MCC-005

POST GRADUATE DIPLOMA IN COMMUNITY

CARDIOLOGY (PGDCC)

Term-End Examination 00043December, 2009

MCC-005 : COMMON CARDIOVASCULAR DISEASES-III

Time : 2 hours Maximum Marks : 60

Note :

There will be multiple choice type of questions in this examination which are to be answered in

OMR Answer Sheets.

All questions are compulsory.

Each question will have four options and only one of them is correct. Answers have to be marked in

figures in the appropriate rectangular boxes corresponding to what is the correct answer and then

blacken the circle for the same number in that column by using HB or lead pencil and not by ball pen

in OMR Answer Sheets.

If any candidate marks more than one option, it will be tdken as the wrong answer and no marks will

be awarded for this.

Erase completely any error or • unintended marks.

There will be 60 questions in this paper and each question carries equal marks.

There will be no negative marking for wrong answers.

No candidate shall leave the examination hall at least for one hour after the commencement of the

examination.

MCC-005

1 P.T.O.

Commonest congenital heart disease among these is :(1) ASD (2) VSD (3) PDA (4) Congenital Pulmonary Stenosis

In congenital Pulmonary Stenosis, the intensity and length of ESM is governed by :(1) Severity of PS (2) Systemic Vascular Resistance(3) Pulmonary Vascular Resistance (4) Systemic Blood Pressure

Differential Cyanosis can occur in :(1) ASD (2) VSD (3) PDA (4) Supravalvular Aortic Stenosis

Cardiomegaly is more common and feature of :(1) Ebstein's Anomaly (2) Tetrology of Fallot(3) Aortic stenosis (4) Mitral Stenosis

5. Respiratory Infections are more common in congenital heart diseases associated with :Right to left shuntLeft to Right shuntLeft ventricular outflow obstructionRight ventricular outflow obstruction

6. Following is the cyanotic heart disease with increased pulmonary blood flow :Pulmonary arterio-venous fistulaASD PrimumTetrology of fallotUnobstructed total Pulmonary Venous Drainage.

7. Following are features of Valvular Aortic Stenosis except :Harsh Ejection Systolic murmur loudest in right upper sternal areaInconstant Ejection ClickX-ray-Normal heart sizeECG - Left Ventricular hypertrophy

8. Prostaglandin E, is used with newborn in one of the following conditions :To hasten the closure of PDATo keep the PDA patentIn large PDA with left to right shut if patient is in failure.Treatment of apnea when associated with cyanotic congenital heart disease

9. Optimum time for surgery for Ruptured sinus of Valsalva aneurysm :Before one year of agePre-school (4-5 years of age)As soon as the diagnosis is madeBefore Puberty

10. Glenn Shunt is communication where :Subclavian artery is connected with respected Pulmonary ArteryAscending Aorta is connected with right Pulmonary ArterySuperior vena cava is connected to pulmonary ArteryDescending Aorta is connected to Left Pulmonary Artery.

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Lutembacher's Syndrome consists of :(1) ASD and Mitral Stenosis (2) ASD and Tricuspid stenosis(3) ASD and Pulmonary Stenosis (4) ASD and Aortic Stenosis

RASTELLI's operation is :Harvesting the native pulmonary valve and implanting it in the aortic positionClosure of large VSD and establishing RV to PA connection with external conduitRedirecting the whole systemic return into the lungs bypassing the right ventricleSwitching the Great Arteries to restore the normal ventriculoarterial connections

In cyanotic congenital heart disease, least common incidence of Brain Abscess is in thefollowing age group :(1) Under 2 years of age (2) Under 5 years of age(3) Under 10 years of age (4) Under 15 years of age

Following drug does not depress spontaneous discharge of the normal sinus node :(1) Amiodarone (2) Disopyramide (3) Verapamil (4) Propanolol

One of the following drug was not used in cardiac Arrhythmia Suppression Trial (CAST)(1) Encainide (2) Flecainide (3) Morcizine (4) Propafenone

Following Antiarrhythmic drug after an initial increase in blood pressure causes fall in bloodpressure :(1) Amiodarone (2) Sotalol(3) Ibatilide (4) Bretylium Tosylate

Rapid administration of a following drug may cause a seizure :(1) Adenosine (2) Metoprolol (3) Lignocaine (4) Esmolol

Verapamil should not be used in the following arrhythmia :Arrhythmia because of sinus node reentryArrhythmia because of AV node reentryOrthodromic AV reciprocating tachycardia associated with an accessory pathwayAtrial Fibrillation and anterograde conduction over an accessory pathway

In the setting of chronic atrial fibrillation preferred drug for control of ventricular rate is :(1) Digoxin (2) Amiodarone (3) Atenolol (4) Propafenone

For management of Digitalis Toxicity, following drug should be avoided :(1) Potassium (2) Magnesium (3) Phenytoin (4) Amiodarone

A pacemaker that senses the atria and paces the ventricle in a triggered node with no rateresponse or multisite pacing is conventionally designated as :(1) AVTOO (2) AVIOO (3) VATOO (4) VATOV

Drug which does not fit into Vaughan Williams classification of antiarrhythmic drugs is :(1) Quinidine (2) Mexiletine (3) Verapamil (4) Adenosine

MCC-005

3 P.T.O.

Following percentage of patients with large VSD seen at one month of age may closespontaneously :(1) 20% (2) 40% (3) 60% (4) 80%

Following Technique of operation for coarctation is not prefered nowadays :Resection and Primary End to End AnastomosisSubclavian Flap AortoplastyEnd to End Anastomosis with subclavian flap AortoplastyDacron Patch Aortoplasty

First open heart surgery using heart lung machine was performed by :(1) Dr. John Gibbon (2) Dr. Walton Lillchei(3) Dr. John Kirklin (4) Dr. Christian Barnard

For safe cardiopulmonary bypass, Activated clotting time should be :(1) > 100 Seconds (2) > 200 Seconds(3) > 300 Seconds (4) > 400 Seconds

27. At the beginning of cardiopulmonary bypass, the pump output is usually kept at :2.4 litres per meter per minute3.4 litres per meter per minute4 litres per meter per minute5 litres per meter per minute

28. It is important that heart does not distend during cardiopulmonary bypass. This isaccomplished by :(1) Hypothermia (2) Myocardial Protection(3) Venting (4) Priming the Circuit

29. Infra Aortic Balloon is contraindicated in :Moderate to Severe Mitral RegurgitationModerate to Severe Aortic RegurgitationPost - Infarction VSDAcute Myocardial Infarction

30. When left internal mammary artery is anastomed to LAD which has more than 70% block,expected patency at the end of ten years is :(1) 92 percent (2) 82 percent (3) 72 percent (4) 62 percent

Following minimum percentage of stenosis of left main coronary artery is an indication forsurgery :(1) 40 percent (2) 50 percent (3) 60 percent (4) 70 percent

Late follow up, shows the percentage of patients free of fatal and nonfatal myocardialinfarction 10 years after CABG is :(1) 95 percent (2) 90 percent (3) 85 percent (4) 80 percent

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Currently favoured drug for treatment of Atrial Fibrillation in post operative period afterCABG is :

(1) Propranolol (2) Metoprolol (3) Diltiazem (4) Amiodarone

It is recommended that minimum criteria the patient should have before he is advised redoCABG is :

Two good target vessels of more than 2 mm with more than 75 percent proximal stenosisThree good target vessels of more than 1.5 mm with more than 75 percent proximalstenosis.Normal Left Ventricular functionsOne good target vessel of more than 1.5 mm with more than 75 percent of proximalstenosis

35. St. Jude Medical Valve is a :Cage and Ball Valve

Bi-leaflet Valve

Low profile Central tilting disc ValvePericardium preserved in gluteraldehyde and mounted on a flexible stent.

36. Following Biological Valve is generally not used nowadays :

Xenograft ValvesPericardial Valves

Allograft (homograft) Valves

Duramater Valves

37. One of the dreaded complications of Mitral valve replacement is ventricular rupture. Itusually occurs at following sites except

At the insertion of papillary muscleAnnular level

Midway between papillary muscle insertion and annulus

LV apex

38. Following are contraindications for Balloon Mitral Valvotomy except :

Moderate MR

Heavy calcification of the commissures and edges of the cusps

Left Atrial clot

Severe pulmonary hypertension

39. In our country, before any valve surgery, coronary angiogram as a diagnostic test is advisedabove :

(1) 30 years (2) 40 years (3) 50 years (4) 60 years

MCC-005

5 P.T.O.

40. Following statements are true except :Degenerative calcific Aortic Stenosis is more common in western countries thanrheumatic aortic valve diseaseSevere aortic regurgitation is less common in degenerative calcific aortic stenosis ascompared to rheumatic aortic valve diseaseBicuspid Aortic Valve may be stenotic with commissural fusion early in life but oftenpresent later in adult lifeCongenital Aortic Valve Stenosis occurs only with unicuspid or bicuspid valves andnever with tricuspid valves

41. In Aortic Valve Stenosis, significant symptoms occur when valve area is reduced to :(1) 2/3rd of normal area (2) 1/2 of normal area(3) 1/3rd of normal area (4) 1/4 of normal area

42. Ross operation denotes :Aortic Valve Replacement with Prosthetic Valve with interrupted suture techniqueAortic Valve Replacement with Prosthetic Valve with continuous suture techniqueAortic Valve Replacement with Medtronic Hancock Valve in which the fixation pressureis zero and toludine blue is added to inhibit calcium depositionAortic valve is replaced by patient's own pulmonary valve (Autograft)

43. Following is an indication for emergency surgery in Aortic Regurgitation :Patient with severe LV dysfunction (EF < 0.25)Patient with NYHA class III with impaired LV function (EF < 0.50)Patient with Canadian Heart Association class II or more for anginaInfective endocarditis with uncontrolled failure

Following are causes of organic Tricuspid Regurgitation except :(1) Infective Endocarditis (2) Elistein's Anomaly(3) Carcinoid Syndrome (4) Dilation of Right Ventricle

Pericardiectomy in constrictive pericarditis has a mortality of :(1) 0 - 1 percent (2) 3 -5 percent (3) 6 - 10 percent (4) 11 - 15 percent

46. Pre requisite for formation of post infarction aneurysm is :Multivessel coronary artery diseaseTransmural InfarctSubepicardial InfarctSubendocardial Infarct

47. Commonest cause of Ascending Aortic Aneurysm is :(1) Cystic Medial Necrosis (2) Syphilis(3) Atherosclerotic (4) Infections Aortitis

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48. In classification of Acute Dissection of Aorta, as per site of origin and extent, De BakeyType II denotes :

Ascending Aorta extending to Arch or BeyondAscending Aorta confined to Ascending AortaDescending Thoracic Aorta distal to left subclavian artery and confined to itDescending Thoracic Aorta di gital to left subclavian artery and extends into AbdominalAorta.

49. Hospital Mortality in repair of Post Myocardial Infarction Ventricular septal defect is :(1) 20 percent (2) 30 percent (3) 40 percent (4) 50 percent

A MET is an energy unit defined as the use of following ml of oxgen per minute per kilogramof body weight :(1) 3.5 ml (2) 4.5 ml (3) 5.5 ml (4) 6.5 ml

Following statements about LIMA as conduit for CABG are true except :Size matches the coronary arteriesResistant to AtherosclerosisHas excellent long term patency rateMore prone to vasospasm as compared to radial artery conduit

The most common symptom of Infective Endocarditis is :(1) Fever (2) Chills (3) Sweats (4) Anorexia

The Principal diagnostic test to confirm the diagnosis in suspected case of Pulmonary Embolismamong these is :

ECGEcho with DopplerChest CT with IV contrastPulmonary radionuclide perfusion scintigraphy

54. Following statements about Coarctation of Aorta are true except :May present in Neonate with LV failureECG in symptomatic neonate may show RVHMurmur in older child arises because of flow across collaterals and not at the coarctsegmentCoarctation can be localized narrowing or associated with long segment tubularhypoplasia.

55. Following statements about Elistein Anomaly are true except :There is apical displacement of the septal tricuspid leaflet in conjunction with leafletdysplasiaRight Bundle Branch Block is common in adultsXray may show a right ward convexity from an enlarged right atrium and atrializedright ventricle coupled with a leftward convexity from a dilated infundibulum givingthe heart a "Water bottle" appearanceApical displacement of the septal leaflet of the tricuspid valve by 3 mm/m2 or more isdiagnostic.

MCC-005

7 P.T.O.

56. Favourable candidates for electrical cardioversion of atrial fibrillation include patients exceptSymptomatic Atrial Fibrillation of recent outset (< 12 months) duration and derivesignificant benefit from sinus rhythmAssociated with sinus node dysfunction and various unstable supraventriculartachyarrhythmias or bradyarrhythmiasContinues to have Atrial Fibrillation after the precipitating cause has been removed(eg. after treatment of thyrotoxicosis)Have a rapid ventricular rate that is difficult to slow.

57. Following are features of Endocardial cushion defect except :Down Syndrome occurs in 35% of patientsMost patients have left Axis DeviationIn four chambered view on echocardiography, AV valves appear at the same levelSpontaneous closure occurs in 5-10 percent of patients.

58. Following statements about Acute Pulmonary Thromboembolism are true except :Dyspnoea is the most frequent symptomMortality is reported to be 50 percent, if 50 percent of pulmonary vasculature isobstructedIn pulmonary bifurcation block, mortality approaches 100 percent.Surgical Embolectomy is the treatment of choice in all cases.

59. Following statements about ASD are true except :Shunt > 1 : 5 : 1 is an indication for closureOptimal Age for closure is 1 to 2 yearsClosure can be by surgery or percutaneous intervention - device closurePulmonary Vascular Resistance to > 3 units/m 2 at rest makes an ASD inoperable

60. Following can interrupt the function of pacemaker except :(1) Arc welding equipment (2) Microwave oven(3) MRI scanner (4) Shock wave lithotripsy

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MCC-005 8