Self-Assessment Questions (MCQ)

CARDIOVASCULAR DISEASES

1) Mobitz type II:

A) It is usually due to block within the His bundle system
B) It is not preceded by a lengthening atrioventricular conduction time
C) The block is usually nodal when the QRS complexes are narrow
D) The block is usually infranodal when the QRS complexes are wide.

2) Select the possible etiology of Mobitz type I block:

A) Inflammatory processes
B) Infarction
C) Fibrosis
D) Calcification
E) Digitalis.

3) The characteristics of complete heart block are the following, EXCEPT:

A) Narrow QRS complexes
B) Ventricular rate less than 50/min
C) The first heart sound varies in intensity
D) Wide pulse pressure
E) Exercise does not increase the rate.

4) Select the causes of atrioventricular dissociation due to slowing of atrial impulses with
emergence of a subsidiary pacemaker:
A) Beta-blocking drugs
B) Sinoatrial exit block
C) Diltiazem

5) Select the causes of atrioventricular dissociation due to acceleration of the rate of a subsidiary
pacemaker:
A) Digitalis toxicity
B) Postoperative state
C) Atropine.

6) Select the complete left bundle branch block diagnosis criteria:

A) Supraventricular rhythm
B) ST –T opposition

7) Select the complete right bundle branch block diagnosis criteria:

A) Supraventricular rhythm
B) QRS complex duration > 0,12 s

8) The ECG criteria of left anterior hemiblock are the following:

A) Normal repolarisation
B) Normal intrinsecoid deflection
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 C) Supraventricular rhythm
D) qR aspect in D1, aVL.

9) Select the left posterior hemiblock diagnosis criteria:

A) Right QRS axis deviation
B) Normal repolarisation

10) Select the false statements concerning the intraventricular block:

A) Pacing is usually warranted
B) Right bundle branch block is associated with a higher risk of mortality

11) Systolic function of the heart is governed by:

A) Heart rate
B) The impedance to left ventricular ejection
C) The contractile state of the myocardium.

12) Preload depends on the following factors:

A) Central venous pressure
B) Atrial contraction
C) Volume of circulating blood

13) Preload is increased in:

A) Fever
B) Thyrotoxicosis

14) Afterload depends on the following factors:

A) Aortic diastolic pressure
B) Compliance of the arteries
C) Diastolic pressure of the pulmonary artery.

15) Afterload is increased in:

A) Pulmonary hypertension
B) Aortic stenosis

16) The contractile state of the myocardium depends on:

A) Acidosis (negative inotropic effect)
B) Autonomic nervous system factors
C) Cathecholamines
D) Hypoxia

17) Early compensatory mechanisms in cardiac failure are the following:

A) Frank – Starling mechanisms
B) Anaerobic metabolism
C) Tachycardia.

18) Delayed compensatory mechanisms in cardiac failure are the following:

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 A) Water and salt retention
B) Myocardial hypertrophy.

19) Select the true statements about cardiac failure:

A) Normal cardiac outflow during rest: 4,5 –5 l/min
B) The majority of anti – arrhythmic drugs are having negative inotropic effect
C) Cardiac index: 3200 ml/m2/min

20) Select the false statements concerning cardiac failure:

A) Afterload is increased in diseases disturbing the ventricular function by high volume
B) Cardiac index: 1500 ml/m2/min.

21) Select the characteristics of acute infective endocarditis:

A) Intense tissue destruction
B) Embolism is common

22) Select the characteristics of subacute infective endocarditis (IE):

A) Microorganisms of low virulence
B) Previously damaged endocardium
C) Rarely IE causes metastatic infection

23) What are the risk procedures for infective endocarditis?

A) Adenoidectomy
B) Sclerotherapy for esophageal varices
C) Prostatic surgery

24) The most important investigation in infective endocarditis is:

A) Blood culture

25) Select the major criteria used in positive diagnosis of infective endocarditis:
A) New partial dehiscence of prosthetic valve
B) Typical microorganism for infective endocarditis from 2 separated blood cultures.

26) Select the minor criteria used in positive diagnosis of infective endocarditis (IE):
A) Fever > 38,0
B) Roth spots
C) Major arterial emboli.

27) Prophylaxis of infective endocarditis is recommended in:

A) Bronchoscopy with a rigid bronchoscope
B) Vaginal hysterectomy
C) Cystoscopy

28) Select the complications of infective endocarditis:

A) Mycotic aneurysm
B) Congestive heart failure
C) Myocarditis
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 D) Stroke

29) Select the true statements concerning prosthetic valve endocarditis (PVE):

A) The risk is the greatest during the initial 6 months after valve surgery
B) Resistance to antibiotic therapy is common
C) Microorganisms implicated in PVE reflects the nosocomial infection

30) Select the false statements concerning infective endocarditis:

A) Roth spots are small, blue areas located on palms
B) Immunological test is the most important investigation

31) The pathogenesis of essential hypertension includes the following:

A) Genetic factors
B) Excessive sodium intake
C) Sympathetic nervous system hyperactivity
D) Cell membrane alteration

32) The cardiovascular risk factors in essential hypertension are:

A) Diabetes mellitus
B) Stress
C) Dyslipidemia
D) Low activity level

33) Initial physical exam for hypertensive patients includes:

A) Cardiac and chest exam
B) Neurologic exam
C) Funduscopic exam

34) Diastolic blood pressure which increases in orthostatism with more than 15 mm Hg may suggest:
A) Renovascular hypertension

35) To establish the cardiovascular risk factors in hypertensive patients, some initial tests are
recommend, such as:
A) Total cholesterol
B) HDL cholesterol
C) ECG

36) Primary hypertension stage II is characterized by the following, EXCEPT:

A) Congestive heart failure
B) High resistance to treatment

37) Accelerated hypertension (malignant hypertension) includes:

A) Malignant nephrosclerosis
B) High resistance to treatment
C) Rapid renal failure

38) Positive diagnosis in aortic coarctation includes the following:

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 A) Symmetrical absence of the femoral pulse at the level of the Scarpa’s triangle
B) Visible pulse in the jugular incision
C) Left parasternal systolic ejection murmur in the 3rd i. c. space

39) Select the true blood findings in renovascular systemic hypertension:

A) Mild azotemia
B) Mild proteinuria
C) Plasma renin activity very much increased (> 3,2 ng/ml/min)
D) Alkalosis

40) Pheochromocytoma is having all of the following features, EXCEPT:

A) Abnormal urea clearance
B) Decreased level of fatty acids in the blood

41) Metabolic effects of aldosterone excess in Conn’s adenoma include:

A) Hypernatremia
B) Alkalosis
C) Urinary pH over 6

42) Metabolic disturbances in pheochromocytoma are the following:

A) Increased basal metabolism
B) Increased level of fatty acids in the blood

43) Primary hypertension stage III is characterized by the following:

A) Hypertensive retinopathy
B) Hematuria
C) Congestive heart failure

44) Positive diagnosis in pregnancy systemic hypertension is made in the presence of the following
signs:
A) Edema
B) Proteinuria

45) A 32 years old patient is having the following signs and symptoms: palpitations with tachycardia,
inappropriate increased perspirations, weight loss. Paraclinical investigations: ECG –
repolarization changes, hyperglicemia, VMA in urine – 80 mg/24 h. TA – 195/100 mm Hg. Your
positive diagnosis is:
A) Pheochromocytoma

46) Positive diagnosis of AMI takes into account the following types of criteria:
A) Enzymatic criteria
B) ECG criteria

47) Clinical criteria of AMI diagnosis include:

A) Identification of CAD risk factors
B) Abruptly installed precordial pain
C) Hypotension

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48) Select the true statements concerning AMI:
A) Hypertermia is a severity indicator
B) Nausea and vomiting are frequent

49) ECG criteria in AMI diagnosis include:

A) ST segment elevation
B) Significant Q wave

50) Non Q myocardial infarction is characterized by the following ECG criteria:

A) ST segment depression
B) Negative, symmetrical T wave

51) Associate any localization of the AMI with one of the following ECG criteria:
A) Anterolateral AMI ---3
B) High lateral AMI-----4
C) Anteroseptal AMI----1
D) Inferoposterior AMI----2

1) ST elevation, +/- Q wave, in V1 – V3

2) ST elevation, +/- Q wave, in DII, DIII, aVF
3) ST elevation, +/- Q wave in V3 – V6
4) ST elevation, +/- Q wave in DI, aVL

52) The “mirror image” in V1 and V2 (ST depression) may be seen in:
A) Inferoposterior AMI

53) Differential diagnosis of ECG in AMI includes the following:

A) Acute pericarditis
B) Myocarditis
C) Wolf – Parkinson – White syndrome

54) Arrthytmias due to electrical instabilities in AMI may be:

A) Ventricular tachycardia

55) Class IV of the Forrester’s classification is characterized by:

A) PCP > 18 mm Hg
B) Signs of peripheral hypoperfusion

56) Mechanical complications of AMI are the following, EXCEPT:

A) Pulmonary tromboembolism

57) Select the possible etiology of the primary cardiomyopathy:

A) Dilated cardiomyopathy
B) Restrictive cardiomyopathy

58) Secondary cardiomyopathy may be:

A) Bacterial
B) Granulomatous
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 C) Viral

59) Secondary cardiomyopathy may be caused by:

A) PAN
B) Nutritional disease
C) Toxic aggression
D) Drug therapy

60) Associate the type of cardiomyopathy with its consequence:

A) Dilated---------1
B) Hypertrophic-----------2-
C) Restrictive-------2

1. systolic failure
2. diastolic failure

61) The consumption of alcohol may result in myocardial damage by the next mechanism:
A) Direct toxic effect
B) Nutritional effects
C) Additives in the drinks

62) Major criteria of alcoholic cardiomyopathy are:

A) Heart failure
B) Abuse chronic (> 5 years) and excessive (80 mg/day pure alcohol)

63) Minor criteria of alcoholic cardiomyopathy are

A) Characteristic face
B) IgA increased
C) Korsakov psychosis

64) Clinical features in arrhythmogenic right ventricular dysplasia are the following:
A) Normal physical examination
B) Palpitations

65) Select the true statement(s) concerning idiopathic dilated cardiomyopathy:

A) It is most frequently in blacks and males

66) Clinical features of Idiopathic dilated cardiomyopathy are:

A) Symptoms of left ventricle failure
B) Symptoms of right ventricle failure
C) Systemic embolism

67) Paraclinical investigations in idiopathic dilated cardiomyopathy may show:

A) Hemochromatosis
B) Cardio-thoracic index > 0,60
C) Atrial fibrillation

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68) Select the true statement(s) concerning clinical features in hypertrophic cardiomyopathy:
A) Dyspnea is the most common symptom

69) Chest X – ray in hypertrophic cardiomyopathy may show:

A) Pulmonary stasis
B) LV hypertrophy

70) Echocardiography in hypertrophic cardiomyopathy may reveal the following:

A) Small left ventricular cavity
B) Reduced septal motion

71) The major criteria in hypertrophic cardiomyopathy diagnosis are:

A) Abnormal Q waves

72) Select the possible etiology of primary restrictive cardiomyopathy:

A) Loeffler’s cardiomyopathy
B) Endomyocardial fibrosis

73) Physical examination in restrictive cardiomyopathy reveals following signs of global heart
failure:
A) Presence of S3
B) Presence of S4
C) Peripheral edema
D) Palpable apical impulse

74) The cardinal symptom of angina is the chest pain, having several characteristics:
A) Retrosternal, rarely precordial pain
B) It usually lasts 3 – 5 min, maximum 15 min

75) Cardiac examination in stable angina may reveal during attack:

A) Tachycardia
B) Gallop rhythms
C) Arrhythmias

76) Non–specific symptoms in cardiac arrhythmias may be:

A) Palpitations
B) Dizziness
C) Sudden death

77) Cardiac arrhythmias are characterized by some abnormalities of heart sounds, such as:
A) S2 splitting: bundle branch block

78) Carotid sinus massage is unadvisable in the following disorders:

A) Atrial fibrillation
B) Carotid stenosis
C) Digitalis intoxication

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79) Select the true statements concerning sinus bradycardia:
A) The rate usually decreases during administration of atropine
B) The rate increases during exercise
C) Sinus bradycardia is due to decreased vagal influence on the normal pacemaker
D) Sinus bradycardia can occur also in healthy individuals

80) Paroxysmal supraventricular tachycardia occurs commonly in patients with:

A) Mitral valve prolapse
B) WPW syndrome
C) Acute pericarditis
D) Pulmonary disease

81) The most common mechanism for paroxysmal supraventricular tachycardia is:
A) Reflection
B) Abnormalities of impulse conduction
C) Re-entry
D) Accelerated automacity

82) Select the false statement(s) concerning atrial fibrillation:

A) The heart sounds vary in intensity
B) It may occur in patients with rheumatic heart disease
C) The ventricular response is regular
D) It is characterized by segmental atrial contraction

83) Atrial fibrillation is a major risk factor for:

A) Stroke
B) AMI
C) Thromboembolic phenomena
D) WPW syndrome

84) Select the correct statement(s) about atrial flutter:

A) Atrial flutter is the commonest arrhythmia affecting humans
B) It is almost always associated with organic heart disease
C) The atrial ectopic rate varies between 200 and 260/min
D) The pulse rate is irregular if the AV block is fixed

85) The ECG criteria of the atrial flutter are the following:
A) The atrial rate 400-600/min
B) Usually there is a 2:1 AV block
C) The ventricular rhythm is about 150/min
D) Carotid sinus massage: “button – like effect”

86) Type I atrial flutter is characterized by:

A) It can be always interrupted by rapid atrial pacing
B) It cannot be interrupted by rapid atrial pacing
C) Atrial rates range from 340 to 433/min

87) The ECG criteria of the Wolf – Parkinson – White syndrome are:
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 A) Right QRS axis deviation
B) PR interval < 0,12 s
C) Supraventricular rhythm
D) Narrow QRS complexes

88) Select the true statement(s) concerning ventricular tachycardia:

A) Carotid sinus massage has “button-like effect
B) The usual rate is 120-240/min
C) The usual rate is 300-400/min
D) During a VT episode, the patients may develop dyspnea

89) Ventricular tachycardia ECG criteria are the following:

A) Narrow QRS complexes
B) Regular ventricular rhythm
C) Wide QRS complexes
D) Sudden onset

90) Causes for long QT interval and torsades de pointes tachycardia include:
A) Hypercalcemia
B) Mitral valve prolapse
C) AMI
D) Central nervous system disease

91) Select the false statement(s) concerning physical examination of the heart:
A) The chest should be examined from the patient’s left side
B) An epigastric pulsation suggests aneurysm of the arch of the aorta
C) A slight pulsation can be seen over the lower left parasternal area in adult patients with thin
chest walls

92) The intensity of first heart sound depends on:

A) The mobility of the mitral valve
B) The rate of mitral valve closure
C) Blood pressure

93) Accentuated S1 may occur in:

A) Mitral stenosis
B) Atrial septal defect
C) Mitral regurgitation
D) Congestive heart failure
E) Tricuspid stenosis

94) Select the true statement(s) about pathologic splitting of S2:

A) It usually disappears during expiration
B) Fixed splitting does not vary with respiration
C) Wide splitting may be caused by right bundle branch block

95) Extra heart sounds in systole are the following, except:

A) Aortic ejection sound
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 B) Systolic click
C) The pathologic S3
D) The physiologic S3

96) Select the possible etiology of the midsystolic murmurs:

A) Anemia
B) Fever
C) Aortic stenosis
D) Ventricular septal defect

97) The major risk for atherosclerotic coronary artery disease are:
A) Stress
B) Physical inactivity
C) Arterial hypertension
D) Genetic factors

98) Effects of cigarette smoking on the cardiovascular system are the following:
A) Decreased platelet aggregation
B) Reduced levels of high-density lipoprotein cholesterol
C) Increased fibrinogen levels
D) Decreased alpha-adrenergic tone

99) Type V of lipoprotein phenotypes (Frederickson and Levy classification) includes:

A) Extremely elevated triglycerides
B) Mildly elevated cholesterol
C) Eruptive xanthomas
D) LPL molecular defects

100) Disorders associated with triglycerides < 200 mg/dl are:

A) Hepatic lipase deficiency
B) Polygenic hypercholesterolemia
C) Type V hyperlipoproteinemia
D) Type III hyperlipoproteinemia

101) The most definitive investigation in angina (“the gold standard”) is:
A) ECG during attack
B) Exercise ECG
C) Coronarography
D) CT
E) Pressure catheterism

102) Biochemical tests in angina pectoris may reveal:

A) Hyperlipoproteinemia
B) Normal serum levels of cardiac enzymes
C) Hyperuricemia

103) In rheumatic fever, the following connective tissues are in particular affected:
A) Myocardium
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 B) Endocardium
C) Synovial membranes
D) Ascending aortic wall
E) Pericardium

104) All of the following statements concerning rheumatic fever are correct, EXCEPT:
A) The onset may be sudden with pain, swelling and stiffness in one or more joints, fever,
sweating and tachycardia.
B) The large joints are principally affected, e.g. knees, ankles, shoulders and wrists
C) The disease is often preceded by a streptococcal gr. A tonsillitis or pharyngitis, one to three
days before.
D) Tachycardia tends to be out of proportion to the degree of fever and may persist after the
latter has settled.
E) The commonest ECG changes in rheumatic myocarditis are prolongation of the PR interval
and abnormalities of ST segment and T wave.

105) What are the Stollermann`s criteria of rheumatic carditis ?

A) New cardiac murmur development during rheumatic fever attack
B) Global enlargement of the heart (demonstrated radiological)
C) New ischemic disturbances on ECG.
D) New heart failure signs or symptoms development
E) Pericardial rub development during rheumatic fever attack

106) Select the Anschutz`s criteria of an organic systolic murmur ?

A) Pansystolic
B) The murmur must radiate
C) Changed by respiratory movements
D) High intensity
E) First heart sound is loud
F) No change by patient position

107) Select the true statements:

A) The Still murmur is an early-midsystolic non-radiating functional murmur
B) The Carey-Coombs middiastolic apical murmur is always functional
C) The severity of rheumatic endocarditis murmurs depends on its intensity
D) In rheumatic fever attack, the plasma globulins, specially 2 are diminished
E) The anti-streptolysin “O” titre raising is a major criteria of rheumatic fever

108) The normal mitral valve orifice is about 4 to 6 cm2 in diastole. In tight (severe) mitral stenosis,
the orifice is
A) 1—1,5 cm2
B) < 2 cm2
C) < 1 cm2
D) 1,5—2,5 cm2

109) In mitral stenosis etiology are included the following diseases, EXCEPT:
A) Rheumatic fever
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 B) Congenital lesions
C) Syphilis
D) Systemic lupus erythematosus
E) Cor triatriatum sinistrum

110) Select the false statements concerning haemodynamics in mitral stenosis:

A) The left cardiac output is reduced
B) Reduction in size of the mitral valve orifice and elevated left atrial pressure will primary
induce a rise in pulmonary arteriolar pressure.
C) When a mitral stenosis has right ventricular hypertrophy, the ,,second stenosis” is already
developed in lungs.
D) In mitral stenosis the left ventricular hypertrophy is less severe than in mitral regurgitation
E) Any supraventricular tachyarrhythmia is a great emergency in mitral stenosis, because the
left atrial systole is disturbed.

111) The heart murmur characteristic for mitral stenosis is: (select the best definition)
A) Rumbling, apexian, diastolic murmur, starting after opening snap
B) Rumbling, apexian, diastolic murmur, radiates in axilla
C) Soft blowing, decrescendo diastolic murmur in 5th left i.c. space, Erb area and 2nd right i.c.
space.
D) Pansystolic apexian murmur and loud 1st heart sound
E) Middiastolic apexian murmur diminishing in left side position of the patient

112) The permanent present auscultation signs in mitral stenosis are:

A) Accentuated 1st heart sound + presystolic murmur
B) Accentuated 1st heart sound + rumbling diastolic murmur
C) Opening snap + accentuated 1st heart sound
D) Middiastolic murmur + presystolic accentuation
E) Opening snap + middiastolic murmur

113) The mitral stenosis simptomatology includes the following features, EXCEPT:
A) Systemic embolism
B) Hemoptysis
C) Hoarseness
D) Dyspnea
E) Cough
F) Palpitations
G) Dysphagia
H) Syncope
I) Sudden death
J) Jugular veins distension

114) In mitral stenosis, the ECG may show:

A) Bifid P waves due to left atrial hypertrophy
B) Bifid P waves due to right atrial hypertrophy
C) Biphasic P waves in V1 lead
D) Atrial fibrillation
E) Left ventricular hypertrophy
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115) The chest radiography in mitral stenosis may show:
A) Double contour of the right border of heart
B) Pulmonary haemosiderosis
C) Kerley`s B lines due to interstitial oedema
D) Accentuation of the ,”heart gulf” (depression of the middle left heart arch)
E) Enlarged left atrium displaces the oesophagus posteriorly (lateral view with barium)
F) Prominent inferior left arch of the heart

114) In mitral stenosis, the echocardiography may show the following aspects, EXCEPT:
A) Thickening of the mitral valve cusps
B) Left atrium enlargement
C) Estimation of transvalvular gradient
D) High-frequency fluttering of anterior mitral valve leaflet
E) Mitral valve area
F) Anterior motion of the posterior mitral valve leaflet

115) Select the possible complications of mitral stenosis:

A) Systemic embolization
B) Infective endocarditis
C) Aortic regurgitation
D) Tricuspid regurgitation
E) Systemic hypertension

116) Etiology of acute mitral regurgitation includes:

A) Infective endocarditis
B) Ischemic heart disease with papillary muscle dysfunction
C) Rheumatic fever
D) Mitral valve prolapse
E) Mitral commisurotomy

117) The severity of mitral regurgitation is defined by the quantity of blood that regurgitates from
the L.V. to the L.A. Select the correct volume related to severe mitral regurgitation:
A) < 10 ml/systole
B) 10 ml/systole
C) 20 ml/systole
D) > 30 ml/systole

118) Physical examination in mitral regurgitation includes the following features, with one
EXCEPTION:
A) Wide splitting of 2nd heart sound in expiration period
B) 3rd heart sound
C) Loud apexian holosystolic murmur
D) Loud 1st heart sound
E) Systolic thrill over the apex

119) Investigations in mitral regurgitation may show the following features, EXCEPT:
A) X-ray: left atrium & left ventricular enlargement + pulmonary congestion
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 B) Phonocardiogram: soft blowing, decrescendo diastolic murmur
C) Phonocardiogram: harsh, mid systolic, diamond shape murmur
D) ECG: left ventricular hypertrophy

120) Select the possible etiology of the aortic regurgitation (aortic incompetence):
A) Infective endocarditis
B) Rheumatic fever
C) Syphilis
D) Congenital
E) Dissecting aortic aneurysm
F) Ischemic heart disease

121) Select the false statements concerning aortic regurgitation:

A) Bradycardia is a gravity factor in aortic regurgitation
B) Bradycardia is a compensatory factor in aortic regurgitation
C) Systemic lupus erythematosus is a possible etiology of aortic regurgitation
D) The left ventricle dilates and hypertrophies, so that the inside volume is increased
E) The left ventricle hypertrophies, so that the inside volume is decreased

122) What are the characteristics of the aortic regurgitation murmur ?

A) Soft blowing, decrescendo murmur
B) Linked to the 2nd heart sound
C) Maximum over aortic area and Erb area
D) Best heard if the patient do full inspiration & lean forward
E) Systolic murmur
F) Diastolic murmur

123) Physical examination in aortic regurgitation may show:

A) “Celer et altus” pulse (Waterhammer pulse, Corrigan`s pulse)
B) “Tardus et parvus” pulse
C) Thrusting apex beat
D) Increased systolic & decrease diastolic blood pressure
E) Capillary pulsation (Quinke sign)
F) Pulsation of the head (Alfred de Musset sign)

124) Investigations in aortic regurgitation include all the following EXCEPT:

A) “Boot-shaped heart” (aortic configuration of the heart)
B) Duchosal time increased
C) High-frequency fluttering of anterior mitral valve leaflet
D) Left ventricle enlargement
E) Dilated ascending aorta

125) What are the 3 cardinal symptoms of the aortic stenosis ?

A) Dyspnea
B) Angina pectoris
C) Palpitations
D) Dysphagia
E) Syncope
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126) Write the missing values and features, to define a severe aortic stenosis:
A) ECG:.........................................................................................
B) Phonocardiogram: .....................................................................
C) Carotidogram: Duchosal time.....................................................
D) Echocardiogram: Aortic valve opening:................., Aortic orifice area:........................
E) Pressure gradient L.V—Ao:...........................

127) Ferrer`s definition (1968) of sick sinus syndrome includes the following components
EXCEPT:
A) Severe persistent sinus bradycardia
B) Apparent sinus arrest
C) Slow rate atrial fibrillation
D) Sinoatrial exit block
E) Bradycardia-tachycardia syndrome (alternation of paroxysms of rapid regular or irregular
atrial tachyarrhythmias and periods of slow atrial and ventricular rates)
F) Wandering pacemaker
G) Atrial flutter

128) Carotid massage in atrial flutter will leads to:

A) Decreased conduction in A-V node, so ventricular rate decreases rapidly (immediately),
but on release of pressure, the rate return to its original level, by the same fashion
B) Decreased conduction in A-V node, so ventricular rate decreases slowly.
C) In 50% of cases, the arrhythmia will stop immediately
D) No effect

129) Left bundle branch block diagnostic criteria are the following, EXCEPT:
A) Supraventricular rhythm
B) QRS complex duration > 0.10 seconds
C) Enlarged, monophasic R wave in D1, aVL, V5 & V6 leads
D) ST-T opposition
E) Left axis deviation

130) Wolf-Parkinson-White syndrome includes the following characteristics, EXCEPT:

A) Sinus rhythm
B) “Delta” wave (QRS complex > 0.12 s)
C) P-Q interval > 0.12 s
D) Left axis deviation

131) Silver wiring of retinal arteries & kinking of veins at arteriovenous crossings, means:
A) Retinopathy grade I
B) Retinopathy grade II
C) Retinopathy grade III
D) Retinopathy grade IV

132) A 28 years old patient is admitted in the hospital, having the following sings and symptoms:
headache, tinnitus,epistaxis, coldness & pallor in the lower half of the body, intermittent
claudications in the lower limbs. Pulsating intercostal arteries in the interscapular area especially
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 when the patient bends with the arms hanging down. Femoral pulse is weaker & delayed than the
radial. EKG : left ventricular hypertrophy. Blood pressure: 180/95 mm Hg. Heart rate :
100/min. Your positive diagnosis is:
A) Systemic hypertension due to a congenital cardiac malformation
B) Da Costa syndrome
C) Coarctation of aorta
D) Renovascular hypertension
E) Essential hypertension
F) Pheochromocytoma

133) Dry pericarditis diagnosis includes:

A) Chest pain aggravated by leaning forward, supine position
B) Chest pain aggravated by cough, deep breath
C) Chest pain relieved by sitting upright or “Mohammed-prayer” position
D) Dyspnea
E) Pericardial friction rub
F) Elevated ST segment that includes T wave and is convex upwards

134) Tamponade refers to compression of the heart by a large or rapidly developing effusion,
which interferes with diastolic filling. Positive diagnosis includes:
A) Pulsus paradoxus: diminished pulse volume during inspiration
B) Pulsus paradoxus: diminished pulse volume during expiration
C) Jugular venous pressure increased
D) Hypertension
E) Enlarged tender liver (hepatomegaly)
F) Tachycardia
G) X-ray: pulmonary stasis
H) “Water-bottle configuration” of the heart (increased size of cardiac silhouette)
I) Cough, change of voice, dysphagia & dyspnea

135) The ECG features in pericardial effusion stage I (Braunwald) includes the following, except:
A) Elevated, concave upwards ST segment in DI,II,III, V2-6, aVF (concordant)
B) S wave is kept
C) T wave is not included in ST elevation
D) Amplitude of elevation > 4 mm

136) Select the true statements:

A) Electrical alternans is usually caused by large pericardial effusions
B) Electrical alternans means alternating size of QRS complex
C) Electrical alternans is due to swinging of heart

137) The etiology of constrictive pericarditis includes:

A) Tuberculosis
B) Idiopathic
C) Bacterial pericarditis (suppurative, pyogenic)
D) Myxoedema
E) Nephrotic syndrome
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138) In complicated myocardial infarction, the following arrhythmias are induced by pump failure,
EXCEPT:
A) Atrial fibrillation
B) Atrial flutter
C) > 10/min atrial extrasystolic beats
D) Sinus tachycardia
E) Idioventricular tachycardia (accelerated idioventricular rhythm)

139) Acute mitral regurgitation & interventricular septum rupture caused by myocardial infarction,
have the following common consequences:
A) Systolic apexian murmur
B) Acute heart failure
C) Acute pulmonary edema
D) Cardiogenic shock
E) Systemic hypertension
F) Acute lower limbs edema

140) “Dressler`s syndrome” is:

A) Pericartidis developing in the first 72 hours after myocardial infarction
B) Pleuropericarditis developing 6-12 weeks after myocardial infarction
C) Pericarditis developing during post infarction angina pectoris
D) Pericarditis developing in direct relationship with myocardial aneurysm

141) Select the true statement(s) concerning “the pulseless” disease:

A) The disease is most prevalent in young men
B) The arch of the aorta may be involved
C) Weight loss, fatigue and anorexia are common

142) Clinical features in thoracic aortic aneurysms are:

A) Permanent chest pain radiating to the back
B) Dysphagia
C) Cough

ANSWERS – CARDIOVASCULAR SYSTEM MCQs

1) ABDE 12) ABD 23) ABD

2) ABCDE 13) CD 24) D
3) A 14) ABE 25) CE
4) ABE 15) CD 26) BDE
5) BCE 16) ABCD 27) ABE
6) BC 17) BCE 28) ABDE
7) AC 18) CE 29) BCD
8) ACDE 19) BD 30) AE
9) BC 20) CE 31) ABCE
10) AB 21) BC 32) ABCE
11) ACE 22) ABD 33) ABD

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34) B 75) BCD 116) D
35) ABD 76) ABC 117) AB
36) BC 77) C 118) ABDE
37) BCE 78) BC 119) D
38) ACE 79) BD 120) D
39) BCDE 80) ABD 121) BC
40) AE 81) C 122) ABCDE
41) BCE 82) C 123) BE
42) BD 83) AC 124) ACF
43) ACE 84) B 125) ACDEF
44) CD 85) BCD 126) BC
45) B 86) A 127) ABE
46) BD 87) B 128) A: ECG: left ventricle
47) ABC 88) BD hypertrophy +/- left atrium
48) AC 89) BCD enlargement
49) AB 90) BCD B: Phonocardiogram:
50) BC 91) AB reversed splitting of S2
51) A3, B4, C1, D2 92) AB (during expiration) + S4
52) C 93) ABE C: Duchosal time > 0,06
53) BCD 94) BC s
54) C 95) CD D: Echo: valvular
55) BD 96) ABC opening < 8 mm, aortic
56) B 97) C valve area < 0,75 cm2
57) AC 98) BC E: Pressure gradient: LV
58) ACD 99) AC – AO > 80 mm Hg
59) ABCD 100) B 129) F
60) A1, B2, C2 101) C 130) A
61) ACD 102) ABC 131) BE
62) AC 103) ABCE 132) CD
63) BCE 104) ABDE 133) B
64) CD 105) ABDE 134) C
65) A 106) ABDF 135) BCDE
66) ABC 107) A 136) ACEFHI
67) BCD 108) C 137) D
68) A 109) C 138) ABC
69) AC 110) BDE 139) AB
70) BC 111) A 140) E
71) A 112) C 141) AB
72) AD 113) HI 142) B
73) ABCD 114) ACD 143) BC
74) AB 115) ABCE 144) ABC

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