Term-End Examination December, 2009 MCC-006 : CARDIOVASCULAR EPIDEMIOLOGY

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1 MCC-006 POST GRADUATE DIPLOMA IN CLINICAL CARDIOLOGY (PGDCC) Term-End Examination December, 2009 MCC-006 : CARDIOVASCULAR EPIDEMIOLOGY Time : 2 hours Maximum Marks : 60 Note : There will be multiple choice type of questions in this examination which are to be answered in OMR Answer Sheet. All questions are compulsory. (iii) Each question will have four options and only one of them is correct. Answers have to be marked in figures in the appropriate rectangular boxes corresponding to what is the correct answer and then blacken the circle for the same number in that column by using HB or lead pencil and not by ball pen in OMR Answer Sheet. If any candidate marks more than one options it will be taken as the wrong answer and no marks will be awarded for this. Erase completely any error or unintended marks. There will be 60 questions in this paper and each question carries equal marks. There will be no negative marking for wrong answers. (viii) No candidate shall leave the examination hall at least for one hour after the commencement of the examination. MCC P.T.O.

2 Modifiable risk factors for CAD are the following except : (1) Diabetes (2) Hypertension (3) Gender (4) Lipids Following are components of life style modifications except : Stoppage of smoking and tobacco Use of statins Encouragement of physical activity Behavioural change for stress management 3. The effects of stress in causation of CAD is mediated through : Stress hormone like adrenalin and noradrenalin Thyroid hormones Glucagon Oxytocin 4. CAD occurs in young before the age of : (1) 40 years (2) 35 years (3) 20 years (4) 60 years The estimated incidence of CAD in young in India is : (1) 12% (2) 22% (3) 02% (4) 36% Over half of myocardial infarctions occur in persons less than : (1) 45 years (2) 55 years (3) 30 years (4) 70 years India spends about what percentage of its gross domestic product (GDP) on health : (1) 5% (2) 10% (3) 2% (4) 3% The developmental periods of coronary artery disease are divided into following periods except : (1) Incubation period (2) Preclinical and latent period (3) Clinical period (4) Quarantine period The fatty streaks progress to fibrous plaque in : (1) third decade (2) first decade (3) 8th decade (4) at birth Regarding atheroma development the first stage is : (1) fibrous plaque (2) fatty streaks (3) atheroma (4) complicated stage MCC-006 2

3 11. The following are true regarding atheroma are true except : Stable plaques are responsible for ischemia and anginal symptoms Unstable plaques do not rupture Atherosclerosis not confined to coronary artery only Atherosclerosis affects brain vessels also 12. The mechanisms of atheroma formation are all of the following except : (1) Damage to the endothelium (2) Changes in the blood lipids (3) Combination of (1) and (2) (4) Type B personality status Biochemical or physiological risk factors for CAD except : (1) Hypertension (2) Diabetes (3) Dyslipidemia (4) Age Family history of CAD is significant when it occurs : in men < 55 years and women < 65 years in men < 45 years and women < 55 years in men > 25 years and women > 35 years in men > 70 years and women > 65 years 15. Trans fats have higher atherogenic risk than the saturated fats because : they not only increase LDL but also decrease HDL they decrease LDL and increase HDL they decrease both LDL and HDL they increase HDL and decrease triglycerides 16. The amount of nicotine absorbed through the lungs with each puff of smoke : (1) p,g (2) (3) [tg (4) > 600 pg 17. All of the following are true regarding nicotine except : It is a potent agonist of sympathetic nervous system It releases norepinephrine Increases coronary tone Powerful vasodilator 18. Protective effect of moderate alcohol intake on CAD is due to : (1) elevation in serum HDL levels (2) elevation in LP (a) levels (3) decrease in LDL cholesterol (4) increase in triglyceride level MCC P.T.O.

4 The following condition predisposes to CAD : (1) type A personality (2) type B personality (3) regular exercises (4) yoga The BP goal for primary and secondary prevention of CAD and heart failure include : (1) < 130/85 mm Hg (2) < 140/90 mm Hg (3) < 150/100 mm Hg (4) < 90/70 mm Hg In the pathogenesis of CAD all of the following are true except : (1) Low HDL - C levels (2) High LDL - C levels (3) A ratio of TC/HDL - C > 4.5 (4) A ratio of TC/HDL - C < 4.5 Regarding atherosclerosis in diabetic patients all of the following are true except : Diabetes decreases relative protection of the female gender Diabetes accelerates the atherosclerosis and thrombosis Improves endothelial function Diabetes impairs fibrinolysis Which one of the following is called "CAD equivalent"? (1) Diabetes mellitus (2) Old age (3) High LDL levels (4) Type A personality All of the following are true regarding CAD in diabetic patients except : They have more severe CAD More extensive calcifications Low prevalence of left main stem disease Reduced coronary collateral artery recruitment Obesity is defined as increase in body weight over the ideal body weight by : (1) 10% (2) 20% (3) 30% (4) 40% All of the following are true regarding obesity except : Independently associated with left ventricular hypertrophy Obesity associated with two fold increase in the risk of CAD Rarely associated with hypertension Insulin resistance is a associated condition with obesity 27. Definition of underweight with BMI of : (1) < 20 kg/m2 (2) 20 - < 25 kg/m2 (3) 25 - < 30 kg/m2 (4) 40 kg/ m2 MCC-006 4

5 28. All of the following are true regarding abdominal fatmass except : Abdominal obesity has increased risk for CAD Abdominal fatmass is inert It is linked to insulin resistance Visceral adipose tissue generates TNF-a 29. Metabolic syndrome - components include all of the following except : Elevated triglyceride levels 150 mg/dl Reduced HDL - C levels < 40 mm Hg Reduced BP 130/85 mm Hg Raised fasting blood glucose 100 mg/dl 30. Newer risk factors for CAD include all except : left ventricular hypertrophy (LVH) oxidative stress infectious agents elevated LDL - C levels 31. Left ventricular hypertrophy (LVH) is defined as LV mass exceeding : 131 g/m2 in men and 100 g/m2 in women 120 g/m2 in men and 90 g/m2 in women 110 g/m2 in men and 110 g/m 2 in women 140 g/m2 in men and 130 g/m 2 in women Deficiency of which of the following vitamin is associated with hyper homocysteinemia : (1) vitamin B12 (2) vitamin K (3) vitamin C (4) vitamin D All of the following factors are associated with CVD risk except : (1) high factor VII levels (2) plasminogen activator inhibitor - 1 (PAI - 1) (3) increased platelet aggregation (4) decreased fibrinogen levels 34. All of the following vitamins may provide protection against CVD except : (1) vitamin A (2) vitamin D (3) vitamin C (4) vitamin E What percentage of men and women die within one year after a heart attack? (1) 25% of men and 38% of women (2) 36% of men and 46% of women (3) 40% of men and 50% of women (4) 10% of men and 5% of women Sudden cardiac death is seen within 6 years of heart attack in : (1) 7% of men and 6% of women (2) 2% of men and 4% of women (3) 10% of men and 12% of women (4) 20% of men and 22% of women MCC P.T.O.

6 37. Secondary prevention is defined as : protecting a healthy people who are free from risk factors controlling, reversing and treating the risk factors to prevent the recurrences of events giving aspirin to a diabetic patient with no previous history of CAD 38. Regardless of their lipid levels, which of the following individuals mandate lipid lowering drug therapy : candidates with a risk of 15% CVD in next 10 years or so candidates with a risk of 10% CVD in next 10 years candidates with a risk of 5% CVD in next 2 years candidates with a risk of 25% CVD in next 20 years Which one of the following is not a secondary prevention trials? (1) 4S (2) CARE (3) LIPID (4) WOSCOPS The percentage reduction in coronary events by using statins is : (1) 30% (2) 60% (3) 10% (4) 50% Which one of the following is not a polyunsaturated fat? (1) Sunflower oils (2) Corn (3) Soybean oils (4) Peanut oils Regarding dietary recommendations all of the following are true except : Fat intake should be < 30% of total calories Saturated fat < 10% Cholesterol < 300 mg Low fibres, fruits and vegetables One year after quitting of smoking the risk of heart attack is reduced by : (1) 50% (2) 25% (3) 75% (4) 30% Lack of exercise could be as bad as all of the following except : (1) smoking 20 cigarettes a day (2) having high blood pressure (3) high levels of LDL-cholesterol (4) high levels of HDL cholesterol 45. Exercise training reduces the sudden cardiac death after heart attack by : (1) 35% (2) 25% (3) 20% (4) 50% MCC-006 6

7 The threshold of exercise for cardiovascular protection has been calculated to be about : (1) 630 kj/day (2) 750 kj/day (3) 300 kj/day (4) 100 kj/day "Non-HDL" cholesterol is defined as : LDL - cholesterol minus HDL - C Total cholesterol minus HDL - C HDL - C minus Triglycerides Triglycerides minus HDL - C All of the following will increase HDL - cholesterol except : (1) Stopping smoking (2) Nicotinic acid (3) Increasing physical activity (4) Increased alcohol intake The threshold for antihypertensive treatment in type 1 Diabetes mellitus is : 130 mm Hg systolic and/or 80 mm Hg diastolic 140 mm Hg systolic and/or 90 mm Hg diastolic 150 mm Hg systolic and/or 95 mm Hg diastolic?- 155 mm Hg systolic and/or 100 mm Hg diastolic Successful weightloss requires energy deficit of : (1) k cal/day (2) k cal/day (3) k cal/day (4) k cal/day Morbid obesity defined as a BMI of : (1) 40 kg/m2 (2) > 35 kg/m2 (3) > 30 kg/m2 (4) > 45 kg/m2 52. All of the following are true regarding the hormone replacement therapy (HRT) except : HRT should neither be initiated nor continued for prevention of CVD There is no definite evidence - based rationale to prescribe HRT Statins are more effective than HRT in lowering LDL - C HRT should not be combined with statins 53. All of the following substances are generated by visceral adipose tissue except : (1) Angiotensinogen (2) Plasminogen activator inhibitor - 1 (PAI - 1) (3) TNF - a (4) Glucagon MCC P.T.O.

8 54. All of the following are true regarding lipoprotein (a) [ LP (a) except : LP (a) is not influenced by gender, diet or smoking Pathological effects begin at a level of mg/dl Pathological effects magnified in the presence of high LDL - C Indians have a higher levels of LP (a) 55. Which of the following infectious agent appears to be the most plausible candidate for CAD risk factor? (1) Chlamydia pneumoniae (2) Cytomegalovirus (3) H.Pylori (4) Herpes Simplex 56. "Barker hypothesis" is : relationship between low birth weight and enhanced susceptibility to CAD in adult life LDL - cholesterol causes CAD Hyper Homocysteinemia leads to thrombosis low HDL - cholesterol is a CVD risk factor 57. Anticipated average life expectancy in 2030 is : (1) 72 years (2) 62 years (3) 80 years (4) 45 years The most important risk factor for development of CAD throughout India is : (1) Cigarette smoking (2) Dyslpidermia (3) Hypertension (4) Obesity The most important source of prevalence of RHD in India is : (1) school surveys (2) hospital records (3) household surveys (4) sentinel survilance 60. Between 6-10 years of age the prevalence of RHD is : (1) 3.9/1000 (2) 8.2/1000 (3) 39/1000 (4) 0.003/ o 0 o -

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