Question 1

1 / 1 pts
TR, 56 yo, male, hypertensive, non-diabetic, no known renal problem. He has been on
his antihypertensive medication for the past 8months. What should be the BP goal for
TR?
Correct!
  
<140/90 mmHg
 

  
<160/90 mmHg
 

  
<130/90 mmHg
 

  
<150/90 mmHg
 
 
Question 2
1 / 1 pts
In the management of hypertension with chronic kidney disease, which of the following
is the preferred initial antihypertensive drug?
Correct!
  
ARB
 

  
Calcium Channel blocker
 

  
Thiazide
 

  
Beta blocker
 
 
Question 3
1 / 1 pts
In the case of TR, you started him with one antihypertensive drug, and titrate it to
maximum dose. Upon follow-up, his BP is 160/90 mmHg. You decided to add a second
drug. This is based on what treatment strategy?

  
Strategy C
 

  
Strategy B
 

  
Strategy D
 
Correct!
  
Strategy A
 
 
Question 4
1 / 1 pts
Mean Arterial Blood Pressure is calculated as:

  
(DBP + 2SBP)/3
 
Correct!
  
(SBP + 2DBP)/3
 

  
DBP + 3SBP)/2
 

  
(SBP+3DBP)/2
 
 
Question 5
1 / 1 pts
Which of the following condition will NOT lead to Pulmonary Hypertension?
Correct!
  
Pregnancy
 

  
Left Heart Failure
 

  
Anemia
 

  
Chronic Thromboembolic pulmonary events
 

  
Bronchiectasis
 
 
Question 6
1 / 1 pts
MS, has been complaining of dyspnea, chest pain and syncope. Findings from history,
physical examination, chest radiograph and ECG may suggest presence of pulmonary
hypertension. In order to confirm your diagnosis, what will be the next step to do for this
patient?
Correct!
  
Right -sided cardiac catherization
 

  
Pulmonary angiography
 

  
Ventilation-perfusion lung scanning
 

  
Two-dimensional transthoracic echocardiography
 
 
Question 7
1 / 1 pts
RK, 55 yo male, chronic smoker diagnosed with COPD. His difficulty in breathing is due
to the following:

  
The wall of the airways in the lungs thickened and inflamed
 

  
The airways are clogged with excess mucus
 

  
The lungs lose its elasticity
 
Correct!
  
All of the above
 
 
Question 8
0 / 1 pts
Rk’s spirometry reveal an FEV1/FVC  65%; FEV 1 >80% predicted. RK’s severity of
airflow obstruction is:

  
Severe COPD
 

  
Very Severe COPD
 
You Answered
  
Mild COPD
 
Correct Answer
  
Moderate COPD
 
 
Question 9
1 / 1 pts
What should be included in the management of RK?

  
Influenza vaccine
 

  
Respiratory rehabilitation
 
Correct!
  
All of the above
 

  
As needed Short-acting bronchodilator
 

  
Long-acting bronchodilator
 
 
Question 10
1 / 1 pts
Pathognomonic to TB infection
Correct!
  
Tubercle
 

  
Weight loss
 

  
Cough lasting for 2 weeks
 

  
Anorexia
 
 
Question 11
1 / 1 pts
Beta-blockers like propranolol that slow AV conduction and prolong PR interval are
classified as what class of anti-arrhythmics?

  
Class III
 
Correct!
  
Class II
 

  
Class I
 

  
Class IV
 
 
Question 12
1 / 1 pts
What is the most common mechanism involved in clinically important cardiac
arrhythmias?

  
parasystole
 

  
triggered activity
 
Correct!
  
reentry
 

  
abnormal automaticity
 
 
Question 13
1 / 1 pts
Failure is associated with no limitations on ordinary activities  and symptoms but are
revealed during exercise.

  
NYHA Class II
 
Correct!
  
NYHA Class I
 

  
NYHA Class IV
 

  
NYHA Class III
 
 
Question 14
1 / 1 pts
A 62-year-old asymptomatic hypertensive had an echocardiogram for a murmur. The
rest of the physical examination was normal. Echocardiogram showed normal LV wall
thickness and wall motion with ejection fraction (EF) of 65%. Valves were normal. Mitral
E/A velocity ratio was 0.7. What does the patient have?
Correct!
  
Stage B HF
 

  
HFpEF
 

  
Stage A heart failure (HF)
 

  
none
 
 
Question 15
0 / 1 pts
Echocardiography is used in the diagnosis of the following conditions, EXCEPT:

  
mitral stenosis
 

  
ventricular hypertrophy
 
Correct Answer
  
coarctation of the aorta
 
You Answered
  
pericardial effusion
 
 
Question 16
1 / 1 pts
Which modifiable cardiovascular risk factor is responsible for the most morbidity and
mortality worldwide?

  
high BMI
 

  
smoking
 

  
low fruit intake
 
Correct!
  
high blood pressure
 
 
Question 17
1 / 1 pts
Which of the following is correct regarding the normal anatomy and physiology of the
pericardium?
Correct!
  
The human pericardium consists of two distinct layers, the inner serosa and the outer
fibrosa
 

  
Congenital absence or surgical removal of the pericardium is fatal
 

  
Most of the innervation of the pericardium occurs via the vagus nerves
 

  
It allows great distention of the cardiac chambers and increased cardiac filling
 
 
Question 18
1 / 1 pts
A 55-year-old woman presents to your clinic with vague chest pain and dyspnea. A
chest radiograph reveals a mass in the right costophrenic angle. CT of the chest
suggests a pericardial cyst. Which of the following is correct?

  
Pericardial cysts are smooth, thin-walled structures usually filled with pus
 

  
Pericardial cysts are usually symptomatic and tend to increase in size over time
 
Correct!
  
The recommended therapeutic course is observation of the patient
 

  
The patient’s symptoms are likely unrelated to the cyst
 
 
Question 19
1 / 1 pts
A 65-year-old man was referred for cardiac consultation following a 2-year history of
dyspnea on minimal exertion. He had a coronary angiography in the past that revealed
normal coronaries. His physical examination revealed a 3/6 systolic ejection systolic
murmur across the precordium. An echo was obtained showing left ventricular
dysfunction with an EF of 38%, a calcified aortic valve with a mean gradient of 29 mm
Hg, and AVA (aortic valve area) of 0.9 cm2. Which of the following is the best next step
in the management of this patient?

  
Left and right cardiac catheterization
 
Correct!
  
Dobutamine stress echocardiography (DSE)
 

  
SAVR after coronary angiography
 

  
TAVR
 
 
Question 20
1 / 1 pts
A 19-year-old woman is followed in cardiology clinic for pulmonary valve stenosis, but
she has missed her last appointments because she “felt fine.” She now notes
progressive exertional dyspnea and can no longer play sports with her friends. Four
years ago, the physical examination revealed a systolic ejection click, a preserved but
delayed P2, and a 2/6 systolic murmur peaking in early-to-mid systole that was best
heard over the pulmonary area. Given the clinical suspicion of worsening pulmonary
valve stenosis, which of the following physical examination findings would not be
expected at this time?

  
Murmur has gotten louder
 
   
Murmur peaks later in systole
 
Correct!
  
Systolic ejection click is more prominent in inspiration
 

  
P2 has gotten softer
 
 
Question 21
1 / 1 pts
A 68-year-old man with a history of myocardial infarction and congestive heart failure is
comfortable at rest. However, when walking to his car, he develops dyspnea, fatigue,
and sometimes palpitations. He must rest for several minutes before these symptoms
resolve. Which of the following is his New York Heart Association classification?

  
Class I
 

  
Class II
 

  
Class IV
 
Correct!
  
Class III
 
The New York Heart Association (NYHA) classification is a tool to define
criteria that describe the functional ability and clinical manifestations of patients in heart failure.
It is
also used in patients with pulmonary hypertension. These criteria have been shown to have
prognostic
value with worsening survival as class increases. They are also useful to clinicians when
reading studies
to understand the entry and exclusion criteria of large clinical trials. Class I is used for patients
with no
limiting symptoms; class II for patients with slight or mild limitation; class III implies no
symptoms at
rest but dyspnea, angina, or palpitations with little exertion, and patients are moderately limited;
class IV
is severely limited, so that even minimal activity causes symptoms. Treatment guidelines also
frequently
base recommendations on these clinical stages. This patient has symptoms with mild exertion
but is
comfortable at rest; therefore, he is NYHA class III.
 
Question 22
1 / 1 pts
Mr. Brian is a 57-year-old basketball team coach with a prior history of hypertension,
hyperlipidemia, and tobacco abuse. He presents to the emergency department tonight
after
experiencing chest discomfort during a practice. He notes that he first began
experiencing chest
discomfort 3 weeks prior with vigorous exertion during practice. However, over the last
week, it has
taken less exertion to initiate the discomfort. Tonight, it occurred while he was just
sitting on the
bench. He describes the discomfort as a pressure, radiating to his jaw. It typically lasts
about 10
minutes. His ECG shows new T-wave inversions in leads I, II, aVL, V5, and V6 since his
last
cardiogram 2 years ago at a routine physical examination. Which of the following clinical
entities is
an appropriate diagnosis for Mr. Brian?

  
Stable angina
 

  
Unstable angina
 

  
Non–ST-segment elevation myocardial infarction
 
Correct!
  
More information is required before making a diagnosis.
 
The diagnosis of acute coronary syndrome (ACS) is based largely on the
clinical presentation. Typically, chest discomfort is severe and has at least one of three features:
(1) it
occurs at rest (or with minimal exertion), lasting >10 minutes; (2) it is of relatively recent onset
(i.e.,
within the prior 2 weeks); and/or (3) it occurs with a crescendo pattern (i.e., distinctly more
severe,
prolonged, or frequent than previous episodes). The diagnosis of non–ST-segment elevation
myocardial
infarction (NSTEMI) is established if a patient with these clinical features develops evidence of
myocardial necrosis, as reflected in abnormally elevated levels of biomarkers of cardiac
necrosis. Given
the ECG without ST elevations, this patient does not have ST-segment elevation myocardial
infarction
(STEMI). Also, this clinical presentation of accelerating angina now occurring at rest obviates
stable
angina. However, because this patient does not yet have cardiac biomarker results, one cannot
differentiate between unstable angina and NSTEMI. Further information is needed.

  
ST-segment elevation myocardial infarction
 
 
Question 23
1 / 1 pts
All of the following ECG characteristics will aid in differentiating acute pericarditis from
acute myocardial infarction EXCEPT:

  
Absence of the development of Q waves
 
Correct!
  
ST elevation in V2
 
The ECG in acute pericarditis without massive effusion usually displays
changes secondary to acute subepicardial inflammation. It typically evolves through four stages.
In stage
1, there is widespread elevation of the ST segments, often with upward concavity, involving two
or three
standard limb leads and V2–V6, with reciprocal depressions only in aVR and sometimes V1.
Also, there is
depression of the PR segment below the TP segment, reflecting atrial involvement. Usually
there are no
significant changes in QRS complexes. After several days, the ST segments return to normal
(stage 2),
and only then, or even later, do the T waves become inverted (stage 3). Weeks or months after
the onset
of acute pericarditis, the ECG returns to normal (stage 4). In contrast, in acute myocardial
infarction, ST
elevations are convex, and reciprocal depression is usually more prominent; these changes
may return to
normal within a day or two. Q waves may develop, with loss of R-wave amplitude, and T-wave
inversions are usually seen within hours before the ST segments have become isoelectric. ST-
segment
elevation in V2 may be seen in either acute pericarditis or myocardial infarction.

  
PR depression
 

  
T-wave inversions after return of the ST segments to baseline
 

  
Concave shape to ST elevations
 
 
Question 24
1 / 1 pts
A 47-year-old woman with a body mass index (BMI) of 37 kg/m2 was recently
diagnosed with type 2 diabetes mellitus. As part of her patient education, you inform her
that which of the following is the most common cause of death in adults with type 2
diabetes mellitus?
Correct!
  
Coronary artery disease
 
Diabetes mellitus, both insulin- and non–insulin-dependent, is an
independent risk factor for CAD and accounts for 14%–50% of new cases of cardiovascular
disease. CAD
is by far the most common cause of death in adults with diabetes. The incidence of CAD relates
to the
duration of diabetes and level of glycemic control, both motivating factors for patients to comply
with
therapy. Compared to their nondiabetic counterparts, diabetic patients are more likely to have a
myocardial infarction, have a greater burden of CAD, have larger infarct size, and have more
postinfarct
complications, including heart failure, shock, and death. Importantly, diabetic patients are more
likely to
have atypical ischemic symptoms; nausea, dyspnea, pulmonary edema, arrhythmias, heart
block, or
syncope may be their anginal equivalent. Additionally, “silent ischemia,” resulting from
autonomic
nervous system dysfunction, is more common in diabetic patients, accounting for up to 90% of
their
ischemic episodes.

  
Stroke
 

  
Renal failure
 

  
Infection
 

  
Neuropathy
 
 
Question 25
1 / 1 pts
In the current model describing the steps of atherosclerosis initiation and evolution,
which of the following constitutes the first step?

  
Arterial endothelial cells overexpress adhesion receptors for leukocytes.
 
Correct!
  
Low-density lipoproteins accumulate within the arterial intima.
 
An integrated view of experimental results in animals and studies of
human atherosclerosis suggests that the “fatty streak” represents the initial lesion of
atherosclerosis.
These early lesions most often seem to arise from focal increases in the content of lipoproteins
within
regions of the intima. In particular, the fraction of lipoproteins related to low-density lipoprotein
(LDL)
that bear apolipoprotein B appears causally related to atherosclerosis. This accumulation of
lipoprotein
particles may not result simply from increased permeability, or “leakiness,” of the overlying
endothelium. Rather, the lipoproteins may collect in the intima of arteries because they bind to
constituents of the extracellular matrix, increasing the residence time of the lipid-rich particles
within the
arterial wall. Lipoproteins sequestered from (plasma) antioxidants in the extracellular space of
the intima
become particularly susceptible to oxidative modification, giving rise to hydroperoxides,
lysophospholipids, oxysterols, and aldehydic breakdown products of fatty acids and
phospholipids. Next,
recruitment of leukocytes to the endothelium occurs. The inflammatory cell types typically found
in the
evolving atheroma include monocyte-derived macrophages. A number of adhesion molecules or
receptors
for leukocytes expressed on the surface of the arterial endothelial cell probably participate in the
recruitment of leukocytes to the nascent atheroma. Once resident within the intima, the
mononuclear
phagocytes mature into macrophages and become lipid-laden foam cells, a conversion that
requires the
uptake of lipoprotein particles by receptor-mediated endocytosis.

  
Macrophages become lipid-laden foam cells via endocytosis of lipoprotein particles.
 

  
Lipoprotein particles undergo oxidative modifications.
 

  
Macrophages and other leukocytes are recruited to the arterial intima.
 
 
Question 26
1 / 1 pts
All of the following are major determinants of myocardial oxygen demand EXCEPT:

  
Heart rate
 
Correct!
  
Heart rhythm
 
Central to an understanding of the pathophysiology of myocardial
ischemia is the concept of myocardial supply and demand. In normal conditions, for any given
level of a
demand for oxygen, the myocardium will control the supply of oxygen-rich blood to prevent
underperfusion of myocytes and the subsequent development of ischemia and infarction. The
major
determinants of myocardial oxygen demand (MVO2) are heart rate, myocardial contractility, and
ventricular wall tension (stress). Heart rhythm is not a major determinant of myocardial oxygen
demand.

  
Ventricular wall stress
 

  
None
 

  
Myocardial contractility
 
 
Question 27
1 / 1 pts
An individual who is demonstrating elevated levels of troponin, creatine kinase–
isoenzyme MB (CK-MB), and lactic dehydrogenase (LDH) is exhibiting indicators
associated with which condition?

  
Coronary artery disease (CAD)
 

  
Hypertension
 
Correct!
  
Myocardial infarction (MI)
 

  
Myocardial ischemia
 
 
Question 28
1 / 1 pts
A 58-year-old man is evaluated for dyspnea and found to have a moderate right-sided
pleural effusion. He undergoes thoracentesis with the following characteristics.
Appearance: serosanguineous
pH: 7.48
Protein: 5.8 g/dL (serum protein 7.2 g/dL)
LDH: 285 IU/L (serum LDH 320 IU/L)
Glucose 66 mg/dL
WBC: 3800/uL
RBC 24,000/uL
PMNs: 10%
Lymphocytes: 80%
Mesothelial cells: 10%
Cytology: Lymphocytosis with chronic inflammation and no malignant cells or organisms
identified
Which of the following is NOT likely to be a cause of the pleural effusion in this patient?
 

  
Pulmonary embolism
 
Correct!
  
Cirrhosis
 
The characteristics of the pleural fl uid in this patient are
consistent with an exudate by Light’s criteria. These criteria are as follows: pleural fl uid
protein/serum protein ratio >0.5, pleural fluid lactate dehydrogenase (LDH)/serum LDH ratio
>0.6, and pleural fluid LDH more than two-thirds of the upper limit of normal serum values. If
one of the criteria is met, then the effusion would be classified as an exudate. This patient
clearly
meets the criteria for an exudate. Exudative pleural effusions occur when there are alterations in
the local environment that change the formation and absorption of pleural fl uid. The most
common causes of exudative pleural effusion are infection and malignancy. Other less common
causes include pulmonary embolism, chylothorax, autoimmune diseases, asbestos exposure,
drug
reactions, hemothorax, and following cardiac surgery or other cardiac injury, among others.
Unfortunately, 25% of transudative effusions can be incorrectly identified as exudates by these
criteria. Most often, this occurs when the effusion has an increased number of cells to cause an
elevation in the LDH or has been treated with diuretics to cause an increase in pleural fl uid
protein. Transudative effusions are most often caused by heart failure, but can also be seen in
cirrhosis, nephrotic syndrome, and myxedema.

  
Tuberculosis
 

  
Mesothelioma
 

  
Lung cancer
 
 
Question 29
1 / 1 pts
M.A., a 63-year-old man who has been previously healthy is admitted to the hospital
with a 2-day
history of cough, rigors, fever, and right-sided pleuritic chest pain. Chest x-ray shows
consolidation
of the right lower lobe (RLL) and a free-flowing right pleural effusion. Thoracentesis is
performed,
and the pleural fluid has the following characteristics:
Cell count = 1110/mm3
Glucose = 75 mg/dL (serum glucose = 85 mg/dL)
Protein = 4.0 g/dL (serum protein = 7.0 g/dL)
LDH = 400 U/L (serum LDH = 200 U/L, normal = 100 – 200 U/L)
pH = 7.35
What is the pathogenesis of the pleural effusion?
Correct!
  
Increased permeability of visceral pleural membrane capillaries
 
Clinical conditions associated with either an increase in hydrostatic pressure
(such as congestive heart failure) or a decrease in oncotic pressure (such as nephrotic
syndrome) are
associated with transu-dative pleural effusions. This patient’s pleural fluid is exudative by all
three of
the Light criteria: pleural fluid/serum protein ratio is greater than 0.5, pleural fluid LDH/serum
LDH
ratio is greater than 0.6, and pleural fluid LDH is greater than two-thirds the upper limits of the
normal serum LDH. The most likely explanation for an exudative pleural effusion in the setting of
an
acute pneumonia is a parapneumonic effusion. Parapneumonic effusions occur in about 40% of
patients with bacterial pneumonia. Parapneumonic effusions are exudative due to the fact that
there is
increased permeability of the visceral pleural membrane capillaries, and interstitial fluid moves
across the visceral pleura into the pleural space. Parapneumonic effusions may be simple or
complicated. Simple parapneumonic effusions are sterile and free flowing. If bacteria invade the
pleural space, neutrophils move into the pleural space and anaerobic metabolism of glucose
results in
a low pleural fluid pH (<7.20) and glucose (<60). The characteristics of this patient’s pleural fluid
suggest that bacterial invasion of the pleural space has not occurred, and that this is a simple
parapneumonic effusion. Hemorrhage into the pleural space occurs with trauma, cancer, and
pulmonary embolism, but rarely with pneumonia.

  
Decrease in oncotic pressure
 

  
Increase in hydrostatic pressure
 

  
Bacterial infection in the pleural space
 

  
Hemorrhage into the pleural space
 
 
Question 30
1 / 1 pts
K. J., a 64-year-old woman presents with 6 weeks of fatigue, dyspnea, and night
sweats. She has lost 11 lb. She has no history of trauma, has never had surgery, and
takes no medications. Chest x-ray reveals a large right-sided pleural effusion.
Thoracentesis yields pleural fluid that appears milky. Pleural fluid triglyceride level is
500 mg/dL. Which of the following disorders is most likely in this patient?
Correct!
  
Lymphoma
 
This patient has a chylothorax. In chylothorax, the pleural fluid appears milky
and has a triglyceride level over 110 mg/dL. Chylothorax occurs when chyle accumulates in the
pleural space due to disruption of the thoracic duct. This is most often due to traumatic or
surgical
injury to the thoracic duct. In this patient without trauma or recent surgery, a mediastinal tumor
(such
as lymphoma) would be most likely. Chylous pleural effusions are usually exudative. Pulmonary
embolism, systemic lupus, and pneumonia may all be associated with pleural effusions, but
pleural
effusions associated with these conditions are not chylous. Congestive heart failure is a very
rare
cause of chylous pleural effusion, but would be much less likely than lymphoma.

  
Congestive heart failure
 
   
Pulmonary embolism
 

  
Pneumonia
 

  
Systemic lupus erythematosus
 
 
Question 31
1 / 1 pts
Temporal  arteritis is a disease of:

  
Asthmatics
 

  
Chronic smokers
 
Correct!
  
Elderly
 

  
Drug addict
 
 
Question 32
1 / 1 pts
The most common warning sign of cancer in children:

  
unusual masses or swelling
 

  
sudden or progressive weight loss
 
Correct!
  
prolonged unexplained fever or illness
 

  
unexplained pallor
 
 
Question 33
1 / 1 pts
Leukocoria is seen in:

  
Wilm's tumor
 
Correct!
  
Retinoblastoma
 

  
Hodgkin’s lymphoma
 

  
Leukemia
 
 
Question 34
1 / 1 pts
Periorbital ecchymosis is seen in:

  
Hodgkin's lymphoma
 

  
retinoblastoma
 

  
Wilm's tumor
 
Correct!
  
Neuroblastoma
 
 
Question 35
1 / 1 pts
One of the following is a characteristic of myeloblast morphology:

  
Smooth nuclear membrane
 

  
Indistinct nucleoli
 
Correct!
  
Low nuclear-cytoplasmic ratio
 

  
Absent Auer rods in cytoplasm
 
 
Question 36
1 / 1 pts
Peroxidase-positive on immunochemistry:

  
Neither ALL nor AML
 
Correct!
  
AML
 

  
ALL
 

  
Both ALL and AML
 
 
Question 37
0 / 1 pts
Macrocytosis with elevated homocysteine and normal methylmalonic acid are seen in:
You Answered
  
Folate deficiency anemia
 

  
iron deficiency anemia
 

  
All mentioned forms of anemia
 
Correct Answer
  
Vitamin B12 deficiency anemia
 
 
Question 38
1 / 1 pts
Microcytosis with target cells are seen in:

  
Vitamin B12 deficiency
 
Correct!
  
thalassemia
 

  
leukemia
 

  
Iron deficiency anemia
 
 
Question 39
1 / 1 pts
The following laboratory findings are suggestive of hemolysis, EXCEPT:
Correct!
  
Reticulocyte count of 1%
 

  
Increased LDH
 

  
Haptoglobin 20mg/dL
 

  
Increased indirect bilirubin
 
 
Question 40
0 / 1 pts
A RBC Distribution Width of 20% suggests:
Correct Answer
  
Anisocytosis
 

  
Poikilocytosis
 

  
All mentioned conditions
 
You Answered
  
Anemia
 
 
Question 41
0 / 1 pts
An 8-year old child was observed to be pale. The following laboratory findings are
expected, EXCEPT:

  
Serum ferritin 15 nanograms/mL
 
Correct Answer
  
TIBC 200 micrograms/dL
 
You Answered
  
None of the situations mentioned
 

  
Serum iron 50 micrograms/dL
 
 
Question 42
0 / 1 pts
Based on the Ann Arbor classification, localized involvement of an extralymphatic organ
or site and 1 or more LN region on same side of diaphragm is classified as:
Correct Answer
  
Stage II lymphoma
 

  
Stage III leukemia
 

  
Stage II leukemia
 
You Answered
  
Stage III lymphoma
 
 
Question 43
1 / 1 pts
Which of the following statements refer to adjuvant chemotherapy?
Correct!
  
It is given to take care of residual or microscopic metastasis
 

  
It is given to shrink the tumor
 

  
It is given before surgery
 

  
None of the other statements mentioned.
 
 
Question 44
1 / 1 pts
Phase III of the recommended Child Life Program in the treatment of cancer:
Correct!
  
Bridging transition from hospital to home
 

  
Bereavement
 

  
Assistance during health care procedures
 

  
Hospice care
 
 
Question 45
1 / 1 pts
The anemia in ALL is usually:
   
Microcytic
 

  
Macrocytic
 
Correct!
  
Normocytic
 

  
No pattern
 
 
Question 46
0 / 1 pts
Once there are at least _____ blast forms in the bone marrow, the suspicion of
leukemia should already be raised:

  
15%
 

  
3%
 
You Answered
  
25%
 
Correct Answer
  
5%
 
 
Question 47
1 / 1 pts
According to the FAB Cooperative Working Group classification, the type of
lymphoblasts that occur in 90% of children with ALL:
   
resemble closely the cells of Burkitt’s lymphoma
 

  
large with prominent nucleoli
 
Correct!
  
L1 lymphoblasts
 

  
present with cytoplasmic vacuoles
 
 
Question 48
1 / 1 pts
Common metastatic sites of neuroblastoma, EXCEPT:

  
bone
 

  
local lymph nodes
 

  
bone marrow
 
Correct!
  
orbit
 
 
Question 49
1 / 1 pts
Single most important prognostic factor in ALL:
Correct!
  
Treatment
 

  
Age
 

  
Ploidy
 

  
Initial WBC count
 
 
Question 50
0 / 1 pts
Which of the following findings is NOT consistent with anemia of chronic kidney
disease?

  
MCV 90 fL
 
You Answered
  
Hemoglobin 9 g/dL
 

  
Echinocytes on peripheral smear
 
Correct Answer
  
Reticulocyte production index of 3%
 
 
Question 51
0 / 1 pts
DOES NOT play in the atherosclerotic  process
Correct Answer
  
Polymorphonuclear cells
 
   
Macrophages
 
You Answered
  
Smooth muscle cells
 

  
Platelets
 
 
Question 52
1 / 1 pts
Common complication of bacterial endocarditis

  
Chronic pericarditis
 

  
Pulmonary embolism
 
Correct!
  
Abscess formation in brain, spleen & kidneys
 

  
None
 
 
Question 53
1 / 1 pts
Temporal  arteritis is a disease of:
Correct!
  
Elderly
 

  
Drug addicts
 

  
Chronic smokers
 

  
Asthmatics
 
 
Question 54
0 / 1 pts
A lateral left ventricular infarction is due to the occlusion of

  
Right marginal
 

  
Left anterior descending
 
You Answered
  
Right coronary
 
Correct Answer
  
Left circumflex
 
 
Question 55
1 / 1 pts
The most common primary benign tumor of the heart

  
fibroma
 

  
rhabdomyoma
 
Correct!
   
myxoma
 

  
elastoma
 
 
Question 56
1 / 1 pts
MOST common type of cardiomyopathy
Correct!
  
dilated
 

  
restrictive
 

  
Arrhythmogenic
 

  
hypertrophic
 
 
Question 57
1 / 1 pts
Episodic chest pain due to artery spasm

  
Prinzmetal Angina
 

  
Variant Angina
 
Correct!
  
Both
 
   
None
 
 
Question 58
0 / 1 pts
Presence of granulation tissue formation in myocardial infarction is seen in
You Answered
  
1-7 days
 

  
0-4 hours
 

  
12-24 hours
 
Correct Answer
  
1-2 Weeks
 
 
Question 59
1 / 1 pts
Irreversible type of atelectasis

  
Resorption
 

  
Compression
 
Correct!
  
Contraction
 

  
None
 
 
Question 60
1 / 1 pts
Type of emphysema associated with Alpha-1 Antitrypsin deficiency

  
centriacinar
 
Correct!
  
panacinar
 

  
paraseptal
 

  
centrilobular
 
 
Question 61
1 / 1 pts
The epitheloid cells seen in the granuloma of tuberculosis are believed to be modified
Correct!
  
Macrophage
 

  
Lymphocyte
 

  
Neutrophil
 

  
Fibroblast
 
 
Question 62
0 / 1 pts
The usual cause of  interstitial pneumonia

  
Mixed type
 
Correct Answer
  
Viral
 
You Answered
  
Bacterial
 

  
Fungal
 
 
Question 63
1 / 1 pts
TRUE of Squamous cell carcinoma of the lungs:

  
It is found predominantly in the major bronchi
 
Correct!
  
all of these
 

  
It grows slowly than Oat cell carcinoma.
 

  
Its tumor cells are readily found in the sputum
 
 
Question 64
1 / 1 pts
Causes of Adult Respiratory Distress syndrome include all of the following EXCEPT

  
Viral infections
 
Correct!
  
Amyloidosis of the lungs
 

  
Fat embolism
 

  
Oxygen toxicity
 
 
Question 65
1 / 1 pts
The etiologic agent common to both chronic bronchitis and emphysema

  
Alcohol
 
Correct!
  
Tobacco
 

  
Inhaled allergens hypersensitivity
 

  
Persistent viral infection
 
 
Question 66
1 / 1 pts
Chordia tendinae attaches to the following structures ,one is not

  
Papillary muscles
 

  
Tricuspid valve
 

  
Mitral valve
 
Correct!
  
Pulmonic valve
 
 
Question 67
1 / 1 pts
Which of the statements is true concerning abnormal valve function?

  
Valve stenosis occurs during that phase of cardiac cycle when the valve is closed
 

  
Combinations of valve lesions cannot coexist
 
Correct!
  
One valve lesion can cause another valve lesion
 

  
Valve regurgitation happens when there is forward flow of blood
 
 
Question 68
1 / 1 pts
In the either valve stenosis or regurgitation, which of the following compensation of the
heart precedes prior to the development of heart failure?

  
Dilatation
 
   
Hypertrophy
 

  
Scarring
 
Correct!
  
Dilatation & hypertrophy
 
 
Question 69
1 / 1 pts
In the evaluation of a patient with valvular heart disease, the following essential
questions shall be asked, one is not:

  
What are the patients wishes?
 

  
What is the patient’s life expectancy?
 

  
Are there any signs in an asymptomatic patient present which may indicate a worse
outcome if intervention is delayed
 
Correct!
  
None
 
 
Question 70
0 / 1 pts
The heart murmur that is associated with a thrill

  
Grade 11/VI
 

  
Grade 1/VI
 
You Answered
  
Grade V/VI
 
Correct Answer
  
Grade III/VI
 
 
Question 71
0 / 1 pts
What is true of echocardiograpy?

  
Essential in both acute and chronic valve disease
 

  
mainstay of diagnosis and follow-up
 
Correct Answer
  
radiation harm
 
You Answered
  
Allows real time measurement of chambers and wall diameter
 
 
Question 72
1 / 1 pts
Assesses severity of regurgitation:

  
Aortography
 
Correct!
  
Angiography
 

  
CMRI
 

  
Hemodynamic assessment
 
 
Question 73
1 / 1 pts
What is the dominant cause of valvular heart disease  in low -income and developing
countries?

  
congenital heart disease
 

  
infective endocarditis
 
Correct!
  
rheumatic heart disease
 

  
heart attack
 
 
Question 74
0 / 1 pts
What statement is  not true of bicuspid aortic valve disease?

  
x-linked
 
You Answered
  
autosomal
 
Correct Answer
  
2-4:1 female – male predominance
 

  
most common
 
 
Question 75
1 / 1 pts
When is valve replacement indicated is AS?
Correct!
  
When symptoms occur
 

  
When there is elevated intraventricular pressure
 

  
When LV hypertrophy is present
 

  
When valve orifice is < 2cm
 
 
Question 76
1 / 1 pts
That type of cardiomyopathy equated with emotional malady:

  
hypertrophic
 

  
dilated
 

  
restrictive
 
Correct!
  
takutsubo
 
 
Question 77
1 / 1 pts
Chemotherapy agents are the most common drugs implicated in toxic cardiomyopathy.
Which of the following can cause recurrent coronary spasm and leads to depressed
contractility?

  
cyclophosphamide
 

  
doxurubicin
 
Correct!
  
cisplatin
 

  
ifosfamide
 
 
Question 78
1 / 1 pts
What nutritional deficiency can develop during fasting and early refeeding following a
prolonged fast  and during hyperalimentation?

  
selenium deficiency
 

  
hypocalcemia
 

  
hypomagnesemia
 
Correct!
  
hypophosphatemia
 
 
Question 79
1 / 1 pts
 In the stages of pneumonia,what is the avascular stage?

  
resolution
 

  
congestion
 

  
red hepatization
 
Correct!
  
gray hepatization
 
 
Question 80
1 / 1 pts
What is the best way of stopping the spread of pneumonia from fomites?

  
coughing etiquette
 

  
vaccination
 

  
antibiotic
 
Correct!
  
hand washing
 
 
Question 81
1 / 1 pts
A 44 year old woman, currently working in a bakery, presents with a 1 year history of
asthma and allergic rhinitis symptoms, including episodic cough, wheeze, shortness of
breath and chest tightness with itchy red watery eyes and a stuffy, runny, itchy nose.
These symptoms become worse within 1-2 hours of starting work each day, and worsen
throughout the work week.
What is the characteristic physiologic abnormality in asthma?

  
Atopy
 

  
Bronchoconstriction
 
Correct!
  
Airway hyperresponsiveness
 

  
Chronic inflammation
 
 
Question 82
1 / 1 pts
Which of the following is an inflammatory mediator in bronchial asthma?
Correct!
  
nitric oxide
 

  
mast cell
 

  
fibroblast
 
   
eosinophil
 
 
Question 83
1 / 1 pts
Which of the following drugs inhibit the inflammatory process associated with bronchial
asthma?

  
beta-2 agonists
 

  
anti-cholinergics
 
Correct!
  
Leukotrienes
 

  
methylxanthines
 
 
Question 84
1 / 1 pts
What is not a sign of Beck’s triad?

  
distention of jugular veins
 

  
hypotension
 
Correct!
  
hypertension
 

  
muffled heart sounds
 
 
Question 85
1 / 1 pts
Which of the following physical examination findings is not consistent with pneumonia
with consolidation?

  
egophony
 
Correct!
  
amphoric breath sounds
 

  
bronchial breath sounds
 

  
pleural friction rub
 
 
Question 86
1 / 1 pts
A 14-year-old boy is seen by a pediatric cardiologist because of increasing shortness of
bbreath. Studies reveal increased pulmonary
vascular resistance, left axis deviation on Electrocardiogram (ECG), and mitral
regurgitation murmur. What is the most likely diagnosis?

  
ostium secundum defect
 

  
TOF
 

  
right aortic arch
 
Correct!
  
ostium primum defect
 
 
Question 87
1 / 1 pts
A cyanotic female neonate is born with transposition of the great arteries. Metabolic
acidosis and hypoxemia are present and are life
threatening. Which of the following is the best initial treatment?
Correct!
  
Prostaglandin E1 and atrial septotomy
 

  
Urgent Mustard operation
 

  
Prostaglandin E1
 

  
Atrial septotomy
 
 
Question 88
1 / 1 pts
A 65-year-old man undergoes cardiac surgery for triple vessel coronary artery disease.
What can he anticipate?
Correct!
  
If the internal mammary artery is used as a conduit, patency is increased.
 

  
Mortality if 60–70% in most centers
 

  
99% chance his grafts will occlude after 12 months.
 

  
Functional improvement with the saphenous vein graft is better than internal memory
artery
 
 
Question 89
1 / 1 pts
Three months after aortic valve replacement with a mechanical prosthesis, a 60-year-
old man describes malaise, and increasing shortness of breath. Examination reveals
pulsus paradoxus. ECG shows low voltage precordially. What test is most useful for
making the diagnosis?
Correct!
  
echocardiography
 

  
stress thallium exam
 

  
CPK
 

  
CT scan of chest
 
 
Question 90
1 / 1 pts
Three months after aortic valve replacement with a mechanical prosthesis, a 60-year-
old man describes malaise, and increasing shortness of breath. Examination reveals
pulsus paradoxus. ECG shows low voltage precordially. 
In the patient described above urine output decreases to 20 cc/h. Studies reveal
paradoxical septal motion. What is the next course of
therapy?
Correct!
  
Pericardial window
 

  
Left chest tube
 

  
Redo aortic valve surgery
 

  
Expectant medical therapy
 
 
Question 91
1 / 1 pts
A 58-year-old man is in cardiogenic shock in the emergency department after sustaining
an acute myocardial infarction (MI). An intraaortic balloon pump (IABP) is inserted.
Which statement is TRUE about IABP?

  
The balloon increases peripheral resistance.
 

  
The balloon increases coronary perfusion during systole.
 

  
The balloon is inflated in systole and diastole.
 
Correct!
  
The balloon increases coronary perfusion during diastole.
 
 
Question 92
1 / 1 pts
A 66-year-old female has had two MIs in the past. She is admitted to the emergency
department in congestive heart failure. After admission and appropriate therapy her
Holter monitor shows frequent PVCs and her ejection fraction is found to be 35%.
Appropriate treatment would include which of the following?

  
cardioversion
 
Correct!
   
Internal cardiac defibrillator (ICD)
 

  
Single chamber pacemaker
 

  
Dual chamber pacemaker
 
 
Question 93
1 / 1 pts
During a routine examination of a 30-year-old female actuary seeking life insurance, she
is found to have a ventricular septal defect (VSD). She undergoes subsequent studies
including ECG, chest x-ray, echocardiography, and Doppler ultrasound. What is the
major determinant of operability in VSD?

  
Location of the VSD
 
Correct!
  
Pulmonary vascular resistance
 

  
Age of patient
 

  
Size of the VSD
 
 
Question 94
1 / 1 pts
At the age of 3 years, a child with a VSD becomes progressively short of breath and
requires urgent surgery. What is the most common type of VSD

  
Posterior septal defect
 
Correct!
  
Membranous septal defect
 

  
Defect anterior to the crista supraventricular
 

  
Low muscular defect
 
 
Question 95
1 / 1 pts
At birth, the 6 weeks premature infant is noted to have progressive dyspnea. There is a
continuous murmur in the pulmonic area second left intercostal space), and cyanosis is
absent. ECG findings are normal. An x-ray of the heart shows cardiomegaly, and the
pulse is bounding. Patent ductus arteriosus (PDA) is diagnosed. What does treatment
include?

  
Dialysis
 

  
Immediate surgical correction
 

  
Cortisone
 
Correct!
  
Administration of indomethacin
 
 
Question 96
1 / 1 pts
Wenckebach's type AB block is recognized by

  
progressive PQ shortening
 
Correct!
  
progressive lengthening of the PR interval
 

  
RR shortening with dropped beat
 

  
tachycardia
 
 
Question 97
1 / 1 pts
Mechanism of action of positive inotropic drugs
Correct!
  
block Na+ / K+-ATPase
 

  
reduce Angiotensin II synthesis
 

  
lower blood volume
 

  
increases cAMP levels in cardiac and vascular tissue
 
 
Question 98
0 / 1 pts
Ventricular gallop or third heart sound is characteristic of 
Correct Answer
  
mitral stenosis
 
You Answered
  
mitral regurgitation
 

  
aortic stenosis
 

  
tricuspid regurgitation
 
 
Question 99
1 / 1 pts
A 40-year-old woman presents to the emergency room with chest pain, fever, and night
sweats. She has recently returned from travelling in rural areas and has lost 10 pounds.
Which of the following findings is not consistent with a diagnosis of tuberculous
pericarditis with pericardial effusion?

  
Lack of signs and symptoms of pulmonary tuberculosis
 

  
Presence of pulsus paradoxus
 
Correct!
  
Negative acid-fast bacilli staining and mycobacterium cultures on pericardial fluid
 

  
Electrical alternans on ECG
 
 
Question 100
1 / 1 pts
A 75-year-old man complains of chest pain while climbing stairs. On physical
examination, there is a II/VI systolic ejection murmur that radiates to the neck. The
carotid upstrokes are delayed and diminished in volume. The best test to confirm the
diagnosis is:

  
An ECG
 
   
CXR
 
Correct!
  
An echocardiogram
 

  
An exercise stress test