SECTION A: Read each question carefully and record the answer "TRUE" or "FALSE":
1. The pain of myocardial ischemla:
a) Is typically Induced by exercise and relieved by rest.
b) Radiates to the neck and Jiw but not teeth.
c) Rarely lasts longer than 10 seconds after resting.
d) Is easily distinguished from oesophageal pain.
e) Invariably worsens as exercise continues.
2. The pulse characteristic listed below are typical features of the following disorders:
a) Pulsus bisferiens-combinfed, mitral stenosis and regurgitation
b) Pulsus paradoxus- aortic regurgitation.
c) Collapsing pulse-severe anaemia.
d) Pulsus altemans-extrasystoles every alternate beat.
e) Slow rising pulse-mitral stenosis.
3. The following statements about the jugular venous pressure (JVP) are true:
a) The external jugular vein is a reliable guide to right atrial pressure.
b) The JVP is conventionally measured from the suprastenal notch.
c) The normal JVP, unlike the blood pressure, does not rise with anxiety.
d) The normal JVP does not rise on abdominal compression.
e) The normal JVP falls during inspiration.
4. The auscuitatory findings listed below are associated with the following phenomena:
a) Third heart sound-opening of mitral valve.
b) Varying intensity of first heart soupd-atrioventricular dissociation.
c) Soft first heart sound-mitral stenosis.
d) Reversed splitting of second heart sound-left bundle branch lock.
e) Fourth heart sound-atrial fibrillation.
5. The cardiac drugs listed below are associated with the following adverse effects:
a) Digoxin-acute confusional state.
b) Verapamil-constipation.
c) Amiodarone-photosensitivity.
d) Propafenone-comeal microdeposits.
e) Lignocaine-convulsions.
6. In the normal electrocardiogram
a) the PR interval is measured from the end of the P wave to the beginning of the R wave
b) each small square represents 40 milliseconds at a standard paper speed of 25 mm/sec
c) the heart rate is 75 per minute if the R-R interval measuras by squares
d) Rwaves- become progressively larger from leads V1-V6
e) the P wave represents sinoatrial node depolarization
7. The pulse characteristics listed below are typical features of the following disorders
a) pulsus bisferiens - combined mitral stenosis and regurgitation
b) pulsus paradoxus -aortic regurgitation
c) collapsing pulse - severe anaemia
d) pulsus altemans - extrasystoles every alternate beat
e) slow rising pulse -mitral stenosis
8. The abnormalities of the jugular venous pulse listed below are associated with the following disorders
a) cannon waves - pulmonary hypertension
b) giant a waves - tricuspid stenosis
c) v waves - tricuspid regurgitation
d) inspiratory rise in jugular venous pressure - pericardia! Tamponade
e) absent a waves - atrioventricular dissociation
9. The auscultatory findings listed below are associated with the following phenomena
a) third heart sound - opening of mitral valve
b) varying intensity of first heart sound - atrioventricular dissociation
c) soft first heart sound - mitral stenosis
d) reversed splitting of second heart sound - left bundle branch block
e) fourth heart sound--atrial fibrillation
10. In patients with atrial fibrillation (AF)
a) aspirin therapy alone does not reduce the risk of stroke
b) the radial pulse is typically irregularly irregular
c) the response in cardiac output to exercise is reduced due to the absence of atrial systole
d) elective direct current (DC) cardioversion is contraindicated during anticoagulant therapy
e) alcohol abuse should be considered as a likely cause
11. Digoxln
a) shortens the refractory period of conducting tissue
b) usually converts atrial flutter to sinus rhythm
c) acts primarily on 'cell membrane Ionic pumps
d) effects are potentiated by hyperkalaemia
e) is a recognised cause of ventricular arrhythmias
12. In a patient with central chest pain at rest
a) intrascapular radiation suggests the possibility of aortic dissection
b) postural variation in pain suggests the possibility of pericarditis
c) chest wall tenderness is a typical feature of Tietze's syndrome
d) relief of pain by nitrates excludes an oesophagealcause
e) features of autonomic disturbance are specific to cardiac pain
13. In a patient with cardiogenic shock due to acute myocardial Infarction
a) the absence of pulmonary oedema suggests right ventricular infarction
b) the central venous pressure is the best index of left ventricular filling pressure
c) dopamine In low dose increases renal blood flow
d) high flow, high concentration oxygen Is Indicated
e) colloid infusion Is Indicated if oligurla and pulmonary oedema develop
14. In the treatment of cardiac failure associated with acute pulmonary oedema
a) controlled oxygen therapy should be restricted to 28% oxygen In patients who smoke
b) morphine reduces angor animi and dyspnoea
c) frusemide therapy given intravenously reduces preload and afterload
d) nitrates should be avoided if the systolic blood pressure < 140 mmHg
e) ACE inhibitors decrease the afterload but increase the preload
15. In patients with significant mitral stenosis
a) the mitral valve orifice is reduced from 5 cm2 to about 1 cm2
b) a history of rheumatic fever or chorea is elicited in over 90% of patients
c) left atrial enlargement cannot be detected on the chest X-ray
d) the risk of systemic emboli is trivial in sinus rhythm
e) mitral balloon valvuloplasty is not advisable if there is also significant mitral regurgitation
16. Disorders typically producing the sudden onset of symptomatic mitral regurgitation include
a) Marian's syndrome
b) acute myocardial infarction
c) acute rheumatic fever
d) infective endocarditis
e) diphtheria
17. Clinical features suggesting severe aortic stenosis Include ,
a) late systolic ejection click
b) pulsus bisferiens
c) heaving, displaced apex beat
d) syncope associated with anginal pain
e) loud second heart sound
18. The typical features of congenital pulmonary stenosis Include
a) breathlessness and central cyanosis
b) giant a waves in the jugular venous pressure
c) loud second heart sound preceded by an ejection systolic click
d) left parastemal heave and systolic thrill
e) enlargement of the pulmonary artery visible on chest X-ray
19. In Infective endocarditis
a) streptococci and staphylococci account for over 80% of cases
b) left heart valves are more frequently involved than right heart valves
c) normal cardiac valves are not affected
d) glomerulonephritis usually occurs die to immune complex disease
e) a normal echocardiograram excludes the diagnosis
20. The risks of developing clinical evidence of coronary artery disease are
a) increased by exogenous oestrogen use In postmenopausal female
b) diminished by stopping smoking
c) reduced by the large consumption of alcohol
d) Increased in hyperfibrinogenaemia
e) Increased by hypercholesterolaemia not hypertriglyceridaemla
21. The-clinical features of acute myocardial infarction inc-tide
a) nausea and vomiting
b) breathlessness and angor animi
c) hypotension and peripheral cyanosis 4
d) sinus tachycardia or sinus bradycardia
e) absence of any symptoms or physical signs
22. Findings consistent with an acute anterior myocardial Infarction Include
a) hypertension and raised jugular venous pressure
b) rumbling low-pitched diastolic murmur at the cardiac apex
c) ST elevation > 2 mm in leads II, III and AVF on ECG
d) gallop rhythm and soft first heart sound
e) an increased serum gamma-glutamyl transferase activity > 306 e
23. Drug therapies which improve the long-term prognosis after myocardial infarction include
a) aspirin
b) nitrates
c) calcium antagonists
d) ACE inhibitors
e) B-blockers
24. Recognised causes of secondary hypertension include
a) persistent ductus arteriosus
b) primary hyperaldosteronismi
c) acromegaly
d) oestrogen-containing oral contraceptives
e) thyrotoxicosis
25. Complications of systemic hypertension include
a) retinal microaneurysms
b) dissecting aneurysm of the ascending aorta
c) renal artery stenosis
d) lacunar strokes of the internal capsule
e) subdural haemorrhage
26. Accelerated phase or malignant hypertension Is suggested by hypertension and
a) a loud second he art sound
b) a heaving apex beat
c) headache
d) retinal soft exudates or haemorrhages
e) renal or cardiac failure
27. Important explanations for hypertension refractory to medical therapy include
a) poor compliance with drug therapy
b) inadequate drug therapy
c) phaeochromocytoma
d) primary hyperaldosteronism
e) renal artery stenosis
28. Clinical features compatible with .hypertrophic cardlomyopathy Include
a) family history of sudden death
b) angina pectoris and exertlonal syncope
c) jerky pulse and heaving apex beat
d) murmurs suggesting both aortic stenosis and mitral regurgitation
e) soft or absent second heart sound
29. Typical features of acute pericarditis include
a) chest pain identical to that of myocardial infarction
b) a friction rub that is best heard in the axilla in mid-expiration
c) ST elevation on, the ECG with upward concavity
d) elevation of the serum creatine kinase
e) ECG changes that are only seen in the chest leads
30. The typical features of constrictive pericarditis Include
a) severe breathlessness
b) a normal chest X-ray
c) a previous history of tuberculosis
d) tachycard'a and a loud third heart sound
e) marked elevation of the jugular venou pressure with a steep x and y descent
31. In atrial septa) defect
a) the lesion is usually of secundum type
b) the initial shunt is right to left.
c) splitting of the second heart sound Increases in expiration
d) the ECG typically shows right bundle branch block
e) surgery should be deferred until shunt reversal occurs
32. In right-to-left shunt reversals of congenital heart disease (Elsenmenger's syndrome)
a) pulmonary, arterial hypertension is usually present
b) closure of the underlying lesion produces symptomatic relief
c) the chest X-ray is typically normal
d) central cyanosis and finger clubbing are often present
e) physical signs of the underlying lesion parsist unchanged
33. Typical clinical features of coarctation of the aorta include
a) An association with bicuspid aortic valve
b) Cardiac failure developing in male adolescents
c) Palpable collateral arteries around scapulae
d) Rib notching on chest X-ray associated with weak femoral pulses
e) ECG showing right ventlc-ular hypertrophy
34. In Pallet's tetralogy
a) pulmonary and aortic stenosis arecombined with a ventricular septa) defect
b) both finger clubbing and bentral cyanosis are present at birtk
c) the second heart sound is loud and widely split on inspiration
d) the bhest X-ray and ECG are typically normal
e) cyanotic spells occur due to episodes of dysrhythmia
35. Cardiovascular changes In normal pMgnancy Include.
a) an increase in cardiac output of 150% by 12 weelys
b) tachycardia, elevated jugular venous pressure and third heart sound
c) reduction in systemic diastolic pressure
d) pulmonary systolic murmur
e) increased blood coagulability
36. The autoantibodies listed below are associated with the following diseasas
a) antinuclear antibodies-rheumatoid arthritis
b) anti-topoisomerase-progressive systemic sclerosis -(P$,S)
c) anti-SSA (anti-Roy--Sjog.en's syndrome
d) anti-centromere anti bodies--.dermatomyositis
e) antinuclear, cytoplasmic antibodies-CREST syndrome
37. The following features suggest a mechanical rather than Inflammatory cause of back pain
a) radiation of pain down the back of one teg to the ankle
b) an elevated C-reactive protein (CRP)
c) localised tenderness over the greater sciatic notch
d) gradual mode of onset in an elderly patient
e) back pain and stiffness exacerbated by resting
38. Osteoarthritis is
a) evident radiologically in at least 80% of patients > 65 years old
b) more likely to be generalised and severe in males
c) characterised by degeneration of cartilage and synovial inflammation
d) associated with increased collagen synthesis in the affected cartilage
e) best managed with anti-inflammatory doses of NSAIDs
39. In the treatment of gout
a) NSAID therapy increases urinary urate excretion
b) salicylates control symptoms and accelerate resolution of the acute attack
c) allopurinol inhibits xanthine oxidase and hence urate production
d) tophi should resolve with control of hyperuricaemia
e) allopurinol or probenecid should be given within 24 hours of onset of the acute attack
40. The following statements about shock syndromes are correct
a) in severe hypovolaemia, a source of blood/fluid loss is Invariably apparent clinically
b) in cardiogenic shock, the peripheries are characteristically warm
c) massive pulmonary embolism typically presents with shock
d) anaphylactic shock is associated with profound alleigen-induced systemic vasoconstriction
e) arteriovenous shunting is a significant contributory factor in septic shock
41. Typical clinical features of acute circulatory failure due to anaphylactic shock include
a) elevated jugular venous pressure
b) warm'dry skin
c) stridor
d) confusion
e) polyuria
42. Acute circulatory failure with an elevated central venous pressure are typical findings in
a) acute pancreatitis
b) massive pulmonary embolism
c) ruptured ectopic pregnancy
d) acute right ventricular infarction
e) pericardial tamponade
43. In a patient with suspected septic shock
a) the lower urinary tract is the commonest source of infection
b) a normal transthoracic electrocardiogram excludes endocarditis
c) intravenous access sites need only be changed if cutaneous evidence of infection is visible
d) prior treatment with histamine receptor antagonists makes pneumonia a more likely cause
e) corticosteroid therapy is of no proven benefit
44. The expected effects of the following vasoactive drugs Include
a) sodium nitroprusside - reduction in systemic vascular resistance
b) prostacyclin - Increased pulmonary vascular resistance
c) isoprenaline - sin-is tachycardia
d) dopamine - sinus bradycardia
e) adrenaline - increased splanchnic blood
45. Echocardiography is the most sensitive method of diagnosing
a) presence and degree of mitral stenosis
b) evaluation of left ventricular function
c) detection of valvular vegetations
d) detection of pericardial effusion
e) assessing the degree of coronoray stenosis
SECTION B: Only one Item appropriately applies to the Statement.
46. All the following signs BUT ONE are suggestive of left ventricular hypertrophy:
a) Slapping apex
b) Apical displacement downwards and outwards
c) Hyperkinetic apex
d) Heaving apex
e) Localised apex
47. Percussion of the heart may be useful in the diagnosis of the following conditions EXCEPT:
a) Pulmonary hypertension
b) Angina pectoris
c) Pericardial effusion
d) Right atrial enlargement
e) Aortic aneurysm
48. Splitting of the second heart sound occurs In:
a) Mitral incompetence
b) Left bundle branch block
c) Severe aortic stenosis
d) Atria[ septal defect
e) All of the above
49. The following signs are indicative of a massive pericardial effusion EXCEPT:
a) Ewart's sign
b) Kussmaul's sign
c) Pulsus paradoxus
d) Harsh pericardial rub
e) Rotch's sign
50. Stokes - Adams attack Is characterized by, except:
a) Sudden fall to the ground.
b) Loss of consciousness.
c) Slow or absent pulse.
d) Rapid week pulse.
51. Orthostatic syncope is characterized by, except.
a) Common in elderly.
b) Change < 20 mmHg in systolic B.P in supine and standing.
c) Change > 20 mmHg in systole in supine and standing.
d) Vasodilators should be better avoided.
52. An abnormal early diastolic sound heard at the apex and lower sternal border can be:
a) Loud P2.
b) S3 gallop.
c) Opening snap.
d) All of tho above.
e) None of the above.
53. Graham Steell murmur is:
a) An early diastolic murmur.
b) A pansystolic murmur,
c) An Austin Flint murmur.
d) A subvalvular murmur.
e) A pericardial murmur.
54. In severe mitral stenosis , the following occurs except:
a) Pulmonary hypertenelon,
b) Wider A2 -OS time Interval.
c) Long mid-diastolic murmur.
d) Low cardiac output,
e) Valve area less than approximately 1.0 cm2/m2 body surface area.
55. In aortic regurgitation , the following occur except:
a) Quincke's sign.
b) Duroziez's sign.
c) Traube's area.
d) Corrigan's sign.
e) Austin Flint murmur.
56. Diastolic heart failure Is characterized by all the following except:
a) Poor ventricular contractility.
b) impaired compliance of the ventricle.
c) High pulmonary venous pressure.
d) High EDP.
57. Cardiac transplantation Is absolutely contraindicated in:
a. Patients with ejection fraction < 0.20.
b. Patients with congestive cardiomyopathy.
c. Patients with high pulmonary resistance.
d. Patient with post infraction cardiomyopathy.
58. ACEI Is regarded the first line of treatment in heart failure because It:
a) decreases preload.
b) decreased both pre and after load.
c) increased contractility.
d) potent loop diuretic.
59. ACEIs are contraindicated in:
a) Bilateral renal artery stenosis.
b) Hypokalemia.
c) Ejection fraction < 40%.
d) Diastolic heart failure.
60. Beta blockers in heart failure:
a) Absolutely contrainedicated in CHF.
b) Prescribed only in patients with class IV heart failure.
c) Can be prescribed with ACEIs in class II & III heart failure.
d) Safe and beneficial in corpuimonal with respiratory failure.
61. The commonest clinical manifestation of MEN-1 is:
a. Glucaigonoma.
b. Hyperpttrathyroidism
c. Cushing disease
d. Medullary carcinoma thyroid
62. One of the following features is pathgnomonic to MEN-2B:
a. Pheochrarnocytoma
b. Hyperparathyroidism
c. Insulinoma
d. Mucosal neuromas
63. The followings are true about PAS- I except:
a. An autosornal recessive disorder
b. Equally affects both sex
c. Hypopuratityroidism is very common
d. Autoimmune thyroid disease is more frequent than in type II APS
65. The following features are present in APS- II except:
a) Addison's disease
b) Typa-1 diabetes
c) Mucocutanenus candidiasis
d) Pernicious anaemia
66. Pregnant lady In her last trimester presented to the emergency room with clinical,signs of acute deep venous thrombosis of her left leg ;initial treatment for this lady:
a) Heparin followed immediately by oral anticoagulants.
b) 13- Oral anticoagulants without heparin .
c) Heparin during pregnancy followed by oral anticoagulants in the post-partum period.
d) Thrombolysis
67. Insertion of venacaval filter for patients with pulmonary embolism Is best suited in the following situation:
a) Primary treatment in all patients with pulmonary embolism.
b) Patients with recurrent pulmonary emboli Inspite of adequate anticoagulation .
c) Young patient with Hypercoagulable state and extension of thrombosis to the IVC
d) Deep venous thrombosis in patient with long period of Immobilization.
Match each of the following Items marked by letters with those marked by numbers. Do not use any item more than once:
a ] Late systolic mitral murmur
b ] Early diastolic basal murmur
c ] Short mid-diastolic mitral murmur
d ] Short presystolic mitral murmur
e ] Short mesosystolic pulmonary murmur
67 Austin Flint
68 Carry Coomb
69 Still's
70 Mitral Valve Prolapse
71 Graham Steel
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