Primary pulmonary hypertension ……..all are true...Except

1.   ?    an associated with HIV infection has been seen.
2.   ?    medial hypertrophy and fibrinoid necrosis are seen in ALL branches of the pulmonary arterial tree and result in pulmonary vascular obstruction
3.   ?    physicial signs are usually unimpressive until right sided heart failure sets in
4.   ?    5 out of every ten cases are familial.
5.   ?    most patients die within 2-3 years of diagnosis.

Cor pulmonale ……..all are true except

1.   ?    may be acute or chronic
2.   ?    the first physical sign is raised JVP
3.   ?    may be caused by postpoli syndrome
4.   ?    the usual end result of many chronic debilitating lung diseases
5.   ?    it is defined as right sided heart failure

You have been asked to examine this 70 year old gentleman with COPD who presents with excessive day time somnolence ……you noticed that he is a little bit dark in color …..You will then examine which one of the followings:

1.   ?    the chest for any new changes …
2.   ?    fundoscpe
3.   ?    trying to count the respiratory rate for hypoventilation
4.   ?    his heart for any heart failure
5.   ?    his neck for any swelling

Pulmonary thromboembolisom ……all are true except:

1.   ?    has diverse clinical manifestations ranging from totally asymptomatic to sudden death
2.   ?    Bed side echocardiography is a useful and rapid tool in cases of acute massive pulmonary theromboembolism
3.   ?    symptomatic pulmonary thromboembolism occurs up to 1% of all post operative patients.
4.   ?    Autopsy incidence of post operative thromboembolism is 10-25 %
5.   ?    up to 50% of all pulmonary thromboemboli came from the leg veins

Chest x ray findings in pulmonary thromboembolism …all are true except

1.   ?    may be normal
2.   ?    subtle changes may be present like regional oligmemia
3.   ?    peripheral wedge shaped opacities are commonly seen
4.   ?    elevation of the diaphragm is a well recognized sign
5.   ?    abscess formation has been documented .

ECG changes in acute pulmonary thromboembolism…all are true except:

1.   ?    sinus tachycardia is the commonest
2.   ?    RBBB has been documented
3.   ?    atrial fibrillation may be seen
4.   ?    S1 Q3 T3 pattern is common and useful
5.   ?    T inversion over the right chest leads

Treatment of acute pulmonary thromboembolism all are true except

1.   ?    Emergency embolectomy is rarely needed
2.   ?    Thrombolytics should be used in a massive pulmonary thromboembolism proved by CT or angiography
3.   ?    heparin therapy has been shown to decrease mediator induced pulmonary vasoconstriction
4.   ?    heparin therapy has not been shown to reduce the overall mortality in pulmonary thromboembolism,
5.   ?    oral anticoagulants have no place in the management of life threatening thromboembolic disease

General measures in the acute thromboembolic events: all are true except:

1.   ?    opiates may be necessary to relieve pain and disstress
2.   ?    the use of inotropic agents is of great value in massive events
3.   ?    duiretics and vasodilators should be avoided at all times
4.   ?    O2 should be given to all hypoxemic patients
5.   ?    resuscitation by external cardiac massage may be successful in moribund patients by dislodging and breaking up a large central embolus

Congenital heart disease…all are true regarding the incidence of various typesyes my father i …except

1.   ?    the commonest type is VSD -about 30 %
2.   ?    atrial septal defects -10%
3.   ?    patent ductus arteriosus -10%
4.   ?    tetralogy of fallot -16 %
5.   ?    Coarctation of aorta -7%

Congenital heart disease …..All are true except:

1.   ?    Aortic regurgitation may occur in VSD due to loss of support of the right coronary cusp
2.   ?    fallot tetralogy patients are protected from Eisenmenger's syndrome because of the pulmonic steosis
3.   ?    ASD primum usually presents in infancy with arrhythmias
4.   ?    preventing the closure a Patent Ductus arteriosus with certain medications is useful in certain congenital heart diseases like tricuspid atresia
5.   ?    transpositon of great vessels is the commonest cause of "cardiac cyanosis at birth"

Congenital heart diseases may have certain associations …..All are true except

1.   ?    ASD and triphalyngeal thumb
2.   ?    infant of a psychiatric mother -Epstein anomaly
3.   ?    maternall rubella and infant PDA
4.   ?    epileptic mother and interrupted aortic arch in the neonate
5.   ?    Noonan's syndrome and mitral stensois

In Aortic Regurgitation the following clues are important in the etiology of the regurgitation ……all are true except

1.   ?    bilateral small irregular pupils
2.   ?    long standing back pain with upper lobes fibrosis
3.   ?    Both cubital fossae examination may be of great help
4.   ?    hand examination can give no extra information
5.   ?    slit lamp examination is useful in certain cases

Mitral stenosis…..all are true...Except

1.   ?    Giant CV waves may be seen
2.   ?    pulmonary edema in pregnancy is an indication for emergency valvotomy
3.   ?    Transmitral diastolic gradient of more than 15 mmHg indicates mild-moderate degree of stenosis
4.   ?    an episode of pulmonary edema without a precipitating cause is an indication for surgery what ever the severity of stenosis was.
5.   ?    although secondary pulmonary hypertension is common, yet Graham Steel murmur is rare

ECG findings in uncomplicated congenital heart disease…..all are true..except

1.   ?    ASD secondum-partial RBBB
2.   ?    ASD primum -Left axis deviation
3.   ?    VSD-biventricular hypertrophy
4.   ?    PDA-RVH usually seen than LVH
5.   ?    coarcatation of aorta -LVH

Chest X ray findings in congenital heart disease…….which one is true

1.   ?    rarely abnormal in long standing cases
2.   ?    boot shaped heart usually suggestive of ASD
3.   ?    the sign of 3 is seen in aortic coarctation .
4.   ?    lagre prominent hili in Eisenmenger syndrome
5.   ?    the patent ducuts is seen on the plain PA film