EXAM KOLEGIUM PERKI

1. A 50-year-old-man had a 3 graft CABG operation, LIMA to LAD, SVG to distal LCX,
and SVG to distal RCA with Aox time 90 minutes and CPB time 120 minutes. ECG pre-
op showed normal and went well during operation. EF pre-op was 67% with global
normokinetic. On day 0 at ICU, the hemodynamic was unstable, Lactate was 10, with
mixed vein 45. After 3 days in ICU patient stabil and plan move to intermediate wards
but before move patient had Atrial Fibrition.
Choose one of the criteria that should be considered if he had PMI?
a. None above are correct
b. Less volume
c. Sign of tamponade
d. NRWMA was negative
e. Unstable hemodynamic if the other causes were ignored

2. A 68-year-old woman presents to the emergency room with severe orthopnea for past 12
hours. She has a history of hypertension, osteoarthritis, and borderline diabetes mellitus.
Exam reveal irregular rate and rhythm with heart rate 115 bpm, blood pressure 190/100
mm Hg, jugular pressure 14 cm, and body mass index 38 kg/m2. Chest auscultation
showed bilateral rales, while precordial exam reveal an irregular and rapid heart rate with
distant heart sound and no discernible gallop. The patient is given intravenous
furosemide, diltiazem, and nitroglycerin infusion, with prompt improvement in
symptoms.
Forty-eight hours later, she is now on oral losartan, diltiazem, aspirin, and furosemide.
Her heart rate is now irregular at 70 bpm, blood pressure is 130/65 mm Hg, venous
pressure is normal, but she still complaints of moderate dyspnea on exertion.
Which of the following would you recommend?
a. Nocturnal supplemental oxygen.
b. Transesophageal echocardiogram-guided cardioversion.
c. Switch diltiazem to atenolol.
 d. Recommend bariatic surgery.
e. Switch losartan to lisinopril.

3. A 45-year-old music teacher with a history of bicuspid aortic valve status post aortic
valve replacement is admitted to the hospital with progressive fatigue and dyspnea. She
admits to nonadherence with sodium restriction, and has been drinking 2-3 glasses of
wine per night. Her bedside hemodynamic evaluation suggest elevated right and left heart
filling pressure and low cardiac output. An echocardiogram reveals moderate LV dilation
with an end-diastolic dimension of 6,4 cm, moderate systolic dysfunction with an EF of
30%, a well-seated mechanical aortic valve with normal leaflet function, 3+ mitral
regurgitation, and 2+ tricuspid regurgitation.
She responds well to empiric treatment with IV diuretic for 3 days, with resolution of
dyspnea. Her examination then reveals jugular venous pressure of 6 cm of water, no
hepatomegaly, and warm extremities without edema. Plans are made for discharge home
with follow-up in the HF clinic in 1 week.
Which of the following is a quality measure recommended by the ACC/AHA for all HF
patients at the time of hospital discharge?
a. Counseling regarding alcohol cessation.
b. Achieving optimal volume status.
c. Documentation of LV size.
d. Scheduling a follow-up visit within 1 week.
e. Optimizing therapy with an aldosterone antagonist.

4. A 55-year-old male presents with shortness of breath for 6 months. He’s been sleeping in
chair for the past month because he coughs whenever he lies back. He’s also noticed that
his heart is racing most of the time. He’s had no antecedent illnesses. He tells you that his
brother died suddenly several year ago in his 30s. He drinks socially.
He appears comfortable with a BP of 110/75 and regular HR 115. His jugular venous
pressure is 18 cm of water, lungs are clear, and the heart is enlarge on palpation. He has a
gallop rhythm and a diffuse precordial systolic murmur. The abdomen is mildly tender in
the RUQ with a liver edge easily palpable. He is warm with trace pedal edema.
 An EKG demonstrates sinus tachycardia, and narrow QRS.
In addition to diuretic management, you initiate:
a. Digoxin.
b. Angiotensin receptor blocker (ARB).
c. Beta-blocker.
d. Aldosterone antagonist.
e. Angiotensin converting enzyme (ACE) inhibitor.

5. Randomized-controlled trial study that showed exercise training intervention after

coronary angioplastycan improve functional capacity and quality of life, lowered residual
stenosis, decreased events and hospital readmission significantly is…
a. ETICA
b. ExtraMATCH
c. EURO-ASPIRE
d. HF-action
e. GOSPEL

6. An 80 year old hypertensive male referred to cardiology clinic with stable NYHA FC III
angina for 3 months treated with aspirin, metoprolol succinate 150 mg daily, isosorbide
mononitrate 120 mg daily, and simvastatin 40 mg daily. On exam, the heart rate is 57, the
blood pressure is 98/60 mmHg, and the cardiopulmonary exam is unremarkable. Resting
ECG is within normal limits. An exercise stress test is significant for 2 mm horizontal ST
depression and exercise limiting chest discomfort at 6 METs.
The Duke Treadmill Score for this patient is:
a. – 14, high risk
b. – 10, intermediate risk
c. – 9, intermediate risk
d. – 9, high risk
e. – 14, intermediate risk
7. A 50-year-old African-American man with no significant pas medical history presents
with palpitations. On examination, he has a mildly elevated jugular venous pressure at 10
cm H20, a faint parasternal lift, and an RV S3 gallop. His ECG is notable for sinus
rhythm, with incomplete right bundle branch block pattern. Coronary angiography
reveals no significant epicardial coronary artery disease. Echocardiogram suggest RV
cavity dilation and moderate tricuspid valve regurgitation.
This pastient most likely has a disorder associated with a defect in the gene encoding
which of the following proteins?
a. Dystrophin. kardiomiopati
b. Lamin A/C. Kardiomiopati
c. Tafazzin. Kardiomiopati >> LV
d. Myosin heavy chain.
e. Plakoglobin.  arvd

8. A 50 year old woman has left shoulder discomfort that she notices when she climbs
stairs, walks uphill, or becomes upset with her children. The discomfort generally
resolves within one or two minutes after she stop the activity. Her resting ECG showed
nonspecific ST- and T-wave abnormalities, with less than 1 mm of ST-segment
depression. The patient had a TMET and exercised for 6 minutes on a Bruce protocol to a
HR of 130 bpm and a BP of 155/70 mmHg. She stopped because of severe chest
heaviness and left shoulder pain. The exercise ECG did not show any ST-segment
depression. Which of the following statements is correct about this patient’s Duke
treadmill score?
a. It is calculated as -2 and places the patient at intermediate risk for subsequent
cardiac event
b. It is not clinically meaningful because the treadmill score apllies only to patients with
normal resting ECGs
c. It is not clinically meaningful because the treadmill score apllies only to men
d. It is calculated as +6 and places the patient at low risk for subsequent cardiac events
e. It is calculated as -2 and places the patient at low-to-intermediate risk for subsequent
cardiac event
9. A50 yearsold male patient broughthis treadmill test result that performed after he had
finished phase II of cardiac rehabilitation program after undergone elective PCI. His
baseline HR was 70bpm. There was no ST-T changes, no arrhythmia, normal response of
BP and HR during exercise. The test was stopped at 9 minutes of exercise (Bruce
protocol), with HR 150 (Rate Percieved Exertion : Borg Scale 17). What is his HR target
for treadmill at home using 65-75% HRR (Heart Rate Reserve) formula?
a. 102 – 107bpm
b. Can’t be measured
c. 122-130bpm
d. 97-112bpm
e. 110-127bpm

10. A 65-year-old man with a longstanding ischemic cardiomyopathy and LVEF 20% by an
echocardiogram obtained 1 month ago, was admitted to the hospital yesterday for
increased shortness of breath over the last 3 weeks. You are evaluating him in
consultation with his internist. Overnight he made 1 liter urine in response to diuretic
therapy.
On examination, you find him to be in no acute distress at rest, blood pressure 110/70
mm Hg, pulse 96 bpm and regular, and his BMI is 38 kg/m2. He reports persistent
shortness of breath when ambulating in the corridors or in the supine positions, the latter
requiring two pillows to allow him to breathe comfortably. The remainder of his
examination is notable for JVP estimated to be 14 cm, S12 with no S3 or murmur, a
benign abdomen with no hepatomegaly, and extremities which are entirely free of edema
and are warm to touch. His mental status is normal. Laboratory studies today include:
sodium 140, blood urea nitrogen 55, creatinine 1,9 (stable from admission), and
hematocrit 34. Admission BNP was 75. A chest X-ray shows cardiomegaly with no
evidence of pulmonary edema, pleural effusions, or infiltrates.
At this point, which of the following is the most appropriate therapy to recommend?
a. Order an echocardiogram and base further therapeutic decisions about the need for
diuretic or saline administration on the E/e’ ratio.
 b. Administration of IV Lasix 80 mg bid plus an infusion of dobutamine 2,5 mcg/kg/min
to provide inotropic support for treatment of acute on chronic systolic heart failure
complicated by renal insufficiency.
c. Administration of IV Lasix 80mg bid for presumed acute on chronic systolic heart
failure.
d. Administration of normal saline at 75 cc/hour for possible volume depletion.
e. Schedule for right heart catheterization and adjust therapy based on invasively
measured hemodynamics.

11. A 46-year-old woman with history of breast cancer in remission presents with a 2-week
history of dyspnea on exertion and weight gain. She does not have any history of cardiac
disease, but has a history of hypertension and type 2 diabetes mellitus. She presents to the
emergency room because she now has shortness of breath at rest. She denies other
cardiac complaints. On admission, her creatinine is 1,2 mg/dl, potassium is 4.4 mEq/L,
HbA1c is 6,4%, blood glucose is 123 mg/dl, low-density lipoprotein (LDL) 112, high
density lipoprotein (HDL) 32, triglycerides 188 mg/dl, and BNP is 2202 pg/ml. Her ECG
showns sinus tachycardia, 110bpm, intraventricular conduction delay with a prolonged
QRS interval of 128 ms.
After intravenous diuretic therapy in the emergency room, she gets admitted and an
echocardiogram reveals a dilated LV of 7 cm, and LVEF of 10% with spontaneous
echocontrast in the LV. On day 3, she undergoes coronary angiography, which reveals
angiographically normal coronary arteries. An ACE inhibitor and beta-blocker are started
during the hospital course, and she tolerates these well with a modest improvement in her
symptoms.
Which of the following is the best additional treatment choice at this point?
a. Statin.
b. Cardiac resynchronization therapy with defibrillator.
c. Aldosteron antagonist.
d. Cardiac resynchronization therapy without defribillator.
e. Aspirin.
12. Each of th following statements regarding high-sensitivity C-reactive protein (hsCRP) is
true :
a. An hsCRP level >2 mg/L in a patient with unstable angina is associated with an
increased riskof recurrent coronary events.
b. Statin reduce hsCRP in a manner directly related to their low density
lipoprotein-lowering effect.
c. Included in Global Risk Score, a predictive of the onset of metabolic syndrome.
d. The cardiovascular benefit of aspirin therapy appears to be greatest in patient with
elevated hsCRP levels.

13. Which of the following would you recommended for a 19-year-old asymptomatic,
nonobstructive HCM patient with a maximal LV wall thickness of 18 mm, who is playing
professional soccer?
a. EP study.
b. ASA.
c. Disopyramide.
d. Discontinuation from organized, competitive sports.

14. A 45 year-old man is admitted to a hospital due to typical chest pain after exercise with 4
hours onset. He reveals that this not the first time, the symptoms were already develop
over one year and he had a syncope last month. The patient was a heavy smoker, his
father already passed away at his 50’s due to heart disease. On physical examination the
blood pressure is 140/80 mmHG, normal S1 and S2 with a grade 3/6 holosytolic murmur
at the apex and axilla. An Electrocardiogram shown left ventricular hypertrophy with
strain, left atrial enlargement. Cardiac enzyme were normal.
What is the best modalities to define the diagnosis of this patient?
a. Transthoracic Echocardiography
b. Cardiac MRI
c. Cardiac CT
d. Coronary Angiography
e. Transesophageal Echocardiogray
15. False statement regarding the assessment of coronary microvascular obstruction by CMR:
a. Infracted tissue is seen as a region of hypo enhancement
b. The index of microcirculatory
c. A dark core of hypoenhancement within the infarct tissue is taken as a region of
coronary microvascular obstruction
d. Images obtained 10-15 min after injecting a gadolinium-based contrast

16. A 45 year-old man is admitted to a hospital due to typical chest pain after exercise with 4
hours onset. He reveals that this not the first time, the symptoms were already develop
over one year and he had a syncope last month. The patient was a heavy smoker, his
father already passed away at his 50’s due to heart disease. On physical examination the
blood pressure is 140/80 mmHG, normal S1 and S2 with a grade 3/6 holosytolic murmur
at the apex and axilla. An Electrocardiogram shown left ventricular hypertrophy with
strain, left atrial enlargement. Cardiac enzyme were normal. This patient could possibly
having :
a. Amyloidosis
b. Aortic Stenosis
c. Farby Disease
d. Hypertensive Heart Disease
e. Hypertrophic Cardiomyopathy

17. A 45 year-old man is admitted to a hospital due to typical chest pain after exercise with 4
hours onset. He reveals that this not the first time, the symptoms were already develop
over one year and he had a syncope last month. The patient was a heavy smoker, his
father already passed away at his 50’s due to heart disease. On physical examination the
blood pressure is 140/80 mmHG, normal S1 and S2 with a grade 3/6 holosytolic murmur
at the apex and axilla. An Electrocardiogram shown left ventricular hypertrophy with
strain, left atrial enlargement. Cardiac enzyme were normal. On imaging studies shows
this following findings, EXCEPT?
a. LV wall thickness is 32mm symmetrical
 b. Systolic anterior motion of the mitral leaflet
c. LVOT pressure gradient 35mmHg
d. Pulmonary venous systolic flow reversal
e. Systolic anterior motion of the mitral leaflet

18.
What is the diagnosis from the left heart chateterization pressure tracing below?
a. Severe Aortic regurgitation
b. Hyperthropic obstructive cardiomyopathy
c. Severe aortuc regurgitation
d. Severe left ventricular systolic dysfunction

19. A 32 year-old woman with primary PH is referred to follow up of her pulmonary

pressure. In addition of tricuspid regurgitant jet velocity, the following information is
needed to estimate pulmonary systolic pressure in this patient:
a. Antegrade velocity in the pulmonary artery
b. Hepatic vein flow
c. Imaging of the inferior vena cava
d. RV free wall thickness
e. Mitral regurgitation maximal velocity

20. The patient with acute pericarditis and treated successfully with non steroid anti-
inflammatory agents. Over the next five years, she has recurrent episodes of pericarditis,
 each treated with indomethacin. She now presents with the gradual onset of lower
extremity edema over six months. She has vague symptoms of exertional dyspnea and
abdominal bloating but doesn’t feel acutely ill. When you see her in the office, she has
obvious edema and distended neck veins although her lung fields are clear. Her voltage
on ECG is not significantly different from her baseline, and an office echocardiogram
suggest normal left ventricular function and no significant effusion. Which of the
following findings would you expect to see during right heart catheterization?
a. Right atrial pressure of 3 mm Hg
b. Increased ventricular filling
c. Right atrial pressure tracing with a steep Y descent
d. Increased cardiac output
e. Left ventricular end diastolic pressure of 25 mm Hg and right ventricular end
diastolic pressure of 10 mm Hg

21. There is some specific, supportive sign and quantitative parameters in grading of mitral
regurgitation. Which of the following parameter / criteria is suitable for severe mitral
regurgitation:
a. Soft, triangular CW Doppler MR signal
b. Vena contracta > 0,3cm, with EROA 0,2 – 0,3cm2
c. Regurgitant fraction > 50 %
d. Regurgitant jet hugging the entire LA wall (> 75% of LA)
e. Dens, parabolic CW Doppler MR signal

22. During the cardiac catheterization of a person who was found to be normal, the blood
withdrawn through the catheter had an oxygen saturation of 60%, and the recorded
pressure oscillated each heart beat between 14 and 26 mmHg. Most likely, the catheter tip
was located in the:
a. Foramen ovale.
b. Pulmonary artery.
c. Right atrium.
d. Azygous vein.
 e. Coronary sinus.

23. Regarding stress echocardiography, which of the following statement is appropriate to

perform stress echocardiography :
a. Exercise stress in patient with history of nonsustained ventricular tachycardia,
Framingham risk is moderate to high
b. All answer are correct
c. Asymptomatic patient with Agatson score greater or equal to 400
d. As a risk assessment following unstable angina/ non ST elevation MI without sign
and symptom of heart failure and not planning to undergo early catheterization
e. Patient with chest pain with low pre test probability of CAD and the ECG is
uninterpretable

24. Factors that will reduced cardiac output?

a. Digitalis glycoside
b. Baroreceptor stimulation
c. Volume load
d. Phosphodiesterase inhibitor (milrinone, theophylline)
e. Sympathetic tone

25. Regarding trans-thoracal echocardiography, which of the following statement is

appropriate to perform trans-thoracal echocardiography:
a. Routine perioperative evaluation of cardiac structure and function prior to noncardiac
solid organ transplantation
b. Routine surveillance (>3 y) of mild stenosis without change in clinical status/ cardiac
exam
c. To evaluate arrhythmias in infrequent APC/ VPC without evidence of heart disease
d. Routine surveillance (<1 y) of mild stenosis without change in clinical status/ cardiac
exam
e. Initial evaluation in patient with murmur or click without other sign and symptoms of
structural heart disease
26. Regarding echocardiographic score used to predict outcome of mitral ballon velocity,
when the Mobility: mid and base portion of the leaflet mobile normally. Subvalvular
thickening: The thickening chordate structural extending up to one-third of the chordal
length Thickening: The valve thickening extending through the entire leaflet and
Calcification: some scattered areas of brightness confined to leaflet margins, the mitral
score will be:
a. 2-3-3-2
b. 3-2-2-2
c. 2-3-2-2
d. 2-2-2-2
e. 2-2-3-2

27. Regarding calculation of LV mass, Relative Wall Thickness (RWT) ? 0,42 is considered:
a. Eccentric hypertrophy if the LV mass index > 95 (female) and > 115 (male)
b. Concentric remodeling if the LV mass index ? 115 (female) and ? 95 (male)
c. Either concentric remodeling or concentric hypertrophy if the LV mass index ? 95
(female) and ? 115 (male)
d. Normal if the LV mass index ? 115 (female) and ? 95 (male)
e. Concentric hypertrophy if the LV mass index ? 95 (female) and ? 115 (male)

28. A 75-year-old woman is referred urgently to the cardiology clinic. She had a myocardial
infarction 4 years earlier, percutaneous coronary intervention with a stent for angina 12
month earlier and has had two blackouts in the last month, 3 weeks apart. She tells you
that in one occasion she was gardening and trying to lift a heavy plant pot. She had no
warning and suddenly found herself on the ground. She was alert on recovery. There was
no seizure-like activity. She does have exertional breathlessness although she can manage
400m on the flat and single flight of stairs. She has not had angina since her coronary
stent 12 month earlier. Occasionally she feels ligh-headed if she stand up too quickly. She
is currently taking aspirin, a beta-blocker, an ACE inhibitor, a loop diuretic and a statin.
Her physical examination reveals blood pressure 130/55 mmHg, resting pulse 55 bpm,
 regular, normal volume. The JVP is raised by 2 cm, her apex beat is displaced to the
lateral clavicular line, sixth intercostals space and there is a systolic murmur heard all
over the precordium and in the carotids. The lung field are clear and there is mild pitting
edema at the level of her shins.
All of the following would be the cause of blackout in this patient, EXECPT?
a. A bradycardia caused by Stoke-Adam attack
b. Severe aortic stenosis
c. Orthostatic hypotension
d. A tachycardia caused by ventricular tachycardia

29. Medications found with her are as follows : furosemide 80 mg po od, atenolol 50 po od,
warfarin, digoxin 0,125 mg po od. Routine observations are as follows: temperature
370C, pulse 130 bpm, irregular, blood pressure 190/100 mmHg, respiratory rate 40
breath/min, 02 saturation are 88% on 10 L/min 02 through rebreathe mask. Examination
reveals central cyanosis and cool peripheries. Auscultation of the chest reveals
widespread inspiratory crepitations; pulse are absent below the femoral arteries in both
legs. The following investigation are available: arterial blood gases, pH7,12; pO2 5,8
kPa; pCO2 3,2 kPa; bicarbonate 6,0 mmol/L. Routine electrolytes; sodium 130 mmol/L;
potassium 5,5 mmol/L; creatinine 300 umol/L; glucose 6,0 mmol/L. Her CXR shows
cardiomegaly, air shadowing and kerley B-lines. EKG recording demonstrate widespread
ST depression and ST elevation in lead aVR.
This patient is given 40 mg of furosemide intravenously and commenced on intravenous
nitrates. One hour after commencing therapy she remains acutely unwell. O2 saturation
are 85% on 10 L/min 02 via rebreath mask, blood pressure is now 140/70 mmHg and the
respiratory rate is 35 breath/min; there was been no urine output.
What other interventions would be the most valuable you consider?
a. Continuous positive airways pressure
b. Intra aortic ballon counterpulsation
c. Administration of cardiac glycoside
d. Hemofiltration
e. High-dose intravenous diuretics
30. An 70 –year old woman is admitted via ambulance to emergency room. She is very
dyspneic and unable to give history. Medications found with her are as fllows :
furosemide 80 mg po od, atenolol 50 mg po od, warfarin, digoxin 0,125 mg po od.
Routine observations are as follows: temperature 370C, pulse 130 bpm, irregular, blood
pressure 190/100 mmHg, respiratory rate 40 breath/min, 02 saturation are 88% on 10
L/min 02 through rebreathe mask. Examination reveals central cyanosis and cool
peripheries. Auscultation of the chest reveals widespread inspiratory crepitations; pulse
are absent below the femoral arteries in both legs. The following investigation are
available: arterial blood gases, pH7,12; pO2 5,8 kPa; pCO2 3,2 kPa; bicarbonate 6,0
mmol/L. Routine electrolytes; sodium 130 mmol/L; potassium 5,5 mmol/L; creatinine
300 umol/L; glucose 6,0 mmol/L. Her CXR shows cardiomegaly, air shadowing and
kerley B-lines. EKG recording demonstrate widespread ST depression and ST elevation
in lead aVR.
What is the probable working diagnosis?
a. Pulmonary emboli and severe pneumonia
b. Pulmonary edema and acidosis
c. Bilateral pleural effusions
d. Pulmonary emphysema and cor-pulmonale
e. Hypertensive heart failure

31. A 75-year-old woman is referred urgently to the cardiology clinic. She had a myocardial
infarction 4 years earlier, percutaneous coronary intervention with a stent for angina 12
month earlier and has had two blackouts in the last month, 3 weeks apart. She tells you
that in one occasion she was gardening and trying to lift a heavy plant pot. She had no
warning and suddenly found herself on the ground. She was alert on recovery. There was
no seizure-like activity. She does have exertional breathlessness although she can manage
400m on the flat and single flight of stairs. She has not had angina since her coronary
stent 12 month earlier. Occasionally she feels ligh-headed if she stand up too quickly. She
is currently taking aspirin, a beta-blocker, an ACE inhibitor, a loop diuretic and a statin.
Her physical examination reveals blood pressure 130/55 mmHg, resting pulse 55 bpm,
 regular, normal volume. The JVP is raised by 2 cm, her apex beat is displaced to the
lateral clavicular line, sixth intercostals space and there is a systolic murmur heard all
over the precordium and in the carotids. The lung field are clear and there is mild pitting
edema at the level of her shins.
If you choose ICD implantation as a class I indication in patient like this, the reason you
choose this one are based on all of the following EXCEPT ?
a. C
b. B
c. A

32. An 70 –year old woman is admitted via ambulance to emergency room. She is very
dyspneic and unable to give history. Medications found with her are as fllows :
furosemide 80 mg po od, atenolol 50 mg po od, warfarin, digoxin 0,125 mg po od.
Routine observations are as follows: temperature 370C, pulse 130 bpm, irregular, blood
pressure 190/100 mmHg, respiratory rate 40 breath/min, 02 saturation are 88% on 10
L/min 02 through rebreathe mask. Examination reveals central cyanosis and cool
peripheries. Auscultation of the chest reveals widespread inspiratory crepitations; pulse
are absent below the femoral arteries in both legs. The following investigation are
available: arterial blood gases, pH7,12; pO2 5,8 kPa; pCO2 3,2 kPa; bicarbonate 6,0
mmol/L. Routine electrolytes; sodium 130 mmol/L; potassium 5,5 mmol/L; creatinine
300 umol/L; glucose 6,0 mmol/L. Her CXR shows cardiomegaly, air shadowing and
kerley B-lines. EKG recording demonstrate widespread ST depression and ST elevation
in lead aVR.
All of the following are the findings on the arterial blood gases, EXCEPT?
a. Type 1 respiratory failure
b. Metabolic acidosis related to renal failure
c. Profound lactic acidosis
d. Severe hyperkalemia due to renal dysfunction
e. A ventilation perfusion mismatch
33. An 70 –year old woman is admitted via ambulance to emergency room. She is very
dyspneic and unable to give history. Medications found with her are as fllows :
furosemide 80 mg po od, atenolol 50 mg po od, warfarin, digoxin 0,125 mg po od.
Routine observations are as follows: temperature 370C, pulse 130 bpm, irregular, blood
pressure 190/100 mmHg, respiratory rate 40 breath/min, 02 saturation are 88% on 10
L/min 02 through rebreathe mask. Examination reveals central cyanosis and cool
peripheries. Auscultation of the chest reveals widespread inspiratory crepitations; pulse
are absent below the femoral arteries in both legs. The following investigation are
available: arterial blood gases, pH7,12; pO2 5,8 kPa; pCO2 3,2 kPa; bicarbonate 6,0
mmol/L. Routine electrolytes; sodium 130 mmol/L; potassium 5,5 mmol/L; creatinine
300 umol/L; glucose 6,0 mmol/L. Her CXR shows cardiomegaly, air shadowing and
kerley B-lines. EKG recording demonstrate widespread ST depression and ST elevation
in lead aVR.
Additional findings on cardiovascular examination are of a prominent apex beat, which is
displaced to the mid-axillary line. There is a soft systolic murmur present throughout the
precordium and gallop rhythm.
What is the most likely caused in this woman after evaluate all of the history and clinical
examination?
a. Acute myocardial infarction
b. Flash pulmonary edema associated with renal failure
c. Critical myocardial ischemia
d. Dilated cardiomyopathy
e. Acute on chronic renal failure

34. A 70 yo woman presents to your office with dyspnea and peripheral edema. On
examination, her BP is 180/70 mmHg and her pulse is 100 bpm. She has elevated jugular
venous pressure, peripheral edema of the ankles, and a fourth heart sound. All of the
following would be reasonable to obtain in the near future except
a. Serum electrolytes, CBC, UL
b. ECG, CXR
c. 24-h Holter monitor
 d. 6 min walking test
e. echocardiogram

35. Pseudonormalization of filling pattern is seen in :

a. stage II LV diastolic dysfunction
b. stage I LV diastolic dysfunction
c. stage III LV diastolic dysfunction
d. stage IV LV diastolic dysfunction

36. 25 yo pregnant woman (G1P0A0, gestational age 32 weeks) was admitted to the hospital
with main complaint shortness of breath and orthopnea. She never complained this
symptoms before. Patient also complain hemoptysis. On physical examination, blood
pressure 100/60, HR 132x/min, irregularly irreguler, RR 28x/min. Px has distended
jugular vein and left parasternal heave. Cardiac auscultation revealed low pitched
rumbling mid diastolic murmur. CXR revealed congested upper lobe vein and kerley B
lines. Which of the following is the most appropriate anti thrombotic drugs for this
patients?
a. Warfarin
b. Unfractionated heparin
c. Fondaparinux
d. LMWH
e. Dabigatran

37. A 45 yo business executive presents to A&E with a 2-hour history of central crushing
chest pain and breathlessness. He is a non-smoker, previously very fit and well and
attends a gym four times a week. There is no family history of ischemic heart disease. His
cholesterol measured at an insurance medical was 3,3 mmol/L. His observations on
admission are as follows; pulse 105 bpm; BP 80/50 mmHg; O2 saturations 90% on room
air. He is apyrexial. An ECG is performed and shown sinus tachycardia of 105 bpm.
Right axis deviation and non-specific T-wave inversion in leads III, aVF, V2-V4.
Based on the ECG findings, what is your working diagnosis?
 a. Paroxysmal rapid atrial dysrhythmias
b. Right ventricular dysplasia
c. Chronic cor pulmonale
d. Primary pulmonary hypertension
e. Pulmonary embolism

38. A 38-yo man came to emergency department with chief complaint shortness of breath,
non radiating chest tightness and 2 sincopal episodes. The symptom has been felt since 1
month before admission, but it was going worse in the recent 1 week. From the
anamnesis, one week before admission the patient felt pain and swelling on upper right
leg, after he drove a car for two and a half hours. The leg was then being massaged and
the symptoms were going worse and he started feeling shortness of breath. From the
medical history, the patient was obese (BMI 31kg/m2), and has history of smoking for 19
years. The patient was a frequent distance traveler (average duration 4 to 6 hours for
about 12 times/month). Patients has no history of hypertension and diabetes. On
admission, his BP was 90/60 mmHg, pulse 120 times/minute and regular respiratory rate
26 breaths/minute, temperature 360c, and oxygen saturation 89%.Other physical
examination were unremarkable.
Which of the following is the most likely diagnosis for this patient?
a. Acute myocardial infarction
b. Aortic dissection
c. Pulmonary embolism
d. Acute lung oedema
e. Cardiac tamponade

39. You are asked to see a 50 yo female dietitian in consultation for HTN. She was found to
have an elevated BP on a medical check up 4 years ago. She followed her physician’s
recommendations and uses only sodium substitutes, limits alcohol cunsumption, and
exercises. She adopted a vegetarian lifestyle. Despite these measures, her BP remained
above normal and her health care provider prescribed several medication regimens.
However, her BP could not be maintained at <160/90mmHg. Her medications include :
 Metoprolol:25mg twice daily, Lisinopril:20mg twice daily, Amlodipine:10mg daily.
Your examination detects the following: BP:188/100mmHg (seated), 190/100mmHg
(standing); HR:70bpm sitting, 80bpm standing. Normal funduscopic examination, normal
peripheral pulses and no abdominal bruits, normal cardiopulmonary examination. Serum
aldosterone concentration in this patient was 2ng/dL (normal : 1-21 ng/dL); which of the
following substances might be playing a role in this patient’s HTN?
a. Angiotensin II
b. Premarin
c. Alcohol
d. Diuretic

40. Which of the following tests would be appropriate to confirm a diagnosis of PAF in a
patient with elevated right ventricular systolic pressure demonstrated by
echocardiography?
a. liver function test
b. antinuclear antibody
.
41. You are asked to see a 50 yo female dietitian in consultation for HTN. She was found to
have an elevated BP on a medical check up 4 years ago. She followed her physician’s
recommendations and uses only sodium substitutes, limits alcohol cunsumption, and
exercises. She adopted a vegetarian lifestyle. Despite these measures, her BP remained
above normal and her health care provider prescribed several medication regimens.
However, her BP could not be maintained at <160/90mmHg. Her medications include :
Metoprolol:25mg twice daily, Lisinopril:20mg twice daily, Amlodipine:10mg daily.
Your examination detects the following: BP:188/100mmHg (seated), 190/100mmHg
(standing); HR:70bpm sitting, 80bpm standing. Normal funduscopic examination, normal
peripheral pulses and no abdominal bruits, normal cardiopulmonary examination. This
patient has continued medical therapy and improves somewhat with addition of
triamterene/HCTZ (37,5/25mg) daily. Her BP is now 160 mmHg systolic. Laboratory
results include: CBC: Normal Creatinine:1,9mg/dL Sodium:145mEq/L
Potassium:3,5mEq/L Uric Acid:3,0mg/dL.
 ECG: LVH by voltage criteria CXR:normal
This patient has continued medical therapy and improves somewhat with addition of
triamterene/HCTZ (37,5/25 mg) daily. Her BP is now 160 mmHg systolic.
Laboratory results include :
CBC: normal
Creatinine : 1.9 mg/dL
Sodium : 145 mEq/L
Potassium : 3.5 mEq/L
Uric Acid : 3.0 mg/dL
ECG : LVH by voltage criteria
CXR : normal
The most likely secondary form of HTN in this setting is :
a. renovascular stenosis
b. chronic renal failure
c. primary aldosteronism
d. pheochromocytoma
42. A 45yo business executive presents to A&E with a 2-hour history of central crushing
chest pain and breathlessness. He is a non-smoker, previously very fit and well and
attends a gym four times a week. There is no family history of ischemic heart disease. His
cholesterol measured at an insurance medical was 3,3 mmol/L. His observations on
admission are as follows; pulse 105 bpm; BP 80/50 mmHg; O2 saturations 90% on room
air. He is apyrexial. An ECG is performed and shown sinus tachycardia of 105 bpm.
Right axis deviation and non-specific T-wave inversion in leads III, aVF, V2-V4.
The patient responds to the intravenous fluid replacement (blood pressure 100/70 mmHg,
pulse 100 bpm) but remains hypoxic (O2 saturation 90%). What further imaging may be
helpful at this point?
a. Transthoracic echocardiogram can be very useful diagnostically
b. Chest x-ray is enough to confirm pulmonary embolic disease
c. CT pulmonary angiogram has a moderate sensitivity for acute cor pulmonale
d. Ventilation perfusion scan can identifying chronic cor pulmonale
e. Perfusion scan help to exclude pulmonary hypertension
43. 68 yo woman presents to your office for initial evaluation. She has had progressive
dyspnea over the past 2 years. She has long-standing hypertension and reports tobacco
use (50 pack-years). She has been treated with bosentan for idiopathic PAH (iPAH).
Currently, she is assessed as having World Health Organization (WHO) functional class
III limitations.
Evaluation reveals the following :
Echocardiogram : EF 66%, grade 3 diastolic abnormality, moderate LVH, no significant
valvular disease
Right heart catheterization : right atrial pressure 8 mmHg, right ventricular pressure
45/20 mmHg, pulmonary artery pressure 50/24 mmHg, mean pulmonary artery pressure
33 mmHg, pulmonary capillary wedge pressure 25 mmHg, and cardiac output 5.5 L/min.
Which of the following scenarios may occur upon acute vasodilator challenge
(pulmonary hypertension reactivity test) in this patient?
a. Altered mental status
b. The patient may not respond and can then be considered for chronic calcium channel
blocker therapy
c. Acute renal failure
d. Acute life threatening pulmonary edema in the setting of a markedly elevated
pulmonary capillary wedge pressure

44. 68 yo woman presents to your office for initial evaluation. She has had progressive
dyspnea over the past 2 years. She has long-standing hypertension and reports tobacco
use (50 pack-years). She has been treated with bosentan for idiopathic PAH (iPAH).
Currently, she is assessed as having World Health Organization (WHO) functional class
III limitations.
Evaluation reveals the following :
Echocardiogram : EF 66%, grade 3 diastolic abnormality, moderate LVH, no significant
valvular disease
Right heart catheterization : right atrial pressure 8 mmHg, right ventricular pressure
45/20 mmHg, pulmonary artery pressure 50/24 mmHg, mean pulmonary artery pressure
33 mmHg, pulmonary capillary wedge pressure 25 mmHg, and cardiac output 5.5 L/min.
 Which of the following treatments would you recommend at this time?
a. Phosphodiesterase-5 inhibitor
b. Cardiac resynchronization therapy
c. Increase bosentan dose
d. Diuretics, salt restriction, and BP control

45. 68 yo woman presents to your office for initial evaluation. She has had progressive
dyspnea over the past 2 years. She has long-standing hypertension and reports tobacco
use (50 pack-years). She has been treated with bosentan for idiopathic PAH (iPAH).
Currently, she is assessed as having World Health Organization (WHO) functional class
III limitations.
Evaluation reveals the following :
Echocardiogram : EF 66%, grade 3 diastolic abnormality, moderate LVH, no significant
valvular disease
Right heart catheterization : right atrial pressure 8 mmHg, right ventricular pressure
45/20 mmHg, pulmonary artery pressure 50/24 mmHg, mean pulmonary artery pressure
33 mmHg, pulmonary capillary wedge pressure 25 mmHg, and cardiac output 5.5 L/min.
Based on your review of her evaluation findings, which of the following represents the
appropriate diagnosis?
a. Viral cardiomyopathy
b. Pulmonary arterial hypertension
c. Chronic obstructive pulmonary disease (COPD)
d. Pulmonary vein hypertension

46. A 38 yo man came to emergency department with chief complaint shortness of breath,
non radiating chest tightness and 2 sincopal episodes. The symptom has been felt since 1
month before admission, but it was going worse in the recent 1 week. From the
anamnesis, one week before admission the patient felt pain and swelling on upper right
leg, after he drove a car for two and a half hours. The leg was then being massaged and
the symptoms were going worse and he started feeling shortness of breath. From the
medical history, the patient was obese (BMI 31kg/m2), and has history of smoking for 19
 years. The patient was a frequent distance traveler (average duration 4 to 6 hours for
about 12 times/month). Patients has no history of hypertension and diabetes. On
admission, his BP was 90/60 mmHg, pulse 120 times/minute and regular respiratory rate
26 breaths/minute, temperature 360c, and oxygen saturation 89%.Other physical
examination were unremarkable.

Below is ECG findings that can be found in the above patient, except :
a. Inverted T wave in anterior lead
b. Atrial arrhythmia with P pulmonale
c. ST elevation with right bundle branch block in V1-V2
d. Sinus tachycardia
e. Left bundle branch block

47. You are asked to see a 50 yo female dietitian in consultation for HTN. She was found to
have an elevated BP on a medical check up 4 years ago. She followed her physician’s
recommendations and uses only sodium substitutes, limits alcohol cunsumption, and
exercises. She adopted a vegetarian lifestyle. Despite these measures, her BP remained
above normal and her health care provider prescribed several medication regimens.
However, her BP could not be maintained at <160/90mmHg. Her medications include :
Metoprolol:25mg twice daily, Lisinopril:20mg twice daily, Amlodipine:10mg daily.
Your examination detects the following: BP:188/100mmHg (seated), 190/100mmHg
(standing); HR:70bpm sitting, 80bpm standing. Normal funduscopic examination, normal
peripheral pulses and no abdominal bruits, normal cardiopulmonary examination.

Of the following statements regarding the clinical presentation, which is correct?

a. The next step should be US assessment of renal arterial flow
b. The HTN is not “resistant” because the patient is not taking appropriate medications
at their maximum doses
c. The BP response to postural change suggests a state of low volume-high resistance
HTN
d. The absence of an abdominal bruit excludes renovascular HTN as the underlying
diagnosis
48. You are asked to see a 50 yo female dietitian in consultation for HTN. She was found to
have an elevated BP on a medical check up 4 years ago. She followed her physician’s
recommendations and uses only sodium substitutes, limits alcohol cunsumption, and
exercises. She adopted a vegetarian lifestyle. Despite these measures, her BP remained
above normal and her health care provider prescribed several medication regimens.
However, her BP could not be maintained at <160/90mmHg. Her medications include :
Metoprolol:25mg twice daily, Lisinopril:20mg twice daily, Amlodipine:10mg daily.
Your examination detects the following: BP:188/100mmHg (seated), 190/100mmHg
(standing); HR:70bpm sitting, 80bpm standing. Normal funduscopic examination, normal
peripheral pulses and no abdominal bruits, normal cardiopulmonary examination.

This patient has continued medical therapy and improves somewhat with addition of
triamterene/HCTZ (37,5/25 mg) daily. Her BP is now 160 mmHg systolic.
Laboratory results include :
CBC: normal
Creatinine : 1.9 mg/dL
Sodium : 145 mEq/L
Potassium : 3.5 mEq/L
Uric Acid : 3.0 mg/dL
ECG : LVH by voltage criteria
CXR : normal
According to this patient, the diagnosis of primary aldosteronism requires each of the
following except :
a. Hypokalemia (salt replete)
b. Hypertension
c. Increased 24-hr urinary aldosterone rate
d. Suppressed plasma renin activity
e. Normal renal arteries

49. A 38 yo man came to emergency department with chief complaint shortness of breath,
non radiating chest tightness and 2 sincopal episodes. The symptom has been felt since 1
month before admission, but it was going worse in the recent 1 week. From the
 anamnesis, one week before admission the patient felt pain and swelling on upper right
leg, after he drove a car for two and a half hours. The leg was then being massaged and
the symptoms were going worse and he started feeling shortness of breath. From the
medical history, the patient was obese (BMI 31kg/m2), and has history of smoking for 19
years. The patient was a frequent distance traveler (average duration 4 to 6 hours for
about 12 times/month). Patients has no history of hypertension and diabetes. On
admission, his BP was 90/60 mmHg, pulse 120 times/minute and regular respiratory rate
26 breaths/minute, temperature 360c, and oxygen saturation 89%.Other physical
examination were unremarkable.

Which of the following echocardiographic findings that can be found in above patients?
a. Acute mitral regurgitation
b. Hypokinesis of the anterior and inferior wall
c. Right ventricular free wall hypokinesis in the presence of normal right ventricular
apical
d. RV acceleration time >60 ms in the presence of tricuspid insufficiency pressure
gradient >60 mmHg
e. Visualization of true lumen and false lumen

50. A 38 yo man came to emergency department with chief complaint shortness of breath,
non radiating chest tightness and 2 sincopal episodes. The symptom has been felt since 1
month before admission, but it was going worse in the recent 1 week. From the
anamnesis, one week before admission the patient felt pain and swelling on upper right
leg, after he drove a car for two and a half hours. The leg was then being massaged and
the symptoms were going worse and he started feeling shortness of breath. From the
medical history, the patient was obese (BMI 31kg/m2), and has history of smoking for 19
years. The patient was a frequent distance traveler (average duration 4 to 6 hours for
about 12 times/month). Patients has no history of hypertension and diabetes. On
admission, his BP was 90/60 mmHg, pulse 120 times/minute and regular respiratory rate
26 breaths/minute, temperature 360c, and oxygen saturation 89%.Other physical
examination were unremarkable.
What is the most important therapy for above patients?
 a. Urgent surgery
b. Pericardiocentesis
c. Primary percutaneous intervention
d. LMWH
e. Fibrinolysis

51. A 38 yo man came to emergency department with chief complaint shortness of breath,
non radiating chest tightness and 2 sincopal episodes. The symptom has been felt since 1
month before admission, but it was going worse in the recent 1 week. From the
anamnesis, one week before admission the patient felt pain and swelling on upper right
leg, after he drove a car for two and a half hours. The leg was then being massaged and
the symptoms were going worse and he started feeling shortness of breath. From the
medical history, the patient was obese (BMI 31kg/m2), and has history of smoking for 19
years. The patient was a frequent distance traveler (average duration 4 to 6 hours for
about 12 times/month). Patients has no history of hypertension and diabetes. On
admission, his BP was 90/60 mmHg, pulse 120 times/minute and regular respiratory rate
26 breaths/minute, temperature 360c, and oxygen saturation 89%.Other physical
examination were unremarkable.
What is the golden diagnostic tool for the above patient?
a. Cardiac marker
b. Chest CT angiography
c. Echocadiography
d. Electrocardiography
e. Coronary angiography

52. Which of the following patients with an LVEF of 25% would be most appropriate to refer
for a right heart catheterization?
a. An 85 yo man with a 30-year history of diabetes previously received laser
photocoagulation therapy of diabetic retinopathy, and has ongoing leg pain from
neuropathy. He now presents with shortness of breath, has a BP of 200/100mmHg,
anasarca, and creatinine of 10.
 b. a 40 yo woman with asthma and heart failure is admitted to the hospital. Her
examination is notable for blood pressure 150/80mmHg; pulse 110 bpm and regular;
lungs with diffuse expiratory wheezes; JVP < 8cm with no hepatojugular reflux;
cardiac auscultation with S12 and no S3; legs with no edema and are warm to touch.
c. a 20 year-old man is referred for cardiac transplantation due to his low LVEF despite
6 months of beta blocker therapy. He reports mild fatigue while playing racquetball
and his examination shows BP 120/80 mmHg, pulse 72bpm, JVP <8 with no
hepatojugular reflux, and there is no S3. Extremities are warm to touch, with no
edema.
d. a 30-year-old woman is admitted to the hospital with shortness of breath and a blood
pressure of 90/70mmHg. Following 2 days of intravenous diuretics, her examination
is notable for JVP of 16 cm and 2+ leg edema, with a systolic blood pressure of 78
mmHg. Her creatinine has increased from 1.6 to 2.5, with diuresis.
e. a 60 yo man with an LVEF of 25% is admitted with shortness of breath and is found
to have blood pressure 130/80mmHg, pulse 90bpm, and JVP of 14cm with 2+leg
edema and warm extremities, with creatinine 1.2.

53. Which of the following is the most common presenting symptom in patients with PAH?
a. Chest pain
b. Fatigue.
c. Dyspnea
d. Presyncope

54. a 53 year old male with a history of obesity, obstructive sleep apnea, hypertension, and
hypercholesterolemia presents to the cardiovascular clinic complaining of a nonhealing
ulcer on his left ankle present for the past month. His blood pressure is 160/80 mmHg.
His physical exam is remarkable for mild bilateral lower leg edema as well as
lipodermatosderosis and hyperpigmentation around the ankles. A midly tender,
superficial ulceration is observesed with an irregular pink base above his medial
malleolus. His feet and toes are warm , pink and have 2 second capillary refill and intact
 sensation. Laboratory test on this patient include a random blood sugar of 160 mg/dL,
creatinine of 1.1 mg/dL, calcium 10.2 mg/dL, phosphorus of 4.4 mg/dL.
What is the most likely etiology of the ulceration?
a. Chronic venous insuffidency
b. Calciphylaxis
c. Critical limb ischemia
d. Peripheral arterial disease
e. Diabetes mellitus

55. Which of the following statements regarding transesophalgeal findings of aorting

atheroma is not true?
a. Limited data suggest that these patients may benefit from anticoagulation therapy
with warfarin.
b. Mobile components are associated with an increased risk of stroke
c. Plaques >2 mm in the ascending aorta are associated with incread risk of stroke
d. Plaques >4 mm in the ascending aorta are associated with incread risk of stroke.

56. a 60 years old man with complaints night cramp,heaviness, pitting edema,
hyperpigmentation and active skin ulcer of left ankle since last year in the bilateral lower
limbs. Varicose veins were seen in the medial of left thigh and calf. Duplex ultrasound
showed severe reflux in the bilateral lower limb but just only incompetent calf perforator
vein with diameter 5 mm in the left lower limb. Duplex ultrasound showed saphenous
junction with diameter 10 mm and great saphenous diameter 4,5 mm just above knee.
Management therapy is needed in the case above, except?
a. Great saphenous ablation
b. Varicose phlebectomy
c. Saphenous junction ligation
d. Calf perforator ligation
e. Stocking compression
57. a 45 year old man presents to your office complaining of right leg pain and swelling of 3
days’ duration. The patient was well until he had a wreck while riding his dirt bike1 week
ago. The patient states that he injured his right leg in this accident. Initially,his legwas
moderately sore on weight bearing , but swelling and persistent pain have now
developed. On physical examination,you note an extensive bruise on the patient’s right
calf and 2+ edema from the foot to midthigh. You suspect trauma associated deep vein
thrombosis (DVT).
Which of the following statements regarding DVT is true?
a. The post thrombotic syndrome is a rare sequela of DVT and is associated with low
morbidity
b. Thrombi cofined to the calf are large and typically result in pulmonary venous
thromboembolism (VTE)
c. Most patient presenting with a new DVT have an underlying inherited thrombophilia
d. The most common cause of inherited thrombophilia associated with this illness is
activated protein C resistance.

58. an 80 year old patient of yours is scheduled to undergo total knee replacement. He is
excellent health, and except for osteoarthiritis, his medical history is notsignificant. The
orthopedic surgeon asks you for advice regarding VTE prophylaxis.
What would you advise for this patient?
a. Aspirin, 325 mg q.d., should started immediatly after surgery
b. LMWH and intermittent pneumatic compression devices are equally effective in
preventing VTE after knee surgery
c. LMWH is contraindicated because of the risk of bleeding ; intermittent pneumatic
compression devices would be preferable
d. Intermittent pneumatic compression devices are contraindicated because of the
location of the surgery; LMWH is prefeble
e. The risk of VTE after knee replacement is so low as to make prophylaxis
unnecessary.
59. a 45 year old woman presents to the emergency departement eith eight hour of chest
pain. The pain is constant, severe, and misdternal in location. She notes that it is worse
when she lies down. She denies exposure to sick friends or relatives. Past history is
noteable for tobacco use, borderline hypertension, and elevated cholesterol. Her father
died of a myocardial infargtion at age 67 years. Examination is noteable for a heart rate
of 104, and a blood pressure of 125/80 in both arms. Her lung are dear. On cardiac
examination, she has a prominent friction rub with two out of three components present.
The remainder of the examination is unremarkable.
Which of the following ECG abnormalities does not suggest pericarditis in the absence of
an effusion?
a. Concave upward ST segment elevation
b. Sinus tachycardia
c. PR segment depression
d. PR segment elevation in lead AVR
e. Electrical alternans

60. a 66 year old caucasian woman is evaluated in the heart failure clinic for concideration
of advance therapeutics , including possible heart transplantation. She has longstanding
history of ischemic cardiomyooathy with an EF of 15% despite optimal medical therapy
with beta-blockers,ACE inhibitors, aldosterone antagonists, digoxin,and diuretics. She
has a 60 pack-year history of smoking , hypertension , and diet controlled diabetes , and
had defibrillator/biventricular pacemaker device placed 2 years ago. Her primary
cardiologist was concerned about her worsening functional status , as she becomes
dyspenic with minimal activity. She performed “poorly” on a 6MWT , primarily limited
by dyspenea. A cardiopulnonary exercise test reveals peak VO2 of 16.1 ml/kg/min.
Which of the following statements is TRUE regarding this patient and her functional
capacity?
a. NYHA dassification is an objective assessment of functional status with
littleinterobsever variability.
b. Based on her peak VO2, she should be considered for heart transplatation at this time.
 c. Peak VO2 is affacted by age and gender , both of which should be accounted for
when assessing functional capacity.
d. The 6MWT does not effectively discriminate the etiology of a patient’s functional
limitations, and it therefore has no nprognostic value in patients with her failure.

61. Sick sinus syndrome in post op congenital heart disease occurs most often in :
a. Arterial switch
b. Fontan and Glen
c. None of the above
d. TOF repair.

62. 10 day old baby boy is admitted to PICU with the severe cyanoses. The parents and the
midwives have noted the appearance of their baby since he was born. The parents did not
bring the baby to the tertiary hospital because they refused to be reffered. In the last 24
hours the baby looked very sick and fatigue so that finally he was brought to our hospital.
On physical examination the baby is cyanotic with poor periphery perfusion. He was
intubated and saturating at 45%. He got a normal S1 with enhancement of S2. Continous
murmur grade III/6 heard ICS2 LSB. No gallop is heard. On chest X-ray the lungs is
oligemic. Which of the following is a possible diagnosis differential :
a. Edward syndrome
b. AP window
c. a lesion of dependent pulmonary circulation
d. Ventride septal defect
e. Patent ductus arteriosus.

63. a 25 year old woman who is 30 weeks pregnant is referred to you because of a murmur
that was noted during her current pregnancy as well as intermittenly in the past. The
patient is asymptomatic. Physical examination shows slight elevation of the jugular
venous pressure, with an a wave. A parasternal lift is also noted. S1 is normal, and S2 is
somewhat prominent, fixed, and split. A grade 2 mid –peaking ejection systolic murmur
is noted at the left sternal border.
 True statement about this patient condition include all of the following EXCEPT:
a. In children this condition typically experience easy fatigability and exertional
dyspnea
b. The most common presenting symptom are exercise intolerance and palpitation
c. A patent foramen ovale can be found in approximately 25% of healthy adults
d. The sinus venonus type is almost always accompanied by anomalous pulmonary
venous connections
e. Atrial arrhythmia are uncommon in children with this condition.

64. a 25 year old woman who is 30 weeks pregnant is referred to you because of a murmur
that was noted during her current pregnancy as well as intermittently in the past. The
patients asymptomatic. Physical examination shows slight elevation of the jugular venous
pressure, with an A wave. A parasternal lift is also noted. S1 is normal, and S2 is
somewhat prominent, fixed ,and split. A grade 2 mid peaking ejection systolic murmur is
noted at the left sternal border.
Which of the following is the most likely diagnosis?
a. Physiologic murmur related to pregnancy
b. Pulmonary valve stenosis
c. Aortic valve regurgitation
d. Atrial septal defect with associated volume overload
e. Mitral valve stenosis.

65. a 3 year old boy just admitted to PICU from the OR. Corrective tetralogy of fallot has
been done. The above patient presents asymptomatic low cardiac output syndrome. The
heart rate was 200 beats per minute. Which of the following should be careful done?
a. Consider junctional ectopic tachycardia and treat with amiadarone
b. Assess type of rhythm disturbances, exclude any symptom of hypovolemia, fever and
electrolyte imbalance
c. Hypovolemia is the most common problem
d. In unstable tachycardia always consider whether this is a shockable event.
e. Hypothermia should always be considered.
66. You are asked to review an ECG of a baby on the intensive care unit. The baby was well
at birth, but soon became unwell and cyanosed. There was on heart murmur. ECG
findings reveal a superior axis, absent right ventricular voltages, and a large P wave.
What is the MOST likely diagnosis?
a. Total anomalous pulmonary venous connection (TAPVC)
b. Complete atrioventricular septal defect
c. Tricuspid atresia
d. transposition of the great arterie
e. Critical pulmonary stenosis
67. a 30 year old bank executive is referred to outpatients for assessment by GP. He is known
to be hypertensive. On routine examination he has been found to have a systolic and
diastolic murmur. He is usually very fit and well and on the advice of his GP has recently
taken up swimming which he finds helpful for a long standing complaint of back pain. He
is now swimming up tp 30 lengths of swimming pool twice a week and feels well. The
GP has performed some routine blood examination including FBC, electrolytes; blood
pressure 200/100 mmHg; JVP not elevated; S2 is normal; added S4. On auscultation in
outpatients an ejection systolic murmur radiating to the carotid sis heard. There is an
early diastolic murmur heard at the left sternal edge, and mid-to-late diastolic murmur at
the apex.
All the following are indications for surgery in pure aortic regurgitation, EXCEPT?
a. LV end diastolic dimension greater than 7 cm
b. LV diastolic dimension greater than 5 cm
c. Falling ejection fraction
d. Progressive LV dilation (>0.75 cm over 12 months)
e. Symptomatic AR

68. Which of the following disruptions of normal myocyte signaling occurs in heart failure ?
a. Internalizations of the ryanodine receptor, making it unavailable on the surface
membrane
b. Use of T-type rather than L-type calcium channels to initiate contraction
 c. Uncoupling of the beta-1 adrenergic receptor from G proteins
d. Increase in the speed of cross-bridge cycling
e. Increased levels of SERCA2a with calcium overload of the sarcoplasmic reticulum

69. The following data were obtained from a 75 year old man with calcified aortic valve : left
ventricular outflow tract (LVOT) velocity (V1) 0.8 m/s, transaortic velocity (V2) 4m/s,
LVOT diameter 2
True statement about this case include all the following EXCEPT:
a. Gastrointestinal bleeding has been associated with this disorder
b. Syncope in this disorder commonly occurs without significance change in vascular
tone
c. Patient with this disorder wo describe angina may not have significant coronary
arterial obstruction
d. Orthopnea, paroxysmal nocturnal dyspnea, and pulmonary edema are late
manifestations of this disorder
e. Syncope may have been due to arrhythmia in this patient

70. Based om epidemiological studies, which of the following risk factors has the lowest
relative risk range for developing extremity peripheral arterial disease ?
a. Diabetes
b. Hypercholesterolemia
c. Smoking
d. Hyperhomocysteinemia
e. Hypertension

71. a 25 year old pregnant woman (G1P0A0, gestational age 32 weeks) was admitted to
hospital with main complaint shortness of breath and orthopnea. She never complained
this symptoms before. Patient was also complain hemoptyisis. On physical examination,
blood pressure 100/60 mmHg. Heart rate was 132 x / minute irregularly irregular.
Respiratory rate 29 breaths / minute. Patient had distended jugular vein and left
 parasternal heave. Cardiac auscultation revealed low pitched rumbling mid diastolic
murmur. Chest x ray revealed congested upper lobe vein and Kerley B lines.
Which of the following is the indication for surgery or repair in this patient?
a. Hemoptysis
b. Thromboembolic events
c. Valve area > 1,5 cm2
d. Pulmonary artery systolic pressure < 60mmHg during exercise
e. Pulmonary artery systolic pressure < 50 mmHg at rest

72. a 25 year old pregnant woman (G1P0A0, gestational age 32 weeks) was admitted to
hospital with main complaint shortness of breath and orthopnea. She never complained
this symptoms before. Patient was also complain hemoptyisis. On physical examination,
blood pressure 100/60 mmHg. Heart rate was 132 x / minute irregularly irregular.
Respiratory rate 29 breaths / minute. Patient had distended jugular vein and left
parasternal heave. Cardiac auscultation revealed low pitched rumbling mid diastolic
murmur. Chest x ray revealed congested upper lobe vein and Kerley B lines.
Which of the following is the most likely anatomic diagnosis for this patient?
a. Mitral stenosis
b. Aortic stenosis
c. Tricuspid stenosis
d. Pulmonary stenosis
e. Aortic regurgitation

73. The following data were obtained from a 75 year old man with calcified aortic valve : left
ventricular outflow tract (LVOT) velocity (V1) 0.8 m/s, transaortic velocity (V2) 4m/s,
LVOT diameter 2. The calculated aortic valve area (AVA) is :
a. 1 cm2
b. 0.6 cm2
c. 1.2 cm2
d. 0.4 cm2
e. 0.8 cm2
 74. a 25 year old woman presents with exertional dyspnea and orthopnea in the 30th week of
her first pregnancy. She has a history of rheumatic fever in childhood and has not had a
recent cardiac evaluation. She is currently on no medications. Physical examination
reveals a pulse of 100 bpm with a regular rhythm. The BP is 110/76 mmHg. There is
mild JVD. A and V waves are visible. The lungs are clear. Cardiac examination reveals a
palpable first heart sound and a parasternal lift. The second heart sound is somewhat
increased. There is an opening snap followed by a grade 2/6 diastolic rumble at the apex
and LSB. The ECG demonstrates sinus rhythm with LA abnormality. A TTE is
performed and this demonstrates MS.
The patient is started on medical therapy. She returns with persistent symptoms of
dyspnea and orthopnea after 1 week of therapy. Physical examination demonstrates a HR
at 65 bpm. The cardiac examination findings are similar to those previously noted. A
limited TTE is repeated. This demonstrates similar valve morphology. The resting mean
gradient across the mitral valve is 12 mmHg. The calculated valve area is 1.0 cm2. The
calculated RSVP is 60mmHg. Which of the following is the most appropriate at this
time?
a. Change medical therapy
b. Urgent cesarean delivery
c. PBMV
d. Open mitral commmisurotomy
e. MVR

75.
 The echocardiography was performed the pressurized half time of the mitral valve was
measured at 440ms. MVA for this patient:
a. Cannot calculate with information available
b. 2.0 cm2
c. 0.5 cm2
d. 1.5 cm2
e. 1.1 cm2

76. a 25 year old woman presents with exertional dyspnea and orthopnea in the 30th week of her
first pregnancy. She has a history of rheumatic fever in childhood and has not had a recent
cardiac evaluation. She is currently on no medications. Physical examination reveals a pulse
of 100 bpm with a regular rhythm. The BP is 110/76 mmHg. There is mild JVD. A and V
waves are visible. The lungs are clear. Cardiac examination reveals a palpable first heart
sound and a parasternal lift. The second heart sound is somewhat increased. There is an
opening snap followed by a grade 2/6 diastolic rumble at the apex and LSB. The ECG
demonstrates sinus rhythm with LA abnormality. A TTE is performed and this demonstrates
MS.
Which of the following is the most appropriate at this time ?
a. Institution of HR control, diuresis and warfarin
b. MVR
c. Echocardiography hemodynamic study
d. PBMV
 e. Open mitral commisurotomy

77. a 25 year old pregnant woman (G1P0A0, gestational age 32 weeks) was admitted to hospital
with main complaint shortness of breath and orthopnea. She never complained this symptoms
before. Patient was also complain hemoptyisis. On physical examination, blood pressure
100/60 mmHg. Heart rate was 132 x / minute irregularly irregular. Respiratory rate 29
breaths / minute. Patient had distended jugular vein and left parasternal heave. Cardiac
auscultation revealed low pitched rumbling mid diastolic murmur. Chest x ray revealed
congested upper lobe vein and Kerley B lines.
Which of the following is the most appropriate treatment to control the heart rate ?
a. Methyldopa
b. Flecainide
c. Digoxin
d. Amiodarone
e. Verapamil

78. Which of the following statements is true concerning the comparison of primary PCI and
thrombolysis in the treatment of AMI ?
a. Success rate of rescue PCI after failed thrombolysis are similar to those of primary PCI
b. Survival benefit with primary PCI compared to thrombolysis is confined to anterior MI
c. Successful PCI and survival benefit with primary PCI is not associated with operator
volume
d. Survival with PCI in an 74 year old diabetic patient female who presented 2 hrs after the
onset of MI with cardiogenic shock is likely to be better than with aggressive medical
treatment
e. Survival is higher among elderly patients if treated with thrombolytic agents rather than
primary PCI

79. According to ACCF/ AHA 2009 Focused update of the 2005 Guidelines for the Diagnosis
and Management of Heart Failure in Adults, which of the following is the class I
recommendation for the prevention of chronic HF in patients at high risk of developing HF
(stage A)?
a. Thyroid disorders should be treated in accordance with contemporary guidelines
 b. Angiotensin converting enzyme inhibitors can be useful to prevent HF in patients at high
risk for developing HF due to a history of atherosclerosis vascular disease, diabetes
mellitus, or hypertension with associated cardiovascular risk factors
c. Angiotensin II receptor blockers can be useful to prevent HF in patients at high risk for
developing HF due to a history of atherosclerosis vascular disease, diabetes mellitus, or
hypertension with associated cardiovascular risk factors
d. Beta blockers can be useful to prevent HF in patients of high risk of developing HF who
have a history of atherosclerotic vascular disease, diabetes mellitus, or hypertension with
associated cardiovascular risk factors
e. Routine use of nutritional supplements to prevent the development of structural heart
disease is recommended

80. HF prognosis correlates MOST STRONGLY with which of the following?

a. Genetic predisposition
b. Impaired renal function
c. NYHA class
d. Diastolic dysfunction
e. Resting EF

81.

With regard to the diagram (figure 1), which of the following points or curves will move first
if a patient develops an infiltrative process such as amyloid heart disease ?
a. Curve B
b. Curve E
c. Curve A
 d. Curve C
e. Curve D

82. a 65 years old man admitted to hospital with sudden shortness of breath preceding by sharp
chest pain and not relieved by resting. Before having chest pain, patient was walking about
400 meters. 3 days before patient having typical angina chest pain and diaphoresis, but
patient refuse to seek medical assistant. Patient was an active smoker, had history of diabetes
and uncontrolled hypertension. On physical examination, the patient was found to have a
blood pressure of 100/70 mmHg, pulse 96 times per minutes. His JVP was raise and found
3/6 harsh systolic murmur at the left sternal border. Blood studies showed Hb 14 g/dl, Ht
43,7%, WBC 11900/uL, platelet 213.000/ iL, CK 240, CKMB 55
Which of the following is the most likely anatomic diagnosis for this patient ?
a. Ventricular septal defect
b. Acute myocardial infarction
c. Ventricular septal rupture
d. Acute ischemia mitral regurgitation
e. Acute lung edema

83. a 70 years old farmer presents with 3 days of intermittent chest pressure and dyspnea with
minimal exertion/ he had one episode of nocturnal dyspnea 3 days prior. He is currently
medicated with metoprolol 25 mg twice daily aspirin 325 mg daily. On physical examination
his BP is 140/85 mmHg and his HR is 76 BPM and regular. His JVP is normal. His carotid
upstrokes are normal and without bruits. His lungs are clear to auscultation. His heart has a
regular rate and rhythm. The apical impulse is in the normal location and normal quality. The
fits and second heart sound are normal. There are no murmurs or gallops appreciated. The
abdomen is soft with no masses or bruits. The extremities have no clubbing, cyanosis or
edema and the peripheral pulses are normal. The ECG shows nonspecific ST-T wave changes
without frank elevation or depression. The chest x-ray is interpreted as normal, CBC,
electrolytes and cardia biomarkers are all negative
The best next step is:
a. Diagnostic coronary angiography with possible percutaneous revascularization
b. Start therapy with tirofiban 0.1 Mcg/kg/min
 c. Increase beta blockade and add nitrates, followed by noninvasive stress testing
d. As the geriatric patient is now asymptomatic, it is best to manage him medically
e. Pharmacologic stress testing

84. a 65 years old man admitted to hospital with sudden shortness of breath preceding by sharp
chest pain and not relieved by resting. Before having chest pain, patient was walking about
400 meters. 3 days before patient having typical angina chest pain and diaphoresis, but
patient refuse to seek medical assistant. Patient was an active smoker, had history of diabetes
and uncontrolled hypertension. On physical examination, the patient was found to have a
blood pressure of 100/70 mmHg, pulse 96 times per minutes. His JVP was raise and found
3/6 harsh systolic murmur at the left sternal border. Blood studies showed Hb 14 g/dl, Ht
43,7%, WBC 11900/uL, platelet 213.000/ uL, CK 240, CKMB 55
Which of the following statement is correct in this case ?
a. Primary PCI is the best choice for this patient
b. Hypotermic cardiopulmonary bypass with optimal myocardial protection must be done
c. IABP has no benefit
d. Inotropic or vasopressor must be given when the blood pressure is low
e. Beta blocker is contra indicated

85. a 72 yo patient with long standing hypertension and dyslipidemia came to see you due to
sudden onset of chest pain lasting 15 minutes which occur three days prior. After appropriate
diagnostic workup and medical therapy are commenced. A diagnostic coronary angiography
was performed and demonstrated a 95% stenosis in the middle LAD coronary artery. This
was treated with an intracoronary bare metal stent
With regard to this patient
a. Aspirin 81mg plus warfarin adjusted to an INR of 2.0 to 2.5 should be commenced
b. Aspirin 325 mg and clopidogrel 75 mg daily should be commenced
c. There is a 4% to 6% risk of in-stent restenosis over the next 6 months
d. Noninvasive stress testing is required at 3 to 6 months following the percutaneous
procedure regardless of the patients symptom status

86. a 80 year old hypertensive male referred to cardiology clinic with stable NYHA FC III
angina for 3 months treated with aspirin, metoprolol succinate 150 mg daily, isosorbide
 mononitrate 120 mg daily, simvastatin 40 mg daily. On exam the heart rate is 57, the blood
pressure is 98/60 mmHg and the cardiopulmonary exam is unremarkable. Resting ECG is
within normal limits. An exercise stress test is significant for 2mm horizontal ST depression
and exercise limiting chest discomfort at 6 METs
The most appropriate next step would be
a. Add calcium channel blocker
b. Increase beta blocker dose
c. Echocardiography
d. Cardiac catheterization
e. Increase nitrate dose

87. A previously healthy 36 years old African American man is admitted from the emergency
department with newly diagnosed congestive heart failure. An echocardiogram is obtained on
admission and reveals significant four chamber dilatation an EF of 25% and an LV end
diastolic dimension of 7.3 cm. A left heart catheterization reveals no evidence of obstructive
coronary disease. The patient does not use alcohol, cocaine, or other illicit drugs and he has
no recent history of viral illness. While discussing his medical history, he notes that his father
died of heart failure at age 38. You consider the possibility that the patient has some form of
familial cardiomyopathy
Which of the following statements is true concerning familial cardiomyopathies?
a. To identify the accurate diagnosis, all family members should be tested first for multiple
mutations associated with the disease
b. Most familial cardiomyopathy exhibit autosomal recessive inheritance patterns
c. A thorough family history should be taken, including at lease three generations
d. It is estimated that <5% of idiopathic dilated cardiomyopathies are familial in origin

88. Among patients with class II angina and one or two vessel disease , PCI is indicated for
which of the following :
a. To alleviate asymptomatic ischemia
b. To prevent progression of CAD
c. Prevention of death
d. Prevention of MI
 e. To improve symptoms

89. a 60 year old man presented to the cardiovascular clinic for consultation. He described
typical angina climbing one flight of stairs.
Symptom was improved with ISDN 5 mg sl. He was smoker and had history of hypertension
for 5 years which was controlled with amlodipine 5 mg od. Resting ECG was normal. Which
of the following statement about the case is correct ?
a. Risk stratification with non invasive stress test has to be done before refers the patient to
cath lab for coronary angiography
b. Coronary angiography is appropriate for the patient without prior non invasive stress test
c. Coronary angiography is indicated because high risk patient
d. Coronary angiography is inappropriate because the patient is stable and well controlled
with medicamentosa

90. a 78 year old diabetic male is referred to your clinic for preoperative evaluation prior to left
knee replacement. He currently can only walk 1 to 2 blocks before stopping, but he is limited
by knee pain and denies angina or shortness of breath. He has an adenosine sestamibi stress
test that demonstrates a small area of ischemia at the apex. He did not note any discomfort
during the test. He is currently on 81 mg of aspirin daily and has adequate beta blockade with
metoprolol. His vitals are : HR 62 bpm; BP : 118/70 mmHg; LDL 68 mg/dL, HDL 45
mg/dL, TG 98 mg/dL
Your next step is
a. Tell patient that nothing further evaluation is needed at this time
b. Increase aspirin to 325 mg daily and continue beta blocker
c. Advise patient to postpone surgery for further diagnostic testing
d. Proceed to coronary angiogram to perform PCI on the LAD
e. Proceed to coronary angiogram to define the anatomy

91. a 45 year old man is admitted to a hospital due to typical chest pain after exercise with 4
hours onset. He reveals that this not the first time, the symptoms were already develop over
one year and he had syncope last month. The patient was a heavy smoker, his father already
passed away at his 50’s due to heart disease. On physical examination the blood pressure is
140/80 mmHg, normal s1 and s2 with a grade 3/6 holosystolic murmur at the apex and axilla.
 An electrocardiogram shows left ventricular hypertrophy with strain, left atrial enlargement.
Cardiac enzyme were normal. This following were the major clinical features associated with
increased risk of SCD that possibly happen to this patient, EXCEPT:
a. Family history
b. Non sustained ventricular tachycardia
c. Gender
d. Frequent syncope episode
e. Age

92. a 72 yo patient with long standing hypertension and dyslipidemia came to see you due to a
sudden onset of chest pain lasting 15 minutes which occur three days prior. After appropriate
diagnostic workup and medical therapy are commenced. A diagnostic coronary angiography
was performed and demonstrated a 95% stenosis in the middle LAD coronary artery. This
was successfully treated with and intracoronary bare metal stent
One year later this patient is in need of cholecystectomy. He remains asymptomatic. The
surgeon arranged for a TMT before you visited with the patient. The patient exercised to an
equivalent of 9.0 METS with a normal HR and BP response. The ECG was interpreted as
non diagnostic (<1mm of up sloping ST depression) at peak exercise and resolved by 3 min
into recovery
At this point which of the following is true ?
a. The operation should be postponed until an imaging stress test can be obtained
b. You should recommend IV beta blockers and IV NTG with PA catheter monitoring and
to proceed with cholecystectomy
c. Repeat stress testing was not necessary at this point in time as the patient was active and
asymptomatic
d. Repeat coronary angiography and possible coronary revascularization will improve the
patient’s operative outcome

93. Optimal time for elective non cardiac surgery coronary stenting with bare metal stent:
a. Between 45 days to 180 days
b. Beyond 1 year
c. Between 180 days to 1 year
 d. Within 45 days

94. a 45 year old woman is evaluated for palpitations that occur intermittently during the day,
vary in severity and cause a sensation of skipped beats. She has no other associated
symptoms. She had similar episode 2 years ago while undergoing a stressful job relocation,
but did not seek medical attention at that time/ she is now under pressure at work and her son
is leaving for college in 1 week. On physical examination, her blood pressure is 160/90
mmHg and her heart rate is 80 beats / min. cardiac examination shows normal heart sounds
and no murmurs. Electrocardiogram shows sinus rhythm with premature atrial contractions
and a 24-hour ambulatory monitor shows 5673 premature atrial contractions, 127 premature
ventricular contractions and no runs of arrhythmias. Result of laboratory test, including
thyroid function tests and complete blood count are normal. The patient remains highly
symptomatic, despite reassurance.
Which of the following is the most appropriate next step in the management of this patient ?
a. Start diuretic therapy
b. Perform an exercise treadmill test
c. Start beta blocker therapy
d. Perform an electrophysiologic study
e. Start disopyramide therapy

95. a 75 year old woman is referred urgently to the cardiology clinic. She had a myocardial
infarction 4 years earlier, percutaneous intervention with a stent for angina 12 months earlier
and has had two blackouts in the last month, 3 weeks apart. She tells you that in one occasion
she was gardening and trying to lift a heavy plant pot. She had no warning and suddenly
found herself on the ground. She was alert on recovery. There was no seizure-like activity.
She does not had angina since her coronary stent12 months ago. Occasionally she feels light-
headed if she stand up too quickly. She is currently taking aspirin, a beta blocker an ACE
inhibition, a loop diuretics and a statin. Her physical examination reveals blood pressure
130/55 mmHg, resting pulse 55 bpm. Regular, normal volume. The JVP is raised by 2 cm,
her apex beat is displaced to the lateral clavicular lin, sixth intercostal space and there is a
systolic murmur heard all over the precordial and in the carotids. The lung field are clear and
there is mild pitting edema at the level of her shins.
 The patient refuses immediate hospital admission but agrees to have a 24-houts Holter
monitor attached and is scheduled for elective day case electrophysiologic study the
following week. Coronary angiography demonstrates a chronically occluded LAD artery, and
a patent in her RCA. Programmed ventricular stimulation is then performed, including
monomorphic ventricular tachycardia at 200 bpm with loss of consciousness and is promptly
cardioverted with a single external 50 J biphasic shock. In this case what is the most
appropriate treatment ?
a. Stent implantation in occluded LAD artery
b. ICD implantation
c. Amiodarone for preventing SCD
d. Send the patient to cardia surgeon
e. Correct the electrolyte imbalance

96.

.
The chanellopathy underlying the clinical presentation in the patient history of cardiac arrest
is:
a. Gain of function in calcium channel
b. Loss of function in the sodium channel
c. Loss of function in the potassium channel
d. Gain of function in the potassium channel
e. Gain of function in the sodium channel
97.

A 25 year old male with no known medical history suddenly collapsed while playing a
vigorous game of ultimate Frisbee. His friends immediately started CPR and called 118. The
paramedics arrived within 5 minutes and found him in F. he was defibrillated successfully
with one shock with return of spontaneous circulation. He was transported to the hospital for
subsequent care. The following ECG was obtained upon arrival to the hospital:
What is the most likely diagnosis?
a. Short QT syndrome
b. Timothy syndrome
c. Brugada syndrome
d. Long QT syndrome
e. Cathecolamine polymorphic VT

98. Which of the following is not an AV node independent tachycardia?

a. Atrial tachycardia
b. Atrial flutter
c. Atrial fibrillation
d. Atrioventricular reentrant tachycardia
99.

A 25 year old male with no known medical history suddenly collapsed while playing a
vigorous game of ultimate Frisbee. His friends immediately started CPR and called 118. The
paramedics arrived within 5 minutes and found him in F. he was defibrillated successfully
with one shock with return of spontaneous circulation. He was transported to the hospital for
subsequent care.
This patient makes a complete neurologic recovery. An echocardiogram is within normal
limits. What is the next appropriate step in management?
a. Implant a dual-chamber pacemaker
b. Implant an ICD
c. Start a beta blocker and restrict him from participation in competitive sports
d. Exercise testing to assess if his QT shortens appropriately
e. EP testing with administration of a class 1 antiarrythmic (flecainide and procainamide) to
determine risk of sudden death