examinations are: echocardiography (to award the accurate left and right ventricular function), ECG: SA node or electrical conduction system dysfunction, left ventricular hypertrophy, repolarisation dysfunction. Chest X-ray: to adjudicate the size of the heart and the stasis of the lung. In dilatative cardiomyopathy the myocardial perfusion scintigraphy at rest has not got a direct diagnostic role, because the isotope examination shows prior myocardial infarct, in which regional and not diffuse myocardium lesion is typical.

Answer 240

A

D) thrombolysis

EXPLANATION
The alcoholic cardiomyopathy which goes hand in hand with reduced left ventricular function, demand the use of diuretics, physical tolerance and the prohibition of alcohol. By the edification of multicentric megatrial ACE inhibitor is very necessary because it can improve the survival. Antiarrhythmic therapy can be necessary too, because there could be ventricular or life-threatening arrhythmias, and atrial fibrillation is also quite common. In these cases thrombolyis is not to be thought of.

Answer 241

A

B) left ventricular aneurysm after an extensive anterior myocardial infarct

EXPLANATION
Left ventricular aneurysm after an extensive anterior myocardial infarct, which cause left-sided heart failure. Dyskinesis of the affected heart area allude to the development of an aneurysm, which verified by echocardiography and radionuclid-ventriculography. It cannot be a decompensated aortic vitium, the patient does not have a thrill. The segmental dyskinesis is dominant in the failure of the left ventricular function. The failure of the other parts of the left ventricular function is caused by the “remodelling-effect”. Tricuspid valve insufficiency has a thrill and it could detached by echocardiography. Left atrial myxoma has a special echocardiographic image too. The symptoms of a stent thrombosis do not develop progressively, acute myocardial infarct came forward as cardiogenic shock.

Answer 242

A

F) nifedipine

EXPLANATION
The applicable conservative medical therapy consist: ACE inhibitors (they improve long-term the left ventricular function and the survival, prevent the left ventricular remodelling), statins (in post-infarct patients improve the survival because of the anti-atherosclerotic effect). Diuretics because of the pulmonary stasis made by the left-sided heart failure, salicylates as antiplatelets, anticoagulants (Syncumar) as thromboembolic prophylaxis. The use of Nifedipin is contraindicated, because it worsens the systolic function of the left ventricle (negative inotropic effect), moreover it causes tachycardia.

Answer 243

A

C) pericarditis exsudativa after a virus infection, with a lot of pericardial fluid, with threatening of cardiac tamponade

EXPLANATION
The right diagnosis: pericarditis exsudativa with massive pericardial fluid. The auscultation status is not typical for mitral vitium, the heart sounds are soft, labor or echocardiography results do not verify rheumatic carditis. On chest X-ray there are cor bovinum with sluggish heart contour-pulsations. In echocardiography in this case the left ventricular function is good.

Answer 244

A

E) pericardiac punction guided by echocardiography

EXPLANATION
Although the patient does not have a paradox pulse, the jugular vein distension, hepatomegaly, cyanosis and tachycardia suggest the possibility of a life-threatening pericardiac tamponade. In echocardiography “swinging-heart”and the big amount of pericardial fluid support the possibility of pericardiac tamponade. Because of the life-threatening pericardiac tamponade we should perform a pericardiac punction guided be echocardiography as soon as possible. Anticoagulant and digitalis therapy in acute case is contraindicated. Acute pericardiocentesis is necessary. Depending on the type of pericarditis later we should give salicylat, steroid or antibiotics.

Answer 245

A

E) treadmill exercise test

EXPLANATION
Right answer: treadmill exercise ECG test, because of the anamnesis there is a clinical opportunity to have pulmonary embolism, where treadmill exercise ECG test is contraindicated.

Answer 246

A

A) heparin

EXPLANATION
From the listed medication the initiation of anticoagulants therapy is justified, so the use of heparin. First of all in the embolism which concern small and medium vessels. In big-vessel-embolism thrombolytic therapy and embolectomy come into question.

Answer 247

A

A) 1st, 2nd and 3rd answers are correct

EXPLANATION
In pulmonary embolism the frontal line R-vector with left axis deviation is not pathological.

Answer 248

A

B) 1st and 3rd answers are correct

EXPLANATION
There are two right answers. The obvious answer is pericarditis and consequently pericardiac fluid, because fever and „big silent heart” is typical for pericarditis. If there are more options, we need to think of other options, for example that the patient has a major disease (an unknown dilatative cardiomyopathy) with a concomitant disease. This is a less possible solution, but it could fit to the symptoms.

Answer 249

A

C) transthoracic echocardiography

EXPLANATION
Every disease in cardiology, moreover the obvious differentiation in the listed diagnosis the rutine transthoracic echocardiography is the best diagnostic method. Even pericardiac fluid, even dilatative cardiomyopathy can differentiate with echocardiography. In severe, decompensated aorta vitium the physical status is high-frequented diastolic murmur, it can easily recognize with color Doppler. In hyperkinetic circulation this is diagnostic that there are any organic variance in echocardiography.

Answer 250

A

A) 1st, 2nd and 3rd answers are correct

EXPLANATION
Because of pericardiac tamponade there are inhibition in filling, this cause jugular vein distension, because of the reduced filling as a compenzation mechanism we observe tachycardia. Pulsus paradoxus also caused by the reduced filling. Laterally displaced apical impulse is not typical, because in pericardiac fluid or in pericardiac tamponade apical impulse disappear.

Answer 251

A

A) Mantoux-test

EXPLANATION
In infective endocarditis Mantoux-test is not diagnostic. CRP, microscopic hematuria in urine, positive hemocultures, moreover vegetations in transesophageal echocardiography enhance the diagnosis of infective endocarditis.

Answer 252

A

E) all of the answers are correct

EXPLANATION
All answers are right, in the vegetation all of the listed components are founded. Vegetation is an infected thrombus, that is why it can cause septic embolism, if one piece comes away. With transthoracic echocardiography in 60%, with transesophageal echocardiography in 100% could be detected.

Answer 253

A

C) intravenous verapamil immediately

EXPLANATION
The blood pressure and as far as possible the heart rate are definitely decreasable, however the specifically negative inotropic verapamil should not be used instead of captopril and digoxin. The last one is quite favourable beacuse of the positive inotropic effect. The immediate use of diuretics decrease the shortness of breath and help the recovery of diuresis.

Answer 254

A

B) 1st and 3rd answers are correct

EXPLANATION
Echocardiography plays an important role to judge the myocardium function and to demonstrate a vitium or a prior myocardial infarct which can be a cause. ECG plays a role to diagnose arrhythmias caused by heart failure and (same as echo) to adjudicate atrial load, myocardium hypertrophy and ischaemia. Abdominal ultrasound usually do not give any information about heart failure. Lung scintigraphy sould perform in the suspect of pulmonary embolism.

Answer 255

A

C) short-acting calcium channel blocker

EXPLANATION
STE-ACS local care includes effective pain relief (Morphin), except rare cases (cardiogenic schock, right ventricular infarct) nitroglycerin, oxigen in nasal probe and antiplatelet therapy. Short-acting calcium channel blocker can provoke undesired hypotension and heart failure.

Answer 256

A

C) ST-elevation at least two cohesive leads, chest pain

EXPLANATION
The diagnose of STEMI can set up after chest pain and significant ST-elevation at least two cohesive leads. More affirmative examination, e.g. biomarker test is not necessary, it means unnecessary loss of time. An early reperfusion therapy is necessary.

Answer 257

A

D) the first sign of a significant aortic stenosis

EXPLANATION
All of the mentioned causes can cause coronary occlusion. In aortic dissection, if the coronary ostia get into a fail lumen because of the rupture of the intima the aortic valve stenosis does not cause coronary occlusion. Because of the haemodinamic effect the main symptoms are effort syncope, heart failure an effort angina.

Answer 258

A

B) high content of lipid, without infective cells

EXPLANATION
The so called vulnerable plaque, which is liable for rupture consists of: high lipidcontent, the exist of inflammatory cells and thin fibrotic „cap”. The content of whitewash of these plaques are typically low and do not or not necessarily cause stenosis in the lumen.

Answer 259

A

C) ventricular tachycardia

EXPLANATION
All of the listed complications can be the complication of myocardial infarct, but we do not regard ventricular tachycardia as a mechanical complication, because this is an arrhythmia.

Answer 260

A

B) with big dosage of statins

EXPLANATION
According to the testimony of clinical studies plaque regression is available only with the use of high dose statin therapy (40mg rosuvastatin, 80mg atorvastatin), any other medical treatment combination is unadapted.

Answer 261

A

B) percutan coronary intervention (PCI)

EXPLANATION
In STE-ACS an early reperfusion is the aim, the opening of a coronary occlusion. This is available with thrombolysis or with PCI. In point of mortality and complications PCI is the primary, thrombolysis is well-founded in special cases, if the interventional centre is not available. The intravenous anticoagulants-, beta-blocker- and antiplatelet-therapy are belong to the STE-ACS therapy, but from this therapy we could not wait for reperfusion.

Answer 262

A

D) NSTE-ACS

EXPLANATION
In all of the listed diseases fibrinolysis could be justified, except in NSTE-ACS, in this case fibrinolysis is contraindicated, harmful.

Answer 263

A

E) all statement in one case

EXPLANATION
All of the listed conditions indicate very high risk of NSTE-ACS, the immediate coronarography is justified.

Answer 264

A

E) pericarditis acuta

EXPLANATION
All the listed disease cause chest pain, however pericarditis acuta is not life-threatening. The possible pericardiac fluid evolve during days.

Answer 265

A

C) CT-angiography

EXPLANATION
Both echocardiography (proximal aorta, aortic root), and chest X-ray help to set up the diagnosis, but the correct enlargement of the aneurysm discover the CT-angiography. Coronarography is a not-suitable examination.

Answer 266

A

D) mitral valve chordae tendineae rupture

EXPLANATION
In aortic dissection the mitral valve and the mitral apparatus are never affected.

Answer 267

A

A) proximal aortic dissection

EXPLANATION
The proximal aortic dissection – the risk of the complications- demand an urgent operation. If only the descendent is affected, it could attempt by controlled hypotension. The treatment of the other three is non-surgical.

Answer 268

A

A) Marfan- syndrome

EXPLANATION
Marfan-syndrome, whice cause the weakness of connected tissues directly predispose aortic dissection, the others causes the progression of atherosclerosis, but directly they are not predisposing factors.

Answer 269

A

C) hypertension

EXPLANATION
Hypertension increases the risk of atherosclerosis, the other diseases increase the risk of pulmonary embolism with different mechanisms.

Answer 270

A

B) increased pulmonary pressure for example measured by echocardiography

EXPLANATION
The increased pulmonary pressure allude to extended pulmonary embolism. The other signs can show pulmonary embolism as well (none of them is specific), but alone none of them has a prognostic role.

Answer 271

A

B) left bundle branch block, symptomatic systolic heart failure with optimal medical treatment, ejection fraction (EF) < 35%

EXPLANATION
III. degree atrioventricular block means pacemaker indication, but to implant biventricular device is not necessary. Clinical studies showed, that if there is left bundle branch block cardiac resynchronization therapy improve the prognosis and the functional status.

Answer 272

A

C) VVI pacemaker

EXPLANATION
The left ventricular function is good, biventricular device or malignant ventricular arrhythmia in this case do not come up. In permanent atrial fibrillation atrial pacing is meaningless.

Answer 273

A

B) long QT-syndrome, sudden cardiac death of the parents

EXPLANATION
In I. degree atrioventricular block ICD is not to be thought of. In postinfarct status, in HOCM and in primary DCM ICD implantation might justified, but the exist of other predisposable factors are necessary.

Answer 274

A

D) antitachycardia pacing function

EXPLANATION
Antitachycardia pacing function is owned by ICD devices. The role is to terminate the arrhythmia with a faster rate than the detected ventricular tachycardia before the DC shock.

Answer 275

A

B) first-degree atrioventricular block

EXPLANATION
I. degree atrioventricular block does not require neither pacemaker implantation, usually nor suspense beta-blocker.

Answer 276

A

C) sedation, electrical cardioversion

EXPLANATION
In fast ventricular tachycardia which cause hemodinamic instability the patient is in an acute life-threatening status, we need to do cardioversion.

Answer 277

A

D) Cumarin

EXPLANATION
Cumarin is an anticoagulant, the others are antiplatelets.

Answer 278

A

A) After myocardial infarct one year long combined acetylcalicilic acid (ASA) + Clopidogrel treatment is supposed.

EXPLANATION
Clinical studies proved, that one year long after a myocardial infarct – independently from the method of the revascularization, or there was any revascularization at all – double antiplatelet therapy is suggested.

Answer 279

A

D) Aspirin

EXPLANATION
In high thromboembolic risk Aspirin does not substitute the effective anticoagulant therapy.

Answer 280

A

A) it is the consequence of neointima proliferation

EXPLANATION
The neointima proliferation is responsible for the development of instent restenosis. Slow procedure, which causes myocardial infarct very rare. It presents in the first 6 months after stent implantation.

Answer 281

A

C) effective anti-platelet medical treatment

EXPLANATION
In the background of instent restenosis stays neointima proliferation. Antiplatelet therapy do not affect to the procedure. The drug eluting stents are expanded to interfere this proliferation.

Answer 282

A

A) in effort angina pectoris + heart rate > 70/min

EXPLANATION
The cardiac effect of ivabradin is to slow down the heart rate because to inhibit the sinoatrial node. It is useful to slow down the frequency of sinoatrial node, for example in effort angina pectoris beside or instead of beta-blocker.

Answer 283

A

C) RCA (right coronary artery)

EXPLANATION
RCA gives the right ventricular vessels and usually the IVP (interventricular posterior), that is why RCA is responsible for the inferior and right ventricular STE-ACS.

Answer 284

A

B) right ventricle

EXPLANATION
The ICD shock electrode comes through the central venous cannula into the right ventricle.

Answer 285

A

D) myocardial infarct

EXPLANATION
The myocardial infarct does not cause the dilatation of aortic ascendent, the other diseases potentially does. Hypertension through pressure loading and through causing atherosclerosis, the Marfan-syndrome through connective tissue disease, the chronis aortic valve insufficienty through high volume oscillation.

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