1. Key To Past Papers – Cardiology Part 2
Prepared By : Dr Abdul Wasay Baloch
PGR (Dip Card)
Punjab Institute of Cardiology (PIC)
Lahore
abdulwasay789@gmail.com
Sep – 2020
COURTESY: DR MUHAMMAD ARIF for his generous sharing of past papers answers
5. • A)
• B) Raised JVP on examination
– ECG infwall elevation with v4R Elevation,
– Echo findings of RV Infarction study
– PA Catheterization – high RA Pressure and low PCWP
• C) medical measure to stabilize
– Volume loading mantaining haemodynamics,
– Inotropes, Dobutamine is good choice
• D) typical pulmonary artery catheterization finding
– High RA pressure with low PCWP
27. a. Risk factors
a. Modifiable risk factors, obesity, hypertension, smoking, sedentary
life style,
b. Non modifiable, age, family hx, Previous MI, DM, HTN, familial
hypercholestrolemia, prtein C, S deficiency , homocysteinuria,
Factor 5 laden deficiency, antiphospholipid syndrome,thyroid
disease
b. Drugs at discharge,
a. Aspirin, cloidogrel, statins, B Blocker, ACE if previous transmural MI,
Diuretics, CCB, nitrates if symptomatic
34. a. D/D
a. PPCMP
b. Pulmonary Embolism
c. Mitral regurgitation
d. Criteria for diganosis is Hx & Echo findings are suggestive
of HF,
b. Standard Heart failure treatment BB, ACE/ARB.,
Diuretics, inotropes if severe HF/Cardiogenic shock
c. Indications for Biventricular Pacing
a. QRS more than 120 ms
b. Lv EF <35
c. NYHA class 3 , 4,
d. Symptomatic despite of OGMT
39. a. Hypothyroidism
b. Serum T3,T4,TSH
c. Detailed hx, examination, investigation (T3, T4, TSH,
ecg, echo, thyroid scan), medical management with
thyroxine and theophylline, fro cosmectic reasons and
obstructive symptoms, like dysphagia and hoarseness
of voice surgical treatment may be warranted
43. a. Types of ASD
a. Ostium secondum 75%
b. Ostium primum 20%
c. Sino septal ASD 10%
b. Exercise intolerance, fatigue, dyspnea, svt, afib,a
flutter , paradoxical embolism causing TIA/stroke
c. Intervention is recommended if
a. Haemodynamically significant shunt, evidence of RH Dilatation,
possible paradoxical embolims and associated symptoms
54. a. Note
a. Pulses Alterans - arterial pulse waveform showing alternating strong and weak beats. It is almost
always indicative of left ventricular systolic impairment, and carries a poor prognosis.
b. Pulses paradoxes- abnormally large decrease in stroke volume, systolic blood pressure and pulse
wave amplitude during inspiration. E.g cardiac tamponade, chronic sleep apnea, croup, and
obstructive lung disease (e.g. asthma, COPD).
b. CRT - is treatment to help your heart beat with the right rhythm. It uses a pacemaker to
restore the normal timing pattern of the heartbeat. The CRT pacemaker coordinates how
timing of the upper heart chambers (atria) and the lower heart chambers (ventricles)
c. Complication of Prosthetic valve - thromboembolism, prosthesis-patient mismatch,
structural valve dysfunction, endocarditis, and hemolysis
60. a. Constrictive pericarditis leading to Pericardial effusion
b. Pericardial knock/rub
c. Decreased breath sounds at bases due to effusion
d. ECG will show low voltage to normal, Echo findings will be
a. Pericardial thickening
b. Flattening of LV
c. Abnormal respirophasic septal shift
d. IVC Plethora
e. Septal bounce
f. High E Velocity
g. Annulus paradoxes
Courtesy to Dr Waseem for his generous contribution for key
82. a. Prosthetic valve thrombosis
b. Echo findings
c. Thrombolysis/fibrinolysis
d. Redo surgery after stabilization with explanation ,
surgery (debridement and valve replacement for left
sided) if thrombolysis is unsucessful
120. a. Flash pulmonary edema is the development of respiratory distress related to the rapid accumulation
of fluid within the lung interstitium (the tissue and space around the air sacs of the lungs) secondary to
elevated cardiac filling pressures
b. .
c. Adenosine is the drug of choice in haemodynamically stable patients, DCC is the treatment of choice in
all haemodynamically compromised patients,
b)
121. causes of ST-segment elevation include left
ventricular hypertrophy, pericarditis, ventricular-
paced rhythms, hypothermia, hyperkalemia and
other electrolyte imbalances, and left ventricular
aneurysm, LBBB pseudo elvation
a)
b)
162. a. Short notes
a. PULSUS ALTERNANS is a physical finding with arterial pulse waveform showing alternating strong and weak
beats. It is almost always indicative of left ventricular systolic impairment, and carries a poor prognosis
b. PULSUS PARADOXUS, also paradoxic pulse or paradoxical pulse, is an abnormally large decrease in stroke
volume, systolic blood pressure and pulse wave amplitude during inspiration. The normal fall in pressure is less
than 10 mmHg. When the drop is more than 10 mmHg, it is referred to as pulsus paradoxus.
b. CARDIAC RESYNCHRONIZATION THERAPY (CRT) is treatment to help your heart beat with
the right rhythm. It uses a pacemaker to restore the normal timing pattern of the heartbeat.
The CRT pacemaker coordinates how timing of the upper heart chambers (atria) and the
lower heart chambers (ventricles).
c. COMPLICATIONS include thromboembolism, prosthesis-patient mismatch,
structural valve dysfunction, endocarditis, and hemolysis