1. In the pathobiology of atherosclerosis, which of the following statements are correct

It is an int1ammatory/repair response in vessel wall initiated by lipid.

Majority of foam cells are derived from monocytes.

Small pools of extracellular lipids seen in type II lesion.

Stage IV lesion is characterised by formation of a fibrous capsule.

a+b

c+d

a+d



2. Which of the following statements are correct

Systolic BP correlates to CAD more than diastolic BP.

Atherogenic risk is present in prediabetes state.

Adverse effects of smoking is stronger in men than women.

Total body fat rather than its distribution correlates with CAD.

a+b

c+d

a+d



3. Which of the following occur in metabolic syndrome?

Low levels of small dense LDL particles

High HDL-C

Central obesity

Insulin resistance

a+b

c+d

a+d



4. Which of the following are correct regarding cardiovascular risk of obesity

Obesity is associated with elevated blood sugar, cholesterol and blood pressure

BMI is (weight in kg^2)/height in meters

Relative risk for CAD in morbid obese women is 2

Weight/Hip ratio correlates better with CAD than BMI

a+b

c+d

a+d



5. Which of the following statements are correct

Vitamin levels should be checked before initiation of folate for B12 hyperhomocysteinemia

Weight loss and exercise increase CRP levels

Plasma fibrinogen levels of above 150 mg/dL increases risk for stroke and myocardial infarction

Thrombospondins influence cell adhesion and vascular integrity



c+d

a+d



6. Which of the following regarding coronary circulations are wrong?

Myocardium derives energy only from aerobic metabolism

EDRF and prostacyclin have opposing actions on vascular smooth muscle

Coronary auto regulation influences collaterals

Adenosine causes coronary reactive hyperaemia

a+b

c+d

a+d



7. Which of the following statements are correct

Chylomicrons carry exogenous triglyceride

Chylomicron remnants are cleared by skeletal muscles

HDL particles contain apoprotein B100

VLDL particles carry cholesterol and triglyceride from liver

a+b

c+d

a+d



8. Which of the following regarding diet in therapeutic life style changes are wrong?

Saturated fat to be less than 15% of total calories

Carbohydrates form 25 of total calories

Dietary cholesterol less than 200 mg/day

Dietary soluble fibre of 5 -10 gm/day

a+b

c+d

a+d



9. A 40 years old diabetic, dyslipidemic male with strong family history of coronary artery disease has retrosternal discomfort while walking for the past 6 months. Which of the following statements are incorrect

His resting ECG is likely to be abnormal

Treadmill test will give diagnostic and prognostic information

Myocardial perfusion scan will indicate the involved arterial territory

Coronary angiogram to be done urgently

a+b

c+d

a+d



10. A known case of exertional angina on regular medication for the past one year comes with history of one episode of angina at rest 3 weeks ago. Which of the following statements are correct

He is in Brawnwald clinical classification class IB2

Heparin to be given for 5 days

Should be put on dual antiplatelets if ECG shows ST, T changes

Estimation of biomarkers of necrosis helps in risk stratification

a+b

c+d

a+d



11. A poorly controlled diabetic of 10 years duration presents to emergency room with sudden onset of chest discomfort. On examination he has tachycardia, systolic BP of 80 mm Hg, jugular venous distension and no pulmonary congestion. Which of the following statements are correct

Patient is in Killip class III

Morphine can be given for pain relief

Nitroglycerine infusion to be avoided

ECG may show ST elevation in II, III and a VF

a+b

c d

a



12. Which of the following statements regarding cardiac injury enzymes are correct

Troponin I is more specific than troponin T.

CK -MB is more useful to diagnose reinfarction than troponins.

Myoglobin levels increase 8 hours after myocardial infarction.

LDH levels normalise by 72 hours after myocardial infarction.

a+b

c d

a



13. Which of the following are true regarding cardiogenic shock?

Presents with cold extremities, tachycardia, sweating

Systolic BP is less than 90 mm Hg

Mortality is around 30%

Cardiac index is more than 1.8 L/min/m2

a+b

c d

a



14. Which of the following statements about complete heart block in acute myocardial infarction are correct

More common in inferior rather than anterior wall infarction

Escape rhythm in inferior wall infarction will have narrow QRS

In anterior wall infarction, indicates extensive myocardial damage

In inferior wall infarction, indicates infra Hisian lesion

a+b

c d

a d



15. Regarding arrhythmias in myocardial infarction, which of the following are not correct

Accelerated idioventricular rhythm requires no drug therapy

Hemodynamically stable ventricular tachycardia can be managed by parenteral amiodarone

Synchronized cardioversion is needed for ventricular fibrillation

Intravenous adenosine will revert atrial fibrillation to sinus rhythm

a+b

c+d

a+d



16. Which of the following statements regarding supraventricular arrhythmias in acute myocardial infarction is wrong

Supraventricular tachycardia is well tolerated

Atrial flutter is most uncommon

Atrial fibrillation can occur with ventricular dysfunction

Atrial fibrillation in myocardial infarction, does not influence morbidity and mortality a+b c+d a+d

17. Which of the following are contraindications for thrombolysis

Intracranial hemorrhage in the past

Suspected aortic dissection

Within a week of renal biopsy

Heavy menstrual bleeding

a+b

c+d

a+d



18. Which of the following statements are correct

Papillary muscle rupture is uncommon in anterior wall myocardial infarction

Ventricular septal rupture can complicate within 24 hours of myocardial infarction

Free wall rupture presents as sudden unanticipated death

Acute mitral regurgitation leads to grade IV holosystolic murmur

a+b

c+d

a+d



19. Which of the following secondary prevention strategy is most useful?

Weight reduction

Smoking cessation

Antiplatelets

Statin

20. Which of the following are incorrect regarding management of ventricular tachycardia?

In hemodynamically stable patient, asynchronous electrical cardioversion is to be done

If systolic BP is less than 90 mm Hg, pharmacological cardioversion is indicated

IV lignocaine is preferred over amiodarone

If pulse is not felt, management should be as a cardiopulmonary arrest

a+b

c+d

a+d



21. Which of the following statements regarding CPR are correct

Defibrillation is the most important step to ensure survival

The optimal adult paddle for defibrillation should be 8 -10 cms

Endotracheal route is not a substitute for a venous access when drugs have to be given

Calcium gluconate is useful only if there is hyperkalemia or hypocalcemia

a+b

c+d

a+d



22. Which of the following statements are correct

Norepinephrine is a powerful vasoconstrictor with mild inotropic effect

Isoprenaline is a naturally occurring catecholamine

Phenyl ephrine improves cardiac contractility

Parenteral calcium is useful in over dosage of verapamil

a+b

c+d

a+d



23. Which of the following statements are correct?

Alpha 2 stimulation decreases intracellular free calcium

Beta 2 stimulation decreases cyclic AMP level

Dobutamine stimulates Beta Beta 2 receptors

Dopamine has dose dependent effect on Beta 1 and Alpha 1 receptors

a+b

c+d

a+d



24. Which of the following are true about cyanotic spell

Often precipitated by bradycardia

Pulmonary ejection systolic murmur becomes louder

IV metoprolol is recommended

Sodabicarbonate diluted in Islyte and to be given

a+b

c+d

a+d



25. Which of the following statements regarding diagnosis of pulmonary embolism are true?

D dimer estimation has high positive predictability

A PTT is useful to monitor low molecular weight heparin therapy

CT pulmonary angiogram is the gold standard imaging modality for pulmonary embolism

Sub massive pulmonary embolism with RV dysfunction requires thrombolysis

a+b

c+d

a+d



26. Which of the following statements are correct regarding blood pressure estimation

Width of the cuff should be 40% of arm circumference

Length of the cuff should be more than 80% of arm circumference

Arm should be well supported

Phase 4 korotkoff sound corresponds to diastolic BP

a+b

c+d

a+d



27. Which of the following statements are correct?

White coat hypertension can be diagnosed by home estimation of BP

Ambulatory blood pressure recording detects masked hypertension

Auscultatory gap can be avoided if palpatory estimation of systolic BP is done first

A diastolic BP of 90 mm Hg can be normal in pregnancy a+b c+d a+d

28. Which of the following are clues to secondary hypertension?

Weak, delayed lower limb pulses

Persistent hypokalemia

Spells of headache, sweating, palpitation and tremors

Low levels of 24 hours urinary cortisol

a+b

c+d

a+d



29. BP should be rapidly controlled in which of the following situations?

Eclampsia

Epistaxis

Aortic dissection

Diastolic BP of 110 mm of Hg in elderly

a+b

c+d

a+d



30. Which of the following statements regarding gestational hypertension are correct?

ACE inhibitors are contraindicated

Methyldopa is commonly used

Betablocker can induce fetal bradycardia

Diuretics to be used for preventing eclampsia

a+b

c+d

a+d



31. Which of the following statements are wrong?

Pre-eclampsia denotes elevated BP after 28 weeks of gestation

ACE inhibitors and diuretics reduce recurrence of stroke

Daily consumption of more than 1 ounce of ethanol increases BP

Risk of stroke doubles when diastolic BP increases from 91 mm Hg to 105 mm Hg

a+b

c+d

a+d



32. Which of the following statements regarding ACE inhibitors are correct

To be discontinued if baseline serum creatinine increased by 10%

Cause degradation of bradykinin

Reduce after load

Improve baroreceptor function

a b

c d

a d

a b c

33. Which of the following antihypertensive drugs are centrally acting?

Methyldopa

Clonidine

Monoxidine

Terazosin

a+b

c+d

a+d



34. Which of the following are correct about cilnidipine

Is a calcium channel blocking drug

Blocks Land N type of calcium channels

Decreases Pressure in capillary bed

Causes reflex tachycardia

a

c d

a d



35. In a patient with diabetes, bronchial asthma and hypertension which of the following drugs can be used?

Verapamil

Perindopril

Telmisartan

Propranolol

a

d

a d



36. An asymptomatic diabetic with family history of cardiomyopathy has no other risk factors. With respect to staging of heart failure, which of the following statement is correct

Stage A heart failure

Stage B heart failure

Stage C -New York Heart Association Class I

Stage C -New York Heart Association Class II

37. Systemic infections precipitate heart failure by

Increased body metabolism enforces hemodynamic burden on the heart

Increased heart rate worsens heart failure

Inflammatory cytokine affect automaticity

All infections cause myocarditis

a+b

c+d

a+d



38. Which of the following statements on heart failure are correct

Angiotensin 2 leads to vasoconstriction

Beta 2 receptors stimulation in juxta glamerular apparatus results in renin release

Aldosterone has no direct effects on myocardium

Angiotensin 2 causes remodelling of cardiac myocytes

a+b

c+d

a+d



39. Which of the following drugs cause dilatation of pulmonary vein

Nitroglycerine

Frusemide

Morphine

Sodium nitroprusside

a+b

c+d

a+d



40. Which of the following statements are correct

Sodium and water retention cause pulmonary congestion and edema in long term

Vasoconstriction increases BP but causes pump dysfunction by increase in after load

Hypertrophy unload individual muscle fibres and increase wall tension

Sympathetic stimulation increases heart rate and stroke volume and decreases energy expenditure

a

c+d

a d



41. Which of the following statements regarding cardiac transplantation are correct

5 year survival rate is about 70%

Immunosuppressants can lead to cancers on long term

Coronary atherosclerosis in transplanted heart is rare

Cyclosporine rarely causes renal dysfunction

a+b

c+d

a+c

b+d

42. Which of the following statements about Digoxin are correct

Digitoxicity occurs when serum digoxin levels are between 0.7 and 1.2 nanogram/mL

Digoxin is not useful when patients are symptomatic on diuretics and ACE inhibitors

Useful in patients with heart failure in atrial fibrillation

Has no mortality benefit in cardiac failure

a+b

c+d

a+d



43. Which of the following statements are correct regarding digitoxicity

Digitoxicity is rare with serum levels below 1.8 nanogram/mL

Half life of digoxin immunofab is shorter than that of digoxin

Lidocaine is not useful for digoxin induced ventricular arrhythmias

Electrical cardioversion is ideal

a+b

c+d

a+d



44. Which of the following statements about diuretic are correct

Metalazone acts on proximal convoluted tubule

Epilerone decreases potassium secretion by distal convoluted tubule

Continuous IV infusion of loop diuretics may overcome diuretic resistance

Metalazone should not be combined with loop diuretics

a+b

c+d

a d

a

45. Which of the following statements regarding treatment of cardiac failure are correct

For similar positive inotropic effect, dobutamine causes less increase in heart rate compared to dopamine

Inotropic effect of dobutamine is affected through norepinephrine release from myocardium

Ventricular arrhythmias are uncommon with long term dobutamine use

Dobutamine cause mild decrease in peripheral vascular resistance

a+b

c+d

a+d



46. Following are suggestive of renovascular hypertension except:

Abrupt onset of moderate hypertension

Hypertension in young

Presence of abdominal bruit

Marked fluctuations in blood pressure

47. Following are suggestive of endocrinal hypertension except:

Truncal obesity

Persistent hypokalemia

Malignant hypertension with papilledema

Thin skin

48. Following are true about gestational hypertension except:

Usually seen in primigravida in 20th week

Increase of blood pressure by 30/15 mm Hg or more above 140/80 mm Hg

Can progress to pre-eclampsia

Associated with ketonuria

49. Feature inappropriate for usual primary hypertension is

Onset before 20 years

Serum creatinine> 1.5 mg/100 mL

Abdominal bruit

Persistent hyperkalemia

50. Following is not true about involvement of heart in hypertension:

Left ventricular hypertrophy

10 -fold increase in coronary artery disease when blood pressure> 91 -105 mm Hg

Myocardial ischemia is common

Diastolic heart failure can occur

51. Following is not seen in Keith -Wagner Grade III retinopathy:

Papilledema

Copper -wire appearance

Silver -wire appearance

Cotton -wool exudates

52. Following condition requires rapid treatment of hypertension:

Acute aortic dissection

Stable angina

Intra -cerebral hemorrhage

Eclampsia

53. Following is not used in treating hypertensive emergency:

Sublingual nifedipine

Sodium nitroprusside infusion

LV. diazoxide

LV. enalapril

54. Following drug is used in treating pre -eclampsia:

Diuretics

ACE inhibitor

Methyldopa

Amlodepine

55. Phase 4 Korotkoff sound is

Tapping

Soft murmur

Loud murmur

Muffled

56. Korotkoff sounds are difficult to hear in

Aortic stenosis

Shock

Heart failure

All of the above

57. Isolated systolic hypertension is defined as a systolic BP more than:

140 mm Hg

150 mm Hg

160 mm Hg

170 mm Hg

58. Difference in BP between two arms is abnormal when it is more than

5mmHg

10mmHg

15 mmHg

20mmHg

59. Renal damage in hypertension include all except:

Microalbuminuria

Nephrosclerosis

Renal failure

None of the above

60. Treatment goal for hypertension in diabetes is less than:

120/80 mm Hg

125/85 mm Hg

130/80 mm Hg

140/80 mm Hg

61. One kg decrease in body weight is associated with a fall in BP by

1.2 mmHg

1.6 mmHg

2.0mmHg

2.5 mmHg

62. Following are not true about salt restriction in hypertension except:

No addition of salt during cooking

Avoid fast foods

To use half sodium half potassium salt if required

None of the above

63. Following is not used to treat hypertension after myocardial infarction:

ACEI

ARB

Diltiazem

Beta-blockers

64. Anti -hypertensives of choice in heart failure are all except

Diuretic

ACEI

ARB

Beta-blockers

65. Following ARB is/are shown to have better effect in renal hypertension:

Candesartan

Irbesartan

Both

None

66. Following arrhythmias can aggravate heart failure except:

Tachyarrhythmias

Marked bradycardia

Abnormal intraventricular conduction

None of the above

67. Following can precipitate heart failure except:

Pregnancy

Hypothyroidism

Hyperthyroidism

None of the above

68. According to Frank-Starling's law increased left ventricular volume leads to

Faster rate of relaxation

Lesser peak pressure

Slower rate of pressure rise

All of the above

69. Activation of RAAS leads to

Maintains blood pressure

Maintains perfusion of vital organs

Both

None

70. Following are true about natriuretic peptides except:

ANP is stored in atrium

CNP is located in vasculature

BNP is stored mainly in ventricular myocardium

None of the above

71. Angiotensin II

Is a powerful vasoconstrictor

Stimulates aldosterone release

Causes remodelling of the myocytes

All of the above

72. Commonest cause of right heart failure is

COPD

Left heart failure

Pulmonary hypertension

None of the above

73. In diastolic heart failure all are present except:

Ventricular relaxation is impaired

Ventricular filling pressure is elevated

Systemic venous congestion can occur

None of the above

74. All contribute to P.N.D. except:

Increased sympathetiC support

Increased intrathoracic pressure

Depression of respiratory center

None of the above

75. Hemoptysis in heart failure can result from:

Respiratory infection

Pulmonary embolism

Rupture of pulmonary v«enules

All of the above

76. Fatty streak is lesion:

Type I

Type II

Type III

Type IV

77. Following category of patients will have more atherosclerotic plaques:

Smokers Hypertensives Hyperlipidemics All of the above MCC-003 14 78. Patients with diabetes will have: More short segment coronary lesions

Greater number of affected coronary vessels

Both of the above

None of the above

79. Basal portion of the interventricular septum is supplied by:

Posterior Descending artery

Left anterior descending artery

Left circumflex artery

None of the above

80. Most of the coronary blood flow occurs during:

Systole

Diastole

Both

None

81. Reverse cholesterol transport is mediated by

LDL

HDL

VLDL

IDL

82. Patient's risk of future event is based on

Presence of known CAD

Family history of premature CAD

Both

None

83. All are side -effects of statin except:

Elevation of transaminases

Myopathy

Mild gastrointestinal disturbances

None of the above

84. All are statin trials except:

WOSCOPS

HPS

HYVET

CARE

85. Unstable Angina is characterized by

Rest angina

Recent angina

Crescendo angina

None

86. Rest angina within 48 hrs. is Braunwald's

Class II

Class I

Class III

None

87. In a case of myocardial infarction Q-wave in the ECG appears in

Hyperacute phase

Acute phase

Subacute phase

None of the above

88. Most sensitive right precordial lead for detection of RV infarction is

V4R

V5R

V6R

None

89. Which of the following is not helpful in treating a child with a cyanotic spell

Knee chest position

Sedation

Oxygen

Beta-blockers

90. Primary PCI is indicated when

Availability of skilled PCI laboratory

Short transport time

Cardiogenic shock

All of the above