1) Choose the correct option
1.0) Don't know.
1.A) The rapid fibers are within the limits of the SA node.
1.B) The resting potential of rapid fibers is more negative than the one of slow fibers.
1.C) Purkinje fibers have phase 1 absent.
1.D) Phase 2 is prolonged in atrial cells.
1.E) Conduction velocity in the N region is moderately rapid.

2) Choose the correct option
2.0) Don't know.
2.A) M cells have a spontaneously ascending phase 4.
2.B) Contractile cells do not have spontaneous diastolic depolarization.
2.C) Purkinje fibers are rich in glycogen.
2.D) Phase 2 has potassium as its main electrolyte.
2.E) M cells are located in the epicardial region in the ventricular wall.

3) Choose the correct option
3.0) Don't know.
3.A) The profile of M cells is similar to that of Purkinje cells.
3.B) Contractile cells are poor in mitochondria.
3.C) M cells are important in long QT syndrome pathophysiology.
3.D) Purkinje fibers are abundant in the atria.
3.E) a and c are correct.

4) Choose the correct option
4.0) Don't know.
4.A) Nodal, P, or pacemaker cells are located within the SA and AV nodes.
4.B) Nodal, Pm or pacemaker cells are located exclusively within the SA node.
4.C) P cells are rich in cellular interconnection channels or GAP JUNCTIONS.
4.D) Phase 0 of P cells has a great amplitude and depends on the slow inflow of Ca2+.
4.E) Phase 0 of P cells has a low amplitude and depends on the slow inflow of Na+.

5) Choose the correct option
5.0) Don't know.
5.A) A greater diastolic depolarization occurs in the AV node.
5.B) Nodal, P, or pacemaker cells are located exclusively within the SA node.
5.C) Dromotropism in the central region of the SA node is 20 to 50 mm/s.
5.D) Dromotropism in the central region of the SA node is 2 to 5 mm/s.
5.E) In preferential internodal bundles of the atria (Bachmann, Wenckebach, and Thorel), there are no Purkinje cells.

6) About Purkinje cells, which statement is true?:
6.0) Don't know.
6.A) They are cells with greater conduction velocity, because they are smaller in size.
6.B) They have a 150 μm to 200 μm length and a 35 μm to 40 μm diameter.
6.C) They have a 15 μm to 20 μm length and a 3.5 μm to 4 μm diameter.
6.D) Dromotropism is minimal within them.
6.E) Their profile of action potential does not display overshoot.

7) Choose the correct option
7.0) Don't know.
7.A) Rhythmicity is not a synonym to automaticity.
7.B) Cardiomyocytes are connected by three types of connexins: Cx41, Cx44, and Cx46.
7.C) Cardiomyocytes are connected by three types of connexins; Cx40, Cx43, and Cx45.
7.D) Phase 2 depends on outflow of K+ by slow delayed rectifying channels.
7.E) Slow fibers are found in the atrial and ventricular contractile myocardium, internodal bundles, His bundle and its branches, and Purkinje arborizations.

8) Choose the correct option
8.0) Don't know.
8.A) In rapid fibers, the potential inversion in activation (overshoot) may be absent or up to +15.
8.B) Slow fibers display a marked notch in phase 1.
8.C) Dromotropism in slow fibers is 500 to 4,000 m/s.
8.D) The mean amplitude of phase 0 in rapid fibers is in average 70 mV.
8.E) The mean amplitude of phase 0 in rapid fibers is in average 110 mV.

9) Which of the following cells does not have spontaneous diastolic depolarization?:
9.0) Don't know.
9.A) P, nodal or pacemaker cells. Cells located in the central region of the sinoatrial node (SA node).
9.B) Purkinje cells of internodal bundles: Bachmann's anterior, Wenckebach's middle, and Thorel's posterior.
9.C) M cells.
9.D) AV node cells.
9.E) His-Purkinje system cells.

10) About atrial contractile cells, we may say that it is not true that:
10.0) Don't know.
10.A) They have phase 0: rapid, wide and dependent on Na+.
10.B) Phase 1: imperceptible.
10.C) They have very long AP duration (APD) (plateau of long duration) and very sensitive to acetylcholine.
10.D) Phase 4: stable and with conduction velocity relatively rapid. Near 400 mm/sec.
10.E) They are rich in glycogen.

11) Choose the correct option
11.0) Don't know.
11.A) The duration of the action potential of mid-myocardial cells is lower.
11.B) The duration of the action potential of ventricular endocardial cells is greater.
11.C) The duration of the action potential of mid-myocardial cells is in average 800 ms.
11.D) The duration of the action potential of mid-myocardial cells is in average 300 ms.
11.E) The duration of the action potential of epicardial cells is in average 800 ms.

12) Choose the correct option
12.0) Don't know.
12.A) The duration of QRS complexes in complete blocks is 120 ms or more.
12.B) The duration of the QRS complex in incomplete blocks is between 110 and 120 ms.
12.C) In the WPW syndrome, the QRS complex is a fusion beat and it may reach 120 ms.
12.D) None is correct.
12.E) All are correct.

13) Choose the correct option
13.0) Don't know.
13.A) The PR interval duration in normal adults should not be greater than 200 ms.
13.B) The PR interval duration in normal elderly people should not be greater than 200 ms.
13.C) In WPW syndrome, the PR interval is short.
13.D) None is correct.
13.E) All of them are correct.

14) Choose the correct option
14.0) Don't know.
14.A) The QoT interval stretches from the QRS onset to the end of the T wave.
14.B) The QeT interval stretches from the QRS onset to the T wave onset.
14.C) The QaT interval stretches from the QRS onset to the apex of the T wave.
14.D) The JT interval stretches from the J point to the apex of T wave.
14.E) The JT interval is not useful in cases of branch blocks or WPW.

15) Choose the correct option
15.0) Don't know.
15.A) A Q-aTc interval <= 270 ms seems to be a significant indicator of hypercalcemia.
15.B) Severe hypercalcemia may mimic Brugada sign.
15.C) Calcium shortens phase 2 of action potential, leading to ST segment shortening.
15.D) The increase of QT of the LQT3 variant depends on ST prolongation.
15.E) All are correct.
15.F) All are incorrect.

16) About Torsade de pointes, which of the following statements is not correct?:
16.0) Don't know.
16.A) Its rate may vary between 200 bpm and 250 bpm.
16.B) In baseline ECG, the U wave may display great voltage.
16.C) They occur nearly always in the presence of long QT interval.
16.D) The initial beat shows short coupling.
16.E) It may degenerate into VF.

17) About atrial fibrillation, which of the following statements is not correct?:
17.0) Don't know.
17.A) It is the most frequent irregular tachyarrhythmia.
17.B) Progressive increase is observed with age.
17.C) The genetic form is observed in younger people.
17.D) Isolated or idiopathic AF is more frequent in older people.
17.E) AF by mitral stenosis predominates in women.

18) About atrial fibrillation, which of the following statements is not correct?:
18.0) Don't know.
18.A) Idiopathic AF is defined as the one that appears without any evidence (clinical or from laboratory) of structural heart disease or systemic disease.
18.B) Idiopathic AF represents 30% of the total of AF cases.
18.C) The genetic form is observed in younger people.
18.D) The familial form of AF is a dominant autosomal disease.
18.E) AF is observed approximately in 13% of cases of acute infarction.

19) Which of the following are factors of bad prognosis in CLBBB?:
19.0) Don't know.
19.A) QRS > 170 ms.
19.B) SAQRS with extreme shift to the right.
19.C) Intermittent block.
19.D) a and b are correct.
19.E) All are correct.

20) About atrial fibrillation, which of the following statements is not correct?:
20.0) Don't know.
20.A) In coarse fibrillation, f waves are >= 1 mm.
20.B) In coarse fibrillation, f waves are >= 0.5 mm.
20.C) The two previous ones are correct, depending on the author.
20.D) The heart rate proper of f waves may fluctuate between 350 and 700 bpm.
20.E) Patients with AF by rheumatic disease usually show fine AF.

21) About AF by mitral stenosis (MS), which of the following statements is not correct:
21.0) Don't know.
21.A) The appearance of AF in MS may occur even with a small left atrium in case of pulmonary embolism.
21.B) AF in MS is part of the natural history of the disease.
21.C) AF in MS has 1.5 fold a greater risk of embolism than patients with mitral insufficiency and AF.
21.D) The appearance of AF in a patient with MS may trigger an episode of acute pulmonary edema.
21.E) To maintain reversion after electric or pharmacological cardioversion of AF in patients with MS, it is only possible in patients with a greater time of evolution at 6 months.

22) About AF by atrial septal defect (ASD) of the ostium secundum type, which of the following statements is not correct:
22.0) Don't know.
22.A) It is usually observed in the third or fourth decade of life.
22.B) It is usually observed after the sixth decade of life.
22.C) It is observed more frequently in the second decade of life.
22.D) b and c.
22.E) AF by ASD of the ostium secundum type, which is not corrected in the adult phase, is observed in 15% of the adult cases.

23) About AF:
23.0) Don't know.
23.A) In AF, where there is digitalis intoxication, the ECG may show QRS of regular and rapid appearance, which indicates the presence of intoxication.
23.B) QRS complexes show slow and regular heart rate in AF associated to complete AV block.
23.C) AF with high rate of ventricular response in the presence of Wolff-Parkinson-White may degenerate in VF.
23.D) All are incorrect.
23.E) All are correct.

24) From the following sentences, only one is incorrect. Indicate which:
24.0) Don't know.
24.A) In arrhythmogenic RV dysplasia, the pattern of IRBBB is observed in approximately 18% of the cases and CRBBB in 15%.
24.B) T wave inversion from V1 through V3 is characteristic of ARVD; however, it is not specific.
24.C) The so-called Epsilon wave may be found in approximately one third of the cases of the most severe forms of ARVD.
24.D) Ventricular tachycardia of ARVD has a pattern of CRBBB.
24.E) The source of origin of VT of ARVD is the so-called triangle of dysplasia.

25) About short QT interval, which is not true:
25.0) Don't know.
25.A) In hereditary or familial short QT syndrome, the QTc interval could be <= 300 ms.
25.B) The digitalis intoxication could be an acquired cause of short QT interval.
25.C) Hyperthermia may cause QT interval shortening.
25.D) Hypothermia shortens the QT interval.
25.E) Autonomous tone alterations may shorten the QT interval.

26) Point the incorrect answer:
26.0) Don't know.
26.A) The T wave from the hereditary short QT syndrome is similar to the T in tent of hyperpotassemia.
26.B) In hereditary short QT syndrome, there is a high tendency to developing AF.
26.C) Quinidine could be a therapeutic resource in hereditary SQTS.
26.D) Hereditary short QT syndrome affects calcium channels.
26.E) Hereditary short QT syndrome affects potassium channels.

27) Choose the correct option
27.0) Don't know.
27.A) Brugada syndrome is less frequent in the yellow race.
27.B) Brugada syndrome is more frequent in the male gender.
27.C) Sudden cardiac death in Brugada syndrome occurs preferentially during night rest.
27.D) Sudden cardiac death in Brugada syndrome occurs preferentially during physical activity.
27.E) Answers a and d are correct.
27.F) Answers a and d are incorrect.

28) Choose the correct option
28.0) Don't know.
28.A) In noncomplicated CLBBB, the QRS/ST-T amplitude ratio is 2:1 or 3:1.
28.B) In CLBBB complicated with necrosis, the QRS/ST-T amplitude ratio is 1:1.
28.C) In CLBBB complicated with infarction, the ST segment usually presents superior convexity.
28.D) The so-called dome and dart QRS complex configuration in CLBBB complicated with infarction, is characterized by QRS complexes in V6, made up by initial q wave followed by low-voltage R wave of the dome and dart type, and final s wave.
28.E) The so-called Cabrera sign in CLBBB that is associated to anterior infarction, consists of a 50 ms notch in the ascending ramp of S wave of V3 and V4.
28.F) All of the above are correct.

29) In the presence of CLBBB and regarding prognosis, it is incorrect to say that:
29.0) Don't know.
29.A) When it is intermittent, the LBBB is of bad prognosis.
29.B) Extreme shift of SAQRS to the right in the FP in the presence of CLBBB (paradoxical type) in general is of worse prognosis.
29.C) The presence of CLBBB in chronic chagasic heart disease is a rare fact, and in general of bad prognosis.
29.D) The presence of CLBBB with coronary etiology in a male patient with QRS ? 170 ms is usually of worse prognosis.
29.E) Intermittent LBBB is of better prognosis.

30) From the following statements, about LPFB, which is incorrect:
30.0) Don't know.
30.A) It is the most frequent intraventricular dromotropic disorder.
30.B) It may mimic RVE.
30.C) It shifts the electric axis to the right.
30.D) It shows qR pattern in DIII.
30.E) It shows rS pattern in DI.

31) From the following statements, which is incorrect:
31.0) Don't know.
31.A) LSFB causes prominent anterior forces (PAF).
31.B) The dorsal or dorso-lateral infarction causes prominent anterior forces.
31.C) The C type right ventricular enlargement causes PAF.
31.D) Duchenne's disease is one of the causes of PAF.
31.E) Wolff-Parkinson-White with posterior anomalous bundle causes PAF.

32) From the following statements, which is correct:
32.0) Don't know.
32.A) Lev disease may cause complete AV block.
32.B) Lenegre disease is one of the causes of pacemaker indication in natural history.
32.C) Lenegre disease affects the SCN5A gene.
32.D) Lenegre disease is allelic to Brugada syndrome.
32.E) All are correct.

33) From the following statements, which is incorrect:
33.0) Don't know.
33.A) Endocardial cushion defects are characterized by association of RVE + RBBB + LAFB and counterclockwise rotation of QRS loop in the FP.
33.B) Tricuspid atresia is characterized by LVE + LAFB + RAE and cyanosis.
33.C) P wave of Ebstein's anomaly may be of great voltage and the QRS complex may be relatively small with initial q wave in V1.
33.D) ASD of the ostium secundum type with high rate, shows IRBBB or CRBBB pattern; however, without extreme shift of SAQRS to the left.
33.E) Endocardial cushion defects are characterized by association of RVE + RBBB + LAFB and clockwise rotation of QRS loop in the FP.

34) From the following statements, which is incorrect:
34.0) Don't know.
34.A) In LAFB, extreme shift of SAQRS in the FP is an essential criterion for diagnosis.
34.B) In chronic chagasic cardiomyopathy, the association of CRBBB + LAFB + polymorphic PVC in a middle-aged patient, from an endemic area, is characteristic.
34.C) A LAFB recording during stress test may indicate critical obstruction of the left main coronary artery or proximal obstruction of the anterior descending artery.
34.D) Small initial q wave in DI and aVL and small initial r wave in DIII is characteristic of LPFB.
34.E) Small initial q wave in DI and aVL and small initial r wave in DIII is characteristic of LAFB.

35) From the following statements, which is incorrect:
35.0) Don't know.
35.A) The VCG displays a greater sensitivity than ECG for the diagnosis of diaphragmatic infarction associated to LAFB.
35.B) VCG has less sensitivity and specificity than ECG in dorsal infarction diagnosis.
35.C) VCG has a greater sensitivity than ECG to determine the severity of aortic stenosis of congenital origin.
35.D) VCG optimizes the differential diagnosis between right and left fascicular blocks.
35.E) VCG is a method that represents the electrical activity of the heart in the three planes of space.

36) About the ST segment and the T wave, we can say:
36.0) Don't know.
36.A) The so-called subepicardial lesion is characterized by ST segment elevation.
36.B) The subepicardial lesion current translates by ST segment depression.
36.C) Subepicardial ischemia is characterized by symmetrical negative T wave with wide base.
36.D) Subendocardial ischemia is characterized by symmetrical negative T wave with wide base.
36.E) b and d are incorrect.

37) About ST segment and T wave, we could say:
37.0) Don't know.
37.A) The so-called subepicardial lesion current is characterized by ST segment depression.
37.B) The subepicardial lesion current translated by nonshifted ST segment.
37.C) Subepicardial ischemia is characterized by positive and asymmetrical T wave with wide base.
37.D) Subendocardial ischemia is characterized by positive symmetrical T wave with wide base.
37.E) All are incorrect.

38) Indicate the incorrect statement:
38.0) Don't know.
38.A) After 3 months of the acute phase of infarction, if the subepicardial lesion current remains, it indicates the possibility of residual ventricular aneurysm.
38.B) The peripheral or ischemic area of the infarction lesion modifies the ST segment.
38.C) The intermediate area of the lesion modifies the ST segment.
38.D) The central or necrosis area modifies the QRS complex (Q wave > 40 ms).
38.E) Electric death does not necessarily coincide with cell death.

39) Indicate the incorrect information:
39.0) Don't know.
39.A) The electrode that faces the subendocardial infarction records a negative deflection followed by r terminal positive R wave: QR or Qr.
39.B) The "mirror" image translates as ST segment depression in the opposite wall to the compromised one.
39.C) In the dorsal infarction, accessory leads V7, V8, and V9 increase diagnostic sensitivity.
39.D) In the dorsal infarction, the accessory leads V7, V8, and V9 do not increase diagnostic sensitivity.
39.E) Ischemic T wave is characterized by being symmetrical, pointed and wide-based.

40) About inappropriate sinus tachycardia, the statements below are correct, except:
40.0) Don't know.
40.A) Heart rate is permanently high >= 100 bpm without justification.
40.B) The rate of recurrence post-ablation treatment with radiofrequency is just 2% to 5%.
40.C) P wave displays SAP morphology and normal polarity, which indicates sinus command or close.
40.D) Absence of vagal physiological decrease of heart rate during sleep, with values always above 90 bpm in this period.
40.E) Exaggerated increase of heart rate in the face of physiological stress.

41) About the main types of atrial flutter, which of the following statements is incorrect?
41.0) Don't know.
41.A) The rate of F waves of common or classical flutter is around 240 and 339 bpm.
41.B) The F waves of common flutter show negative polarity in DII, DIII and aVF, and no baseline.
41.C) F waves of atypical or rare flutter are of negative polarity in DII, DIII and aVF without baseline.
41.D) The most frequent electrophysiological mechanism of type 1 flutter is intercaval macroreentry with circular counterclockwise motion.
41.E) The most frequent electrophysiological mechanism of type 2 flutter is macroreentry in the junction of the right atrial appendix in the RA near the atrioventricular sulcus with circular clockwise motion.

42) About atrial flutter with ventricular response rate 1:1, the following statements are correct, except:
42.0) Don't know.
42.A) It is a medical emergency.
42.B) It may be observed in the presence of pre-excitation of the WPW type, because the stimulus is conducted in an anterograde way by the anomalous pathway.
42.C) It may be secondary to hyperthyroidism.
42.D) It is more frequent in adults.
42.E) It may be the consequence of the initial use of class IA drugs (quinidine, procainamide, or disopyramide).

43) The following are characteristics of reentrant paroxysmal tachycardia of the junction by double nodal or intranodal pathway (AVNRT), except:
43.0) Don't know.
43.A) In V1, P' wave may distort the end of QRS, mimicking R'.
43.B) In inferior leads, the P' wave usually distorts the end of QRS, and it may originate a false S.
43.C) QRS duration: 100 ms or less, and normal aspect most frequently.
43.D) The onset and the end of the event have a nonparoxysmal character.
43.E) The onset and the end of the event have a paroxysmal character.

44) The following are criteria for ventricular pre-excitation, except:
44.0) Don't know.
44.A) Short PRi interval: <120 ms in adults and 90 ms in children.
44.B) Broader QRS complex: = > 100 ms 70% of the cases; 30% <100 ms.
44.C) QRS complex onset thicker or with notch: Δ wave d.
44.D) P-J interval not altered.
44.E) Prolonged P-Z interval.
44.F) Alterations secondary to ventricular repolarization (ST-T): dependent on aberrant depolarization.

45) Indicate the correct statement:
45.0) Don't know.
45.A) The normal value of the PA interval of the hisian electrogram is 30 to 40 ms.
45.B) The normal value of the AH interval of the hisian electrogram is 50 to 120 ms.
45.C) The normal value of the HV interval of the hisian electrogram is 35 to 55 ms.
45.D) The normal value of the PR interval of ECG is 120 to 200 ms.
45.E) All are correct.

46) Indicate the statement that is not characteristic of PR interval prolongation of supra-hisian location:
46.0) Don't know.
46.A) In 75% of the cases it is associated to narrow QRS.
46.B) It shows AH or PA interval prolongation in the electrogram.
46.C) It is of worse prognosis than infra-hisian prolongation.
46.D) It undergoes a great influence by the autonomous nervous system.
46.E) The QRS complexes lower than 100 ms predominate.

47) Choose the correct option
47.0) Don't know.
47.A) Nonsustained VT (NS-VT) is defined as the one with more than three consecutive ventricular depolarizations with a rate greater than 100 bpm and with a duration of less than 30 seconds.
47.B) Incessant VT is the one that occurs during more than 50% of the time of 24 hs recording, it has a paroxysmal character and it has a rate in general lower than supraventricular ones.
47.C) Monomorphic VT are defined as those that present consecutive ventricular complexes (QRS), either similar or with the same morphology in each one of the twelve leads in the frontal plane and in the horizontal plane, possibly with the exception of the initial and/or final complex.
47.D) Sustained monomorphic VT with CLBBB morphology and inferior SAQRS (positive QRS in DII, DIII and aVF) originates in the RVOT (infundibulum). SAQRS is at the right of > 90º.
47.E) All of the above are correct.

48) The following are characteristics of ASD of the ostium secundum type, except:
48.0) Don't know.
48.A) SAQRS with extreme shift to the left in the frontal plane.
48.B) PR interval: with possible small prolongation.
48.C) Some evidence of RVE of the volumetric type.
48.D) Triphasic morphology of QRS complexes in V3R, V1 and V2 with duration < 120 ms: IRBBB, CRBBB or ECD.
48.E) S wave: broader in the left leads.

49) About the Lutenbacher syndrome, it is not true that:
49.0) Don't know.
49.A) Rhythm is sinus; however, AF could be earlier than in isolated ASD.
49.B) P wave may reveal LAE or BAE.
49.C) SAQRS shows a greater shift to the right and more evidence of RVE than in isolated ASD.
49.D) Extreme shift to the left of SAQRS is frequent.
49.E) It consists of the association of congenital heart disease (ASD-OS) with mitral stenosis, usually rheumatic.

50) Which of the following statements is not true in Ebstein's anomaly?
50.0) Don't know.
50.A) Giant P waves of right atrial enlargement are characteristic.
50.B) Initial Q wave in right and middle precordial leads are recorded in approximately 50% of the cases from V1 through V3.
50.C) Prolonged PR interval observed in 20% of the cases.
50.D) Long PR observed in 60% of the cases.
50.E) QRS: bizarre with RBBB of low voltage and initial small q wave in V1.