Cairo University – Faculty of Medicine

Examination of the MD degree

In cardiology

November 23, 2002. Paper I.

Answers of the multiple choice questions in the next volume

( Volume 15 )

All questions should be attempted

Time: 3 hours

1) Discuss the pathophysiology and management of disorders of cardiac repolarization.

(30 marks)

2) Give an account of each of the following:

            a- Cardiovascular consequences of acute mental stress.

(10 marks)

            b- Molecular basis of iron overload cardiac injury.

(10 marks)

            c- Natural history of Kawasaki disease.

(10 marks)

            d- Rehabilitation after cardiac transplantation.

(10 marks)

3) Select the one best response to each of the following questions.

(2 marks each)

    (Write number of the question and the corresponding response in the answer paper)

1- Which of the following statements regarding flow limiting stenosis is true?

      a- a greater basal trans-stenotic pressure results in increased coronary flow reserve.

      b- the subepicardium is most vulnerable to ischemia in the presence of decreased poststenotic pressure.

      c- coronary angiography provides the best assessment of the degree of coronary stenoses.

      d- dynamic stenoses are usually eccentric.

      e- all patients with flow-limiting  stenosis develop collateral circulation.

2- Which of the following statements regarding the postoperative management of a patient following bypass surgery is true?

      a- the transient myocardial depression that is present following bypass surgery is attributed to the effects cardiopulmonary bypass (CPB).

      b- depressed myocardial function is directly related to CPB.

      c- hypothermia may result in postoperative hypotension.

      d- generally a localized bleeding site, such as an internal mammary pedicle, is responsible for severe, postoperative bleeding.

      e- if vasodilatation with increased venous capacitance is considered responsible for hypotension, the patient should be given coloids.

3- Which of the following would NOT be inhibited by warfarin?

      a- factor VII

      b- protein C

      c- factor XII

      d- factor II

      e- protein S

4- Which of the following statements regarding cost-effective strategies in the treatment of heart failure is true?

      a- digoxin therapy is cost saving if the incidence of digoxin toxicity is less than 5 percent

      b- digoxin therapy in appropriate patients is cost neutral

      c- disease management programs are not cost effective

      d- angiotensin-converting enzyme (ACE) inhibitor therapy in heart failure is cost saving

      e- the cost-effectiveness of carvidolol makes it more attractive than ACE inhibition

5- which of the following statements regarding recent advances in EP mapping technique is true?

      a- the main value of endocardial mapping is to determine the utility of various antiarrhythmic drugs

      b- the CARTO endocardial mapping system utilized a magnetic field generator pd under the patient table coupled with an endocardial reference catheter to produce a color-coded 3D image of the direction of impulse propagation.

      c- the EnSite 3000 endocardial mapping system uses a balloon with an array of 64 sensors on its surface coupled with an external high-frequency transmitter to produce a 3D image of the direction of impulse propagation.

      d- the CARTO device is not applicable to the mapping of atrial flutter.

      e- the EnSite 3000 is useful for mapping the site of left-sided accessory pathways.

6- which of the following statements regarding heart tube development is true?

      a- laminin and type IV collagen are responsible for setting up migratory pathways through the cardiac jelly.

      b- cells of the cardiac jelly eventually make up the fibrous skeleton of the cardiac valves.

      c- as the tubular heart grows, it bends to the left and anteriorly.

      d- the outflow tract of the heart while in the heart tube formation is connected only to the right ventricle.

      e- the formation of a d-loop results in ventricular inversion along with transposition of the great arteries.

7- which of the following statements regarding pericardial heart disease is true

      a- pericardial disease is present in up to 50 percent of HIV-positive patients but is not indicative of poor prognosis.

      b- pericarditis is associated with HIV infection, Lyme disease, tuberculosis, uraemia, and immunosuppression.

      c- bacterial infections are the most common cause of pericarditis in hospitalized patients.

      d- thrombolytic therapy increases the incidence of post-infarction pericarditis.

      e- congenital malformation of the pericardium usually require surgical repair within the first year of life.

8- which of the following statements regarding acquired immune deficiency syndrome (AIDS) and cardiomyopathy is true?

      a- symptomatic cardiomyopathy is commonly associated with humen immunodeficiency virus type (HIV-1) infection.

      b- echocardiographic evidence of left ventricular dysfunction is seen less commonly than symptoms are reported.

      c- heart failure is responsible for a significant number of AIDS-related deaths.

      d- there is a greater mean intensity of tumor necrosis factor a (TNF-a) in HIV patients compared with idiopathic cardiomyopathy patients.

      e- most cardiac damage is as a result of the HIV virus invading the myocyte using the CD4 + receptor.

9- which of the following statements is characteristic of the cardiomyopathy caused by the anthracycline chemotherapeutic agents?

      a- about half of the subjects who develop anthracycline cardiomyopathy will recover completely.

      b- subjects who present early have a better prognosis.

      c- there is a characteristic extracellular deposition of proteins.

      d- there is a relative absence of hypertrophy and dilatation and a higher heart rate than that usually.

10- which of the following statements regarding the genetics of single-gene disorder is true?

      a- allele heterogeneity refers to the same disease being due to single or multiple mutations in two or more genes.

      b- an elongated mutant is a result of two genes interacting and part of the nucleotide sequence of one becoming incorporated into the other.

      c- to have expressivity, a genetic trait must be penetrant.

      d- in a disease with autosomal dominant inheritance, normal children of affected individuals will have affected offspring approximately half of the time.

      e- women are affected more often that men in diseases with X-linked inheritance.

11- which of the following statements regarding the selection of lesions for PCI is true?

      a- a lesion with heavy calcification has a 60 to 85 percent success rate.

      b- a type C lesion has a high success rate following coronary intervention.

      c- eccentric lesions have a low success rate.

      d- a lesion the is diffuse (>2cm in length) carries moderate risk.

      e- in-stent restenosis occurs through a combination of negative remodeling and intimal proliferation.

12- which of the following statements regarding myocardial trabeculation is true?

      a- rapid cell division of endothelial cells along the endocardial tube and rapid reabsorption of cardiac jelly results in myocardial ridges and trabeculae.

      b- myocardial trabeculation generally extends toward the further apex of the heart.

      c- there are no distinct morphologic differences between the trabeculation of the trabeculation of the right and left ventricles in the embryonic heart.

      d- in noncompaction of the ventricular myocardium, there is always right ventricular involvement regardless of whether the left ventricle is involved or not.

      e- there is generally low familial recurrence with noncompaction of the ventricular myocardium.

13- a patient shows progressive atrial dysfunction that eventually results in permanent paralysis of the atria. Histopathologic studies show myofibril necrosis and interstitial accumulation of fat. The disease shows patterns of autosomal dominant inheritance. What is the most likely diagnosis?

      a- Duchenne's muscular dystrophy.

      b- myotubular (centronuclear) myopathy.

      c- Fasioscapulohumeral muscular dystrophy.

      d- Becker's muscular dystrophy.

      e- myotonic dystrophy.

14- which of the following statements regarding paring costs with outcome is true?

      a- patient utility is often used to compare various measures of outcome.

      b- patient utility does not vary with time.

      c- the patient preference method of time tradeoff measures the risk of death that are willing to take to live in perfect health.

      d- life-expectancy is note included in the measures of st-effectiveness.

      e- death is often the only outcome considered in cost effectiveness measures.

15- which of the following statements regarding acute thrombosis is true?

      a- strong thrombogenic stimuli cause growth the white thrombi.

      b- a local inflammatory activation by infections or noninfectious stimuli represents a strong thrombogenic stimuli.

      c- thrombus formation is the first physiologic self-limiting step of vascular injury repair.

      d- occlusive thrombosis can be caused by weak, nonpersistent thrombogenic stimuli with a normal circulatory state.

      e- plaque vulnerability usually lasts for only a few days.