[MCQ] Ischemic Heart Disease- Part 2

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Ischemic Heart Disease- Part 2

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Congratulations - you have completed Ischemic Heart Disease- Part 2. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%

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Question 1

Overall sensitivity of exercise stress electrocardiography is ?

A	~ 55 %
B	~ 65 %
C	~ 75 %
D	~ 85 %

Question 1 Explanation:

Overall sensitivity of exercise stress electrocardiography is only ~75%.

Question 2

Incidence of false-positive exercise stress electrocardiography is significantly increased in ?

A	Patients taking digitalis and antiarrhythmic agents
B	Patients with ventricular hypertrophy
C	Patients with abnormal serum potassium levels
D	All of the above

Question 2 Explanation:

Incidence of false-positive tests is significantly increased in patients with low probabilities of IHD like asymptomatic men <40 years or in premenopausal women with no risk factors for premature atherosclerosis. It is also increased in patients taking cardioactive drugs like digitalis & antiarrhythmic agents, or in those with intraventricular conduction disturbances, resting STsegment & T-wave abnormalities, ventricular hypertrophy, or abnormal serum potassium levels.

Question 3

Modified (heart rate limited) exercise stress tests can be earliest performed safely in patients of uncomplicated MI after how many days ?

A	3 days
B	6 days
C	9 days
D	12 days

Question 3 Explanation:

Modified (heart rate limited rather than symptom-limited) exercise tests can be performed safely in patients as early as 6 days after uncomplicated MI.

Question 4

Contraindications to exercise stress testing include all except ?

A	Rest angina within 48 hours
B	Unstable rhythm
C	Severe aortic stenosis
D	Severe mitral stenosis

Question 5

Contraindications to exercise stress testing include all except ?

A	Acute myocarditis
B	Uncontrolled heart failure
C	Hypertension
D	Active infective endocarditis

Question 5 Explanation:

Contraindications to exercise stress testing include rest angina within 48 hours, unstable rhythm, severe aortic stenosis, acute myocarditis, uncontrolled heart failure, severe pulmonary hypertension and active infective endocarditis

Question 6

Adverse prognostic signs in exercise stress testing include all except ?

A	Failure of blood pressure to increase
B	Development of angina
C	Severe ST-segment depression at low workload
D	ST-segment depression persisting for > 3 minutes after termination of exercise

Question 7

Stress myocardial perfusion imaging is more informative than exercise test in all of the following conditions except ?

A	Wolff-Parkinson-White syndrome
B	Left bundle branch block
C	Right bundle branch block
D	Paced ventricular rhythm

Question 7 Explanation:

When resting ECG is abnormal (Wolff-Parkinson-White syndrome, >1 mm of resting ST segment depression, left bundle branch block, paced ventricular rhythm), information gained from an exercise test can be enhanced by stress myocardial perfusion imaging.

Question 8

Which of the following drugs is used for stress echocardiography ?

A	Dipyridamole
B	Dopamine
C	Adenosine
D	All of the above

Question 8 Explanation:

Intravenous dipyridamole or adenosine can be used in place of exercise for noninvasive stress testing to create a coronary “steal” by temporarily increasing flow in nondiseased segments of the coronary vasculature at the expense of diseased segments. Graded incremental infusion of dobutamine may be administered to increase MVO2

Question 9

Agatston score is used for ?

A	Regional wall motion abnormalities
B	Myocardial ischemia quantification
C	Coronary calcium quantification
D	Collateral blood flow quantification

Question 9 Explanation:

Coronary calcium detected by electron beam computed tomography (EBCT) & multidetector computed tomography (MDCT) is quantified using the Agatston score which is based on the area & density of calcification.

Question 10

Glagov effect, or positive remodeling refers to ?

A	As coronary plaque burden increases, atherosclerotic mass tends to stay external to lumen, which allows diameter of lumen to be maintained
B	Coronary plaque tends to produce different levels of coronary obstruction at different times
C	Coronary plaque is unduly unstable
D	All of the above

Question 10 Explanation:

Coronary arteriography outlines the lumina of the coronary arteries. It provides no information about the arterial wall, and severe atherosclerosis that does not encroach on the lumen may go undetected

Question 11

Which of the following is associated with coronary artery aneurysms ?

A	Kawasaki disease
B	Antiphospholipid antibody syndrome
C	Syphilis
D	Bacterial endocarditis

Question 11 Explanation:

Vasculitis of the coronary arteries (intimal proliferation and infiltration of the vessel wall with mononuclear cells) occurs in Kawasaki disease leading to beadlike aneurysms and thromboses, myocardial ischemia and infarction.

Question 12

Which of the following in not a risk factor for CHD in both men & women ?

A	Elevated cholesterol levels
B	Elevated total triglyceride
C	Hypertension
D	Smoking

Question 13

Which of the following is an independent risk factor for CHD in women but not in men ?

A	Obesity
B	Low HDL cholesterol
C	Diabetes
D	Elevated total triglyceride

Question 13 Explanation:

Elevated cholesterol levels, hypertension, smoking, obesity, low high-density lipoprotein (HDL) cholesterol levels, diabetes, and lack of physical activity are important risk factors for CHD in both men and women. Total triglyceride levels are an independent risk factor for CHD in women but not in men. Low HDL-cholesterol and diabetes are more important risk factors for CHD in women than in men. Smoking is an important risk factor for CHD in women.it accelerates atherosclerosis, exerts direct negative effects on cardiac function, and is associated with an earlier age of menopause

Question 14

Nitroglycerin deteriorates with exposure to ?

A	Air
B	Moisture
C	Sunlight
D	All of the above

Question 14 Explanation:

Nitroglycerin deteriorates with exposure to air, moisture, and sunlight.

Question 15

Increase in which of the following causes relaxation of vascular smooth muscle ?

A	Guanosine diphosphate (GDP)
B	Guanosine triphosphate (GTP)
C	Cyclic guanosine monophosphate
D	Platelet guanylyl cyclase

Question 15 Explanation:

When metabolized, organic nitrates release nitric oxide (NO) that binds to guanylyl cyclase in vascular smooth muscle cells, leading to an increase in cyclic guanosine monophosphate, which causes relaxation of vascular smooth muscle.

Question 16

To minimize nitrate tolerance, patient should be kept free of the drug for a minimum of how many hours each day ?

A	2 hours
B	4 hours
C	6 hours
D	8 hours

Question 16 Explanation:

In order to minimize the effects of nitrate tolerance, minimum effective dose should be used and a minimum of 8 hours each day kept free of the drug.

Question 17

Asymptomatic persons with severe coronary atherosclerosis include ?

A	Patients with higher pain thresholds
B	Patients with higher endorphin levels
C	Diabetics with autonomic dysfunction
D	All of the above

Question 17 Explanation:

Asymptomatic persons with severe coronary atherosclerosis who exhibit ST-segment changes during activity include those who exhibit higher thresholds to electrically induced pain, higher endorphin levels and diabetics with autonomic dysfunction

Question 18

Which of the following drug is useful in the management of angina pectoris ?

A	Betaxolol
B	Ranolazine
C	Pentaerythritol tetranitrate
D	All of the above

Question 18 Explanation:

Betaxolol is a selective beta 1 blocker. Ranolazine casts its antianginal effect through blockage of late inward sodium current. Pentaerythritol tetranitrate is used sublingually for its antianginal effect

Question 19

Which of the following is not a dihydropyridine calcium channel blocker ?

A	Amlodipine
B	Felodipine
C	Diltiazem
D	Isradipine

Question 20

Which of the following is a nondihydropyridine calcium channel blocker ?

A	Nicardipine
B	Nifedipine
C	Nisoldipine
D	Verapamil

Question 21

Which of the following calcium channel blocker has the longest duration of action ?

A	Amlodipine
B	Isradipine
C	Nisoldipine
D	Nicardipine

Question 22

Which of the following calcium channel blocker may be associated with increased risk of mortality if administered during acute myocardial infarction ?

A	Amlodipine
B	Diltiazem (Immediate release)
C	Nifedipine (Immediate release)
D	Verapamil (Immediate release)

Question 22 Explanation:

Nifedipine (Immediate release) may be associated with increased risk of mortality if administered during acute myocardial infarction. In general, short-acting dihydropyridines should be avoided because of the risk of precipitating infarction, particularly in the absence of beta blockers.

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See all quizzes of Ischemic Heart Disease at here:

Ischemic Heart Disease- Part 1| Ischemic Heart Disease- Part 2

1.Overall sensitivity of exercise stress electrocardiography is ?
A. ~ 55 %
B. ~ 65 %
C. ~ 75 %
D. ~ 85 %

2. Incidence of false-positive exercise stress electrocardiography is significantly increased in ?
A. Patients taking digitalis and antiarrhythmic agents
B. Patients with ventricular hypertrophy
C. Patients with abnormal serum potassium levels
D. All of the above

3. Modified (heart rate limited) exercise stress tests can be earliest performed safely in patients of uncomplicated MI after how many days ?
A. 3 days
B. 6 days
C. 9 days
D. 12 days

4. Contraindications to exercise stress testing include all except ?
A. Rest angina within 48 hours
B. Unstable rhythm
C. Severe aortic stenosis
D. Severe mitral stenosis
5. Contraindications to exercise stress testing include all except ?
A. Acute myocarditis
B. Uncontrolled heart failure
C. Hypertension
D. Active infective endocarditis

6. Adverse prognostic signs in exercise stress testing include all except ?
A. Failure of blood pressure to increase
B. Development of angina

C. Severe ST-segment depression at low workload
D. ST-segment depression persisting for > 3 minutes after
termination of exercise

7. Stress myocardial perfusion imaging is more informative than exercise test in all of the following conditions except ?
A. Wolff-Parkinson-White syndrome
B. Left bundle branch block
C. Right bundle branch block
D. Paced ventricular rhythm

8. Which of the following drugs is used for stress echocardiography ?
A. Dipyridamole
B. Dopamine
C. Adenosine
D. All of the above

9. Agatston score is used for ?
A. Regional wall motion abnormalities
B. Myocardial ischemia quantification
C. Coronary calcium quantification
D. Collateral blood flow quantification

10. Glagov effect, or positive remodeling refers to ?
A. As coronary plaque burden increases, atherosclerotic mass tends to stay external to lumen, which allows diameter of lumen to be maintained
B. Coronary plaque tends to produce different levels of coronary obstruction at different times
C. Coronary plaque is unduly unstable
D. All of the above

11. Which of the following is associated with coronary artery aneurysms ?
A. Kawasaki disease

B. Antiphospholipid antibody syndrome
C. Syphilis
D. Bacterial endocarditis

12. Which of the following in not a risk factor for CHD in both men & women ?
A. Elevated cholesterol levels
B. Elevated total triglyceride
C. Hypertension
D. Smoking
13. Which of the following is an independent risk factor for CHD in women but not in men ?
A. Obesity
B. Low HDL cholesterol
C. Diabetes
D. Elevated total triglyceride

14. Nitroglycerin deteriorates with exposure to ?
A. Air
B. Moisture
C. Sunlight
D. All of the above

15. Increase in which of the following causes relaxation of vascular smooth muscle ?
A. Guanosine diphosphate (GDP)
B. Guanosine triphosphate (GTP)
C. Cyclic guanosine monophosphate
D. Platelet guanylyl cyclase

16. To minimize nitrate tolerance, patient should be kept free of the drug for a minimum of how many hours each day ?
A. 2 hours
B. 4 hours
C. 6 hours
D. 8 hours

17. Asymptomatic persons with severe coronary atherosclerosis include ?
A. Patients with higher pain thresholds
B. Patients with higher endorphin levels
C. Diabetics with autonomic dysfunction
D. All of the above

18. Which of the following drug is useful in the management of angina pectoris ?
A. Betaxolol
B. Ranolazine
C. Pentaerythritol tetranitrate
D. All of the above

19. Which of the following is not a dihydropyridine calcium channel blocker ?
A. Amlodipine
B. Felodipine
C. Diltiazem
D. Isradipine
20. Which of the following is a nondihydropyridine calcium channel blocker ?
A. Nicardipine
B. Nifedipine
C. Nisoldipine
D. Verapamil
21. Which of the following calcium channel blocker has the longest duration of action ?
A. Amlodipine
B. Isradipine
C. Nisoldipine
D. Nicardipine
22. Which of the following calcium channel blocker may be associated with increased risk of mortality if administered during acute myocardial infarction ?
A. Amlodipine
B. Diltiazem (Immediate release)
C. Nifedipine (Immediate release)
D. Verapamil (Immediate release)

Ischemic Heart Disease

[MCQ] Ischemic Heart Disease- Part 2

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Ischemic Heart Disease- Part 2

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[MCQ] Ischemic Heart Disease- Part 1

[MCQ] Unstable Angina and NonST-Segment Elevation Myocardial Infarction

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