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DIRECTIONS: Each question below contains five suggested responses. Select the ONE BEST
response to each question.
1. Each of the following heart sounds may occur shortly after S2 EXCEPT:
A. Opening snap
C. Ejection click
D. Tumor plop
E. Pericardial knock
A. This is a continuous murmur, most likely a venous hum commonly heard in adolescents
C. This is a continuous murmur due to a congenital shunt, likely a patent ductus arteriosus
D. Continuous murmurs of this type can only be congenital; murmurs due to acquired
arteriovenous connections are purely systolic
E. This murmur, the result of left subclavian artery stenosis, is not considered continuous, as a
continuous murmur can result only from an arteriovenous communication
3. Unequal upper extremity arterial pulsations are commonly found in each of the following
disorders EXCEPT:
A. Aortic dissection
B. Takayasu’s disease
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E. Subvalvular aortic stenosis
4. All of the following statements about pulsus paradoxus are true EXCEPT:
C. Pulsus paradoxus is observed in patients with pulmonary disease associated with wide swings
in intrathoracic pressure
D. In the presence of aortic regurgitation, pulsus paradoxus is less likely to develop, despite the
presence of tamponade
5. Which of the following electrocardiographic features is typical of left anterior fascicular block?
6. True statements about the blood pressure response during exercise testing include all of the
following EXCEPT:
A. Normal subjects will display a progressive increase in systolic blood pressure to a peak level
between 160 and 220 mm Hg
B. Black subjects tend to have higher systolic blood pressure responses than white subjects
2
E. Postexercise hypotension is less suggestive of severe underlying coronary artery disease than
is exertional hypotension
7. Each of the following statements regarding splitting of the second heart sound is true EXCEPT:
B. Delayed closure of the pulmonic valve with inspiration contributes to physiologic splitting of S 2
C. Fixed splitting of S2 is the auscultatory hallmark of an ostium secundum atrial septal defect
A. This test is conclusive for severe stenosis of the proximal right coronary artery
B. His risk of death due to an acute myocardial infarction (MI) during the next year is greater than
50 percent
D. The test predicts a 25 percent risk of cardiac events over the next 5 years, most likely the
development of angina
9. In which of the following clinical scenarios do ST depressions during standard exercise testing
increase the diagnostic probability of significant coronary artery disease?
A. A 56-year-old man with left bundle branch block and a family history of premature coronary
disease
B. A 45-year-old woman with diabetes and hypertension, with left ventricular hypertrophy on her
baseline ECG
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C. A 76-year-old woman with new exertional dyspnea, a history of cigarette smoking, and a
normal baseline ECG
D. A 28-year-old woman with pleuritic left-sided chest pain following a gymnastics class
E. A 63-year-old man with exertional dyspnea on beta-blocker, digoxin, and nitrate therapy
10. Each of the following statements regarding cardiac catheterization is true EXCEPT:
E. Retrograde left heart catheterization should not be performed in patients with tilting-disc
prosthetic aortic valves
11. A 75-year-old woman was brought to the catheterization laboratory in the setting of an acute MI.
She presented with chest pain, epigastric discomfort, and nausea. Physical examination was pertinent
for diaphoresis, bradycardia (heart rate = 52 beats per minute), hypotension (blood pressure = 85/50),
jugular venous distension, and slight bilateral pulmonary rales. Coronary angiography demonstrated
ostial occlusion of a dominant right coronary artery, without significant left-sided coronary artery
disease. The presenting ECG likely showed all of the following features EXCEPT:
C. Sinus bradycardia
E. PR segment depression
12. Using Doppler ultrasound methods, the following values are obtained for a patient with a
restrictive ventricular septal defect (VSD) and mitral regurgitation: systolic mitral flow velocity = 5.8
m/sec, systolic flow velocity at the site of the VSD = 5.1 m/sec. The patient’s blood pressure is
144/78. The estimated right ventricular systolic pressure is (choose the single best answer):
4
A. 35 mm Hg
B. 40 mm Hg
C. 45 mm Hg
D. 50 mm Hg
E. 55 mm Hg
13. Which of the following statements regarding left bundle branch block (LBBB) is true?
A. The majority of patients with LBBB do not have structural heart disease
B. In LBBB the second heart sound is widely split with normal respiratory variation
D. In LBBB the T wave vectors are oriented in the same direction as the QRS complex
A. The bluish discoloration of cyanosis results from either an increased amount of reduced
hemoglobin or the presence of abnormal hemoglobin pigments
C. Patients with marked polycythemia become cyanotic at higher levels of arterial oxygen
saturation than patients with normal hematocrit
15. Each of the following statements regarding cardiac hemodynamics is true EXCEPT:
A. The x descent of the right atrial pressure waveform represents relaxation of the atrium and
downward pulling of the tricuspid annulus by right ventricular contraction
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B. In the left atrium, in contrast to the right atrium, the v wave is more prominent than the a wave
16. For which of the following scenarios is the diagnostic sensitivity of standard exercise testing
sufficient to forego additional imaging with either nuclear scintigraphy or echocardiography?
A. A 53-year-old woman with hypertension and left ventricular hypertrophy who has developed
exertional chest pressure
B. A 74-year-old man with two prior myocardial infarctions and left ventricular dysfunction, on
angiotensin converting enzyme (ACE) inhibitor, beta-blocker, and digoxin therapy
D. A 44-year-old male smoker with Wolff-Parkinson-White syndrome and a positive family history
of coronary artery disease with new exertional chest discomfort
E. A 53-year-old man with hyperlipidemia, a normal baseline ECG, and sharp, fleeting chest
pains
17. All of the following statements about the ECG depicted in (Fig. 1) are correct EXCEPT:
C. The Ashman phenomenon is based on the fact that the refractory period is directly related to
the length of the preceding R-R interval
D. Right bundle branch block morphology is more commonly associated with this type of
aberrancy
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E. Because the bundle of His has the longest refractory period, it is the likely anatomical location
of the conduction delay
A. Early systolic
B. Presystolic
C. Midsystolic
D. Holosystolic
E. Early diastolic
19. Which of the following statements about the jugular venous waveform are true? Answer true (T)
or false (F):
A. The Kussmaul sign may be present in either constrictive pericarditis or congestive heart failure
B. The c wave is a reflection of ventricular diastole and becomes visible in patients with diastolic
dysfunction
D. Phasic declines in venous pressure (the x and y descents) are typically more prominent to the eye
than the positive pressure waves (the a, c, and v waves)
20. Each of the following statements regarding the measurement of cardiac output is true EXCEPT:
A. In the thermodilution method, cardiac output is directly related to the area under the
thermodilution curve
C. In the presence of tricuspid regurgitation, the Fick technique is preferred over the
thermodilution method for measuring cardiac output
D. A limitation of the Fick method is the necessity of measuring oxygen consumption in a steady
state
7
21. Which of the following conditions is associated with the Doppler transmitral inflow pattern shown
in the figure (Fig. 2)?
A. Gastrointestinal hemorrhage
B. Constrictive pericarditis
C. Normal aging
D. Restrictive cardiomyopathy
E. Hyperthyroidism
22. A 71-year-old woman is hospitalized because of a non-Q wave MI. On the fourth hospital day
she is asymptomatic, ambulating around the hospital floor. Her medications include aspirin, a beta-
blocker, an ACE inhibitor, and an HMG CoA reductase inhibitor. She undergoes predischarge
exercise testing, and is able to complete 9 minutes on a modified Bruce protocol (5 METS) without
symptoms or ST segment changes. Her heart rate increases from 62 to 104 during exercise (70
percent of maximal predicted heart rate), and her blood pressure rises from 120/72 to 162/74. Which
of the following statements is true?
A. The test is invalid because of inability to reach target heart rate; the beta-blocker should have
been discontinued prior to testing
B. She is ready for discharge and can return to her usual light housekeeping
C. Since she suffered a non-Q wave infarction, her risk of subsequent events is high and she
should undergo cardiac catheterization for further risk stratification
8
23. The Doppler tracing in Fig. 3 permits accurate assessment of each of the following EXCEPT:
24. A patient with a long history of pulmonary emboli undergoes noninvasive assessment of cardiac
status by Doppler echocardiography. Assuming the following values:
RA pressure = 4 mm Hg
A. 64 mm Hg
B. 68 mm Hg
C. 50 mm Hg
D. 20 mm Hg
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E. Insufficient information to determine the value
25. Which of the following statements is true regarding the response to aerobic exercise in healthy
older adults?
A. Ventricular stroke volume decreases with age such that there is an age-related fall in cardiac
output during exercise
B. Systolic and diastolic blood pressures each rise significantly during aerobic exercise
E. Maximum aerobic capacity does not change significantly with age in sedentary individuals
26. Physiological states and dynamic maneuvers alter the characteristics of heart murmurs. Which
of the following statements is correct?
A. In acute mitral regurgitation, the left atrial pressure rises dramatically so that the murmur is
heard only during late systole
B. Rising from a squatting to a standing position causes the murmur of mitral valve prolapse to
commence later in systole
C. The diastolic rumble of mitral stenosis becomes more prominent during the strain phase of a
Valsalva maneuver
D. The murmur of aortic stenosis, but not mitral regurgitation, becomes louder during the beat
following a premature ventricular contraction
27. All of the following are true regarding the echocardiographic assessment of mitral regurgitation
(MR) EXCEPT:
C. Regurgitant color flow Doppler jets directed toward the atrial wall underestimate the severity of
MR
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D. Echocardiography may be used to assess the hemodynamic consequences of MR
28. Findings easily shown on both two-dimensional and M-mode echocardiography in mitral
stenosis include all of the following EXCEPT:
B. Inadequate separation of the anterior and posterior leaflets of the valve during diastole
D. The presence of fibrosis and calcifications as revealed by an increase in the number of echoes
29. Which of the following statements regarding ST segment changes during exercise testing is
true?
A. The ECG localization of ST segment depression predicts the anatomic territory of coronary
obstructive disease
D. Persistence of ST depression for 60 to 80 msec after the J point is necessary to interpret the
ECG response as abnormal
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A. Reversal of limb leads
A. Regardless of the exercise protocol, in order to achieve a valid test the heart rate and systolic
and diastolic blood pressures must all increase substantially
B. A fall in systolic blood pressure during exercise is associated with more severe coronary artery
disease
D. Bicycle, treadmill, and arm ergometry protocols all produce approximately equal heart rate and
blood pressure responses
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32. Which of the following patients is LEAST likely to have a cardiac cause of his/her recent onset of
dyspnea?
A. An active 54-year-old man with a congenitally bicuspid aortic valve who has recently noticed
shortness of breath walking his usual 18 holes of golf
B. A 70-year-old woman who sustained an anterior MI 1 year ago with a left ventricular ejection
fraction of 50 percent at that time. She has not had recurrent angina but has noted dys-pnea during
her usual housework over the past 2 months
C. A 46-year-old woman with a history of asymptomatic rheumatic mitral stenosis who recently
noticed irregular palpitations and shortness of breath while climbing stairs
D. A 38-year-old woman with a small ostium secundum atrial septal defect, now 8 months
pregnant, who has noted shortness of breath during her usual weekly low-impact aerobics class
E. A 22-year-old man with trisomy 21 and a heart murmur noticed shortness of breath carrying
grocery bundles over the past 3 months
33. Which of the following ECG findings is LEAST likely in a patient experiencing an acute anterior
Q-wave MI
C. New RBBB
34. All of the following statements regarding nuclear imaging and acute MI are true EXCEPT:
A. The size of the resting myocardial perfusion defect after acute MI correlates with the patient’s
prognosis
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B. Increased lung uptake of Tl at rest correlates with an unfavorable prognosis
C. Submaximal exercise imaging prior to discharge from the hospital is a better predictor of late
complications from acute MI than adenosine or dipyridamole myocardial perfusion imaging
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E. Measuring infarct size by 99mTc-sestamibi prior to discharge from the hospital is a reliable way
to predict subsequent ventricular remodeling
35. Which of the following statements regarding ST segment elevation during exercise is true?
C. The ECG leads manifesting ST elevation localize the anatomic regions of ischemia
36. All of the following are true of prognosis as determined by myocardial perfusion imaging
EXCEPT:
D. The combination of clinical and cardiac catheterization data provides more prognostic
information than the combination of clinical and myocardial perfusion data
E. Both the number and extent of myocardial perfusion defects and the magnitude of defect
reversibility are predictors of future cardiac event
37. All of the following statements concerning radiographic contrast agents are true EXCEPT:
B. Nonionic, low osmolar contrast agents cause fewer acute adverse hemodynamic and
arrhythmic side effects than ionic agents
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C. There is no advantage of low osmolar contrast over ionic contrast in the prevention of
nephrotoxicity in patients with normal renal function
D. Saline hydration is less effective than furosemide and mannitol for prevention of contrast-
induced nephrotoxicity in patients with baseline renal insufficiency
38. Each of the following statements regarding intracardiac shunts is true EXCEPT:
A. A left-to-right shunt should be suspected if the difference in oxygen saturation between the
superior vena cava and the pulmonary artery is 8 percent or more
B. Oxygen saturation in the inferior vena cava (IVC) is normally higher than that in the superior
vena cava (SVC)
C. In a suspected atrial septal defect with left-to-right flow, mixed venous O2 content should be
measured at the level of the pulmonary artery
D. A pulmonic-to-systemic blood flow ratio of less than 1 indicates a net right-to-left shunt
E. Pulmonary artery oxygen saturation exceeding 80 percent should raise the suspicion of a left-
to-right shunt
DIRECTIONS: Each question below contains suggested answers. For EACH of the alternatives, you
are to respond either TRUE (T) or FALSE (F). In a given item, ALL, SOME, OR NONE OF THE
ALTERNATIVES MAY BE CORRECT.
40. Which of the following statements regarding echocardiography in pericardial disease are true?
A. Small pericardial effusions tend to accumulate anterior to the heart, adjacent to the right ventricular
free wall
C. In cardiac tamponade, right ventricular diastolic collapse may be absent in the presence of
pulmonary hypertension
D. In the presence of a pericardial effusion, right atrial diastolic indentation is a less specific sign of
cardiac tamponade than early diastolic collapse of the right ventricle
41. For each of the following statements about nuclear imaging in cardiac disease, indicate true (T)
or false (F):
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A. Similar to exercise ECG testing, stress myocardial perfusion imaging is less accurate in women
B. Patients with complete left bundle branch block should be studied with dipyridamole or adenosine,
rather than exercise, to avoid artifactual perfusion defects
C. Nuclear myocardial perfusion imaging has been found to be a useful modality for preoperative
assessment of cardiac risk for both cardiac and noncardiac surgery
D. It has been shown that outcomes are similar in diabetics compared to nondiabetics for any given
myocardial perfusion defect
42. Which of the following statements concerning the echocardiographic evaluation of aortic
stenosis are true?
A. The peak instantaneous pressure gradient agrees well with the peak-to-peak gradient measured at
cardiac catheterization
B. It is not necessary to calculate an aortic valve area if the peak aortic flow velocity is between 2 and
3 m/sec, since this never represents significant aortic stenosis
C. Among echocardiographic-Doppler techniques, the most accurate transaortic valve flow velocity in
aortic stenosis is determined by pulsed wave Doppler
D. The greatest degree of error in the calculation of aortic valve area using the continuity equation
resides in inaccurate measurement of the left ventricular outflow tract diameter
E. The mean aortic valve gradient measured by Doppler echocardiography is invariably higher than
the mean gradient measured by cardiac catheterization
43. With reference to intracardiac shunts, which of the following statements are true?
A. In normal subjects, O2 content in different portions of the right atrium may vary by as much as 2
volumes percent (20 ml O2/L), reflecting that streaming of blood received from the SVC, the IVC, and
the coronary sinus occurs in the right atrium
B. Atrial septal defect, anomalous pulmonary venous drainage, and ruptured sinus of Valsalva may all
lead to significant step-up in O2 saturation values between the venae cavae and the right atrium
C. Because of the normal variability in O2 saturation, shunts with pulmonary-to-systemic flow ratios
(Qp/Qs) 1.3 at the level of the pulmonary artery or right ventricle may escape detection by oximetry
run analyses
D. When a shunt is unidirectional (e.g., left-to-right only), its magnitude is calculated as the difference
between the pulmonary and systemic blood flows as determined using the appropriate variations of
the Fick equation
E. In patients with a pure right-to-left shunt, such as in tetralogy of Fallot, the calculated right-to-left
shunt will be a negative value
44. Which of the following findings of an exercise test are associated with multivessel (or left main)
coronary artery disease?
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A. Early onset of ST segment depression
45. Which of the following statements about the Doppler flow tracing in Fig. 6 are true?
D. Based on the Doppler findings, one would expect to find premature closure of the mitral valve on
M-mode echocardiographic examination of this patient
E. One would expect the two-dimensional (2D) echocardiogram of this patient to reveal left ventricular
hypertrophy
46. Which of the following imaging techniques are capable of correctly identifying acutely necrotic
myocardial tissue?
A. 99mTc-pyrophosphate scintigraphy
B. Echocardiography
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C. Monoclonal antimyosin-specific antibody scintigraphy
D. Coronary angiography
47. Which of the following statements regarding abnormalities of the extremities in cardiac
conditions are true? Respond true (T) or false (F).
D. Janeway lesions are small, tender hemorrhagic lesions on the hands and feet in patients with
infective endocarditis
48. Which of the following statements are true regarding the echocardiographic evaluation of
suspected infective endocarditis?
A. After successful antibiotic therapy, previously detected vegetations should not be visible by
echocardiography
B. Bacterial vegetations are most commonly located on the downstream, lower-pressure side of a
valve
C. Serial echocardiograms should be obtained during antibiotic therapy, even if clinical improvement
is evident
D. Functional and structural consequences of valvular infection are rarely observed by transthoracic
echocardiographic evaluation, and transesophageal study is mandatory
49. Which of the following statements regarding the arterial pulse are true? Respond true (T) or
false (F).
A. A reduced carotid pulse with a late systolic peak is characteristic of severe aortic stenosis
B. A bisferious pulse is characterized by a systolic and then a diastolic peak and is typical of mixed
mitral valve disease
C. The carotid artery is the blood vessel used to best appreciate the contour, volume, and consistency
of the peripheral vessels
D. In coarctation of the aorta, there is a distinct difference in the examination of the brachial and
femoral pulses, with the lower extremity pulses having smaller volumes and later peaks
E. The abdominal aorta is normally palpable both above and below the umbilicus
18
50. Correct statements regarding coronary angiography include which of the following? Respond
true (T) or false (F).
A. The risk of retroperitoneal hemorrhage is decreased when the femoral artery puncture is made
proximal to the inguinal ligament
D. Patients with a history of contrast allergy should not undergo coronary angiography
51. Which of the following statements are true regarding the use of cardiopulmonary exercise
testing in patients with congestive heart failure? Respond true (T) or false (F).
B. Patients with ejection fractions less than 20 percent consistently have peak oxygen consumptions
less than 10 ml/kg/min, and exercise testing is of little utility in this population
C. The exercise limitation in severe heart failure is due primarily to an inability to raise the heart rate
D. Exercise training in congestive heart failure patients results in decreased functional capacity
E. Results of exercise testing are rarely used when making clinical decisions in heart failure patients,
such as timing for cardiac transplantation
52. Which of the following statements concerning the echocardiographic findings in HCM are true?
A. The presence of systolic anterior motion of the mitral valve is a sensitive and specific finding in
HCM
B. Early systolic closure of the aortic valve, while indicative of significant outflow obstruction, is not a
specific sign of HCM
53. Which of the following associations between altered electrolytes and ECG abnormalities are
true?
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D. Hypokalemia causes peaked T waves
54. True statements about the effects of maneuvers on auscultation of cardiac murmurs include
which of the following? Respond true (T) or false (F).
A. In patent ductus arteriosus, the diastolic phase of the murmur is intensified by isometric hand grip
B. The murmur of hypertrophic obstructive cardiomyopathy becomes softer with standing or during a
Valsalva strain maneuver
D. Sudden squatting or isometric handgrip increases the diastolic murmur of aortic regurgitation
E. The middiastolic and presystolic murmurs of mitral stenosis become louder with exercise
55. Which of the following statements about diastolic murmurs are true (T) and which are false (F)?
A. Diastolic murmurs are classified according to their time of onset as early diastolic, middiastolic, or
late diastolic
B. In aortic regurgitation due to aortic root dilatation, the murmur typically radiates to the right sternal
border
C. It is impossible to differentiate the murmur of acute aortic regurgitation from that of chronic aortic
regurgitation
D. The presence of a late diastolic (presystolic) murmur indicates that the patient is in atrial fibrillation
56. Which of the following statements regarding coronary artery anatomy are true? Respond true
(T) or false (F).
A. The left main coronary artery is best visualized in the anteroposterior (AP) projection with slight
caudal angulation
D. The most densely vascularized area of the heart is the interventricular septum
E. Coronary artery fistulae are the most common coronary congenital abnormalities that are
hemodynamically significant
57. True statements about continuous murmurs include which of the following? Respond true (T) or
false (F).
20
B. By definition, a continuous murmur must continue without interruption through S1
58. Which of the following echocardiographic findings suggest that aortic regurgitation is severe?
D. A color Doppler regurgitant jet extends to the tips of the papillary muscles
59. Which of the following statements regarding pharmacological agents used in myocardial
perfusion stress testing are true? Respond true (T) or false (F).
A. Patients who cannot perform exercise can be evaluated for coronary artery disease (CAD) with
vasodilating medications
60. True statements about digitalis-induced arrhythmias include all of the following EXCEPT:
C. Ventricular bigeminy with varying morphology and regular coupling may be a sign of digitalis
toxicity
D. Atrioventricular (AV) dissociation in a patient taking digitalis is a strong indication of digitalis toxicity
E. Ventricular premature contractions are not highly specific for toxicity in the patient on digitalis
therapy
61. Conditions that may mimic the pain of myocardial ischemia include which of the following?
Respond true (T) or false (F).
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A. Esophageal spasm
B. Aortic dissection
C. Herpes zoster
D. Bronchiectasis
E. Costal chondritis
62. Which of the following statements regarding exercise testing in symptomatic patients are true
(T) and which are false (F)?
A. Patients with chronic ischemic heart disease should undergo exercise testing before angiography
unless specific contraindications exist
B. In the presence of chronic stable angina pectoris, an excellent exercise tolerance is not as precise
a predictor of prognosis as the anatomical extent of coronary artery disease
C. Symptomatic patients who are unable to exercise past Bruce stage I and who exhibit 1 mm or
more of ST-segment depression have an annual mortality of 5 percent or more based on the CASS
study
E. In the CASS study, patients stratified by coronary anatomy and left ventricular function had similar
survival rates regardless of whether their ischemia was silent or symptomatic
63. Which of the following statements regarding cardiac arrhythmias and conduction disturbances
during exercise testing are true and which are false?
B. Patients with arrhythmias who develop QT interval prolongation during exercise testing are likely to
benefit from type IA antiarrhythmic drugs
D. Patients who develop exercised-induced LBBB have a threefold increase in subsequent cardiac
morbidity and mortality
E. Tachyarrhythmias are commonly precipitated during exercise testing in patients with Wolff-
Parkinson-White syndrome
A. Ejection sounds of aortic origin are most prominent in association with a deformed aortic valve,
such as a bicuspid valve, or in congenital or rheumatic aortic stenosis (AS)
B. While aortic ejection sounds due to a dilated aortic root may be less prominent than those
associated with valvular disease, they have a similar timing early in systole
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C. A decrease in intensity of the pulmonic ejection sound with inspiration is heard in pulmonic valve
stenosis
D. It can be shown by echophonocardiography that high-frequency ejection sounds start before the
aortic or pulmonic valve is completely open
65. Which of the following statements regarding the ECG in chronic obstructive lung disease with
secondary right ventricular hypertrophy are correct? Respond true (T) or false (F).
66. Which of the following conditions are often associated with a prominent R wave in
electrocardiographic lead V1? Respond true (T) or false (F).
B. Wolff-Parkinson-White syndrome
67. The cardiac catheterization tracing in Fig. 7 could be associated with the following features:
A. A large systolic pressure gradient between the left ventricle and aorta
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B. A bifid aortic pulse contour
D. A slow and delayed rise in the aortic pressure as compared with that of the left ventricle
68. Which of the following statements about the second heart sound (S2) are true (T) and which are
false (F)?
C. Physiological splitting of S2 results mainly from the earlier timing of A2 following inspiration
69. Which of the following bedside maneuvers are useful to distinguish the murmur of mitral valve
prolapse from other valvular lesions? Respond true (T) or false (F).
A. Isometric handgrip
D. Valsalva maneuver
70. Rotation of the heart within the chest cavity results in which of the following changes in the ECG?
A. A “horizontal” heart leads to a QRS complex in aVL that resembles that in leads V5 and V6
B. “Clockwise rotation” causes the “rS” portions of the QRS complex to be present in leads V2 to V5
C. A “vertical” heart leads to a QRS complex in lead aVF that resembles that in leads V5 and V6
A. A patient with a 50 percent stenosis of the right coronary artery will likely develop ischemic ST
changes in ECG leads II, III, and aVF at a peak rate-pressure product less than 15,000 mm Hg ·
beats/min
D. Failure of systolic blood pressure to rise during exercise is a common response in normal
24
E. Maximal predicted heart rate is approximately 220 minus the patient’s age
72. Which of the following statements concerning the cardiac catheterization laboratory evaluation of
valve orifice areas are true?
A. Valve area in cm2 is calculated as: Flow (in ml/sec) ÷ K X (mean pressure gradient in mm Hg)1/2,
where K is an empirical constant for the valve in question
B. The presence of valvular regurgitation will result in a falsely low calculated valve area because
actual flow across the valve is greater than the flow calculated from the systemic cardiac output
C. Calculation of mitral valve area often relies on substitution of a confirmed pulmonary capillary
wedge pressure for left atrial pressure
D. Valve area calculation is more strongly influenced by errors in the pressure gradient measurement
than by errors in cardiac output measurement
73. A 54-year-old man who underwent coronary artery bypass grafting 4 years ago has ST and T
wave abnormalities on his baseline ECG. During exercise myocardial perfusion imaging, he stopped
at 5 minutes (stage II) of the standard Bruce treadmill protocol because of fatigue. The accompanying
99mTc-sestamibi images (Fig. 8) demonstrate which of the following? Respond true (T) or false (F).
A. No perfusion defects
74. Which of the statements below concerning the ECG in MI are true (T) and which are false (F)?
25
A. In the majority of patients presenting early with an MI, the initial ECG is nondiagnostic
B. The time of onset of Q waves varies between several hours and 1 or 2 days
D. Infarction of an electrocardiographically silent area of the heart is one of several explanations for a
normal ECG in patients with evolving MI
75. Which of the following statements regarding the effect of the potassium concentration on the ECG
are true and which are false?
76. Computed tomography of the pericardium can delineate or differentiate which of the following
features?
77. Which of the following conditions can result in significant electrocardiographic Q waves in the
absence of infarction? Respond true (T) or false (F).
A. Cerebrovascular accident
D. Acidosis
E. Wolff-Parkinson-White syndrome
DIRECTIONS: The group of questions below consists of lettered headings followed by a set of
numbered items. For each numbered item select the ONE lettered heading with which it is MOST
26
closely associated. Each lettered heading may be used ONCE, MORE THAN ONCE, OR NOT AT
ALL.
For each of the chest roentgenograms shown (Fig. 9. A–D), match the most appropriate
cardiac diagnosis:
27
78. Mitral stenosis
28
Match each of the following clinical scenarios to the most likely cause of syncope:
A. Ventricular tachycardia
B. High-degree AV block
C. Epilepsy
D. Neurocardiogenic syncope
E. Hysterical fainting
82. A 73-year-old man with a remote history of MI feels the onset of palpitations while driving, then
awakens having driven his car into a ditch, unaware of what has transpired
83. A 25-year-old woman on chronic antiseizure medication becomes warm, diaphoretic, and very
pale after donating blood, then suffers frank syncope while seated upright in a chair. After being
helped to the floor, she awakens embarrassed and alert
84. A 73-year-old woman with recent episodes of dizziness begins to feel lightheaded while seated at
church, then within seconds turns pale and slumps to the floor with a few clonic jerks. She regains
consciousness 1 minute later, completely aware of where she is and asks what has happened. When
an ambulance arrives, her heart rate is 48 beats per minute
85. A 32-year-old man with a history of prior syncope notices an odd odor, after which he falls to the
ground. He awakens 3 minutes later confused and disoriented and is found to be incontinent of urine
86. An 18-year-old army recruit falls to the ground while standing at attention for 20 minutes during his
first week of basic training. He immediately awakens, feels a bit groggy, but quickly is able to rejoin
his squad
Match the clinical scenario with the most appropriate diagnostic test:
B. Transesophageal echocardiography
C. Exercise echocardiography
E. Coronary angiography
87. A 53-year-old man with acute onset of severe “ripping” chest discomfort radiating to his upper
back. His ECG demonstrates low limb lead voltage and 0.5 to 1 mm ST elevation in leads II, III, and
aVF
88. A 74-year-old woman with exertional chest discomfort and dyspnea; her ECG shows a left bundle
branch block pattern
29
89. A 46-year-old man who is hypertensive and smokes cigarettes has had sharp chest discomfort
after eating for the past 4 months; his baseline ECG is normal
90. A 64-year-old man who has a history of a large MI and known three-vessel disease. His ejection
fraction is 30 percent with severe regional wall motion abnormalities, including anterior akinesis; his
ECG shows anterior and inferior Q waves
For each arteriogram or set of arteriograms (Fig. 10 A–E), match the appropriate descriptive
phrase:
30
31
91. Right anterior oblique (RAO) projection: left anterior descending (LAD) artery, demonstrating
myocardial bridging with narrowing in systole and near-normal caliber in diastole
92. Left anterior oblique (LAO) projection: right coronary arteriogram demonstrating anomalous origin
of the left circumflex artery from the proximal right coronary artery (RCA)
93. LAO projection: collateral vessels arising from the distal RCA and supplying an occluded LAD
artery
94. RAO projection: catheter-induced coronary spasm and restoration of normal caliber with
introduction of nitroglycerin
95. LAO projection: showing early filling of a markedly dilated left circumflex artery and subsequent
coronary sinus opacification due to a congenital fistula
For each of the following diuretic agents, match the appropriate adverse effect:
A. Ototoxicity
B. Gynecomastia
C. Metabolic acidosis
D. Hypercalcemia
96. Acetazolamide
97. Metolazone
99. Spironolactone
32
For each clinical scenario, select the appropriate ECG from Fig. 11 A–D:
33
100. A 49-year-old man with chronic renal failure and progressive fatigue
101. A 37-year-old man with a recent viral syndrome and sharp anterior chest pain that worsens when
he changes position
103. A 38-year-old woman with perioral and peripheral cyanosis, digital clubbing, and a history of
cardiac surgery as a child
34
ELECTROCARDIOGRAMS
DIRECTIONS: Each of the 12-lead ECGs below is introduced by a brief descriptive phrase. For each
ECG, perform a systematic reading. Begin by noting any atrial, AV junctional, or ventricular rhythms
present and point out whether any AV conduction abnormalities or atrial-ventricular interactions exist.
Determine whether criteria are met for abnormal voltage, ventricular hypertrophy, or intraventricular
conduction disturbances. Continue by noting abnormal ST and T wave changes as well as any Q
wave MI that may be apparent. Conclude by citing any suggested clinical abnormality compatible with
each tracing.
104. An elderly man was seen in a nursing home with a complaint of occasional dizziness (Fig. 12)
105. A 71-year-old man with symptoms of dizziness and shortness of breath in the emergency
department (Fig. 13)
35
106. A 54-year-old woman with weight loss (Fig. 14)
107. An exercise tolerance test tracing from a 46-year-old man (Fig. 15)
108. A 23-year-old woman with a history of a heart murmur seen in a cardiology clinic (Fig. 16)
36
109. A 29-year-old man with a history of a heart transplant seen in clinic (Fig. 17)
110. An 18-year-old woman in the emergency room with chest pain (Fig. 18)
37
111. A 20-year-old man with a heart murmur (Fig. 19)
112. A 35-year-old woman with shortness of breath seen in the cardiology clinic (Fig. 20)
38
113. An 86-year-old woman with an extensive history of cigarette smoking presents to the emergency
department with shortness of breath (Fig. 21)
39
115. An 18-year-old woman with dyspnea and cyanosis (Fig. 23)
116. An 85-year-old woman during her routine clinic appointment (Fig. 24)
40
117. A 15-year-old boy with episodes of palpitations (Fig. 25)
41
119. A 63-year-old man with symptoms of palpitations (Fig. 27)
120. A 58-year-old man with a history of a prior MI presents to the emergency department with
symptoms of palpitations (Fig. 28)
42
121. A 21-year-old woman with symptoms of palpitations and presyncope (Fig. 29)
122. A 72-year-old man seen in cardiology clinic with chronic dyspnea on exertion (Fig. 30)
43
123. A young man in the cardiology clinic (Fig. 31)
124. A 56-year-old man in the coronary care unit (CCU) (Fig. 32)
44
125. A 42-year-old man in the emergency room with palpitations (Fig. 33)
45
127. An asymptomatic 52-year-old man (Fig. 35)
46
129. A 43-year-old woman presents to the emergency department with symptoms of palpitations
(Fig.37)
DIRECTIONS: Each question below contains five suggested responses. Select the ONE BEST
response to each question.
B. In the absence of structural heart disease, detection of premature ventricular complexes has
no impact on survival
C. Type IC antiarrhythmic agents are the drugs of choice for suppression of premature ventricular
complexes following myocardial infarction (MI)
D. Most concealed accessory pathways are located between the left ventricle and the left atrium
131. All of the following statements about the management of heart failure are true EXCEPT:
B. Carbonic anhydrase inhibitors improve the alkalemia caused by other diuretic agents
47
D. Loop diuretic agents often result in hypokalemia and metabolic alkalosis
132. A 56-year-old man with a history of hypercholesterolemia and smoking is referred to the
cardiology clinic for preoperative risk assessment prior to an orthopedic procedure. He denies any
cardiovascular symptoms and exercises regularly. His electrocardiogram (ECG) is shown (Fig. 38). All
of the following statements are true EXCEPT:
A. This syndrome is thought to account for 40 to 60 percent of all cases of idiopathic ventricular
fibrillation
B. Genetic mutations in the sodium channel have been identified in some families with this
syndrome
C. Implantable cardiac defibrillators are appropriate therapy for preventing sudden death
A. The major determinants of cardiac output are heart rate and ventricular stroke volume
B. The myocardium extracts oxygen from blood nearly maximally at rest such that the coronary
sinus oxygen saturation is <40 percent
134. True statements regarding the prevention of sudden cardiac death include all of the following
EXCEPT:
A. The therapy of choice for survivors of sudden cardiac death is implantation of a cardioverter-
defibrillator
48
B. The use of class I antiarrhythmic drugs to suppress ventricular ectopy after MI is associated
with an adverse outcome
C. Among survivors of out-of-hospital cardiac arrest not associated with an MI, the risk of
recurrent cardiac arrest at 1 year is about 30 percent
D. Implantable cardioverter defibrillators are the preventive therapy of choice in patients with the
Brugada syndrome
E. Amiodarone is the most appropriate therapy for patients with hypertrophic cardiomyopathy
with a prior history of syncope
135. True statements regarding atrioventricular (AV) blocks include all of the following EXCEPT:
B. The conduction abnormality in Mobitz type I second-degree heart block with normal QRS
duration is almost always at the level of the AV node, proximal to the His bundle
C. In Mobitz type I second-degree heart block, the absolute increase in conduction time
decreases progressively over subsequent beats
D. In Mobitz type II second-degree heart block, the PR intervals are constant prior to the
nonconducted P wave
E. The ventricular escape rate in acquired complete heart block is usually less than 40 beats/min
136. True statements about the use of Holter monitoring in the detection of cardiac arrhythmias
include all of the following EXCEPT:
B. The frequency of premature ventricular contractions after myocardial infarction increases over
the first several weeks
C. Holter monitoring has proved useful in the detection of potentially serious arrhythmias in
patients with mitral valve prolapse
E. In normal subjects, the cardiac rhythm detected by ambulatory monitoring shows little variation
from one recording period to the next
49
137. All of the following statements about the auscultatory findings in mitral stenosis are correct
EXCEPT:
E. The presence of an opening snap implies a mobile mitral valve or anterior mitral leaflet
138. A 9-year-old girl is brought in for evaluation because of several episodes of fainting. During one
episode, which occurred while she was reading a book with her mother, she turned blue and was
resuscitated. Her past medical history is unremarkable except for congenital deafness. The family
history is remarkable for a sister who died suddenly at the age of 3 years. The most likely diagnosis
is:
C. Romano-Ward syndrome
D. Lown-Ganong-Levine syndrome
E. Barlow’s syndrome
139. All of the following statements regarding syncope are true EXCEPT:
C. The most common causes of syncope are vascular in origin, including reflex-mediated
syncope and orthostatic hypotension
50
140. Which of the following conditions is likely to precipitate symptomatic heart failure in patients with
previously compensated left ventricular (LV) dysfunction?
A. Atrial fibrillation
D. Ventricular tachycardia
141. True statements about permanent pacemakers include all of the following EXCEPT:
A. The second position in pacemaker nomenclature refers to the chamber being sensed
B. The presence of first-degree AV block with left anterior fascicular block in an asymptomatic
patient is not an indication for pacemaker placement
C. Rate-adaptive pacemakers are designated by the letter R in the fourth position of the
pacemaker code
E. A pacemaker mode switching option is beneficial for patients with paroxysmal supraventricular
rhythm disturbances
142. All the following characteristics are typical of hypertensive crisis EXCEPT:
B. Retinal hemorrhages
51
143. Which of the following statements regarding the therapy of heart failure is correct?
A. Digoxin therapy decreases the rate of hospitalizations for patients with chronic heart failure
B. ACE inhibitors improve survival in heart failure more than the combination of hydralazine plus
isosorbide dinitrate
C. Angiotensin II receptor blockers (ARBs) should be used only as second line agents for
patients who are intolerant of ACE-inhibitor therapy
D. Spironolactone reduces mortality in patients with class III-IV heart failure symptoms
144. A 63-year-old man who has been an insulin-requiring diabetic for 10 years presents to the office
for initial management of hypertension (180/100). Urine and serum chemistries at this time are normal
except for serum creatinine, 1.8 mg/dl, and blood urea nitrogen (BUN), 30 mg/dl. Because of
gastroparesis you elect to initiate therapy with a potassium-sparing diuretic. When he returns in 2
weeks his serum potassium is 6.8 mmol/L with no significant change in BUN or creatinine. The most
likely explanation is:
C. Primary hypoaldosteronism
D. Hyporeninemic hypoaldosteronism
145. Each of the following statements about cardiac transplantation is true EXCEPT:
C. The majority of patients who have received cardiac transplants have had end-stage heart
disease due to coronary artery disease or cardiomyopathy
D. Patients with heart transplants have limited exercise capacity because of absence of
autonomic neural control
52
E. Endomyocardial biopsy is the most reliable technique to assess allograft rejection
146. All of the following statements regarding syncope are true EXCEPT:
C. One-year mortality in patients with syncope due to noncardiovascular causes is less than 15
percent
147. All of the following statements about cardiac hypertrophy in athletes are true EXCEPT:
148. Each of the following statements regarding cardiac transplantation is true EXCEPT:
C. A measured peak oxygen uptake ( O2max) of less than 10 ml/kg/min warrants consideration
of cardiac transplantation
D. Donor ischemic times of <6 hours are acceptable for donor hearts
E. The 1-year and 3-year survival rates of cardiac transplant recipients are 82 percent and 74
percent, respectively
53
149. A 78-year-old man who lives in a nursing home is admitted via the emergency room because of
fever and disorientation. His physical examination and ECG are normal except for sinus tachycardia
and tachypnea. Laboratory results include an elevated white blood cell count, low platelet count, and
prolonged prothrombin time. Urine sediment contains numerous polymorphonuclear leukocytes. A
cardiology consultation is obtained for evaluation of the chest x-ray in (Fig. 39). The most likely
explanation for the accompanying chest x-ray findings is:
A. LV failure
B. Pneumococcal pneumonia
D. Gram-negative pneumonia
E. Posterior wall MI
150. A pacemaker’s pulse generator is connected electrically to the heart via an electrode system
referred to as a lead. True statements with regard to unipolar and bipolar electrodes include all of the
following EXCEPT:
B. Pacing thresholds for generation of stimuli are similar for unipolar and bipolar electrodes
C. Unipolar electrodes are more susceptible to extracardiac interference from skeletal muscle
potentials (myopotentials)
D. The signal amplitudes of the electrograms generated by both types of electrodes are similar
151. The following statements about laboratory findings in heart failure are true EXCEPT:
A. Serum electrolyte values are usually normal in patients with untreated heart failure of short
duration
54
D. Acute hepatic venous congestion due to heart failure may produce a syndrome that closely
resembles viral hepatitis
152. Each of the following statements about myocardial contraction is true EXCEPT:
E. The sarcoplasmic reticulum plays a key role in the release and uptake of calcium
153. All of the following interventions may lower blood pressure EXCEPT:
154. Each of the following statements regarding cardiac transplant rejection is true EXCEPT:
B. Lymphocyte infiltration and myocyte necrosis are the most important biopsy features of post-
transplant rejection
C. Most episodes of acute rejection occur more than 3 months after transplantation
D. Total lymphoid irradiation has been used to treat patients with persistent or recurrent rejection
55
E. Pulsed corticosteroids are the therapy of choice for episodes of early rejection
B. Procainamide, like quinidine, may accelerate the ventricular response in patients with atrial
fibrillation or flutter
C. Procainamide may block conduction in the accessory pathway of patients with the Wolff-
Parkinson-White syndrome
E. Procainamide is a preferred drug for the control of the tachyarrhythmias in patients with
bradycardia-tachycardia syndrome
156. All of the following are primary determinants of cardiac output EXCEPT:
A. Heart rate
B. LV preload
C. LV afterload
157. Each of the following statements about exercise testing in the diagnosis of cardiac arrhythmias is
true EXCEPT:
A. Approximately one third of normal subjects develop ventricular ectopy during exercise testing
B. Nonsustained ventricular tachycardia of six beats or less can occur in normal subjects and
does not predict cardiovascular morbidity
C. Patients with ischemic heart disease develop premature ventricular contractions at lower heart
rates than normal subjects
D. Exercise testing should be avoided in patients with a history of serious ventricular arrhythmia
56
E. Exercise testing is less sensitive than prolonged ambulatory monitoring in detecting ventricular
ectopy
158. With respect to renovascular disease, all of the following statements are true EXCEPT:
A. Fewer than 2 percent of adults with hypertension in a general practice have renovascular
hypertension
B. Atherosclerotic disease most commonly involves the proximal third of the main renal artery
C. The most common form of fibroplastic renovascular disease in adults involves the media
E. Patients with severe, accelerated hypertension have the highest prevalence of renovascular
disease
159. Each of the following statements about invasive electrophysiology study of the cardiac
conduction system is true EXCEPT:
B. The presence of an His-ventricular (HV) interval equal to or greater than that recorded during
normal sinus rhythm is consistent with the diagnosis of a ventricular tachycardia
D. Sinus node recovery time (SNRT) is defined as the difference between the spontaneous sinus
node cycle length prior to pacing and the duration of the first spontaneous sinus response after
termination of pacing
160. True statements about the use of adenosine in the management of cardiac arrhythmia include all
of the following EXCEPT:
57
C. Intravenous verapamil remains the agent of choice to terminate acutely a supraventricular
tachycardia
E. Flushing, dyspnea, and chest pressure are all common side effects of adenosine therapy
161. Each of the following statements with respect to primary aldosteronism is true EXCEPT:
A. The most common cause for primary aldosteronism is a solitary benign tumor
D. Patients with primary aldosteronism usually have high plasma renin activity
E. If a patient has high urinary potassium and low serum potassium but low serum aldosterone
levels, licorice ingestion should be considered as a possible cause of the laboratory abnormalities
162. Comparison of LV parameters in pressure- and volume-overloaded hearts reveals all of the
following changes EXCEPT:
163. All of the following are correct statements with respect to management of hypertension in
pregnancy EXCEPT:
58
D. Beta-blockers may be useful
164. Each of the following statements regarding coronary artery disease in cardiac transplant
recipients is true EXCEPT:
E. Lipid lowering with HMG CoA reductase inhibitor therapy has been reported to decrease the
incidence of graft arteriopathy
165. Each of the following statements about the clinical manifestations of digitalis toxicity is correct
EXCEPT:
A. Digitalis overdose may lead to nausea and vomiting due to central nervous system
mechanisms
D. Paroxysmal atrial tachycardia with AV block (PAT with block) is virtually pathognomonic of
digitalis excess
E. Common arrhythmias due to digitalis toxicity include atrioventricular junctional escape rhythms
and ventricular bigeminy or trigeminy
166. All of the following statements about shunt detection are true EXCEPT:
59
C. Among the sources of right atrial venous blood, the inferior vena cava has the lowest oxygen
saturation
D. Although the sensitivity of oximetry for shunt detection is low, most clinically relevant left-to-
right shunts can be detected using this method
167. Each of the following statements about the use of digoxin in heart failure is correct EXCEPT:
A. Clinical trials have demonstrated that digoxin reduces mortality in patients with chronic heart
failure
B. The ideal trough serum digoxin level, for maximum hemodynamic benefit and safety, is 0.5 to
1 ng/dl
D. Quinidine, verapamil, and propafenone can each increase the serum digoxin level
168. Each of the following statements about vasodilator agents used in heart failure is true EXCEPT:
D. The combination of hydralazine plus isosorbide dinitrate reduces mortality in chronic heart
failure at least as much as ACE inhibitors.
E. ACE inhibitors lead to a decline in left and right ventricular filling pressures with little or no
change in heart rate in patients with heart failure
169. A 45-year-old woman with a history of breast cancer presents because of progressive shortness
of breath. Her ECG is shown in (Fig. 40). Each of the following statements regarding her condition is
true EXCEPT:
60
B. A prominent y-descent is expected in the right atrial pressure tracing
170. All of the following statements concerning measurement of cardiac output are true EXCEPT:
A. Angiographic cardiac output measurements are preferred to Fick and thermodilution methods
for calculation of stenotic valve areas in patients with severe aortic or mitral regurgitation
C. When interpreting results of the indicator-dilution method, the area under the curve is directly
related to the cardiac output
E. Thermodilution cardiac outputs may cause a falsely elevated cardiac output value in low-
output states
171. Each of the following statements concerning therapy of patients with LV dysfunction is true
EXCEPT:
A. Use of amiodarone in patients with LV dysfunction has been shown to increase mortality
C. An ICD is the therapy of choice in patients with LV dysfunction who have symptomatic
sustained ventricular tachycardia
D. An ICD is the therapy of choice in patients with LV dysfunction who have asymptomatic
nonsustained, but inducible ventricular tachycardia
E. Biventricular pacing increases LV ejection fraction, reduces wall stress, and decreases filling
pressures
172. Each of the following statements regarding antiarrhythmic therapy with quinidine is true
EXCEPT:
61
A. The most common adverse effects of quinidine are gastrointestinal
173. Each of the following statements concerning atrial fibrillation (AF) is true EXCEPT:
C. Physical findings in patients with AF include variations in the intensity of S1 and in the
amplitude of a waves in the jugular venous pulse
D. A greater frequency of right bundle branch block is noted in patients who develop AF in the
year following acute MI
E. In the absence of underlying heart disease, subjects with AF have no increase in cardiac risk
but do display a higher incidence of stroke than the general population
B. When measuring the blood pressure, an inappropriately small cuff size results in a spuriously
low systolic measurement
D. Chronic renal disease is the second most common cause of hypertension after essential
hypertension
62
175. Each of the following statements regarding the cardiac conduction system is true EXCEPT:
A. The sinus node is innervated with postganglionic adrenergic and cholinergic nerve terminals
B. In 60 percent of people, the arterial supply to the AV node is derived from a branch of the left
circumflex artery
C. The conduction system in the upper muscular interventricular septum receives its blood supply
from branches of the anterior and posterior descending arteries
D. Inhibition of the delayed rectifier K+ current (IKr) has been implicated in the acquired form of the
long QT syndrome
E. The resting transmembrane potential of the cardiac myocyte is close to the equilibrium
potential of potassium
176. True statements about the syndrome of circulatory shock include all of the following EXCEPT:
A. The clinical signs of shock reflect a decrease in blood flow to a variety of organs
B. ECG signs of myocardial ischemia may appear in patients with apparently normal hearts due
to a reduction in regional coronary blood flow
C. Circulatory shock in the first 3 months of life is often due to gram-negative bacteremia
E. During circulatory shock, pulmonary blood flow is often protected at the expense of cerebral
and renal perfusion
B. Use of amiodarone in patients with congestive heart failure increases the mortality rate
C. Corneal deposits develop in nearly all patients who are treated with amiodarone for more than
6 months
E. Amiodarone-induced pulmonary toxicity may develop within the first week of therapy
63
178. Each of the following statements about edema in heart failure is correct EXCEPT:
A. Edema in heart failure does not correlate well with the level of systemic venous pressure
B. Peripheral edema may be detected when extracellular fluid volume has increased by as little
as 1 to 2 L
C. Severe edema may cause rupture of the skin and extravasation of fluid
D. In patients with acute heart failure, edema may not be present initially
E. In patients with hemiplegia due to a cerebral vascular accident, edema is usually more
apparent on the paralyzed side
179. Major alterations in pulmonary function testing in patients with congestive heart failure include all
the following EXCEPT:
180. Each of the following statements regarding cardiac arrhythmias is true EXCEPT:
A. In the common form of AV nodal reentry tachycardia (AVNRT), anterograde conduction occurs
down the “slow” pathway
B. In antidromic AV reciprocating tachycardia, the activation wave travels via the accessory
pathway to the ventricles and retrogradely via the AV node to the atria
C. In most patients with Wolff-Parkinson-White syndrome, the accessory pathway conducts more
rapidly than the normal AV node but takes longer to recover excitability
64
181. Each of the following statements about high-output heart failure is true EXCEPT:
A. Thyrotoxicosis, anemia, and pregnancy are all examples of high-output states that may lead to
heart failure
B. The extremities of the patient with high-output failure are usually warm and flushed
E. Evidence of biventricular failure, sensory and motor peripheral neuropathy, and prolongation of
the QT interval is consistent with the diagnosis of thiamine deficiency (beriberi)
B. Cardiac index may remain unchanged in patients on verapamil because afterload reduction
produced by the drug counteracts its negative inotropic effect
C. Verapamil is helpful in slowing the rapid ventricular response in patients with atrial fibrillation
and wide QRS complexes due to Wolff-Parkinson-White syndrome
183. Each of the following statements about physical findings in heart failure is true EXCEPT:
A. Chronic marked elevation of systemic venous pressure may produce exophthalmos or even
visible systolic pulsation of the eyes
B. Pallor and coldness of the extremities are primarily due to elevation of adrenergic nervous
system toxicity
C. A positive abdominojugular reflex reflects the combination of hepatic congestion and the
inability of the right side of the heart to accept an increased venous return
D. The presence of hepatic tenderness reflects long-standing right-sided heart failure with chronic
stretching of the liver capsule
E. Protein-losing enteropathy may occur in patients with visceral congestion and may result in a
reduced plasma oncotic pressure
65
184. Each of the following statements regarding class III antiarrhythmic drugs is true EXCEPT:
B. Sotalol can precipitate heart failure in patients with reduced baseline systolic function
C. After ibutilide administration, patients can be safely discharged 2 hours after conversion from
atrial flutter to normal sinus rhythm
E. Ibutilide therapy should be avoided in patients with QTc interval of >440 msec
DIRECTIONS: Each question below contains suggested answers. For EACH of the alternatives, you
are to respond either TRUE (T) of FALSE (F). In a given item, ALL, SOME, OR NONE OF THE
ALTERNATIVES MAY BE CORRECT.
185. Digitalis is of potential benefit in which of the following conditions? For the following choices,
answer true (T) or false (F).
A. Mitral stenosis with atrial fibrillation and normal right ventricular function
B. LV hypertrophy, normal sinus rhythm, normal LV ejection fraction, and elevated LV end-diastolic
pressure
C. Hypertrophic obstructive cardiomyopathy with LV ejection fraction of 70 percent and normal sinus
rhythm
D. Mitral stenosis with normal sinus rhythm and normal right ventricular function
186. For each of the following statements regarding the cardiac cycle, you are to respond true (T) or
false (F).
A. The third heart sound (S3) corresponds to the rapid early diastolic filling of the ventricles
B. A prominent a wave on the right or left atrial pressure tracing is typical of atrial fibrillation
C. The QRS complex on the ECG corresponds to the timing of isovolumic ventricular contraction
D. The v wave on the right or left atrial pressure tracing occurs after the T-wave on the ECG
E. The mitral valve opens in diastole when the left atrial pressure falls below that of the left ventricle
66
187. Common features in the clinical presentation of renovascular hypertension secondary to
fibromuscular hyperplasia, as opposed to atherosclerosis, include the following:
B. Female gender
C. Coexisting cardiomegaly
188. Indicate whether the following statements about physical findings in heart failure are true (T) or
false (F):
A. Hydrothorax in heart failure is most often bilateral, but when unilateral it is usually confined to the
left side of the chest
B. The absence of pulmonary rales on examination excludes the presence of an elevated pulmonary
capillary pressure
D. The absence of peripheral edema is a reliable indicator that the systemic venous pressure is
normal
188. Indicate whether the following statements about physical findings in heart failure are true (T) or
false (F):
A. Hydrothorax in heart failure is most often bilateral, but when unilateral it is usually confined to the
left side of the chest
B. The absence of pulmonary rales on examination excludes the presence of an elevated pulmonary
capillary pressure
D. The absence of peripheral edema is a reliable indicator that the systemic venous pressure is
normal
189. For each of the conditions listed below respond true (T) if the condition is associated with high-
output heart failure and false (F) if it is not.
A. Iron overload
B. Hyperthyroidism
67
C. Systemic arteriovenous fistulas
D. Thiamine deficiency
E. Paget’s diseas
190. For each of the suggested answers regarding treatment of digitalis intoxication, you are to
respond either true (T) or false (F).
A. Lidocaine and phenytoin are useful agents in treating arrhythmias due to digitalis excess
C. Recurrence of digitalis toxicity can occur 24 to 48 hours following the administration of antidigoxin
Fab antibodies
191. For each of the following statements about heart failure, respond either true (T) or false (F):
A. Over the past decade, the incidence and prevalence of heart failure have increased
B. Heart failure occurs in 10 percent of patients over 75 years old but only in 1 to 2 percent of patients
50 to 59 years of age
192. True statements regarding hypomagnesemia in patients with congestive heart failure include
which of the following?
A. Both thiazide and loop diuretics may cause urinary magnesium wasting
D. A total daily urinary magnesium excretion of <1 mEq in the absence of diuretics is suggestive of
magnesium depletion
E. Elevated magnesium levels in congestive heart failure may predict as poor a prognosis as
hypomagnesemia
193. For each of the following statements regarding the use of adenosine as an antiarrhythmic agent,
respond either true (T) or false (F):
68
C. The dose of adenosine should be doubled in patients taking dipyridamole
E. Flushing, dyspnea, and chest pain develop in up to 40 percent of patients after adenosine
administration
194. A patient presents with a wide-complex tachycardia. Which of the following statements are true
in distinguishing ventricular tachycardia (VT) from supraventricular tachycardia (SVT) with aberrant
ventricular conduction?
195. For each of the following statements regarding electrical cardioversion, respond either true (T) or
false (F):
A. Electrical cardioversion is the treatment of choice for tachyarrhythmias caused by digitalis toxicity
D. Repeated shocks at the same energy level increase chest wall impedance
196. For each of the following statements regarding the antiarrhythmic drug disopyramide, respond
either true (T) or false (F):
B. Disopyramide may increase the sinus node discharge rate because of its muscarinic receptor
blocking activity
69
197. AV block exists when the atrial impulse is conducted with delay or is not conducted at all to the
ventricle. True statements about second-degree AV block include which of the following?
A. Type I AV block is associated with a benign clinical course in all age groups
C. Type I AV block with a normal QRS complex occurs at the level of the AV node or in the His bundle
D. Type II AV block in association with bundle branch block occurs at the level of the AV node or the
His bundle
E. 2:1 AV block may be either type I or type II second-degree AV block and is more likely to be type I
if the QRS complex is normal
198. For each of the following conditions, respond either true (T) or false (F). LV preload is increased
in the presence of:
A. Sepsis
C. Mitral regurgitation
D. Dehydration
199. A 74-year-old man with a long history of LV failure secondary to several MIs comes to the
emergency room acutely short of breath 2 hours after eating a large holiday meal. Physical
examination and chest x-ray findings are consistent with acute pulmonary edema. ECG shows a
narrow-complex junctional tachycardia at a rate of 130/min with 1 mm ST segment depression in
leads V4 through V6. Blood pressure is 170/100; respirations, 32. His current medical treatment
includes nitrates, calcium channel antagonists, digoxin, and chlorothiazide. Appropriate initial therapy
in the emergency room would include:
A. Nasal O2
B. Morphine sulfate
C. Intravenous furosemide
D. Intravenous digoxin
E. Sublingual nitroglycerin
70
200. Permanent cardiac pacing is appropriate for which of the following patients with AV block?
Respond either true (T) or false (F):
B. A 70-year-old man with LV hypertrophy, persistent fatigue, and lightheadedness, with marked first-
degree AV block (PR interval = 0.36 sec)
201. A 60-year-old man had a pacemaker inserted 5 years ago because of sinus bradycardia with
poor LV function following an inferior MI. As part of his exercise program, he has been using a rowing
machine. Recently, he has had several episodes of near-syncope that occurred only while rowing. An
ambulatory ECG (Holter monitor) revealed an abnormal rhythm during a near-syncopal event while
rowing. The ECG shown in (Fig. 41) indicates:
A. The half-life of digoxin in subjects with normal renal function is about 36 to 48 hours
B. In patients with normal renal function who have not previously taken digitalis, institution of daily
maintenance therapy without a loading dose leads to a steady-state plateau concentration of the drug
in about 7 days
71
D. Obese patients taking digoxin who undergo dramatic weight loss must have their digoxin dosage
decreased to avoid toxicity
E. Patients taking digoxin who subsequently begin propafenone therapy often require a decrease in
digoxin dosage to avoid toxicity
203. Each of the following conditions is associated with the development of pulmonary edema
EXCEPT:
B. High altitude
D. Eclampsia
E. Heroin overdose
204. For each of the suggested answers regarding electrical therapy of cardiac arrhythmias, respond
either true (T) or false (F):
C. Synchronized shocks delivered late in the QRS complex are more effective and less likely to
induce acceleration of the arrhythmia than shocks delivered near the QRS onset
D. When properly synchronized, direct-current shock does not result in ventricular fibrillation
205. For each of the following statements regarding hypertension, indicate whether the statement is
true (T) or false (F):
A. Increased LV muscle mass is a strong and independent risk factor of cardiac mortality
B. The risk of ventricular arrhythmias is increased at least twofold in the presence of LV hypertrophy
C. Low birth weight is associated with an increased incidence of hypertension later in life
D. Women have greater cardiovascular morbidity and mortality than men for all degrees of
hypertension
206. True statements about cardiac physical findings in patients with congestive heart failure include:
B. Pulsus alternans occurs most commonly in heart failure due to concomitant mitral regurgitation
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C. Pulsus alternans results from variation of the stroke volume due to incomplete recovery of
contracting myocardial cells
D. A low-grade fever that is due to cutaneous vasoconstriction and impaired heat loss may occur in
severe heart failure
207. Correct statements regarding the association of oral contraceptive pills and hypertension include:
B. The incidence of hypertension is about 2.5 times greater in pill users than in nonusers
E. Cigarette smoking more than doubles the cardiovascular complications associated with use of oral
contraceptives
208. Which of the following statements regarding sinus node function are true? Respond either true
(T) or false (F).
B. During sleep, the heart rate of normal individuals can fall to 35 beats/min
C. Sinus arrest is identified as a pause that is an exact multiple of the P-P interval of the underlying
rhythm
D. Sinus arrest and AV block are common in patients with sleep apnea
E. In the respiratory form of sinus arrhythmia, the P-P interval cyclically shortens during inspiration
209. True statements with regard to distribution of blood flow and intravascular pressure in the upright
lung include:
A. Pulmonary artery pressure is greater than alveolar pressure at the lung apices
C. Alveolar pressure increases from the lung base to the lung apex
D. Pulmonary vascular redistribution occurs when there is a relative reduction in perfusion of the
bases with a relative increase in apical perfusion
210. Which of the following are considered complications of cyclosporine therapy in the cardiac
transplant recipient?
A. Renal dysfunction
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B. Bone marrow suppression
C. Hepatotoxicity
D. Neurological effects
E. Hirsutism
211. For each of the following statements regarding pheochromocytoma, indicate if the statement is
true (T) or false (F).
D. Urinary metanephrine levels increase after the administration of x-ray contrast media containing
methylglucamine
212. For each of the following statements regarding arrhythmogenic right ventricular dysplasia
(ARVD), respond either true (T) or false (F):
A. Ventricular tachycardia in patients with ARVD typically has a right bundle branch block morphology
213. Features of the systemic lupus erythematosus (SLE)-like syndrome that may be induced by
procainamide include:
C. A similar occurrence of SLE syndrome due to the N-acetylprocainamide (NAPA) metabolite of the
drug
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214. For each of the following statements regarding the hypersensitive carotid sinus syndrome,
respond either true (T) or false (F):
B. During carotid sinus stimulation, a decrease in systolic blood pressure >30 mm Hg and
reproduction of the patient’s symptoms is consistent with the vasodepressor form of this syndrome
C. The hypersensitive carotid sinus reflex is commonly associated with coronary artery disease
E. Single-chamber atrial pacing is sufficient therapy for most patients with carotid sinus
hypersensitivity
215. For each of the following statements regarding the antiarrhythmic drug amiodarone, respond
either true (T) or false (F):
D. In patients with heart failure symptoms due to dilated cardiomyopathy, the addition of amiodarone
to standard therapy has been shown to reduce mortality
216. A 62-year-old previously healthy man is brought to the emergency room because of severe
headache, nausea, and dizziness. He takes no medications. The blood pressure is 176/98 mm Hg;
heart rate is 56 and regular. The presenting ECG is as shown in (Fig. 42). Which of the following
actions are appropriate? Respond true (T) or false (F).
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D. Obtain a head CT scan
E. Proceed directly to cardiac catheterization if ST-T wave abnormalities fail to quickly normalize with
anti-ischemic therapy
217. Indicate whether each of the following statements regarding sudden cardiac death (SCD) is true
(T) or false (F):
E. An intraventricular conduction abnormality on the ECG is a stronger predictor of SCD than findings
of LV hypertrophy
218. A patient with the ECG shown in (Fig. 43) could also exhibit:
219. For each of the following statements regarding SCD, respond either true (T) or false (F):
A. SCD is the first clinical manifestation of coronary artery disease in approximately 25 percent of
patients
B. LV dysfunction and ventricular ectopic activity after an MI increase the risk of SCD
E. The outcome of patients with bradycardic/asystolic out-of-hospital cardiac arrest is worse than if
ventricular fibrillation is the initial arrhythmia
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220. Which of the following statements regarding electrophysiological testing are true?
A. A long His-ventricular (HV) interval (>80 msec) identifies patients at increased risk of developing
AV block
B. The HV interval has a high sensitivity and low specificity for predicting the development of
complete AV block
C. A prolonged sinus node recovery time (SNRT) is very specific for identifying patients with sinus
node dysfunction
D. The sensitivity of the SNRT in identifying sinus node dysfunction is about 95 percent
221. Lidocaine is a widely used pharmacological agent for the treatment of cardiac arrhythmias.
Correct statements about lidocaine include:
A. Lidocaine has little effect on the electrophysiological properties of atrial myocardial cells or on
conduction in accessory pathways
B. In the absence of severe LV dysfunction, clinically significant adverse hemodynamic effects from
lidocaine are rarely noted
C. The elimination half-life of lidocaine in patients after relatively uncomplicated MI is two to four times
that in normal subjects
D. Patients treated with an initial bolus of lidocaine followed by a maintenance infusion may
experience transient excessive plasma concentrations of the drug 30 to 120 minutes after therapy is
begun
222. For each of the following statements regarding specific modes of cardiac pacing respond true (T)
or false (F):
C. Single-chamber triggered pacing (AAT or VVT) increases the drain on the pacemaker battery
D. Atrial Inhibited Pacing (AAI) is an appropriate mode of pacing for patients with AV nodal
dysfunction
E. Dual-Chamber Pacing and Sensing with Inhibition and Tracking (DDD) is the preferred mode of
pacing for patients in atrial fibrillation
223. For each of the following statements regarding cardiac pacemakers, respond either true (T) or
false (F):
B. Lead dislodgement or inadequate initial lead placement should be suspected if true undersensing
is present
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C. Industrial-strength welding equipment (more than 500 A) can cause significant pacemaker
interference
D. Right bundle branch block is an appropriate ECG pattern after successful transvenous pacemaker
implantation
224. For each of the following statements about patients with symptomatic heart failure, respond
either true (T) or false (F):
E. The circulating level of the inflammatory cytokine, tumor necrosis factor-alpha, is increased
225. For the following statements regarding post-cardiac transplant complications, respond either true
(T) or false (F):
A. Infectious complications are the most common cause of death after transplantation
D. CMV-negative recipients who receive an allograft from a CMV-positive donor are the most
vulnerable for developing CMV infection
E. Transplant recipients have a threefold increase in the incidence of cancer compared with age-
matched controls
226. Which of the following statements regarding intra-aortic balloon (IAB) counterpulsation are true?
A. Patients with cardiogenic shock or mechanical complications of an acute MI often benefit from the
placement of an IAB
C. The IAB should be timed to deflate during the isovolumetric phase of LV contraction
D. The tip of the IAB should be positioned just distal to the left subclavian artery
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227. For the following statements regarding pacemaker complications, respond either true (T) or false
(F):
A. Acceptable rates of lead dislodgement are less than 1 percent for ventricular leads and less than 2
to 3 percent for atrial leads
228. In patients with marked LV dysfunction, which of the following statements is/are true regarding
pulsus alternans?
E. The strong and weak beats are almost always concordant on both sides of the circulation (i.e., both
ventricles)
229. For the following statements regarding side effects of antihypertensive agents, respond either
true (T) or false (F):
C. Fewer than 3 percent of patients taking an ACE inhibitor will develop a cough during prolonged use
D. ACE inhibitor–induced cough may persist for 3 weeks or longer after discontinuation of the drug
E. A pure beta-blocker is the pharmacological therapy of choice for patients with pheochromocytoma
230. A 55-year-old previously healthy man is brought to the emergency room because of left-sided
chest pain over the past 3 hours. He denies shortness of breath or cough. The discomfort seems less
intense when he sits forward. The chest radiograph is unremarkable, and the ECG is shown in (Fig.
44). Which of the following statements regarding this patient’s condition are true?
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A. Thrombolytic therapy is indicated if cardiac catheterization is not immediately available
E. Cardiac isoenzymes can quickly differentiate the cause of the chest pain
231. For each of the following statements regarding hypertension during pregnancy, indicate if the
statement is true (T) or false (F):
A. Gestational hypertension is more common in primigravid women compared to those with prior
pregnancies
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233. True statements regarding the antiarrhythmic agent procainamide include:
A. Procainamide’s major metabolite, NAPA, is excreted almost exclusively via the kidneys
C. Procainamide should be avoided in patients with WPW syndrome with rapid atrial fibrillation
E. During chronic procainamide therapy, fewer than 10 percent of patients develop antinuclear
antibodies
234. For each of the following statements regarding therapy of patients with heart failure, respond
either true (T) or false (F):
A. In asymptomatic patients with LV dysfunction, the use of ACE inhibitors decreases mortality
B. ACE inhibitors are indicated in patients with heart failure and LV dysfunction irrespective of the
functional class
C. Digoxin has been shown to decrease heart failure hospitalizations but has no effect on mortality
D. Spironolactone has been shown to decrease mortality in patients with New York Heart Association
(NYHA) class III-IV symptoms
235. For each of the following statements regarding WPW syndrome, respond either true (T) false (F):
A. A positive delta wave deflection in lead V1 indicates that the accessory pathway is located in the
right ventricle
236. For each of the suggested answers, respond either true (T) or false (F). Thiazide diuretics may
cause many side effects, including:
A. Hypomagnesemia
B. Hypouricemia
C. Hypercalcemia
D. Hypercholesterolemia
E. Hyponatremia
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DIRECTIONS: The questions below consist of lettered headings followed by a set of numbered items.
For each numbered item select the ONE lettered heading with which it is MOST closely associated.
Each lettered heading may be used ONCE, MORE THAN ONCE, or NOT AT ALL.
B. Romano-Ward syndrome
D. Brugada syndrome
238. Typically, ECG reveals a right bundle branch block morphology with ST segment elevation in the
anterior precordial leads
For each condition, match the appropriate pattern of LV filling recorded by diastolic Doppler
mitral flow velocities (E wave = early diastolic filling; A wave = period of atrial contraction):
Match the following antiarrhythmic drug actions with the appropriate Vaughan Williams drug
classification:
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C. Predominantly block the slow calcium channels
D. Reduce the rate of rise of the action potential upstroke (Vmax) and prolong the action potential
duration
E. Block sodium channels, but shorten the action potential duration and do not reduce Vmax
For each condition capable of precipitating high-output cardiac failure, match the appropriate
phrase:
A. Hyperthyroidism
B. Beriberi
C. Arteriovenous fistula
D. Carcinoid syndrome
E. Osler-Weber-Rendu syndrome
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253. Aortic valve stenosis with peak systolic gradient >30 mm Hg
256. Mitral valve regurgitation with regurgitant flow >20 ml per beat
For each clinical condition, match the most appropriate pacemaker modality:
A. VAT
B. VVIR
C. DDD
D. DDDR
E. AAIR
257. A 58-year-old man with tachycardia-bradycardia syndrome who develops symptomatic sinus
bradycardia with beta-blocker therapy (which was given for inappropriate sinus tachycardia)
258. A 70-year-old woman with atrial fibrillation who complains of dizziness, and is found on
examination to have a ventricular rate of 30/min
259. A 62-year-old man with complete heart block following aortic valve surgery
260. A 45-year-old man with symptomatic sinoatrial exit block and junctional escape rhythm
A. Atrial tachycardia
B. Atrial flutter
C. Sinus rhythm
E. Atrial fibrillation
261. P waves are negative in lead aVR and upright in leads I, II, aVF
264. The initial P wave of the tachycardia is usually different than the subsequent P waves
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Match each drug below with the potential adverse reactions:
B. Urinary retention
C. Seizures
D. Gingival hypertrophy
265. Disopyramide
266. Procainamide
267. Phenytoin
268. Lidocaine
For each of the following conditions, select the most appropriate statement about the physical
examination:
C. Paradoxical splitting of S2
D. Widened splitting of S2
For each of the following conditions, match the corresponding clinical presentations of
syncope:
A. A 20-year-old woman “blacked out” during phlebotomy for a routine blood test
C. A 35-year-old man sustained syncope during exercise and has a systolic murmur that intensifies
upon standing upright
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E. A 28-year-old woman with recurrent episodes of breathlessness, lightheadedness, and syncope
following changes in body position
For each of the following antiarrhythmic agents, match the appropriate influence of disease
states on drug pharmacokinetics. Each lettered heading can be used ONCE, MORE THAN
ONCE, OR NOT AT ALL:
A. Lidocaine
B. Procainamide
C. Both
D. Neither
282. Atenolol
283. Labetalol
284. Acebutolol
285. Pindolol
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DIRECTIONS: Each question below contains five suggested responses. Select the ONE
BEST response to each question.
286. Which of the following is true regarding atrial septal defect (ASD) in children:
287. An 80-year-old man presents with syncope. During his evaluation, a cardiac murmur is detected
and an echocardiographic study obtained. A continuous-wave Doppler recording through the aortic
valve is shown in (Fig. 48). True statements about this case include all of the following EXCEPT:
B. Some patients with this disorder and angina will not have significant coronary arterial
obstruction on angiographic examination
C. Syncope in this disorder commonly occurs without significant change in systemic vascular
tone
288. A 45-year-old man comes to the office because of recurrent chest discomfort and shortness of
breath. He rides his bicycle daily to and from work and this past winter noticed occasional episodes of
discomfort during bicycling. An exercise tolerance test (ETT) was performed for 12 minutes with a
standard Bruce protocol without the development of significant symptoms or ECG findings. He was
placed on a beta-blocker, but his symptoms have persisted. You perform a repeat ETT, which again is
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negative, except for upsloping ST-segment depressions present at 85 percent of maximal predicted
heart rate. You would recommend next:
B. No further work-up
C. Echocardiography
E. Coronary arteriography
289. Each of the following statements regarding the effects of HMG-CoA reductase inhibitors
(“statins”) is true EXCEPT:
290. A 44-year-old farmer develops fever, chills, and a cough. He is treated by his local physician with
tetracycline for 1 week and feels improved. However, a week later he again develops a low-grade
fever associated with myalgias. Over the next few days he has several episodes of palpitation and
chest tightness that are worse with exertion. He is referred to you for further evaluation. On
examination, he has a temperature of 99.5°F, pulse 90/min, respirations 16/min, blood pressure
130/85. His lungs are clear. There is no jugular venous distention and the carotid upstrokes are
normal. The left ventricular (LV) impulse is not displaced; S1 and S2 are normal. There is a grade II/VI
midsystolic murmur that increases with handgrip. A midsystolic click is also present. The rest of the
examination is unremarkable. Chest x-ray and ECG findings are normal. Laboratory findings include
hemoglobin (Hgb) 14.2 mg/dl; white blood cell count (WBC) 15,000/mm 3 with 80 percent polys, 3
percent bands, 17 percent lymphs; Na 140 mmol/L, Cl 100 mmol/L, K 5.0 mmol/L, and HCO 3 25
mmol/L; urinalysis: clear, pH 6.6, 1+ protein, no WBC, 2 to 3 RBC/hpf. What would you order now?
A. Exercise testing
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C. Ambulatory Holter monitor
D. Blood cultures
291. True statements regarding the macrophage in the pathogenesis of atherosclerosis include all of
the following EXCEPT:
B. Macrophages are the principal cells in the initial lesion of atherosclerosis, the fatty streak
292. True statements regarding the clinical history of patients with acute myocardial infarction (MI)
include all of the following EXCEPT:
B. Between 20 and 60 percent of nonfatal MIs are unrecognized by the patient and are identified
only by a subsequent routine ECG
C. One third of patients with a prodrome have had symptoms for 1 to 4 weeks before
hospitalization
D. Over one half of patients with a transmural MI have nausea and vomiting
293. Each of the following statements regarding the use of percutaneous transluminal coronary
angioplasty (PTCA) as a primary therapy in acute MI is true EXCEPT:
B. The primary success rate for PTCA during acute MI is approximately 90 percent
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C. The PAMI trial showed that patients randomized to primary PTCA had a lower incidence of
death or reinfarction by hospital discharge and at 6-month follow-up
D. When performed in experienced centers, hospital length of stay and follow-up costs are
significantly less than for patients treated with thrombolysis
E. Primary PTCA is associated with a worse outcome compared with thrombolysis for acute MI
patients presenting with cardiogenic shock
294. True statements about effusive-constrictive pericarditis include all of the following EXCEPT:
295. The following statements regarding myocardial stunning are true EXCEPT:
D. Oxygen free radicals and excess intracellular calcium likely contribute to stunning
296. True statements regarding the effect of medications on the lipid profile include all of the following
EXCEPT:
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C. Estrogen replacement therapy raises HDL and triglyceride levels
297. True statements about the ECG in congenital heart disease include all of the following EXCEPT:
B. By the time the infant is 72 hours of age, the T waves should be inverted in V 1 to V3
C. The presence of right ventricular hypertrophy suggests single ventricle or inversion of the
ventricles
E. T-wave inversion in the lateral precordial leads may be observed in subendocardial ischemia
298. The following statements regarding abrupt vessel closure after balloon coronary angioplasty are
correct EXCEPT:
E. The use of stents and platelet glycoprotein IIb/IIIa inhibitors has reduced the incidence of
abrupt closure
299. True statements about the progression of atherosclerosis in venous aortocoronary artery bypass
grafts include all of the following EXCEPT:
A. Between 12 and 20 percent of vein grafts are occluded by the end of the first year following
surgery
B. At 10 years, the overall occlusion rate for a saphenous vein graft approaches 50 percent
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C. The atherosclerotic process that occurs in venous grafts is histologically different from that
which occurs in native arterial vessels
D. Progression of disease in native coronary arteries occurs at a rate of 18 to 38 percent over the
first decade after operation
E. The annual rate of saphenous vein graft occlusion after the first year is only on the order of 2
percent
300. All of the following statements regarding ventricular septal defect (VSD) are true EXCEPT:
A. It is the most common form of congenital heart disease in infants and children
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