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POST GRADUATE DIPLOMA IN CLINICAL CARDIOLOGY (PGDCC)

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Term-End Examination |une, 2009 MCC-004 : CoMMoN CARDIO-VASCULAR DISEASES II

MaximumMarks:60

:2hours Time
Note; 0 (it Aiil

in which are to be answered in Theretuill be multiple choicetype of questions this examination OMR Answer Sheets. are All questions comPulsory. in luae to bemarked correct. Answers and will haae Eachquestion four options only oneof themis and then to corresponding what is the correctans\I)er rectangularboxes figures in the appropriate pen by numberin thnt c:olumn using HB or leadpenciland not by ball the blacken circle ttrcsctme for in OMR Answer Sheets.

no markswill marksmorethanoneoption,it zoittbe takenas thellrong answerand (ia) lf any candidate be awarded this. for

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(at)

marks. any completety error or unintended Erase cartiesequalmarks. in Therewitt be 6A questions thispapersnd eachquestion

marking wrong nns\L,ers. (ail Therewill he no negatiue for of the hall tlrc shall leazte examination at least onehour after the commencement for (aiit No candidate examination. P.T.O.

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Acute Rheumatic fever is a sequel of the following infection : (1) staph' Aurens Gr A. Beta haemolytic streptococcus --'---'"-r L'! v!r\ Q) (3) streptococcus viridans pneumocci (4) In neonates Infective Endocarditis typically involves : (1) Mitral Valve (2) (3) Pulmonary Valve

2.

(4)

Aortic Valve Tricuspid Valve

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osler's nodes and Spliter haemorrhagesare seen in Infective Endocarditis in : (1) 80 % Cases (2) 20 - 4A % Cases (3) 5-15%Cases (4) Less than 5 % Cases Mycotic aneurysms due to infective Endocarditis occur most frequently i. , (1) visceral arteries Arteries of lower limb e) (3) Intracranial arteries (4) Arteries of upper limb The following situation reducesgradient across Mitral Valve in Mitral Stenosisis : (1) Atrial fibrillation sinus bradycardia e) (3) Anaemia Fever @ The Diastolicrumble of MS at apex is long in : (1) Mild MS (2) MS with MR (3) SevereMS (4) Arrial fibrillation Mitral Balloon valvuloplasty is not recommended in : (1) Mildly restrictedmobilify of leaflets (2) (3) (4) scatteredcalcificationconfined to margins Thickening extending to entire leaflet Extensivecalcification of leaflets

4'

c.

6.

7.

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The Commonest rheumatic valve disease is :

(1) (3) 9'

Mitral Stenosis Aortic Stenosis

(2) (4)

Tricuspid Stenosis Aortic Regurgitation

LV ejectionfraction decreases after MV surgery in caseof chronic MR due to : (1) Decreased preload Increasedafterroad e) (3) Decreased contractilitv (4) Increased contractility 2

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1-0. Sudden worsening of symptoms in a stablepatient of chronic MR is not due to : (1) Chordal rupture (z) Infective endocarditis (3) onset of A 7 (4) sinus Tachycardia l1.'. The-following cardiac chamber is nat enlargedin chronic MR not in failure : (1) Left atrium (Z) Left ventricle (3) Rt. ventricle L A appendage $)

T2. severe Mitral regurgitation is diagnosedby echocardiographywhen :

(1) (2) (3) (4) Mitral regurgitation volume is < 60 ml Effectiveregurgitant orifice is >- 0.40cm2 No pulmonary vein systolicflow reversal Regurgitantfraction < 55 per cent

L3. Surgery rs notindicated in a patient of MR in :

(1) (2) (3) (4) 14. Asymptomatic patient with normal LV function Symptomaticpatient with normal LV function Asymptomatic patient with EF less than 60 % Asymptomatic patient with LVESD > 43 mm

Acute mitral regurgitation is not seenwith : (1) Chordal rupture (2) Infective endocarditis (3) Acute MI @) Chronic AR

1.5. The Valve area of moclerate Aortic Stenosis : is 'r,.s (1) 3 cm2 (2) cnf (3)

<'r. cm2

(4)

> 1..8 cm2

16. The typical carotid pulse in severeaortic stenosisis : (1) Pulsusbisferiense (2) Slow rising low volume pulse (3) Pulsus paradoxus (4) Normal volume pulse 17, Typical murmur of valvular aortic stenosisis : (1) Crescendo- decrescendosystolic murmur (2) Long decrescendomurmur (3) Continuous murmur in Rt. 2nd space (4) Early diastolic murmur The following ECG change is not seenin Aortic stenosis: (1) LVH with ST-T change (2) RVH with ST-T change (3) LA enlargement (4) 10 AV clock g

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The following condition does not causeAortic regurgitation : (1) Marfan's syndrome (2) Aortic dissection (3) High vSD (4) Aneurysm of Abdominal Aorta Examination of peripheral pulse in chronic SevereAR reveals : (1) Narrow pulse pressure (2) Rapid upstroke of radial pulse (3) Low volume pulse (4) Slow rising upstroke SevereAR presentsthe following feature in echo cardiography : (t) Flow reversalin descendingaorta (2) Regurgitant jet width / LVor diameter < ia o/o (3) Aortic regurgitant pressurehalf time > 400m sec (4) LVEDD < 6A mm

20,

21.

22- Severeprimary kicuspid regurgitation will not have symptom of : (1) Fatigue (2) Effort intolerance (3) Abdominal fullness (4) PND 23. ECG changesin Acute pericarditis are : (1) sr- segmentelevation (z) (3) Reciprocalchanges (4)

pR segmentelevation Bradycardia

24- The causeof electrical alternansin large pericardial effusion is : (1) Decreasedmovement of parietal pericardium (2) Large echofree space around cardiac shadow (3) swinging movement of heart within pericardial fluid (4) Tachycardia 25. I4trhich the following are Cardiovasculardiseases(cvD's) ? of (1) Coronary Heart disease (2) Cerebrovasculardisease (3) Rheumatic Heart disease (4) All of the above 26. ECG feature of Cardiac Aamponade is : (1) Sinus bradycardia Q) (3) Frequent VPCs (4)

Total electrical alternans Tall T wave

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Jugular venous pulse in constrictive pericarditis does not show the following feature : (1) Prominent Y-descent (z) prominent X-descent (3) Kussmaul'ssign (4) Elevated JVP 4

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ZB. Typical characterof Apical impulse in Hypertrophic cardiomyopathy is : (2) Tapping (1) Heaving (4) Diffuse Pulsation (3) Double apical imPulse
29. Systolic murmur increases with Valsalva manoever in :

(1) (3) 30.

Valvar AS MVP

(2)

Mitral regurgitation

(4) HocM

Infective endocarditis of Rt. sided valves occurs in : (2) Rheumatic ms (1) Prostheticvalves (4) MVP (3) IV drug abusers pharyngitis is in the age Sroup : Maximum incidence of Gr. A beta haemolytic Streptococcal

3L.

(1) 5-15yrs. (3) 20-40yrs.

(2) 10-20yrs. (4) 0-5 yrs.

92. The following is a minor manifestation of Acute Rheumatic fever : (2) Erythema marginatum (1) Carditis (4) Prolonged P-R interval module (3) Subcutaneous 33. prosthetic valve endocarditis is called early when symptoms begin within : (2) 80 days (1) 60 days (4) 120 days (3) 100 days

94. Systemic embolisation in Infective endocarditis occurs in : (2) 20-50 % cases (1) 10-15 % cases (4) 80-100 % cases (3) 50-70 % cases 35. The commonestsymptom of Mitral stenosisis : (2) Palpitation (1) Chest pain (4) Syncope (3) Dyspnoea The first heart sound is soft in Mitral stenosisin : (2) SevereMS (1) Mild MS (4) Sinus tachYcardia (3) Calcific MV

35.

97. The most informative investigation in MS is : (2) Blood tests (1) Chest X-ray (4) ECG (3) Echo-cardiograPhY P.T.O.

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The acute life threatening complication in MS is :

(1) (3)

Arrial rjbrillation Pulmonary oedema

(2)

Severe PH

(4) cc 7

39. The Commonestvalvular abnormality seenin clinical practice is : (1) Mitral stenosis (2) Mirral regurgitation (3) Aortic regurgitation (4) pulmonary varve stenosis

40. The following is not a causeof Mitral regurgitation :

(1) Infective Endocarditis

(3) 41'

Cleft anterior Mitral leaflet

(2) (4)

Bicuspid aortic valve Hypertrophic Cardiomyopathy

LV ejectionfraction is maintained in Mitral regurgitation by : (1) IncreasedAfterload Increasedpreload e) (3) Dilated left atrium (4) small size of LV First heart sound (SI) is not soft in MR due to : (1) Rheumatic MR (2) Mitral valve prolapse (3) Papillary muscle dysfunction (4) Marfan's Syndrome

42.

43. The following drug is beneficial in a patient of MR in Sinus Rhythm :

(1) (3) Beta blocker Vasodilator (2) (4) Digoxin Diuretic

44. The following patients of MR do better after MV surgery : (1) with preserved LV function (z) High NYHA Class (3) Large LVEDV (4) with poor EF %

45. Causesof Aortic stenosisin young adult is most likely .--r to be :

(1) (2) (3) (4) Rheumatic CongenitalTricuspid aortic valve Fibrocalcificchangesin aortic valve Carcinoid tumor

46.

In the natural history of Aortic Stenosis: (1) systolic function is maintained till late (2) Diastolicfunction is maintained till late (3) LV dilatation occurs early (4) Patients have decreasedLVEDP

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Acute Aortic regurgitation occurs in : (1) Aortic Dissection (3) Fibrocalcific degeneration

(2) (4)

Congenital Bicuspid Aortic valve Rheumatic heart disease

48. Patientswith chronic severeAR may be : (1) Symptomaticvery early (2) Asymptomatic for many years (3) Presentwith LV dysfunction very early (4) Presentwith sudden death 49. Characteristic murmur of moderately severe chronic AR : (1) Middiastolic rumbling murmur syst. murmur (2) Rough crescendo-decrescendo (3) Blowing early diastolic murmur (4) Continuous murmur at LSB

50. The following statementrs true for Aortic regurgitation :

(1) (2) (3) (4) Vasodilatorslower stroke volume and degreeof regurgitation Vasodilatorsimprove stroke volume by lowering systemicresistance Vasodilators are indicated in mild AR with normal LV size ACE inhibitors are better choice following AVR

51. In Tricuspid Stenosisfollowingrs not seenclinically :

(1) (2) (3) (4) 52.

'a' wave Prominent Slow y descent shape Diastolic murmur with crescendo-decrescendo Severepulmonary hypertension

Acute Pericarditis clinically presentswith : (2) (1) Chest pain (4) (3) Hypotension

BradYcardia PND

53.

The following is not a symptom of periodical effusion : (2) DYsPhagia (1) Dyspnoea (4) Headache (3) Irritating Cough Following are the clinical signs of Cardiac Tamponade except : (2) TachYPnoea (1) Elevated]VP (4) Pulsusbisferiens (3) Pulsus paradoxus P.T.O.

54.

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The following is not the presenting feature of Hypertrophic Cardiomyopathy : (1) Chest pain (Z) Syncope (3) Palpitation (4) Headache The most important investigation for diagnosisof Hypertrophic Cardiomyopathy is : (1) ECG Chest X_ray @ (3) Echo-cardiography (4) EMG Ejectionclick is commonly heard in : (1) Rheumatic AS (3) Cong. Valvar AS

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57.

(2) (4)

HOCM Cong. Subvalvar AS

58.

Medical Therapy for HOCM does not include the following drug : (1) Verapamil (2) Digoxin (3) Beta blocker (4) Amiodarone ECG of Arrhythmogenic RV Cardiomyopathy shows following features except : (1) Inverted T in Rt. precardiallead (2) Tall T in Vu, Vu (3) VT of RV origin (4) VT with LBBB pattern Adverse outcome in dilated cardiomyopathyis related with : (1) Marked LV dilatation (2) Low LV mass (3) Good LV systolic function (4) < moderate MR -o0o-

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