BELAJAR BARENG

CARDIO
JANUARI II
1. Which of the following statements about
physical findings in heart failure is TRUE?

A. Hydrothorax in heart failure is most often bilateral, but when unilateral it is usually
confined to the right side of the chest

B. The absence of pulmonary rales on examination excludes the presence of an elevated

pulmonary capillary pressure

C. Hepatomegaly typically follows the development of overt peripheral edema

D. The absence of peripheral edema indicates the lack of volume overload and systemic
venous congestion

E. In left ventricular failure, P2 is often reduced in intensity

Heart failure-related pleural effusions are usually bilateral, but when they
are unilateral they are usually present on the right side.

The absence of pulmonary rales could happen in patients w/ chronic heart

failure who may have well-developed lymphatic drainage.

Hepatomegaly is often present in patients with heart failure before the

development of overt peripheral edema.

A substantial gain of extracellular fluid volume (>4 L in adults) must occur

before peripheral edema develops.

In left ventricular failure, pulmonary artery pressures rise and the pulmonic
component of the second heart sound is accentuated.
2. A 66-year-old man with a history of
diabetes and hypertension presents for
evaluation of exertional dyspnea. He denies
associated chest discomfort, but frequently
awakens from sleep with shortness of breath. On
examination, he has prominent jugular venous
distention, a regular heart rhythm with an apical
S4 gallop, bibasilar rales, hepatomegaly, and
mild bilateral pedal edema.
Electrocardiography reveals sinus rhythm at a
rate of 94 beats/min without ST-segment
deviations or pathologic Q waves.
Echocardiography is notable for a left
ventricular ejection fraction of 25% and akinesis
of the anterior wall. Subsequent coronary
angiography reveals severe three-vessel
coronary artery disease with distal targets
suitable for surgical revascularization. Which of
the following statements about this patient’s
ischemic cardiomyopathy is correct?
+ A. Coronary artery bypass grafting (CABG) is superior to
medical therapy only if angina is present
+ B. In this patient’s case, dobutamine echocardiography
could be used to differentiate anterior wall infarction
from hibernating myocardium
+ C. CABG improves quality of life and survival more than
medical therapy only if >50% of the myocardium is
shown to be viable
+ D. Stunned myocardium refers to persistent contractile
dysfunction caused by chronically reduced coronary
blood flow
+ E. Surgical ventricular reconstruction should be
performed along with CABG because the anterior wall is
akinetic
 A. Lidocaine is a useful agent for treating
arrhythmias due to digitalis excess

3. Which of B. Second- and third-degree atrioventricular blocks

in this setting often respond to atropine
the following
statements C. Recurrence of digitalis toxicity may occur 24 to
48 hours after the administration of antidigoxin

about digitalis immunotherapy

D. Direct-current cardioversion may precipitate
toxicity is NOT ventricular arrhythmias in patients with digitalis
intoxication and should be avoided
correct? E. Dialysis is effective in cases of massive
overdose
4. A 57-year-old man is admitted to the hospital with 2 hours of
severe chest pain. His initial electrocardiogram shows 3-mm ST-
segment elevations and small Q waves in leads V1–V4. Emergency
coronary angiography reveals occlusion of the proximal left anterior + A. Implantation of a
descending artery (LAD) without collateral vessel flow. The left defibrillator
circumflex and right coronary arteries are patent without significant
obstruction. Primary percutaneous coronary intervention of the LAD + B. Valsartan 80 mg daily
restores Thrombolysis in Myocardial Infarction grade 3 flow.
Following coronary intervention, his physical examination reveals a + C. Eplerenone 25 mg
blood pressure of 120/70 mm Hg and heart rate of 70 beats/min. The
jugular venous pressure is not elevated. On lung auscultation, daily
bibasilar crackles are audible without wheezes. Cardiac examination
reveals a normal apical impulse, a prominent fourth heart sound, and + D. Amiodarone 200 mg
a grade II/VI apical holosystolic murmur. His extremities are warm daily
and peripheral pulses are symmetric and full. The chest radiograph
shows a normal cardiac silhouette with interstitial pulmonary edema.
Echocardiography reveals a reduced left ventricular ejection fraction + E. Warfarin adjusted to
of 34% with anteroapical akinesis. No apical thrombus is visualized. an international
Moderate mitral regurgitation is present. Brief runs of nonsustained normalized ratio of 2.0 to
ventricular tachycardia are noted on the first hospital day. His current
regimen includes aspirin 81 mg daily, clopidogrel 75 mg daily, 3.0
atorvastatin 80 mg daily, metoprolol succinate 50 mg daily, and
lisinopril 10 mg daily. Which of the following interventions prior to
discharge would further reduce his mortality risk?
5. The circulatory support device seen in the radiograph below has
been shown to significantly improve survival and quality of life in select
patients with advanced heart failure. Common adverse events
associated with this therapy include all of the following EXCEPT

+A. Stroke

+B. Driveline infection

+C. Pump rotor failure

+D. Gastrointestinal bleeding

+E. Right ventricular failure

6. A 56-year-old woman with atrial fibrillation
+ A. Addition of dopamine 2 mcg/kg/min by
and nonischemic dilated cardiomyopathy is
continuous IV infusion
admitted to the hospital with acute
decompensated heart failure. Her past medical + B. Addition of milrinone 0.25 mcg/kg/min by
history is notable for type 2 diabetes, chronic renal continuous IV infusion
insufficiency, and gout. Her admission blood
pressure is 90/76 mm Hg with an irregular heart + C. Addition of sodium nitroprusside 20 mcg/min
rate of 94 beats/min and her examination is by continuous IV infusion
notable for pulmonary and systemic congestion.
Treatment is initiated with a continuous IV + D. Insertion of a pulmonary artery catheter for
furosemide infusion at 10 mg/h after an assessment of central hemodynamics
intravenous bolus. However, her urine output
remains <70 mL/h and her serum creatinine + E. Initiation of bedside ultrafiltration
increases from 1.4 mg/dL to 2.1 mg/dL over the
first 48 hours of hospitalization. Short runs of
nonsustained ventricular tachycardia are noted on
telemetry. Which of the following would be most
appropriate in the management of this patient?
Cardiorenal
syndrome
7. Picture below displays posteroanterior and lateral chest radiographs of
a patient with an idiopathic cardiomyopathy, symptomatic heart failure, left
ventricular ejection fraction <0.35, and left bundle branch block on the ECG.
Which of the following statements about the pictured device is NOT correct?

+ A. Implantation of this device reduces left

ventricular dimensions and mitral regurgitation

+ B. Placement of this type of device is associated

with improved survival

+ C. A complication of device implantation is phrenic

nerve stimulation with diaphragmatic pacing

+ D. Minimization of this form of ventricular pacing

is important to prevent progressive heart failure

+ E. QRS duration on the surface ECG is an important

predictor of clinical benefit
 8. Which of the following conditions is NOT
associated with the development of pulmonary
edema?

A. Increased pulmonary venous pressure

B. High altitude
C. Increased plasma oncotic pressure
D. Eclampsia
E. Heroin overdose
 A. Cardiomegaly is usually absent in primary
restrictive cardiomyopathy
9. True
statements about B. Elevated jugular venous pressure and an S4
gallop in patients with heart failure are each
cardiac physical associated with a poor prognosis
findings in C. Pulsus alternans results from variation of the
stroke volume, likely owing to incomplete recovery
patients with of contracting myocardial cells
heart failure D. Low-grade fever may occur in advanced heart
include all of the failure in the absence of underlying infection
following
E. Sleep-disordered breathing is common in
EXCEPT patients with heart failure
 + Analysis of the Studies of Left Ventricular Dysfunction
treatment trial has demonstrated that the physical
Heart examination carries important prognostic information in
patients with heart failure.
failure + In particular, elevated jugular venous pressure and a third
heart sound are each independently associated with adverse
outcomes, including progression of heart failure.
 10. Which of these statements regarding the
relationship between perfusion pressure and airway
pressure in the upright lung is NOT correct?

A. Pulmonary artery pressure is greater than alveolar pressure at the lung apices

B. Pulmonary venous pressure exceeds alveolar pressure at the lung bases

C. Measurement of pulmonary capillary wedge pressure is most meaningful in lung

zones in which pulmonary venous and arterial pressures exceed alveolar pressure

D. Pulmonary vascular redistribution on the chest radiograph occurs when there is a

relative reduction in perfusion of the bases with a relative increase in apical perfusion
11. Which of the following is NOT likely to
be a complication of cyclosporine therapy
in the cardiac transplant recipient?
A. Gingival hyperplasia
B. Myelosuppression
C. Hypertension
D. Tremor
E. Hirsutism
12. Which of the following statements about
acute heart failure is NOT correct?
A. Most patients with acute heart failure present with normal or elevated blood
pressure
B. Milrinone does not improve in-hospital mortality

C. Serum vasopressin levels are elevated in acute heart failure and contribute to
hyponatremia, a marker of poor prognosis
D. Tolvaptan, a vasopressin receptor antagonist, reduces the risk of death and
heart failure re-hospitalization
E. Noninvasive ventilation in patients with acute pulmonary edema does not reduce
short-term mortality compared with oxygen alone
 13. Which of the following statements about
patients with symptomatic heart failure is NOT
correct?
A. Plasma norepinephrine level is usually elevated

B. Serum B-type natriuretic peptide is elevated

C. Cardiac beta-adrenergic receptor density is increased

D. Serum aldosterone level is elevated

E. The circulating level of tumor necrosis factor-alpha is increased

14. Which of the following statements
regarding post-cardiac transplantation
complications is NOT true?
+ A. Infectious complications are responsible for approximately 20% of deaths during the
year after transplantation

+ B. Allograft coronary artery disease is the most significant factor limiting long-term
survival

+ C. The propensity for allograft rejection decreases with time

+ D. Cytomegalovirus infection is associated with development of post-transplantation

lymphoproliferative disorder

+ E. Transplant recipients have an increased incidence of cancer compared with age-

matched controls
post-cardiac
transplantation
complications
 + A. The tip of the IAB should be positioned just
15. Which of the distal to the left subclavian artery

following + B. The IAB should be timed to deflate during the

isovolumetric phase of left ventricular contraction
statements
+ C. Inflation of the IAB should be timed with aortic
regarding intra- valve closure on the arterial pressure waveform

aortic balloon + D. Aortic valve stenosis is a strict

contraindication to the use of an IAB
(IAB) counter- + E. In the SHOCK II trial, IAB therapy did not reduce
pulsation is NOT 30-day mortality in comparison to medical
therapy among patients with acute myocardial
correct? infarction complicated by cardiogenic shock for
whom early revascularization was planned
 A. Angiotensin receptor blocking drugs are less effective
than angiotensin-converting enzyme (ACE) inhibitors in the
16. Which of reduction of mortality in patients with heart failure

the following B. ACE inhibitors are indicated in patients with heart failure and
left ventricular dysfunction, irrespective of the functional New

statements York Heart Association classification

regarding C. Digoxin has been shown to decrease heart failure

hospitalizations

therapy for D. Spironolactone has been shown to decrease mortality in

patients with patients with class III to IV symptoms

heart failure is E. Regular physical exercise does not reduce mortality in

patients with chronic heart failure
NOT correct?
 A. Adenosine administration aids in the diagnosis of
wide QRS complex tachycardias

17. Which of the

following B. Slow, peripheral intravenous administration of 6
to 12 mg of adenosine terminates supraventricular
statements about tachycardias involving the atrioventricular node

the use of C. Patients with heart transplants demonstrate an

exaggerated response to adenosine
adenosine in the
management of D. Adenosine may be ineffective in patients who have
cardiac recently consumed caffeine

arrhythmias is
E. Flushing, dyspnea, and chest pressure are common
NOT correct? side effects of adenosine
18. Which of the following statements
regarding dysrhythmias is NOT correct?
A. The prevalence of premature ventricular complexes increases with age

B. In the absence of structural heart disease, detection of premature ventricular

complexes has no impact on survival

C. Class IC antiarrhythmic agents are the drugs of choice for suppression of

premature ventricular complexes after myocardial infarction

D. Most concealed accessory pathways are located between the left ventricle and the
left atrium

E. A concealed accessory pathway should be suspected in narrow-complex tachycardias

when the retrograde P wave occurs after completion of the QRS complex
19. A 56-year-old man with
a history of
hypercholesterolemia and
smoking is referred to the
cardiology clinic for
preoperative risk assessment
before an orthopedic
procedure. He denies any
cardiovascular symptoms
and exercises regularly. His
ECG is shown in picture
below. Which of the following
statements is NOT correct?
A. This syndrome is thought to account for 40% to 60% of all
cases of idiopathic ventricular fibrillation

B. Genetic mutations in the sodium channel have been identified

in some families with this syndrome

C. An implantable cardioverter-defibrillator is appropriate therapy

for some patients with this syndrome to prevent sudden death

D. Antiarrhythmic therapy with procainamide reliably

prevents ventricular arrhythmias in this syndrome

E. Screening of family members for this condition is

recommended
 A. The therapy of choice for survivors of SCD is
implantation of a cardioverter-defibrillator
20. True
statements B. Defibrillators reduce the risk of sudden death from
arrhythmia in patients with nonischemic cardiomyopathy
regarding the and left ventricular ejection fraction (LVEF) ≤35%

prevention of C. For survivors of out-of-hospital cardiac arrest not

associated with a myocardial infarction, the risk of recurrent
sudden cardiac cardiac arrest at 1 year is about 30%

death (SCD) D. Prophylactic defibrillator implantation is appropriate for

include all of prevention of sudden death in patients with left ventricular

dysfunction (LVEF ≤ 30%) and prior myocardial infarction

the following E. Amiodarone is the most appropriate long-term

EXCEPT prophylactic strategy for patients with hypertrophic

cardiomyopathy and a prior history of syncope
 A. In first-degree AV block, the intensity of the first heart
sound is increased

21. Which of B. The conduction abnormality in Mobitz type I seconddegree

the following heart block with normal QRS complex duration is almost
always at the level of the AV node, proximal to the His bundle

statements C. In typical Mobitz type I second-degree heart block, the RR

interval progressively shortens over consecutive beats until a
regarding beat is dropped

atrioventricular D. In Mobitz type II second-degree heart block, the PR intervals

are constant prior to the nonconducted P wave
(AV) block is
NOT correct? E. The ventricular escape rate in acquired complete heart block
is usually <40 beats/min
22. Which of the + A. A long-term loop recorder is frequently useful for
following diagnosis in patients with frequent symptoms and an
unrevealing Holter recording
statements about
the use of
+ B. Type I second-degree atrioventricular block is commonly
present in normal subjects
ambulatory + C. Sinus bradycardia with rates as low as 35 beats/min and
electrocardiograp sinoatrial exit block may be found in persons without

hic monitoring for cardiac disease

the detection of + D. Long-term monitoring of patients with a history of atrial

cardiac
fibrillation (AF) indicates that symptomatic AF episodes
occur more commonly than asymptomatic episodes
arrhythmias is + E. The frequency of ventricular premature beats after
NOT correct? myocardial infarction increases over the first several weeks
 A. Cardiac causes account for 10% to 20% of
syncopal episodes

23. Which of B. Syncope of cardiac origin is associated with a

30% 1-year mortality
the following
statements C. The most common causes of syncope are
vascular in origin, including reflex-mediated

regarding syncope and orthostatic hypotension

D. Supraventricular tachycardia has been
syncope is identified as a common cause of syncope

NOT correct? E. The cause of syncope can be identified in a large

percentage of patients based on history and
physical examination alone
 A. AAIR pacing is appropriate for patients with sinus
node dysfunction and intact atrioventricular (AV)
conduction
24. Which of B. Symptomatic Wenckebach AV block is an indication
the following for permanent pacing

statements C. Pacemaker syndrome can be manifest in any pacing

mode in which there is AV dissociation
about
permanent D. Medically refractory hypertrophic
cardiomyopathy is a class I indication for the
pacemakers is placement of a permanent dualchamber pacemaker

NOT correct? E. A pacemaker mode-switching option is beneficial for

patients with paroxysmal supraventricular rhythm
disturbances
25. Which of the + A. A dual-chamber system must be present
following to cause PMT

statements + B. Intact atrial sensing is required for PMT

regarding + C. Premature ventricular contractions

pacemaker frequently initiate PMT

mediated + D. Shortening the postventricular atrial

tachycardia (PMT) refractory period will prevent PMT

is NOT correct? + E. Retrograde P waves are typically present

THANK YOU