NIZAMS INSTITUTE OF MEDICAL SCIENCES

Punjagutta, Hyderabad 500 082, A.P., India.

Set A
2012 DM Cardiology

Question Booklet

Entrance Examination for Admission to Subject DM Cardiology

24 June 2012

Marks 90

Time: 1 hr: 30 min

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Q1. Radiofrequency catheter ablation therapy is recommended over implantable cardioverter-defibrillator for which of the following VT A) B) C) D) Q2. LV fascicular VT LV Scar VT VT in Arrhythmogenic RV Dysplasia. VT in Idiopahic Dilated Cardiomyopathy.

All the following are tributaries of coronary venous sinus except

A) B) C) D) Q3.

inferior cardiac vein posterior cardiac vein middle cardiac vein small cardiac vein.

Renal artery stenosis may occur in all of the following except A) B) C) D) atherosclerosis fibromuscular dysplasia Takayasu's arteritis polyarteritis nodosa

Q4. Preferred angiographic view to evaluate ostial portion of the left anterior descending and circumflex coranary arteries is A) B) C) D) LAO caudal LAO cranial AP cranial RAO cranial

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Q5. During sinus impluse activation of the atria , following is the last part of the atrium to get activated A) B) C) D) Q6. crista terminalis part of right atrium lower septal porion of the right atrium superolateral part of left artium inferolateral part of left atrium

Isomerism of left atrial appendages is associated with A) B) C) D) anterior position of inferior vena cava trilobed lungs asplenia atrial arrythmias

Q7.

Regarding ductus arteriosus A) B) C) D) during intrauterine life , its diameter is smaller than that of branch arteries. functional closure begins 24 hours after birth post natal closure is hastened by high altitude. anatomical closure begins near pulmonary artery and progresses towards aorta

Q8. A patient's serological report reveals HBsAg +ve, HBeAg Negative, Anti HBe +ve, anti HBc IgM negative, HBV DNA quantitative 19,00,000 IU/ml. The diagnosis based on serology is A) B) C) D) chronic HBsAg carrier wild type chronic HBsAg carrier with acute exacerbation chronic HBsAg carrier with pre core mutation HBV related acute viral hepatitis

Q9. Which of the following criteria is most likley to affect the generalizability of the results of a clinical trial to patients seen in routine practice A) B) C) D) Q10. enrollment criteria power of the study selection bias randomisation strategy

In a carcinoma with unknown primary the most common histology seen is A) B) C) D) squamous cell carcinoma neuroendocrine histology well differentiated adenocarcinoma poorly differentiated adenocarcinoma

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Q11.

Regarding precordial lead V6 in ECG A) B) C) D) is located in left 6th intercostal space is located in the same horizontal plane as V4 is in left posterior axillary line shows ST depression in acute lateral myocardial infarction

Q12. A patient who has undergone AICD implantation reports to emergency room with history of multiple AICD shocks in the last one hour. ECG done in the emergency room shows atrial fibrillation with rapid ventricular rate. Management would be A) B) C) D) I.V amiodarone bolus followed by infucion over 12 hours I.V adenosine I.V verapamil Apply magnet over AICD pulse generator

Q13. Which of the following food types have a significant effect on altering the risk of coronary heart disease 1. high fruit and vegetable intake 2. total coffee intake 3. dairy food consumption 4. intermittent moderate alcohol consumption A) B) C) D) only 1, 2 and 3 are correct only 1 and 3 are correct only 2 and 4 are correct only 4 is correct

Q14. A 50 year old man, an alcoholic and a smoker presents with a 3 hours history of increasing shortness of breath and chest pain. He started having this pain while eating, which was constant and radiated to the back and interscapular region. He was a known hypertensive. On examination, he was cold and clammy with a heart rate of 130/min, and a BP of 80/40 mmHg. JVP was normal. All peripheral pulses were present and equal. and ejection systolic murmur was heard.Which one of the following is the most likely diagnosis A) B) C) D) acute aortic dissection acute myocardial infarction rupture of the esophagus acute pulmonary embolism

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Q15. Regarding postural orthostatic tachycardia syndrome - on upright tilt patients exhibit A) B) C) D) significant increase in heart rate and blood pressure. significant increase in heart rate with no significant change in BP. significant increase in heart rate with significant fall in BP. inappropriate increase in resting heart rates with no significant further change.

Q16. Large v waves on pulmonary capillary wedge (PCW) tracing are seen in all of the following except A) B) C) D) papillary muscle dysfunction rheumatic mitral regurgitation acute AR ventricular septal defect

Q17. with

Inducible ischemia can be diagnosed by exercise testing in symptomatic patients

A) B) C) D)

complete RBBB. WPW syndrome. complete LBBB. electronically paced ventricular rhythm.

Q18. Assertion: during percutaneous coronary intervention smaller ST segment changes are noticed in balloon inflations subsequent to initial inflation Reason: ischemic preconditioning is the proposed mechanism for cardiac protection A) Both Assertion and Reason are true, and Reason is the correct explanation for Assertion B) Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true

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Q19. Correct match of ECG pattern to the time range following onset of myocardial infarction

1)

2)

3)

4)

A) B) C) D)

1-week , 2-hour ,3-year ,4-minute 1-minute ,2-hour ,3-year ,4-week 1-minute ,2-hour ,3-week ,4-year 1-week ,2-year ,3-minute ,4-hour

Q20. Which of the following measure/ measures is/ are highly recommended by ACC/AHA in the treatment of patients with endstage heart failure 1.cardiac transplantation 2. intermitent infusion of positive inotrope agents 3. left ventricular assist device in patients expected to survive for less than a year with medical therapy 4. mitral valve repair for severe secondary mitral regurgitation A) B) C) D) only 1, 2 and 3 are correct only 1 and 3 are correct only 2 and 4 are correct only 4 is correct

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Q21. Which of the following drug/ drugs has / have the potential to precipitate decompensation in patients with chronic heart failure 1. allopurinol 2. rosiglitazone 3. alpha adrenergic blockers 4. non steroidal anti-inflammatory drugs A) B) C) D) only 1,2 and 3 are correct only 1 and 3 are correct only 2 and 4 are correct only 4 is correct

Q22. Assertion : under stress myocardial oxygen delivery increases dominantly due to increased extraction of oxygen from blood Reason: oxygen extraction is almost maximal under resting conditions A) Both Assertion and Reason are true, and Reason is the correct explanation for Assertion B) Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true

Q23. A 26 year old lady came with the complaints of fever with altered sensorium and reduced urine output of 1 week duration. On evaluation her hemoglobin was 7 gm/dl, platelet count of 30,000/cu.mm with peripheral smear showing schistocytes.Serum creatinine was 3mg/dl.Prothrombin time and activated partial thromboplastin time were normal. Enzyme most likely to be deficient in this situation is A) B) C) D) hexokinase pyruvate kinase ADAMTS 13 glucose-6 phosphate dehydrogenase

Q24.

Regarding blood supply to the cardiac conduction system all are true except A) B) C) D) right bundle branch has dual blood supply from RCA and LAD left anterior fascicle has dual blood supply from LAD and RCA. left posterior fascicle has dual blood supply from LAD and RCA. AV node is supplied by dominant coronary artery

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Q25. Troponin - T is preferable to CPK - MB in the diagnosis of acute myocardial infarction (MI) in the following situation/situations 1. bedside diagnosis of acute MI 2. postoperatively (after CABG) 3. small infarcts 4. reinfarction after 4 days A) B) C) D) Q26. only 1, 2 and 3 are correct only 1 and 3 are correct only 2 and 4 are correct only 4 is correct

Doppler principle states that

A) change in received frequency is inversely proportional to the velocity of blood moving towards the transducer B) change in received frequency is directly proportional to the velocity of blood moving towards the transducer C) change in received signal amplitude is directly proportional to the velocity of blood moving towards the transducer D) change in received signal amplitude is inversely proportional to the velocity of blood moving away from transducer Q27. In an elderly hypertensive patient with depression which of the following drug is to be avoided A) B) C) D) sertaline phenelzine imipramine mirtazapine

Q28.

Bosentan used for treatment of pulmonary arterial hypertension is A) B) C) D) selective ET-A receptor antagonist both ET-A and ET-B receptor antagonist phosphodiesterase inhibitor prostacyclin

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Q29. A resident doctor inserted central venous catheter for a patient with hypotension in the emergency medicine department. The cotton dressing stained with blood should then be placed into A) B) C) D) Q30. yellow plastic bag red plastic bag black plastic bag white translucent plastic bag

Which of the following is not used for bypass grafting of coronary arteries A) B) C) D) radial artery gastroepiploic artery ulnar artery inferior epigastric artery

Q31. Which of the following prehospital measures are acceptable in the care of a patient with snakebite A) B) C) D) application of splint to the bitten extremity incision and application of suction to the bite site application of ice or poultices application of tourniquet

Q32. Which one of the following third generation beta blockers, is a beta-1- selective, vasodilator A) B) C) D) carvedilol labetalol nebivolol bucindolol

Q33. Regarding adverse drug reaction of chemotherapeutic agent which is a wrong match A) B) C) D) 5-FU- acute coronary syndrome doxorubicin-LV dysfunction cisplatin-Hypokalemia paclitaxel-Hypotension

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Q34. Which of the following is/are cardiac manifestations in primary antiphospholipid syndrome 1. pericarditis 2. non bacterial endocarditis 3. conduction system disease 4. thrombotic coronary artery disease A) B) C) D) Q35. only 1,2 and 3 are correct only 1 and 3 are correct only 2 and 4 are correct only 4 is correct

Regarding the definition of pulmonary arterial hypertension

1.pulmonary arterial pressure more than 25 mmHg at rest 2.pulmonary capillary wedge pressure less than 15 mmHg 3.increased pulmonary vascular resistance 4.presence of pulmonary embolism A) B) C) D) only 1, 2 and 3 are correct only 1 and 3 are correct only 2 and 4 are correct only 4 is correct

Q36. Mason - Likar modification of 12 lead ECG placement during Tread mill Test causes 1. Right axis shift 2. Appearance of Q wave in II , III , avf 3. Appearance of Q wave in a v L 4. Left axis shift A) B) C) D) only 1,2 and 3 are correct only 1 and 3 are correct only 2 and 4 are correct only 4 is correct

Q37.

The graft with the highest patency rate in coronary artery bypass surgery is A) radial artery to the right coronary artery B) left internal mammary to the left anterior descending artery C) radial artery to the left anterior descending artery D) left internal mammary artery to the circumflex artery

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Q38. Patient with Primary VF (within first 24 hours) during Acute Myocardial Infarction requires A) B) C) D) Q39. long term amiodarone. subsequent Electrophysiologic study for inducibility of VT. implantable Cardioverter- Defibrillator none of the above.

Given the following ECG of cyanotic child, the most likely diagnosis is

A) B) C) D)

d-transposition if great arteries TAPVC Ebsteins anomaly tricuspid atresia

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Q40.

In which following conditions left atrium is not enlarged A) B) C) D) ventricular septal defect atrial septal defect aortopulmonary window patent ductus arteriosus

Q41.

During ventricular pressure pulses square root wave is seen in A) B) C) D) ASD MVPS dilated cardiomyopathy constrictive pericarditis

Q42. A 15-year old girl presented with recurrent palpitations and central cyanosis. Auscultation revealed quadruple rhythm and holosystolic murmur at lower left sternal border. Her electrocardiogram is depicted below.

Most probable clinical diagnosis is A) B) C) D) Ebstein's anomaly tricuspid atresia Eisenmenger atrial septal defect (ASD) tetralogy of Fallot (TOF)

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Q43.

Regarding prasugrel, a newer antiplatelet drug A) B) C) D) it is an 5-HT2A antagonist it is shortacting is a prodrug exhibits high inter-individual variablity in platelet response

Q44.

In Brugada syndrome VF episodes are precipitated most with A) B) C) D) exercise. catecholamines. quinidine. fever.

Q45. A 59 year man with severe myxomatous mitral regurgitation is asymptomatic, with a left ventricular ejection fraction of 45% and an endsystolic diameter index of 2.9cm/m2. The most appropriate treatment is A) B) C) D) Q46. mitral valve repair or replacement no treatment ACE inhibitor therapy digoxin diuretic therapy

Among the atrial septal defects shown below, the darkly shaded defect is of type

A) B) C) D)

ostium primum ostium secundum sinus venosus coronary sinus

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Q47.

Regarding Stress ECG testing in an otherwise healthy individual

1. diastolic pressure raises 5mm Hg at each stage 2. isolated VPCs at peak exercise suggest left main disease 3. false negative result more common in single vessel disease in LAD than other two vessels 4. S-T-depression limited to recovery phase do not generally represent false-positive response. A) B) C) D) only 1,2, and 3 are correct only 1 and 3 are correct only 2 and 4 are correct only 4 is correct

Q48. Which of the following situations would be rated as the most appropriate indication for the use of radionuclide imaging for detection of coronary heart disease (CHD) A) asymptomatic patient with intermediate risk of CHD according to ATP III criteria with an uninterpretable ECG B) acute chest pain with definite acute coronary syndrome C) troponin elevation without additional evidence of acute coronary syndrome D) new onset atrial fibrillation with an unclear etiology

Q49. Drug B is investigated in a meta-analysis for its effect on mortality after acute myocardial infarction. It is found that, when this drug is administered, the mortality drops from 11% to 3%. How many patients will have to be treated with drug B to prevent one death A) B) C) D) 3 11 12.5 24

Q50. Which of the following investigation has the highest sensitivity for diagnosing myocarditis A) B) C) D) CK-MB isoform Indium -111 antimyosin scintigraphy myocardial biopsy echocardiography

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Q51.

True about Dressler's syndrome is all, except A) B) C) D) occurs with in hours after myocardial infarction recurrence may be seen chest pain is common responds well to salicylates

Q52.

Which of the following hemodynamic changes occur in pregnancy

1. decreased peripheral vascular resistance 2. decreased pulmonary vascular resistance 3. increased blood volume 4. decreased venous pressure in lower extremities A) B) C) D) Q53. only 1, 2 and 3 are correct only 1 and 3 are correct only 2 and 4 are correct only 4 is correct

Regarding ranolazine

Assertion: it is a piperazine derivative that has anti ischemic properties Reason: it blocks rectifier potassium currents and also lowers heart rate A) Both Assertion and Reason are true, and Reason is the correct explanation for Assertion B) Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true Q54. In patients with diabetes and kidney disease

Assertion: Angiotensin converting enzyme blockers and angiotensin receptor antagonists are the preferred over calcium channel blockers antihypertensives in patients with diabetic nephropathy Reason: Angiotensin converting enzyme blockers and angiotensin receptor antagonists are more effective in lowering blood pressure in those with diabetes A) Both Assertion and Reason are true, and Reason is the correct explanation for Assertion B) Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true

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Q55.

All of the following are useful in the treatment of instent restenosis except A) B) C) D) brachytherapy atherectomy devices Gp IIb IIIa inhibitors DES implantation

Q56.

Regarding cardiac output during rest and exercise in a normal person

1. at rest is ~5 to 6 liters/minute and can increase approximately fivefold during strenuous exercise 2. increases with a decrease in the pressure gradient (P1 - P2) generated by the heart 3. during exercise blood flow to the skin and skeletal muscle increases to constitute as much as 85 % of the cardiac output 4. during exercise the brain, kidney and splanchnic circulations receive about 1/3rd of their basal flow A) B) C) D) only 1,2 and 3,are correct only 1 and 3 are correct only 2and 4 are correct only 4 is correct

Q57. Regarding vein graft in CABG Assertion: degeneration occurs significantly after 5 years of CABG Reason: degenerative process in vein grafts is similar to native vessel atherosclerotic disease A) Both Assertion and Reason are true, and Reason is the correct explanation for Assertion B) Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true Q58. Discontinuity between the anterior mitral leaflet and coronary cusps are present in

1. d-transposition of great arteries 2. l-transposition of great arteries 3. discrete sub-aortic stenosis 4. mitral valve prolapse A) B) C) D) only 1, 2, and 3 are correct only 1 and 3 are correct only 2 and 4 are correct only 4 is correct

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Q59. The term "extensively drug-resistant tuberculosis (XDR-TB)" refers to isolates of M.tuberculosis resistant to A) streptomycin, rifampicin, pyrazinamide, ethambutol and cycloserine B) isoniazid, rifampicin, flouroquinolones and atleast one injectable second line drug C) pyrazinamide, isoniazid, ethambutol and atleast one injectable second line drug D) streptomycin, rifampicin, pyrazinamide, ethambutol and ethionamide Q60. Regarding statins

Assertion: Pravastatin should be taken in the evening whereas atorvastatin can be taken at any time in the day. Reason: Pravastatin causes day time drowsiness as a most common side effect. A) Both Assertion and Reason are true, and Reason is the correct explanation of Assertion. B) Both Assertion and Reason are true, but Reason is not the correct explanation of Assertion. C) Assertion is true but Reason is false. D) Assertion is false but Reason is true. Q61. Regarding Malaria

Assertion: plasmodium vivax malaria is characterized by long term relapses Reason: the latent erythrocytic stage lasts for several years A) Both Assertion and Reason are true, and Reason is the correction explanation for the assertion B) Both Assertion and Reason are true, and Reason is not the correction explanation for the assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true Q62. Regarding normal ventricular activation A) B) C) D) Q63. activation front is directed from epicardium to endocardium. earliest LV activation is in apex on left side of septum. earliest RV activation involves pulmonary conus. posterobasal LV is last to be activated.

Ezetimibe exerts its action by A) B) C) D) inhibiting intestinal cholesterol absorption inhibiting intestinal triglyceride absorption inhibiting HMG Co-A reductase activity binding to bile acids to form insoluble complexes 17 of 25

Q64. Ideal emergency imaging modality for unstable patient with proximal aortic dissection is A) retrograde aortography. B) MRI C) transesophageal echocardiography D) intravasucular ultrasound / transthoracic echocardiography Q65. Rastelli operation is done for

A) Transposition of great arteries(TGA) with intact Ventricular septum B) TGA with ventricular septal defect(VSD) C) TGA, VSD with left ventricular outflow tract (LVOT) obstruction D) Tetralogy of Fallot

Q66. Which of the following combinations of lung volume abnormalities are most likely in idiopathic pulmonary fibrosis A) decreased total lung capacity (TLC), decreased vital capacity (VC), decreased residual volume (RV), increased FEV1/FVC ratio, normal maximum inspiratory pressure (MIP) B) normal TLC, normal residual volume RV, normal FEV1/FVC ratio, normal MIP C) increased TLC, decreased VC, decreased FEV1/FVC ratio D) decreased TLC, increased residual volume RV, normal FEV1/FVC ratio, decreased MIP

Q67. The primary biochemical lesion in homozygotes with familial hypercholesterolemia A) the loss of apoprotein B B) the malfunctioning of acyl CoA cholesterol acyl transferase (ACAT) C) the functional deficiency of plasma membrane receptors for low density lipoproteins D) the increased production of low density lipoproteins

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Q68. A specific predictor for higher risk of sudden cardiac death in patients with idiopathic dilated cardiomyopathy(non-ischemic CMP) is A) B) C) D) Q69. non-sustained ventricular tachycardia induction of polymorphic VT or VF during EP testing unexplained syncope any of the above

All of the following are seen in cardiac tamponade except A) B) C) D) pulsus paradoxus diastolic collapse of right ventricle on echocardiogram electrical alternans Kussmaul's sign

Q70. A 24 year old patient presents to casualty department with chest pain of 2 day duration, pulse-110/min,BP:100/70mmhg, Temp 100F,Resp-22/min, Chest-B/l equal air entry ,CVS-normal heart sounds,no murmurs. The given electrocardiogram is suggestive of

A) B) C) D)

acute pericarditis acute myocardial infarction pulmonary embolism early repolarization changes

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Q71.

In TOF severity of cyanosis depends on

1) severity of infundibular obstruction 2) amount of aortic override 3) systemic vascular resistance 4) site of VSD A) B) C) D) only 1,2 and 3 are correct only 1 and 3 are correct only 2 and 4 are correct only 4 is correct

Q72. Regarding use of calcium channel blockers in management of acute coronary syndrome Assertion: they are indicated as first line drugs in the management of acute coronary syndrome Reason: they inhibit vascular smooth muscle function and cause coronary and peripheral vasodilatation A) Both Assertion and Reason are true, and Reason is the correct explanation for Assertion B) Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true

Q73. A 45 year old male having a long history of cigarette smoking presented with gangrene of left foot. An amputation of the left foot was done. Representative sections from the specimen revealed presence of arterial thrombus with neutrophilic infiltrate in the arterial wall. The inflammation also extended into the neighbouring veins and nerves. The most probable diagnosis is A) B) C) D) Takayasu arteritis Giant cell arteritis hypersensitivity angitis thromoboangitis obliterans

Q74. Prospective gating in coronary computerised tomography angiography is associated with A) B) C) D) low radiation dose x ray tube continuously on evaluation of both systole and diastole enables flexible reconstruction in the event of arrhythmias

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Q75. Infection /infections that occur in the first 2 weeks after allogeneic stem cell transplantation is/ are 1. gram positive bacterial sepsis 2. candida sepsis 3. herpes simplex virus disease 4. cytomegalovirus disease A) B) C) D) Q76. only 1, 2 and 3 are correct only 1 and 3 are correct only 2 and 4 are correct only 4 is correct

The antiretroviral drug implicated in the development of heart muscle disease A) B) C) D) nevirapine efavirenz zidovudine emtricitabine

Q77.

Regarding cryptococcal infection

1. lifelong maintenance therapy is recommended to prevent a symptomatic clinical relapse in patients with HIV infection. 2. pulmonary cryptococccosis in an immunocompetent host always progresses to disseminated cryptococcosis if not treated. 3. complications of central nervous system cryptococcosis include cranial nerve deficits, vision loss and cognitive impairment. 4. the echinocandins , caspofungin and micafungin are highly effective against cryptococcus species A) B) C) D) Q78. only 1,2 and 3 are correct only 1 and 3 are correct only 2 and 4 are correct only 4 is correct

Cardiac involvement in sarcoidosis is characterised by A) B) C) D) Right heart failure secondary to primary cardiac involvement Echocardiographic evidence of myocarditis is seen >80% cases Intraventricular delays and atrioventricular blocks Apical regional wall motion abnormality secondary to coronary involvement

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Q79.

Regarding fondaparinux A) B) C) D) is a orally acting direct thrombin inhibitor requires dose adjustment with APTT levels excreted mainly through hepatic metabolism is a synthetic pentasacharide that inhibits factor Xa

Q80. In a patient with chronic congestive cardiac failure, all of the following drugs prolong survival except A) B) C) D) Q81. metoprolol carvedilol enalapril digoxin

Which of the following is a minor criteria for diagnosis of infective endocarditis A) B) C) D) antiphase I IgG antibody titer for Coxiella brunetti > 1:800 new partial dehiscence of prosthetic valve single positive blood culture for coagulase negative staphylococci rheumatoid factor

Q82.

All of the following statements about mitral valve prolapse are true except A) B) C) D) it is more common in females most patients are symptomatic it has a benign clinical course transient cerebral ischemia is a known complication

Q83. Regarding digoxin Assertion: it controls ventricular response in CHF patients with atrial fibrillation Reason: it has vagolytic action. A) Both Assertion and Reason are true, and Reason is the correct explanation for Assertion B) Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true

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Q84.

The following pedigree is an example of what pattern of inheritance

A) B) C) D)

X-linked dominant X-linked recessive autosomal recessive autosomal dominant

Q85. In which of the following category of patients with CHD does coronary bypass surgery result in improved survival A) B) C) D) mild ischemia, two vessel disease, ejection fraction more than 50% mild ischemia,two vessel disease(LCX and RCA),ejection fraction < 50% mild ischemia, triple vessel involvement, ejection fraction less than 50% moderate ischemia, two vessel disease, ejection fraction more than 50%

Q86.

Which among the following is short RP tachycardia A) B) C) D) atypical AVNRT AVRT with slowly conducting pathway orthodromic AVRT sinus node re-entry

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Q87. Patient of HOCM underwent dual chamber pacemaker implantation, following are pressure traces at different AV(atrio-ventricular)

intervals

Assertion: AV delay of 240msec is ideal in this patient Reason: optimal AV delay involves minimal LVOT gradient, normal stroke volume with no significant rise in LA pressure A) Both Assertion and Reason are true, and Reason is the correct explanation for Assertion B) Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true Q88. Multi drug resistant salmonella typhi infection is resistant to the following drugs

A) B) C) D)

quinolones and chloramphenicol chloramphenicol, ampicillin and trimethoprim ciprofloxacin, ampicillin and ceftriaxone nalidixic acid and chloramphenicol

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Q89.

Augmented limb lead aVL has its negative terminal in A) B) C) D) wilson central terminal. combined output of right arm and left foot electrodes. left arm. combined output of right arm, left arm and left foot electrodes.

Q90. Higher risk of sudden cardiac death is predicted by which one of the following features on exercise testing A) B) C) D) lower resting heart rate. large increments in heart rate during exercise. lower increment in heart rate during first minute of recovery lower decrement in heart rate during first minute of recovery.

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