Ischemic Heart Disease (IHD)
1) 55 years old man presented with severe central chest pain for 2 hours duration. ECG showed dome shaped (convex upward) ST elevations in the anterior chest leads. An ECG taken on the previous day was normal. Regarding this patient,
a) Acute myocardial infarction is a likely diagnosis
b) CK-MB levels will be elevated
c) Streptokinase is indicated
d) Pethidine is the drug of choice for analgesia
e) Aspirin improves mortality due to its anticoagulant effect
2. T/F regarding myocardial infarction
a) Bradycardia common in anterior MI than inferior MI
b) Streptokinase is indicated in normal ECG with typical symptoms
c) Beta blocker improves survival rate
d) Aspirin is with held until diagnosed by ECG
e) Statin is given even in normal LDL level
3. What are the treatment options in patient with NSTEMI?
a) Streptokinase
b) Heparin
c) Clopidogrel
d) Warfarin
e) Atorvastatin
4. Regarding stable angina
a) Resting ECG is abnormal in 50%
b) Upward sloping ST segment depression is more suggestive of ischemia
c) May undergo spontaneous improvement with time
d) Treatment with nitrates improve the survival
e) Aortic stenosis may have a similar presentation
5. Regarding unstable angina
a) Hypothyroidism is a risk factor
b) Thrombolytic therapy is indicated in severe disease
c) Men & women are equally affected
d) Troponin T elevated in most cases
6. Regarding thrombolysis in MI
a) If LBBB is present, ST elevation should be confirmed before thrombolysis
b) Arrhythmias during the thrombolysis carry a worst prognosis
c) Q waves may not develop if successful thrombolysis occurs
d) Can be repeated if chest pain recur within 1 week
e) Has a long term mortality benefit
7. Regarding MI
a) Sub-endocardial Ml manifest in specific leads
b) Pericardial rub occurs simultaneously with 1st ECG changes
c) Pansystolic murmur at apex may signify papillary muscle dysfunction
d) Breathlessness may be the only symptom
e) Vomiting is more common with anterior MI
8. A 56 year old male with a past history of myocardial infarction is admitted with sudden onset palpitations. ECG shows a broad complex tachycardia. The patient is conscious with blood pressure of 110/80 mmHg. What is the most appropriate treatment?
a) Carotid massage
b) Intravenous adenosine
c) Intravenous amiodarone
d) DC cardioversion
e) Intravenous digoxin
9. A 45y old male complains of recurrent episodes of left sided chest pain on exertion. Resting ECG is normal, the next most appropriate ix to arrive a diagnosis is
a) Coronary angiogram
b) Brain natriuretic peptide
c) Echo
d) Exercise ECG
e) Troponin I
10. 75 year old woman who has recurrent angina on GTN spray, aspirin, atorvastatin, enalapril and verapamil came to clinic. On examination her BP was 130/80, Pulse 60 bpm. To prevent the above problem what is your appropriate next management?
a) Changing verapamil to diltiazem
b) Changing enalapril to captopril
c) Add beta-blocker d) Give daily oral GTN
e) Reassure that it is normal
11. 55 year old female with diabetes mellitus and hypertension presented to ETU with retrosternal chest pain for 1 hour. ECG reveals 4 mm ST elevation in V1-V6. After excluding all contraindications, streptokinase 1.5 units were given. 2 hours later pain was persistent and there was 3 mm ST elevation in same leads of ECG. What is the best management?
a) Urgent coronary artery bypass graft
b) Rescue PCI
c) Repeat streptokinase
d) S/C enoxaparin
e) IV GTN
Heart Failure (HF)
1. Heart failure
a) MI is the commonest cause of LVF
b) Increased preload can maintain the cardiac output in severe heart failure
c) Rennin angiotensin mechanism is activated
d) Diastolic dysfunction is more common in elderly
e) Pansystolic murmur that best heard in inspiration may occur in LVF
2. Regarding chronic heart failure
a) Arrhythmias is the commonest cause of death in class II of NYHA classification
b) Angiotensin levels are elevated
c) Survival benefit of Furosemide is well proved in clinical trials
3. A 30 year old man who presented with progressive shortness of breathing. He found to have a blood pressure of 80/50 mmHg and elevated JVP with muffled heart sounds. Which of the following are expected findings,
a) Ankle oedema
b) Pulses paradoxes
c) Bilateral basal crepitations of the lungs
d) ECG showing small complexes
e) Globular heart in chest x-ray
4. In heart failure
a) ACE inhibitors are the 1st choice in management
b) Treatment with furosemide reduces the cardiac output
c) Beta blockers are prescribed to relieve the symptoms
d) Calcium channel blockers has special role in diastolic dysfunction
e) Implanted devices has no place in the management f) Digoxin is given only if atrial fibrillation is present
5. Which of the following has mortality benefit in CCF?
a) spironolactone
b) captopril
c) Isosorbide mononitrate
d) furosemide
e) metaprolol
6. Which of the following give survival benefit in cardiac failure
a) Captopril
b) HCT
c) Carvedilol
d) Digoxin
e) Spironolactone
7. A 50 year old man develops shortness of breath and leg swelling while away on a business trip. He was told that he had congestive cardiac failure, but asymptomatic now, with normal vital signs & physical examination. An echocardiogram shows an estimated ejection fraction of 38%. The patient likes to keep medications to a minimum. He is currently on aspirin and simvastatin. Which would be the most appropriate additional treatment?
a) Begin an ACE inhibitor and a beta-blocker on a scheduled basis. b) Begin digoxin plus furosemide on a scheduled basis.
c) Begin spironolactone on a scheduled basis.
d) Begin furosemide plus nitroglycerin.
e) Given his preferences, no other medication is needed unless shortness of breath and swelling occur.
8. A 60 year old previously well male complained of progressive breathlessness, abdominal discomfort and swelling of the legs. On examination there was a gross ascites, elevated JVP, bibasal crepitations and enlarged liver. BP - 180/80 mmHg, RR-25/min, PR - 36 bpm. On ECG heart rate is 96 bpm. What is the best management option?
a) Digoxin
b) Digoxin + Furosemide
c) Furosemide
d) Abdominal paracentesis
e) Transthoracic pacemaker
9. 54 y old man treated for heart failure had SOB in exertion. Had P/Hx of MI back. PR=80 regular, BP=130/90 mmHg. RS Ex normal. CXR-cardiomegaly he is on Furosemide 40 mg, Enalapril 10 mg. next drug?
a) Digoxin
b) Metoprolol
c) HCT
d) Atenolol
e) Losartan
10. 35 year old male with a previous history of STEMI presented with SOB & ankle Oedema after 2/52. Echo showed scarring of the L/ventricle. What is the best drug with survival benefit for this patient?
a) ISMN
b) Carvedilol
c) Diltiazem
d) Warfarin
e) Furosemide
