MCC-007 POST GRADUATE DIPLOMA IN COMMUNITY CARDIOLOGY (PGDCC)

00214

Term-End Examination December, 2009

MCC-007 : CARDIO-VASCULAR RELATED DISORDERS Time : 2 hours

Maximum Marks : 60

Note : (i)

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 answer 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. (viii) No candidate shall leave the examination hall at least for one hour after the commencement of the examination. MCC-007



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Find the correct statement : Excess calories are stored in liver and muscles as glycogen and in adipose tissue as triglyceride. Insulin prevents storage of excess calories Glucagon helps in storage of calories Stored calories from glycogen is mobilized by insulin

2.

3.

4.

Insulin has two polypeptide chains, a and 13 and no. of amino acids are : (1)

a- 30 and 13 - 21

(2)

a - 21 and 13 - 30

(3)

a - 50 and 13 - 100

(4)

a - 100 and 13 - 50

Pro insulin is cleaved to insulin inside : (1)

Muscle cell

(2)

Liver cell

(3)

B - cell of pancreas

(4)

Adipose cell

Find the wrong statement : Glucagon level is increased in fasting state In glucose metabolism effect of glucagon is opposite to that of insulin. Glucagon is secreted by a cell of pancreas. Glucagon is released from hepatocytes

5.

In diabetes cohort, type 2 DM is : (1) 85 - 95%

6.

(2) 60 - 65%



(3) 70 - 75%

(4) 75 - 80%

In Maturity Onset Diabetes of the Young (MODY) which of the following statement is wrong: Develops Diabetes in 2nd or 3rd decade. Autosomal dominant mode of inheritance. Destruction of B-cells of pancreas. Many family members suffer from DM.

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In OGTT using venous plasma IGT is diagnosed if PPBS is > 140 but < 200 mg with FBS : (4) < 90 mg (3) < 140 mg (2) < 110 mg (1) < 126 mg Which of the following is the result of micro vascular complication of DM : (2) Cerebral Ischemic stroke (1) Coronary atherosclerosis (4) Peripheral vascular disease (3) Diabetic nephropathy IGT patients are susceptible to : Microvascular complications. Macrovascular complications. Both macro and microvascular complications. No macro or microvascular complications.

10.

WHO criteria for diagnosis of gestational DM is 2 hour post glucose in OGTT (1) > 180 mg

(3) > 140mg

(2) > 200 mg

(4) > 250 mg

Hypoglycemia is more common when treated with the drug : (2) Biguarides (1) Suiphonyluria (4) Alpha glucosidase inhibitors (3) Insulin Sensitizers Find out the wrong statement : Fatty acids are metabolized to ketone bodies. Ketone bodies are highly acidic, so blood pH drops if produced in excess. Severe deficiency of Insulin converts glucose to ketone bodies. Rothera's test in urine confirms ketone bodies. 13. In diabetic ketoacidosis blood sugar is very high, so dehydration to be corrected with : 0.9% saline only 0.9% saline followed by 3% saline Colloids and 0.9% saline 0.9% saline followed by 5% dextrose MCC-007



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14. Hyperosmolar Non ketotic comma is treated with : 0.9% saline 0.9% dextrose 0.9% saline and then 5% dextrose Half normal saline (0.45% saline) 15. Ankle Brachial Index is normally : (2) < 1 (1) > 1

(3)

< 0.5

(4)

0.5 - 1.0

16. Commonest cerebral vessels involved in DM : Small penetrating vessels in brain & brain stem Common carotid arteries Internal carotid arteries Circle of Willis 17. Find out correct statement : Perfect control of DM perse can prevent macrovascular complications. Good control of DM can prevent atherosclerotic heart diseases. Control of Hyperglycemia helps in secondary prevention of CAD only. Tight control of hyperglycemia cannot prevent macrovascular complications. 18. Which type of dyslipidemia is more common in DM : High total cholesterol, high triglyceride, and high HDL. High triglyceride, low HDL and high Lp (a). Low triglyceride, high LDL and low HDL. High triglyceride, high HDL and high LDL 19. For isolated systolic hypertension - find the wrong statement : It is the result of decreased elasticity of arteries. It is a risk factor for stroke mostly in elderly.

It is distributed equally in all the age group. Treatment of this is beneficial to prevent stroke. MCC-007

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20. Which statement is wrong in neuropathic foot : Skin atrophic, blanching on elusation Foot is warm Foot pulses palpable Veins on dorsum of foot are distended 21. In relation to microvascular complications - find out the wrong statement : Hall mark of pathogenesis is thickening of basement membrane of the capillary endothelium. These complications are related to duration of DM rather than security of hyperglycemia. These complications can be reduced by tight control of hyperglycemia. These complications lead to myocardial infarction and stroke. 22. Which is not true because of Autonomic neuropathy : Sudden cardiac standstill especially during anaesthesia. May lead to fixed heart rate. Increased chances of myocardial infarction. Postural hypotension 23. Diabetic Nephropathy is defined if proteinuria is : (1) > 300 mg / 24 hours (2) > 500 mg/24 hours (3) > 1 gm/ 24 hours (4) > 3 gm/ 24 hours 24. Find the wrong statement with DM patients : With clinical nephropathy most patients are hypertensive. by 5 -7 years after macro-albuminuria end stage renal failure develops. Retinopathy is present in virtually all patients with nephropathy. Nephropathy is present in all patients with retinopathy. MCC-007



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25. Target Blood Pressure in diabetic patient is : < 130/80 in young adult and < 160/90 in elderly. < 140/90 for all age group. < 130/80 preferably around 120/75. < 140/90 in Type Il DM and < 130/80 in type I DM 26. With progressive renal insufficiency in DM : requirement of insulin decreases. requirement of insulin increases. chances of hypoglycemia decreases. long acting insulin is the preferred choice. Sweetening agent which does not contain calories is : (2) Xylitol (3) Saccharin (1) Sorbitol

(4)

Fructose

(4)

Acarbose

OHA which can produce lactic acidosis is : (1)

Glimepiride

(2)

Phenformin

(3) Pioglitazone

Find out the Ist generation sulphonylurea : (1) Glipizide (2) (3) Glibenelamide (4)

Glimepiride Tolbutamide

Which of ,the following OHA agent reduces appetite and thereby useful in obese Type 2 DM : (1)

Chlorpropamide

(2)

Metformin

(3)

Pioglitazone

(4)

Gliclazide

31. For Acarbose which statement is wrong : It is insulin sensitizer It prevents alpha glucosidase enzyme. It does not cause hypoglycemia if used alone. It is safe to use in elderly and renal failure MCC-007

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32. Insulin analogue means : Human insulin derived from genetic engineering. Insulin produced by culture of E-coli. Rearrangement of aminoacids in two chains of insulin. Processed insulin to increase polymerization. 33. What is ideal goal of Blood sugar in treatment Type 2 DM ? FBS < 110 mg% and PPBS < 140 mg%. FBS < 126 mg% and PPBS < 200 mg%. FBS < 90 mg% and PPBS < 120 mg %. PPBS < 250 mg%. 34. What preferably needs to be done if FBS < 126 mg and PPBS > 200 mg% on drug therapy: Increase the dose of drug. More diet control keeping the drug dose same. Add additional drug. Change the drug. 35. Metabolism in diabetic pregnancy : which statement is wrong : Liver is resistant to insulin action. Placental lactogen and other steroids have anti-insulin effect. Insulin requirement is high as compared to non-gravid state. Insulin requirement is decreased as placenta produces insulin like substances. 36. Target Blood Sugar on treatment in Gestational diabetes is : FBS < 60 - 90 mg% and PPBS < 140 mg%. FBS < 126 mg% and PPBS < 200 mg%. FBS < 110 mg% and PPBS < 160 mg%. FBS < 126 mg% and PPBS < 250 mg%. MCC-007



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37. Which statement is correct in pregnancy ? B.P. starts to fall during 1st trimester, max i" fall in mid pregnancy and returns to pre-gestational levels before term. Both systolic and diastolic B.P. fall, but fall of systolic B.P. is more. B.P. falls in early pregnancy, increases in mid and late pregnancy and returns to prepregnancy level after 6 weeks of delivery. There is no significant change of B.P. during pregnancy. 38. Which of the following murmur is likely to be pathological ? Ejection systolic murmur at pulmonary area. Continuous murmur over precordium (Lt. breast). Mid-diastolic murmur over apex. Early diastolic murmur over Lt. parasternal area. 39. Following are normal variations of ECG in pregnancy except : QRS axis may shift to left or right minimally. There may be ST segment elevation in limb leads Lii, L iii avF. Small Q and inverted T in Liii. Greater R wave amplitude in V2. 40. Following may be the normal echocardiogrphic changes in pregnancy except : Progressive increase in all cardiac chambers' dimensions. Paradoxical motion of IVS. Small precardial effusion. Progressive dilatation of mitral annulus leading to mild MR. 41. Find out the wrong statement with use of Beta-blockers in pregnancy : It causes teratogenic effect. Causes intrauterine growth retardation. Causes birth apnoea and hypoglycemia . It causes prolong labour. MCC-007

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42. Which statement is correct with use of digitalis in pregnancy ? Digitalis crosses placenta and causes teratogenic effect. Digitalis does not cross placenta, so safe in pregnancy. Digitalis crosses placenta but no teratogenic effects are reported. Digitalis crosses placenta in insignificant amount. 43. Which is not true with Nifedipine in pregnancy ? Effective and safe antihypertensive. It can cross placenta and foetus can metabolize the drug. It is not teratogenic. It is excreted in milk, so breast feeding is not safe. A hypertensive female, well controlled B.P. with drug has gone for pregnancy. She may continue same drug during pregnancy except the drug : (1) Atenolol (2) Lisinopril (3) Nifedipine (4) Alpha methyldopa In pregnancy with peristaltic valve, 3 options of anticoagulation are available. Find out the wrong option. Heparin throughout pregnancy LMWH throughout pregnancy Heparin or LMWH - 1st trimester, then warfarin till 38 weeks of pregnancy, then Heparin or LMWH Warfarin throughout pregnancy 46. In pregnancy induced hypertension which statement is wrong : It is the most common medical complication in pregnancy. Hypertension is detected in 1st trimester. Major cause of both foetal and maternal mortality. BP > 140/90 in at least 2 occasions six hours apart. MCC-007



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47. With antihypertensive drug therapy - find the wrong statement : It improves perinatal outcome. May adversely affect uteroplacental circulation. It should be prescribed only for maternal safety. It improves maternal mortality and no affect on perinatal outcome. 48. Foetal cyanide poisoning may occur with use of : (2) Labetalol I.V. (1) Hydralazine I.V. (3)



Sodium Nitroprusside I.V.

(4)

Enalapril I.V.

49. Meta analysis of drug treatment for stage I and II hypertension in pregnancy showed a direct relation. between treatment induced fall of BP and proportion of small for gestational age infants. between good control of BP and better foetal outcome. between poor control of BP and proportion of intrauterine growth retardation. between type of antihypertensive agent and proportion of foetal outcome. 50. Which one should be the least choice of antihypertensive agent in breast-feeding mother ? (2) Hydrochlorothiazide (1) Labetalol (4) Propranolol (3) Nifedipine Which is the commonest supraventricular arrhythmia in pregnancy ? (1) (3)



Atrial fibrillation

(2)

Atrial flutter

Atrial tachycardia (automatic)

(4)

Supraventricular re-entrant tachycardia

Pregnancy should be considered as absolute contraindication in the following situation except : Rheumatic valvular heart-disease Eisenmenger's syndrome Primary pulmonary hypertension Dissection of Aorta

Which of the following condition can lead to high output cardiac failure ? (1)

Hypertension

(2)

Peripartum cardiomyopathy

(3)

Corpulmonale

(4)

Myocardial infarction

B - Type natriuretic peptide (BNP) is predominantly released from : (3) Ventricules (4) Atria (2) Kidneys (1) Brain Most common symptomatic valvular lesion found in pregnancy is : (1)

Aortic Regurgitation

(2)

Mitral stenosis

(3)

Mitral Regurgitation

(4)

Aortic stenosis

In pregnancy with prosthetic valve, which of the following statement is correct : Pregnancy is a hypercoagulable state, so thromboembolism is high Pregnancy leads to anaemia, so thromboembolism is less Heparin crosses placenta, so foetal haemorrhage is high Warfarin does not cross placenta, so safe in pregnancy 57. Which statement is wrong with Peripartum cardiomyopathy : Develop CCF in last month of pregnancy or within 5 months after delivery. Dilatation of all cardiac chambers. Documented systolic dysfunction. Hypertension is often associated. 58. Find the wrong statement in relation ventilation perfusion lung scan : In PE, the ventilation is normal and perfusion to the affected segment is reduced. In PE, ventilation is abnormal and perfusion may or may not be abnormal. Normal VQ scan virtually excludes PE. Multiple perfusion defects favour diagnosis of PE. MCC-007



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Which is not the indication of thrombolytic therapy in PE in isolation ? Multiple VQ scan mismatch Massive PE with life threatening emergencies PE with acute RV dysfunction on echo Recurrent PE despite treatment with heparin Commonest cause of right heart failure due to pulmonary hypertension is : (1) Left heart failure (2) Primary pulmonary hypertension (3) Cor - pulmonale (4) Pulmonary thromboembolism -o0o-

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