05 August 2009
CVS MCQ (Rewrite) 2009
CVS MCQ (Rewrite) Model Answer
A - Types
1.
A patient with a dilated and thin walled left ventricle was admitted to hospital with heart failure. Her
left ventricular ejection fraction was 18% (normal value ~60%). Her systolic blood pressure was 96
mm Hg.
The most likely cause of her heart failure would be:
a.a stiff heart because of fibrosis.
b.high output heart failure.
c.an increased wall stress.
d.mitral stenosis.
e.a thiamine deficiency.
2.
A patient with biventricular failure has preserved left ventricular systolic function, a normal cardiac
output at rest, but reduced left ventricular diastolic function. She was admitted to hospital
complaining of fatigue when exercising. She had no symptoms at rest.
The most likely cause of her fatigue while exercising is:
a.gravity-induced changes in venous return.
b.restricted ventricular filling.
c.reduced sympathetic activation.
d.right heart failure.
e.an anaemic hypoxia.
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CVS MCQ (Rewrite) 2009
3.
QUESTIONS 3, 4 and 5
The following pressures, measured in the left ventricle, the left atrium and the aorta, were obtained
from a 53 year old woman who had fallen to the floor unconscious when straining on the toilet. A
family member had noted that her heart rate, when estimated soon after she fell was well over 100
beats.min-¹.
The activity indicated in this case, that led to her falling unconscious, normally results in:
a. decreased intrathoracic pressure
b. increased venous return
c. decreased sympathetic nervous system activity
d. decreased baroreceptor firing
e. increased vagal tone.
4.
The patient fell to the floor unconscious as a result of:
a. an increased systemic vascular resistance
b. autonomic nervous system failure
c. a decreased ventricular contractility
d. an obstruction to ventricular ejection
e. an increased heart rate.
5.
The pathological abnormality in this patient is likely to:
a. involve a valve that normally has two cusps
b. involve the chordae tendinae
c. be the result of a pericardial disease
d. be the result of an endocardial disease
e. produce a systolic cardiac murmur
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CVS MCQ (Rewrite) 2009
6.
QUESTIONS 6 and 7
An angiotensin-converting enzyme inhibitor was administered intravenously to a patient with a
cardiovascular problem. The following haemodynamic changes were recorded before, and 10
minutes after, administration of this agent.
Before
After
______________________________________________________________________
Blood pressure (mm Hg)
146/94
110/84
Stroke volume (mls.beat-1)
70
86
Heart rate (beat per minute)
72
96
Assuming that right atrial pressure is 0 mm Hg both before and after drug administration, systemic
vascular resistance is:
-1
a. 28 mm Hg.min.l before drug administration
-1
b. 11 mm Hg. min.l after drug administration
c. independent of arteriolar function
d. independent of baroreceptor reflexes
e. changed because of a decrease in aldosterone concentrations
7.
The change in blood pressure is the result of:
a. decreased release of calcium from the arteriolar sarcoplasmic reticulum
b. closure of cardiac calcium channels
c. venodilation
d. vascular adventitial changes
e. endothelial effects
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CVS MCQ (Rewrite) 2009
8.
QUESTIONS 8, 9 and 10
The following figure illustrates the normal Frank-Starling relationship (line graph) and data points (Ato-D) obtained from four different individuals. Point A represents data obtained from a normal person
at rest. CO=cardiac output and LVEDV=left ventricular end diastolic volume.
The normal relationship in the above figure is the result of increases in:
a. heart rate
b. LV contractility
c. myofilament overlap
2+
d. troponin C sensitivity to Ca
2+ _
2+
e. myocyte Ca induced Ca release
Question 8 Removed
9.
Point D represents data obtained from an individual with:
a. endocarditis
b. ischaemic heart disease
c. fluid in the pericardium
d. a dilated cardiomyopathy
e. myocarditis
10. A 29 year old alcoholic male, who was short of breath when he exercised, was admitted to hospital.
He was noted to be markedly malnourished and had symptoms and signs consistent with “wet” beriberi including a blood pressure of 172/66 mm Hg. Haemodynamic measurement showed that his
heart function was consistent with Point C in the previous diagram.
He is most likely to have:
a. an increase in cardiac contractility
b. an increase in left atrial pressure
c. a decrease in pulmonary capillary hydrostatic pressure
d. a decrease in right ventricular afterload
e. a decrease in left ventricular wall stress
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CVS MCQ (Rewrite) 2009
11. QUESTIONS 11, 12 and 13
The following electrocardiograph (ECG) recording was obtained from a patient admitted to a
coronary care unit prior to initiation of therapy. The patient had a modestly reduced left ventricular
ejection fraction and evidence of diastolic abnormalities of the left ventricle. He received a diuretic
agent, oxygen, a morphine derivative, a ß-adrenoreceptor blocker, a nitrate preparation , aspirin and
a thrombolytic agent.
The ECG indicates transmural myocardial ischaemia in the :
a. right ventricular free wall
b. septal wall
c. base of the ventricles
d. inferior wall of the ventricles
e. left atrium
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CVS MCQ (Rewrite) 2009
12. The ECG indicates the presence of occlusion of the:
a. circumflex coronary artery
b. right coronary artery
c. left anterior descending coronary artery.
d. left and right coronary arteries
e. coronary veins
Question 12 Removed
13. The LVEF could occur as a result of:
a. a decrease in free fatty acid concentrations
b. a decrease in inorganic phosphate
2+
c. increased binding of Ca to troponin C
d. decreased sympathetic nervous system activity
+
e. excessive H ions
14. Amniocentesis of a pregnancy at 16 weeks gestation reveals a karyotype of 47,XXY (Klinefelter
syndrome). Which of the following is the most accurate statement regarding this finding?
a. This condition is inherited from the paternal side of the family
b. This condition is associated with infertility in the affected individual
c. Females with this condition have mild cognitive impairment
d. A definite diagnosis can only be made after the baby is born
e. This condition is associated with a shortened lifespan
A is incorrect as this condition is not ‘inherited’
C is incorrect as these individuals are male
D is incorrect as amnio provides a definite diagnosis
E is incorrect as lifespan is usually normal
15. Which one of the following is the most likely reason that the health care markets 'fail'?
a. Patients do not have full information about quality or price.
b. The government intervenes to control market activity.
c. The individual benefit of immunization is the same as the public benefit.
d. The poor are not able to afford care.
e. The government provides free primary care to the potential ‘market’.
Question 15 Removed
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CVS MCQ (Rewrite) 2009
X - Types
16. Regarding the surface anatomy and auscultation of the heart valves:
a. The pulmonary valve lies posterior to the 4th
costal cartilage at the left parasternal border
True
False
Don't know
b. The tricuspid valve is positioned behind the the
right side of the sternum at the level of the 4th
intercostal space
True
False
Don't know
c. The aortic valve is positioned behind the left side
of the sternum at the sternum at the level of the 3rd
intercostal space
True
False
Don't know
d. The pulmonary valve is in the 5th intercostal
space in the left midclavicular line
True
False
Don't know
e. The mitral valve is auscultated at the 2nd
intercostal space on the left parasternal border.
True
False
Don't know
Option C Removed
17. A 23-year-old male patient, whose mother and father were both reported to have died
before they were 50 years old, as a consequence of cardiovascular disease, consults
you for advice on how to reduce his cardiovascular risk. He has a body mass index of
22 kg/m2.
Your advice would include the following:
a. stop smoking.
True
False
Don't know
b. reduce body weight.
True
False
Don't know
c. exercise regularly.
True
False
Don't know
d. consume more fruit and vegetables.
True
False
Don't know
e. check plasma cholesterol concentrations.
True
False
Don't know
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CVS MCQ (Rewrite) 2009
18.
Five years later the same patient as above consults you. You record his blood pressures
(mm Hg) on three separate occasions, two weeks apart as: 144/92; 146/96; 148/94
and note on further examination that he has: no fundal changes; no evidence of left
ventricular hypertrophy (LVH) and proteinuria is absent.
Your most likely initial choice of anti-hypertensive management for this patient would
be
a. lifestyle management alone.
True
False
Don't know
b. thiazide diuretic monotherapy.
True
False
Don't know
c. hospitalization at the first visit.
True
False
Don't know
d. aldosterone receptor antagonist monotherapy.
True
False
Don't know
e. angiotensin-converting enzyme inhibitor
monotherapy.
True
False
Don't know
19. Fifteen years later the same patient as above consults you. You record his blood
pressures (mm Hg) on three separate occasions, two weeks apart as: 170/98; 174/96;
168/100 and note on further examination that he has: evidence of left ventricular
hypertrophy (LVH) and proteinuria is present.
You order an electrocardiograph in this patient. The electrocardiographic changes you
observe are likely to include
a. an equiphasic QRS complex in lead V3.
True
False
Don't know
b. a right axis shift.
True
False
Don't know
c. an increased amplitude of QRS complexes in V5.
True
False
Don't know
d. a negative QRS complex in lead I.
True
False
Don't know
e. a positive QRS complex in lead aVL.
True
False
Don't know
20. You also order routine blood tests on this patient. The results of the blood tests reveal
that this patient has a raised plasma cholesterol concentration. You are concerned
about the development of atherosclerosis in this patient as hypertension:
a. decreases oxidative stress.
True
False
Don't know
b. promotes platelet aggregation.
True
False
Don't know
c. decreases collagen production.
True
False
Don't know
d. promotes smooth muscle cell proliferation.
True
False
Don't know
e. increases plasma HDL cholesterol concentration.
True
False
Don't know
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CVS MCQ (Rewrite) 2009
21. As a consequence of his chronic hypertension, this patient has developed vascular
remodelling.
The remodelling of arterioles
a. is due to an increase in smooth muscle.
True
False
Don't know
b. is associated with an increased production of
endothelin.
True
False
Don't know
c. is associated with an increased production of
nitric oxide.
True
False
Don't know
d. results in a reduction in vascular lumen diameter.
True
False
Don't know
e. results in a reduction in vascular wall thickness.
True
False
Don't know
Option A Removed
22. Causes of cardiac systolic murmur include
a. an increase in blood velocity.
True
False
Don't know
b. aortic valve stenosis.
True
False
Don't know
c. mitral valve stenosis.
True
False
Don't know
d. tricuspid valve incompetence.
True
False
Don't know
e. a decrease in blood flow.
True
False
Don't know
Option A Removed
23. Mitral valve
a. stenosis is associated with an increase in left
atrial pressure.
True
False
Don't know
b. opening occurs at the beginning of isovolumetric
relaxation.
True
False
Don't know
c. closure produces the ‘c’-wave of the atrial
pressure trace.
True
False
Don't know
d. closure contributes toward the first heart sound.
True
False
Don't know
e. incompetence is associated with a diastolic
murmur.
True
False
Don't know
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CVS MCQ (Rewrite) 2009
24. Which of the following conditions are consistent with the definition of birth defects:
a. Cystic fibrosis
True
False
Don't know
b. Huntington disease
True
False
Don't know
c. Alcoholism
True
False
Don't know
d. Fetal alcohol syndrome
True
False
Don't know
e. Coronary heart disease
True
False
Don't know
Answers: a,b,d (Structural/functional abnormalities that are present at birth, and may or
may not be clinically obvious)
25. In order for a genetic screening program to be introduced, which of the following
criteria should be met?
a. The disease being screened for should be rare in
the target population
True
False
Don't know
b. The disease being screened for should have a
serious effect on health
True
False
Don't know
c. The test should provide a definitive diagnosis
True
False
Don't know
d. The screening program should be compulsory
True
False
Don't know
e. The test should be non invasive and easy to
perform
True
False
Don't know
Answers: b, e. (Others incorrect because: Disease should have a high incidence in the
target population, does not necessarily provide a definitive diagnosis as a further diagnostic
test will be performed if the individual screens positive, participation should be voluntary)
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CVS MCQ (Rewrite) 2009
26. With reference to the figure below, which shows the health care choices of 1000 people
during a typical month in the USA:
a. Most people go to a doctor when they experience
a health symptom.
True
False
Don't know
b. The figure illustrates the help-seeking behaviour
of a sample of 1000 people in the US.
True
False
Don't know
c. The figure suggests that the popular sector has a
significant role in the ecology of health care.
True
False
Don't know
d. The figure illustrates very well the concept of the
“clinical iceberg”.
True
False
Don't know
e. The figure shows that in terms of the ecology of
health care the academic hospital is an appropriate
training site for medical students
True
False
Don't know
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CVS MCQ (Rewrite) 2009
27. The Ottawa Charter set out five “areas for action” to promote health.
Which of the following would promote cardiovascular health, in agreement with the
Ottawa Charter?
a. Develop new drugs to manage cardiac failure
adequately
True
False
Don't know
b. Upgrade primary care clinics to manage
hypertension properly
True
False
Don't know
c. Improve facilities for cardiothoracic surgery in
tertiary hospitals
True
False
Don't know
d. Educate people so that they understand and
practise cardiopreventive exercise
True
False
Don't know
e. Legislate to print warnings on cigarette packets
that smoking can cause heart disease.
True
False
Don't know
28.
Regarding pharmacological action on the sympathetic nervous system:
a. Phenylephrine causes peripheral vasodilation
True
False
Don't know
b. Cocaine decreases synaptic levels of
noradrenaline
True
False
Don't know
c. Dopamine is a beta-1-adrenoreceptor stimulant
True
False
Don't know
d. Atenolol decreases systolic blood pressure
True
False
Don't know
e. Alpha-methyldopa blocks the action of
noradrenaline on the alpha-1-adrenoceptor
True
False
Don't know
a. digoxin stimulates membrane Na+/K+- ATPase
activity
True
False
Don't know
b. atenolol slows conduction through the AV node
True
False
Don't know
c. enalapril reduces end diastolic volume
True
False
Don't know
d. bisoprolol decreases myocardial oxygen
consumption
True
False
Don't know
e. isosorbide mononitrate decreases venous
capacitance
True
False
Don't know
29. Regarding cardiovascular drugs:
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CVS MCQ (Rewrite) 2009
30. Regarding drugs acting on the renin-angiotensin system:
a. captopril blocks AT1 angiotensin receptors
True
False
Don't know
b. ramipril increases total peripheral resistance
True
False
Don't know
c. losartan is contraindicated in pregnancy
True
False
Don't know
d. valsartan inhibits the breakdown of bradykinin in
the larynx
True
False
Don't know
e. ramipril increases the risk of hyperkalaemia
True
False
Don't know
31. Carvedilol
a. causes tachycardia
True
False
Don't know
b. causes vasodilation
True
False
Don't know
c. blocks beta 2 adrenoreceptors
True
False
Don't know
d. causes high blood pressure
True
False
Don't know
e. increases myocardial contractility
True
False
Don't know
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CVS MCQ (Rewrite) 2009
R - Types
32. A. Atheromatous aneurysm of the basilar artery
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
Berry aneurysm
Calcific aortic valve stenosis
Calcific stenosis of the mitral valve ring
Cor Pulmonale
Dense neutrophilic infiltrate and myocytolysis
Fibrinoid necrosis
Hyaline arteriolosclerosis
Hypertrophy and dilatation of the left ventricle
Mitral valvular stenosis
Myocyte necrosis and lymphocytic infiltration
Recurrent pulmonary emboli
Thrombotic occlusion of the circumflex coronary artery
Thrombotic occlusion of the anterior descending branch of the left coronary artery
Thrombotic occlusion of the posterior descending branch of the right coronary artery
For each of the statements/scenarios below identify in the list above the cardiovascular
pathology which is most likely to be involved.
32. A 50-year-old man is admitted for congestive heart failure. He has no history of chest pain
or alcohol abuse. On physical examination he has a blood pressure of 190/120 mm Hg, mild
hepato-splenomegaly, and no cardiac murmur.
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
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CVS MCQ (Rewrite) 2009
33. A 55-year old male patient was admitted to hospital with severe chest pain and found to
have developed the most common form of acute myocardial infarction
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
34. A female patient is admitted in cardiac failure, after being treated for many years for
chronic lung disease. On physical examination the clinician finds that that she has an enlarged
heart, but the left ventricle is normal in size and configuration.
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
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CVS MCQ (Rewrite) 2009
35. A 65 year-old female presents with right ventricular failure and clinical evidence of a raised
pulmonary arterial pressure
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
36. A 25 year old female was admitted in coma with a history of sudden onset of severe
headache. She was found to be hypertensive on clinical examination.
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
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CVS MCQ (Rewrite) 2009
37. A 55 year old male patient was admitted to hospital with severe chest pain and on clinical
examination he is diagnosed as having transmural infarction of the lateral wall of the left
ventricle.
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
33. A. Acute bacterial endocarditis
B.
C.
D.
E.
F.
G.
Calcific stenosis of the mitral valve ring
Calcification of the aortic valve
Fibrin-platelet vegetations on the mitral valve
Floppy mitral valve
Floppy mitral valve
Sub-acute bacterial endocarditis
For each of the statements/scenarios below, identify in the list above the valvular
pathology which is most likely to be involved.
38. A 12 year old child was brought to the local clinic by her mother who said that the
child was “unwell” and was getting progressively out of breath when playing with other
children. Clinical examination showed the presence of mild peri-orbital oedema and a
cardiac murmur
A
B
C
D
E
F
G
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CVS MCQ (Rewrite) 2009
34. A. Ductus arteriosus
B. Ductus venosus
C. Foramen ovale
D. Foramen primum
E. Fossa ovalis
F. Ligamentum teres
G. Ligamentum venosum
H. Septum primum
I. Septum secundum
For each of the statements below identify the structure associated with fetal circulation
that is most applicable
39. Allows blood in the left umbilical vein to by-pass the liver
A
B
C
D
E
F
G
H
I
40. Allows blood from the right ventricle to by-pass the lungs
A
B
C
D
E
F
G
H
I
41. Derived from the left umbilical vein
A
B
C
D
E
F
G
H
I
Ouestion 41 Removed
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CVS MCQ (Rewrite) 2009
35. A. Deformation
B. Disruption
C. Dysplasia
D. Malformation
E. Sequence
For each case below select the most likely underlying mechanism causing the structural
defects from the list above
42. A set of twins is delivered at a gestation of 36 weeks. Twin one is noted to have
plagiocephaly, bilateral club foot, and contractures at both elbows. Twin two does not
have any abnormalities.
A
B
C
D
E
43. A newborn baby with an unusual facial cleft, amputation of the tips of the 3rd, 4th
and 5th digits on the left hand and a constriction band above the right ankle.
A
B
C
D
E
36. Dr Jones has been caring for Mrs Brown for many years. She has hypertension and
osteoarthritis. Mrs Brown visits Dr Jones today because the pain in her right knee has
been worse since she slipped and fell last week.
A. An encounter of care
B. An episode of care
C. Clinical sign
D. Diagnostic process
E. Reason for encounter
F. Symptom
G. Therapeutic process
For each of the following statements regarding the consultative process between Mrs
Brown and Dr Jones, select the most appropriate concept from the list A-H above
44. Mrs Brown says she can’t take the
pain any more
A
B
C
D
E
F
G
45. Dr Jones asks her how and why she
fell
A
B
C
D
E
F
G
46. Dr Jones orders some tablets for
her to take for the pain
A
B
C
D
E
F
G
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