1.	Infective endocarditis:

A.	In intravenous drug abuses commonly affects the tricuspid valve.
B.	May produce a microcytic hypochromic anemia.
C.	If caused by streptococci has a mortality rate of over 50%.
D.	Usually affects more than one heart valve.
E.	Often produces a shift to the right in granulocytes.

2.	The complications of infective endocarditis are:

A.	Glomerulonephritis.
B.	Brain abscess.
C.	Myocarditis.
D.	Valvular insufficiency.
E.	Sepsis.

3.	Nonbacterial thrombotic endocarditis:

A.	Mitral and tricuspid valves are commonly affected.
B.	Does not form emboli.
C.	May be associated with stomach cancer.
D.	Previously called marantic endocarditis.
E.	Occurs in SLE and antiphospholipid syndrome.

4.	Atrial septal defect:

A.	Is the commonest congenital cardiac anomaly.
B.	Is associated with Down’s syndrome.
C.	Usually causes death before puberty if untreated.
D.	May lead to pulmonary hypertension.
E.	Occurs more frequently in males than females. 

1.	Infective endocarditis:

A.	True. The tricuspid valve is affected in over half the intravenous drug abusers who develop infective endocarditis.
B.	True. This occurs secondary in intravenous hemolysis.
C.	False. Streptococcal endocarditis can be eradicated in over 90% of cases using appropriate antibiotic therapy.
D.	False. The aortic or mitral valve is affected in > 80%.
E.	False. A left shift is the usual blood picture.

2.	The complications of infective endocarditis are:

A.	True. This is due the deposition of immune complexes in the glomeruli and subsequent activation of complement.
B.	True. Septic emboli to the brain.
C.	False.
D.	True. The inflammatory reaction damages the valves.
E.	True. Bacteremia is common.

3.	Nonbacterial thrombotic endocarditis:

A.	True. 
B.	False. May embolize to brian, heart, or elsewhere.
C.	True. Occurs in settings of visceral adenocarcinomas or prolonged illnesses, e.g. sepsis, chronic renal failure.
D.	True.
E.	True.

4.	Atrial septal defect:

A.	False. VSD (25%) compared to ASD’s 10%.
B.	True.
C.	False. Survival to middle age is usual.
D.	True. As a result of increased pulmonary blood flow due to left-to-right shunt
E.	False. ASD is more common in females.

5.	The following are major risk factors for the development of atherosclerosis:

A.	Cigarette smoking.
B.	Hypercholesterolaemia.
C.	Hypertension.
D.	Diabetes insipidus.
E.	Male sex.

6.	The following statements of infective endocarditis:

A.	Acute infective endocarditis is caused by highly virulent organisms.
B.	Subacute infective endocarditis occurs in an abnormal valve.
C.	Pseudomonas mallei is a common pathogen.
D.	Embolic complications is more common in acute infective endocarditis.
E.	The mortality rate for both acute and subacute forms is close to 50%.

7.	The following are risk factors for infective endocarditis:

A.	Mitral valve prolapse.
B.	Bicuspid aortic valve.
C.	Chronic steroid use for rheumatoid arthritis.
D.	Systemic lupus erythematosus.
E.	Central line in internal jugular vein.

8.	There is an increased incidence of deep venous thrombosis in the following states:

A.	Pregnancy.
B.	Carcinoma of pancreas.
C.	Oral contraceptive use.
D.	Advanced age.
E.	Congestive heart failure.
5.	The following are major risk factors for the development of atherosclerosis:

A.	True.
B.	False.
C.	True.
D.	False.
E.	True.

6.	The following statements of infective endocarditis:

A.	True. Such as Staphylococcus aureus.
B.	True. Usually caused by an organism of low virulence, e.g. Streptococcus viridans seeding an abnormal valve.
C.	False.
D.	True. Due to larger vegetations.
E.	False. In subacute form, disease tend to run a protracted course.

7.	The following are risk factors for infective endocarditis:

A.	True.
B.	True.
C.	True.
D.	False.
E.	True.

8.	There is an increased incidence of deep venous thrombosis in the following states:

A.	True. Predisposition is due to hypercoagulability and inhibition of fibrinolysis.
B.	True. Pancreas cancer is associated with Trosseau’s syndrome or migratory thrombophlebitis.
C.	True.
D.	True.
E.	True.

9.	Mitral valve prolapse:

A.	Occurs typically between 10 and 20 years of age.
B.	Affects mitral valve leaflets.
C.	Common in Marfan syndrome.
D.	Associated with polycystic kidney. 
E.	A midsystolic click can be heard.

10.	Complications of mitral valve prolapse:

A.	Sudden death.
B.	Infective endocarditis.
C.	Atrial fibrillation.
D.	Rheumatic valvular disease.
E.	Pulmonary hypertension.

11.	In malignant hypertension:

A.	Renin levels are decreased.
B.	There may be a microangiopathic hemolytic anemia.
C.	Arterioles often show fibrinoid necrosis.
D.	Papilloedema is rare.
E.	With treatment, the 5-year survival rate is about 10%.

12.	Aschoff bodies:

A.	Contain fibroblasts.
B.	May contain Anitschkow cells.
C.	Are found exclusively in the heart.
D.	Are always associated with active rheumatic fever.
E.	May contain Askanazy cells.

9.	Mitral valve prolapse:

A.	False. Between 20 and 40 years.
B.	True. Mitral valve leaflets are enlarged and floppy, balloon back into left atrium during systole.
C.	True.
D.	True. In 20% of cases.
E.	True.

10.	Complications of mitral valve prolapse:

A.	True.
B.	True.
C.	True.
D.	False.
E.	False.

11.	In malignant hypertension:

A.	False. Renin levels are markedly increased due to ischemia.
B.	True. Mechanical trauma in red blood cells leads to intravascular hemolysis.
C.	True.
D.	False.
E.	False. With good treatment, the 5-year survival rate is about 50%.

12.	Aschoff bodies:

A.	True. Fibroblasts appear in Aschoff bodies during the proliferative phase of their development.
B.	True. These cells have a perculiar pattern of nuclear chromatin.
C.	False. Are also found in synovium, tendons and other connective tissue.
D.	False.
E.	False. Are found in Hashimoto’s thyroiditis. 

13.	Rheumatic fever:

A.	Occurs 1 – 4 weeks after streptococcal infection.
B.	Due to host antistreptococcal antibodies that are cross-reactive to cardiac antigens.
C.	Death is most frequently due to myocarditis.
D.	Causes fibrous thickening of valve leaflets.
E.	Jones criteria is used for diagnostic purposes.

14.	Thrombo-angiitis obliterans (Buerger’s disease):

A.	Often causes thrombosis in tibial arteries.
B.	Is associated with cigarette smoking.
C.	Usually affects those older than 60 years.
D.	Leads to fibrous encasement of neurovascular bundles.
E.	Has an increased incidence in individuals with HLA haplotypes A9 and B5.

15.	Kawasaki disease.

A.	Affects infants and children.
B.	Coronary thrombosis is a complication.
C.	Is usually fatal.
D.	Treatment involves aspirin and IV gamma globulin.
E.	Characterized by ‘cherry-red’ lips.

16.	Varicose veins:

A.	Occurs in the deep veins of the leg.
B.	Common amongst pregnant women.
C.	Leads to venous stasis and ulceration.
D.	Is inflammation of the veins.
E.	Veins are dilated and tortuous.

13.	Rheumatic fever:

A.	True.
B.	True.
C.	True.
D.	True.
E.	True.

14.	Thrombo-angiitis obliterans (Buerger’s disease):

A.	True. The radial arteries are the other common site.
B.	True. 
C.	False. Peak incidence is between 25 and 50 years.
D.	True.
E.	True.

15.	Kawasaki disease.

A.	True.
B.	True.
C.	False. Typically is self-limited.
D.	True. Thought to prevent coronary complications.
E.	True. The other symptoms are fever, lymphadenopathy, skin rash, conjunctival erythema.

16.	Varicose veins:

A.	False.
B.	True.
C.	True.
D.	False.
E.	True.

17.	Aortic aneurysms of atherosclerotic origin:

A.	Are more common in males than females.
B.	Are more common in the aortic arch than the descending aorta.
C.	Rarely contain mural thrombus.
D.	Often rupture when greater than 60mm in diameter.
E.	May occlude the renal arteries.

18.	The following features are described as part of Fallot’s tetralogy:

A.	Atrial septic defect.
B.	Patent ductus arteriosus.
C.	Right ventricular hypertrophy.
D.	Ventricular septal defect.
E.	Displacement of aorta to the right.

19.	Long-term complications of rheumatic valvulitis include:

A.	Congestive heart failure.
B.	Atrial fibrillation.
C.	Infective endocarditis.
D.	Myocarditis.
E.	Mitral valve insufficiency.

20.	Fatty streaks in the aorta:

A.	Contain lipid which is predominantly extracellular.
B.	Often appear in the first year of life.
C.	Contain a proliferation of smooth muscle.
D.	Are rare in Third World populations.
E.	Are usually greater than 10mm in diameter. 

17.	Aortic aneurysms of atherosclerotic origin:

A.	True.
B.	False. Commonest in abdominal aorta.
C.	False.
D.	True.
E.	True. The iliac and mesenteric arteries are also vulnerable.

18.	The following features are described as part of Fallot’s tetralogy:

A.	False.
B.	False.
C.	True.
D.	True.
E.	True.

19.	Long-term complications of rheumatic valvulitis include:

A.	True.
B.	True.
C.	True.
D.	False.
E.	False. Leads to mitral stenosis.

20.	Fatty streaks in the aorta:

A.	False. The lipid is predominantly intracellular within the cytoplasm of foamy macrophages.
B.	True.
C.	False.
D.	False.
E.	False.

21.	Congenital heart disease:

A.	Paradoxical emboli is associated with right-to-left shunt.
B.	Left-to-right shunts may result in cyanosis in the long run.
C.	Increased risk of infective endocarditis.
D.	Brain abscess is a complication.
E.	Children seldom survive beyond 20 years.

22.	Patent ductus arteriosus:

A.	Is associated with intra-uterine rubella infection.
B.	Occurs most commonly in males than females.
C.	May cause death from infective endocarditis.
D.	Is usually the only anomaly present.
E.	May produce a heart murmur with a “machinery-like” quality.

23.	The following factors may acutely exacerbate ischemic heart disease:

A.	Platelet aggregation.
B.	Thrombosis.
C.	Arterial spasm.
D.	Hemorrhage into an atherosclerotic plaque.
E.	Hypotension. 

24.	The following features are likely to be present when a myocardial infarct of 24 hours’ duration is examined by light microscopy:

A.	Distortion of mitochondrial cristae.
B.	Edema.
C.	A heavy infiltrate of neutrophils in the interstitium.
D.	Total coagulative necrosis with loss of nuclei.
E.	Hemorrhage. 

21.	Congenital heart disease:

A.	True.
B.	True.
C.	True.
D.	True.
E.	False.

22.	Patent ductus arteriosus:

A.	True. Also associated with prematurity and respiratory distress syndrome.
B.	False. Occurs more frequently in females.
C.	True. Death may also occur from right-sided heart failure in middle age.
D.	False. Associated with transposition of great vessels.
E.	True. A continuous systolic/diastolic murmur with a harsh quality is characteristic. 

23.	The following factors may acutely exacerbate ischemic heart disease:

A.	True
B.	True.
C.	True.
D.	True.
E.	True. Systemic hypotension superimposed on pre-existing arterosclerosis may lead to myocardial infarction. 

24.	The following features are likely to be present when a myocardial infarct of 24 hours’ duration is examined by light microscopy:

A.	False.
B.	True.
C.	True.
D.	False. It is not apparent until 72 hours.
E.	True.

25.	The following are causes of pericarditis:

A.	Tuberculosis.
B.	Lung cancer.
C.	Uremia.
D.	Rheumatoid arthritis.
E.	Coxsackie virus infection.

26.	These conditions may occur as complications of infective endocarditis:

A.	Libman-Sacks endocarditis.
B.	Diffuse proliferative glomerulonephritis.
C.	Erosion of the chordae tendineae.
D.	Intracerebral infarction.
E.	Marantic vegetations.

27.	Familial hypercholesterolaemia:

A.	Is found in about 10% of the population.
B.	In the homozygous form may produce death from myocardial infarction before the age of 20 years.
C.	Is caused by deficient high-density lipoprotein (HDL) receptors.
D.	In the heterozygous form is not associated with an increased incidence of atherosclerosis.
E.	Is associated with raised triglyceride levels. 

28.	Cardiomyopathy:

A.	Dilated cardiomyopathy is associated with chronic alcoholism.
B.	May have a familial disposition.
C.	Death is due to heart failure.
D.	Hypertrophic cardiomyopathy may be asymptomatic.
E.	Endomyocardial fibrosis is common in Africa.

25.	The following are causes of pericarditis:

A.	True.
B.	True.
C.	True.
D.	True.
E.	True.

26.	These conditions may occur as complications of infective endocarditis:

A.	False. Occurs in SLE.
B.	True.
C.	True.
D.	True.
E.	False. They are sterile vegetations seen in advanced malignancy.

27.	Familial hypercholesterolaemia:

A.	False: It is found in about 1 in 500 of the population.
B.	True.
C.	False. Due to lack of LDLs.
D.	False. Plasma cholesterol levels of heterozygotes are 2 – 3 times greater than normal.
E.	False. Triglyceride levels are normal.

28.	Cardiomyopathy:

A.	True.
B.	True.
C.	True.
D.	True.
E.	True.

29.	Dissecting aortic aneurysm:

A.	Have an increased incidence in subjects with Marfan’s syndrome.
B.	Have a peak incidence in the third decade of life.
C.	Usually originate from intimal tears around atheromatous plaques.
D.	Have an untreated mortality of about 90%.
E.	May lead to a ‘double-barrelled’ aorta.

30.	Cranial (giant-cell) arteritis:

A.	Has a positive association with polymyalgia rheumatica.
B.	May cause blindness.
C.	Is usually diagnosed by serological testing.
D.	Can be treated by administration of glucocorticoids.
E.	Only affects arteries in the head and neck. 

31.	Vascular tumors:

A.	Cavernous hemangiomas are common in the liver.
B.	Usually benign vascular neoplasms.
C.	Kaposi sarcoma can occur in transplant patients.
D.	Angiosarcoma is a resectable tumor.
E.	May be associated with congenital malformation.

32.	The following agents may cause myocarditis:

A.	Group B coxsackieviruses.
B.	Polioviruses.
C.	Trypanosoma cruzi.
D.	Ionizing radiation.
E.	Adriamycin.

29.	Dissecting aortic aneurysm:

A.	True.
B.	False. 
C.	False. Most commonly occurs in disease-free areas of the aortic intima.
D.	True.
E.	true.

30.	Cranial (giant-cell) arteritis:

A.	True.
B.	True.
C.	False. The disease is diagnosed clinically or by histological examination of the superior temporal artery.
D.	True. Usually responds well to steroid therapy.
E.	False. Any artery in the body may be affected.

31.	Vascular tumors:

A.	True.
B.	True.
C.	True.
D.	False. Highly malignant and metastasize widely.
E.	True. Capillary hemangioma on face in Struge-Weber syndrome. 

32.	The following agents may cause myocarditis:

A.	True.
B.	False.
C.	True.
D.	True.
E.	True.

33.	Cardiac myxomas:

A.	First presentation may be peripheral vascular disease.
B.	Consists of multipotential mesenchymal cells.
C.	Is a common complication of tetralogy of Fallot.
D.	The most common cardiac tumors in adults.
E.	Treatment is surgical excision.

34.	Takayasu’s diease:

A.	Usually affect cranial arteries.
B.	May cause hypertension.
C.	Is characterized by a necrotizing arteritis.
D.	Affects males more commonly than females.
E.	Has a better prognosis than cranial arteritis.

35.	Coarctation of aorta:

A.	Cardiomegaly is a common occurrence.
B.	Most occur just distal to the ductus.
C.	Is an uncommon cause of intracranial hemorrhage.
D.	May lead to congestive heart failure.
E.	Patient may complain of cold limbs.

36.	Atrial myxomas:

A.	Arise in the right atrium more commonly than in the left.
B.	Are the most frequent primary cardiac tumors.
C.	May cause ischemia of the lower limbs.
D.	Are thought to represent organized thrombus.
E.	Are associated with signs of mitral valve disease.