MEDICAL RESIDENTS EXAMINATION 2020

CARDIOVASCULAR SYSTEM 2

MARCH 13, 2020

Name:_________________________________________ Year level:__________ Score____________

1. Most common cause of right sided heart failure/

A. Cor pulmonale

B. COPD

C. Pulmonary hypertension

D. Left sided heart failure

2. Which of the following agents is considered a cornerstone of pharmacotherapy that leads

to improvement of cardiac structure and function with symptom reduction in patients with
HFrEF?

A. Digoxin

B. Vasodilators

C. Beta blockers

D. Diuretics

3. Which of the following is NOT a cause of heart failure with preserved ejection fraction?

A. Hypertension

B. Hemochromatosis

C. Aging

D. Chaga’s Disease

4. Which of the following beta blockers has NOT been proven to improve survival among
patients with HFrEF?

A. Carvedilol

B. Bisoprolol

C. Metoprolol tartrate

D. Metoprolol succinate

5. The most sensitive biomarker for the presence of heart failure with reduced EF?

A. Troponin

B. B type Natriuretic peptide

C. Soluble ST - 2

D. Galectin 3

6. Main and most common pathophysiologic process in unstable angina?

A. Dynamic obstruction (coronary spasm)

B. Plaque rupture and non-occlusive thrombosis

C. Advancing coronary atherosclerosis

D. Increased myocardial oxygen demand

7. What drug when combined with aspirin confers a 20% relative reduction in cardiovascular
death, MI, stroke compared to aspirin alone, but with absolute 1% increase in major
bleeding?

A. Clopidogrel

B. Ticagrelor

C. Prasugrel

D. Cilostazol

8. Drug of choice for Prinzmetal’s variant angina?

A. Beta blocker

B. ARB or ACEi

C. Nitrates and CCBs

D. ALL OF THE ABOVE

9. True statements regarding cardiac enzymes or biomarkers, except:

A. Cardioversion causes false elevation of CK-MB

B. Measurement of both troponin and CK-MB is not cost effective

C. CK-MB remains elevated 7-10 days after STEMI

D. Peak concentration of biomarkers correlates weakly with infarct size

10. Most out of hospital mortalities from STEMI are due to:

A. Pump failure

B. Respiratory arrest

C. Septal rupture

D. Ventricular fibrillation

11. A patient presenting with severe chest pain, evidence of inferior infarction on ECG, elevated
JVP, clear lugs and hypotension most likely has:

A. Severe LV pump failure

B. Aortic dissection

C. Right ventricular infarction

D. Concomitant sepsis

12. Infarction of how much left ventricular mass usually results in cardiogenic shock?

A. >40%

B. >30%

C. >20%

D. at least 60%

13. Contraindication to the use of nitrates in UA:

A. Obstructive airway disease

B. Advanced A-V block

C. Use of Sildenafil within 24 hours prior

D. Congestive heart failure

14. Therapeutic agents considered highly beneficial for CHF complicating STEMI, except:

A. Nitrates

B. ACE inhibitors

C. Digitalis

D. Diuretics

15. Pericarditis complicating STEMI is best treated with:

A. ASA 650mg 4x /day

B. Avoidance of anticoagulants

C. Avoidance of corticosteroids or NSAIDs

D. All of the above

16. Congenital heart disease characterized by a downward displacement of the tricuspid valve
into the right ventricle due to anomalous attachment of the tricuspid leaflets:

A. Ttricuspid atresia

B. Ebstein anomaly

C. Lutembacher’s syndrome

 D. Kartagener’s syndrome

17. Beck’s triad of cardiac tamponade include hypotension, soft or absent heart sounds, and:

A. Summation gallop

B. Jugular venous distention, with prominent x descent but absent y descent

C. Electrical alternans

D. Pulsus paradoxus

18. Most common tumor of the heart?

A. Sarcoma

B. Myxoma

C. Cardiac metastases

D. Rhabdomyoma

19. Components of Tetralogy of Fallot, except:

A. Dextrocardia

B. Aortic override of ventricular septal defect

C. Ventricular septal defect

D. Obstruction of right ventricular outflow tract

20. Characteristic ECG pattern in acute pericarditis:

A. Widespread ST elevation with upward concavity

B. Diffuse ST depression

C. Prominent Q waves in anterior leads

D. Presence of prominent “U” waves

21. Established chest x ray abnormalities in pulmonary embolism, except:

A. Right sided cardiomegaly (McConell’s sign)

B. Peripheral wedged-shaped density above the diaphragm (Hampton’s hump)

C. Enlarged right descending pulmonary artery (Palla’s sign)

D. Normal CXR

22. Recommended treatment duration for patients with cancer associated VTE with LMWH as
monotherapy without warfarin:

A. 3 months

B. 6 months

C. 1 year

D. Indefinitely (or until cancer free)

23. Leading cause of mitral stenosis in adults:

A. Congenital

B. Rheumatic fever

C. SLE

D. Calcification

24. Conditions associated with increased risk for venous thrombosis, except:

A. Acute myocardial infarction

B. Thromboangiitis obliterans

C. Malignancy

D. Chronic kidney disease

25. Most common toxin implicated in chronic dilated cardiomyopathy?

A. Alcohol

B. Chemotherapy agents

 C. Amphetamines

D. Cocaine

26. Which of the following statements regarding diagnosis of hypertrophic cardiomyopathy is

false?

A. Cardiac imaging is central to diagnosis due to insensitivity of physical examination

and ECG

B. Biopsy is needed to diagnose hypertrophic cardiomyopathy

C. Identification of a disease-causing mutation in a proband can focus family

evaluations on mutation carriers

D. Unlike hypertrophic cardiomyopathy, hypertrophy in the athlete’s heart regresses

with cessation of training, and is accompanied by supernormal exercise capacity, mild
ventricular dilatation and normal diastolic function.

27. Common first symptom of dilated cardiomyopathy:

A. Exertional dyspnea

B. Early fluid retention

C. Orthopnea

D. Chest pain

28. A 2D echocardiogram was done on a hypotensive ICU patient, revealing a black

echoluscent ovoid structure around the heart with right ventricular collapse, right atrial
collapse, and dilated IVC. What would be the appropriate course of treatment?

A. Immediate referral for CABG

B. DC cardioversion

C. Pericardiocentesis

D. IV Dobutamine/Dopamine infusion

29. Most common symptom of peripheral arterial disease (PAD):

A. nocturnal leg cramps

B. intermittent claudication

C. intolerance to cold

D. numbness and tingling in the feet

30. Phosphodiesterase inhibitor with vasodilator and antiplatelet properties can increase
claudication distance by 40-60% and improve quality of life:

A. Cilostazol

B. Sildenafil

C. Pentoxyfilline

D. Dipyridamole

31. Characterized by digital ischemia, manifested clinically by sequential digital blanching,

cyanosis, and rubor after cold exposure and subsequent rewarming:

A. Buerger’s disease

B. Pernio

C. Erythromelalgia

D. Raynaud’s phenomenon

32. For asymptomatic AAAs, operative repair is indicated once the diameter reaches:

A. >10cm

B. >5.5cm

C. >3.5cm

D. >15cm

33. Classic description of chest pain of acute aortic dissection:

A. Sudden, severe, and tearing

B. Often radiates to the interscapular area

C. Associated with diaphoresis

D. All of the above

34. This infection typically causes aneurysms of the aortic arch or ascending aorta due to
periaortitis and mesoaortitis:

A. Tuberculosis

B. Syphilis

C. Lyme disease

D. Candidiasis

35. Risk factors associated with degenerative aortic aneurysms, except:

A. Cigarette smoking

B. Hypercholesterolemia

C. Female sex

D. Positive family history