IM Cardiology
IM Cardiology
IM Cardiology
Answer: D
Note: Most common cause of death in the first several days after a
myocardial infarction is ventricular arrhythmia (ventricular
tachycardia, ventricular fibrillation).
Note: general poor prognostic factors after MI include old age (>75
years), female gender, presence of HF or severe left ventricular
dysfunction, and arrhythmias.
I think something in the question is wrong since both genders are
choices as well as age<60. Age and male sex are wrong choices.
Note: The prognosis is worse for anterior than for inferior infarcts.
Bundle branch block and high cardiac marker levels both indicate
extensive myocardial damage. Old age, depression and social
isolation are also associated with a higher mortality.
Answer: A
Answer: D
Answer: D
11) Question about what is the first enzyme to raise after MI:
a) CPK-MB
b) Troponin l
c) Myoglobin
Answer: C
Note: CK-MB raises 4-6 hrs after symptom onset. Myoglobin rises
2-4 hours after onset of infarction. Troponin rises after 6-12 hrs of
onset of myocardial damage.
12) A patient presents with typical chest pain, his pain was relived
with nitroglycerin, ECG shows ST depression in v1 -v4
what is your next step?
a) Discharge him home
b) Gives him thrombolytic
c) Admission on B-blocker, ACE-I and aspirin
d) Stress test
Answer: C
13) Right ventricle infarction, which of the following you will not
see?
a) Congestion on the lungs (pulmonary edema)
b) Increase JVP
c) Occlusion or RCA
d) Low capillaries wedge pressure
e) Hypotension
Answer: A
Answer: A
16) Long case. 65y male come to ER with severe retrosternal pain, BP
90/50, bradycardia, ST elevation in aVR, leads 2, 3, diagnosis:
a) Aortic dissection
b) Inferior MI
c) Right MI
d) Inferior MI with right
Answer: B
17) All the following are false about stable angina except:
a) Occur at rest
b) It is a new onset angina
c) Precipitated by eating
d) It is angina that increase in frequency and severity
e) Angina not relived by sublingual nitrate
Answer: C
18) Case: patient complains from chest pain upon walking uphill,
lasting for 5 min , relieved by test , normal ECG and normal Echo :
a) +Stable Angina
19) Which is not related to unstable angina
a) Angina of recent onset
b) Post MI angina
c) Angina at rest
d) Predictable angina in some patients
Answer: D
Answer: C
Answer: E
Answer: B
Answer: B
26) All of the following are sites for radiating MI, except :
a) Forehead
b) Intracellular
c) Left. Scapula
Answer: A
Note: no idea what intracellular is supposed to be.
27) All of the followings are risk factors for IHD except :
a) Homocystinemia
b) High LDL level
c) Low HDL level
d) Alcohol
Answer: D
28) All of the following are precipitating factors for IHD except :
a) HTN
b) Smoking
c) Homocystenemia
d) Father who died because of MI, when he was 72 Years
Answer: D
30) A Healthy 38 year old man comes to cardiology clinic for routine
checkup; he is smoker, no HTN, no family history of DM or HTN.
Everything is normal. What will you do to complete his exam as a
screening tool?
a) FBG
b) Fasting lipid profile
c) CBC
d) Abdominal US
e) ECG
Answer: B
Note: Since everything is normal, and his age is above 35, this is
the age to screen for hyperlipidemia.
The U.S. Preventive Services Task Force (USPSTF) strongly
recommends screening men 35 years and older for lipid disorders.
The USPSTF recommends screening men 20 to 35 years of age for
lipid disorders if they are at increased risk of coronary heart
disease (CHD).
31) All of the following are risk factor of coronary artery disease
except:
a) Hyperlipoproteinemia
b) Increase LDL
c) Increase insulin
d) Increase estrogen
e) Increase homocystine
Answer: D
32) Patient with inferior MI, developed 3rd degree heart block, the
management of choice will be:
a) +Keep him on his medication, and observe
Answer: A
36) Patient 50 years old had MI, after 4 weeks he developed pleuritic
chest pain aggravated by inspiration, your Dx:
a) Dressler syndrome
b) Another MI
Answer: A
Answer: E
6) ACE-Inhibitors/ARB:
Start in patients with acute anterior MI & their BP is stable &
normal
Start in the first 24 hrs
Remember that this group may cause postural hypotension,
so make sure that the patient is stabilized.
41) Inferior MI with ST elevation, BP < 90/60 u will give all except:
a) +IV nitroglycerin
42) A long case ( which wasn’t important) which one of the following
ECG finding is an indication for thrombolysis:
a) +ST elevation in V4-V6 about 2 mm
Answer: C
44) Patient with USA. Which one of the following cannot be given?
a) Aspirin
b) Heparin
c) Nitroglycerin
d) Streptokinase
Answer: D
45) Old male presented with retrosternal chest pain and diaphoresis.
ECG showed ST depression on leads II, III, aVF. All of the following
are part of the management, EXCEPT:
a) Streptokinase
b) Aspirin
c) Heparin
d) Beta-blockers
e) Nitrates
Answer: A
Answer: B
Note: Secondary prevention of post myocardial infarction
includes ABCDE:
A-Aspirin and anti-anginals
B- Beta blockers and blood pressure
C- Cholesterol and cigarettes
D- Diet and diabetes
E- Education and exercise
Long acting nitrates are reserved for patients with continuous and
frequent chest pain because tolerance may occur.
Answer: B
Answer: C
NOTE: Not exactly sure but all of these questions are dumb tbh.
Answer: D
Note: the pt in D is a case of suspected aortic dissection
(uncontrolled HTN and the aortic regurgitation murmur)!!
Answer: C
Answer: D
Answer: D
Note: Hypokalemia causes ST segment depression.
Answer: A
Answer: C
Note: also known as "Cephalization of the pulmonary vessels".
Answer: E
59) Patient with S4 with picture suggestive of MI. What is the cause
of S4?
a) Increased ventricular compliance
b) Decreased ventricular compliance
c) Decreased ventricular contraction
Answer: B
Note: a low-frequency gallop sound that results from forceful
atrial contraction into a ventricle which cannot expand further.
Answer: A
62) All of the followings are signs of left ventricular heart failure
except:
a) S3 gallop
b) Basal crepitation
c) Dyspnea
d) Edema
Answer: D
Answer: A
Answer: C
Note: S3 has a low sensitivity but a high specificity (up to 99%) for
clinical diagnosis of HF.
Answer: B
71) All of the following conditions are associated with high output
heart failure, EXCEPT:
a) Paget’s disease of the bone
b) Iron overload
c) Hyperthyroidism
d) Thiamine deficiency
e) Large AV fistula
Answer: B
Answer: B
Answer: E
74) A case about a patient who is using aspirin and furosemide and
now he is starting to feel tired while walking uphill which one of the
following treatment is best to be added :
a) Spironolactone
b) Hydrochlorothiazide
c) Enalapril
Answer: C
Note: Initial therapy of systolic heart failure includes a
combination of diuretic therapy, an angiotensin system blocker
(ACE inhibitor or ARBs) and a beta blocker.
Enalapril is an ACE inhibitor and so it is the answer.
75) Patient long case of heart failure, admitted to the hospital 5 days
ago due to fluid overload, after that ABG was done:
PH = 7.49 PCO2 = 42 HCO3 = 32 …. What is the cause?
a) Diuretic drug
b) Shock
c) Respiratory muscle weakness
Answer: A
Answer: E
Answer: D
Note: this table is from Medstudy IM and it's very useful as reference
of when solving cardiology drugs drama.
79) All of the following increase survival in patients of heart failure,
EXCEPT:
a) Spironolactone
b) ICD
c) ACE inhibitors
d) High atrial natriuretic peptide (ANP)
e) High body mass index
Answer: E
Answer: C
81) All of the following Doesn't affect mortality rate of heart failure
(increase survival in heart failure ) except :
a) Digoxin
b) IV nitroglycerin
c) IV propranolol
d) Defibrillator implant
Answer: A
Answer: C
Answer: A
84) All of the following are true regarding chronic LBBB, EXCEPT:
a) QRS > 0.12 s
b) ST-T depression in leads I, aVL, V2-V6
c) ST-T elevation in V1,V2
d) Septal Q-waves in V5,V6
Answer: D
Note: in LBBB there will be absence of q wave in leads I, V5 and
V6.
Answer: E
Answer: A
Answer: B
Answer: A
Answer: A
92) One can't be presented in the ECG in 3rd degree heart block:
a) +Absent P wave
Answer: A
Answer: A
Note: Sinus tachycardia is the most common ECG finding but
S1Q3T3 pattern is classic of PE.
Answer: D
Note: This is a case of SVT.
Answer: A
Answer: A
Answer: A
102) All are possible findings of ECG in patients with hyperkalemia,
except :
a) Prolong QT interval
b) Peaked T wave
c) Wide QRS complex
d) Prolonged PR interval
e) Absent P wave
Answer: A
Answer: A
105) Stable patient with rapid ventricle response AF, start by:
a) IV procainamide
b) IV amiodarone
c) IV metoprolol
d) Cardioversion
Answer: Mostly C
Answer: B
Answer: A
Explanation: Management of VT
Prompt action to restore sinus rhythm is required and should
usually be followed by prophylactic therapy. Synchronized DC
cardioversion is the treatment of choice if systolic BP is less than
90 mmHg. If the arrhythmia is well tolerated, intravenous
amiodarone may be given as a bolus, followed by a continuous
infusion.
Answer: A
112) A 59 year old male patient presented with left upper abdominal
pain and a CT scan of the abdomen showed a splenic infarction.
Which of the following is the most likely cause of her condition
a) Aplastic anemia
b) Gilbert’s disease
c) Idiopathic pulmonary fibrosis
d) Atrial fibrillation
e) Idiopathic thrombocytopenic purpura
Answer: A
Answer: D
Answer: A
Answer: B
Note: S4 is the sound when atria contract to force blood into LF. In
atrial fib, contraction of left atrium is lost and so the sound S4
cannot be present.
Answer: B
Note: AF can cause stroke. But recent study shows that A-Fib does
not increase the probability of PE
(http://www.ncbi.nlm.nih.gov/pubmed/22212132)
Answer: A
Answer: C
Note: Arrhythmias associated with WPW Syndrome include AVRT,
AVNRT, Atrial fibrillation, Atrial flutter, Ventricular tachycardia,
Ventricular fibrillation and sudden death.
CARDIOMYOPATHY
123) All of the following are bad prognostic features in HOCM
(Hypertrophic Obstructive Cardiomyopathy) except:
a) Non-sustained VT at 24-hrs Holter ECG monitoring
b) High LVOT (Left Ventricular Outflow Tract) gradient
c) History of recurrent syncope during exercise
d) Family history of sudden death at young age
e) Excessive septal hypertrophy (more than 30 mm as measured by
echocardiography)
Answer: B
Answer: D
125) All increases the obstruction , thus increases the intensity of the
murmur in HOCM ) Hypertrophic cardiomyopathy ( except:
a) Squatting
b) Standing
c) Valsalva maneuver
d) Exercise
Answer: A
Answer: B
Answer: A
133) A 35 years old female with 37 weeks gestation. She has lower
limb edema, lower bilateral crackles, JVP 13 cm and hypertensive
(previously normotensive). There was diffuse apical sound with S3
gallop and holosystolic murmur heard at apex. What is your
diagnosis?
a) Peripartum cardiomyopathy
b) Severe tricuspid regurgitation
Answer: A
Note: In a patient with PPCM, signs of heart failure are the same
as in patients with systolic dysfunction who are not pregnant.
Tachycardia and decreased pulse oximetry (should be ≥ 97% at sea
level) are present.
Answer: C
Answer: B
Note: causes of restrictive cardiomyopathy are amyloidosis,
sarcoidosis, hemochromatosis, scleroderma, carcinoid syndrome,
chemotherapy or radiation induced, idiopathic.
Answer: D
Note: Previous chemotherapy treatment is the clue to reach
diagnosis.
PERICARDIAL DISEASE
Answer: B
Answer: B
Answer: B
Answer: B
Answer: B
Note: Signs of classical cardiac tamponade include three signs, known
as Beck's triad. Low blood pressure occurs because of decreased stroke
volume, jugular-venous distension due to impaired venous return to the
heart, and muffled heart sounds due to fluid buildup inside the
pericardium.
Other signs of tamponade include pulsus paradoxus (a drop of >10
mmHg in arterial blood pressure with inspiration),narrow pulse
pressure(due to decreased stroke volume) and ST segment changes on
the electrocardiogram, which may also show low voltage QRS
complexes, as well as general signs and symptoms of shock (such as fast
heart rate, shortness of breath and decreasing level of consciousness) .
Acute myocardial regurgitation causes (causenl or increase systolic
pressure).
146) Patient with dyspnea and dizziness for few days. Presented later
with hypotension and distended jugulars and S3 on apex. There was
significant decrease of systolic pressure on inspiration. What is the
diagnosis?!
a) Restrictive cardiomyopathy
b) Cardiac tamponade
c) Acute myocardial regurgitation
d) Cardiac tamponade
Answer: D
147) All the following are classic signs for cardiac tamponade EXCEPT:
a) Tachycardia
b) Muffled heart sounds
c) Wide pulse pressure
d) Raised JVP
e) Hypotension
Answer: C
Answer: A
Answer: A
155) All of these cause wide splitting of the second heart sound
except:
a) Pulmonary embolism
b) RBBB
c) LBBB
d) Ventricular ectopic beat
e) Left ventricular pacemaker
Answer: C
Answer: B
Answer: A
Answer: D
Answer: A
Answer: D
Answer: B
Answer: A
Answer: A
Answer: D
Note: The physical signs of mitral stenosis are often found before
symptoms develop and their recognition is of particular importance
in pregnancy. The forces that open and close the mitral valve increase
as left atrial pressure rises. The first heart sound (S1) is therefore loud
and can be palpable (tapping apex beat). An opening snap may be
audible and moves closer to the second sound (S2) as the stenosis
becomes more severe and left atrial pressure rises. However, the first
heart sound and opening snap may be inaudible if the valve is heavily
calcified. (Opening snap, which due to leaflets tension).
169) Case about a patient who has vegetations in the mitral valve and
was dx of mitral (stenosis?), he underwent Trans thoracic Echo,
what else do you want to do?
a) Cath
b) transesophageal
c) Colonoscopy
Answer: A
170) Diastolic murmur, cardiac apex, (the question also said loud S2
and then low sound after S2 I think):
a) Mitral stenosis
b) Aortic regurge
c) Mitral regurge
Answer: A
Answer: D
Answer: D
Note: We need to be careful when using vasodilators in aortic
stenosis since then can cause life-threatening hypotension.
Generally speaking, medical therapy is of limited value in aortic
stenosis.
Answer: E
Answer: A
Answer: A
180) Which one of the following isn’t a risk factor for aortic valve
regurgitation:
a) Rheumatic fever
b) Infective endocarditis
c) Cardiomyopathy
d) Bicuspid valve
Answer: C
181) Decrescendo low pitched s2 heard on the left 3rd sternal border:
a) Aortic regurgitation
Answer: C
Answer: A
185) All of the following are true about mitral regurgitation except:
a) Wide pulse pressure
b) Hemoptysis diffuse alveolar Hemorrhage Syndrome in silent MR
c) Atrial dilation
d) Pulmonary hypertension " edema "
Answer: A
186) All of these causes mitral regurgitation except:
a) PDA
b) MI
c) Papillary muscle injury
Answer: A
Answer: E
188) One of the following is not true about mitral valve prolapse:
a) Low risk of infective endocarditis
b) Increased risk of regurgitation with thick, redundant leaflets
c) Complications are more common in females
d) Regurgitation is associated with worse prognosis
e) Most cases are asymptomatic
Answer: A
Answer: B
191) Pansystolic murmur that's present in left lower sternal angle and
increases with inspiration is:
a) Regurgitation tricuspid
b) Mitral regurgitation
c) Aortic regurgitation
Answer: A
Answer: C
194) All the following are true regarding heart murmurs and their
associated pathological conditions except:
a) Pansystolic murmur – Tricuspid regurgitation
b) Mid-diastolic murmur – Aortic regurgitation
c) Late diastolic murmur – Complete heart block
d) Pansystolic murmur – Mitral regurgitation
e) Ejection systolic murmur – Aortic stenosis
Answer: B
195) All of the followings are considered as part Jones major criteria
except:
a) Erythema multiforme
b) Migratory polyarthritis
c) subcutaneous nodule
d) Sydenham chorea
Answer: A
196) Which one of these is not in the major criteria of rheumatic heart
disease
a) Polyarthritis
b) Sydenham's chorea
c) Erythema marginatum
d) Severe arthralgia
e) SC nodules
Answer: D
Answer: A
Note: Arthritis is the most common criteria.
Answer: D
Note: Gottron's papules found in Dermatomyositis
Answer: C
Answer: C
204) Which one of the following has the highest risk of infective
endocarditis :
a) Presence of the prosthetic valve
b) Mitral valve prolapse with regurgitation
Answer: B
Note: not sure as they’re both risk factors.
Answer: D
206) A 60-year old man presents with general malaise, fever, and
night sweats. He has a history of rheumatic heart disease. On
physical examination, there is evidence of a new onset Pansystolic
murmur. All the following are true about his condition except:
a) Prior antibiotic use is a common cause for blood-culture-negative
endocarditis
b) Prophylactic antibiotic is indicated in this patient before any
dental extraction
c) Normal transthoracic echocardiography does not rule out
infective endocarditis
d) The most common microorganism is Streptococcus viridans
e) The presence of prosthetic valve is not an indication for surgical
valve replacement
Answer: B
Answer: A
Answer: A
Answer: C
212) Patient had history of URTI after a while he started to feel chest
pain and dyspnea, by CXR cardiomegaly was found, what is the best
finding?
a) +Pericardial rub
Answer: A
Answer: A
218) Which of the following congenital heart diseases causes
cyanosis?
a) HOCM
b) TOF
c) VSD
Answer: B
Answer: D
Note: all are associated with coarctation of the aorta, but the
least common is "rib notching" as dr Mohammad al Jarrah
answered this Q after the exam!!
Answer: A
HYPERTENSION
Answer: C
Answer: D
Answer: A
Answer: E
Answer: B
Note: low HDL is a risk factor for HTN (LANGE Current Medical
Diagnosis and Treatment 2013)
228) Previously healthy female 35 years with family history of HTN,
her blood pressure recently starts to increase gradually within few
months now presented with Bp 155/95. What's most appropriate?
a) Kidney MRI
b) Start with thiazide it is essential HTN
c) Start with b blocker & ACEI
d) Reassure her with follow after 1y or 3 month can't remember if
exactly was its as I wrote
Answer: C
Note: If the patient was not in pain, then the answer would most
likely be B. IV morphine.
Answer: A
Answer: C
Answer: A
Answer: A
Answer: C
Answer: A
Note: Common adverse drug reactions of ACEI include:
hypotension, cough, hyperkalemia, headache, dizziness, fatigue,
nausea, and renal impairment.
Answer: D
Answer: B
Answer: A
Answer: A
Answer: A
244) A 16 Year old female presented with HTN and hypokalemia , all
of these are causes of that presentation, except:
a) Renal artery stenosis
b) Hyperaldosteronism
c) +Something else
Answer: E
Answer: A
247) All of the following diseases can lead to elevated blood pressure
EXCEPT:
a) Renal artery stenosis
b) Primary hyperaldosteronism
c) Cushing’s syndrome
d) Polycystic kidney disease
e) Acute pyelonephritis
Answer: E
248) You will look for 2dry cause of HTN in all except:
a) LVH
b) Age<25
c) Active urinary sedimentation
d) Hypokalemia
Answer: A
Answer: A
DRUGS
Answer: B
Answer: A
Answer: A
Answer: A
254) Digoxin can lead to all of the following ECG abnormalities except:
a) Increase in number of premature ventricular beats
b) ST segment depression in lateral chest leads (V4, V5 and V6)
c) Ventricular tachycardia
d) Prolongation of the PR interval
e) Complete heart block
Answer: (All of the above choices are possibly caused by
digoxin)
Answer: A
Answer: B
257) Which of the following is not matched with its side effect:
a) Thiazide thrombocytosis
b) Digoxin 3rd degree heart block
c) Spironolactone gynecomastia
Answer: A
Answer: A
Answer: C
Answer: B
Answer: A
Answer: E
Answer: C
Note: in HOCM we use Beta-blockers or verapamil.
266) One of the followings is not a risk factor for Aortic dissection:
a) Hypothyroidism
b) Pregnancy
c) HTN
d) Bicuspid value
Answer: A
Answer: A
269) All the following conditions will cause peripheral cyanosis
except?
a) DVT
b) Peripheral vascular disease
c) Raynaud phenomena
d) Cold
Answer: A
Explanation: Cholesterol embolism syndrome should be
suspected in a patient who develops worsening renal function,
hypertension, distal ischemia, or acute multisystem dysfunction
after an invasive arterial procedure. Atheroemboli may also occur
spontaneously.
Answer:
Note: Generally speaking pleural effusion is very common in
congestive heart failure, and should resolve with treatment of
congestive heart failure. However, refractory, recurrent, massive
or significant pleural effusions warrant treatment by pleural
drainage.
Answer: A
Answer: D
Answer: A
Thyrotoxicosis
Severe anemia
Pregnancy
Thiamine deficiency (wet beriberi)
AV fistula
Volume depletion
Sympathetic overdrive
Aortic regurgitation
Answer: A
Answer: A
Note: All choices are actually correct but this is the closest to what
they want I guess.
281) Mismatch:
a) Folate Cord degeneration
b) S1 loud Mitral regurgitation
c) 70 years Syncope
d) Systolic murmur AS
Answer: B
282) Which one of the following isn’t a known cause of left ventricular
hypertrophy :
a) Old age
b) Obstructive hypertrophic cardiomyopathy
c) Aortic stenosis
d) Mitral stenosis
e) HTN
Answer: D
Answer: A
Answer: E
Answer: C
288) Case of DVT, D dimer was done, the next diagnostic test is:
a) +Doppler Ultrasound
290) Case: female complaining from sudden left ant. chest pain, SOB,
she was cold cyanotic :
a) +I think acute pulmonary edema due to MI