Final exam in Cardiology 1)A patient comes in with chest pain; all are life-threatening causes that should be excluded, except A.Irritable bowel syndrome (IBS) B.Acute coronary syndrome C.Aortic dissection D.Esophageal rupture (Boerhaave’s syndrome) ANSWER:A 2)All are Causes of Chest Pain, except A.A heart attack results from blocked blood flow, often from a blood clot, to your heart muscle B.Disorders of the esophagus can make swallowing difficult and even painful. C.If the membrane that covers your lungs becomes inflamed, it can cause chest pain that worsens when you stop breathing D.Pericarditis as an inflammation of the sac surrounding your heart. It usually causes sharp pain that gets worse when you breathe in or when you lie down E.Pneumothorax ANS: C 3)all are correct about coronary circulation except A.The anterolateral papillary muscle more frequently receives blood supplies from right coronary artery B.Collateral routes ensure blood delivery to heart even if major vessels are occluded C.Circumflex artery is a branch of Left coronary artery D.The left coronary artery distributes blood to the left side of the heart, the left atrium and ventricle, and the interventricular septum ANS: A 4)Which is correct for heart anatomy except A)The heart pumps blood with a rhythm determined by a group of pacemaking cells in the sinoatrial node B)The cardiac skeleton is made of dense connective tissue and this gives structure to the heart C)The walls of the right ventricle are lined with trabeculae carneae, ridges of cardiac muscle covered by endocardium D)The heart wall is made up of three layers: the outer endocardium, middle myocardium and inner epicardium. ANS: D 5)All are Limb Leads, except A)II B)III C)aVF D)V1 ANS: D 6)All are correct for Cardiovascular Risk factors, except A) Genetic factors influence the development of cardiovascular disease in men who are less than 55 years-old and in women who are less than 65 years old B) Age is the most important risk factor in developing cardiovascular or heart diseases, with approximately a tripling of risk with each decade of life C) Coronary heart diseases are 2 to 5 times more common among middle-aged women than men D) The amount of dietary salt consumed is also an important determinant of blood pressure levels and overall cardiovascular risk ANS: C 7) All diseased can induce ENLARGEMENT OF RIGHT HEART AND BORDER on X-ray except A) Right atrial enlargement B) Eventration or hernia of diaphragm C) Cardiac tumor D) Left ventricular diverticulum ANS: D 8) All are supraventricular tachycardias except A) Junctional tachycardia B) Ventricular contractions C) AV re-entrant tachycardia D) AV node re-entrant tachycardia ANS: B 9) All are Brady arrhythmias except A) Sinus bradycardia B) Sinus arrest (“Sick Sinus Syndrome”) C) third degree Atrioventricular block D) atrial fibrillation ANS: D 10) All are correct for heart failure, except A) The failure could begin on the left or right side of your heart, or both sides may fail at the same time. B) Left-sided heart failure is the most common type of heart failure, may become short of breath, due to backed-up fluid in the lungs C) Heart failure is caused by any condition which reduces the efficiency of the heart muscle, through damage or overloading. D) The term "congestive heart failure" is often used as one of the common symptoms of myocardial infarction. ANS: D 11) All treatment for chronic heart failure are correct, except A) Angiotensin-converting enzyme inhibitors (ACE inhibitors) open up narrowed blood vessels to improve blood flow B) Beta blockers not only slows your heart rate and reduces blood pressure but also limits or reverses some of the damage to your heart if you have systolic heart failure C) Digoxin reduces heart failure symptoms in systolic heart failure. It may be more likely to be given to someone without a heart rhythm problem. D) Diuretics make urinate more frequently and keep fluid from collecting in the body ANS: C 12) All are correct for Acute infective endocarditis, except A) Acute suppurative inflammation that affects healthy valves. B) Organisms: Highly virulent as staph. Aureus, strept.hemolyticus and gonococci C) Tricuspid most commonly affected. D) The mural endocardium may be also affected. E) The affected valve and mural endocardium show acute suppurative inflammation with vegetations ANS: C 13) All are correct for Angina pectoris, except A)Angina is usually due to obstruction or spasm of the coronary arteries B)There is a weak relationship between severity of pain and degree of oxygen deprivation in the heart muscle. C)Worsening angina attacks, sudden-onset angina at rest, and angina lasting more than 15 minutes are symptoms of stable angina D)Cardiac syndrome X, sometimes known as microvascular angina is characterized by angina-like chest pain, in the context of normal epicardial coronary arteries ANS: C 14) All are correct for types of angina, except A)Also known as 'effort angina', this refers to the classic type of angina related to myocardial ischemia B)Unstable angina (UA) (also "crescendo angina"; this is a form of acute coronary syndrome) is defined as angina pectoris that changes or worsens C)Prinzmetal’s angina almost always occurs when a person is at physical activity, usually between midnight and early morning D)Since microvascular angina is not characterized by major arterial blockages, it is harder to recognize and diagnose ANS: C 15) All are correct for Myocardial infarction, except A)The location of a myocardial infarction will be largely determined by which coronary blood vessel is occluded. B)The left anterior descending artery supplies blood to the bulk of the anterior left ventricular wall C)Subendocardial myocardial infarction, meaning it involves the full thickness of the ventricular wall, D)During myocardial infarction Pressing or crushing sensation often accompanied by nausea, vomiting, sweating and weakness due to hypotension. A significant percentage of myocardial infarctions are “silent” and have no symptoms. ANS: C 16) All are correct for Restrictive Cardiomyopathy, except A) is a form of cardiomyopathy in which the walls of the heart are rigid (but not thickened) B) Thus the heart is restricted from stretching and filling with blood properly C) It is the least common of the three original subtypes of cardiomyopathy D) Diagnosis is typically made via ECG ANS: D 17) All are correct for Hypertrophic Cardiomyopathy, except A) is a condition in which a portion of the heart becomes thickened without an obvious cause B) Treatment may include the use of beta blockers, diuretics, or disopyramide C) It is type of cardiomyopathy, a group of diseases that affects coronary artery and then the heart muscle D) Complications include heart failure, an irregular heartbeat, and sudden cardiac death ANS: D 18) All are correct for myocarditis, except A) Ischemic heart disease B) Can be result of systemic disorder or infectious agent C) Can be Viral-Coxsackie B, echovirus, influenza, parainfluenza, Epstein-Bar, and HIV D) Can be Bacterial-C. Diptheria, N. meningitidis, M. pneumonia, and beta-hemolytic strep E) Frequently accompanied with pericarditis ANS: A 19) All are correct for Acute Pericarditis, except A)Most common-sudden or gradual onset of sharp or stabbing pain with radiation to back, neck, Left shoulder or arm B)Radiation to Left trapezial ridge is distinguishing C)Pain more severe with sittingand relieved with lying supine D)Low grade fever, dyspnea and dysphagia ANS: C 20) All are correct for rheumatic heart disease, except A)Rheumatic fever is a post-streptococcal immune-mediated inflammatory disease affect heart and extra-cardiac sites e.g. joints, skin, brain B)An acute attack of streptococcal pharyngitis by group A beta-hemolytic streptococci. C)Within 2-4 years after this attack anti-streptococcal antibodies are formed and attack the heart and the extra-cardiac sites. D) The mechanism of this immune reaction is not yet understood, however, the most accepted hypothesis is antigenic similarity hypothesis. ANS: C 21) All are correct for atrial fibrillation, except A) Atrial fibrillation is diagnosed on an electrocardiogram (ECG), an investigation performed routinely whenever an irregular heart beat is suspected B) It can be regular, which may make it more difficult to separate from other supraventricular tachycardias or ventricular tachycardia C) AF episodes may be detected and documented with the use of ambulatory Holter monitoring D) QRS complexes should be narrow, signifying that they are initiated by normal conduction of atrial electrical activity through the intraventricular conduction system. ANS: B 22) All Aortic dissection mimickers are correct except A) Myocardial ischemia due to an acute coronary syndrome with or without ST segment elevation B) Pericarditis C) Mediastinal tumors D) Lower limbs edema ANS: D 23) All are correct for Aortic Stenosis except A) Causes include being born with a bicuspid aortic valve, and rheumatic fever B) Thickening of the valve without narrowing is known as aortic stenosis C) If heart failure, loss of consciousness, or heart related chest pain occurs due to AS the outcomes are worse D) is the narrowing of the exit of the left ventricle of the heart (where the aorta begins), such that problems result ANS: B 24) all are correct, except A)V1 and V2 - Right side of the heart B)V5 and V6 - Left side of the heart C)Q Wave – 3rd downward wave of the complex D)QRS complex - ventricular depolarization; begins in Bundle of His ANS: C 25) All are correct for Ventricular Fibrillation,except A)Ventricular fibrillation is a cause of cardiac arrest and sudden cardiac death B)Idiopathic ventricular fibrillation most commonly occurs within diseased hearts, and, in the vast majority of cases, is a manifestation of underlying ischemic heart disease C)The medication epinephrine or amiodarone may be given if initial treatments are not effective D)is when the heart quivers instead of pumping due to disorganized electrical activity in the ventricles ANS: B 26) Which type AV block represented on ECG A. First-degree atrioventricular block B. Second-degree atrioventricular block (Mobitz I) C. Second-degree atrioventricular block (Mobitz II) D. Third-degree atrioventricular block ANS: C 27) All are Cardiovascular Risk factors, except A) Hypertension B) Cigarette smoking C) Obesity (body mass index ≥30 kg/m2) D) Physical activity ANS: D 28) All Chest Pain Can Kill, except A) Acute Coronary Syndromes B) Pulmonary Embolism C) Aortic Dissection D) Esophagitis ANS: D 29) All are correct for paroxysmal atrial tachycardia, except A)atrial 160-250/min: may conduct to ventricles 1:1, or 2:1, 3:1, 4:1 into the presence of a block. B)P wave morphology usually varies from sinus C)paroxysmal atrial tachycardia appears in ventricles D)paroxysmal atrial tachycardia may occur in the normal as well as diseased heart. ANS: C 31)All are correct for the causes of atrial fibrillation, except A.Pulmonary embolism, Pulmonary disease, Post-operative B.Ischemic heart disease, Idiopathic (“lone atrial fibrillation”), IV central line (irritating the right atrium) C.Sleep apnea, Sepsis, Surgery D.Hypothyroidism ANSWER: D 32)All medications for systolic congestive heart failure reduce mortality, except A.Beta-blockers, B.Aangiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) C.Spironolactone. D.Digoxin ANSWER:D 33)All are correct about primary hypertension, except A.High blood pressure is a common condition in which the long-term force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease. B.Blood pressure is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries.. C.You can have high blood pressure (hypertension) for years without any symptoms D.Most people with high blood pressure have signs or symptoms, before blood pressure readings reach dangerously high levels ANSWER: D 34)All are correct about syncope, except A.Adams-Stokes syndrome is a cardiac syncope that occurs with seizures caused by complete or incomplete heart block. B.The most common cause in this category is fainting associated with an acute myocardial infarction or ischemic event C.Aortic dissection (a tear in the aorta) and cardiomyopathy can also result in syncope D.Vasovagal (situational) syncope is rare type ANSWER: D 35)All are correct radiographic features of mitral stenosis, except A.Convexity or straightening of the left atrial appendage just below the main pulmonary artery (along left heart border) B.Upper zone venous enlargement due to pulmonary venous hypertension C.Secondary pulmonary hemosiderosis, often difficult to appreciate on a plain radiograph D.Enlargement of the left atrial appendage is frequent and suggests a non rheumatic etiology ANSWER: D 36)All are correct for Classification of Heart Failure