51- An elderly man with a history of asthma, congestive heart failure, and peptic ulcer disease is admitted with bronchospasm and rapid atrial fibrillation. He recieves frequent nebulised salbutamol and IV digoxin loading, his regular medications are continued. 24 hours after admission his serum potassium is noted to be 2.8 mmol/l. Which of his medications is most likely to have caused this abnormality.
1) Digoxin
2) ACE inhibitor
3) Salbutamol
4) Ranitidine
5) Spironolactone
Answer-3
52- In the diagnosis of rheumatic fever, which of the following may be helpful?
1) A generalised macular-papular rash.
2) ASO titre of less than 1:200.
3) Polyarthritis.
4) Staphylococcus aureus grown on throat culture.
5) Splinter haemorrhages.
Answer-3
53- A 55 year old man presents with gynaecomastia while receiving treatment for Heart failure.
Which of the following drugs is most likely to be the cause of his gynaecomastia
1) Amiloride
2) Carvedilol
3) Frusemide
4) Omeprazole
5) Ramipril
Answer-4
Omeprazole is associated with gynaecomastia.
54- A 78 year old female is referred by her GP with high blood pressure. Over the last three months her blood pressure is noted to be around 180/80 mmHg. She has a body mass index of 25.5kg/m2, is a nonsmoker. There are no features to suggest a secondary cause for her hypertension. Which of the following is the most appropriate treatment for her blood pressure?
1) Alpha-Blocker
2) Angiotensin Converting Enzyme (ACE) Inhibitor
3) Angiotensin Blocker
4) Beta-blocker
5) Calcium channel blocker
Answer-5
55- A 17-year-old woman loses consciousness while out jogging one afternoon, as she has done for many years. She is taken to Accident and Emergency, where a chest X-ray, CT brain scan, FBC, and biochemistry are all normal. Over the next year, she develops mild dyspnea and fatigue. There are several episodes of pre-syncope. After another syncopal episode, she is referred to a cardiologist who orders and ECG that shows changes of left ventricular hypertrophy and broad Q waves. An echocardiogram reveals left ventricular and septal hypertrophy, small left ventricle, and reduced septal excursion. The septum has a "ground glass" appearance. She then dies suddenly and unexpectedly. The microscopic appearance of the septum with trichrome stain reveals myofiber disarray. Which of the following conditions is she most likely to have had?
1) Diabetes mellitus
2) Hypertrophic cardiomyopathy
3) Rheumatic heart disease
4) Systemic lupus erythematosus
5) Viral myocarditis
Answer-2
56- Which of the following is true regarding the coronary circulation?
1) Adenosine is the most important mediator of metabolic vasodilation.
2) Coronary blood flow is independent of myocardial oxygen consumption due to autoregulation.
3) Coronary blood flow within a normal range of blood pressure is primarily determined by perfusion pressure.
4) Increased myocardial O2 demand is met primarily by increasing O2 extraction.
5) The vasodilatory reserve of the epicardium and endocardium is equivalent under normal physiologic conditions.
Answer-1
57- A 54 year old man presents with central crushing chest pain. Examination is normal. 12-lead ECG shows ST segment elevation in leads II, III, aVF and ST depression in V1, V2 and V3. Which coronary artery is occluded?
1) Circumflex
2) Left Anterior Descending
3) Left Main Stem
4) Obtuse Marginal
5) Right Coronary Artery
Answer-5
58- Which of the following is true regarding mitral stenosis?
1) it is tolerated well in pregnancy
2) there is characteristically a low wedge pressure
3) in AF, the opening snap disappears
4) The opening snap is not heard when the mitral valve is heavily calcified
5) Doppler U/S is usually inaccurate in determining severity
Answer-4
59- A 26-year-old man is noted to have cyanosis of the lower limbs and clubbing of the toes but not the fingers. Which of the following statements is true?
1) He has Eisenmenger's syndrome.
2) He has coarctation of the aorta.
3) He is likely to have a loud continuous 'machinery' murmur below the left clavicle.
4) He is likely to need urgent surgery.
5) He has had a Blalock shunt operation.
Answer-1
60- A 74-year-old man has had increasingly severe, throbbing headaches for several months, centered on the right. There is a palpable tender cord-like area over his right temple. His heart rate is regular with no murmurs, gallops, or rubs. Pulses are equal and full in all extremities, BP is 110/85 mmHg. A biopsy of this lesion is obtained, and histologic examination reveals a muscular artery with lumenal narrowing and medial inflammation with lymphocytes, macrophages, and occasional giant cells. He improves with a course of high-dose corticosteroid therapy. Which of the following laboratory test findings is most likely to be present with this disease?
1) Anti-double stranded DNA titer of 1:1024
2) Erythrocyte sedimentation rate of 110 mm/hr
3) HDL cholesterol of 0.6 mmol/L
4) pANCA titer of 1:160
5) Rheumatoid factor titer of 80 IU/mL
Answer-2
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1) Digoxin
2) ACE inhibitor
3) Salbutamol
4) Ranitidine
5) Spironolactone
Answer-3
52- In the diagnosis of rheumatic fever, which of the following may be helpful?
1) A generalised macular-papular rash.
2) ASO titre of less than 1:200.
3) Polyarthritis.
4) Staphylococcus aureus grown on throat culture.
5) Splinter haemorrhages.
Answer-3
53- A 55 year old man presents with gynaecomastia while receiving treatment for Heart failure.
Which of the following drugs is most likely to be the cause of his gynaecomastia
1) Amiloride
2) Carvedilol
3) Frusemide
4) Omeprazole
5) Ramipril
Answer-4
Omeprazole is associated with gynaecomastia.
54- A 78 year old female is referred by her GP with high blood pressure. Over the last three months her blood pressure is noted to be around 180/80 mmHg. She has a body mass index of 25.5kg/m2, is a nonsmoker. There are no features to suggest a secondary cause for her hypertension. Which of the following is the most appropriate treatment for her blood pressure?
1) Alpha-Blocker
2) Angiotensin Converting Enzyme (ACE) Inhibitor
3) Angiotensin Blocker
4) Beta-blocker
5) Calcium channel blocker
Answer-5
55- A 17-year-old woman loses consciousness while out jogging one afternoon, as she has done for many years. She is taken to Accident and Emergency, where a chest X-ray, CT brain scan, FBC, and biochemistry are all normal. Over the next year, she develops mild dyspnea and fatigue. There are several episodes of pre-syncope. After another syncopal episode, she is referred to a cardiologist who orders and ECG that shows changes of left ventricular hypertrophy and broad Q waves. An echocardiogram reveals left ventricular and septal hypertrophy, small left ventricle, and reduced septal excursion. The septum has a "ground glass" appearance. She then dies suddenly and unexpectedly. The microscopic appearance of the septum with trichrome stain reveals myofiber disarray. Which of the following conditions is she most likely to have had?
1) Diabetes mellitus
2) Hypertrophic cardiomyopathy
3) Rheumatic heart disease
4) Systemic lupus erythematosus
5) Viral myocarditis
Answer-2
56- Which of the following is true regarding the coronary circulation?
1) Adenosine is the most important mediator of metabolic vasodilation.
2) Coronary blood flow is independent of myocardial oxygen consumption due to autoregulation.
3) Coronary blood flow within a normal range of blood pressure is primarily determined by perfusion pressure.
4) Increased myocardial O2 demand is met primarily by increasing O2 extraction.
5) The vasodilatory reserve of the epicardium and endocardium is equivalent under normal physiologic conditions.
Answer-1
57- A 54 year old man presents with central crushing chest pain. Examination is normal. 12-lead ECG shows ST segment elevation in leads II, III, aVF and ST depression in V1, V2 and V3. Which coronary artery is occluded?
1) Circumflex
2) Left Anterior Descending
3) Left Main Stem
4) Obtuse Marginal
5) Right Coronary Artery
Answer-5
58- Which of the following is true regarding mitral stenosis?
1) it is tolerated well in pregnancy
2) there is characteristically a low wedge pressure
3) in AF, the opening snap disappears
4) The opening snap is not heard when the mitral valve is heavily calcified
5) Doppler U/S is usually inaccurate in determining severity
Answer-4
59- A 26-year-old man is noted to have cyanosis of the lower limbs and clubbing of the toes but not the fingers. Which of the following statements is true?
1) He has Eisenmenger's syndrome.
2) He has coarctation of the aorta.
3) He is likely to have a loud continuous 'machinery' murmur below the left clavicle.
4) He is likely to need urgent surgery.
5) He has had a Blalock shunt operation.
Answer-1
60- A 74-year-old man has had increasingly severe, throbbing headaches for several months, centered on the right. There is a palpable tender cord-like area over his right temple. His heart rate is regular with no murmurs, gallops, or rubs. Pulses are equal and full in all extremities, BP is 110/85 mmHg. A biopsy of this lesion is obtained, and histologic examination reveals a muscular artery with lumenal narrowing and medial inflammation with lymphocytes, macrophages, and occasional giant cells. He improves with a course of high-dose corticosteroid therapy. Which of the following laboratory test findings is most likely to be present with this disease?
1) Anti-double stranded DNA titer of 1:1024
2) Erythrocyte sedimentation rate of 110 mm/hr
3) HDL cholesterol of 0.6 mmol/L
4) pANCA titer of 1:160
5) Rheumatoid factor titer of 80 IU/mL
Answer-2
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