Deck 1: Cardiac Medicine

Question 1

Which of the following findings is suggestive of pulsus paradoxus?

A)Inspiratory drop in SBP > 10 mmHg
B)Expiratory drop in SBP > 10 mmHg
C)Inspiratory rise in SBP > 10 mmHg

Answer 1

Inspiratory drop in SBP > 10 mmHg

Question 2

The nurse is preparing to record the blood pressure of a patient. What should be the correct position of the patient and arm?

A)Patient sitting on chair taken in left arm
B)Patient supine and upright taken in both arms
C)Patient in any position taken in any of the arms
D)Patient lying down on bed taken in right arm

Answer 2

Patient supine and upright taken in both arms

Question 3

Which of the following correctly defines pulse pressure?

A)Mean of systolic blood pressure and diastolic blood pressure
B)Difference of systolic blood pressure and diastolic blood pressure
C)Sum of systolic blood pressure and diastolic blood pressure
D)Mean arterial blood pressure

Answer 3

Difference of systolic blood pressure and diastolic blood pressure

Question 4

Pulsus bisferiens is present in which of the following conditions?

A)Aortic stenosis + Aortic regurgitation
B)Aortic stenosis
C)Aortic regurgitation
D)Mitral stenosis + Mitral regurgitation

Question 5

What is the character of pulsus parvus et tardus?

A)Slow uprising
B)Sharp uprising
C)Slow down falling
D)Sharp down falling

Question 6

Which of the following statements is not true about third heart sound (S3)?

A)Heard in volume overloaded ventricle
B)Occurs during period of rapid ventricular filling
C)Heard in pressure overloaded ventricle
D)Low frequency sound, best heard with bell at apex

Question 7

Which of the following terms correctly defines the character of pericardial friction rub?

A)Rough rumbling sound
B)Soft cooing sound
C)Scratchy sound like Velcro
D)Harsh and husky

Question 8

In which of the following set of conditions murmur heard is not a flow murmur?

A)Thyrotoxicosis
B)Anaemia
C)Aortic stenosis
D)Pregnancy

Question 9

A patient presents with complaints of palpitations and loss of weight. Blood investigations show thyrotoxicosis. Which of the following murmurs are expected to be heard on auscultation?

A)Diastolic murmur
B)Soft systolic murmur
C)Flow murmur
D)Crescendo-decrescendo murmur

Question 10

Which of the following waveforms is not a part of jugular venous pulsation?

A)a-wave
B)v-wave
C)d-wave
D)c-wave

Question 11

A 75-year old male patient is undergoing carotid endocardiectomy. A cardiac nurse is explaining to the patient about the procedure. Which of the following statements correctly represent the method involved and aim of the procedure?

A)Carotid artery is clamped and plaque is removed to increase the cerebral blood flow
B)Carotid artery is dissected and plaque is removed to increase the cerebral blood flow
C)Diseased part of carotid artery is removed to increase the cerebral blood flow
D)Diseased carotid artery is closed and a bypass graft is applied to increase the cerebral blood flow

Question 12

In which of the following conditions is ST segment elevation seen on an ECG?

A)LAH
B)RVH
C)Early repolarization after an attack of angina
D)Myocardial infarction

Question 13

The bypass pathway known as bundle of Kent is present in Wolf-Parkinson-White syndrome. Which anatomical structures are connected via the bundle of Kent?

A)Sinoatrial node and atrioventricular node
B)Sinoatrial node and ventricle
C)Atria and ventricle
D)Atrioventricular node and ventricle

Question 14

Which of the following is not a cause of long QT?

A)Hypomagnesemia
B)Hypermagnesemia
C)Hypokalemia
D)Hyponatremia

Question 15

Presence of delta wave in ECG is characteristic finding of Wolf-Parkinson-White syndrome. How and where is it visible in ECG?

A)Slurring at the end of QRS complex
B)Initial slurring of down stroke of QRS complex
C)Delayed upstroke at the end of QRS complex
D)Slurred upstroke of QRS complex

Question 16

Which of the following statements are not true about sick sinus syndrome?

A)Sick sinus syndrome is caused due to structural sinoatrial node disease
B)Treatment is pacing for bradycardia and medicines for tachycardia
C)It may present as complete heart block
D)It may present as tachy-brady syndrome

Question 17

Which of the following is not an indication of cardiac stress testing?

A)Assessment of chest pain
B)Assessment of myocardial viability
C)Assessment of ventricular function
D)Preoperative screening and risk assessment

Question 18

Which of the following parameters are not used for assessment of ventricular function?

A)Left ventricular ejection fraction
B)Right ventricular ejection fraction
C)Ventricular size and volume
D)Thickness of interventricular septum

Question 19

A cardiac nurse records the ECG of a patient presenting with severe chest pain which shows ST-segment elevation and pathological Q-waves in leads II, III and aVF. Which of the following arteries is likely to be involved?

A)Left anterior descending
B)Right coronary artery
C)Circumflex artery
D)Both Right coronary artery and Circumflex artery

Question 20

A patient presents whom is diagnosed to have dyslipidemia. Which of the following is not a part of goal of treatment in this patient?

A)Decreasing low-density lipoprotein level
B)Increasing total cholesterol levels
C)Increasing triglyceride levels
D)Increasing high-density lipoprotein levels

Question 21

Which of the following are not used as stressors in cardiac stress testing?

A)Treadmill
B)Dipyridamole
C)Noradrenaline
D)Dobutamine

Question 22

Which of the following statement is correct about junctional premature beat?

A)Multiple ectopic supraventricular beat
B)No P wave preceding the premature QRS complex
C)Single ectopic ventricular beat
D)Abnormal P wave before each QRS complex

Question 23

"Ashman phenomenon" is associated with which of the following arrhythmias?

A)Atrial flutter
B)Atrial fibrillation
C)Paroxysmal supraventricular tachycardia
D)Junctional tachycardia

Question 24

The nurse records the ECG of a patient presenting with complaints of sudden onset palpitation with ventricular rate of about 200/ minute. ECG shows paroxysmal supraventricular tachycardia. Which of the following drugs the nurse should prepare if this patient is not responding to vagal maneuvers?

A)Digoxin
B)Adenosine
C)Beta blocker
D)Verapamil

Question 25

Which of the following statements are true about primary Raynaud's phenomena versus secondary Raynaud's phenomena?

A)Secondary Raynaud's phenomena is an inherited condition and runs in families while primary does not
B)Secondary Raynaud's phenomena is associated with many diseases while primary Raynaud's phenomena is an inherited condition
C)Primary Raynaud's phenomena is associated with hypothyroidism and atherosclerosis but secondary Raynaud's phenomena has no such association
D)Primary Raynaud's phenomena is precipitated by cold while secondary is not

Question 26

Which of the following is not a histopathologic finding in hypertrophic cardiomyopathy?

A)Myocardial fiber disarray
B)Fluid in the intramyocardial space
C)Myocyte hypertrophy
D)Interstitial fibrosis

Question 27

Which of the following is not a part of major criteria of the modified Jones criteria for diagnosis of rheumatic fever?

A)Pancarditis
B)Erythema marginatum
C)Subcutaneous nodules
D)Polyarthralgia

Question 28

A nurse records the ECG of a patient presenting with chest pain. The ECG shows ST elevation in precordial leads. Which of the following diagnosis is unlikely?

A)Acute myocardial infarction
B)Acute pericarditis
C)Subendocardial infarction
D)Prinzmetal's angina

Question 29

A patient presents with chest pain in emergency department was diagnosed to have acute myocardial infarction. What is the goal of treatment in this patient?

A)To relieve pain
B)To give rest to the heart
C)To minimize the infarct and prevent complication
D)To mobilize the patient at earliest

Question 30

A 62-year male patient presents to emergency with severe acute chest pain. After looking at which of the following ECG findings, should the nurse prepare for thrombolytic therapy?

A)2 mm ST elevation in leads II and V1
B)1 mm ST elevation in leads II and V1
C)2 mm ST elevation in leads V1 and V2
D)1 mm ST depression in leads II and V1

Question 31

Which one of the following is an absolute contraindication for thrombolytic therapy in acute myocardial infarction?

A)60 year old male presenting with new LBBB and chest pain for 1 hour with ST elevation in V4, V5, and V6
B)40 year old lady with chest pain, ST elevation in lead V3, V4, V5 who underwent cholecystectomy 2 weeks ago
C)70 year old hypertensive male with acute chest pain, ST elevation in leads II, III and aVF and a new diastolic murmur in the left lower sternal region
D)ST elevation in leads V1, V2, V3 with a blood pressure of 180/100 easily controlled with antihypertensive medications

Question 32

All of the following group of drugs improve the survival in congestive heart failure as shown by many studies except

A)Beta blockers
B)Spironolactone
C)ACE inhibitor
D)Nitrates

Question 33

A patient presenting to emergency room was diagnosed to have acute myocardial infarction. Which of the following measures should the nurse be prepared to take in the emergency room?

A)Sedation, thrombolysis with streptokinase, echocardiography,
B)ECASA 325 mg chewed stat, oxygen, sublingual nitroglycerine, morphine, sedation, venodilation and ß blockers
C)Morphine for pain relief, oxygen inhalation, endotracheal intubation
D)ECASA 325 mg chewed stat, DC cardioversion, positive pressure ventilation

Question 34

In a patient of mitral stenosis which of the following is not true?

A)Congenital mitral stenosis is rare
B)All patients will have atrial fibrillation
C)Malar flush may be present
D)It is a low cardiac output state

Question 35

Which of the following is not an indication of surgery in patients with mitral stenosis?

A)Mitral valve area <1 cm2
B)Infective endocarditis
C)Worsening pulmonary hypertension
D)Atrial fibrillation

Question 36

Which of the following statements are not true about secondary Raynaud's phenomena?

A)Secondary Raynaud's phenomena is associated with scleroderma, lupus, rheumatoid arthritis, eating disorders
B)Secondary Raynaud's phenomena is a hereditary disease which runs in families
C)Occupational hazards including exposure to vibrating equipment, vinyl chloride and cold are associated with secondary Raynaud's phenomena
D)Reflex sympathetic dystrophy is associated with secondary Raynaud's phenomenon

Question 37

Jones criteria are for diagnosis of which of the following diseases?

A)Typhoid fever
B)Rheumatic fever
C)Yellow fever
D)Dengue fever

Question 38

What is the overall goal of management of metabolic syndrome?

A)To reduce the risk of developing hypertension and development of hypertrophic cardiomyopathy
B)To reduce the risk of developing cardiovascular disease and development of type I diabetes
C)To reduce the risk of developing cardiovascular disease and development of type II diabetes
D)To reduce the risk of developing peripheral vascular disease and development of type II diabetes

Question 39

Which of the following recommendations the nurse should suggest a person who has been diagnosed to have metabolic syndrome?

A)Maintain proper lipid, blood pressure levels, glucose levels, proper urea and blood urea nitrogen levels
B)Maintain proper lipid levels, blood pressure levels, glucose levels, maintain proper blood electrolyte levels
C)Maintain proper lipid levels, blood pressure levels, glucose levels, and maintain proper serum calcium levels
D)Maintain proper lipid, blood pressure, glucose levels, maintain proper albumin excretion and creatinine levels

Question 40

Which of the following pharmacologic agents are not used for treatment of metabolic syndrome?

A)Lipid-lowering agents
B)Antihypertensives
C)Oral antidiabetic agents and insulin
D)Antibiotics

Question 41

Which of the following set of diseases represent the co-morbid conditions associated with metabolic syndrome?

A)Polycystic ovary syndrome, fatty liver disease, hemochromatosis
B)Polycystic ovary syndrome, liver cirrhosis, dilated cardiomyopathy
C)Fatty liver disease, restrictive cardiomyopathy, nephropathy
D)Hypertensive cardiomyopathy, coronary heart disease, peripheral vascular disease

Question 42

A 32- year old male patient has been diagnosed with dyslipidemia. He is curious to know about the underlying metabolic disorder. What is the correct answer the nurse should give this patient?

A)Dyslipidemia is a disorder of lipoprotein metabolism
B)Dyslipidemia is a disorder of carbohydrate metabolism
C)Dyslipidemia is a disorder of lipid metabolism
D)Dyslipidemia is a disorder of protein metabolism

Question 43

Which of the following is not a feature of dyslipidemia?

A)Elevation in low-density lipoprotein cholesterol
B)Elevations in total cholesterol
C)Elevation in high-density cholesterol levels
D)Elevation in triglyceride levels

Question 44

Which of the following approaches are not used for reducing triglyceride levels?

A)Omega-3 fatty acids
B)Antiplatelets
C)Nicotinic acid
D)Statins

Question 45

A non-diabetic non-hypertensive male presents with symptoms of discoloration of fingers and toes when exposed to cold. Which of the diagnostic tools are useful to distinguish between primary and secondary Raynaud's phenomena?

A)Venous doppler, peripheral angiography, serum albumin and globulin
B)Venography, handgrip exercise test, stress ECG testing
C)Nail fold capillaroscopy, measurement of hand temperature gradients, digital artery pressure measurements, Doppler ultrasound
D)Allen's test, color Doppler, digital artery pressure measurement

Question 46

The nurse records the ECG of a patient presenting with dizziness, light headedness and palpitations. The ECG shows absent p-waves and fibrillatory waves. Which of the following invasive approaches are not beneficial in treating this patient's arrhythmia?

A)AV node ablation
B)Dual chamber pacemaker
C)Radiofrequency catheter ablation
D)Surgical maze procedure

Question 47

Which of the following statements is not true regarding cardiac arrhythmias?

A)Arrhythmia is defined as dysregulation of cardiac electrical activity
B)Supraventricular arrhythmias originate in the ventricle
C)Tachycardia is a condition when the heart rate is faster than normal
D)Bradycardia is a condition that occurs when an arrhythmia beats slower than normal

Question 48

A child having aortic regurgitation has been advised for valve replacement surgery. The parents are concerned to know about the type of aortic valve prosthesis which is suitable for their child. What is the correct answer given by nurse?

A)Mechanical valve
B)Bioprosthetic valve
C)Pulmonary autograft
D)Aortic homograft

Question 49

A patient with atrial fibrillation is presents with acute pain in left lower limb which progressed to loss of sensation and feeling of cold and numbness over few hours. What is the first treatment the nurse should start?

A)Prepare the patient for embolectomy
B)Immediate heparinization
C)Send the patient for arteriography
D)Identify and treat the underlying cause

Question 50

Which of the following drugs is liable to cause dilated cardiomyopathy?

A)Adriamycin
B)Amiodarone
C)Atenolol
D)Ampicillin

Question 51

Dilated cardiomyopathy is not a manifestation of which of the following?

A)Amyloidosis
B)Coronary artery disease
C)Alcohol consumption
D)Hypothyroidism

Question 52

The antibiotic used for treatment of acute streptococcal infection in patients of acute rheumatic fever is:

A)Crystalline penicillin
B)Benzyl penicillin
C)Benzathine penicillin
D)Ampicillin

Question 53

Which of the following set of symptoms constitute the triad of aortic stenosis?

A)Angina, vertigo, calf pain
B)Angina, syncope, dyspnea
C)Angina, vertigo, headache
D)Angina, syncope, anasarca

Question 54

Which of the following criteria is not used to diagnose Buerger's disease?

A)Individuals younger than 45 years of age
B)Past or present tobacco use
C)Pain in muscles on walking
D)Presence of ischemic ulcers and gangrene in distal extremity

Question 55

A 40-year old male patient has been diagnosed to have Buerger's disease. The nurse is explaining this patient about the available treatment options for his condition. Which of the following treatment methods should the nurse not mention to the patient?

A)Smoking cessation
B)Anti-coagulants
C)Lipid-lowering agents like statins
D)Surgery to cut nerves in infected painful areas

Question 56

A 45-year old female patient is on warfarin therapy for atrial fibrillation. She has planned to undergo mitral valve replacement surgery for mitral stenosis and mitral regurgitation. What advice should be given by the nurse regarding the anticoagulant medication?

A)Stop warfarin on the day of surgery
B)Stop warfarin 4-5 days before surgery
C)Stop warfarin 4-5 days prior to surgery; admit and start on IV heparin; stop IV heparin 2-3 hours pre-op
D)Continue warfarin therapy

Question 57

A 65-year old male had undergone percutaneous transluminal coronary angioplasty. What tests should the nurse order to evaluate this patient of post percutaneous transluminal coronary angioplasty?

A)Electrocardiogram, echocardiogram, hematocrit, serum creatinine
B)Electrocardiogram, echocardiogram, cardiac enzymes
C)Electrocardiogram, echocardiogram, physical assessment, monitoring of peripheral blood flow
D)Physical assessment and evaluation of cardiac pain

Question 58

A 72-year old male patient has been diagnosed to have peripheral arterial disease. What are the contraindications of percutaneous transluminal angioplasty of the lower extremity in this patient?

A)Hypertensive patients of poor ventricular function
B)Patients having dyslipidemia
C)Medically unstable, diabetic patient, long arterial occlusion, poor distal run off
D)Patient who has undergone coronary angioplasty

Question 59

The nurse is taking care of a patient who has percutaneous transluminal angioplasty of the lower extremity. What are the possible complications the nurse should be watchful in this patient?

A)Myocardial infarction, angina
B)Vasospasm, thrombus formation, arterial dissection, vessel perforation, compartment syndrome, arterial dissection
C)Aneurysmal rupture, dissection of aorta
D)Circulatory shock, renal failure

Question 60

Which of the following statement is correct about relationship between smoking and atherosclerosis?

A)Smoking predisposes individuals to development of atherosclerosis
B)Smoking not only predisposes individuals to atherosclerosis, but it increases the progression of the disease
C)Smoking increases the progression of atherosclerosis
D)Smoking increases the risk of individuals to develop atherosclerosis

Question 61

Nurse is explaining a patient about the various manifestations of atherosclerosis. Which of the following statement is not true regarding this disease?

A)Atherosclerosis leads to altered vascular function which may result in including coronary heart disease and cause myocardial ischemia and myocardial infarction
B)Atherosclerosis may lead to cerebrovascular insufficiency and stroke
C)Atherosclerosis leads to altered vascular function which affects all the arteries except the renal artery and aorta
D)Peripheral vascular disease, limb ischemia, vasculitis are also manifestation of atherosclerosis

Question 62

Which of the following is a correctly matched correlation of jugular venous pulse?

A)Loss of "a" wave: atrial fibrillation
B)Slow "y" descent: constrictive pericarditis
C)Giant "a" waves: tricuspid regurgitation
D)Sharp "y" descent: mitral valve prolapse

Question 63

After recording the ECG of a patient the nurse observes that QRS complex is wider. Which of the following is unlikely to be the cause of this finding?

A)Ventricular premature beat
B)Paroxysmal Ventricular tachycardia
C)Left bundle branch block
D)Intraventricular conduction defect

Question 64

An 80-year old male is having end-stage aortic stenosis. Definitive treatment for his condition is aortic valve replacement but he is critically ill and surgery cannot be performed at the moment. Which surgical procedure can be used as a bridge to aortic valve replacement surgery in this patient?

A)Commissurotomy
B)Balloon Valvuloplasty
C)Aortotomy
D)Debridement

Question 65

Coronary angiogram of a 75-year old male patient shows 30 % blockage in right coronary artery. All other coronary arteries are normal. Which set of medications is recommended for treatment of atherosclerotic disease in this patient?

A)Statin, aspirin, clopidogrel
B)Beta-blocker, aspirin, warfarin
C)Calcium channel blockers, warfarin, clopidogrel
D)Angiotensin converting enzyme inhibitor, statin, aspirin

Question 66

A 65-year hypertensive non-smoker male patient has an abnormal lipid profile. What lifestyle modification should the nurse advise to this patient?

A)Restriction of physical activity, dietary supplementation
B)Physical exercise, healthy diet, control of blood pressure
C)Physical exercise, healthy diet, dietary supplementation,
D)Restriction of physical activity, diet rich in saturated fat

Question 67

The nurse receives the blood test reports for a patient who was admitted to hospital with complaints of chest pain. The report shows an elevated level of Troponin I. What does this test signify in this patient?

A)Damage to myocardium
B)Damage to intercostal muscles
C)Liver damage
D)None

Question 68

A patient presenting to emergency room with severe dyspnea is diagnosed to have pulmonary edema. Which of the following drugs should the nurse immediately prepare to give this patient?

A)High flow O2 administration
B)Intravenous morphine
C)Intravenous furosemide at a higher dose
D)Intravenous adenosine

Question 69

The nurse is explaining to a 54-year smoker male patient about prognosis of intermittent claudication. Which of the following statements is true about his condition?

A)Almost all patients with intermittent claudication tend to improve over time
B)About1/2 of patients remain stable
C)The patients who continue to smoke usually deteriorate
D)Smoking has no relation with the prognosis of intermittent claudication

Question 70

Pericardial fluid has been aspirated and examined from a patient presenting with pericardial effusion. The fluid examination report shows a transudative fluid. Which of the following is unlikely to be the cause of this pericardial effusion?

A)Hypoalbuminemia/hypoproteinemia
B)Congestive heart failure
C)Aortic dissection
D)Hypothyroidism

Question 71

The nurse is examining a patient of pericardial effusion. Which of following signs are unlikely to be present?

A)Low volume pulse
B)Bounding pulse
C)Pericardial rub
D)Dominant "x" descent in JVP

Question 72

Holter monitoring of a 65-year old female patient having cervical carcinoma stage 3 shows ventricular tachycardia resulting in syncope. The condition is treatable by implantable cardio-defibrillator. Which of the following is a contraindication of use of ICD in this patient?

A)Cervical carcinoma stage 3
B)Ventricular tachycardia
C)Age > 60 years
D)Female gender

Question 73

Which of the following statements is true about atrial septal defect?

A)Pulmonary hypertension is an indication for surgery
B)Closure should be done after puberty
C)Increased pulmonary blood flow and leads to recurrent respiratory infections
D)Pulmonary blood flow is decreased in these patients

Question 74

Choose the correct statement about ventricular septal defect (VSD).

A)Surgical repair should be delayed until puberty
B)VSD is most frequent in the muscular part of septum
C)Child usually has pulmonary oligemia
D)Transcatheter closure can be performed only for muscular defects

Question 75

Which of the following is not a correct pair of the signs of chronic aortic regurgitation and the organ where it is demonstrated?

A)Corrigan's pulse - carotid artery
B)Mueller sign - liver
C)Quincke's sign - nail bed
D)Duroziez's test - femoral artery

Question 76

A child has a patent ductus arteriosus (PDA). Which of the following statements is true regarding this condition?

A)PDA leads to right ventricular volume overload
B)It always presents in isolation and is never a part of complex congenital defects
C)If PDA persists beyond third month of life, it is an indication of surgery
D)Transcatheter closure is done using an amplatzer device

Question 77

Which of the following descriptions of the various procedures used for valvular repair is correctly matched with its name?

A)Annuloplasty - repairs the junction between the valve leaflet and cardiac muscle
B)Annuloplasty - repairs the valve leaflet itself
C)Chordoplasty - repair of ruptured sinus of Valsalva
D)Chordoplasty - repairs the junction between chordae tendinea and cardiac muscle

Question 78

Which of the following sets of drugs might slow the conduction through AV node and cause second degree heart block?

A)Digoxin, statins, nitrates
B)Procainamide, statins, fibrates
C)Digoxin, beta-blockers, calcium channel blockers
D)Calcium channel blockers, potassium channel openers

Question 79

Which of the following sets represent the group of vascular diseases that lead to second degree atrioventricular block?

A)Amyloidosis, hemochromatosis, systemic lupus erythematosus
B)Ankylosing spondylitis, dermatomyositis, rheumatoid arthritis,
C)Hyperkalemia, hypermagnesemia, hypocalcemia, hypoglycemia
D)Scleroderma, multiple sclerosis, Reiter syndrome

Question 80

Which of the following surgical methods are not used for treatment of hypertrophic cardiomyopathy?

A)Septal myomectomy
B)Alcohol ablation
C)Surgical Maze procedure
D)Implantable cardioverter defibrillator