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1. The followings are causes of prominent R wave in Lead V1 EXCEPT:

A. ? Posterior wall myocardial infarction.

B. ? RBBB.
C. ? Mirror image dextrocardia.
D. ? Wolf-Parkinson-White Syndron type A.
E. ? LEFT VENTRICULAR HYPERTHROPHY.

2. Which one of the following is associated with ST segment elevation in

ECG?

A. ? LVH
B. ? RVH
C. ? Digoxin effect
D. ? early repolarization .
E. ? subendocardial infarction

3. The commonest type of Arrhythmia in WPW syndrome is:

A. ? Vnetricular Tachycardia
B. ? Ventricular Fibrillation
C. ? Ventricualr Premature Complexes
D. ? Atrial Ectopics
E. ? AV Re-entry Tachycardia.

4. The MOST COMMON CARDIAC LESION IN DOWNE SYNDROME

 A. ? AORTIC STENOSIS.
B. ? pumonary artery stenosis
C. ? branch pulmonary artery stenosis
D. ? HOCM
E. ? COMMON AV CANAL.

5. Causes of long QT Syndrome include all of the followings except :

A. ? Hypokalaemia
B. ? Hypocalcaemia
C. ? Hypomagnesaemia
D. ? Hypermagnesaemia
E. ? Rheumatic carditis

6. In Hypertrophic Cardiomyopathy which one is true?

A. ? Caused by mutation in Na channels

B. ? 10% are associated with a positive family history
C. ? COMMONLY associated with left ventricular outflow
obstruction
D. ? all patients are symptomatic
E. ? the commonest type of hypertrophy is the Apical type.

7. In acute pericarditis, which one is false?

A. ? the commonest cause is the idiopathic type (may be viral)

 B. ? the majority progresses to tamponade
C. ? in uraemic pericarditis, there is a risk of tamponade
formation
D. ? the rub is usually transient
E. ? TB pericarditis is rarely an acute one

8. The following indicates an absolute contraindication to thrombolytic

therapy in Acute ST segment elevation MI...Choose one:

A. ? 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
B. ? 40 year old lady with 7 missed periods and abdominal
distension
C. ? 34 old diabetic male recently underwent "LASER Retinal
therapy " as he said ..came with ST ELEVATION V1-V4
D. ? ST elevation in lead V1,V2,V3 with a blood pressure of
180/100 easily controlled with antihypertensive medications
E. ? 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

9. Bad prognostic factors in UNSTABLE angina include all of the

followings except:

A. ? development of heart failure

B. ? prolonged chest pain
 C. ? ST elevation
D. ? high cardiac troponin T
E. ? intermittent chest pain, RELEIVED BY NTG SUB
LINGUAL.

10. The followings are true except

A. ? the right coronary artery supplies the AV node in 90 % of

cases
B. ? the right coronary artery supplies the SA nose in 60 % of
cases
C. ? left main stem coronary artery is easily dilated by at PTCA
in atheromatous narrowing and should be routinely done in such
cases.
D. ? Prinzmatal angina usually occurs at night
E. ? Prinzmetal angina may occur with coronary atheroma

11. Amiodaroneall are ture except:

A. ? 40 % of it is iodine ..hence the risk of either hypo or

hyperthyroidism
B. ? potentiates the effect of warfarine
C. ? potentiates the effect of digoxin
D. ? USED JUST IN ATREAL ARHYTHMIAS.
E. ? prolonges the plataue phase of action potential .

12. Causes of raised JVP include all of the followings except:

A. ? mediastinal lumphoma
B. ? mediastinal irradiation 2 years previously .
C. ? ST elevation in lead rV4 and chest pain(RV INFARCTION).
D. ? Liver Cirrhosis
 E. ? Atrialization of the right ventricle(EPISTEIN ANOMALY).

13. In Coarctation of the aorta which one of the followings is False?

A. ? in adults usually causes and presents as hypertension

B. ? BICUSPID AORTIC VALAVE is a common association
C. ? Rib notching is usually seen from the 3rd rib till 9th rib from
birth.
D. ? associated with radiofemoral delay.
E. ? Subarachnoid hemorrhage may occur.

14. The followings improve the survival figure in chronic congestive heart
failure as shown by many studies...Except

A. ? bisprolol
B. ? metaprolol
C. ? carvidolol
D. ? spironolactone
E. ? atenolol

15. In infective endocarditis which one is false?

A. ? streptococcus viridans is the cause of up to 50% of naitive

valve endocarditis
B. ? staph species may be the cause in 50% of prosthetic valve
endocarditis
C. ? the commonest cause of culture negative endocarditis is
partial treatment with antibiotics
 D. ? 2 negative serial blood cultures usually exclude infective
endocarditis in the appropriate clinical setting
E. ? the sensitivity of transesophageal Echocardiography here
is 95% versus 65% in the transthoracic approach .

16. The followings cardiac lesions are associated with a high risk of
infective endocarditis except:

A. ? fallot tetralogy.
B. ? prosthetic aortic valve.
C. ? previous history of infective endocarditis.
D. ? patient with heart transplantation.
E. ? Mitral stenosis

17. The treatment of infective endocarditis all are true except:

A. ? persistent fever may indicates a non bacterial cause like

fugal cause .
B. ? bacteriocidal drugs rather than statics should be used .
C. ? always await the culture results before giving any
treatment.
D. ? intravenous route is always preferred .
E. ? persistent fever may indicate a drug fever .

18. In mitral stenosis all are true except:

A. ? malar flush may be seen

B. ? low cardiac output state
C. ? rarely congenital
D. ? S3 sound is commonly seen
E. ? 20 % stays in sinus rhythm despite severe stenosis
19. Aortic stenosis .all are true except:

A. ? Carotid shudder is common

B. ? syncpoe and dyspnea indicates an need for intervention
C. ? the most common cause is rheumatic.
D. ? marked LVH per se is a risk factor for angina and
arrhythmias
E. ? valve replacement is the usual mode of treatment

20. The objectives in the medical treatment of heart failure ..all are true
.except:

A. ? Reduction of the after load

B. ? optimization of the preload
C. ? augmentation of the cardiac contractility
D. ? controlloing the heart rate
E. ? aggressive diuresis to remove all edemas

21. In diastolic heart failure which one of followings is true :

A. ? aortic regurgitation usually causes diastolic dysfunction

B. ? till now there is no general consensus about the optimal
medical management for it
C. ? myocardial ischemia starts with systolic dysfunction
D. ? tachycardia is needed to compensate for the defect and
hence the heart rate should be kept above 90 beats/minutes
E. ? ACE inhibitors had been shown to improve the overall
mortality figure
22. In secondary hypertension ..the clues to it are all of the followings
except :

A. ? rapidly developing
B. ? poor response to standard medical therapy
C. ? age blow 20 and above 50 years
D. ? certain physical signs like mooning of the face and
abdominal striae
E. ? strong family history of hypertension

23. Long standing hypertension choose the most true :

A. ? very weak effect on the coronary arteries

B. ? a strong risk factor for the development of intracerebral
bleeding
C. ? in diabetic nephropathy the target blood pressure should be
140 / 85mmHg
D. ? ACE inhibitors should be routinely prescribed
E. ? Diuretics are usually not effective in elderly

24. Possible Risk factors for ischemic heart disease one is incorrect:

A. ? hyperhomocystenemia
B. ? obesity
C. ? sedentary life style
D. ? high blood fibrinogen
E. ? diet rich in vegetables .

25. Complications of long standing hypertension include all of the

followings except:

A. ? Diastolic heart failure

 B. ? Coronary artery disease
C. ? Stroke
D. ? peripheral vascular disease
E. ? Systolic heart failure

26. Atrial myxoma.. which one is the false statement :

A. ? may present as an SBE like picture

B. ? may present as a vasculitis like picture
C. ? high recurrence following surgery in sporadic cases
D. ? high recurrence following surgery in familial cases
E. ? when arises from the right side of the heart we should think
of familiar predisposition

27. When examining the JVP which one is a wrong statement:

A. ? rapid x descent and steep y descent occurs in pericardial

constriction
B. ? rapid x descent and blunted y descent occurs in pericardial
tamopnade
C. ? lagre CV wave occurs in tricuspid regurgitation
D. ? hepatojugular reflux is important only if it sustains with
continuous pressure on the abdomen
E. ? regular cannon A waves indicates complete heart block

28. Deep Permanent Q wave may be seen in...Choose one

A. ? early phase acute anterior wall MI

B. ? WPW syndrome
 C. ? established subendocarial infarction
D. ? established acute phase isolated posterior MI
E. ? during Prinzmetal angina

29. In the medical treatment of acute MI..the followings are true except :

A. ? aspirin per se reduces the mortality by 30%

B. ? thrombolysis reduces the overall mortality by 25-50%
C. ? beta blockers like iv metoprolol greatly reduces the
susceptibility to arrhythmias
D. ? iv nitroglycerin have no effect on the overall mortality figure
E. ? Morphin better to be given by a subcutaneous rout rather
than iv because this confers a longer half life

30. Secondary prophylaxis of MI which one is a false statement :

A. ? ACE inhibitors have a favorable effect by many

independent mechanisms
B. ? Bata blocker are important if no contraindication to it
C. ? Statins had been shown to produce regression of the
atherosclerotic plaques
D. ? cardiac rehabilitation programs should not be forgotten
E. ? Digoxin had been shown to have a favorable effect

31. Contraindication to exercise ECG testing in the contest of a heart

diseases all are true except :

A. ? uncontrolled hypertension
B. ? fever or a febrile illness
C. ? severe aortic stenosis
D. ? acute pericarditis
 E. ? subjective feeling weakness

32. The followings indicate strong positive exercise ECG testing ..except

A. ? deep ST depression
B. ? wide spread ECG changes upon exercise
C. ? prolonged ST depression after finishing the test
D. ? ST elevation per se
E. ? Mild -moderate ST T segment abnormalities in middle aged
woman with chest pain with no risk factors for ischemic heart
disease

33. False positive exercise ECG testing are common In clinical practice
causes include all of the followings except

A. ? prior treatment with digoxin

B. ? treatment with beta blockers
C. ? marked LVH per se
D. ? early development of wide spread ECG changes in stage I
Bruce protocol
E. ? MVP

34. 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

A. ? pulmonary thromboembolism
B. ? tension pneumothorax
C. ? profound shock due to bleeding
D. ? hypokalemia
E. ? treatment with xylocain
35. Use of ACE inhibitors in the medical treatment of Post- MI patients ...all
are true except

A. ? had been shown to decrease ventricular remodeling and

hence aneurismal formation
B. ? prevent the onset of overt heart failure in asymptomatic
patient
C. ? reduce the hospitalization rate
D. ? should be given to all patient if tolerated and no
contraindication
E. ? contraindicated in post MI patient with a chronic renal
failure

36. Treatment of hypertension with diuretics all are true except:

A. ? loop diuretics are preferred because of its powerful effect .

B. ? Diuretics in the treatment of hypertension uncommonly
produces acid base and electrolyte disturbances compared
when used in the treatment of heart failure states
C. ? As an anti- hypertensive medication ..they work by an
independent mechanism of their DIURETIC action .
D. ? first line agents in an elderly with systolic hypertension
E. ? may worsen the lipid profile