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MCC-OO4Signatureof the CandidateSignatureof the Invigilator

Seal& Signature of theExam Centre SuPerintendent

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Enrolment NumberExam Centre Code

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POST GRADUATE DIPLOMA IN CLINICALCARDIOLOGY (PGDCC)Term-End Examination

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

Time2hours MaximumMarks:60Note;0 There uill bemultiplechoice ypeof questionsn this examination hich are to beanswerednOMR Answer Sheets.(i t All questionsre comPulsory.Aiil Eachquestionwill haaeour options ndonlyoneof them s correct. Answersuae to bemarkedn

figures in the appropriateectangularboxes orrespondingo what is the correctans\I)er nd thenblackenhecircleor ttrcsctmeumbern thntc:olumn y usingHB or leadpencilandnot by ballpenin OMR Answer Sheets.lf anycandidatemarksmore hanoneoption, t zoittbe akenas he lrong answer ndno markswillbeawardedor this.Erase ompletetyny erroror unintendedmarks.Therewitt be6A questionsn thispapersnd eachquestionartiesequalmarks.Therewill heno negatiuemarkingor wrongnns\L,ers.No candidatehall eaztelrc examination all at leastor onehour after thecommencementf theexamination.

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L . Acute Rheumatic fever is a sequel of the following infection :(1) staph' Aurens Q) Gr A. Beta haemolytic streptococcus(3) streptococcus viridans (4) pneumocci--'---'"-r L' ! v!r\

In neonates Infective Endocarditis typically involves :. (1) Mitral Valve(3) Pulmonary Valve

(1) 80 % Cases( 3 ) 5 - 1 5 % C a s e s

(1) Mild MS(3) SevereMS

(1) Mitral Stenosis(3) Aortic Stenosis

(3) Decreased ontractilitvMCC-004

(2) Aortic Valve(4) Tricuspid Valve

(2) 20 - 4A % Cases(4) Less han 5 % Cases

(2) MS with MR(4) Arrial fibrillation

(2) Tricuspid Stenosis(4) Aortic Regurgitation

(4) Increasedcontractility2

3' osler's nodesand Spliter haemorrhagesare seen n Infective Endocarditis n :

c .

4' Mycotic aneurysmsdue to infective Endocarditisoccur most frequently i. ,(1) visceral arteries e) Arteries of lower limb(3) Intracranial arteries (4) Arteries of upper limbThe following situation reducesgradient acrossMitral Valve in Mitral Stenosiss :(1) Atrial fibrillation e) sinus bradycardia(3) Anaemia @ FeverThe Diastolic umble of MS at apex s long in :.

7. Mitral Balloonvalvuloplasty is not recommended n :(1) Mildly restrictedmobilify of leaflets(2) scatteredcalcificationconfined to margins(3) Thickening extending to entire leaflet(4) Extensivecalcificationof leaflets8' The Commonest rheumatic valve disease s :

9 LV ejection raction decreases fter MV surgery in caseof chronic MR due to :(1) Decreased reload e) Increasedafterroad

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T2.

1-0. Suddenworsening 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 Tachycardial1.'. The-following cardiacchamber s nat enlarged n chronic MR not in failure :(1) Left atrium (Z) Left ventricle

(3) Rt. ventricle $) L A appendagesevereMitral regurgitation is diagnosedby echocardiographywhen :(1) Mitral regurgitation volume is < 60 ml(2) Effective egurgitant orifice s >- 0.40cm2(3) No pulmonary vein systolic low reversal(4) Regurgitant raction < 55 per centSurgeryrs notindicated in a patient of MR in :(1) Asymptomatic patient with normal LV function(2) Symptomaticpatientwith normal LV function(3) Asymptomatic patient with EF less han 60 %(4) Asymptomatic patient with LVESD > 43 mm

14.

L3.

1.5.

16.

Acute mitral regurgitation is not seenwith :(1) Chordal rupture (2) Infective endocarditis(3) Acute MI @) Chronic ARThe Valve areaof moclerateAortic Stenosiss :(1 ) 3 cm2 (2)

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t9. The following condition doesnot causeAortic regurgitation :

20, Examinationof peripheral pulse in chronic SevereAR reveals :

(1) Marfan's syndrome(3) High vSD

(1) Narrow pulse pressure(3) Low volume pulse

(1) Fatigue(3) Abdominal fullness

(1) Coronary Heart disease(3) RheumaticHeart disease

(2) Aortic dissection(4) Aneurysm of Abdominal Aorta

(2) Rapid upstroke of radial pulse(4) Slow rising upstroke

(2) Effort intolerance(4) PND

(2) Cerebrovasculardisease(4) All of the above

(4) ElevatedJVP4

21. SevereAR presents he following feature n echocardiography :(t) Flow reversal n descendingaorta(2) Regurgitant et width / LVor diameter < ia o/o(3) Aortic regurgitant pressurehalf time > 400m sec(4) LVEDD < 6A mm22- Severeprimary kicuspid regurgitation will not have symptom of :

23. ECG changes n Acute pericarditis are :(1) sr- segmentelevation (z) pR segmentelevation(3) Reciprocalchanges (4) Bradycardia24- The causeof electricalalternans n large pericardial effusion is :(1) Decreasedmovement of parietal pericardium(2) Large echofreespacearound cardiac shadow(3) swinging movement of heart within pericardial fluid(4 ) Tachycardia25. I4trhich f the following are Cardiovasculardiseases cvD's) ?

26. ECG feature of Cardiac Aamponade is :(1) Sinus bradycardia Q) Total electrical alternans(3) FrequentVPCs (4) Tall T wave

27 Jugularvenouspulse in constrictivepericard tis doesnot showthe following feature :(1) Prominent Y-descent (z) prominent X-descent(3) Kussmaul'ssignMCC-004

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ZB. Typical characterof Apical impulse in Hypertrophic cardiomyopathy is :

29. Systolic murmur increases with Valsalva manoever in :(1) Valvar AS(3) MVP

30. Infectiveendocarditisof Rt. sided valvesoccurs n :

(1) Heaving(3) Double apical imPulse

(1) Prostheticvalves(3) IV drug abusers

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

(1) Carditis(3) Subcutaneousmodule

(1) 60 days(3) 100 days

(1) Chest pain(3) Dyspnoea

(1) ChestX-ray(3) Echo-cardiograPhY

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(2) Tapping(4) Diffuse Pulsation

(2) Mitral regurgitation(4) HocM

(2) Rheumaticms(4) MVP

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

(2) Erythema marginatum(4) ProlongedP-R interval

(2) 80 days(4) 120 days

(2) 20-50 % cases(4) 80-100% cases

(2) Palpitation(4) Syncope

(2) SevereMS(4) Sinus tachYcardia

(2) Blood tests(4) ECG

J

3L. Maximum incidenceof Gr. A betahaemolyticStreptococcal haryngitis is in the age Sroup :

92. The following is a minor manifestationof Acute Rheumatic ever :

33. prostheticvalve endocarditis s called early when symptoms begin within :

94. Systemicembolisation in Infective endocarditis occurs n :(1 ) 10-15 % cases(3) 50-70 % cases

35. The commonestsymptom of Mitral stenosiss :

35. The first heart sound is soft in Mitral stenosisn :(1) Mild MS(3) Calcific MV

97. The most informative investigation n MS is :

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38. The acute life threatening complication in MS is :

39.

40.

The Commonestvalvular abnormality seen n clinical practice s :(1) Mitral stenosis (2) Mirral regurgitation(3) Aortic regurgitation (4) pulmonary varvestenosisThe following is not a causeof Mitral regurgitation

(1) Arrial rjbrillation(3) Pulmonary oedema (2) Severe PH(4) cc 7

is not soft in MR due to :(2) Mitral valve prolapse(4) Marfan's Syndrome

in a patient of MR in Sinus Rhythm :(2) Digoxin(4) Diuretic

(1 ) Infective Endocarditis (2) Bicuspidaorticvalve(3) Cleft anterior Mitral leaflet (4) Hypertrophic Cardiomyopathy41' LV ejection raction is maintained in Mitral regurgitation by :(1) IncreasedAfterload e) Increasedpreload(3) Dilated left atrium (4) small sizeof LV42. First heart sound (SI)(1) Rheumatic MR

43.(3) PapillarymuscledysfunctionThe following drug is beneficial(1) Betablocker(3 ) Vasodilator

44.

45.

46. In the natural history of Aortic Stenosis(1) systolicfunction is maintained il l late(2) Diastolic unction is maintained il l late(3) LV dilatation occursearly(4) Patientshave decreasedLVEDP

The following patients of MR do better after MV surgery :(1) with preservedLV function (z) High NYHA Class(3) Large LVEDV (4) with poor EF %Causesof Aortic stenosis n young adult is most likely to be :(1) Rheumatic .--r(2) CongenitalTricuspid aortic valve(3) Fibrocalcific hanges n aorticvalve(4) Carcinoid tumor

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47.

48 .

49 .

51.

50.

Acute Aortic regurgitation occurs in :(1) Aortic Dissection (2) Congenital Bicuspid Aortic valve(3) Fibrocalcific degeneration (4) Rheumatic heart diseasePatientswith chronic severeAR may be :(1) Symptomaticvery early(2) Asymptomatic for many years(3) Presentwith LV dysfunction very early(4) Presentwith sudden deathCharacteristicmurmur of moderately severechronic AR :(1) Middiastolic rumbling murmur(2) Rough crescendo-decrescendoyst.murmur(3) Blowing early diastolic murmur(4) Continuous murmur at LSBThe following statement s true for Aort ic regurgitation :(1) Vasodilatorsower strokevolume and degreeof regurgitation(2) Vasodilators mprove stroke volume by lowering systemic esistance(3) Vasodilatorsare indicated in mild AR with normal LV size(4) ACE inhibitors are better choice ollowing AVRIn Tricuspid Stenosis ollowingrs not seenclinically :(1) Prominent 'a' wave(2) Slow y descent(3) Diastolicmurmur with crescendo-decrescendohape(4) Severepulmonary hypertension

52. Acute Pericarditis clinically presentswith :(1) Chest pain (2) BradYcardia(3) Hypotension (4) PND

53. The following is not a symptom of periodicaleffusion :(1) Dyspnoea (2) DYsPhagia(3) Irritating Cough (4) Headache

54. Following are the clinical signs of CardiacTamponadeexcept :(1) Elevated VP (2) TachYPnoea(3) Pulsus paradoxus (4) Pulsusbisferiens

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55' The following is not the presenting featureof Hypertrophic Cardiomyopathy :(1) Chestpain (Z) Syncope(3) Palpitation (4 ) Headache56' The most important investigation for diagnosisof Hypertrophic Cardiomyopathy is :(1) ECG

@ ChestX_ray(3) Echo-cardiography57. Ejectionclick is commonly heard in :(1) RheumaticAS

(3) Cong.Valvar AS

(4) EMG

58. Medical Therapy for HOCM doesnot include the following drug :

59' ECG of Arrhythmogenic RV Cardiomyopathy shows following featuresexcept:(1) InvertedT in Rt. precardial ead(2) Tall T in Vu, Vu(3) VT of RV origin(4) VT with LBBB pattern

50. Adverseoutcome n dilated cardiomyopathy s relatedwith :

(1) Verapamil(3) Betablocker

(1) Marked LV dilatation(3) Good LV systolic function

(2 ) HOCM(4) Cong. Subvalvar AS

(2) Digoxin(4) Amiodarone

(2) Low LV mass(4) < moderateMR

- o 0 o -

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