2nd BLOCK

Question 1

Class IV Antiarrhythmic 
• Verapamil
• Lidocaine
• Hydralazine
• Dobutamine
• Flecainide

Answer 1

Verapamil

Question 2

A 59-year-old man with hypertension presents to his primary care physician with lower extremity edema.
Physical examination reveals pitting edema from the ankles to the knees bilaterally. The patient has begun on
furosemide. It is important for the physician to be aware of which of the following drug-to-drug interactions?

• Improves orthostatic hypotension
• Potentiates other antihypertensives
• Ototoxic when combined with thiazide diuretics
• Hyperkalemia with corticosteroids

Answer 2

Ototoxic when combined with thiazide diuretics

Question 3

A man was knifed to the chest and is now in the ER presenting with the classic Beck’s triad. Which of the ff statements is true?

• This patient needs an emergency heart surgery
• The jugular veins are not prominent
• There will be sinus bradycardia
• The patient will have normal blood pressure

Answer 3

This patient needs an emergency heart surgery

Question 4

Which of the following is an indication for surgical repair replacement of the mitral valve in a patient with mitral insufficiency?

• Abnormal exercise testing
• All of the above
• Recent onset of atrial fibrillation
• Any symptom, even if LV function is normal

Answer 4

All

Question 5

A 20-year woman starts to develop subcutaneous nodules associated with erythema marginatum of the skin. She also begins to complain of pain in her knees and hips. The woman was hospitalized 3 weeks earlier due to a severe bout of acute tonsillopharyngitis. Which of the following serum laboratory findings is most characteristic of the disease?

• Elevated anti-streptolysin O
• Elevated C-reactive protein
• Positive RPR test
• Positive ANA test

Answer 5

Elevated anti-streptolysin O

Question 6

Positive Inotropic Drug

• Dobutamine
• Hydralazine
• Flecainide
• Verapamil
• Lidocaine

Answer 6

Dobutamine

Question 7

Which of the following pericardial diseases is likely to produce thick, pearly non-adherent epicardial plaque
more commonly referred to as “soldier’s plaque”?
• Caseous pericarditis
• Serous pericarditis
• none of the above
• Purulent pericarditis
• Chronic pericarditis

Answer 7

Chronic pericarditis

Question 8

DESIRED VALUES: LDL Cholesterol

Answer 8

<100mg/dL

Question 9

INTERPRET THE LEVELS OF LD: CSF in Hydrocephalus & seizures

Answer 9

LD2>LD1>LD3>LD4 >LD5

Question 10

A patient was extracted at 6:00AM for Lipid Profile, with the following results: TAG = 200mg/dL
Total Cholesterol = 220mg/dL HDL cholesterol = 35mg/dL.
Analyze the patient’s LDL & VLDL, using Friedewald Equation:

Answer 10

145.0mg/dL LDL, 40.0mg/dL VLDL

Question 11

General recommended age for surgical repair in patients with Aortic Coarctation

Answer 11

< 6 months

Question 12

The most characteristic lesion seen in the heart of patients with acute rheumatic fever: [2 answers based on rc]

Answer 12

MacCallum plaques

Aschoff bodies

Question 13

The following are considered cardinal anatomic changes seen in a heart affected with chronic rheumatic heart disease except:

• Well delineated valvular cusps and non-fusion of the commisures
• Thickening of the involved valve leaflets
• Shortening and fusion of the tendinous cords
• none of the above
• All of the above

Answer 13

All

Question 14

Normal amount of fluid in pericardial sac

Answer 14

30-50 cc

Question 15

When compared to percutaneous coronary intervention, coronary artery bypass

Answer 15

Provides a more complete relief of angina

Question 16

The most common cyanotic heart anomaly

Answer 16

tetralogy of fallot

Question 17

Not an acute adverse effect of organic nitrates:

• glaucoma
• tachycardia
• orthostatic hypotension
• throbbing headache

Answer 17

Glaucoma

Question 18

What physical examination findings would be consistent with early signs of cardiac tamponade?

Answer 18

Muffled heart sounds

Question 19

Which is the most appropriate statement regarding the difference between pericardial effusion and cardiac tamponade?

• Cardiac tamponade is a physiologic diagnosis with resultant hemodynamic consequences
• Pericardial effusion is a physiologic diagnosis with no hemodynamic consequences.
• Pericardial effusion is an anatomic diagnosis that has resultant hemodynamic consequences
• Cardiac tamponade is an anatomic diagnosis with no hemodynamic consequences

Answer 19

Pericardial effusion is an anatomic diagnosis that has resultant hemodynamic consequences

Question 20

Stage B Heart Failure Therapy:

Answer 20

ACE inhibitors or ARBs in all patients; beta blocker in selected patients

Question 21

The action potential in cardiac cells is divided into 5 phases, which include:

• Phase 0: a fast upstroke from the spontaneous increase in Na permeability
• Phase 1: partial repolarization from the activation of Na+ channels & leaking of K+
• Phase 2: plateau from the opening of calcium channels & outward leaking of K+
• Phase 3: spontaneous depolarization from gradual increase in Na permeability
• Phase 4: repolarization from opening of potassium channels

Answer 21

Phase 0: a fast upstroke from the spontaneous increase in sodium permeability

Question 22

During the past 2 years, a 34-year old woman has had palpitations, fatigue and worsening chest pain. She was afebrile on physical examination. Her PR is 75/minute, RR of 15/ minute and BP of 110/70 mmHg. A midystolic click with late holosystolic murmur is noted on chest auscultation. The patient admitted to having one or two anxiety attach each month. Which of the following best explains the midsystolic click noted on auscultation?

• Incompetent valve
• Rupture of the tendinous cords
• Annular dilatation
• Snapping of the everted cusp

Answer 22

Annular dilatation

Question 23

A 72-year old man who is very athletic and walks half marathons has been successfully treated for exercise-induced angina for several years. He recently has been complaining about being awakened at night with chest pain. Which of the following drugs would be useful in preventing this patient’s nocturnal angina?

• Nitroglycerin (transdermal)
• Esmolol
• Hydralazine
• Amyl nitrite
• Nitroglycerin (sublingual)

Answer 23

Nitroglycerin (transdermal)

Question 24

A 54-year-old woman on antiarrhythmic drug therapy complained to her physician of palpitations, insomnia, diarrhea, and increased sweating for the past 3 weeks. Physical examination revealed a patient in moderate distress with mild hand tremors and exophthalmos. ECG showed atrial tachycardia. Which of the following drugs is she most likely taking?

• Amiodarone
• Propanolol
• Quinidine
• Digoxin
• Verapamil

Answer 24

Amiodarone

Question 25

Which of the following is regarding the clinical manifestation of chronic pericardial effusion? * Beck’s triad * Hypertension * Some patients maybe asymptomatic even on physical exertion * Dyspnea and fatigue are common symptoms

Answer 25

Beck’s triad

Question 26

A 45-year old female has had increasing fatigue, exertional dyspnea and episodes of mild chest pain for the past 7 months. On physical examination, she is afebrile. Her pulse is 79/ minute, respiratory rate of 15/minute and blood pressure if 120/70 mmHg. Her laboratory studies show normal levels of serum troponin I, glucose, creatinine and cholesterol. The patient was diagnosed of mediastinal malignancy 1 1/2 year prior to this admission. She received 7 cycles of radiation therapy, with the last treatment received 10 months prior to the current admission. Which of the following morphologic findings in the heart is most compatible with the condition? * Asymmetric septal hypertrophy * Bi-atrial dilatation and firm myocardium * Four Chamber dilation and flabby myocardium * Concentric hypertrophy

Answer 26

Bi-atrial dilatation and firm myocardium

Question 27

Dronaderone:

Answer 27

An amiodarone derivative that does not have the iodine moieties that are responsible for thyroid dysfunction associated with amiodarone

Question 28

REFERENCE VALUES: Lactate dehydrogenase (LDH)

Answer 28

80-280 U/L at 37 ⁰C

Question 29

FREDRICKSON LIPOPROTEIN PHENOTYPING: Phenotypes - 111 | Lipoprotein Elevation?

Answer 29

VLDL and CM

Question 30

The drug of choice for torsades de pointes and digoxin-induced arrhythmias.

Answer 30

Magnesium sulfate

Question 31

Electrical alternans is characterized by

Answer 31

Alternating low voltage and high voltage height of the QRS on the ECG tracing

Question 32

Tamponade compresses the heart and the pressure increases the cardiac output.

Answer 32

False

Question 33

A patient presents four weeks post myocardial infarction with fever, chest pain, dyspnea, palpitations, lightheadedness, and confusion. The Cardiologist predicts the patient has Dressler's Syndrome which is an inflammatory condition of the pericardium. What will you most likely find on echocardiogram?

Answer 33

Pericardial effusion

Question 34

A 20 year – old boy developed rapid onset of fever, with associated chills and malaise. Heart murmurs are noted upon auscultation at the emergency room. He was immediately brought to the intensive care unit where he expired after 4 days of confinement. The patient is a known Intravenous drug user. What clinical condition did the patient likely succumbed to?

Answer 34

Acute infective endocarditis

Question 35

Which medication should be administered to all patients with acute angina?

Answer 35

Nitroglycerin sublingual tablet

Question 36

Which of the following statements is true regarding Atrial Septal Defect:

Answer 36

ASD result in an increase in pulmonary blood flow secondary to left to right shunting through the defect

Question 37

Class II antiarrhythmic drugs:

Answer 37

Inhibits phase 4 depolarization in SA and AV nodes

Question 38

Class 1B Antiarrhythmic

Answer 38

Lidocaine

Question 39

The closure of the ductus creates a fibrous cord called:

Answer 39

ligementum arteriosum

Question 40

A pericardial effusion involves the presence of an abnormal amount or type of fluid within the pericardial space

Answer 40

True

Question 41

FREDRICKSON LIPOPROTEIN PHENOTYPING: Phenotypes - 11a | Major Plasma Lipid Elevation?

Answer 41

Cholesterol

Question 42

FREDRICKSON LIPOPROTEIN PHENOTYPING: Phenotypes - 11b | Lipoprotein Elevation?

Answer 42

LDL and VLDL

Question 43

Centrally-acting sympathoplegic:

Answer 43

Clonidine

Question 44

Cardiac tamponade is best defined as excessive fluid in the

Answer 44

Pericardium that leads to increased ventricular filling and decreased cardiac output.

Question 45

The diagnostic procedure with the highest sensitivity of detecting a pericardial effusion or cardiac tamponade is:

Answer 45

Two-dimensional echocardiogram.