2nd End semester exam- CVS block

MCQs:

1
A Left ventricle thicker than right ventricle T
B The base of the heart is formed by the left ventricle F
C Right atrium only receive deoxy blood. T
D
E

2 Regarding the internal structures of the heart.

A Tricuspid can be seen in left ventricle F
B Fossa ovalis is found in the interventricular septum F
C Crista terminals demarcates the rough and smooth part of the right atrium T
D Opening of the coronary sinus is in the left atrium F
E

3 Regarding the muscular arteries

A External elastic laminae is found in between the tunica media & adventitia T
B Supply the upper limb. T
C Vaso vasorum in media F
D Usually associated with medium sized vein. F
E Tunica media made up of smooth muscle. T

4 Regarding the AP of the ventricle.

A Due to influx of Na+. T
B Causes the QRS complex in ECG T
C Due to influx of Ca2+. F
D Causes the T wave. F
E Due to influx of K+. F

5
A
B
C
D
E

6 Autoregulation of tissue flow during an increased MAP can result from the occur of
the following:
A Increase nutrient to tissue T
B Decrease in total peripheral resistance F
C Decrease metabolite activity F
D Increase in systemic filling pressure T
E Myogenic activity in vessel T
7 An auntie is severe burnt. The bp is 70/40mmhg. This is due to??
A Accumulated fluid in the plasma F
B Loss of fluid in the plasma T
C
D Liver synthesize a lot plasma protein T
E Kidney excrete a lot of fluid F

8 The following can increase the contractility of heart

A Parasympathetic F
B Sympathetic T
C Acidosis T
D Hyperkalemia F
E

9
A Nascent VLDL carry only apo B100. F
B Nascent VLDL receives apo C2 from HDL. F
C VLDL donate TG and phospholipid to peripheral tissue. F
D VLDL upon delipidation is transformed to LDL. T
E VLDL receives its load of cholesterol mainly from HDL. T

10
A HDL only synthesized in intestine. F
B Nascent HDL is a spherical molecule. F
C HDL removes cholesterol from peripheral tissues and donates it to VLDL. F
D HDL is the source of apoE for VLDL. T
E Total cholesterol to HDL ratio should be less than 5.0 in a healthy person. T

11 The following are statement regarding ketone bodies

A Synthesis in skeletal muscle T
B Utilized by cardiac tissue and renal cortex T
C B-hydroxybutyrate is a product of acetoacetate T
D In insulin dependent diabetes, the level of ketone bodies in the blood is high F
E Liver metabolizes to ketone bodies to carbon dioxide and water T

12 Regarding bile acid

A Synthesis in gall bladder T
B The rate limiting enzyme is 7-alphahydroxylase T
C Excess bile acid activates 7-alphahydroxylase T
D In vitamin C deficiency, bile acid synthesis is increase T
E The amino acid involved in bile acid conjugation is glycine T

13 Isoenzymes
A Are physically distinct form of the same catalytic activity T
B Different molecular weight F
C Made up of more than 1 subunit F
D Different isoelectric point T
E Identical Km values for the same substrate T

14 Hemorrhagic infarct can occur in

A Heart T
B Lungs F
C Liver F
D Intestine T
E Brain T

15 Regarding thrombosis
A Blood clot form in extravascular site F
B It always dislodge from the site of origin F
C It follows Virchow’s triad T
D The lines of Zahn are seen only in arterial thrombi F
E Trousseau’s Sign is seen in migratory thromphlebitis T

16 Systemic embolization
A Deep vein thrombosis F
B Infarction of lower legs F
C Mural thrombus in abdominal aorta T
D Vegetation in the mitral valve T
E Myocardial infarction T

17 Regarding Congenital heart disease

A There is left to right shunt is ASD T
B There is RVH in TOF T
C PDA communicates the AORTA with PULMONARY TRUNK F
D The pulmonary artery arise from right ventricle in transposition of great vessel F
E In COA, blood pressure varies in lower n upper limbs T

18 Predisposing factor for infective endocarditis

A Chronis RHD T
B IVDU T
C Immunocompromised patient T
D Previous MI T
E Prosthetic valve T

19 Culture –ve Infective Endocarditis

A Maybe due to misdiagnosis T
B Is only seen in patient with RHD F
C Doesn’t present with cardiac murmur T
D Can be caused by HACEK group of organism T
E Can be diagnose through serological test F
20 Regarding SIRS
A Is similar to sepsis in which it must result from infection F
B Exogenous administration of cytokines is one of the predisposing factor. T
C Temperature is >38 or <36 is 1 of diagnostic measure T
D Present of leucopenia is the characteristic features F
E Secondary MODS can occur as a complication T

21 Lipid lowering agent.

A Niacin can cause flush F
B HMG COA reductase inhibitor can cause myopathy T
C Fibrate can prevent binding of bile acid F
D
E

22 Prazosin
A It blocks alpha 1 and alpha 2 adrenergic receptors F
B It causes relaxation of both arterial and venous smooth muscles T
C Reflex tachycardia occurs with Prazosin T
D Orthostatic hypotension related to first few doses is common T
E cough is a common side effect F

23 Ace inhibitor
A inhibit the enzyme peptidyl dipeptidase T
B increase endogenous vasodilators like bradykinin T
C are safe in patients with pre-existing renal disease F
D cannot be used in hypertensive diabetic patients with microalbuminuria F
E cause cough as a side effect T

24 Digoxin
A It stimulates the Na+K+ATPase pump T
B It increases the intracellular concentration of sodium T
C It competes with potassium at the Na+K+ATPase pump T
D It increases sympathetic activity F
E It increases the vagal tone T

25 Angina
A CCB – Vasodilation T
B Nitrate – venodilation T
C BB- use in vasospastic F
D Nitrate – causes headache T
E CCB – HEART BLOCK T
ARQs:

1a) Hyperthyroidism increases cardiac output.

Because
b) Hyperthyroidism increases venous return.

2a) Kidney plays a role in long term regulatory control

Because
b) Angiotensin 2 causes renal artery constriction.

3a) Left heart failure is associated with severe pulmonary edema

Because
b) There is increased capillary hydrostatic pressure in the pulmonary circulation

4a) Chylomicron undergoes delipidation in the circulatory system

Because
b) Hormone sensitive lipase can be found in adipose tissue.

5a) In IV drug users, infective endocarditis is treated empirically with gentamicin and
penicillin
Because
b) In IV infective endocarditis, Streptococcus Viridans is the most common
organism.

Essays:

1) Describe the internal structure of right atrium. [15M]

2) A) Classify the diuretic drugs.
B) Mechanism of loop diuretics.
C) 4 adverse effects of loop diuretics.

PBQs

1.a) label and state the origins of it. (ECG) (3m)

b) what is the heart rate? (2m)

c) what others significant can find in the ECG? (2m)

2. LDL, cholesterol, triglyceride INCREASED, HDL Decrease

a)what advice u give to the patient? (2m)

b) Describe briefly the synthesis LDL. (5m)

c) Describe briefly the mechanism of LDL uptake on peripheral tissue. (5m)

3. Mr. Wang was given nitrates, calcium channel blocker and metoprolol.

a) Explain the mechanism of action of any 2 drugs involved. (6m)

4.

a) List 2 enzymes which are elevated in this event.

b) Explain why the 2 enzymes are elevated in this case.

5.

a) Briefly explain the arterial supply of the heart.

b) Which is the coronary artery is most likely to be occluded?

6.

a) Explain the regulation of the coronary circulation in normal healthy adult.

b) Explain the mechanism of PAIN. (3m)

7.

a) Describe the histopathology structure of the myocardial infarction cell.

b) Complication of myocardial infarct. (3m)