Question Rationale

1. Which of the following is predominant In industrialized countries, CAD has the become
cause of HF in industrialized countries both the predominant cause of heart failure
in men and women?
a. Coronary artery disease
b. HTN
c. Valvular heart disease
d. Idiopathic cardiomyopathy

2. Major cause of heart failure in Africa and

Asia especially in the young
a. RHD
b. HTN
c. Chagas Disease
d. Congenital Heart Disease

3. Major cause of HF in South America

a. RHD
b. HTN
c. Chagas disease
d. Nutritional disorder (Beriberi)

4. Frequent concomitant factor in HF in many

developing nations
a. Anemia
b. Malnutrition
c. HTN
d. DM

5. 60/F HFrEF secondary to CAD, easy

fatigability, palpitations, dyspnea and
anginal pain noted during ordinary PA but
claims to be comfy at rest; NYHA fc of
patient?
a. I
b. II
c. III
d. IV

6. Annual mortality rate of HF in NYHA class IV

a. 30-70%
b. 5-10%
c. 30-40%
d. 60-70%

7. Cardinal symptom/s of heart failure

a. PND
 b. Orthopnea
c. Fatigue and SOB
d. Cheyne stokes respirations

8. Cardinal symptom/s of heart failure

a. PND
b. Orthopnea
c. Fatigue and SOB
d. Cheyne stokes respirations

9. Which PE with heart failure is FALSE?

a. Rales frequently absent in patients
with chronic HF
b. Protodiastolic gallop is most
commonly present in patient with
volume overload who have
tachycardia tachypnea, often signifies
severe hemodynamic compromise
c. S4 specific indicator of hf and is
usually present in those with diastolic
dysfunction
d. Peripheral edema cardinal
manifestation of heart failure but is
nonspecific and usually absent in
patients who have been treated
adequately with diuretics

10. Diagnostic testing NOT routinely advocated

for patients with HF
a. CBC
b. ECG
c. Urinalysis
d. Treadmill or bicycle exercises testing

11. Circulating levels of natriuretic peptides are

useful and important adjunctive tools in the
diagnosis of patient with heart failure.
Which of the following is NOT true?
a. Both BNP and NT-proBNP which are
released from failing heart are
relatively sensitive markers for
present of HFrEF
b. Ambulatory patients with dyspnea
the measurement of BNP or NT-
proBNP is useful to support clinical
decision making regarding diagnosis
of HF, especially in setting of clinical
 uncertainty
c. Measurement of BNP or NT-proBNP
is useful for establishing prognosis or
disease severity in chronic heath
failure and can be useful to achieve
optimal dosing of medical therapy in
select clinically euvolemic patients
d. BNP and NT-proBNP usually normal in
HF patients with preserved EF

12. Which of the following is a late finding/sign

of cor pulmonale?
a. Ascites
b. Hepatomegaly
c. Cyanosis
d. Lower extremity edema

13. Which of the following clinical trial in HF

with preserved ejection fraction did not
appear to benefit in terms of all-cause or
cardiovascular mortality who were treated
with nebivolol?
a. CHARM preserved study
b. I-PRESERVE
c. DIG trial
d. SENIORS trial

14. In the analysis of in hospital registries in

patient with acute decompensated heart
failure, which of the following parameters I
not associated with worse outcome?
a. BUN level >43 mg/dl
b. SBP <115 mmHg
c. Creatinine level >2.75 mg/dl
d. Elevated CKMB levels

15. What is the annual mortality rate of heart

failure patient with NYHA class II?
a. 30-70%
b. 5-10%
c. 30-40%
d. 60-70%

16. The 1-year mortality rate after acute MI is

about?
a. 5%
b. 10%
 c. 15%
d. 20%

17. Which of the following is a pivotal

diagnostic and triage tool that is the center
of the decision pathway for management of
ACS
a. ECG
b. Hs trop 1
c. 2d echocardiogram
d. CKMB

18. Most out of hospital death from STEMI are

due to sudden development of?
a. Ventricular fibrillation
b. Complete heart block
c. Ventricular tachycardia
d. Atrial fibrillation

19. The type of MI resulting in cardiac death

with symptoms suggestive of myocardial
ischemia and presumed new ischemic ECG
changes of new LBBB, but death occurring
before blood samples could be obtained or
before cardiac markers could rise?
a. Type 4b
b. Type 2
c. Type 3
d. Type 4a

20. Elevation of cardiac biomarkers value in

coronary artery bypass grafting related MI
is?
a. >5x 99th percentile
b. >10x 99th percentile
c. >15x 99th percentile
d. >20x 99th percentile

21. A 68-year-old male, hypertensive, diabetic,

and chronic smoker, presented at the ER
with sudden onset chest pain associated
with dyspnea and diaphoresis. Vital signs
showed bp 110/70 mmHg, HR 100 bpm, RR
28 cpm, O2 sat 92%. His 12L ECG is shown
below. The ECG showed:
a. Early repolarization
b. Right bundle branch block
 c. Left bundle branch block
d. STEMI (v1,v2,v3)

22. The above patient was given 3 doses of 0.4

mg sublingual nitroglycerin at about 5
minutes interval, but continues to have
severe chest pain. Which should be given
next if there are no contraindication?
a. Tramadol 50 mg IV
b. Morphine 2-4 mg IV
c. Verapamil 5 mg IV
d. Atropine 0.5 to 1 mg IV

23. Which of the following drug should not be

administered to patients who have taken
phosphodiesterase-5 inhibitor within the
preceding 24h?
a. Beta blocker
b. CCB
c. Nitrate
d. Morphine

24. For STEMI admitted at the ER of a non-PCI

capable hospital, initiating fibrinolytic agent
within 30 mins of presentation is class I
indication. Which of the following is a clear
contradiction to the use of fibrinolytic
agent?
a. Non-hemorrhagic stroke within the
past
b. Known bleeding episodes
c. Recent <2 weeks invasive or surgical
procedure
d. Active peptic ulcer disease

25. What is now the primary cause of in

hospital death from STEMI?
a. Cardiac arrhythmia
b. Pump failure
c. Hypovolemia
d. Pericarditis

26. Hypokalemia and hypomagnesemia are risk

factors for VF in patients with STEMI to
reduce the risk, serum concentration of
potassium and magnesium should be?
a. K 4.5, Mg 2.0
 b. K 3.5, Mg 1.5
c. K 4.0, Mg 2.5
d. K 5.0, Mg 3.0

27. Within the first 24 h of STEMI, ventricular Sustained ventricular tachycardia that is well
tachycardia and fibrillation can occur tolerated hemodynamically should be treated
without prior warning arrhythmias. with an intravenous regimen of Amiodarone 150
Sustained ventricular tachycardia that is mg IV over 10 mins followed by infusion of 1.0
well tolerated hemodynamically should be mg/min for 6 h and then 0.5 mg/min
treated with?
a. Amiodarone 300 mg IV bolus,
followed by infusion of 1.0 mg/min
for 6 h and then 0.5 mg/min
b. Amiodarone 300 mg IV over 10 mins,
following by infusion of 1.0 mg/min
for 6 h and then 0.5 mg/min
c. Amiodarone 150 mg IV over 10 mins
followed by infusion of 1.0 mg/min
for 6 h and then 0.5 mg/min
d. Amiodarone 150 mg IV bolus,
followed with infusion of 1.0mg/min
for 6 h and then 0.5 mg/min

28. Which fibrinolytic agent currently

recommended in management of patient
with STEMI?
a. Bivalirudin
b. Streptokinase
c. Tirofiban
d. Eptifibatide

29. A 55-year-old male HTN, DM, smoker

presented at ER because of substernal chest
pain occurring at rest lasting for more than
10 mins and radiates to left shoulder and
left arm. ECG shown below, troponin I was
elevated. What is the diagnosis?
a. STEMI
b. NSTEMI
c. Unstable Angina
d. Stable Angina

30. The above patient was given isosorbide
dinitrate ISORDIL 10 mg sublingually. Which
of the following is are an absolute
contraindication to use of nitrates?
a. Hypotension or recent use of tadalafil
The only absolute contraindications to the use of
nitrates are hypotension or the recent use of
phosphodiesterase type 5 (PDE-5) inhibitor,
sildenafil or valdenafil within 24 h or taladafil
within 48 hours
 within 48 h
b. Vardenafil use within 48 h or
hypotension
c. Hypotension or use of sildenafil
within 72 h
d. Vardenafil use within 48 h or
hypotension

31. Ticagrelor is a novel, potent reversible

platelet P2Y12 inhibitor that was shown to
reduce risk of cardiovascular death, total
mortality or mi compared to clopidogrel
across a broad spectrum patients with ACS.
What is the loading dose?
a. 60 mg
b. 90 mg
c. 180 mg
d. 300 mg

32. Which of the following is not an indication

for an immediate invasive (within 2 h)
strategy in patients with NSTE ACS
a. Refractory angina
b. Hemodynamic instability
c. Sustained ventricular tachycardia
d. New ST-segment depression

33. Early administration of intensive HMG-CoA

reductase inhibitors (statin) prior to PCI,
and continued thereafter, has been shown
to reduce peri procedural MI and
recurrence of ACS. What is the
recommended dose of atorvastatin?
a. 10 mg
b. 20 mg
c. 40 mg
d. 80 mg

34. What is the duration of dual antiplatelet

therapy DAPT in patient with NTE-ACS,
especially those with a drug eluting stent, to
prevent stent thrombosis?
a. 3 months
b. 6 months
c. 9 months
d. 12 months
35. 35-year-old female non-HTN, non-DM, and
10 PY smoker, admitted local hospital
because of severe chest pain occurring at
rest. ECG showed transient ST segment
elevation. Primary diagnosis?
a. Taktsubo cardiomyopathy
b. PVA
c. Pericarditis
d. Unstable angina
Prinzmetal variant angina (PVA) patients are
generally younger and with the exception of
cigarette smoking, have fewer coronary risk
factors than do patients with NSTE ACE
The clinical diagnosis is made by the detection of
transient ST-segment elevation with rest pain
Caused by focal spasm of an epicardial coronary
artery with resultant transmural ischemia and
abnormalities on LV function that may lead to
acute MI, ventricular tachycardia or fibrillation,
and sudden cardiac death

Spasm may be related to hyper contractility of

vascular smooth muscle due to adrenergic
vasoconstrictors, leukotrienes or serotonin.

Coronary angiography demonstrate transient

coronary spasm as the diagnostic hallmark of PVA

36. What are the main therapeutic agents for

above condition?
a. DAPT and high dose statin
b. Nitrates and CCB
c. LMWH and DAP
d. Aspirin 650 mg 4x daily and morphine

37. Which among the following is/are strong

independent risk factors for hypertension?
a. Obesity and weight gain
b. High dietary NaCl intake and alcohol
consumption
c. Psychosocial stress
d. Low levels of PA

38. Recommended criteria for diagnosis of HTN,

based on 24 h bp monitoring
a. Average awake BP >= 125/80; asleep
BP >= 120/85
b. 140/90; 130/80
c. 135/85; 120/75
d. 130/80; 125/85
39. Recommended criteria for diagnosis of HTN,
based on 24 h bp monitoring
a. Average awake BP >= 125/80; asleep
BP >= 120/85
 b. 140/90; 130/80
c. 135/85; 120/75
d. 130/80; 125/85

40. What is the most common etiology of

secondary HTN?
a. Primary renal disease
b. OSA
c. Primary aldosteronism
d. Pheochromocytoma

41. Most common congenital cardiovascular

cause of hypertension is
a. Patient ductus arteriosus
b. Coarctation of aorta
c. Atrial septal defect
d. Ventricular septal defect

42. Recommended BM goal if thrombolytic If thrombolytic therapy is to be used, the

therapy is to be used for patients with recommended goal blood pressure is <185 mmHg
cerebral infarction systolic pressure and <110 mmHg diastolic
a. SBP <140 mmHg, DBP <90 mmHg pressure (pp 1905)
b. SBP <160 mmHg, DBP <100 mmHg
c. SBP < 175 mmHg, DBP <110 mmHg
d. SBP <185 mmHg, DBP <110 mmHg

43. Which of the following medications is Spironolactone binds to progesterone and

effective in treatment of resistant HTN and androgen receptors, side effects may include
one of its side effects is gynecomastia? gynecomastia, impotence, and menstrual
a. Captopril abnormalities
b. Losartan
c. Spironolactone
d. Carvedilol

44. Which of the following anti-HTN

medications provide more stroke
protection?
a. CCB
b. ACEI
c. Beta blockers
d. Spironolactone

45. On average, standard doses of most

antihypertensive agents reduce BP by?
a. 5-7 mmHg/2-4 mmHg
b. 7-9 mmHg/3-5 mmHg
c. 8-10 mmHg /4-7 mmHg
 d. 9-12 mmHg/3-4 mmHg

46. Which anti-HTN agent provide better ACEIs provide better coronary protection than
coronary protection? CCB.
a. ACEI
b. CCB
c. Alpha adrenergic blockers
d. Diuretic

47. Among African Americans with HTN-related
renal disease, which anti-HTN agent is more
effective in slowing decline of GFR?
a. Beta blockers
b. CCB
c. ACEI
d. Alpha adrenergic blocker
Among African American with hypertension
related renal disease, ACEI appear to be more
effective than beta blockers or dihydropyridine
calcium channel blockers in slowing, although not
preventing, the decline of glomerular filtration
rate.

48. Based on clinical trial data, maximum On average, standard doses of most
protection against combined cardiovascular antihypertensitve agents reduce blood pressure
endpoints is achieved with bp of? by 8-10/4-7 mm Hg
a. <140-145 mmHg SBP, <80-90 mmHg
DBP
b. <135-140 mmHg SBP, <80-85 mmHg
DBP
c. <125-135 mmHg SBP, <85-90 mmHg
DBP
d. <110-120 mmHg SBP, <70-75 mmHg
DBP

49. Which of the following anti-HTN agents may

induce lupus-like syndrome?
a. ACEI
b. ARB
c. Hydrochlorothiazide
d. Hydralazine

50. Which among the following anti-HTN agents
was superior in reducing risk of
cardiovascular events and death among
high-risk patients with HTN?
a. ACEI+ diuretic (hydrochlorothiazide)
b. ACEI + Ca agonist (amlodipine)
c. ACEI + betablocker (carvedilol)
d. ACEI + ARB (losartan)
Results of the ACCOMPLISH Trial (Avoiding
Cardiovascular Events Through Combination
therapy in Patients Living with Systolic
Hypertension
ACEi + CCB is superior to ACEi + diuretic