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2013A MEDICINE 4 LE:
CARDIOLOGY MODULE
1. Which of the ff. statements correctly === the surface
projection of the heart and the great vessel?
A: In supine patients, diameter of the PMI is
approximately 1-2.5
nd
2. Paradoxical splitting of the 2 heart sound is:
nd
A: Splitting of the 2 heart sound during expiration
[physiological/normal splitting = inspiration]
3. Which of the ff. statements is correctly === relation of
auscultatory findings to the chest wall?
A: Murmurs arising from the aortic valve may be
heard anywhere from the right segment of the costal
space to the apex
4. What is v wave in a jugular venous pulsation?
A: The rise in the right atrial pressure as it fills up
with blood while the tricuspid valve is closed
st
5. Loud 1 heard sound is heard in:
A: Mitral stenosis [not heard if MS is very severe]
6. Characteristics of carotid pulsation include:
A: A vigorous thrust with single outward component
7. Irregularly irregular heart rhythm is observed in:
A: Atrial fibrillation with varying AV block [almost
always AF]
8. Cyanosis is a physical finding in:
A: Tetralogy of Fallot
9. Differential cyanosis is a physical finding in:
A: Patent Ductus Arteriosus with pulmonary
hypertension [most especially if with Eisenmenger
syndrome]
10. Which of the ff. valvular lesions will most likely be
symptomatic with moderate exercise:
A: moderate --- [NOT in mild (usually no symptoms) or
chronic (has adapted) disease]
11. Left ventricular hypertrophy is likely to be found in:
A: [not read but answer is probably Aortic Stenosis;
ASD = right, MS = LA, Acute AR = none]
12. Acute mitral regurgitation is likely to be seen in:
A: Angina pectoris [MV prolapse, dilated LV due to
ischemia, MR d/t RHD = chronic]
13. Rapid y descent of the jugular venous pulsation is a
finding in:
A: Tricuspid regurgitation
14. Wall stress is increased in:
A: Dilatation [Law of Laplace]
15. True statement regarding heart failure:
A: Volume overload causes diastolic wall stress
16. Diastolic heart failure is predominant in
decompensated:
A: Hypertrophic cardiomyopathy [dilated, ischemic =
systolic]
17. A 46-year old maleeasy fatigability for the past 3
months, complains of associated orthopneaprevious
hospitalization for myocardial infarctionWhat is
thepredisposition of this patient?
A: Coronary artery disease
For Qs 18-20:
A 26-year old male consulted you for pre-employment
clearance for work in Saudi Arabia. He is asymptomatic
cardiopulmonary-wise but admits to not being a very
athletic person. He has a first cousin who died in his early
20s while training to be a policeman. Upon examination,
you noted a 3/6 mid to late systolic murmur over the
apical area which becomes louder upon Valsalva
maneuver, there was no S3.
18. The murmur in this patient is probably due to:
A: Systolic anterior motion of the anterior mitral valve
leaflet due to Venturi effect [murmur over apical area
= MV; Dx: HCM especially if patient is young, athletic,
suddenly dies]
19. The best diagnostic tool for this patient is:
A: 2D Echo
20. Advice for this patient:
A: May work abroad but avoid vigorous physical
activity and dehydration [dehydration will decrease
preload and worsen condition]
For Qs 21-22
A 56-year old male went to you for consult, he was seen
by another doctor due to shortness of breath associated
with orthopnea and bipedal edema, is a known diabetic,
poorly compliant to his medication, his 2D Echo was with
him and findings were left ventricle end-diastolic volume
of 260cc and systolic volume of 200cc, his
BPHRdistended neck veins
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21. [Q not read]
A: The patients --- isdepressed [EF is a function of
systolic]
22. Computed ejection fraction is:
A: 23%
For Qs 23-24
A 56-year olduncontrolled hypertension for the past 7
years, is symptomatic.
23. What is the patients heart failure classification?
A: Stage B [Stage A = asymptomatic but with risk
factors]
24. The best choice of medication for this patient is:
A: ACE-inhibitor
25. Long-term effect of compensatory mechanism in heart
failure include:
A: Left ventricular remodeling
26. True of dilated cardiomyopathy:
A: Clinically presents as systolic heart failure
[hypertrophic = diastolic HF]
27. Which of the ff. will be most likely in a patient with
chronic severe mitral regurgitation?
rd
A: 3 heart sound
28. Which of the ff. statements about the natural history of
severe aortic regurgitation is true?
A: [not read]
29. A 53-year old man complains of a heart murmur. He is
completely asymptomatic and active. He sought consult
at the correctional hospital near Global wherecarotid
delay, single S2 and 3/6
A: Severe aortic stenosis [delayed A2/no normal
splitting because of delayed closure of AoV]
30. Aling Gloria, a 62-year old woman, presents to you
with shortness of breath, no history of heart murmurno
history of rheumatic fever2/6 holosystolic murmur at the
apex
A: Mild mitral stenosis and mitral regurgitation
31. Rapidly rising water hammer pulse:
A: Rapid descent in late systole and diastole
32. What is the hemodynamic hallmark of tricuspid
stenosis?
A: Diastolic pressure gradient between the right
atrium and right ventricle [MS = left side]
33. A 45-year old male came to you for heart murmur.
The patient is asymptomatic and very active. On
examination, a continuous murmur at the left upper
sternal borderWhat is your diagnosis?
A: Patent Ductus Arteriosus
34. The most common congenital anomaly associated
with Downs Syndrome?
A: Atrio-Ventricular Septal Defect
35. What is the most commonof Coarctation of the
Aorta?
A: Bicuspid
36. A 70-year old male presents to you with the ff.
findings: differential hypertension
A: Rib notching [Dx: Coarctation of the Aorta]
37. A 32-year old female came for consult complaining of
difficulty of breathing and shortness of breath. On PE, S1
is soft
A: Ventricular Septal Defect
38. Calf pain on walking relieved by rest is:
A: Intermittent claudication
39. The recommended initial screening test for peripheral
artery disease is:
A: Ankle:Brachial Index [normal ratio: 0.9]
40. 0.75which of the following
A: Moderate
41. Treadmill exercise test is used to provoke clinically
unapparent:
A: Peripheral Arterial Disease
42. The most fatal complication of Deep Vein Thrombosis
is:
A: Pulmonary embolism
43. Outcomes of cardiac rehab training include which of
the ff?
A: AOTA: improved quality of life, control of
symptoms, improved exercise tolerance [but you
cannot improve survival / mortality rate still the same]
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44. Cardiac rehab is indicated in which of the ff:
A: AOTA: chronic stable angina pectoris, underwent
post-coronary bypass surgery, post-transplant
surgery [not an indication in acute decompensated
HF]
45. Parameters that should be assessed prior to start of
symptom-limited exercise testing:
A: AOTA
46. The current mainstay in the diagnosis of deep vein
thrombosis is:
A: [not read but answer is probably Venous Duplex
Scan; Segmental Pressure Study is for PAD]
47. Lifestyle modification and drug-therapy is indicated
among patients with BP of:
A: [not read but answer is probably 140/90mmHg]
48. After initiating lipid-lowering drugs, lipid determination
should be done:
A: After 2 months
49. Virchows triad includes abnormalities of the vessel
wall, changes in the formed and soluble elements of the
blood, and blood stasis. This is seen in:
A: Deep Vein Thrombosis
50. The most common cause of acute limb ischemia is:
A: Atherosclerosis
51. Primary imaging modality for assessment of left
ventricle cavity size, systolic function and wall thickness:
A: 2D Echo
52. A 25-ear old female came to you for pre-employment
evaluation. She had a previous history of Rheumatic
Fever. Shes still on Pen G. On PE you notice a 3/6
systolic murmur. You suspect rheumatic valvular heart
disease. What would be the best diagnostic modality to
validate your suspicion?
A: 2D Echo
53. A 43-year old hypertensive female came to you due to
vague, effort-related chest pain. You think that she falls
into intermediate pre-test probability of having coronary
artery disease. What would be the best modality to
validate your suspicion?
A: Exercise SESTAMIBI (nuclear myocardial perfusion
imaging)
54. The ff. is/are the isotopes being used for myocardial
perfusion scintigraphy:
A: Technitium & Thallium [MRI: Gadolinium]
55. The mechanism on how PET Scan detects myocardial
perfusion abnormality:
A. Permits the detection and quantification of
exogenous glucose utilization in areas of
hypoperfused myocardium
56. The best imaging modality to rule out aortic
dissection:
a. 2D echo [too short to view the entire heart]
b. chest xray [you only see the silhouette, cannot
see the dissection]
c. nuclear perfusion scan [you see perfusion]
d. CT angiogram (GOLD STANDARD)
57. What type of cardiac catheterization
A: Coronary angiogram
58. The method of pressure and O2 saturation
measurement to screen for intracardiac shunts using
Picks principle is done at the:
A: Right heart
59. The method where the catheter is advanced with
fluoroscopic guidance in the central aorta is:
A: Coronary angiogram
60. Evaluates the rapidity of coronary flow rush of
capillary filling into the myocardium is:
A: Angiogram
61. The surgical procedure performed to relieve the
angina and reduce death due to coronary artery disease
using arteries or veins as grafts is:
A: Coronary artery bypass graft
62. Functions of the pericardium include:
A: AOTA: mediates interventricular coupling, serves
as barrier to prevent spread of local infection, reduce
friction between the heart the surrounding
mediastinal structures
63. An exaggerated arterial fall in arterial pressure of
more than 10 mmHg is (as seen in tamponade):
A: Pulsus paradoxus
64. The diagnostic tool in pericardial effusion or
tamponade is:
A: AOTA: ECG [electrical alternans due to its
swinging in pericardial fluid], 2D echo, etc.
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65. The clinical findings in cardiogenic shock is:
a. S3 gallop [diastolic event which is abnormal;
usually seen in acute heart failure]
b. elevated JVP [RA and RV are overloaded due to
congestion due to left-sided heart failure]
c. hypotension [decreased CO and SV means HF]
d.
66. Chronic inflammation causing fibrosis and is:
A: Pericardium
67. Most common primary benign tumor of the heart in
adult is:
A: Myxoma
68. Most common primary valvular tumor of the heart in
adult is:
A: Papillary fibroblastoma
69. Most common location of myxoma is:
A: Left atrium
70. Most common malignant tumor of the heart in adult is:
A: Angiosaroma
71. Most common adult tumor of the heart is:
A: Secondary
72. Which of the following best defines the anatomic
characteristic of an arteriosclerotic disease?
a. ECG [electrical properties]
b. 2D echo [peripheral]
c. angiogram [lumen}
d. intravascular ultrasound [defines the walls of
the arteries]
73. Of the following lipoproteins:
A: HDL [good while LDL is bad]
74. [Q & A not read]
75. Lipid-lowering with statins may reduce plaque
formation through which of the following?
A: Decrease in macrophage
76. [Q not read]
A: Plaque vulnerability
77. Which of the following is true?
A: 35% of the patients have atherosclerosis
78. Angina pectoris is best diagnosed by:
A: History only [angina is only a symptom]
79. Which of the following is best for showing perfusion
defects due to ischemia?
A: PET or Nuclear scan
80. What is the probability that a 38-year old female who
has pain that is intermittent, lasting for a few seconds and
occurring even at rest has ischemia?
A: Low Risk [the patient is still in her reproductive years
(usually older patients will have present with this
symptom) and pain due to ischemia happens during
activity, not at rest]
81. In the secondary progression of a coronary artery
disease, which of the following goals is desirable?
A: Waist:hip ratio should be 0.9 in females, 1.0 in
males
82. 58-year old male has acute onset of moderate to
severe chest pain an hour prior to consult related to
ischemia. Which of the following is an appropriate test?
A: Treadmill exercise [males at 40 y/o have an
increased risk for CAD]
83. In instances where non-surgical procedures are
preferred for patients with MI, which of the following is
recommended?
A: Streptokinase [reperfuse patient with streptokinase
as heparin, statins and aspirin can only prevent
plaque rupture]
84. What is the pathophysiology of coronary artery
disease?
A: Plaque rupture
85. ECG criteria for left ventricle hypertrophy with wide
QRS complex:
A: Bundle branch block [this condition delays the
impulses to the ventricles which causes widening of
the QRS complex]
86. First degree AV block is diagnosed with
A: [not read]
87. Sinus bradycardia may be due to the following drugs:
A: Beta-blockers
88. Old myocardial infarction is diagnosed using p waves
in which of the following
A: [not read]
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89. Tracing: Ischemia?

A: a and b: [ST wave depression]

90. Tracing: What is the HR?

A: >100 bpm

91. Tracing: Rhythm?

A: Sinus rhythm [normal, P followed by QRS, regular

RR interval and P wave is upright]

92. Tracing:

A: Sinus tachycardia

93. Tracing:

A: Skip beats

94. Tracing: What is the origin?

A: Ventricular

95. Tracing: What do the arrows point at?

A: [not read]

96-98. Tracings:

A: [not read]

99. Collapsed during walking:

A: Ventricular fibrillation

100. Student was brought to ER after alcoholic binge.

What is the ECG find?

A: Atrial fibrillation/bradycardic [Holiday heart

syndrome]