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Cardiology Exam for FCPS part 1 with Dr. Sohrab
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Cardiology Exam for FCPS part 1 with Dr. Sohrab
Cardiology Exam for FCPS part 1 with Dr. Sohrab
1
Personal infomations
2
True and false
3
multiple choice
Name
*
Phone number
*
Email
Decrease of stroke volume (SV) is caused by increasing - a) Cardiac output b) Venous return c) Heart rate d) End diastolic volume e) End systolic volume
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Regarding ECG -- a) P wave tall indicates right atrial enlargement b) T inversion occurs in hypokalaemia c) QRS broad occurs in obese person d) Short PR interval indicates pulmonary hypertension e) ST elevation indicates pericarditis
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Which one acts as insulator of transmitting impulse from atria to ventricle?-- a) Ventricular muscle wall b) SA node c) AV node d) Purkinje fibers e) Annulus fibrosus
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Followings are true about Conducting system of heart → a) SA node-0.05 impulse/min b) AV node -1 m/s conduction velocity c) Purkinjee fibers transmit the impulse to all parts of ventricle d) They have the highest conduction velocities e) AV bundle - .05 conduction velocity
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Troponin-I is raised in -- a) Pulmonary embolism b) Unstable angina c) Septic shock d) Pulmonary edema e) Pancreatitis
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Pulsus bisferiens is associated with -- a) Aortic stenosis b) Aortic stenosis + Aortic regurgitation c) Heart failure d) Pulmonary hypertension e) Hypertrophic obstructive cardiomyopathy
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Regarding JVP- a) A rough guide of cardiac cycle b) A-V interval coincide ventricular diastole c) Multiple a wave indicates complete heart block d) Right internal jugular vein pressure is misstated e) V wave- pulmonary HTN
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Regarding glyceryl trinitrate (GTN) -- a) Increase coronary flow in ischemic heart disease b) Causes vasoconstriction c) Lowers the arterial blood pressure d) Can produce methemoglobinemia e) Is effective for only five minutes when given sublingually
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
The baroreceptor reflex -- a) Has receptor located in the carotid & aortic bodies b) Has receptors in the carotid sinus & aortic arch c) Results in tachycardia when a person stands up d) Involves sympathetic vasodilator cholinergic fibers e) Operates in the normal range of arterial blood pressure
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Second heart sound -- a) Is a low frequency sound b) Signals the onset of ventricular systole c) Wide fixed splitting of it is the pathognomonic feature of atrial septal detect d) Reverse splitting of it occurs in left bundle branch block e) The P₂ component is loud in pulmonary stenosis
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Benign murmur -- a) Soft b) Heard at the apex of the heart c) Mid diastolic d) Radiates to the neck e) Associated with cardiac diseases
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Post MI advice on discharge should include -- a) Never to perform an ETT within 3 months b) No smoking because it doubles the risk of another attack c) To recheck blood lipids within 3 months d) To prepare for an angiogram in a month in high risk patients e) To continue aspirin & clopidogrel indefinitely
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Drugs undergo hepatic pass metabolism a) Paracetamol b) Nitroglycerin c) Propranolol d) Chloroquine
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Cardiac output is increased in -- a) Eating b) Sleep c) Moderate change in environmental temperature d) Rapid arrhythmia e) Anxiety & excitement
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Regarding pulmonary HTN -- a) Pressure in pulmonary vasculature is > 25 mmHg b) Mitral stenosis is the most important cause c) B-blocker is contraindicated d) Can be detected by echocardiography e) First heart sound is found loud
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Mean pressure- a) In systemic artery is about 70-105 b) Pulmonary artery 10-20 c) Left ventricle at the end of diaslobe 4-12 d) Right atrium 0-5 e) Right ventricle after diastole.7
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Isometric ventricular volume contraction period - a) Both A-V semilunar valve are open b)up arterial pressure c) down muscle fiber length d) Ventricles are filled during contraction e) 80% of O₂ delivery to heart during diastole
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
JVP -- a) A rough guide of cardiac cycle b) A-V interval coincide ventricular diastole c) Multiple a wave indicates complete heart block d) Right internal jugular vein pressure is measured e) V wave-pulmonary HTN
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
In case of hemodynamic effects of respiration-- a) JVP falls in inspiration b) BP falls in expiration c) HR accelerate during expiration d) 2nd heart sound fuse with inspiration e) Inspiration prolongs RV injection
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
In diagram of JVP -- a) 'a' wave corresponds to ventricular systole b) 'c' wave for atrial systole c) 'v' wave for ventricular diastole d) 'y' decent for 1st heart sound e) 'x' decent for 1st heart sound
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Effects of digitalis on heart include -- a) Inhibition of Na* -K* - ATP ace - b) An increased actin-myosin interaction c) A decrease in the free calcium concentration d) A decrease in intracellular sodium concentration e) A decrease in calcium efflux
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Long QT interval found in -- a) Hypercalcaemi b) Quinidine c) Hypokalaemia d) Erythromycine e) Sotalol
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
3rd heart sound can be audibled in-- a) Normal person b) Heart failure c) Mitral stenosis d) Mitral regurgitation e) Pregnancy
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Plateau in the ventricular muscle due to -- a) Fast sodium channel. b) Efflux of K+ c) Influx of Na* d) Slow sodium channel e) Repolarization
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Left heart failure tends to cause increase in -- a) Pulmonary capillary pressure b) Left atrial pressure c) Lung compliance d) Left ventricular ejection fraction e) Pulmonary oedema
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
On auscultation of a 60-year-old gentleman shows soft first heart sound. Which of the following condition he may have?
Heart failure
Mitral Stenonis
Atrial fibrillation
Left bundle branch block
Aortic stenosis
A physician hears a murmur on auscultation and says the murmur is late systolic. What is the most likely diagnosis?
Mitral regurgitation
VSD
Aortic stenosis
HOCM
Mitral valve prolapse
Mr. Y has heart failure and was started with beta blocker. But his heart rate remains high despite optimum dose of beta blocker. What would be the next plan of action?
Digoxin
Amiodarone
Ivabradine
Vasodilator
Neprilysin inhibitor
A patient complaints to you recurrent attacks of dizziness and collapse, he mentions it occurs more when the arm is used or lifted above, what is the most likely diagnosis?
Takayasu arteritis
Buerger's disease
Raynaud's syndrome
Subclavian steal syndrome
Peripheral vascular disease
A 55-year-old man presents with severe dyspnoea with tachycardia. Examination raises the possibility that pericardial disease may be the cause. Which of the following clinical features best distinguishes cardiac tamponade from constrictive pericarditis?
Hypotension
Kussmaul's sign
Muffled heart sounds
Pulsus paradoxus
Raised JVP
A 13-year-old female presents following a sore throat with chest pain, fever, and a skin rash. Examination reveals a diastolic murmur Her ASO titre is elevated. Which of the following is a major criterion for the diagnosis of rheumatic fever?
Fever
Migratory erythema
Polyarthritis
Prolonged PR interval
Raised ESR
A 59-year-old man who was active all his life develops sudden severe anterior chest pain that radiates to his back. Within minutes, he is unconscious. He has a history of hypertension, but a recent treadmill test had revealed no evidence for cardiac disease. Which of the following is the most likely diagnosis?
Acute myocardial infarction (MI)
Group A streptococcal infection
Pulmonary embolus
Right middle cerebral artery embolus
Tear in the aortic intima
What is the most common cause of aortic aneurysm?
HTN
Smoking
DM
Aortitis
Atherosclerosis
A diabetic patient has peripheral vascular disease, He has dry foot deficient in sweat, what is the most likely reason for that?
Autonomic neuropathy
Arterial calcification
Sensory neuropathy
Motor neuropathy
Immunocompromise
A patient who has ST elevated MI, has been adviced for thrombolytic therapy, which of the following condition would not be a contraindication to the therapy?
Uncontrolled HTN
Old age
Active peptic ulcer
Pregnancy
Surgery within 1 month
A patient requires implantable cardiac defiblilator as secondary prevention, Which of the following fits this criterion?
MI with EF<30%
Cardiomyopathy
Long QT syndrome
Sympotamatic HF with EF<35%
Survivors of ventricular fibrilation
A patient presents with polymorphie VT, ECG shows RBBB with ST elevation in VI and V2, but no QT prolongation, what is your diagnosis?
Bifascicular block
Torsades de pointes
Acute pericarditis
Pulmonary embolism
Brugada syndrome
A 17-year-old girl with a history of Turner’s syndrome attends the reproductive endocrinology clinic for routine follow up. She has a history of hypertension which is managed with amlodipine, but nil else of note. On examination her BP is 142/82 mmHg, and there is a systolic murmur best heard at the right sternal edge. Which of the following is the most likely cause of the murmur?
Bicuspid aortic valve
Coarctation of the aorta
Mitral regurgitation
Patent ductus arteriosus
Ventricular septal defect
A 56-year-old man presents to the Emergency Department with a four week history of intermittent fever, night sweats, weight loss and malaise. He has no change in bowel habit. He had undergone aortic valve replacement two months previously. On examination his temperature is 37.9ºC and his blood pressure is 142/70mmHg. He has no murmurs. Investigations: Transthoracic echocardiogram Vegetations visible on aortic valve What is the most likely causative agent?
Coagulase negative Staphylococcus
Streptococcus bovis
Pseudomonas aeruginosa
Staphylococcus aureus
Streptococcus viridans
A 17-year-old boy is reviewed in the clinic with increasing shortness of breath. Himself and his family have not consulted medical services for many years. On examination, he looks mildly cyanosed at rest and has a respiratory rate of 21/min. His blood pressure is 122/51 mmHg, and he has a pulse of 105 bpm. He has a continuous machinery murmur, loudest in the left upper chest, which is accentuated partially in systole. Colour- flow Doppler echocardiography identifies flow directly between the aortic arch and pulmonary artery. There are signs of pulmonary hypertension. Given the probable diagnosis, what is the likely nature of his pulse on clinical examination?
Collapsing
Jerky
Slow rising
Dicrotic
Thready
A 25-year-old woman presents to the Emergency Department with a one hour history of palpitations. She has no breathlessness or chest pain. She has no past medical history and does not take any medications. On examination her heart rate is 82bpm and her blood pressure is 128/88 mmHg in the left arm, and 126/84mmHg in the right arm. The JVP is not raised. There is no radiofemoral delay. On cardiac auscultation there are no murmurs, and her second heart sound is widely split and fixed but of normal volume. An ECG is normal. What is the most likely diagnosie?
Atrial septal defect
Aortic stenosis
Coarctation
Left bundle branch block
Primary pulmonary hypertension
An 18-year-old woman, who is known to be on a methadone heroin replacement programme, is found dead at home by her partner. A post-mortem is planned. Which of the following is a recognised cause of sudden cardiac death in methadone therapy?
Dilated cardiomyopathy
Complete heart block
Hyperkalaemia
Hypertrophic obstructive cardiomyopathy (HOCM)
Long-QT syndrome
A 54-year-old man is referred with increased swelling of his ankles and abdomen, and a degree of shortness of breath on exertion. His jugular venous pressure (JVP) is elevated with prominent x- and y- descents. Apex beat is normal. ECG shows atrial fibrillation with widespread non-specific ST-segment abnormalities. Echo reveals preserved left ventricular systolic function with biatrial enlargement and an estimated pulmonary artery systolic pressure of around 60 mmHg. Chest X-ray shows atrial enlargement but no other abnormalities. What is the most likely cardiac diagnosis?
Chronic pulmonary emboli (PE)
Dilated cardiomyopathy
Restrictive cardiomyopathy
Secundum atrial septal defect (ASD)
Tricuspid regurgitation
A 28-year-old woman who is known to have a cardiac murmur becomes pregnant. It is noted that the intensity of her murmur diminishes during her pregnancy. Which cardiac abnormality is she likely to have?
Aortic stenosis
Aortic regurgitation
Tricuspid stenosis
Pulmonary stenosis
Atrial septal defect (ASD)
A 22-year-old cocaine addict presents with central crushing chest pain after apparently snorting three lines of the drug. He is pale and sweaty. His blood pressure is 180/110 mmHg. ECG shows anterior ST elevation consistent with myocardial infarction. Which one of the following is the most appropriate treatment?
Glycoprotein 2b/3a inhibitors
Heparin
Naloxone
Percutaneous coronary intervention (PCI)
Thrombolysis
A 62-year-old man presents with central crushing chest pain, palpitations and a syncopal episode, which occurred in the local supermarket. He has a history of ischaemic heart disease and has suffered a previous inferior myocardial infarction. He arrives in the Emergency Department with a broad complex tachycardia and a pulse approaching 200 BPM on the monitor. His BP is 95/60 mmHg. Which of the following would prompt you to think that this is VT rather than SVT with aberrant conduction if you saw it on the 12-lead ECG?
Absence of fusion beats
AV dissociation
Normal ECG axis
QRS 150 ms
Rate <220 BPM
A 36-year-old woman is referred to the rheumatology clinic by her GP. She has a history of Raynaud’s phenomenon over the past 2-3 years, intermittent joint pains, and night sweats. She has recently completed 6 months of therapy for a pulmonary embolus and had a benign tumour removed from her left breast some 5 years ago. On examination, her BP is 123/80, a pulse of 80 and regular. You can hear a murmur consistent with tricuspid stenosis. Her BMI is 21. Which of the following is the most likely diagnosis?
Left atrial myxoma
Primary pulmonary hypertension
Right atrial myxoma
Right sided bacterial endocarditis
SLE
A 16-year-old man presents with a history of progressive cyanosis, haemoptysis, and episodes of syncope. On examination, he has a notably prominent left precordium and an ejection murmur in the second left intercostal space. What is the most likely diagnosis?
Atrial septal defect (ASD) with aortic regurgitation
ASD with aortic stenosis
ASD with mitral stenosis
ASD with pulmonary hypertension
Uncomplicated ASD
A 17-year-old girl is brought to the Emergency Department after collapsing whilst running for a bus. Apparently, she lost consciousness for around 40 s and felt weak and faint afterwards. She has had three previous collapses over the past two years. Apparently, her father died suddenly at the age of 36. On examination her BP is 100/60 mmHg, with pulse 70 bpm and regular. She has no murmurs and her chest is clear. Which of the following is the most likely cause?
Atonic seizure
Cardiac syncope
Generalised tonic–clonic seizure
Psychogenic collapse
Vasovagal syncope
An 80-year-old man presented to Accident and Emergency with gradually increasing confusion and shortness of breath. ECG showed 2:1 atrioventricular block with a ventricular rate of 40/min. In order to localise the site of the block, the physician made the patient do vagal manoeuvres, during which there were no changes in the block. He then gave 500 mcg of atropine and the conduction ratio worsened. Where is the likely site of the conduction block?
Atrioventricular (AV) node
His–Purkinje system
Left bundle branch
Sinoatrial (SA) node
Unable to comment from the data given
