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35.1 Digitalis in creases the force of contraction of ventricles by:
A. Increasing the duration of systole
B. Increasing the rate of contraction without affecting the duration of systole
C. Increasing the rate of contraction, but reducing the duration of systole
D. Increasing both the rate of contraction as well as the duration of systole
35.2 In a failing heart therapeutic dose of digoxin has no effect on the following parameter:
A. Cardiac output
B. Heart rate
C. Tone of ventricular fibres
D. Cardiac vagal tone
35.3 Digitalis slows the heart in congestive heart failure by:
A. Increasing vagal tone
B. Decreasing sympathetic overactivity
C. Direct depression of sinoatrial node
D. All of the above
35.4 The electrophysiological effects of digitalis on Purkinje
fibres include the following except:
A. Enhancement of resting membrane potential
B. Decrease in the slope of phase-0 depolarization
C. Increase in the rate of phase-4 depolarization
D. Abbreviation of action potential duration
35.5 Digitalis induced increase in refractory period of
myocardial fibres is most consistent and pronounced in the:
A. Atria
B. Ventricles
C. A-V node
D. Purkinje fibres
35.6 What is/are the consequence(s) of myocardial Na+ K+ ATPase inhibition by digoxin:
A. Increased intracellular Na+ ion concentration
B. Increased cytosolic Ca2+ ion concentration
C. Increased intracellular K+ ion concentration
D. Both ‘A’ and ‘B’ are correct
35.7 The positive inotropic action of digoxin takes several
hours to develop because:
A. Binding of digoxin to Na+K+ATPase is slow
B. After Na+K+ATPase inhibition by digoxin, Ca2+ loading of myocardial fibres occurs
progressively with each contraction
C. Digoxin inhibits Na+K+ATPase through modification of gene function which takes time
D. Both ‘A’ and ‘B’ are correct
35.8 Among all cardiac glycosides, digoxin is the most commonly used, because:
A. It is the most potent and fastest acting glycoside
B. It has the highest and most consistent oral bioavailability
C. It is the longest acting and the safest glycoside
D. It has intermediate plasma half life so that
dose adjustments are possible every 2-3
days and toxicity abates rather rapidly after
discontinuation
35.9 The most important channel of elimination of digoxin is:
A. Glomerular filtration
B. Tubular secretion
C. Hepatic metabolism
D. Excretion in bile
35.10 Infusion of potassium chloride is indicated in digitalis
toxicity when the manifestation(s) is/are:
A. Vomiting, hyperapnoea and visual disturbance
B. Pulsus bigeminus with heart rate 110/min in a patient on maintenance digoxin therapy
C. Ventricular tachycardia in a child who has accidentally ingested 10 digoxin tablets
D. 2:1 A-V block with occasional ventricular extrasystoles
35.11 Potassium therapy tends to counteract the cardiac toxicity of digitalis by:
A. Reducing the affinity of sarcolemal Na+ K+ATPase for digitalis
B. Suppressing ectopic automaticity enhanced by digitalis
C. Promoting A-V conduction
D. Both 'A' and 'B' are correct
35.12 Select the most suitable antiarrhythmic drug for
counteracting ventricular extrasystoles due to digoxin
toxicity:
A. Lignocaine
B. Quinidine
C. Verapamil
D. Amiodarone
35.13 The following drug given concurrently can enhance toxicity of digoxin:
A. Phenobarbitone
B. Metoclopramide
C. Quinidine
D. Magnesium hydroxide
35.14 Digoxin is contraindicated in:
A. Angina pectoris patients
B. Ventricular tachycardia
C. Hypertensive patients
D. Complete heart-block
35.15 Digitalis is most suitable for treatment of CHF when it is due to:
A. Cor pulmonale
B. Arterio-venous shunt
C. Thiamine deficiency
D. Long-standing uncontrolled hypertension
35.16 The dose of digoxin in congestive heart failure is adjusted by monitoring:
A. Electrocardiogram
B. Heart rate and symptoms of CHF
C. Blood pressure
D. Plasma digoxin levels
35.17 Digoxin affords the following benefit/benefits in CHF:
A. Restores cardiac compensation and relieves symptoms
B. Reverses the pathological changes of CHF
C. Prolongs survival of CHF patients
D. Both ‘A’ and ‘B’ are correct
35.18 Long-term maintenance therapy with digoxin is the
best option in the following category of CHF patients:
A. Hypertensive patients
B. Patients with hypertrophic cardiomyopathy
C. Patients with associated atrial fibrillation
D. Patients having cardiac valvular defects
35.19 A patient of CHF was treated with furosemide and
digoxin. He became symptom-free and is stable for
the last 3 months with resting heart rate 68/min in
sinus rhythm but left ventricular ejection fraction is
low. Which of the following lines of action is warranted:
A. Stop above medication and start an ACE inhibitor
B. Continue all medication as before
C. Continue the diuretic but stop digoxin
D. Continue digoxin but stop the diuretic
35.20 The following action of digoxin is responsible for
beneficial effect in auricular fibrillation:
A. Increased myocardial contractility
B. Suppression of SA node
C. Depression of A-V conduction
D. Enhanced Purkinje fibre automaticity
35.21 Select the drug that can help restore cardiac performance
as well as prolong survival in CHF patients:
A. Spironolactone
B. Furosemide
C. Dobutamine
D. Metoprolol
35.22 The following drug can relieve symptoms of CHF but
does not retard disease progression or prolong
survival:
A. Digoxin
B. Carvedilol
C. Spironolactone
D. Ramipril
35.23 Which of the following drugs can afford both
haemodynamic improvement as well as disease
modifying benefits in CHF:
A. Furosemide
B. Milrinone
C. Losartan
D. Digoxin
35.24 What is the usual response to digoxin in a patient of
atrial fibrillation:
A. Restoration of normal sinus rhythm
B. Conversion of atrial fibrillation to atrial flutter
C. Increase in atrial fibrillation frequency, but decrease in ventricular rate
D. Decrease in atrial fibrillation frequency, but increase in ventricular rate
35.25 Digoxin produces the following effect(s) in atrial flutter:
A. Reduces ventricular rate
B. Prevents shift of A-V block to a lower grade
C. Converts atrial flutter to atrial fibrillation
D. All of the above
35.26 The preferred diuretic for mobilizing edema fluid in CHF is:
A. Hydrochlorothiazide
B. Furosemide
C. Metolazone
D. Amiloride
35.27 Beneficial effect/effects of diuretics in CHF patients include the following:
A. Symptomatic relief
B. Regression of pathological changes
C. Prolongation of life expectancy
D. Both ‘A’ and ‘C’
35.28 Glyceryl trinitrate is used in CHF for:
A. Routine treatment of mild to moderate chronic heart failure
B. Rapid symptom relief in acute left ventricular failure
C. Arresting disease progression
D. Both 'A' and 'B'
35.29 Vasodilators are used to treat:
A. Acute heart failure attending myocardial infarction
B. Chronic heart failure due to diastolic dysfunction
C. Chronic heart failure due to both systolic as well as diastolic dysfunction
D. All of the above
35.30 The following type of vasodilator is not beneficial in
CHF due to systolic dysfunction:
A. Calcium channel blocker
B. Angiotensin converting enzyme inhibitor
C. Nitrate
D. Hydralazine
35.31 Which vasodilator is most suitable for a patient of
CHF who is symptomatic even at rest and has a
central venous pressure of 25 mm Hg and cardiac
index 1.8 L/min/m2:
A. Glyceryl trinitrate
B. Enalapril
C. Hydralazine
D. Nifedipine
35.32 Beneficial effects of β-adrenoceptor blockers in CHF
include the following except:
A. Antagonism of ventricular wall stress enhancing action of sympathetic overactivity
B. Antagonism of vasoconstriction due to sympathetic overactivity
C. Prevention of pathological remodeling of ventricular myocardium
D. Prevention of dangerous cardiac arrhythmias
35.33 The following is true of β-adrenergic blocker therapy in CHF:
A. They are added to conventional therapy after cardiac compensation is restored
B. They are indicated only in severe (NYHA class IV) heart failure
C. They are to be used only at low doses
D. All of the above
35.34 Choose the correct statement about use of β- adrenergic blockers in CHF:
A. All β blockers are equally effective in CHF
B. They are used as alternative to conventional therapy with ACE inhibitors ± digitalis/
diuretic
C. They are most useful in mild to moderate
cases with systolic dysfunction due to
dilated cardiomyopathy
D. They are indicated only in asymptomatic left nventricular dysfunction
35.35 The following drug is used for short-term control of
emergency heart failure, but not for long-term treatment
of congestive heart failure:
A. Digoxin
B. Ramipril
C. Dobutamine
D. Spironolactone
35.36 Select the drug which is an ‘inodilator’ beneficial in
refractory congestive heart failure:
A. Nicorandil
B. Amiodarone
C. Amrinone
D. Carvedilol
35.37 Raised plasma aldosterone level in CHF contributes
to disease progression by exerting the following
effects except:
A. Fibrotic remodeling of myocardium
B. Hyperkalemia and hypermagnesemia
C. Increasing cardiac preload by Na+ and water retention
D. Enhancing cardiotoxicity of sympathetic overactivity
35.38 The following apply to use of spironolactone in CHF except:
A. It is indicated only in NYHA class III/IV cases
as additional drug to conventional therapy
B. It affords prognostic benefit in severe heart
failure over and above that afforded by ACE
inhibitors
C. It helps overcome refractoriness to diuretics
D. It affords rapid symptomatic relief
35.39 Milrinone is best used:
A. In a patient of mild CHF
B. As an additional drug alongwith conventional therapy to tide over crisis in refractory CHF
C. For long-term maintenance therapy of CHF
D. To suppress digitalis induced arrhythmias
Ans:
35.1 C 35.2 C 35.3 D 35.4 A 35.5 C 35.6 D 35.7 D 35.8 D 35.9 A 35.10 B 35.11 D 35.12 A 35.13 C 35.14 B 35.15 D 35.16 B 35.17 A 35.18 C 35.19 A 35.20 C 35.21 D 35.22 A 35.23 C 35.24 C 35.25 D 35.26 B 35.27 A 35.28 B 35.29 D 35.30 A 35.31 B 35.32 B 35.33 A 35.34 C 35.35 C 35.36 C 35.37 B 35.38 D 35.39 B
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