Ultimate Past Paper Set Flashcards by Elmar Lutz

Which of the following is not indicated in angina pectoris patient(1)
A b-blockers
B nitrates
C alpha-blockers
D aspirin
E clopidogrel

C alpha-blockers

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What is the recommended treatment for diabetic patients with hypertension?(2)
A b-blockers
B heparin
C ACE-I
D alpha-blockers
E ARB (angiotensin receptor blocker)

C ACE-I
E ARB (angiotensin receptor blocker)

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A fixed perfusion defect means:(1)
A the defect appears at rest but disappears in stress test B the defect appears both at rest and the stress test
C the defect appears at stress test but not in rest

B the defect appears both at rest and the stress test

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In case of right MI best treatment is: (1)
A give the patient fluids and IABP if needed
B give the patient vasodilators in order to off load the right ventricle C perform PCI

C perform PCI

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To diagnose a right MI on ECG we need:(1)
A ST elevations waves in V1-V6
B deep Q waves in V1-V4
C ST elevation on R-V4 (this is a precordial lead on the right)
D RVH signs

C ST elevation on R-V4 (this is a precordial lead on the right)

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Which of these arrhythmias are focal? (2)
A atrial tachycardia
B AVRT
C AVNRT
D WPW
E right ventricular flow tachycardia

A atrial tachycardia

E right ventricular flow tachycardia

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In a case of an inferior wall MI we should perform an urgent echo to exclude: (1)
A mitral valve rupture
B vetricular septal rupture
C free wall rupture

A mitral valve rupture

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In the case of ventricular extrasystole: (1)
A amiodarone is the first option
B it is benign and doesn’t require any treatment
C verapamil is the treatment of choice

B it is benign and doesn’t require any treatment

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In supraventricular tachycardia we treat with: (3)
A Carotid massage
B Valslva maneuver
C Verapamil
D Amiodarone
E Metoprolol

A Carotid massage
B Valslva maneuver
C Verapamil

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Difference in BP between upper and lower body can be present in:(2)
A Aortic coarctation
B Malignant HT
C Leukemia
D Aortic valve stenosis
E Aortic dissection

A Aortic coarctation

E Aortic dissection

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The following arrhythmias can be indications for cardioversion: (2)
A Atrial fibrillation
B WPW
C Atrial tachycardia
D AVRT
E AVNRT

A Atrial fibrillation

D AVRT

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A cardiac echo is indicated: (2)
A before PCI where symptoms don’t fit the presumed diagnosis
B before heart surgery for evaluation
C always in atrial fibrillation

B before heart surgery for evaluation

C always in atrial fibrillation

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An anemic patient can present: (3)
A pallor
B tachycardia
C systolic murmur
D flush
E diastolic murmur

A pallor
B tachycardia
C systolic murmur

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When we hear a harsh, holosystolic murmur over the chest in a post-MI patient we immediately suspect: (1)
A cardiac tamponade
B PE
C pericarditis
D papillary muscle rupture
E ventricular septal rupture

E ventricular septal rupture

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Pulsus paradoxus is a sign of: (2) 
A aortic stenosis
B aortic regurgitation
C cardiac tamponade
D severe air way obstruction

C cardiac tamponade

D severe air way obstruction

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How do you treat isolated ventricular extrasystoles? (2)
A It’s not necessary to treat if there are no symptoms
B The first choice is B-blocker
C The first choice is amiodarone
D Coronarography is necessary to exclude coronary artery disease E Calcium channel blocker plus B-blocker is a primary option

A It’s not necessary to treat if there are no symptoms

B The first choice is B-blocker

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What does non-sustained VT means? (2)
A Duration of VT isn’t longer than 30 sec
B Five ventricular beats come subsequently
C It can cause hemodynamic instability
D The time of the VT is longer than 30 min

A Duration of VT isn’t longer than 30 sec

B Five ventricular beats come subsequently

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Which diseases may result in systemic thromboembolism? (3) 
A Aortic stenosis
B Atrial fibrillation
C Endocarditis
D Tricuspid regurgitation
E Left ventricular aneurysm

B Atrial fibrillation
C Endocarditis
E Left ventricular aneurysm

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The patient had two MIs. EF= 30%. How do you treat him after a documented fast monomorph ventricular tachycardia? (3)
A Pacemaker implantation
B ICD implantation
C B-blocker therapy
D Digitalis
E Amiodarone

B ICD implantation
C B-blocker therapy
E Amiodarone

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ICDs are able to: (3)
A Terminate ventricular fibrillation with shock delivery
B Work as a pacemaker if necessary
C Terminate ventricular extrasystoles
D Terminate ventricular tachycardia with antitachycardia pacing
E Treat only tachycardias, no therapeutic options against bradycardias

A Terminate ventricular fibrillation with shock delivery
B Work as a pacemaker if necessary
D Terminate ventricular tachycardia with antitachycardia pacing

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VVI pacemaker means: (2)
A One electrode in the ventricle
B One electrode in the atrium
C Two electrodes (atrium and ventricle)
D A sensed signal from the heart inhibits the pacemaker
E A sensed signal in the atrium may trigger a ventricular paced beat

A One electrode in the ventricle

D A sensed signal from the heart inhibits the pacemaker

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Causes that frequently provoke acute heart failure in patients with chronic congestive heart failure: (3)
A Arrhythmias, especially AF
B NSAIDs
C Fever
D GERD
E Ventricular premature beats

A Arrhythmias, especially AF
B NSAIDs
C Fever

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The most common cause of congestive heart failure: (1) A Chronic anemia
B Volume overload
C Ischemic heart disease
D Diabetes mellitus
E Chronic renal failure

C Ischemic heart disease

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Patients with congestive heart failure have increased risk of: (2) 
A Restless leg syndrome
B Ischemic stroke
C Cardiac tamponade
D Sudden cardiac death
E Peripheral artery disease

B Ischemic stroke

D Sudden cardiac death

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``` These drugs are mandatory in patients suffering from chronic heart failure, because they will increase life expectancy: (3) A Digoxin B ACEi C Verospiron (spironolactone) D Nitrates E B-blockers ```

B ACEi C Verospiron (spironolactone) E B-blockers

``` Physical signs and symptoms related to heart failure: (3) A Orthopnea B Hydrothorax C Signs of cerebral edema D Lack of appetite E Bronchospasm ```

A Orthopnea B Hydrothorax D Lack of appetite

``` What can be the etiology of acute aortic valve regurgitation? (3) A Chordal rupture B Infective endocarditis C Aortic dissection D Bicuspid valve E Trauma ```

B Infective endocarditis C Aortic dissection E Trauma

``` What are the most frequent etiologies that can cause chronic aortic valve regurgitation? (3) A Degenerative B Rheumatic C Infective endocarditis D Congenital E Ischemic heart disease ```

A Degenerative B Rheumatic D Congenital

``` Major criteria for the diagnosis of infective endocarditis: (2) A Fever B Positive blood culture C Vasculitic lesions D Vegetation on echo E History of IV drug abuse ```

B Positive blood culture | D Vegetation on echo

Surgery is indicated in patients with infective endocarditis if: (3) A Severe cardiac failure is presented due to valvular compromise B Relapse after optimal medical therapy C In case of septic systemic embolism D Presentation of mitral regurgitation E Pulmonary systolic pressure > 50 mmHg

A Severe cardiac failure is presented due to valvular compromise B Relapse after optimal medical therapy C In case of septic systemic embolism

Myocardial perfusion testing can be useful in: (3) A High clinical suspicion of aortic stenosis B Resting ECG abnormalities preclude exercise stress test interpretation C Culprit vessel identification in multi-vessel disease D After PCI, to evaluate stent restenosis E All of the above

B Resting ECG abnormalities preclude exercise stress test interpretation C Culprit vessel identification in multi-vessel disease D After PCI, to evaluate stent restenosis

How is coarctation of the aorta detected? (1) A Place the thumb of one hand on the brachial pulse and the other on the femoral pulse, and assess the simultaneously. Normally these pulses are equal in volume and timing. A delay in the femoral pulse or a reduction or absence strongly supports the diagnosis of coarctation B Place the thumb of one hand on the brachial pulse and the other on the femoral pulse, and assess the simultaneously. Normally these pulses are equal in volume and timing. A premature femoral impulse strongly supports the diagnosis of coarctation C A paradoxical femoral pulse on both sides supports the diagnosis of coarctation D Alternating low and high volume beats (pulsus alternans) can be characteristic for aortic coarctation

A Place the thumb of one hand on the brachial pulse and the other on the femoral pulse, and assess the simultaneously. Normally these pulses are equal in volume and timing. A delay in the femoral pulse or a reduction or absence strongly supports the diagnosis of coarctation

``` When do you find an elevated JVP? (2) A Hypovolemia B Acute heart failure C Hypervolemia D ACS E Aortic valve regurgitation ```

B Acute heart failure | C Hypervolemia

Which of the following best describes Dressler’s syndrome? (1) A Hypotension, elevated JVP, clear lung fields B Pericardial and pleural fluid, elevated ESR, and fever days to weeks after MI C Pericardial friction rub and pain while taking a deep breath 24 hours after anterior MI D Alternating RBBB and LBBB after anterior MI

B Pericardial and pleural fluid, elevated ESR, and fever days to weeks after MI

Typical re-entry arrhythmias are: (3) A Right ventricular outflow tract tachycardias B Atrial flutter C WPW D AV nodal/ junctional re-entry tachycardia E Atrial fibrillation

B Atrial flutter C WPW D AV nodal/ junctional re-entry tachycardia

Typically regular narrow QRS tachycardias are: (3) A AV nodal/ junctional re-entry tachycardia B Atrial flutter C Ventricular tachycardia D WPW (orthodrom) E WPW (antidrom)

``` A AV nodal/ junctional re-entry tachycardia B Atrial flutter D WPW (orthodrom) ```

``` Pericarditis can be present in: (3) A in chronic or acute renal failure B After MI C In hyperthyroidism D In young patients after upper airway infection E In cerebral malignancy ```

A in chronic or acute renal failure B After MI D In young patients after upper airway infection

``` Which medication is preferred if hypertension is combined with diabetes mellitus? (2) A B-blockers B Loop diuretics C ACEi D Alpha blockers E ARBs ```

C ACEi | E ARBs

``` How would you anticoagluate your 80 yo diabetic patient who has chronic atrial fibrillation? (1) A Aspirin B Clopidogrel and aspirin C Warfarin D Ticlopidine ```

C Warfarin

These are indications of anticoagulant therapy: (3) A Left ventricular thrombus B PE C Aortic dissection D Mechanical prosthetic valve implantation E ICD implantation

A Left ventricular thrombus B PE D Mechanical prosthetic valve implantation

``` Which imaging tests are the most useful in the evaluation of PE? (3) A Radionuclide lung perfusion scan B Pulmonary angiography C Chest X-ray D CT pulmonary angiography E Contrast echo ```

A Radionuclide lung perfusion scan B Pulmonary angiography D CT pulmonary angiography

``` Indications of thrombolytic therapy: (2) A PE with hemodynamic compromise B ST elevation MI within 12 hours C Abdominal emboli D Mitral valve rupture E Left ventricular thrombi ```

A PE with hemodynamic compromise | B ST elevation MI within 12 hours

What is characteristic of AVRT? (2) A Irregular rhythm B Retrograde p waves after the QRS complex C Re-entry tachycardia involving an accessory pathway D Pseudo r’ in lead V1 and pseudo s in inferior leads E Life threatening arrhythmia

B Retrograde p waves after the QRS complex | C Re-entry tachycardia involving an accessory pathway

``` What kind of arrhythmias can we treat with RFCA? (3) A AF B LBBB C WPW D Ventricular extrasystole E Mobitz II AV block ```

A AF C WPW D Ventricular extrasystole

``` What can cause paradoxical pulse? (2) A Anterior STEMI B Congestive heart failure C PE D Pericardial tamponade E Aortic dissection ```

C PE | D Pericardial tamponade

``` When can you find a difference in BP between the upper and lower limbs? (2) A Aortic stenosis B Possibly in aortic dissection C Aortic coarctation D Mitral stenosis E Pericardial tamponade ```

B Possibly in aortic dissection | C Aortic coarctation

``` What is Dressler’s syndrome? (1) A Congenital valve disease B Post MI pericarditis C Post MI hepato-renal syndrome D Pericarditis in renal insufficiency ```

B Post MI pericarditis

``` Risks for atrial fibrillation (4): A mitral stenosis B Hyperlipidemia C IHD D COPD E Pulmonary embolism ```

A mitral stenosis C IHD D COPD E Pulmonary embolism

Male with many IHD risk factors had an anterior wall MI, 3 days later vomited and was bradycardic without ST changes in the ECG. What is the best next step in the care of this patient? (1) A To do an ECG to check if there is a new MI B To perform CXR to check PTX C To continue with the medical therapy D To perform an echo to check for cardiac tamponade

D To perform an echo to check for cardiac tamponade

Vasodilators medicines in case of Prinzmetal angina: (1) A NO, Ca channel blockers, alpha blockers B NO, Ca channel blockers C NO, Ca channel blockers, beta blockers

B NO, Ca channel blockers

``` When do you anticoagulate (3): AF—if this means Afib then it is correct Aortic stenosis Left ventricular aneurysm Right ventricular dilatation Left ventricular thrombus ```

AF—if this means Afib then it is correct Left ventricular aneurysm Left ventricular thrombus

In every infarction we see changes in the ECG: (1) True False

False

How can you asses a specific kind of arrhythmia: (1)

Electrophysiology

CRT (cardiac resynchronization therapy) (3): Increases life expectancy Increases ejection fraction Decreases intraventricular dysynchronization

Increases life expectancy Increases ejection fraction Decreases intraventricular dysynchronization

The most reliable marker for IHD: (1)

Troponin

The most common cause for heart failure: (1)

IHD

``` What can aortic dissection cause? (2) LV hypertrophy RV dilatation Pericardial effusion Aortic regurgitation ```

Pericardial effusion | Aortic regurgitation

The most common etiologies of mitral regurgitation?(2) Rheumatic fever Degenerative process Infective endocarditis

Rheumatic fever | Infective endocarditis

Choose the correct sentence (1) A VF within the first 48 hours after MI increase mortality in the long run B VF after the first 48 after MI increase mortality in the long run C Idioventricular tachycardia the first 48 hours after MI increase mortality in the long run D Idioventricular tachycardia after the first 48 after MI increase mortality in the long run

B VF after the first 48 after MI increase mortality in the long run

75 years old diabetic female typical angina for 2 hours with ST depression on ECG, not relieved after medication what should you do? (1) A wait for biomarkers if positive coronarography B wait for biomarkers if positive thrombolysis C urgent coronarography D thrombolysis

C urgent coronarography

``` Cardiogenic shock symptoms, except: (2) A metabolic alkalosis B anuria- oliguria C hyperkalemia D low blood pressure ```

A metabolic alkalosis | C hyperkalemia

``` Which of the following are not considered to be mechanical post-MI complications? (2) A Papillary rupture B Ventricular free wall rupture C Aortic regurgitation D Atrial fibrillation E Septal rupture ```

C Aortic regurgitation | D Atrial fibrillation

``` Late complications (>1 week) of MI: (2) A aneurysm B Dressler syndrome C VF D acute heart failure ```

A aneurysm | B Dressler syndrome

``` What are the most common etiologies of mitral valve stenosis? (3) A Rheumatic fever B Congenital C Infective endocarditis D Marfan E Cushing ```

A Rheumatic fever B Congenital C Infective endocarditis

``` Contraindicated in aortic stenosis: (2) A ACEi B Nitrate C Ca blockers D B-blockers E diuretics ```

A ACEi | B Nitrate

``` What are the most common complications of mitral valve stenosis? (3) A sustained ventricular tachycardia B non-sustained ventricular tachycardia C AF D Third degree AV block E Bigeminy ```

A sustained ventricular tachycardia C AF D Third degree AV block

``` What can be the etiology of acute aortic valve regurgitation? (3) A chorda tendinae rupture B infective endocarditis C aortic dissection D bicuspid valve E trauma ```

B infective endocarditis C aortic dissection D bicuspid valve E trauma