IDENTIFICACIÓN DE IMPACTOS AMBIENTALES

142.delta wave ===WPW S

143.This man has paroxysmal atrial fibrillation as evidenced by his irregular fast tachycardia. Episodes of tachycardia in this condition may occasionally be precipitated by an excess intake of alcohol

47

144.What statement best describes the effect that class

Ic agents have on electrical activity in the heart ==== Have

minimal effect on the duration of the action potential like flecanide

145.auscultation of the heart reveals a mid systolic

click, and a late systolic murmur (these findings being

accentuated in the standing position) ==== MVP .

146.Acute mitral regurgitation associated with myocardial

infarction may occur due to ruptured chordate tendineae.

147.The short PR interval without delta wave suggests

Long–Ganong–Levine (LGL) syndrome rather than Wolf–

Parkinson–White (WPW) syndrome. It is likely that the patient is suffering from short periods of

48

supraventricular tachycardia, which result in her

palpitations and light-headedness. The management of WPW and LGL syndrome is similar, radiofrequency ablation is recommended for these patients.

148.post MI ==== v.tach due to scar tissue inv === EPS .

149.An echocardiogram has been ordered to

determine the left ventricular ejection fraction.

Which echocardiography mode is the most Appropriate ====Modern transthoracic

49

151.The development of tilt testing has allowed the study of

the pathophysiology of neurocardiogenic syncope.

152.A 62-year-old patient presents with atrial fibrillation of unknown duration. Which drug may slow his ventricular rate over a prolonged period but is unlikely to result in cardioversion

===== digoxin .

153.Which of the following statements are most indicative

of myocardial ischaemia =====Radiation to jaw .

50

aortic stenosis ====Character of S2.esp low S2 as the backflow in aorta is resposable for closure of the valve so in stenosis it is decreased .

155.Beta-blockers may produce benefit in heart failure esp

Bisoprolol and carvedilol

reduce mortality in any grade of stable heart failure.

156.The malignant phase of hypertension is a rare condition

characterised by very high blood pressures, with bilateral retinal haemorrhages and/or exudates or cotton wool spots, without the added requirement for papilloedema. The initial aim of treatment is to lower the

diastolic pressure to about 100–105 mmHg over a period of 2–3 days, withoral therapy like ccb or bb . The maximum initial fall

51

in blood pressure should not exceed 25% of the presenting value.

157.Which of the following conditions when associated with aortic stenosis would indicate a poor prognosis ====

Left ventricular failure

158.If suspecting syncope of cardiac origin do ====24-hour electrocardiogram (ECG)

159.Beta-blocking agents are the cornerstone of the

52

160.Indications for thrombolysis ==== 1 mm ST elevation in 2 limb leads……..or 2 mm in chest leads .

161.This patient is suffering from symptomatic aortic

stenosis as evidenced by the history of syncope,

hypertension, left ventricular hypertrophy and harsh ejection systolic murmur do Cardiac catheterization . As such cardiac catheterisation is the definitive

investigation as it allows for more accurate estimation of valve gradient and characterisation of co-existent coronary artery disease, which may require intervention at the same time.

162.The timing of this man’s deterioration coupled with a murmur of mitral regurgitation and acute pulmonary oedema suggests the onset of papillary muscle

53

dysfunction or even rupture. Echocardiogram is the

investigation of choice to demonstrate the mitral regurgitation.

163.presence of pan systolic murmer following MI = MR =so do

urgent echo

164.pregnant lady with paroxysmal supraventricular tachycardia (SVT ) give =====Metoprolol .

165.Metabolism of simvastatin is inhibited by grapefruit juice.

54

167.Which person is the most appropriate person to make

the decision to discontinue resuscitation ====Resuscitation team leader

168.This lady has been in atrial fibrillation for an unknown period of time and her pressing need at this point is rate control

169.Which of the following ECG features is most

characteristic of moderate to severe hypothermia ===J waves

170.Guidelines published in 2006 recommend warfarinisation

for at least 3 weeks pre and for 4 weeks post

55

171.absolute contra-indication to pregnancy ====Primary pulmonary hypertension

172.Streptococcus viridians ====IV benzylpenicillin + Gentamicin

173.The standard regime for suspected viridans endocarditis would be benzylpenicillin IV together with gentamycin

1mg/kg/day

174.Which part of the ECG is most closely associated with

56

175.What is the time limit after presentation up to which thrombolysis should be administered ====4 1/2 hrs

176.in patient with stroke ===== early

anti-coagulation with heparin has been shown to

increase the risk of intra-cerebral haemorrhage, without

having a significant impact on the risk of long-term disability or death. As such, commencement of aspirin

is the most appropriate option, with anti-coagulation at

a later stage.

177.Dobutamine stress echo simulates the effect of exercise on the heart in patients who are unable to undertake a

stress test. Dobutamine is given via IV infusion, and ECG monitoring with Echocardiography is undertaken both at rest and at the point of maximal stimulation.

57

178.If patient with arrhythmia occur in attack ==== a continuous

loop recorder can be activated by the patient during

symptoms and therefore carries the greatest chance of

recording the arrhythmia.

179.This man has a right to left shunt, with right ventricular pressure greater than left so ====Persistent hypoxia despite maximal oxygen therapy

180.Verapamil leads to a reduction in the risk of torsade de

58

181.Which antihypertensive would be most appropriate for her to start without risk of significant lithium

toxicity ==== Atenolol

182.Which of the following is most directly correlated with increased risk of sudden death ====Degree of left ventricular hypertrophy

183.PR prolongation is the commonest feature seen in

association with congenital myotonic dystrophy.

184.In the UK the commonest drugs used for cardioversion of atrial fibrillation are flecainide and amiodarone.

59

control in long QT syndrome eg Metoprolol . دسب BCD