The followings are causes of prominent R wave in Lead V1 EXCEPT:
Posterior wall myocardial infarction.
RBBB.
Mirror image dextrocardia.
Wolf-Parkinson-White Syndron type A.
Wolf-Parkinson-White Syndrom type B.
Which one of the following is associated with ST segment elevation in ECG?
LVH
RVH
Digoxin effect
early repolarization after an attack of angina
subendocardial infarction
The commonest type of Arrhythmia in WPW syndrome is:
Vnetricular Tachycardia
Ventricular Fibrillation
Ventricualr Premature Complexes
Atrial Ectopics
AV Nodal Re-entry Tachycardia
The followings are seen in Noonan's Syndrome Except:
mental retardation
pumonary artery stenosis
branch pulmonary artery stenosis
HOCM
Mitral stenosis
Causes of long QT Syndrome include all of the followings except :
Hypokalaemia
Hypocalcaemia
Hypomagnesaemia
Hypermagnesaemia
Rheumatic carditis
In Hypertrophic Cardiomyopathy which one is true?
Caused by mutation in Na channels
25% are associated with a positive family history
30% are associated with left ventricular outflow obstruction
all patients are symptomatic
the commonest type of hypertrophy is the Apical type.
In acute pericarditis, which one is false?
the commonest cause is the idiopathic type (may be viral)
the majority progresses to tamponade
in uraemic pericarditis, there is a risk of tamponade formation
the rub is usually transient
TB pericarditis is rarely an acute one
The following indicates an absolute contraindication to thrombolytic therapy in Acute ST segment elevation MI...Choose one:
70year old hypertensive male with acute chest pain and new diastolic murmur in the left lower sternum and ST elevation in lead II,III and aVF
40 year old lady with 7 missed periods and abdominal distension
34 old diabetic male recently underwent "LASER Retinal therapy " as he said ..came with shock ,raised JVP and clear lungs.
ST elevation in lead V1,V2,V3 with a blood pressure of 180/100 easily controlled with antihypertensive medications
60 year old male who is a known case of ischemic heart disease presents with new LBBB and chest pain for 2 hours with ST elevation in V4, V5, and V6
Bad prognostic factors in UNSTABLE angina include all of the followings except:
development of heart failure
prolonged chest pain
ST elevation
high cardiac troponin T
intermittent chest pain
The followings are true except
the right coronary artery supplies the AV node in 90 % of cases
the right coronary artery supplies the SA nose in 60 % of cases
left main stem coronary artery is easily dilated by at PTCA in atheromatous narrowing and should be routinely done in such cases.
Prinzmatal angina usually occurs at night
Prinzmetal angina may occur with coronary atheroma
Amiodarone……all are ture except:
40 % of it is iodine ..hence the risk of either hypo or hyperthyroidism
potentiates the effect of warfarine
potentiates the effect of digoxin
corneal deposits of the drug are usually irreversible.
prolonges the plataue phase of action potential .
Causes of raised JVP include all of the followings except:
mediastinal lumphoma
mediastinal irradiation 2 years previously .
ST elevation in lead rV4 and chest pain
Liver Cirrhosis
Atrialization of the right ventricle
In Coarctation of the aorta …which one of the followings is False?
in adults usually causes and presents as hypertension
BICUSPID AORTIC VALAVE is a common association
Rib notching is usually seen from the 3rd rib till 9th rib in infancy
Dissection is a recognized complication
Subarachnoid hemorrhage may occur.
The followings improve the survival figure in chronic congestive heart failure as shown by many studies...Except
bisprolol
metaprolol
carvidolol
spironolactone
atenolol
In infective endocarditis which one is false?
streptococcus viridans is the cause of up to 50% of naitive valve endocarditis
staph species may be the cause in 50% of prosthetic valve endocarditis
the commonest cause of culture negative endocarditis is partial treatment with antibiotics
3 negative serial blood cultures usually exclude infective endocarditis in the appropriate clinical setting
the sensitivity of transesophageal Echocardiography here is 95% versus 65% in the transthoracic approach .
The followings cardiac lesions are associated with a high risk of infective endocarditis except:
Ventricular septal defect
HOCM
combined mitral valve disease
MVP with significant mitral regurgitation by Echo study
Mitral stenosis
The treatment of infective endocarditis …all are true except:
persistent fever may indicates a non bacterial cause like fugal cause .
cidal drugs rather than statics should be used .
always await the culture results before giving any treatment.
intravenous route is always preferred .
persistent fever may indicate a drug fever .
In mitral stenosis all are true except:
malar flush may be seen
low cardiac output state
rarely congenital
S3 sound is commonly seen
20 % stays in sinus rhythm despite severe stenosis
Aortic stenosis ….all are true except:
Carotid shudder is common
syncpoe indicates an urgent need for intervention
it is sub-valvular in William's Syndrom
marked LVH per se is a risk factor for angina and arrhythmias
valve replacement is the usual mode of treatment
The objectives in the medical treatment of heart failure ..all are true ….except:
Reduction of the after load
optimization of the preload
augmentation of the cardiac contractility
controlloing the heart rate
aggressive diuresis to remove all edemas
In diastolic heart failure which one of followings is true :
aortic regurgitation usually causes diastolic dysfunction
till now there is no general consensus about the optimal medical management for it
myocardial ischemia starts with systolic dysfunction
tachycardia is needed to compensate for the defect and hence the heart rate should be kept above 90 beats/minutes
ACE inhibitors had been shown to improve the overall mortality figure
In secondary hypertension ..the clues to it are all of the followings except :
rapidly developing
poor response to standard medical therapy
age blow 20 and above 50 years
certain physical signs like mooning of the face and abdominal striae
strong family history of hypertension
Long standing hypertension ……choose the most true :
very weak effect on the coronary arteries
a strong risk factor for the development of intracerebral bleeding
in diabetic nephropathy the target blood pressure should be 140 / 85mmHg
ACE inhibitors should be routinely prescribed
Diuretics are usually not effective in elderly
Possible Risk factors for ischemic heart disease …one is incorrect:
hyperhomocystenemia
obesity
sedentary life style
high blood fibrinogen
diet rich in vegetables .
Complications of long standing hypertension include all of the followings except:
Diastolic heart failure
Coronary artery disease
Stroke
peripheral vascular disease
Systolic heart failure
Atrial myxoma.. which one is the false statement :
may present as an SBE like picture
may present as a vasculitis like picture
high recurrence following surgery in sporadic cases
high recurrence following surgery in familial cases
when arises from the right side of the heart we should think of familiar predisposition
When examining the JVP …which one is a wrong statement:
rapid x descent and steep y descent occurs in pericardial constriction
rapid x descent and blunted y descent occurs in pericardial tamopnade
lagre CV wave occurs in tricuspid regurgitation
hepatojugular reflux is important only if it sustains with continuous pressure on the abdomen
regular cannon A waves indicates complete heart block
Deep Permanent Q wave may be seen in...Choose one
early phase acute anterior wall MI
WPW syndrome
established subendocarial infarction
established acute phase isolated posterior MI
during Prinzmetal angina
In the medical treatment of acute MI..the followings are true except :
aspirin per se reduces the mortality by 30%
thrombolysis reduces the overall mortality by 25-50%
beta blockers like iv metoprolol greatly reduces the susceptibility to arrhythmias
iv nitroglycerin have no effect on the overall mortality figure
Morphin better to be given by a subcutaneous rout rather than iv because this confers a longer half life
Secondary prophylaxis of MI which one is a false statement :
ACE inhibitors have a favorable effect by many independent mechanisms
Bata blocker are important if no contraindication to it
Statins had been shown to produce regression of the atherosclerotic plaques
cardiac rehabilitation programs should not be forgotten
Digoxin had been shown to have a favorable effect
Contraindication to exercise ECG testing in the contest of a heart diseases all are true except :
uncontrolled hypertension
fever or a febrile illness
severe aortic stenosis
acute pericarditis
subjective feeling weakness
The followings indicate strong positive exercise ECG testing ..except
deep ST depression
wide spread ECG changes upon exercise
prolonged ST depression after finishing the test
ST elevation per se
Mild -moderate ST T segment abnormalities in middle aged woman with chest pain with no risk factors for ischemic heart disease
False positive exercise ECG testing are common In clinical practice…causes include all of the followings except
prior treatment with digoxin
treatment with beta blockers
marked LVH per se
early development of wide spread ECG changes in stage I Bruce protocol
MVP
During cardiac arrest of your patient in the CCU ..you jumped to use DC shock cardioversion but the nurse shouted that the monitor is showing a heart rate of 90 beats per minutes …..all can this complication except
pulmonary thromboembolism
tension pneumothorax
profound shock due to bleeding
hypokalemia
treatment with xylocain
Use of ACE inhibitors in the medical treatment of Post- MI patients ...all are true except
had been shown to decrease ventricular remodeling and hence aneurismal formation
prevent the onset of overt heart failure in asymptomatic patient
reduce the hospitalization rate
should be given to all patient if tolerated and no contraindication
contraindicated in post MI patient with a chronic renal failure
Treatment of hypertension with diuretics all are true except:
loop diuretics are preferred because of its powerful effect .
Diuretics in the treatment of hypertension uncommonly produces acid base and electrolyte disturbances compared when used in the treatment of heart failure states
As an anti- hypertensive medication …..they work by an independent mechanism of their DIURETIC action .
first line agents in an elderly with systolic hypertension