On a standard ECG, which wave corresponds to atrial depolarization?
A
P wave
B
QRS complex
C
T wave
D
ST-segment
Explanation: explanation: The P wave is the first deflection of the ECG, linked to activation of the atria. The QRS corresponds to ventricular depolarization, the T wave to ventricular repolarization.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: normal ECG
difficulty: medium
submodule_key: y4_cardiologie_explorations_ecg_semiologie
module_title: 4th year · Cardiology · ECG and semiology explorations
What is the normal duration of the QRS complex in adults?
A
Less than 80 ms (< 0.08 s)
B
Less than 120 ms (< 0.12 s)
C
Between 120 and 200 ms
D
More than 200ms
Explanation: explanation: A QRS ≥ 120 ms suggests bundle branch block or aberrant conduction. The normal PR interval is between 120 and 200 ms.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: normal ECG
difficulty: medium
submodule_key: y4_cardiologie_explorations_ecg_semiologie
module_title: 4th year · Cardiology · ECG and semiology explorations
Which ECG lead specifically explores the lower wall of the left ventricle?
A
DI and aVL
B
V1 and V2
C
DII, DIII and aVF
D
V5 and V6
Explanation: explanation: The inferior wall is vascularized by the right coronary artery. DI and aVL explore the high lateral wall, V1-V2 the septum, V5-V6 the low lateral wall.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: ECG – leads
difficulty: difficult
submodule_key: y4_cardiologie_explorations_ecg_semiologie
module_title: 4th year · Cardiology · ECG and semiology explorations
An electrical QRS axis between -30° and +90° is considered as:
A
Deviated to the left
B
Normal
C
Deviated to the right
D
Undetermined
Explanation: explanation: Beyond +90°, we speak of right axial deviation; below -30°, left axial deviation. These deviations point towards specific pathologies.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Electric axis
difficulty: medium
submodule_key: y4_cardiologie_explorations_ecg_semiologie
module_title: 4th year · Cardiology · ECG and semiology explorations
Which ECG criterion is most used to diagnose left ventricular hypertrophy?
A
Sokolow-Lyon criterion (S in V1 + R in V5 or V6 ≥ 35 mm)
B
QRS duration ≥ 120 ms
C
Bifid P wave in DII
D
ST segment elevation in V1-V2
Explanation: explanation: Sokolow-Lyon: SV1 + RV5 or RV6 ≥ 35 mm. A QRS ≥ 120 ms indicates bundle branch block. The bifid P wave suggests left atrial enlargement.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Ventricular hypertrophy
difficulty: difficult
submodule_key: y4_cardiologie_explorations_ecg_semiologie
module_title: 4th year · Cardiology · ECG and semiology explorations
Where is the aortic focus best auscultated?
A
5th left intercostal space, midclavicular line
B
2nd right intercostal space, sternal border
C
3rd left intercostal space, sternal border
D
4th left intercostal space, sternal border
Explanation: explanation: The mitral focus is pointed (5th left EIC), the pulmonary focus at the 2nd left EIC, the tricuspid focus at the 4th left EIC sternal edge.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Semiology – auscultation
difficulty: medium
submodule_key: y4_cardiologie_explorations_ecg_semiologie
module_title: 4th year · Cardiology · ECG and semiology explorations
A pathological Q wave is defined by:
A
Duration > 40 ms and amplitude > 25% of R in at least two contiguous leads
B
Duration > 80 ms in all leads
C
Presence of a Q wave in V1-V2 only
D
Amplitude > 5 mm in precordial leads
Explanation: explanation: Physiological Q waves are thin and shallow. A pathological Q wave indicates old or recent transmural myocardial necrosis.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Pathological ECG waves
difficulty: difficult
submodule_key: y4_cardiologie_explorations_ecg_semiologie
module_title: 4th year · Cardiology · ECG and semiology explorations
What is the normal value of the PR interval?
A
< 80ms
B
120 to 200ms
C
200 to 300ms
D
<40ms
Explanation: explanation: A PR > 200 ms defines 1st degree atrioventricular block. A PR < 120 ms may suggest Wolff-Parkinson-White syndrome or a junctional rhythm.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: ECG intervals
difficulty: medium
submodule_key: y4_cardiologie_explorations_ecg_semiologie
module_title: 4th year · Cardiology · ECG and semiology explorations
The B3 sound (3rd sound) on cardiac auscultation is suggestive of:
A
Calcified aortic stenosis
B
Heart failure with volume overload
C
Pulmonary arterial hypertension
D
Complete bundle branch block
Explanation: explanation: B3 corresponds to rapid ventricular filling in a non-compliant or dilated ventricle. To be distinguished from B4 (presystolic gallop), associated with pressure overload.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Cardiac semiology
difficulty: medium
submodule_key: y4_cardiologie_explorations_ecg_semiologie
module_title: 4th year · Cardiology · ECG and semiology explorations
Horizontal or descending ST segment depression is mainly suggestive of:
A
Acute pericarditis
B
Subendocardial ischemia
C
Complete left bundle branch block
D
Right atrial enlargement
Explanation: explanation: ST elevation is associated with transmural ischemia or pericarditis. ST depression can also be a mirror of elevation in opposite leads.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: ECG – repolarization
difficulty: difficult
submodule_key: y4_cardiologie_explorations_ecg_semiologie
module_title: 4th year · Cardiology · ECG and semiology explorations
The 24-hour Holter ECG is particularly indicated for:
A
Measure left ventricular ejection fraction
B
Detect intermittent paroxysmal rhythm disturbances
C
Assess for aortic valve stenosis
D
Measure blood pressure over 24 hours
Explanation: explanation: Ejection fraction is measured by echocardiography. Blood pressure over 24 hours is measured by ABPM. The Holter reveals arrhythmias not picked up by the resting ECG.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Holter ECG
difficulty: difficult
submodule_key: y4_cardiologie_explorations_ecg_semiologie
module_title: 4th year · Cardiology · ECG and semiology explorations
The exercise test (stress test) is contraindicated in cases of:
A
Well-controlled high blood pressure
B
Stable class I stress angina
C
Symptomatic severe aortic stenosis
D
Moderate exertional dyspnea
Explanation: explanation: The stress test can cause collapse or sudden death in cases of severe RAo. Controlled hypertension, mild stable angina or moderate dyspnea do not systematically contraindicate the test.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Stress test
difficulty: medium
submodule_key: y4_cardiologie_explorations_ecg_semiologie
module_title: 4th year · Cardiology · ECG and semiology explorations
Which of the following is part of the ECG criteria for left ventricular hypertrophy?
A
Sokolow-Lyon criterion ≥ 35 mm
B
Positive Cornell index
C
Complete right bundle branch block
D
Ample and bifid P wave in DII
Explanation: explanation: Right bundle branch block is not a criterion for LVH. The bifid P wave is a criterion for left atrial, not ventricular, hypertrophy.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: ECG – combined semiology
difficulty: difficult
submodule_key: y4_cardiologie_explorations_ecg_semiologie
module_title: 4th year · Cardiology · ECG and semiology explorations
What investigations can be used to assess left ventricular systolic function?
A
Transthoracic echocardiography
B
Myocardial scintigraphy at rest
C
Standard surface ECG
D
Isotope ventriculography
Explanation: explanation: The surface ECG provides information about rhythm, conduction, and ischemia, but does not directly measure ejection fraction.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Cardiological explorations
difficulty: difficult
submodule_key: y4_cardiologie_explorations_ecg_semiologie
module_title: 4th year · Cardiology · ECG and semiology explorations
Which of the following signs correspond to pathological cardiac auscultation?
A
Systolic ejection murmur at the aortic focus
B
B3 noise at the apex in a 60 year old adult
C
Inspiratory splitting of B2
D
Diastolic rolling at the apex
Explanation: explanation: The inspiratory splitting of B2 is physiological. Diastolic rolling at the apex is characteristic of mitral stenosis.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Cardiac auscultation
difficulty: medium
submodule_key: y4_cardiologie_explorations_ecg_semiologie
module_title: 4th year · Cardiology · ECG and semiology explorations
Describe the steps for systematically reading a 12-lead ECG.
Explanation: explanation: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: ECG – systematic reading
difficulty: difficult
submodule_key: y4_cardiologie_explorations_ecg_semiologie
module_title: 4th year · Cardiology · ECG and semiology explorations
What are the main clinical signs of left heart failure?
Explanation: explanation: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Cardiovascular semiology
difficulty: medium
submodule_key: y4_cardiologie_explorations_ecg_semiologie
module_title: 4th year · Cardiology · ECG and semiology explorations
What blood pressure value defines grade 1 hypertension in adults in a doctor's office?
A
SBP ≥ 130 mmHg or DBP ≥ 80 mmHg
B
SBP between 140 and 159 mmHg or DBP between 90 and 99 mmHg
C
SBP ≥ 180 mmHg or DBP ≥ 120 mmHg
D
SBP ≥ 160 mmHg or DBP ≥ 100 mmHg
Explanation: explanation: Hypertension is classified into grades: grade 1 (140-159/90-99), grade 2 (160-179/100-109), grade 3 (≥180/≥110). The general threshold for hypertension in the office is ≥ 140/90 mmHg.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: HTA definition
difficulty: medium
submodule_key: y4_cardiology_hta_cardiovascular_risk
module_title: 4th year · Cardiology · Hypertension and cardiovascular risk
Which element strongly points towards secondary rather than essential arterial hypertension?
A
High blood pressure discovered after age 40 without family history
B
Hypertension resistant to three antihypertensive drugs including a diuretic
C
High body mass index with sedentary lifestyle
D
Active smoking associated with hypercholesterolemia
Explanation: explanation: Essential hypertension represents 90-95% of cases. Secondary causes (primary hyperaldosteronism, renal artery stenosis, pheochromocytoma) must be sought in cases of resistance to treatment, onset before age 30, or spontaneous hypokalemia.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: essential vs secondary hypertension
difficulty: difficult
submodule_key: y4_cardiology_hta_cardiovascular_risk
module_title: 4th year · Cardiology · Hypertension and cardiovascular risk
Which situation corresponds to a true hypertensive emergency (requiring a rapid drop in blood pressure)?
A
SBP at 170 mmHg in an asymptomatic known hypertensive patient
B
SBP at 165 mmHg with isolated headache without neurological deficit
C
SBP at 200 mmHg with sign of hypertensive encephalopathy
D
SBP at 180 mmHg discovered incidentally in the office
Explanation: explanation: Hypertensive emergency involves acute target organ damage. An asymptomatic high SBP is a simple hypertensive flare-up. The rate of blood pressure drop must be controlled to avoid cerebral ischemia.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Hypertensive emergency
difficulty: difficult
submodule_key: y4_cardiology_hta_cardiovascular_risk
module_title: 4th year · Cardiology · Hypertension and cardiovascular risk
Which of the following complications is target organ damage directly related to chronic hypertension?
A
Pulmonary embolism
B
Left ventricular hypertrophy
C
Rheumatic mitral valve disease
D
Infectious endocarditis
Explanation: explanation: Target organ damage in hypertension includes: LVH (heart), hypertensive nephropathy (kidney), retinopathy (eye), stroke/TIA (brain), arteriopathy (vessels). Pulmonary embolism, rheumatic valve disease and endocarditis are not directly caused by hypertension.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Target organ damage
difficulty: medium
submodule_key: y4_cardiology_hta_cardiovascular_risk
module_title: 4th year · Cardiology · Hypertension and cardiovascular risk
To assess the overall cardiovascular risk of a hypertensive patient, the following must be taken into account:
A
Systolic blood pressure level only
B
Blood pressure level, associated risk factors and target organ damage
C
Only the seniority of the HTA
D
The diastolic value in isolation
Explanation: explanation: The assessment of overall cardiovascular risk according to learned societies is based on blood pressure figures, but also on risk factors (tobacco, diabetes, dyslipidemia, age, familial ATCD) and existing target organ damage.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Global cardiovascular risk
difficulty: difficult
submodule_key: y4_cardiology_hta_cardiovascular_risk
module_title: 4th year · Cardiology · Hypertension and cardiovascular risk
What clinical picture should suggest primary hyperaldosteronism as a cause of secondary hypertension?
A
Hypertension with spontaneous hyperkalemia
B
Hypertension with spontaneous hypokalemia and metabolic alkalosis
C
Hypertension with isolated chronic renal failure
D
Hypertension with associated hypothyroidism
Explanation: explanation: Excess aldosterone leads to sodium retention and potassium elimination, hence hypokalemia. It is the main cause of secondary hypertension (5-10% of hypertensives).
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: secondary hypertension
difficulty: medium
submodule_key: y4_cardiology_hta_cardiovascular_risk
module_title: 4th year · Cardiology · Hypertension and cardiovascular risk
Which class of antihypertensive drugs is contraindicated in pregnancy due to its fetal nephrotoxic effect?
A
Dihydropyridine calcium channel blockers
B
Angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin II receptor antagonists (ARBs II)
C
Cardioselective beta blockers
D
Alpha-methyldopa
Explanation: explanation: ACE inhibitors and ARB IIs block the renin-angiotensin system and can cause fetal renal failure, malformations and fetal death. Alpha-methyldopa and certain beta-blockers can be used under supervision.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Antihypertensive classes
difficulty: difficult
submodule_key: y4_cardiology_hta_cardiovascular_risk
module_title: 4th year · Cardiology · Hypertension and cardiovascular risk
Which cardiovascular complication of hypertension is mainly linked to chronic arterial stiffness?
A
Infectious endocarditis
B
Coronary insufficiency due to accelerated atherosclerosis
C
Chronic constrictive pericarditis
D
Mitral stenosis
Explanation: explanation: Hypertension is a major risk factor for atherosclerosis and its complications: coronary artery disease, stroke, arteriopathy of the lower limbs, nephropathy. Endocarditis, pericarditis and MR are not linked to hypertension.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Complications of hypertension
difficulty: medium
submodule_key: y4_cardiology_hta_cardiovascular_risk
module_title: 4th year · Cardiology · Hypertension and cardiovascular risk
ABPM (ambulatory blood pressure measurement) is particularly useful for identifying:
A
White coat hypertension and masked hypertension
B
The secondary cause of resistant hypertension
C
Electrical left ventricular hypertrophy
D
Renal function in hypertensives
Explanation: explanation: White coat hypertension: high figures in the office but normal in the outpatient setting. Masked hypertension: normal in the office but elevated in the outpatient setting. ABPM guides therapeutic decisions.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Ambulatory blood pressure measurement
difficulty: difficult
submodule_key: y4_cardiology_hta_cardiovascular_risk
module_title: 4th year · Cardiology · Hypertension and cardiovascular risk
Which of the following is a major independent cardiovascular risk factor?
A
Isolated asymptomatic hyperuricemia
B
Type 2 diabetes
C
Hypothyroidism treated and balanced
D
Iron deficiency anemia
Explanation: explanation: The major cardiovascular risk factors are: smoking, hypertension, diabetes, dyslipidemia, age, male gender, familial ATCD. Hyperuricemia is controversial; treated and balanced hypothyroidism does not constitute a major independent FDR.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Cardiovascular risk factors
difficulty: medium
submodule_key: y4_cardiology_hta_cardiovascular_risk
module_title: 4th year · Cardiology · Hypertension and cardiovascular risk
What early paraclinical sign indicates renal damage in hypertension?
A
Acute oliguric renal failure
B
Microalbuminuria (30-300 mg/24h)
C
Isolated macroscopic hematuria
D
Massive proteinuria with nephrotic syndrome
Explanation: explanation: Microalbuminuria (30-300 mg/24h) indicates early glomerular damage and predicts progression towards nephropathy. Frank proteinuria is a more advanced stage.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Hypertensive nephropathy
difficulty: difficult
submodule_key: y4_cardiology_hta_cardiovascular_risk
module_title: 4th year · Cardiology · Hypertension and cardiovascular risk
What target organ damage is typically looked for in a hypertensive patient during the initial assessment?
A
Left ventricular hypertrophy on ECG or echocardiography
B
Hypertensive retinopathy at the fundus
C
Mitral valve disease on auscultation
D
Microalbuminuria or impaired renal function
Explanation: explanation: Mitral valve disease is not a target organ damage for hypertension. The standard assessment includes ECG, fundus (high grade), serum creatinine, proteinuria.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: HTA target organ damage
difficulty: difficult
submodule_key: y4_cardiology_hta_cardiovascular_risk
module_title: 4th year · Cardiology · Hypertension and cardiovascular risk
What etiologies should be considered for secondary hypertension in young adults?
A
Renal artery stenosis
B
Pheochromocytoma
C
Primary hyperaldosteronism
D
Horton's disease
Explanation: explanation: Horton's disease (giant cell arteritis) is a vasculitis which can cause vascular abnormalities but is not a classic cause of secondary hypertension. It is listed in the differential diagnosis of inflammatory syndromes.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Secondary hypertension – etiologies
difficulty: difficult
submodule_key: y4_cardiology_hta_cardiovascular_risk
module_title: 4th year · Cardiology · Hypertension and cardiovascular risk
What are the general principles of non-drug management of essential hypertension?
A
Reduced salt intake
B
Regular physical activity
C
Smoking cessation
D
Systematic potassium supplementation
Explanation: explanation: Routine potassium supplementation is not routinely recommended. On the other hand, a diet rich in potassium (fruits, vegetables) is recommended. The DASH diet (Dietary Approaches to Stop Hypertension) is a reference.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: General principles of HTA treatment
difficulty: medium
submodule_key: y4_cardiology_hta_cardiovascular_risk
module_title: 4th year · Cardiology · Hypertension and cardiovascular risk
Define hypertensive emergency and distinguish it from simple hypertensive flare-up.
Explanation: explanation: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Hypertensive emergency
difficulty: difficult
submodule_key: y4_cardiology_hta_cardiovascular_risk
module_title: 4th year · Cardiology · Hypertension and cardiovascular risk
What are the main factors taken into account in the assessment of the overall cardiovascular risk of a hypertensive person?
Explanation: explanation: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Cardiovascular risk assessment
difficulty: medium
submodule_key: y4_cardiology_hta_cardiovascular_risk
module_title: 4th year · Cardiology · Hypertension and cardiovascular risk
Stable exertional angina is mainly characterized by:
A
Unpredictable chest pain occurring at rest
B
Reproducible chest pain with exercise, resolving with rest or with trinitrin in less than 15 minutes
C
Chest pain persisting for more than 30 minutes despite trinitrin
D
Chest pain worsened by wall pressure
Explanation: explanation: Stable angina reflects fixed coronary stenosis with stress ischemia. Unpredictable rest pain defines unstable angina. Pain > 30 min not calmed by trinitrin suggests infarction. The pain increased by pressure is of parietal origin.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Stable angina
difficulty: medium
submodule_key: y4_cardiology_coronaropathies_sca_infarction
module_title: 4th year · Cardiology · Coronary heart disease, ACS and heart attack
The distinction between STEMI and NSTEMI is mainly based on:
A
The intensity of chest pain
B
The presence or absence of persistent ST segment elevation on the ECG
C
The duration of chest pain only
D
The value of serum troponin
Explanation: explanation: STEMI (ST-elevation MI) involves complete coronary occlusion with persistent elevation. NSTEMI (non-STEMI) presents with troponin elevation without persistent ST elevation. Troponin confirms necrosis in both cases but does not differentiate the type.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: SCA – classification
difficulty: difficult
submodule_key: y4_cardiology_coronaropathies_sca_infarction
module_title: 4th year · Cardiology · Coronary heart disease, ACS and heart attack
Which characteristic of chest pain is most suggestive of a coronary origin?
A
Reproducible pain when pressed on the chest
B
Pain worse with deep inspiration
C
Constrictive retrosternal pain radiating to the left arm
D
Epigastric burning pain worsened by meals
Explanation: explanation: Parietal pain is reproducible with pressure. Pleuritic pain is worse on inspiration. Postprandial epigastric pain suggests reflux or digestive pathology. Coronary pain classically radiates to the left arm, jaw or back.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Coronary pain
difficulty: medium
submodule_key: y4_cardiology_coronaropathies_sca_infarction
module_title: 4th year · Cardiology · Coronary heart disease, ACS and heart attack
Which ECG sequence is characteristic of the development of a STEMI in the first hours?
A
Q wave → ST elevation → Negative T wave
B
ST elevation → Necrotic Q wave → Negative T wave
C
ST depression → ST elevation → Q wave
D
Giant T wave → ST depression → Q wave
Explanation: explanation: Hyperacute phase: large sharp T wave then ST elevation. Acute phase: necrotic Q wave appears. Subacute and scarring phase: negative T wave. The elevation gradually decreases.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: ECG in infarction
difficulty: difficult
submodule_key: y4_cardiology_coronaropathies_sca_infarction
module_title: 4th year · Cardiology · Coronary heart disease, ACS and heart attack
Which condition can clinically mimic a STEMI and must be eliminated before any urgent reperfusion strategy?
A
Lobar pneumonia with pleuritic pain
B
Acute aortic dissection type A
C
Bilateral pulmonary embolism
D
Acute pericarditis with effusion
Explanation: explanation: Aortic dissection can occlude the coronary ostium and cause STEMI. Thrombolysis would be catastrophic in this context. This diagnosis should be considered when faced with migratory tearing pain with blood pressure asymmetry.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: SCA differential diagnosis
difficulty: difficult
submodule_key: y4_cardiology_coronaropathies_sca_infarction
module_title: 4th year · Cardiology · Coronary heart disease, ACS and heart attack
What is the most feared mechanical complication of extensive myocardial infarction in the first 24-48 hours?
A
Early reactive pericarditis
B
Rupture of the free wall of the left ventricle
C
Paroxysmal atrial fibrillation
D
Moderate functional mitral regurgitation
Explanation: explanation: Mechanical complications of MI include: free wall rupture (fatal tamponade), interventricular septum rupture (acute L-R shunt), mitral pillar rupture (acute MI). Reactive pericarditis is common but benign. AF is a common electrical complication.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Complication of heart attack
difficulty: medium
submodule_key: y4_cardiology_coronaropathies_sca_infarction
module_title: 4th year · Cardiology · Coronary heart disease, ACS and heart attack
The main difference between unstable angina and NSTEMI is:
A
The presence of ST elevation in NSTEMI
B
Troponin elevation in NSTEMI indicating myocardial necrosis
C
The duration of chest pain only
D
The absence of chest pain in NSTEMI
Explanation: explanation: Unstable angina and NSTEMI share the same clinical presentation and the absence of persistent ST elevation. The difference is biological: in NSTEMI, troponin is elevated, indicating even minimal necrosis. In unstable angina, troponin remains normal.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Unstable angina vs NSTEMI
difficulty: difficult
submodule_key: y4_cardiology_coronaropathies_sca_infarction
module_title: 4th year · Cardiology · Coronary heart disease, ACS and heart attack
Which of the following is considered the strongest modifiable risk factor for coronary heart disease?
A
Male age > 45 years
B
First degree family history
C
Active smoking
D
Asymptomatic hyperuricemia
Explanation: explanation: Smoking increases the coronary risk by 2 to 4. Age and familial ATCD are non-modifiable factors. Hyperuricemia is a controversial factor. Smoking cessation quickly reduces the risk.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Coronary risk factors
difficulty: medium
submodule_key: y4_cardiology_coronaropathies_sca_infarction
module_title: 4th year · Cardiology · Coronary heart disease, ACS and heart attack
ST elevation in V1-V4 with mirror image in inferior leads corresponds to coronary damage of:
A
Right coronary artery (lower territory)
B
Anterior descending artery (IVA) – anterior territory
C
Circumflex artery – lateral territory
D
Left common core only
Explanation: explanation: The IVA irrigates the anterior wall and the septum (V1-V4). The right coronary irrigates the inferior wall (DII, DIII, aVF). The circumflex irrigates the lateral wall (V5-V6, DI, aVL).
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: ST elevation – location
difficulty: difficult
submodule_key: y4_cardiology_coronaropathies_sca_infarction
module_title: 4th year · Cardiology · Coronary heart disease, ACS and heart attack
What is the reference cardiac biomarker for the diagnosis of myocardial infarction?
A
Total creatine phosphokinase (CPK)
B
High sensitivity troponin I or T
C
Lactate dehydrogenase (LDH)
D
Serum myoglobin
Explanation: explanation: Troponin is very specific to the myocardium and rises within 3-6 hours following necrosis. CPK-MB was the old reference marker. LDH rises late. Myoglobin is early but not very specific.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Cardiac biomarkers
difficulty: medium
submodule_key: y4_cardiology_coronaropathies_sca_infarction
module_title: 4th year · Cardiology · Coronary heart disease, ACS and heart attack
Which ECG element distinguishes acute pericarditis from STEMI?
A
Presence of ST elevation in pericarditis but not in STEMI
B
Diffuse, concave-upward ST elevation without mirror image or Q wave in pericarditis
C
Presence of ST depression only in STEMI
D
Absence of T wave in pericarditis
Explanation: explanation: In STEMI: focal elevation (coronary territory), convex upwards, with mirror image and Q wave of necrosis. In pericarditis: diffuse, concave elevation, without precise territory, without Q wave, with PR depression.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Pericarditis vs ACS
difficulty: difficult
submodule_key: y4_cardiology_coronaropathies_sca_infarction
module_title: 4th year · Cardiology · Coronary heart disease, ACS and heart attack
What general principle governs the management of STEMI in the acute phase?
A
Sedation and strict rest while awaiting deferred cardiological evaluation
B
As early as possible coronary reperfusion by primary angioplasty or thrombolysis
C
Exclusive long-term anticoagulation without coronary intervention
D
Immediate emergency coronary artery bypass surgery in all cases
Explanation: explanation: Door-to-balloon delay should be minimized. Primary angioplasty is preferred over thrombolysis if available on time. Thrombolysis is an alternative in the absence of rapid access to the catheterization room.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: SCA support – general principles
difficulty: medium
submodule_key: y4_cardiology_coronaropathies_sca_infarction
module_title: 4th year · Cardiology · Coronary heart disease, ACS and heart attack
What are the early electrical complications of myocardial infarction?
A
Ventricular fibrillation
B
Complete atrioventricular block
C
Pericardial tamponade
D
Sustained ventricular tachycardia
Explanation: explanation: Tamponade is a mechanical complication (wall rupture). Early electrical complications include VF (main cause of prehospital death), VT, AF, BAV (especially in the lower MI due to AVN involvement).
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Complications of MI
difficulty: difficult
submodule_key: y4_cardiology_coronaropathies_sca_infarction
module_title: 4th year · Cardiology · Coronary heart disease, ACS and heart attack
What diagnoses should be ruled out in the face of severe acute chest pain before considering ACS?
A
Acute aortic dissection
B
Massive pulmonary embolism
C
Spontaneous compressive pneumothorax
D
Isolated intercostal neuralgia
Explanation: explanation: Intercostal neuralgia is a benign cause, not very urgent, diagnosed by elimination. The other three are life-threatening emergencies which require different therapeutic strategies, some of which are incompatible with the treatment of ACS (anticoagulation contraindicated in dissection).
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: ACS – differential diagnosis of chest pain
difficulty: difficult
submodule_key: y4_cardiology_coronaropathies_sca_infarction
module_title: 4th year · Cardiology · Coronary heart disease, ACS and heart attack
What elements can trigger or worsen stable angina?
A
Intense physical effort
B
Acute emotional stress
C
Exposure to cold
D
Supine position in deep sleep
Explanation: explanation: These factors increase myocardial oxygen demand (effort, stress) or cause vasoconstriction (cold). Recumbency is not a classic trigger for stress angina, but can be associated with vasospastic angina.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Angina – triggering factors
difficulty: medium
submodule_key: y4_cardiology_coronaropathies_sca_infarction
module_title: 4th year · Cardiology · Coronary heart disease, ACS and heart attack
Describe the diagnostic approach to acute chest pain suggestive of ACS.
Explanation: explanation: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: SCA – diagnostic approach
difficulty: difficult
submodule_key: y4_cardiology_coronaropathies_sca_infarction
module_title: 4th year · Cardiology · Coronary heart disease, ACS and heart attack
What is the meaning of a pathological Q wave on the ECG and what criteria define it?
Explanation: explanation: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Q wave of necrosis
difficulty: medium
submodule_key: y4_cardiology_coronaropathies_sca_infarction
module_title: 4th year · Cardiology · Coronary heart disease, ACS and heart attack
What is the characteristic auscultatory sign of congestive left heart failure?
A
Systolic murmur at the aortic focus
B
Bilateral crepitants of the lung bases
C
Pericardial friction during inspiration
D
Diastolic murmur at the mitral site
Explanation: explanation: Bilateral crackles ('cardiac rales') are linked to pulmonary congestion by increased capillary pressure. Pericardial friction suggests pericarditis. Diastolic mitral murmur suggests mitral stenosis.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Left heart failure
difficulty: medium
submodule_key: y4_cardiology_cardiac_insufficiency_oap_shock
module_title: 4th year · Cardiology · Heart failure, OAP and cardiogenic shock
Which clinical sign is specific to right heart failure and absent in isolated left heart failure?
A
Orthopnea
B
Jugular turgor
C
Exertional dyspnea
D
Bilateral pulmonary crackles
Explanation: explanation: Right IC manifests itself by: jugular turgor, painful hepatomegaly, hepatojugular reflux, edema of the lower limbs. Orthopnea, exertional dyspnea, and crackles suggest left IC.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: IC right vs left
difficulty: difficult
submodule_key: y4_cardiology_cardiac_insufficiency_oap_shock
module_title: 4th year · Cardiology · Heart failure, OAP and cardiogenic shock
What clinical element makes it possible to distinguish a cardiogenic OAP from a severe acute asthma attack?
A
The presence of polypnea with bradycardia
B
Predominant sibilants during expiration, absent when calm
C
Crepitants at the bases with jugular turgor and context of known heart disease
D
Rapid improvement with sitting
Explanation: explanation: Cardiogenic OAP and asthma can both cause wheezing dyspnea (cardiac asthma). However, OAP is accompanied by crackles, jugular turgor, context of heart disease, pink sputum. Asthma presents with predominant wheezing, an atopic background, and the absence of signs of right-sided HF.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: OAP – differential diagnosis
difficulty: medium
submodule_key: y4_cardiology_cardiac_insufficiency_oap_shock
module_title: 4th year · Cardiology · Heart failure, OAP and cardiogenic shock
What hemodynamic parameter characterizes cardiogenic shock compared to hypovolemic shock?
A
Systolic blood pressure lowered in both cases
B
Pulmonary capillary pressure high in cardiogenic shock, low in hypovolemic
C
Low systemic vascular resistance in cardiogenic shock
D
Elevated cardiac output in cardiogenic shock
Explanation: explanation: Cardiogenic shock is characterized by: low cardiac output, high filling pressures (PCP ≥ 18 mmHg), high systemic vascular resistance (reactive vasoconstriction). Hypovolemic shock: low filling pressures, low flow, vasoconstriction.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Cardiogenic shock – criteria
difficulty: difficult
submodule_key: y4_cardiology_cardiac_insufficiency_oap_shock
module_title: 4th year · Cardiology · Heart failure, OAP and cardiogenic shock
Orthopnea is defined as:
A
Dyspnea occurring only with intense exercise
B
Increased dyspnea in supine position, relieved by sitting or standing
C
Stridor inspiratory dyspnea with suprasternal drawing
D
Paroxysmal nocturnal dyspnea with purulent expectoration
Explanation: explanation: In the supine position, venous return increases, worsening pulmonary congestion. The patient must sleep with several pillows (number of pillows = orthopnea rating). To be distinguished from laryngeal inspiratory dyspnea (stridor) and acute bronchitis.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Orthopnea
difficulty: medium
submodule_key: y4_cardiology_cardiac_insufficiency_oap_shock
module_title: 4th year · Cardiology · Heart failure, OAP and cardiogenic shock
Which compensatory mechanism is activated first in chronic heart failure?
A
Ventricular hypertrophy with fibrosis
B
Neurohormonal activation: sympathetic system and renin-angiotensin-aldosterone system
C
Irreversible ventricular dilatation
D
Increased heart rate due to hypothyroidism
Explanation: explanation: Faced with a drop in cardiac output, the body activates the sympathetic system (tachycardia, vasoconstriction) and the RAAS (water and sodium retention). These compensatory mechanisms are initially useful but become harmful in the long term.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: IC pathophysiology
difficulty: difficult
submodule_key: y4_cardiology_cardiac_insufficiency_oap_shock
module_title: 4th year · Cardiology · Heart failure, OAP and cardiogenic shock
A patient who presents with dyspnea upon moderate effort (climbing one floor) without dyspnea at rest corresponds to the NYHA class:
A
Class I
B
Class II
C
Class III
D
Class IV
Explanation: explanation: Class I: no symptoms with ordinary exercise. Class II: symptoms for significant efforts. Class III: symptoms for moderate efforts. Class IV: symptoms at rest.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: NYHA classification
difficulty: medium
submodule_key: y4_cardiology_cardiac_insufficiency_oap_shock
module_title: 4th year · Cardiology · Heart failure, OAP and cardiogenic shock
Heart failure with preserved ejection fraction (HFpEF) is characterized by:
A
LVEF < 40% with ventricular dilatation
B
LVEF ≥ 50% with clinical signs of HF and relaxation disorder
C
An LVEF between 40 and 50% with volume overload
D
A total absence of symptoms despite a collapsed LVEF
Explanation: explanation: HFpEF (formerly diastolic HF) is common in older hypertensive women. Systolic function is preserved but ventricular relaxation is impaired, leading to increased filling pressures.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: CI with preserved vs reduced FE
difficulty: difficult
submodule_key: y4_cardiology_cardiac_insufficiency_oap_shock
module_title: 4th year · Cardiology · Heart failure, OAP and cardiogenic shock
Which biomarker is used for the diagnosis and monitoring of heart failure?
A
High sensitivity troponin I
B
BNP or NT-proBNP
C
Ultra-sensitive CRP
D
Lactate dehydrogenase (LDH)
Explanation: explanation: BNP (B-type natriuretic peptide) is secreted by cardiomyocytes in response to increased wall tension. Elevated BNP confirms HF, guides treatment, and is a prognostic marker. Troponin rises in myocardial necrosis.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: IC biomarkers
difficulty: medium
submodule_key: y4_cardiology_cardiac_insufficiency_oap_shock
module_title: 4th year · Cardiology · Heart failure, OAP and cardiogenic shock
What parameter makes it possible to distinguish cardiogenic shock from septic shock?
A
Blood pressure which is always lower in septic shock
B
Low systemic vascular resistance in septic shock (vasodilation) versus high in cardiogenic shock
C
Higher heart rate in cardiogenic shock
D
The absence of fever in cardiogenic shock in all cases
Explanation: explanation: In septic (distributive) shock: peripheral vasodilation, low SVR, initially warm extremities, high lactates. In cardiogenic shock: reactive vasoconstriction, high SVR, cold extremities, mottling.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Cardiogenic vs septic shock
difficulty: difficult
submodule_key: y4_cardiology_cardiac_insufficiency_oap_shock
module_title: 4th year · Cardiology · Heart failure, OAP and cardiogenic shock
What clinical sign indicates the seriousness of a cardiogenic PAO and requires immediate treatment?
A
Moderate orthopnea with bilateral crackles
B
Pinkish frothy sputum with cyanosis and drawing
C
Mild tachycardia with normal BP
D
Soft bilateral lower limb edema
Explanation: explanation: Severe PAO manifests itself by severe respiratory distress: intense polypnea, drawing, cyanosis, salmon or pink sputum. This is an absolute therapeutic emergency requiring immediate treatment.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: OAP – clinical signs
difficulty: medium
submodule_key: y4_cardiology_cardiac_insufficiency_oap_shock
module_title: 4th year · Cardiology · Heart failure, OAP and cardiogenic shock
What are the classic causes of isolated right heart failure?
A
Massive or recurrent pulmonary embolism
B
Primary pulmonary arterial hypertension
C
Tight aortic stenosis
D
Chronic cor pulmonale due to chronic bronchopneumopathy
Explanation: explanation: Tight aortic stenosis generates pressure overload of the left ventricle, causing left HF. Causes of right HF include pathologies increasing RV afterload: PAH, pulmonary embolism, COPD, cor pulmonale.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Right IC – etiologies
difficulty: difficult
submodule_key: y4_cardiology_cardiac_insufficiency_oap_shock
module_title: 4th year · Cardiology · Heart failure, OAP and cardiogenic shock
Which drug classes have shown a benefit on mortality in heart failure with reduced EF?
A
Beta blockers
B
Ancestral Converting Enzyme Inhibitors (ACEIs)
C
Dihydropyridine calcium channel blockers
D
Mineralocorticoid receptor antagonists (MRAs)
Explanation: explanation: Dihydropyridine calcium channel blockers are not recommended as first-line treatment for HF with reduced EF and may be harmful. Standard treatments (triple therapy) include ACE inhibitor or sacubitril/valsartan, beta blocker, ARM.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Therapeutic principles chronic HF
difficulty: medium
submodule_key: y4_cardiology_cardiac_insufficiency_oap_shock
module_title: 4th year · Cardiology · Heart failure, OAP and cardiogenic shock
What elements indicate the seriousness of a cardiogenic PAO and require monitoring in intensive care?
A
O2 saturation < 90% under O2
B
Respiratory exhaustion with thoraco-abdominal pulling and swinging
C
Systolic blood pressure > 160 mmHg
D
Associated cardiogenic shock
Explanation: explanation: A SBP > 160 mmHg in a context of OAP is not a serious criterion per se (hypertensive OAP often responds well to vasodilators). The severity criteria are: refractory desaturation, signs of respiratory exhaustion, associated shock, disturbances of consciousness.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: OAP – elements of gravity
difficulty: difficult
submodule_key: y4_cardiology_cardiac_insufficiency_oap_shock
module_title: 4th year · Cardiology · Heart failure, OAP and cardiogenic shock
Define cardiogenic shock and distinguish it from other states of shock.
Explanation: explanation: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Cardiogenic shock
difficulty: difficult
submodule_key: y4_cardiology_cardiac_insufficiency_oap_shock
module_title: 4th year · Cardiology · Heart failure, OAP and cardiogenic shock
What are the clinical signs that differentiate left heart failure from right heart failure?
Explanation: explanation: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Left IC – clinical signs
difficulty: medium
submodule_key: y4_cardiology_cardiac_insufficiency_oap_shock
module_title: 4th year · Cardiology · Heart failure, OAP and cardiogenic shock
What is the characteristic auscultatory sound of mitral stenosis?
A
Apex holosystolic murmur radiating to the axilla
B
Diastolic rolling with presystolic strengthening at the apex
C
Mesosystolic ejection murmur at the aortic focus
D
Declining diastolic murmur at left sternal border
Explanation: explanation: RM is characterized by: burst of B1, mitral opening click, diastolic rolling. Presystolic enhancement is present in sinus rhythm. The apex holosystolic murmur corresponds to mitral regurgitation.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Mitral stenosis
difficulty: medium
submodule_key: y4_cardiology_valvulopathies_raa_endocarditis
module_title: 4th year · Cardiology · Valvulopathies, RAA and infective endocarditis
What clinical sign allows you to differentiate mitral stenosis from mitral regurgitation on cardiac auscultation?
A
The presence of an accentuated B2 in both valvular diseases
B
A systolic murmur for MI versus a diastolic murmur for RM
C
A diastolic murmur at the aortic focus for MR
D
A systolic murmur for the RM and a diastolic murmur for the IM
Explanation: explanation: Mitral regurgitation produces a holosystolic systolic murmur (regurgitation during systole), radiating to the axilla. Mitral stenosis generates a diastolic gradient: decreasing diastolic rolling with presystolic strengthening.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: RM vs IM
difficulty: difficult
submodule_key: y4_cardiology_valvulopathies_raa_endocarditis
module_title: 4th year · Cardiology · Valvulopathies, RAA and infective endocarditis
What is the classic symptomatic triad of symptomatic tight aortic stenosis?
A
Palpitations, cyanosis, hemoptysis
B
Angina, exertional syncope, dyspnea (heart failure)
C
Fever, breath, emboli
D
Orthopnea, jugular turgor, hepatomegaly
Explanation: explanation: The angina-syncope-dyspnea triad indicates a tight RAo. From the onset of symptoms, the prognosis is poor without valve replacement: median survival of 2-5 years depending on the initial symptom. Jugular turgor is specific to the right IC.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Aortic stenosis
difficulty: medium
submodule_key: y4_cardiology_valvulopathies_raa_endocarditis
module_title: 4th year · Cardiology · Valvulopathies, RAA and infective endocarditis
What type of murmur is characteristic of chronic aortic insufficiency?
A
Mesosystolic ejection murmur at the aortic focus
B
Holodiastolic murmur decreasing at the left border of the sternum, radiating towards the apex
C
Mitral diastolic roll at apex
D
Apex holosystolic murmur radiating to the axilla
Explanation: explanation: Aortic regurgitation during diastole creates a soft, aspirating, decreasing diastolic murmur, best heard at the left 3rd intercostal space (focus of Erb), with the patient leaning forward. Mitral diastolic rolling is due to MR.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Aortic insufficiency – auscultatory mechanism
difficulty: difficult
submodule_key: y4_cardiology_valvulopathies_raa_endocarditis
module_title: 4th year · Cardiology · Valvulopathies, RAA and infective endocarditis
Which of the following is a major Jones criterion for the diagnosis of rheumatic fever?
A
Fever > 38°C
B
Prolongation of the PR space on the ECG
C
Carditis (with or without breath)
D
CRP elevation
Explanation: explanation: Jones' major criteria include: carditis, migrating polyarthritis, Sydenham's chorea, erythema marginatum, subcutaneous nodules. Minor criteria include: fever, PR prolongation, CRP/ESR elevation. Diagnosis requires 2 major criteria or 1 major + 2 minor + proof of streptococcal infection.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: RAA – Jones criteria
difficulty: medium
submodule_key: y4_cardiology_valvulopathies_raa_endocarditis
module_title: 4th year · Cardiology · Valvulopathies, RAA and infective endocarditis
According to the Duke criteria, the diagnosis of infective endocarditis is certain if:
A
Only one major criterion is present
B
Two major criteria, or one major criterion + three minor criteria, or five minor criteria
C
Two positive blood cultures without echocardiographic criteria
D
Vegetation visible on transesophageal echocardiography only
Explanation: explanation: Duke's major criteria: positive blood cultures for typical microorganism + echocardiographic data (vegetation, abscess, dehiscence). Minor criteria: FDR, fever, vascular, immunological phenomena, atypical blood cultures.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Infective endocarditis – criteria
difficulty: difficult
submodule_key: y4_cardiology_valvulopathies_raa_endocarditis
module_title: 4th year · Cardiology · Valvulopathies, RAA and infective endocarditis
Which organism is most frequently responsible for infective endocarditis of native valves?
A
Staphylococcus epidermidis
B
Streptococcus viridans (oral streptococci)
C
Pseudomonas aeruginosa
D
Enterococcus faecalis
Explanation: explanation: Oral streptococci (viridans) represent approximately 30-40% of native valve AEs, often secondary to dental care. Staphylococci are more common on prosthetic valves or in IV drug users. Enterococci are linked to digestive or urinary infections.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Endocarditis – germs
difficulty: medium
submodule_key: y4_cardiology_valvulopathies_raa_endocarditis
module_title: 4th year · Cardiology · Valvulopathies, RAA and infective endocarditis
What complication should be considered when faced with a revealing cerebral embolism in a febrile patient with valvular heart disease?
A
Ischemic stroke due to atrial fibrillation alone
B
Infective endocarditis with emboligenic vegetation
C
Complicated type A aortic dissection
D
Intracavitary thrombus in dilated cardiomyopathy
Explanation: explanation: IE vegetations can detach and embolize in the greater circulation (brain, spleen, kidney, limbs) or the lesser circulation. Fever + embolism + heart murmur is a triad suggestive of AE. The assessment includes blood cultures and echocardiography.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: AE complications
difficulty: difficult
submodule_key: y4_cardiology_valvulopathies_raa_endocarditis
module_title: 4th year · Cardiology · Valvulopathies, RAA and infective endocarditis
What peripheral clinical sign is characteristic of chronic large aortic insufficiency?
A
Thready and regular pulse
B
Leaping pulse (Corrigan pulse) with expanded pulse pressure
C
Paradoxical pulse on inspiration
D
Bilateral decrease in radial pulse
Explanation: explanation: Significant IAO causes an increase in stroke volume (large pulse) and a rapid drop in diastolic pressure by regurgitation, resulting in enlarged pulse pressure and jumping pulse. The paradoxical pulse evokes tamponade.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: AIo – peripheral signs
difficulty: medium
submodule_key: y4_cardiology_valvulopathies_raa_endocarditis
module_title: 4th year · Cardiology · Valvulopathies, RAA and infective endocarditis
What immune mechanism is responsible for cardiac damage during RAA?
A
Direct deposition of streptococcal bacteria on the valves
B
Autoimmune cross-reaction between streptococcal antigens and cardiac tissues
C
Coronary septic embolism originating from a pharyngeal focus
D
Streptococcal toxemia directly cytotoxic to cardiomyocytes
Explanation: explanation: AAR occurs after pharyngeal infection with group A streptococcus. Anti-streptococcal antibodies cross-react with cardiac proteins (molecular mimicry), resulting in autoimmune pancarditis. This mechanism explains the absence of bacteria on the valves during RAA.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: RAA – pathophysiology
difficulty: difficult
submodule_key: y4_cardiology_valvulopathies_raa_endocarditis
module_title: 4th year · Cardiology · Valvulopathies, RAA and infective endocarditis
What complication should be systematically looked for in any wearer of a mechanical valve prosthesis?
A
Tissue degeneration of the prosthesis
B
Thrombosis or embolism linked to insufficient anticoagulation
C
Organic mitral regurgitation
D
Restenosis due to valvular fibrosis
Explanation: explanation: Mechanical prostheses require long-term anticoagulation. The main risk is thrombosis of the prosthesis or systemic embolism. Tissue degeneration concerns bioprostheses. Monitoring includes regular monitoring of INR.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Valvulopathy monitoring
difficulty: medium
submodule_key: y4_cardiology_valvulopathies_raa_endocarditis
module_title: 4th year · Cardiology · Valvulopathies, RAA and infective endocarditis
Which of the following are major Duke criteria for infective endocarditis?
A
Two positive blood cultures with typical organism (S. viridans, S. aureus)
B
Vegetation or abscess on echocardiography
C
Fever > 38°C
D
Vascular phenomena (arterial emboli, subungual hemorrhages)
Explanation: explanation: Fever and vascular phenomena are minor Duke criteria. The major criteria are: positive blood cultures for typical microorganism (persistent or S. aureus in one blood culture) and echocardiographic elements (vegetation, abscess, prosthesis dehiscence).
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: EI – Duke criteria
difficulty: difficult
submodule_key: y4_cardiology_valvulopathies_raa_endocarditis
module_title: 4th year · Cardiology · Valvulopathies, RAA and infective endocarditis
What complications can occur in advanced mitral valve disease?
A
Atrial fibrillation
B
Pulmonary arterial hypertension
C
Associated aortic stenosis
D
Congestive heart failure
Explanation: explanation: Left atrial dilatation (MR) or ventricular overload (MI) promotes AF. Post-capillary PAH is a complication of MR in particular. IC occurs in the advanced stage. Aortic stenosis is a distinct aortic valve disease, not a direct complication of mitral valve disease.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Valvulopathies – common complications
difficulty: medium
submodule_key: y4_cardiology_valvulopathies_raa_endocarditis
module_title: 4th year · Cardiology · Valvulopathies, RAA and infective endocarditis
What extracardiac manifestations are part of the picture of acute rheumatic fever?
A
Migrant polyarthritis affecting large joints
B
Sydenham chorea
C
Besnier's erythema marginatum
D
Vascular purpura of the lower limbs
Explanation: explanation: Vascular purpura of the lower limbs is characteristic of rheumatoid purpura (HSP) or vasculitis, not RAA. The classic manifestations of AAR: carditis, migrating arthritis, Sydenham's chorea, erythema marginatum, subcutaneous nodules.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: RAA – demonstrations
difficulty: difficult
submodule_key: y4_cardiology_valvulopathies_raa_endocarditis
module_title: 4th year · Cardiology · Valvulopathies, RAA and infective endocarditis
How to make the diagnosis of infective endocarditis and what tests are essential?
Explanation: explanation: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Infective endocarditis – approach
difficulty: difficult
submodule_key: y4_cardiology_valvulopathies_raa_endocarditis
module_title: 4th year · Cardiology · Valvulopathies, RAA and infective endocarditis
Describe the natural history of rheumatic mitral stenosis and its complications.
Explanation: explanation: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: RM – natural history
difficulty: medium
submodule_key: y4_cardiology_valvulopathies_raa_endocarditis
module_title: 4th year · Cardiology · Valvulopathies, RAA and infective endocarditis
What ECG appearance characterizes atrial fibrillation?
A
Regular P waves preceding each QRS with regular RR interval
B
Anarchic atrial activity in 'f' with irregular ventricular response
C
Sawtooth F waves at 300/min with 2:1 block
D
Regular wide QRS complexes without visible P wave
Explanation: explanation: AF presents: absence of organized P wave replaced by anarchic 'f' activity, totally irregular RR intervals, thin QRS (except conduction aberration). Regular sawtooth F waves characterize atrial flutter.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Atrial fibrillation
difficulty: medium
submodule_key: y4_cardiology_disorders_rhythm_conduction
module_title: 4th year · Cardiology · Rhythm and conduction disorders
What is the main ECG difference between atrial flutter and atrial fibrillation?
A
Flutter has a lower atrial rate (< 150/min) than AF
B
Flutter presents regular 'sawtooth' F waves at 300/min, FA irregular anarchic activity
C
AF is always associated with bundle branch block, not flutter
D
Flutter gives wide QRS, FA fine QRS in all cases
Explanation: explanation: Typical atrial flutter has regular 'sawtooth' F waves clearly visible in DII-DIII-aVF at approximately 300/min, with ventricular conduction usually 2:1 (150/min). AF shows chaotic basal activity without identifiable P waves.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Flutter vs FA
difficulty: difficult
submodule_key: y4_cardiology_disorders_rhythm_conduction
module_title: 4th year · Cardiology · Rhythm and conduction disorders
What is the ECG characteristic of the BAV Mobitz II?
A
Progressive lengthening of the PR until a blocked QRS (Luciani-Wenckebach period)
B
Constant PR, then sudden blocking of a P wave without prior PR prolongation
C
Complete atrioventricular dissociation with regular bradycardia
D
PR > 200 ms stable on all cycles without blocking
Explanation: explanation: BAV Mobitz I (Wenckebach): progressive lengthening of the PR until the blocking of a QRS. BAV Mobitz II: constant PR then sudden blockage without warning, poor prognosis. Complete BAV: total AV dissociation. BAV 1st degree: PR > 200 ms without blocking.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: BAV – classification
difficulty: difficult
submodule_key: y4_cardiology_disorders_rhythm_conduction
module_title: 4th year · Cardiology · Rhythm and conduction disorders
What is the typical ventricular rate in a complete BAV with junctional escape rhythm?
A
120-150 beats/min
B
40-60 beats/min
C
20-30 beats/min
D
60-80 beats/min
Explanation: explanation: In complete BAV, the atrioventricular node or His bundle takes over with a frequency of 40-60/min (junctional, fine QRS). If the rhythm comes from the ventricular myocardium, it is slower (20-40/min) with wide QRS.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: complete BAV
difficulty: medium
submodule_key: y4_cardiology_disorders_rhythm_conduction
module_title: 4th year · Cardiology · Rhythm and conduction disorders
What ECG appearance characterizes a complete left bundle branch block (LBBB)?
A
QRS ≥ 120 ms, RSR' appearance in V1, deep S wave in V6
B
QRS ≥ 120 ms, M-shaped appearance widened in V5-V6 with wide, hooked R wave, QS in V1
C
Short PR with delta wave in anterior leads
D
Thin QRS with diffuse ST depression
Explanation: explanation: The BBGC presents a QRS ≥ 120 ms, a wide RR' morphology (in M) in V5-V6, a QS or rS appearance in V1, and a left axial deviation often associated. The BBDC gives an RSR' in V1 ('rabbit ears') and a deep S wave in V6.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Branch block
difficulty: difficult
submodule_key: y4_cardiology_disorders_rhythm_conduction
module_title: 4th year · Cardiology · Rhythm and conduction disorders
What non-drug maneuver can reduce paroxysmal junctional tachycardia?
A
Compression of the eyeballs bilaterally
B
Valsalva maneuver or carotid sinus massage
C
Positioning in Trendelenburg
D
Application of heat to the precordium
Explanation: explanation: Vagal maneuvers increase vagal tone and slow nodal conduction, which may interrupt a reentrant junctional tachycardia. Ocular compression is abandoned (risk of retinal detachment). The Valsalva maneuver in the prone position is the most effective.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Supraventricular tachycardia
difficulty: medium
submodule_key: y4_cardiology_disorders_rhythm_conduction
module_title: 4th year · Cardiology · Rhythm and conduction disorders
Which ECG criterion indicates ventricular tachycardia rather than supraventricular tachycardia with conduction aberration?
A
Wide QRS (> 120 ms) in regular tachycardia
B
Negative or positive concordance of precordial QRS
C
Heart rate > 150/min
D
Absence of visible P wave in all leads
Explanation: explanation: The Brugada criteria make it possible to distinguish TV and TSV with aberration. The concordance (all positive or negative QRS from V1 to V6) is very specific to VT. Wide QRS alone are not enough (also seen in SVT with LBBB or aberration). AV dissociation is the most specific criterion for VT.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: SVT vs VT – differential diagnosis
difficulty: difficult
submodule_key: y4_cardiology_disorders_rhythm_conduction
module_title: 4th year · Cardiology · Rhythm and conduction disorders
What clinical characteristic distinguishes rhythmic syncope from vasovagal syncope?
A
Brief loss of consciousness followed by rapid recovery in both cases
B
Rhythmic syncope occurs during exercise or at rest without vagal prodrome, often traumatic
C
Vasovagal syncope is always accompanied by tonic convulsions
D
Rhythmic syncope is systematically preceded by nausea and cold sweats
Explanation: explanation: Vasovagal syncope presents classic prodromes (nausea, sweating, sensation of heat, pallor) and occurs in a triggering context (emotion, pain, heat, prolonged standing). Rhythmic syncopation is sudden, unpredictable, without prodrome, often traumatic because the fall is not cushioned.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Rhythmic syncopation
difficulty: medium
submodule_key: y4_cardiology_disorders_rhythm_conduction
module_title: 4th year · Cardiology · Rhythm and conduction disorders
What is the main embolic complication of non-anticoagulated atrial fibrillation?
A
Pulmonary embolism due to deep vein thrombosis
B
Ischemic stroke due to left atrial thrombus embolism
C
Coronary embolism with infarction without atherosclerosis
D
Mesenteric ischemia due to spontaneous arterial thrombosis
Explanation: explanation: Blood stasis in the left atrium during AF promotes thrombosis. Emboli can migrate into the cerebral (stroke) or systemic circulation. Anticoagulation is indicated according to the CHA2DS2-VASc score to reduce this risk.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: AF – complications
difficulty: difficult
submodule_key: y4_cardiology_disorders_rhythm_conduction
module_title: 4th year · Cardiology · Rhythm and conduction disorders
What is the ECG definition of 1st degree atrioventricular block?
A
Short PR < 120 ms with delta wave
B
PR > 200 ms constant on all cycles without QRS block
C
Alternation of long PR and short PR
D
Atrioventricular dissociation with bradycardia
Explanation: explanation: The 1st degree BAV reflects a slowing of nodal conduction without interruption. Each P wave is followed by a QRS. It does not cause any symptoms of its own. To be distinguished from BAV 2 (intermittent blockages) and BAV 3 (complete AV dissociation).
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: 1st degree BAV
difficulty: medium
submodule_key: y4_cardiology_disorders_rhythm_conduction
module_title: 4th year · Cardiology · Rhythm and conduction disorders
What ECG appearance is characteristic of a ventricular extrasystole (VES)?
A
Thin QRS without premature P wave
B
Wide and bizarre QRS, premature, without P wave preceding it, followed by a compensatory pause
C
Premature end QRS preceded by a P wave with short PR
D
Wide QRS with progressive PR lengthening
Explanation: explanation: ESVs arise in the ventricular myocardium: absence of triggering P wave, abnormal QRS (wide > 120 ms, odd morphology), compensatory pause (the next cycle is delayed). Atrial extrasystoles give a premature late QRS preceded by an ectopic P wave.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Ventricular extrasystoles
difficulty: difficult
submodule_key: y4_cardiology_disorders_rhythm_conduction
module_title: 4th year · Cardiology · Rhythm and conduction disorders
What types of atrioventricular block require implantation of a permanent pacemaker?
A
Complete BAV (3rd degree BAV)
B
BAV Mobitz II symptomatic
C
Isolated asymptomatic 1st degree BAV
D
BAV Mobitz I asymptomatic on healthy heart
Explanation: explanation: 1st degree BAV and asymptomatic Mobitz I BAV on a healthy heart (athlete, vagotonia) generally do not require a pacemaker. Mobitz II BAV is at high risk of progression to full BAV.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: BAV – classification
difficulty: difficult
submodule_key: y4_cardiology_disorders_rhythm_conduction
module_title: 4th year · Cardiology · Rhythm and conduction disorders
What conditions can trigger or promote atrial fibrillation?
A
Hyperthyroidism
B
Mitral valve disease
C
Complete left bundle branch block
D
Acute pericarditis
Explanation: explanation: Left bundle branch block is a disorder of interventricular conduction, not a triggering factor for AF. The classic causes of AF: structural heart disease (valvulopathy, ischemic heart disease), general causes (hyperthyroidism, alcohol, infection, cardiac surgery, pericarditis).
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: FA – triggering factors
difficulty: difficult
submodule_key: y4_cardiology_disorders_rhythm_conduction
module_title: 4th year · Cardiology · Rhythm and conduction disorders
What criteria allow for the diagnosis of complete right bundle branch block (RBBB)?
A
QRS ≥ 120 ms
B
RSR' aspect in V1-V2
C
Broadened and deep S wave in D1 and V6
D
Marked left axial deviation
Explanation: explanation: Left axial deviation is not a BBDC criterion; it is associated with the BBGC or the left anterior hemiblock. The BBDC typically presents: QRS ≥ 120 ms, RSR' in V1 ('rabbit ears'), wide S wave in DI-V6.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Branch blocks – characteristics
difficulty: medium
submodule_key: y4_cardiology_disorders_rhythm_conduction
module_title: 4th year · Cardiology · Rhythm and conduction disorders
Classify atrioventricular blocks by describing their ECG characteristics and respective prognosis.
Explanation: explanation: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: BAV – systematic classification
difficulty: difficult
submodule_key: y4_cardiology_disorders_rhythm_conduction
module_title: 4th year · Cardiology · Rhythm and conduction disorders
What are the general principles of management of atrial fibrillation?
Explanation: explanation: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: FA – general therapeutic strategies
difficulty: medium
submodule_key: y4_cardiology_disorders_rhythm_conduction
module_title: 4th year · Cardiology · Rhythm and conduction disorders
Which paraclinical examination is considered the reference to confirm deep vein thrombosis of the lower limbs?
A
Contrast venography
B
Venous Doppler ultrasound of the lower limbs
C
Assay of D-dimer in isolation
D
Spiral scanner with injection (angioscanner)
Explanation: explanation: Venous Doppler ultrasound is non-invasive, easily available and sensitive for DVT of the lower limbs. Phlebography is invasive and reserved for difficult cases. D-dimer has a high negative predictive value but is not very specific. CT angiography is the gold standard for pulmonary embolism.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: DVT – diagnosis
difficulty: medium
submodule_key: y4_cardiology_disease_thromboembolic_antithrombotics
module_title: 4th year · Cardiology · Thromboembolic and antithrombotic disease
What ECG pattern is classically associated with severe pulmonary embolism?
A
ST elevation in anterior leads with Q wave in V1-V4
B
S1Q3T3 aspect: S wave in DI, negative Q and T wave in DIII
C
AF with isolated rapid ventricular rhythm
D
Diffuse ST depression with negative T wave in V4-V6
Explanation: explanation: The S1Q3T3 aspect reflects the acute overload of the right ventricle during a massive PE: large S wave in DI, negative Q and T wave in DIII. Sinus tachycardia is the most common ECG sign in PE. An acute right BBD may also be observed.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: EP – ECG sign
difficulty: difficult
submodule_key: y4_cardiology_disease_thromboembolic_antithrombotics
module_title: 4th year · Cardiology · Thromboembolic and antithrombotic disease
What combination of clinical signs specifically points towards a massive pulmonary embolism rather than a myocardial infarction or pneumothorax?
A
Constrictive retrosternal chest pain with Q wave in V1-V4
B
Sudden dyspnea with tachycardia, sign of DVP, cyanosis and right axial deviation ECG
C
Abolition of unilateral gallbladder murmur with tracheal deviation
D
Pleuritic chest pain with cough and isolated minor hemoptysis
Explanation: explanation: Massive pulmonary embolism presents: sudden dyspnea, hypoxemia, signs of PVD (jugular turgor, burst of pulmonary B2), tachycardia, hemodynamic instability, right axial ECG deviation. Unilateral abolition of MV suggests pneumothorax. Constrictive pain with ST elevation suggests MI.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: PE vs MI vs pneumothorax
difficulty: difficult
submodule_key: y4_cardiology_disease_thromboembolic_antithrombotics
module_title: 4th year · Cardiology · Thromboembolic and antithrombotic disease
What is the main clinical utility of D-dimer in thromboembolic disease?
A
Confirm diagnosis of DVT or PE with high specificity
B
Exclude DVT or PE if negative in a patient with low clinical probability
C
Guide the duration of anticoagulation
D
Assess the severity of pulmonary embolism
Explanation: explanation: D-dimers have high sensitivity but low specificity. A negative rate makes it possible to exclude DVT or PE in patients with low pre-test probability (low Wells score). In cases of high probability, imaging is necessary even with normal D-dimer.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: D-dimer – interpretation
difficulty: medium
submodule_key: y4_cardiology_disease_thromboembolic_antithrombotics
module_title: 4th year · Cardiology · Thromboembolic and antithrombotic disease
What is the main mechanism of action of vitamin K antagonists (AVK)?
A
Direct inhibition of thrombin (factor IIa)
B
Inhibition of hepatic synthesis of vitamin K-dependent coagulation factors (II, VII, IX, X)
C
Activation of antithrombin III to inhibit factors Xa and IIa
D
Direct and selective inhibition of factor Xa
Explanation: explanation: VKAs block the regeneration of active vitamin K by inhibiting vitamin K epoxide reductase, thereby reducing the synthesis of factors II, VII, IX, X and proteins C and S. Heparin activates antithrombin III. DOACs directly inhibit thrombin (dabigatran) or factor Xa (rivaroxaban, apixaban).
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Anticoagulants – mechanism
difficulty: difficult
submodule_key: y4_cardiology_disease_thromboembolic_antithrombotics
module_title: 4th year · Cardiology · Thromboembolic and antithrombotic disease
What clinical sign indicates deep vein thrombosis rather than acute arterial ischemia of the lower limb?
A
Limb cold, pale, painful, with absent pulse
B
Limb red, hot, edematous, with calf pain on dorsiflexion of the foot
C
Intermittent claudication appearing after 200 meters of walking
D
Blood pressure asymmetry in the lower limbs with decreased popliteal pulse
Explanation: explanation: DVT manifests itself as unilateral inflammatory edema, warmth, redness, Homans sign (calf pain when dorsiflexion). Acute arterial ischemia gives the 5Ps: Pain, Paleness, Pulselessness, Paresthesias, Paralysis. Chronic PAD results in intermittent claudication.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: DVT vs PAD – differential diagnosis
difficulty: medium
submodule_key: y4_cardiology_disease_thromboembolic_antithrombotics
module_title: 4th year · Cardiology · Thromboembolic and antithrombotic disease
What is the most serious bleeding complication of anticoagulants?
A
Prolonged bilateral epistaxis
B
Intracranial hematoma
C
Minor lower digestive hemorrhage
D
Spontaneous subcutaneous hematoma
Explanation: explanation: Intracranial hemorrhages (subdural hematoma, cerebral hemorrhage) are the most feared complications because they are potentially fatal. They require immediate stopping of the anticoagulant and neutralization. Epistaxis and subcutaneous hematomas are more benign.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Hemorrhagic complication – anticoagulants
difficulty: difficult
submodule_key: y4_cardiology_disease_thromboembolic_antithrombotics
module_title: 4th year · Cardiology · Thromboembolic and antithrombotic disease
What is the mechanism of action of aspirin as an antiplatelet agent?
A
Reversible inhibition of platelet P2Y12 ADP receptors
B
Irreversible inhibition of platelet cyclooxygenase (COX-1) reducing thromboxane A2 synthesis
C
Direct inhibition of platelet glycoprotein IIb/IIIa
D
Inhibition of platelet phosphodiesterase increasing cAMP
Explanation: explanation: Aspirin acetylates and irreversibly inhibits COX-1, blocking the production of TXA2 (powerful aggregator and vasoconstrictor). This effect lasts for the life of the blister (7-10 days). Clopidogrel inhibits P2Y12 receptors. GPIIb/IIIa inhibitors block final aggregation.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Antiaggregants – mechanism
difficulty: medium
submodule_key: y4_cardiology_disease_thromboembolic_antithrombotics
module_title: 4th year · Cardiology · Thromboembolic and antithrombotic disease
In which clinical situation is double antiplatelet aggregation preferred to anticoagulation?
A
Atrial fibrillation with CHA2DS2-VASc score ≥ 2
B
Recent proximal deep vein thrombosis
C
After coronary stenting during acute coronary syndrome
D
Submassive pulmonary embolism with hemodynamic instability
Explanation: explanation: Double anti-aggregation (aspirin + P2Y12 inhibitor) is the standard treatment after coronary stenting to prevent in-stent thrombosis. Anticoagulation is indicated for DVT, PE, and AF. These indications are distinct and should not be confused.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Anticoagulant vs antiplatelet – indications
difficulty: difficult
submodule_key: y4_cardiology_disease_thromboembolic_antithrombotics
module_title: 4th year · Cardiology · Thromboembolic and antithrombotic disease
What is Virchow's triad that promotes venous thrombosis?
A
Hypertension, diabetes, hypercholesterolemia
B
Venous stasis, endothelial injury, hypercoagulable state
C
Smoking, obesity, sedentary lifestyle
D
Tachycardia, hypotension, anemia
Explanation: explanation: These three factors favor the formation of venous thrombus: stasis (immobilization, venous insufficiency), endothelial injury (trauma, surgery), hypercoagulability (thrombophilia, cancer, pregnancy, estrogen-progestin contraception).
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Virchow triad
difficulty: medium
submodule_key: y4_cardiology_disease_thromboembolic_antithrombotics
module_title: 4th year · Cardiology · Thromboembolic and antithrombotic disease
What properties distinguish low molecular weight heparins (LMWH) from unfractionated heparins (UFH)?
A
LMWHs have more predictable subcutaneous bioavailability
B
LMWHs require INR monitoring
C
LMWHs preferentially inhibit factor Xa without requiring monitoring of anti-IIa activity
D
UFHs are administered orally only
Explanation: explanation: The INR monitors AVK, not heparins. UFH is given IV or SC, never orally. LMWHs are administered SC with a predictable anti-Xa effect not requiring systematic biological monitoring as curative treatment in normal patients.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Heparins – types and mechanisms
difficulty: difficult
submodule_key: y4_cardiology_disease_thromboembolic_antithrombotics
module_title: 4th year · Cardiology · Thromboembolic and antithrombotic disease
What risk factors promote venous thromboembolism?
A
Prolonged immobilization
B
Active neoplasia
C
High blood pressure
D
Thrombophilia (protein C, protein S, factor V Leiden deficiency)
Explanation: explanation: Arterial hypertension is an arterial, not venous, cardiovascular risk factor. VTE FDRs include: immobilization, surgery, neoplasia, pregnancy, congenital or acquired thrombophilia, oral contraceptives, prolonged travel.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: VTE risk factors
difficulty: medium
submodule_key: y4_cardiology_disease_thromboembolic_antithrombotics
module_title: 4th year · Cardiology · Thromboembolic and antithrombotic disease
What situations constitute general contraindications to anticoagulants?
A
Recent intracranial hemorrhage
B
Severe thrombocytopenia with platelet count < 50,000/mm³
C
Mild to moderate renal impairment on LMWH
D
Recent eye surgery or neurosurgery
Explanation: explanation: Mild to moderate renal insufficiency requires adaptation of LMWH doses but is not an absolute contraindication. Severe renal insufficiency may contraindicate LMWH (accumulation) in favor of UFH.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Anticoagulants – general contraindications
difficulty: difficult
submodule_key: y4_cardiology_disease_thromboembolic_antithrombotics
module_title: 4th year · Cardiology · Thromboembolic and antithrombotic disease
Describe the diagnostic process for pulmonary embolism and the elements of stratification of its severity.
Explanation: explanation: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: EP – diagnosis and stratification
difficulty: difficult
submodule_key: y4_cardiology_disease_thromboembolic_antithrombotics
module_title: 4th year · Cardiology · Thromboembolic and antithrombotic disease
What are the main pharmacological principles that govern the use of anticoagulants in practice?
Explanation: explanation: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Anticoagulants – general principles
difficulty: medium
submodule_key: y4_cardiology_disease_thromboembolic_antithrombotics
module_title: 4th year · Cardiology · Thromboembolic and antithrombotic disease
What is the definition of vascular intermittent claudication in PAD?
A
Muscle pain in the lower limbs occurring at rest, relieved by walking
B
Pain on exercise in a muscular area distal to an arterial obstruction, relieved by stopping
C
Nocturnal calf cramps unrelated to exercise
D
Unilateral painful edema worsened by walking
Explanation: explanation: Intermittent claudication reflects muscular ischemia due to reduced arterial flow. It is characterized by its walking perimeter (distance from which pain appears) and its location (calf for femoropopliteal involvement). It quickly gives in when the effort stops.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: AOMI – classification
difficulty: medium
submodule_key: y4_cardiology_aorta_arteriopathies_ischemia_member
module_title: 4th year · Cardiology · Aorta, arteriopathies and acute limb ischemia
What are the characteristic clinical signs of acute lower limb ischemia?
A
Edema, warmth, erythema, pain on dorsiflexion of the foot
B
Pallor, coldness, severe pain, loss of pulse, paresthesia/distal paralysis
C
Intermittent claudication appearing suddenly with preservation of pulse
D
Cyanosis of the extremity with mottling and preserved pulse
Explanation: explanation: The 5P rule: Pain, Paleness, Pulselessness, Paresthesias, Paralysis (+ Poikilothermie). Paresthesias and paralysis indicate advanced ischemia (absolute surgical emergency). Warm edema suggests DVT. Cyanosis with preserved pulse may suggest Raynaud's phenomenon.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Acute limb ischemia
difficulty: difficult
submodule_key: y4_cardiology_aorta_arteriopathies_ischemia_member
module_title: 4th year · Cardiology · Aorta, arteriopathies and acute limb ischemia
Which pain feature is most suggestive of aortic dissection?
A
Retrosternal constrictive pain radiating to the left arm
B
Tearing pain migrating from the chest to the back and abdomen, immediately maximal
C
Chest pain increasing on inspiration with auscultatory rubbing
D
Postprandial epigastric pain radiating to the back
Explanation: explanation: Dissection pain is typically: brutal, immediately maximal (unlike MI which increases progressively), tearing or 'stabbing', migrating following the progression of the false channel. Blood pressure asymmetry between the limbs is a suggestive sign.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Aortic dissection – presentation
difficulty: difficult
submodule_key: y4_cardiology_aorta_arteriopathies_ischemia_member
module_title: 4th year · Cardiology · Aorta, arteriopathies and acute limb ischemia
In the Stanford classification of aortic dissections, what is the difference between type A and type B?
A
Type A: involvement of the descending aorta only; Type B: damage to the ascending aorta
B
Type A: involvement of the ascending aorta (with or without descending); Type B: damage limited to the descending aorta
C
Type A: proximal dissection without extension; Type B: dissection with extension to the renal arteries
D
Type A: chronic dissection; Type B: acute dissection
Explanation: explanation: Type A (Stanford) involves the ascending aorta and requires urgent surgery due to the risk of tamponade, acute aortic insufficiency, and coronary occlusion. Type B is often treated medically initially.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Aortic dissection – classification
difficulty: difficult
submodule_key: y4_cardiology_aorta_arteriopathies_ischemia_member
module_title: 4th year · Cardiology · Aorta, arteriopathies and acute limb ischemia
What is the significance of a systolic pressure index (SPI) lower than 0.9 in the lower limb?
A
Sign of severe high blood pressure
B
Sign of obliterating arteriopathy of the lower limbs
C
Sign of chronic venous incompetence
D
Sign of chronic compartment syndrome
Explanation: explanation: The ABI is the ratio of the systolic pressure at the ankle to the systolic pressure at the arm. A normal ABI is between 1.0 and 1.3. An ABI < 0.9 indicates lower limb arterial stenosis (PAAD). An ABI > 1.3 may indicate arterial calcification (incompressibility).
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: IPS – measurement
difficulty: medium
submodule_key: y4_cardiology_aorta_arteriopathies_ischemia_member
module_title: 4th year · Cardiology · Aorta, arteriopathies and acute limb ischemia
What abdominal aortic diameter value defines an abdominal aortic aneurysm (AAA)?
A
Aortic diameter > 25 mm
B
Aortic diameter > 30 mm (i.e. increase > 50% compared to the normal segment)
C
Aortic diameter > 50 mm in all cases
D
Any aortic enlargement visible on ultrasound
Explanation: explanation: The threshold of 30 mm (3 cm) defines aneurysmal dilatation of the infrarenal abdominal aorta. The risk of rupture increases significantly beyond 55 mm, requiring surgical or endovascular intervention.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Aortic aneurysm – definition
difficulty: difficult
submodule_key: y4_cardiology_aorta_arteriopathies_ischemia_member
module_title: 4th year · Cardiology · Aorta, arteriopathies and acute limb ischemia
Why is thrombolysis contraindicated in cases of type A aortic dissection mimicking ACS?
A
Thrombolysis does not dissolve arterial thrombi
B
Thrombolysis can aggravate intraparietal hemorrhage and promote extension of the dissection
C
Thrombolysis is only effective in the first 30 minutes
D
Dissection produces a rise in troponin which invalidates the effect of thrombolysis
Explanation: explanation: Aortic dissection can occlude the coronary ostium and give a picture of ACS with ST elevation. If we administer thrombolysis, we risk aggravating the hemorrhage in the aortic wall and extending the dissection, with immediate life risk. Hence the importance of eliminating dissection before any reperfusion.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Dissection vs coronary artery disease – differential diagnosis
difficulty: medium
submodule_key: y4_cardiology_aorta_arteriopathies_ischemia_member
module_title: 4th year · Cardiology · Aorta, arteriopathies and acute limb ischemia
What Leriche-Fontaine stage does rest pain with skin ischemia correspond to (trophic disorders)?
A
Stage I: Asymptomatic PAD
B
Stage II: intermittent claudication
C
Stage III: rest pain
D
Stage IV: trophic disorders (ulcers, necroses)
Explanation: explanation: Leriche-Fontaine classification: I (asymptomatic), II (intermittent claudication: IIa > 200 m, IIb < 200 m), III (ischemic nocturnal rest pain), IV (trophic disorders: ulcers, necrosis, gangrene). Stages III and IV constitute chronic critical ischemia.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: AOMI – Leriche-Fontaine stadiums
difficulty: difficult
submodule_key: y4_cardiology_aorta_arteriopathies_ischemia_member
module_title: 4th year · Cardiology · Aorta, arteriopathies and acute limb ischemia
What is the main cause of acute lower limb ischemia?
A
Isolated arterial vasospasm
B
Arterial embolism with cardiac origin (FA, MI)
C
Popliteal artery dissection
D
Extrinsic compression by muscular hematoma
Explanation: explanation: Arterial emboli are most often of cardiac origin: atrial fibrillation (left atrial thrombus), myocardial infarction (mural thrombus), valvular disease. Thrombosis from chronic arteritis is the second cause.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Acute ischemia – etiologies
difficulty: medium
submodule_key: y4_cardiology_aorta_arteriopathies_ischemia_member
module_title: 4th year · Cardiology · Aorta, arteriopathies and acute limb ischemia
What clinical element allows us to distinguish acute arterial ischemia from deep vein thrombosis of the lower limb?
A
Pain is present in both tables
B
In arterial ischemia, the limb is pale and cold with an absent pulse; in DVT, the limb is warm, erythematous, edematous with preserved pulse
C
Edema is greater in arterial ischemia than in DVT
D
DVT always causes pulmonary embolism, arterial ischemia never
Explanation: explanation: Acute arterial ischemia and DVT are two vascular emergencies with opposing presentations. Arterial ischemia leads to a lack of blood supply: pallor, coldness, suppressed pulse. DVT causes obstruction of venous return: venous congestion with heat, edema, erythema, preserved arterial pulses.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: DVT vs arterial ischemia – distinction
difficulty: difficult
submodule_key: y4_cardiology_aorta_arteriopathies_ischemia_member
module_title: 4th year · Cardiology · Aorta, arteriopathies and acute limb ischemia
What complications can result from a type A aortic dissection?
A
Pericardial tamponade by extension towards the pericardium
B
Acute aortic insufficiency due to tearing of the aortic valve
C
Coronary occlusion with myocardial infarction
D
Bilateral tension pneumothorax
Explanation: explanation: Pneumothorax is not a complication of aortic dissection. Type A dissection is a surgical emergency because it can lead to: tamponade by hemopericardium, acute IAO by valve disinsertion, coronary occlusion (MI), cerebral ischemia, spinal cord ischemia.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Aortic dissection – manifestations
difficulty: difficult
submodule_key: y4_cardiology_aorta_arteriopathies_ischemia_member
module_title: 4th year · Cardiology · Aorta, arteriopathies and acute limb ischemia
Which risk factors are most strongly associated with PAD?
A
Smoking
B
Diabetes
C
Hypothyroidism treated and balanced
D
Dyslipidemia with elevated LDL
Explanation: explanation: PAD shares its risk factors with atherosclerosis: smoking (risk multiplied by 3-5), diabetes (risk multiplied by 2-4), dyslipidemia, hypertension. Balanced treated hypothyroidism is not an independent risk factor.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: PAD – risk factors
difficulty: medium
submodule_key: y4_cardiology_aorta_arteriopathies_ischemia_member
module_title: 4th year · Cardiology · Aorta, arteriopathies and acute limb ischemia
Describe the diagnostic approach to suspected acute aortic dissection.
Explanation: explanation: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Aortic dissection – diagnostic approach
difficulty: difficult
submodule_key: y4_cardiology_aorta_arteriopathies_ischemia_member
module_title: 4th year · Cardiology · Aorta, arteriopathies and acute limb ischemia
Why is acute limb ischemia an absolute therapeutic emergency?
Explanation: explanation: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Acute limb ischemia – emergency
difficulty: medium
submodule_key: y4_cardiology_aorta_arteriopathies_ischemia_member
module_title: 4th year · Cardiology · Aorta, arteriopathies and acute limb ischemia
Which auscultatory sign is pathognomonic of acute pericarditis?
A
Proto-diastolic gallop (B3)
B
Mesosystolic and end-diastolic pericardial friction
C
Holodiastolic aortic insufficiency murmur
D
Diastolic rolling at the apex
Explanation: explanation: Pericardial friction is described as a fleeting sound of new leather, varying with position (more audible in a seated position leaning forward), in mesosystole and end-diastole. It may subside or disappear if a pericardial effusion forms.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Acute pericarditis – diagnosis
difficulty: medium
submodule_key: y4_cardiology_pericardium_myocardium_htap_heart_pulmonary
module_title: 4th year · Cardiology · Pericardium, myocardium, PAH and cor pulmonale
What ECG sign is characteristic of acute pericarditis and absent in myocardial infarction?
A
Mirrored ST elevation in opposite leads
B
PR Space Undershift (PR Undershift)
C
Appearance of a pathological Q wave
D
De novo left bundle branch block
Explanation: explanation: PR depression (depression of the PR segment) is observed in pericarditis and reflects auricular damage. In infarction, we observe a localized ST elevation (coronary territory) convex upwards, with mirror image and evolution towards the Q wave. In pericarditis: diffuse, concave, mirrorless ST elevation, with PR depression.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Pericarditis vs heart attack – ECG
difficulty: difficult
submodule_key: y4_cardiology_pericardium_myocardium_htap_heart_pulmonary
module_title: 4th year · Cardiology · Pericardium, myocardium, PAH and cor pulmonale
What clinical triad characterizes pericardial tamponade (Beck triad)?
A
Fever, chest pain, pericardial rub
B
Hypotension, jugular turgor, muffled heart sounds
C
Orthopnea, bilateral crackles, gallop B3
D
Jumping pulse, widening pulse pressure, cyanosis
Explanation: explanation: Tamponade results from the accumulation of pericardial effusion compressing the right heart chambers. Beck's triad: hypotension (low cardiac output), jugular turgor (venous hypertension), muffled heart sounds (effusion). Pulsus paradoxus (decrease in SBP > 10 mmHg on inspiration) is an important clinical sign.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Tamponade – signs
difficulty: difficult
submodule_key: y4_cardiology_pericardium_myocardium_htap_heart_pulmonary
module_title: 4th year · Cardiology · Pericardium, myocardium, PAH and cor pulmonale
Which clinical picture is most suggestive of acute myocarditis?
A
Fever with migratory polyarthritis in an adolescent
B
Chest pain and troponin elevation in a young adult after viral infectious syndrome
C
Retrosternal pain with ST elevation in a coronary territory in a 60-year-old smoking patient
D
Progressive dyspnea with bilateral crackles and edema in a 70-year-old hypertensive patient
Explanation: explanation: Myocarditis often occurs in the weeks following a viral infection (enterovirus, parvovirus B19). It can mimic ACS with elevated troponin and ECG abnormalities. Cardiac MRI confirms the diagnosis. The RAA (Jones criteria) concerns children and adolescents.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Myocarditis – presentation
difficulty: medium
submodule_key: y4_cardiology_pericardium_myocardium_htap_heart_pulmonary
module_title: 4th year · Cardiology · Pericardium, myocardium, PAH and cor pulmonale
What mean pulmonary artery pressure (avg PAP) value defines pulmonary arterial hypertension?
A
Mean PAP > 20 mmHg at resting right heart catheterization
B
Mean PAP > 35 mmHg on echocardiography
C
Average PAP > 50 mmHg only during exercise
D
Systolic PAP > 60 mmHg on Doppler echocardiography
Explanation: explanation: The recent definition (ESC 2022) lowers the average PAP threshold to > 20 mmHg (compared to 25 mmHg previously) at right heart catheterization. This threshold is the gold standard. Doppler echocardiography estimates the systolic PAP and guides the diagnosis but does not confirm it.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: PAH – definition
difficulty: difficult
submodule_key: y4_cardiology_pericardium_myocardium_htap_heart_pulmonary
module_title: 4th year · Cardiology · Pericardium, myocardium, PAH and cor pulmonale
What is the most common cause of chronic cor pulmonale?
A
Left mitral valve disease
B
Chronic obstructive pulmonary disease (COPD)
C
Systemic hypertension
D
Primary dilated cardiomyopathy
Explanation: explanation: Chronic cor pulmonale results from pulmonary hypertension secondary to chronic respiratory diseases. COPD is the main etiology, followed by diffuse interstitial lung disease, chronic hypoventilation and recurrent pulmonary embolism. Systemic hypertension affects the left ventricle.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Chronic cor pulmonale
difficulty: medium
submodule_key: y4_cardiology_pericardium_myocardium_htap_heart_pulmonary
module_title: 4th year · Cardiology · Pericardium, myocardium, PAH and cor pulmonale
What ultrasound feature distinguishes dilated cardiomyopathy from obstructive hypertrophic cardiomyopathy?
A
Dilated cardiomyopathy presents with an enlarged left ventricular cavity with collapsed LVEF
B
Hypertrophic cardiomyopathy is characterized by a lowered LVEF <40%
C
Dilated cardiomyopathy presents with asymmetric septal hypertrophy with intraLV gradient
D
The two cardiomyopathies give the same echocardiographic appearance
Explanation: explanation: CMD: LV cavitary dilation, thinned or normal walls, collapsed LVEF (< 40%). HCM: asymmetric ventricular hypertrophy (often septal), small LV cavity, preserved or increased LVEF, intra-LV gradient in obstructive forms.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Dilated vs. hypertrophic cardiomyopathy
difficulty: difficult
submodule_key: y4_cardiology_pericardium_myocardium_htap_heart_pulmonary
module_title: 4th year · Cardiology · Pericardium, myocardium, PAH and cor pulmonale
What is the physiopathological distinction between tamponade and chronic constrictive pericarditis?
A
Tamponade is linked to acute compression by fluid effusion, constriction to a rigid and calcified pericardium
B
Tamponade is a chronic picture, constriction is always acute
C
Constriction is linked to massive fluid effusion, tamponade to a thickened pericardium
D
Tamponade is treated by corticosteroid therapy, constriction by pericardiocentesis
Explanation: explanation: Tamponade is due to a rapid accumulation of pericardial effusion compressing the heart chambers. Constrictive pericarditis results from chronic pericardial fibrosis (post-infectious, post-radiation, post-surgical) resulting in a rigid shell limiting ventricular filling. Tamponade is treated by pericardiocentesis; constriction by surgical pericardiectomy.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Chronic constrictive pericarditis
difficulty: medium
submodule_key: y4_cardiology_pericardium_myocardium_htap_heart_pulmonary
module_title: 4th year · Cardiology · Pericardium, myocardium, PAH and cor pulmonale
How to distinguish dyspnea due to primary pulmonary arterial hypertension from dyspnea due to left heart failure?
A
Primary PAH is accompanied by bilateral crackles at the bases, the left IC not
B
Primary PAH gives dilatation of the RV without damage to the LV, left HF gives dilatation of the LV with lowered LVEF
C
The left IC gives a right axial deviation to the ECG, the PAH does not
D
Primary PAH is manifested only by syncope, left HF by dyspnea
Explanation: explanation: Primary PAH causes RV overload (dilatation, hypertrophy, right side failure) with small LV size. Left HF leads to LV dilation and/or dysfunction with elevated pulmonary capillary pressures (post-capillary PAH). Echocardiography allows the distinction.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: PAH vs left IC – differential diagnosis
difficulty: difficult
submodule_key: y4_cardiology_pericardium_myocardium_htap_heart_pulmonary
module_title: 4th year · Cardiology · Pericardium, myocardium, PAH and cor pulmonale
What examination can confirm the diagnosis of acute myocarditis and formally distinguish it from acute coronary syndrome?
A
12-lead ECG with Q wave search
B
Cardiac MRI showing non-systematized late enhancement in a coronary territory
C
Transthoracic echocardiography with LVEF measurement
D
Dosage of troponin hs at H0 and H3
Explanation: explanation: Cardiac MRI is the reference examination for myocarditis: it shows late subepicardial gadolinium enhancement, not systematized in a coronary territory (unlike MI). Coronary angiography may be necessary if ACS cannot be ruled out.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Myocarditis vs ACS – distinction
difficulty: medium
submodule_key: y4_cardiology_pericardium_myocardium_htap_heart_pulmonary
module_title: 4th year · Cardiology · Pericardium, myocardium, PAH and cor pulmonale
What etiologies should be considered when faced with abundant pericardial effusion?
A
Neoplasia (secondary or primary)
B
Chronic kidney failure (uremic pericarditis)
C
Severe hypothyroidism
D
Asymptomatic grade 1 hypertension
Explanation: explanation: Grade 1 hypertension does not directly cause pericardial effusion. The main etiologies of pericardial effusion: viral (most common in non-endemic areas), neoplasia (metastases, lymphomas), renal failure (uremia), hypothyroidism, systemic diseases (lupus, RA), tuberculosis (important in Algeria).
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Pericardial effusion – etiologies
difficulty: difficult
submodule_key: y4_cardiology_pericardium_myocardium_htap_heart_pulmonary
module_title: 4th year · Cardiology · Pericardium, myocardium, PAH and cor pulmonale
What clinical signs indicate advanced pulmonary hypertension with right side failure?
A
Jugular turgor
B
Painful hepatomegaly
C
Bilateral crackles of the bases
D
Lower limb edema
Explanation: explanation: Bilateral crackles suggest pulmonary congestion of the left IC. In PAH with right failure, the RV cannot overcome the high pulmonary resistance, leading to systemic venous stasis (jugular turgor, hepatomegaly, edema).
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: PAH – clinical signs
difficulty: medium
submodule_key: y4_cardiology_pericardium_myocardium_htap_heart_pulmonary
module_title: 4th year · Cardiology · Pericardium, myocardium, PAH and cor pulmonale
What are the diagnostic criteria for acute pericarditis and how to differentiate it from myocardial infarction?
Explanation: explanation: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Acute pericarditis – diagnostic criteria
difficulty: difficult
submodule_key: y4_cardiology_pericardium_myocardium_htap_heart_pulmonary
module_title: 4th year · Cardiology · Pericardium, myocardium, PAH and cor pulmonale
Explain the pathophysiological mechanism of chronic cor pulmonale in COPD.
Explanation: explanation: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Chronic cor pulmonale – mechanism
difficulty: medium
submodule_key: y4_cardiology_pericardium_myocardium_htap_heart_pulmonary
module_title: 4th year · Cardiology · Pericardium, myocardium, PAH and cor pulmonale
Which congenital heart disease is classified as left-to-right shunts?
A
Tetralogy of Fallot
B
Transposition of the great vessels
C
Atrial Communication (AIC)
D
Pulmonary atresia
Explanation: explanation: Heart diseases with L-R shunt (oxygenated blood to the right heart) are initially non-cyanogenic: CIA, CIV, Patent ductus arteriosus. Cyanogenic heart diseases with D-G shunt include: Tetralogy of Fallot, transposition of the great vessels, pulmonary atresia.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Congenital heart diseases – classification
difficulty: medium
submodule_key: y4_cardiology_congenital_cardiopathies_pregnancy_prostheses
module_title: 4th year · Cardiology · Congenital heart diseases, pregnancy, surgery and prostheses
Why can an untreated left-right shunt be complicated by shunt reversal (Eisenmenger syndrome)?
A
L-R shunt causes irreversible pulmonary vasodilation
B
Increased pulmonary blood flow causes irreversible PAH with shunt reversal
C
Hemodilution anemia forces reversal of flow
D
Right myocardial fibrosis closes the septal orifice
Explanation: explanation: Chronic L-R shunt increases pulmonary flow. This results in progressive pulmonary vascular remodeling with increasing PAH. When pulmonary pressure exceeds systemic pressure, the shunt reverses (D-G), creating central cyanosis: this is Eisenmenger syndrome. At this point, the congenital heart disease is inoperable.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Shunt L-R vs R-L
difficulty: difficult
submodule_key: y4_cardiology_congenital_cardiopathies_pregnancy_prostheses
module_title: 4th year · Cardiology · Congenital heart diseases, pregnancy, surgery and prostheses
What characteristic of a heart murmur in children points toward an innocent murmur rather than congenital heart disease?
A
Diastolic murmur, intense, radiating to the back
B
Soft, short systolic murmur, grade 1-2/6, without radiation, modified by position and respiration
C
Continuous subclavicular murmur persisting during inspiration and expiration
D
Holosystolic murmur with palpable quiver and associated cyanosis
Explanation: explanation: An innocent (functional) breath has no anatomical translation. It is characterized by: systolic, short, gentle (grade ≤ 2/6), without quivering, without irradiation, modified by position (sitting vs lying) and breathing. A diastolic murmur, intense, continuous or associated with symptoms requires exploration.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Innocent Breath – child
difficulty: medium
submodule_key: y4_cardiology_congenital_cardiopathies_pregnancy_prostheses
module_title: 4th year · Cardiology · Congenital heart diseases, pregnancy, surgery and prostheses
Which physiological change during pregnancy represents a particular risk for a woman with severe mitral stenosis?
A
Reducing systemic vascular resistance improves tolerance of MR
B
Increased cardiac output and heart rate worsens the transmitral gradient and may precipitate PAO
C
Physiological bradycardia of pregnancy protects against atrial fibrillation
D
Reduction of plasma volume in the third trimester reduces right overload
Explanation: explanation: Pregnancy leads to an increase in blood volume (40-50%) and cardiac output, physiological tachycardia. In MR, tachycardia shortens diastole (ventricular filling time) and worsens the transmitral gradient, which can precipitate acute decompensation or even PAO in mid-pregnancy.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Pregnancy and heart disease
difficulty: difficult
submodule_key: y4_cardiology_congenital_cardiopathies_pregnancy_prostheses
module_title: 4th year · Cardiology · Congenital heart diseases, pregnancy, surgery and prostheses
What is the main specific risk of mechanical valve prostheses requiring lifelong monitoring?
A
Degeneration and calcification of the prosthesis
B
Thrombosis of the prosthesis or systemic embolism due to insufficient anticoagulation
C
Left ventricular dysfunction due to altered compliance
D
Gram-negative endocarditis only
Explanation: explanation: Mechanical prostheses require long-term anticoagulation (AVK), regular monitoring of which (INR) is essential. The INR target varies depending on the type of prosthesis and its position (mitral vs aortic). Tissue degeneration concerns bioprostheses. The risk of endocarditis concerns all prostheses.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Valve prosthesis – monitoring
difficulty: medium
submodule_key: y4_cardiology_congenital_cardiopathies_pregnancy_prostheses
module_title: 4th year · Cardiology · Congenital heart diseases, pregnancy, surgery and prostheses
What mechanism explains cyanosis in tetralogy of Fallot?
A
Left-right shunt causing lung overload
B
Pulmonary stenosis and CIV causing a right-to-left shunt with unoxygenated blood in the systemic circulation
C
Transposition of the great vessels with parallel circulation
D
Secondary pulmonary hypertension
Explanation: explanation: Tetralogy of Fallot associates: CIV, pulmonary stenosis, dextroposition of the aorta 'straddling' the CIV, RV hypertrophy. Pulmonary stenosis creates resistance to pulmonary flow, forcing venous blood through the IVC into the greater circulation, causing cyanosis.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Tetralogy of Fallot – cyanosis
difficulty: difficult
submodule_key: y4_cardiology_congenital_cardiopathies_pregnancy_prostheses
module_title: 4th year · Cardiology · Congenital heart diseases, pregnancy, surgery and prostheses
What main advantage does the bioprosthetic valve offer compared to the mechanical prosthesis?
A
Longevity greater than 30 years without replacement
B
Does not require long-term anticoagulation, reducing the risk of bleeding
C
Total resistance to thrombosis without anticoagulant
D
Better hemodynamics for small valve orifices
Explanation: explanation: The bioprosthesis (animal, porcine or pericardial tissue) does not require prolonged anticoagulation (except AF or other indication), which is advantageous for patients at risk of bleeding or wishing to become pregnant. Its disadvantage is accelerated degeneration, particularly in young patients, requiring reoperation.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Bioprosthesis vs mechanical prosthesis
difficulty: medium
submodule_key: y4_cardiology_congenital_cardiopathies_pregnancy_prostheses
module_title: 4th year · Cardiology · Congenital heart diseases, pregnancy, surgery and prostheses
What time during pregnancy and postpartum represents the maximum hemodynamic risk for a woman with heart disease?
A
First trimester (implantation and early pregnancy)
B
Second trimester only
C
Childbirth and immediate postpartum period (first 48-72 hours)
D
Third week of pregnancy
Explanation: explanation: Childbirth generates sudden variations in preload (uterine contractions, postpartum autotransfusion) and afterload. The immediate postpartum period sees venous return increase suddenly with the disappearance of caval compression and reabsorption of edema, which can decompensate for underlying heart disease.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Pregnancy and heart disease – risk
difficulty: difficult
submodule_key: y4_cardiology_congenital_cardiopathies_pregnancy_prostheses
module_title: 4th year · Cardiology · Congenital heart diseases, pregnancy, surgery and prostheses
In the event of persistent fever in a prosthetic valve wearer, what is the first test to be carried out?
A
Thoracoabdominal scan to look for another infectious cause
B
Multiple blood cultures before any antibiotic treatment
C
Empirical broad-spectrum antibiotic therapy in emergency without assessment
D
Coronary angiography to rule out infectious coronary embolism
Explanation: explanation: Fever in a prosthetic valve wearer should suggest prosthetic endocarditis (EI-P). Blood cultures must be taken before any antibiotic therapy to identify the responsible organism and guide treatment. Early empirical antibiotic therapy without blood cultures compromises the etiological diagnosis.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Endocarditis on prosthesis
difficulty: medium
submodule_key: y4_cardiology_congenital_cardiopathies_pregnancy_prostheses
module_title: 4th year · Cardiology · Congenital heart diseases, pregnancy, surgery and prostheses
Which heart disease is a relative contraindication to pregnancy due to very high maternal risk?
A
CIA operated with good functional recovery
B
Severe PAH (mPAP > 25 mmHg) or Eisenmenger syndrome
C
Asymptomatic bicuspid aortic valve
D
Well-controlled hypertension without target organ damage
Explanation: explanation: Severe PAH and Eisenmenger syndrome lead to maternal mortality of 30-50% during pregnancy and postpartum. The drop in systemic resistance during pregnancy aggravates the D-G shunt. Pregnancy is not recommended or contraindicated in these situations.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Heart disease and pregnancy – risk classes
difficulty: difficult
submodule_key: y4_cardiology_congenital_cardiopathies_pregnancy_prostheses
module_title: 4th year · Cardiology · Congenital heart diseases, pregnancy, surgery and prostheses
Which congenital heart diseases are classified as cyanogenic heart diseases?
A
Tetralogy of Fallot
B
Transposition of the great vessels
C
Patent ductus arteriosus
D
Unoperated isolated ventricular septal defect (IVD)
Explanation: explanation: Patent ductus arteriosus and uncomplicated isolated IVC are initially non-cyanogenic L-R shunts. Tetralogy of Fallot (R-L shunt by pulmonary stenosis + CIV) and transposition of the great vessels (parallel circulation) are neonatal cyanogenic heart diseases.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Cyanogenic congenital heart diseases
difficulty: difficult
submodule_key: y4_cardiology_congenital_cardiopathies_pregnancy_prostheses
module_title: 4th year · Cardiology · Congenital heart diseases, pregnancy, surgery and prostheses
What monitoring elements are a priority in a woman with heart disease during pregnancy?
A
Repeated echocardiographic monitoring
B
Blood pressure monitoring at each consultation
C
Regular dosage of anti-streptococcal antibodies
D
Monitoring for signs of cardiac decompensation (dyspnea, edema)
Explanation: explanation: Anti-streptococcal antibody testing is not a standard element of cardiological monitoring in pregnancy. Monitoring a pregnant heart disease includes: echocardiographic monitoring (LV function, pressure), blood pressure (screening for pre-eclampsia), signs of HF and multidisciplinary cardiology-obstetrics consultation.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Pregnancy and heart disease – monitoring
difficulty: medium
submodule_key: y4_cardiology_congenital_cardiopathies_pregnancy_prostheses
module_title: 4th year · Cardiology · Congenital heart diseases, pregnancy, surgery and prostheses
What are the specific risks associated with wearing a long-term prosthetic valve?
A
Thrombosis of the prosthesis
B
Infective endocarditis on prosthesis
C
Valve degeneration (for bioprostheses)
D
Left atrial hypertrophy reversible under medical treatment
Explanation: explanation: Left atrial hypertrophy is an adaptive phenomenon linked to the underlying valvular disease, not a specific complication of the prosthesis. Risks specific to prostheses: thrombosis (mechanical ++), systemic embolism, endocarditis on prosthesis, paraprosthetic leak, tissue degeneration (bioprostheses), hemolysis.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Valve prosthesis risks
difficulty: difficult
submodule_key: y4_cardiology_congenital_cardiopathies_pregnancy_prostheses
module_title: 4th year · Cardiology · Congenital heart diseases, pregnancy, surgery and prostheses
Explain the difference between left-right shunt and right-left shunt in congenital heart disease, in terms of clinical consequences.
Explanation: explanation: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Congenital heart diseases – shunts
difficulty: difficult
submodule_key: y4_cardiology_congenital_cardiopathies_pregnancy_prostheses
module_title: 4th year · Cardiology · Congenital heart diseases, pregnancy, surgery and prostheses
Why is anticoagulation monitoring essential and permanent in a mechanical valve prosthesis wearer?
Explanation: explanation: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Mechanical prosthesis and anticoagulation
difficulty: medium
submodule_key: y4_cardiology_congenital_cardiopathies_pregnancy_prostheses
module_title: 4th year · Cardiology · Congenital heart diseases, pregnancy, surgery and prostheses
What is the main mechanism of action of loop diuretics (furosemide)?
A
Inhibition of the ascending loop of Henle with blockade of the Na-K-2Cl cotransporter
B
Blockage of aldosterone receptors in the distal tubule
C
Inhibition of carbonic anhydrase in the proximal tubule
D
Blockage of collecting tubule sodium channels
Explanation: explanation: Furosemide inhibits the NKCC2 cotransporter in the ascending limb of the loop of Henle, preventing the reabsorption of Na+, K+ and Cl-. It is the most powerful diuretic. Aldosterone antagonists (spironolactone) act on the distal tubule. Acetazolamide inhibits carbonic anhydrase.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Diuretics – mechanism
difficulty: medium
submodule_key: y4_cardiology_cardiovascular_therapeutics
module_title: 4th year · Cardiology · Cardiovascular therapeutics
What is the main absolute contraindication of beta-blockers in cardiology?
A
High blood pressure controlled by another antihypertensive drug
B
Severe bronchial asthma or COPD with bronchospasm
C
Type 2 diabetes on oral antidiabetics
D
Heart failure with stable reduced EF
Explanation: explanation: Non-selective beta-blockers can cause fatal bronchospasm in asthmatics. Cardioselective beta-blockers (metoprolol, bisoprolol) are used with caution in stable COPD. Diabetes is not a contraindication but requires increased monitoring (masking of hypoglycemia). HF with reduced EF is, on the contrary, an indication for beta-blockers.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Beta blockers – contraindications
difficulty: difficult
submodule_key: y4_cardiology_cardiovascular_therapeutics
module_title: 4th year · Cardiology · Cardiovascular therapeutics
What is the most common side effect of ACE inhibitors?
A
Severe hyperkalemia
B
Persistent chronic dry cough
C
Bradycardia due to negative chronotropic effect
D
Bilateral lower limb edema
Explanation: explanation: ACE inhibitors inhibit the breakdown of bradykinin (ACE substrate), the accumulation of which causes a dry irritative cough in 10-20% of patients. In case of intolerance to ACE inhibitors, ARB IIs (which do not block the degradation of bradykinin) are a cough-free alternative.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: IEC – adverse effect
difficulty: medium
submodule_key: y4_cardiology_cardiovascular_therapeutics
module_title: 4th year · Cardiology · Cardiovascular therapeutics
Why can ACE inhibitors and ARB IIs cause hyperkalemia?
A
They increase aldosterone secretion, promoting potassium retention
B
They reduce the production of aldosterone, decreasing the renal elimination of potassium
C
They inhibit sodium excretion, leading to hyperkalemia by compensation
D
They directly block K+ channels in muscle cells
Explanation: explanation: The renin-angiotensin-aldosterone system regulates serum potassium: angiotensin II stimulates the secretion of aldosterone which promotes renal elimination of potassium. By blocking this system, ACE inhibitors/ARBs II reduce aldosterone, reduce renal elimination of K+ and can cause hyperkalemia, especially in cases of renal failure.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: IEC/ARA II – hyperkalemia
difficulty: difficult
submodule_key: y4_cardiology_cardiovascular_therapeutics
module_title: 4th year · Cardiology · Cardiovascular therapeutics
What is the mechanism of action of digitalis (digoxin) in cardiology?
A
Inhibition of cardiomyocyte membrane Na+/K+-ATPase, increasing intracellular calcium
B
Activation of myocardial beta-adrenergic receptors
C
Blockage of ventricular L-type calcium channels
D
Inhibition of myocardial phosphodiesterase increasing cAMP
Explanation: explanation: Inhibition of the Na+/K+-ATPase increases intracellular sodium, which decreases the activity of the Na+/Ca²+ exchanger (NCX), leading to intracellular Ca²+ accumulation and a positive inotropic effect. Digitalis also has a negative chronotropic effect (slowing of nodal conduction) used in AF.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Digitalics – mechanism
difficulty: medium
submodule_key: y4_cardiology_cardiovascular_therapeutics
module_title: 4th year · Cardiology · Cardiovascular therapeutics
According to the Vaughan Williams classification, which group includes beta blockers?
A
Group I (sodium channel blockers)
B
Group II (beta blockers)
C
Group III (potassium channel blockers)
D
Group IV (calcium channel blockers)
Explanation: explanation: Vaughan Williams classification: Class I (Na+ blockers: quinidine Ia, lidocaine Ib, flecainide Ic), Class II (beta blockers), Class III (K+ blockers: amiodarone, sotalol), Class IV (Ca²+ blockers: verapamil, diltiazem).
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Antiarrhythmics – classification
difficulty: difficult
submodule_key: y4_cardiology_cardiovascular_therapeutics
module_title: 4th year · Cardiology · Cardiovascular therapeutics
Which organ should be particularly monitored during prolonged treatment with amiodarone?
A
Kidney (risk of direct nephrotoxicity)
B
Thyroid (risk of hypothyroidism or hyperthyroidism)
C
Spleen (risk of splenomegaly due to amiodarone deposition)
D
Articular cartilages (risk of chondrotoxicity)
Explanation: explanation: Amiodarone contains a high iodine content (~37%) and can disrupt thyroid function in either direction: hypothyroidism (Wolff-Chaikoff effect) or hyperthyroidism (Jod-Basedow effect). It can also cause pulmonary, hepatic and corneal toxicity (corneal deposits). A regular thyroid check-up is essential.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Amiodarone – side effects
difficulty: medium
submodule_key: y4_cardiology_cardiovascular_therapeutics
module_title: 4th year · Cardiology · Cardiovascular therapeutics
What mechanism explains the hypokalemia caused by loop diuretics as opposed to the hyperkalemia of potassium-sparing diuretics?
A
Loop diuretics increase glomerular filtration; savers inhibit it
B
Loop diuretics increase distal tubular flow, stimulating potassium secretion; savers block aldosterone or collecting tubule K+ channels
C
Loop diuretics block tubular K+ channels; savers activate them
D
Hypokalemia of loop diuretics is due to inhibition of potassium reabsorption in the proximal tubule
Explanation: explanation: Loop diuretics by increasing flow in the collecting tubule indirectly stimulate the secretion of K+ and H+ in exchange for Na+, leading to hypokalemia and metabolic alkalosis. Potassium-sparing diuretics (spironolactone = aldosterone antagonist; amiloride = ENaC channel blocker) reduce K+ elimination, causing hyperkalemia.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Diuretics – hypokalemia vs hyperkalemia
difficulty: difficult
submodule_key: y4_cardiology_cardiovascular_therapeutics
module_title: 4th year · Cardiology · Cardiovascular therapeutics
What is the general mechanism of action of thrombolytics (fibrinolytics)?
A
Direct inhibition of circulating thrombin
B
Activation of plasminogen to plasmin, leading to lysis of fibrinous thrombus
C
Blocking platelet GPIIb/IIIa receptors
D
Inhibition of the synthesis of vitamin K-dependent coagulation factors
Explanation: explanation: Thrombolytics (rt-PA, streptokinase) are plasminogen activators: they convert circulating plasminogen into plasmin, a serine protease that cleaves fibrin from the thrombus. They are used in MI (STEMI without access angioplasty), massive PE and early ischemic stroke.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Thrombolytics – general mechanism
difficulty: medium
submodule_key: y4_cardiology_cardiovascular_therapeutics
module_title: 4th year · Cardiology · Cardiovascular therapeutics
What is the main pharmacological difference between ACE inhibitors and ARB IIs?
A
ACE inhibitors block angiotensin II at the AT1 receptor; ARA II inhibits the conversion enzyme
B
ACE inhibitors inhibit the converting enzyme (bradykinin ↑, cough); II ARBs block the AT1 angiotensin II receptor (no bradykinin, no cough)
C
ARB IIs have a greater diuretic effect than ACE inhibitors
D
ACE inhibitors are contraindicated in hypertension; ARA II only in the IC
Explanation: explanation: ACE inhibitors inhibit the angiotensin-converting enzyme, preventing the transformation of angiotensin I into angiotensin II AND the breakdown of bradykinin. Accumulation of bradykinin causes coughing. II ARBs (sartans) selectively block the angiotensin II AT1 receptor without altering bradykinin metabolism, thus preventing cough.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: IEC vs ARA II – differences
difficulty: difficult
submodule_key: y4_cardiology_cardiovascular_therapeutics
module_title: 4th year · Cardiology · Cardiovascular therapeutics
In which cardiovascular pathologies have beta-blockers demonstrated a benefit on mortality?
A
Isolated essential hypertension without cardiac comorbidity
B
Heart failure with reduced EF, post-infarction and AF for rate control
C
Acute viral pericarditis
D
Massive pulmonary embolism in the acute phase
Explanation: explanation: Beta blockers reduce mortality in: HF with reduced EF (stabilized), post-MI (protection against ventricular arrhythmias), and control ventricular rate in AF. They are also used in stable angina and certain supraventricular tachycardias.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Beta blockers – indications
difficulty: medium
submodule_key: y4_cardiology_cardiovascular_therapeutics
module_title: 4th year · Cardiology · Cardiovascular therapeutics
What is the fundamental difference between an antiplatelet agent and an anticoagulant?
A
The antiplatelet acts on plasma coagulation; anticoagulant on platelets
B
The antiplatelet inhibits platelet function or aggregation; the anticoagulant acts on the plasma coagulation cascade (clotting factors)
C
Both have the same mechanism of action but differ in their route of administration
D
The anticoagulant is indicated exclusively for arterial thromboses
Explanation: explanation: Arterial thrombi are mainly platelet-like (rapid flow) → treatment with antiaggregants. Venous thrombi are mainly fibrinous (slow flow) → treatment with anticoagulants. Antiaggregants (aspirin, clopidogrel) inhibit platelet activation or aggregation. Anticoagulants (heparin, AVK, DOAC) inhibit factors in the coagulation cascade.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Antiaggregant vs anticoagulant – difference mechanism
difficulty: difficult
submodule_key: y4_cardiology_cardiovascular_therapeutics
module_title: 4th year · Cardiology · Cardiovascular therapeutics
Which therapeutic classes are part of the reference triple therapy in heart failure with reduced EF?
A
IEC or sacubitril/valsartan
B
Beta blocker
C
Mineralocorticoid receptor antagonist (MRA)
D
Dihydropyridine calcium channel blocker
Explanation: explanation: Dihydropyridine calcium channel blockers (amlodipine, felodipine) are not part of the prognostic treatments for HFrEF and can be harmful in certain forms. The three pillars with demonstrated prognostic benefit are: IEC (or sacubitril/valsartan = RNAi), beta-blocker, ARM (spironolactone/eplerenone). SGLT2 inhibitors (gliflozins) have been a 4th pillar since 2021.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Drug classes – IC with reduced EF
difficulty: difficult
submodule_key: y4_cardiology_cardiovascular_therapeutics
module_title: 4th year · Cardiology · Cardiovascular therapeutics
What side effects are common to ACE inhibitors and ARB IIs?
A
Hyperkalemia
B
Renal failure in cases of bilateral renal artery stenosis
C
Chronic dry cough
D
Contraindication in pregnancy (fetal nephrotoxicity)
Explanation: explanation: Dry cough is specific to ACE inhibitors (bradykinin accumulation). II ARBs do not inhibit ACE and do not cause cough. Hyperkalemia and renal failure (by reduction of glomerular flow via angiotensin II) are common to both classes. The contraindication in pregnancy (fetal nephrotoxicity) concerns both.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Adverse effects – IEC and ARA II
difficulty: medium
submodule_key: y4_cardiology_cardiovascular_therapeutics
module_title: 4th year · Cardiology · Cardiovascular therapeutics
What are the classic indications for digitalis (digoxin) in cardiology?
A
Ventricular rate control in atrial fibrillation
B
Symptomatic Reduced EF Heart Failure to Reduce Hospitalizations
C
First-line treatment of complete atrioventricular block
D
Sustained ventricular tachycardia
Explanation: explanation: Digoxin is contraindicated in complete BAV (it slows nodal conduction and can worsen the block). Ventricular VT can be exacerbated by digitalis (digital poisoning). Digoxin reduces hospitalizations in HF but does not improve mortality.
source_reference: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Digital – indications and monitoring
difficulty: difficult
submodule_key: y4_cardiology_cardiovascular_therapeutics
module_title: 4th year · Cardiology · Cardiovascular therapeutics
Describe the main pharmacological characteristics and major adverse effects of amiodarone.
Explanation: explanation: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Amiodarone – pharmacological profile
difficulty: difficult
submodule_key: y4_cardiology_cardiovascular_therapeutics
module_title: 4th year · Cardiology · Cardiovascular therapeutics
What is the mechanism of action of beta-blockers and in which main categories of cardiovascular pathologies are they indicated?
Explanation: explanation: https://univ.ency-education.com/4an_lessons-cardio.html
source_course_title: Cardiology Course – 4th year of medicine (ency-education.com)
theme: Beta blockers – mechanism and general indications
difficulty: medium
submodule_key: y4_cardiology_cardiovascular_therapeutics
module_title: 4th year · Cardiology · Cardiovascular therapeutics