MCC-004

POST GRADUATE DIPLOMA IN CLINICALCARDIOLOGY (PGDCC) 00553

Term-End Examination

December, 2009

MCC-004 : COMMON CARDIO-VASCULAR DISEASES - II

Time : 2 hours Maximum Marks : 60

Note :

There will be multiple choice type of questions in this examination which are to be answered in

OMR Answer Sheets.

All questions are compulsory.

Each question will have four options and only one of them is correct. Answers have to be marked in

figures in the appropriate rectangular boxes corresponding to what is the correct answer and then

blacken the circle for the same number in that column by using HB or lead pencil and not by ball pen

in OMR Answer Sheets.

If any candidate marks more than one option, it will be taken as the wrong anszver and no marks will

be awarded for this.

Erase completely any error or unintended marks.

There will be 60 questions in this paper and each question carries equal marks.

There will be no negative marking for wrong answers.

No candidate shall leave the examination hall at least for one hour after the commencement of the

examination.

MCC-004

1 P.T.O.

Infective Endocarditis is least likely to occur in :

(1) Small venticular septal defect (2) Mitral valve prolapse with mitral regulations

(3) Atrial septal defect (4) Tetralogy of Fallot's

Endocarditis arrest is commonly seen in :

(1) Mitral valve Prolopse (2) Mitral Regurgitations

(3) Mitral Stenosis (4) Tricuspid Stenosis

Most Common heart valve involved in I/V drugs use :

(1) Mitral valve (2) Pulmonary valve

(3) Tricuspid valve (4) Aortic valve

Oster's nudes are seen except :

(1) Knee joint

(2) Elbow joint

(3) TIP of palm with sole (4) Anterior chest wall

5. Vegitations on under surface of AV vales are found in :

Acute rheumatic endocarditis

Libman sacks endocarditis

Non thrombotic bacterial endocarditis

Chronic rheumatic carditis

6. Complications of infective endocarditis are following except :

(1) Perforation of CUSP (2) Vegitations along CUSP

(3) Thrombisus in left atrium (4) Myocardial abscess

Mitral valve vegitation do not embolize to :

(1) liver (2) spleen (3) lung (4) brain

A woman has septic abortion, vegitations on tricuspid valve is likely to go to :

(1) liver (2) spleen infarcts

(3) embolic ti brain (4) septic infarcts to lung

9. Which of the following is a least likely to cause infective endocarditis :

(1) Staphyloccus aebns (2) Streptococcus faecalis

(3) Pseudomonas aeruginusa (4) Salmonella typhi

MCC-004 2

Bacterial Endocarditis is most commonly caused by :

(1) Hemolytic streptococi (2) B - Hemolytic streptococi

(3) Staphyloccus aureus (4) Staph epidermidis

Most common heart valve involved in I.V. drug abusers is :

(1) Mitral valve (2) Tricuspid valve

(3) Pulmonary valve (4) Aortic valve

Infective endocarditis most commonly is seen in :

(1) ASD (2) VSD (3) PDA

(4) Pulmonary Stenosis

Infective endocarditis is least common except :

(1) ASD (2) PDA after repair

(3) Mitral valve prolapse with MR (4) Pulmonary stenosis after repair

All are systemic manifestation of I.E. except :

(1) Fever (2) Chillis (3) Fatigue

(4) Petechiae

Immunolyical Manifestations of infective endocarditis except :

(1) Glomerulonephritis (2) Arthritis

(3) Vasculitis (4) Petechiae

16. Osler's nodes are seen in :(1) Chronic cardia endocarditis

(3) Pseudomonas endocarditis

(2) Acute staphylococal endocarditis

(4) Librran saks endocarditis

Most common organism causing acute infective endocarditis :(1) HACEK group (2) Candida albricans

(3) Staphylococcus Aurous (4) Pseudomonas aeruginosa

True about I E in drug abusers is :

(1) Young male (2) Staphylococcus aureus(3) Tricuspid valve (4) All the above

19. Most common organism causing prothestic valve endocarditis except :

(1) Staphylococcus epidermidis (2) Staphylococcus aureus(3) Candida albican (4) Pseudomonas

MCC-004

3 P.T.O.

Which complications of I.E are unique to aortic valve involvement ?

(1) AV conduction defect (2) Acute ventricular septal defect

(3) Anuerysm of sinus of valsalva (4) All the above

Minimal what size of vegitations are diagnosed by echo cardiography ?

(1) > 5mm in size (2) > 10 mm in size

(3) > 3 mm in size (4) > 15 mm in size

Neurological symptoms from embolic stroke occur in :

(1) 20 - 40%

(2) 10 - 20%

(3) 5 - 10%

(4) 20 - 30%

Clinical manifestations due to transmissions of micro embolic to various organs are :

(1) Roth's spots (2) Oslers Node

(3) Janeway lesions (4) All of the above

What percentage of Echo Cardiography (Transthoracic ECHO) detect Vegitations ?

(1) =80%

(2) = 65%

(3) = 75%

(4) =90%

What percentage TEE able to detect vegitations ?

(1) 100%

(2) 90%

(3) 85%

(4) 70%

Major criteria for diagnosis of I.E except :

(1) positive blood culture (2) positive echo cardiogram

(3) fever > 100.4 F

(4) abscess formation

Indications for cardiac surgical intervention in pts with I.E is :

Persistent bacteremia despite optimal antimicrobial therapy

Lack of effective microbicidal therapy in fungal or Brucella endocarditis

Partially dehiced unstable prothestic valve

All of the above

MCC-004 4

28. High Risk cardiac lesions for which I E prophylaxis treatment needed except :

prothestic heart valveprior becterial endocarditiescomplex cyanotic conjenital heart diasease

hypertrophic cardiomyopathy

29. Early prothestic valve endocarditis is caused by :

(1) streptococci (2) fungi(3) coagulage negative staphylcoccu (4) enterococci

30. Choice in methicillin resistant organism in I E :

(1) cefazolim (2) vancomycin

(3) penicillin (4) ceftriaxone

Which cephalusporin is given in I E ?(1) ceftriaxone (2) cefotaxim

(3) ceftazidime (4) cefurixime

32. All are true about rheumatic fever except :common in poor socio + economic groupdevelops after streptolocal pharyngitisseen in 5-15 years of childrencommunicable disease

33. True about rheumatic heart disease and Rheumatic fever :(1) caused by group B streptococci (2) caused by group A bete hemolytic streptococcus(3) caused by staph aureus (4) carriers have high risk of developing RF

Major criteria of Rheumatic fever except :

(1) chorea

(2) arthritis(3) fever (4) carditis

True about rheumatic fever :

chorea is aggravated during pregnancychorea and arthritis co-exiting

subcutaneous nodules are tender

erythema multiform seen

31.

MCC-004

5 P.T.O.

Rheumatic activity involves mostly :(1) Mitral and tricuspid valve (2) Mitral and aortic valve(3) Aortic and tricuspid valve (4) Aortic and pulmonary valve

In rheumatic heart disease embolism is most commonly caused by :Aortic stenosisTricuspid regurgitation

Mitral stenosis with atrial fibrillationMitral regurgitation

38. Strains frequently assuciated with virulence and Rheumatic fever :

(1) 1, 6, 4, 8, 18 (2) 1, 3, 5, 6, 18

(3) 1, 3, 4, 6, 18 (4) 1, 3, 5, 8, 18

Major criteria for rheumatic fever are following except :(1) Carditis (2) Poly arthritis(3) Erythema marginatum (4) ESR above 25 mm/hr

The Jone's criteria for rheumatic fever updated in :(1) 1944

(2) 1998(3) 1992

(4) 2002

Carditis of Acute rheumatic fever involves :(1) pericardium (2) myo cardium(3) endocardium (4) all the above

HLA associated with rheumatic fever :(1) HLA DR 6 (2) HLA DR 5

(3) HLA DR 4 (4) HLA DR 8

True about rheumatic fever is in children :(1) seen in 10-15 years old children (2) seen in 5-15 years old children

(3)

seen in 5-10 years old children (4) less than 5 years old children

Earliest valvular lesion in a case of acute rheumatic fever :(1) Mitral stenosis (2) Mitral regurgitations(3) Aortic regurgitations (4) Aortic stenosis

MCC-004 6

True about subcutaneous nodules :

(1) present in > 15% of case (2) present in < 10% of case

(3) present in > 20% of case (4) present in > 25% of case

True about subcutaneous modules :

must common manifestation

present over extensor surfaces of joints

most commonly in acute rheumatic fever

TENDER TO TOUCH

True about Erythema marginatum except :

(1) most common manifestation (2) uncommon manifestation

(3) macular eruptions (4) found on the trunk

Migratory poly arthritis present in % Rheumatic fever :

(1) 80% patients (2) 50% patients

(3) 75% patients (4) 100% patients

Rheumatic pericarditis causes following except :

(1) serous effusions (2) fibrin deposit

(3) pericardial calcification (4) constrictive pericarditis

Percentage of streptococci recovered from upper respiratory fract (throat swab) at the timeof diagnosis :

(1) 50-60% (2) 25-40%

(3) 60-70% (4) 100%

Most common manifestation of rheumatic fever is :

(1) carditis (2) Migratory poly arthritis

(3) subcutaneous modules

(4) syndenhams choree

What % of individuals with untreated group A streptococcal pharyngitis willdevelop rheumatic fever ?

(1) =10% (2) =30%

(3) = 3% (4) =15%

MCC-004

7 P.T.O.

What percentage of ASLO Titre positive at the presentation of Rheumatic fever ?(1) =80% (2) =90%(3) = 50% (4) = 95%

What percentage of people show evidence of a preceding group a streptococcal infectionwith anti DNA seB of Anti hyalurodiase along with ASLO ?

(1) > 95%

(2) > 85%

(3) > 90%

(4) > 75%

55. Significant levels of ASLO is :children > 333 todd units/ml, Adults > 250 todd units/ml.Adults > 333 todd units/ml, children > 250 todd units/ml.Children > 300 todd units/ml, Adults > 200 todd units/ml.Adults > 300 todd units/ml, children > 400 todd units/ml.

56. Conventional antibiotic treatment for acute rheumatic fever is given for primary prevention :(1) 10 days (2) 20 days(3) 30 days (4) 5 days

Another drug for treatment of streptococcal sore throat patient who are allergic to penicillin :(1) Cephalo sporins (2) Amikacin(3) Erythromycin (4) Azythromycin

For secondary prevention dose of benzathin penicillin in adults :(1) 1.2 million units once in 4 weeks (2) 1.0 million units once in 3 weeks(3) 1.4 million units once in 4 weeks (4) 1.5 million units once in 3 weeks

59. Treatment of choice for secondary prophylaxis for rheumatic fever in adults are followingexcept :

1/M 1.2 million units benzathine penicillin monthlyoral penicillin 250mg BD dailysulfadazin 1 gram dailysulfadiazin 500mg daily

60. Macullum's patches present in :(1) Left Ventricle wall

(2) Left atrium wall(3) Right ventricle wall

(4) Right atrium wall

- o 0 o -

MCC-004 8