91- Angina due to an imbalance between O2 supply and demand without atherosclerosis would most likely be seen in which of the following circumstances?
1) aortic regurgitation
2) cardiac tamponade
3) pulmonary regurgitation
4) right heart failure
5) tricuspid regurgitation
Answer-1
92- An 18 year old man had repeated episodes of breathlessness and palpitations, lasting about 20 minutes and resolving gradually. There were no abnormal physical signs. What is the most likely cause of these features?
1) Drug abuse
2) Panic disorder
3) Paroxysmal supraventricular tachycardia
4) Personality disorder
5) Thyrotoxicosis
Answer-2
93- A previously well 60 year old lady is admitted with an Acute Anterior Myocardial Infarction. A random blood glucose concentration was found to be 12.1 mmol/L (<6.7). What is the optimal management of her blood sugar?
1) Diet
2) Gliclazide
3) Intravenous insulin plus dextrose
4) Metformin
5) Subcutaneous insulin
Answer-3
94- A 65-year-old was advised to start oral digoxin at a dose of 250 µg daily. His physician explained that the full effect of this treatment would not be apparent for at least a week. Which one of the following pharmacokinetic variables did the physician use to give this explanation?
1) bioavailablity
2) half-life
3) plasma protein binding
4) renal clearance
5) volume of distribution
Answer-2
95- A 75 year-old lady presents with sudden breathlessness and palpitations. On examination, she was observed to have an irregular heart beat with rate of 140 bpm, BP 150/84 and normal heart sounds. On auscultation of the chest, Fine basal crepitations are heard. An ECG confirms AF and an old inferior MI. She is anticoagulated with heparin and given diuretics. Her heart rate remains rapid. What is the most appropriate management of the lady's AF?
1) DCCV.
2) IV amiodarone.
3) IV betablocker.
4) IV digoxin.
5) Oral quinidine therapy.
Answer-4
96- A 45 year old female presents with a two day history of fever and joint pains. She has a past history of hypertension for which she is receiving anti-hypertensives. On examination she has a temperature of 38 Celsius, a facial rash and slight swelling with tenderness of the wrist and ankle joints. Which of the following anti-hypertensives may be
responsible for her presentation.
1) Minoxidil
2) Phenoxybenzamine
3) Hydrallazine
4) Alpha-methyldopa
5) Bendrofluazide
Answer-3
97- A 70-year-old man with dilated cardiomyopathy remains symptomatic in NYHA class 2 due to chronic heart failure. On examination his pulse is 90 regular, BP 140/90, heart sounds normal, chest auscultation did not reveal any abnormalities. He is currently taking Lisinopril 30 mg OD and Frusemide 80 mg OD. What is the best treatment option?
1) Amiodarone
2) Carvedilol
3) Digoxin
4) Spironolactone
5) Valsartan
Answer-2
98- A 40-year-old man received an orthotopic cardiac transplant 7 years ago to treat a dilated cardiomyopathy. Since that time he has been healthy, with no episodes of rejection or infection. Over the next year, however, he develops fatigue with exercise. He has worsening pedal edema and orthopnea. On physical examination, his vital signs are Temperature 36.3°C, Pulse 78, Respiratory rate 16, and BP 130/70 mm Hg. There are no murmurs, rubs, or gallops audible. Bibasilar crackles in the lungs are audible. Which of the following conditions is most likely to account for these findings?
1) Angiosarcoma
2) Coronary arteriopathy
3) Mitral valvular stenosis
4) Myocarditis
5) Pulmonary hypertension
Answer-2
99- Which of the following statements concering the treatment of acute myocardial infarction is correct?
1) A pansystolic murmur developing within the first 24 hours does not require further investigation.
2) Dipyridamole therapy reduces reinfarction within the first year.
3) Heparin is beneficial if given with streptokinase.
4) Prophylactic lignocaine given in the first 48 hours is effective in preventing ventricular fibrillation
5) Treatment with a dihydropyridine calcium antagonist is associated with increased cardiovascular mortality.
Answer-5
100- A 70-year-old man is admitted with an acute Q-wave inferior Myocardial Infarction. On day 5, he suddenly develops pulmonary oedema and a loud systolic murmur. Which of the following would be the most useful in establishing a diagnosis?
1) chest X-ray
2) coronary arteriography
3) ECG
4) right heart catheterisation and oximetry
5) serum cardiac enzymes
Answer-4
101- A 65-year-old man has longstanding stable heart failure treated with frusemide and enalapril. He complains of swelling in his left knee and his GP treats him with Rofecoxib, a cyclo-oxygenase-2 (COX-2) inhibitor. Two weeks later the patient has increasing breathlessness and ankle oedema.
Which one of the following effects of rofecoxib is the most likely to explain his symptoms?
1) decreased absorption of frusemide from the gut
2) decreased myocardial contractility
3) reduced effective action of enalapril
4) the onset of anaemia
5) the onset of fluid retention
Answer-5
102- Which of the following statements are true of coronary artery anatomy?
1) Right bundle branch block in acute anterior myocardial infarction suggests obstruction prior to the first septal branch of the left anterior descending coronary
artery
2) the posterior descending artery is usually a branch of the circumflex artery
3) The sinus node is supplied by a branch of the right coronary in over 90% of subjects.
4) The AV node is supplied by the left anterior descending coronary artery.
5) The left main stem is about 4 cm long
Answer-1
103- A 34 year old male presents with episodes of breathlessness on exertion. Examination reveals a loud P2 and fixed splitting of the second sound. Which of the following may be responsible for these signs?
1) Maternal chicken pox infection
2) Maternal thalidomide therapy
3) 47 XXY karyotype
4) Homocystinuria
5) Excess maternal alcohol consumption
Answer-5
104- A 72-year-old man presents with an episode of collapse. He has had two similar episodes recently, each lasting about one minute. Four years ago he suffered an anterior myocardial infarction. On examination he was orientated and symptom-free with a regular pulse rate of 80 bpm, BP 140/80 mmHg and the apex beat was displaced to the left. There was an apical systolic murmur. There were no signs of trauma. ECG showed sinus rhythm, Q waves and ST segment elevation anteriorly without reciprocal depression. What is the diagnosis?
1) acute anterior myocardial infarction
2) cerebrocasvular accident
3) epileptic seizure
4) pulmonary embolism
5) ventricular tachycardia
Answer-5
105 - Deficiency of which one of the following trace elements is implicated as a cause of cardiomyopathy?
1) chromium
2) copper
3) manganese
4) selenium
5) zinc
Answer-4
Selenium deficiency is one of the reversible causes of dilated cardiomyopathy.
106- A 40-year-old man attending a routing screening has a blood pressure of 166/100 mmHg. Two weeks later his blood pressure was 150/90 mmHg. He does not smoke. He drinks 35 units alcohol / week. His body mass index (BMI) is 30 kg/m2 (20 - 25). What is the best management strategy?
1) amlodipine
2) atenolol
3) bendrofluazide
4) enalapril
5) lifestyle advice
Answer-5
107- 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
108- Which of the following compounds has a vasodilating effect?
1) Antidiuretic hormone
2) Calcitonin
3) Endothelin
4) Renin
5) Somatostatin
Answer-2
109- A 14-year-old boy presents with hypertension. Which of the following statements concerning hypertension in the young is true?
1) Sodium nitroprusside is useful for the long-term treatment of severe cases.
2) Headache is the usual presenting feature.
3) It is defined as systolic blood pressure above the 99th centile for age.
4) Abnormalities are frequently seen on DMSA scan.
5) Aortic coarctation is the commonest secondary cause.
Answer-4
110- A new antihypertensive drug needs to be investigated to establish its relative potency.
Which of the following techniques is most appropriate for this purpose?
1) bioassay
2) case-control study
3) double-blind, randomized, placebo controlled study
4) postmarketing surveillance
5) sequential trial
Answer-1
111- A 53-year-old man presented with hypertension of 150/110 and is found to have the following results on investigation. Raised serum sodium, raised urinary potassium excretion and normal serum renin. What is the likely diagnosis?
1) Adrenocortical adenoma
2) Coarctation of aorta
3) Malignant hypertension
4) Pheochromocytoma
5) Renal tumour
Answer-1
112-A 29-year-old female who is 22 weeks pregnant is noted to have a blood pressure of 150/90 mmHg on 3 separate occasions. Urine protein is negative. Which of the following would be the first line treatment?
1) alpha Methyl Dopa
2) Atenolol
3) Magnesium Sulphate
4) Nifedipine
5) Salbutamol
Answer-1
113-A 58-year-old man presents with sudden onset chest pain. He has a known history of ischaemic heart disease. ECG shows ST segment elevation in V1-V5 without reciprocal depression. In which territory is the infarction most likely to have take place?
1) Anterior
2) Inferior
3) Lateral
4) Inferio-lateral
5) Posterior
Answer-1
This MI is likely to be in the LAD and represents an anterior MI.
114-An 54-year-old male redevelops chest pain 72 hours after treatment for an anterior myocardial infarction. Which of the following markers will be the most sensitive in detecting reinfarction?
1) CK-MB
2) LDH
3) Myoglobin
4) Troponin I
5) Troponin T
Answer-1
Although troponin is highly sensitive and specific it remains elevated for at least one week after infarction. Similarly LDH will be present for approximately one
week after infarction. After myocardial infarction, CK-MB levels become elevated within 3 to 8 hours, peak within 9 to 30 hours, and return to normal after 48 to 72
hours. Although myoglobin has a short half life and rises quickly after an MI and is cleared after an MI, it is not specific enough for diagnostic use.
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1) aortic regurgitation
2) cardiac tamponade
3) pulmonary regurgitation
4) right heart failure
5) tricuspid regurgitation
Answer-1
92- An 18 year old man had repeated episodes of breathlessness and palpitations, lasting about 20 minutes and resolving gradually. There were no abnormal physical signs. What is the most likely cause of these features?
1) Drug abuse
2) Panic disorder
3) Paroxysmal supraventricular tachycardia
4) Personality disorder
5) Thyrotoxicosis
Answer-2
93- A previously well 60 year old lady is admitted with an Acute Anterior Myocardial Infarction. A random blood glucose concentration was found to be 12.1 mmol/L (<6.7). What is the optimal management of her blood sugar?
1) Diet
2) Gliclazide
3) Intravenous insulin plus dextrose
4) Metformin
5) Subcutaneous insulin
Answer-3
94- A 65-year-old was advised to start oral digoxin at a dose of 250 µg daily. His physician explained that the full effect of this treatment would not be apparent for at least a week. Which one of the following pharmacokinetic variables did the physician use to give this explanation?
1) bioavailablity
2) half-life
3) plasma protein binding
4) renal clearance
5) volume of distribution
Answer-2
95- A 75 year-old lady presents with sudden breathlessness and palpitations. On examination, she was observed to have an irregular heart beat with rate of 140 bpm, BP 150/84 and normal heart sounds. On auscultation of the chest, Fine basal crepitations are heard. An ECG confirms AF and an old inferior MI. She is anticoagulated with heparin and given diuretics. Her heart rate remains rapid. What is the most appropriate management of the lady's AF?
1) DCCV.
2) IV amiodarone.
3) IV betablocker.
4) IV digoxin.
5) Oral quinidine therapy.
Answer-4
96- A 45 year old female presents with a two day history of fever and joint pains. She has a past history of hypertension for which she is receiving anti-hypertensives. On examination she has a temperature of 38 Celsius, a facial rash and slight swelling with tenderness of the wrist and ankle joints. Which of the following anti-hypertensives may be
responsible for her presentation.
1) Minoxidil
2) Phenoxybenzamine
3) Hydrallazine
4) Alpha-methyldopa
5) Bendrofluazide
Answer-3
97- A 70-year-old man with dilated cardiomyopathy remains symptomatic in NYHA class 2 due to chronic heart failure. On examination his pulse is 90 regular, BP 140/90, heart sounds normal, chest auscultation did not reveal any abnormalities. He is currently taking Lisinopril 30 mg OD and Frusemide 80 mg OD. What is the best treatment option?
1) Amiodarone
2) Carvedilol
3) Digoxin
4) Spironolactone
5) Valsartan
Answer-2
98- A 40-year-old man received an orthotopic cardiac transplant 7 years ago to treat a dilated cardiomyopathy. Since that time he has been healthy, with no episodes of rejection or infection. Over the next year, however, he develops fatigue with exercise. He has worsening pedal edema and orthopnea. On physical examination, his vital signs are Temperature 36.3°C, Pulse 78, Respiratory rate 16, and BP 130/70 mm Hg. There are no murmurs, rubs, or gallops audible. Bibasilar crackles in the lungs are audible. Which of the following conditions is most likely to account for these findings?
1) Angiosarcoma
2) Coronary arteriopathy
3) Mitral valvular stenosis
4) Myocarditis
5) Pulmonary hypertension
Answer-2
99- Which of the following statements concering the treatment of acute myocardial infarction is correct?
1) A pansystolic murmur developing within the first 24 hours does not require further investigation.
2) Dipyridamole therapy reduces reinfarction within the first year.
3) Heparin is beneficial if given with streptokinase.
4) Prophylactic lignocaine given in the first 48 hours is effective in preventing ventricular fibrillation
5) Treatment with a dihydropyridine calcium antagonist is associated with increased cardiovascular mortality.
Answer-5
100- A 70-year-old man is admitted with an acute Q-wave inferior Myocardial Infarction. On day 5, he suddenly develops pulmonary oedema and a loud systolic murmur. Which of the following would be the most useful in establishing a diagnosis?
1) chest X-ray
2) coronary arteriography
3) ECG
4) right heart catheterisation and oximetry
5) serum cardiac enzymes
Answer-4
101- A 65-year-old man has longstanding stable heart failure treated with frusemide and enalapril. He complains of swelling in his left knee and his GP treats him with Rofecoxib, a cyclo-oxygenase-2 (COX-2) inhibitor. Two weeks later the patient has increasing breathlessness and ankle oedema.
Which one of the following effects of rofecoxib is the most likely to explain his symptoms?
1) decreased absorption of frusemide from the gut
2) decreased myocardial contractility
3) reduced effective action of enalapril
4) the onset of anaemia
5) the onset of fluid retention
Answer-5
102- Which of the following statements are true of coronary artery anatomy?
1) Right bundle branch block in acute anterior myocardial infarction suggests obstruction prior to the first septal branch of the left anterior descending coronary
artery
2) the posterior descending artery is usually a branch of the circumflex artery
3) The sinus node is supplied by a branch of the right coronary in over 90% of subjects.
4) The AV node is supplied by the left anterior descending coronary artery.
5) The left main stem is about 4 cm long
Answer-1
103- A 34 year old male presents with episodes of breathlessness on exertion. Examination reveals a loud P2 and fixed splitting of the second sound. Which of the following may be responsible for these signs?
1) Maternal chicken pox infection
2) Maternal thalidomide therapy
3) 47 XXY karyotype
4) Homocystinuria
5) Excess maternal alcohol consumption
Answer-5
104- A 72-year-old man presents with an episode of collapse. He has had two similar episodes recently, each lasting about one minute. Four years ago he suffered an anterior myocardial infarction. On examination he was orientated and symptom-free with a regular pulse rate of 80 bpm, BP 140/80 mmHg and the apex beat was displaced to the left. There was an apical systolic murmur. There were no signs of trauma. ECG showed sinus rhythm, Q waves and ST segment elevation anteriorly without reciprocal depression. What is the diagnosis?
1) acute anterior myocardial infarction
2) cerebrocasvular accident
3) epileptic seizure
4) pulmonary embolism
5) ventricular tachycardia
Answer-5
105 - Deficiency of which one of the following trace elements is implicated as a cause of cardiomyopathy?
1) chromium
2) copper
3) manganese
4) selenium
5) zinc
Answer-4
Selenium deficiency is one of the reversible causes of dilated cardiomyopathy.
106- A 40-year-old man attending a routing screening has a blood pressure of 166/100 mmHg. Two weeks later his blood pressure was 150/90 mmHg. He does not smoke. He drinks 35 units alcohol / week. His body mass index (BMI) is 30 kg/m2 (20 - 25). What is the best management strategy?
1) amlodipine
2) atenolol
3) bendrofluazide
4) enalapril
5) lifestyle advice
Answer-5
107- 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
108- Which of the following compounds has a vasodilating effect?
1) Antidiuretic hormone
2) Calcitonin
3) Endothelin
4) Renin
5) Somatostatin
Answer-2
109- A 14-year-old boy presents with hypertension. Which of the following statements concerning hypertension in the young is true?
1) Sodium nitroprusside is useful for the long-term treatment of severe cases.
2) Headache is the usual presenting feature.
3) It is defined as systolic blood pressure above the 99th centile for age.
4) Abnormalities are frequently seen on DMSA scan.
5) Aortic coarctation is the commonest secondary cause.
Answer-4
110- A new antihypertensive drug needs to be investigated to establish its relative potency.
Which of the following techniques is most appropriate for this purpose?
1) bioassay
2) case-control study
3) double-blind, randomized, placebo controlled study
4) postmarketing surveillance
5) sequential trial
Answer-1
111- A 53-year-old man presented with hypertension of 150/110 and is found to have the following results on investigation. Raised serum sodium, raised urinary potassium excretion and normal serum renin. What is the likely diagnosis?
1) Adrenocortical adenoma
2) Coarctation of aorta
3) Malignant hypertension
4) Pheochromocytoma
5) Renal tumour
Answer-1
112-A 29-year-old female who is 22 weeks pregnant is noted to have a blood pressure of 150/90 mmHg on 3 separate occasions. Urine protein is negative. Which of the following would be the first line treatment?
1) alpha Methyl Dopa
2) Atenolol
3) Magnesium Sulphate
4) Nifedipine
5) Salbutamol
Answer-1
113-A 58-year-old man presents with sudden onset chest pain. He has a known history of ischaemic heart disease. ECG shows ST segment elevation in V1-V5 without reciprocal depression. In which territory is the infarction most likely to have take place?
1) Anterior
2) Inferior
3) Lateral
4) Inferio-lateral
5) Posterior
Answer-1
This MI is likely to be in the LAD and represents an anterior MI.
114-An 54-year-old male redevelops chest pain 72 hours after treatment for an anterior myocardial infarction. Which of the following markers will be the most sensitive in detecting reinfarction?
1) CK-MB
2) LDH
3) Myoglobin
4) Troponin I
5) Troponin T
Answer-1
Although troponin is highly sensitive and specific it remains elevated for at least one week after infarction. Similarly LDH will be present for approximately one
week after infarction. After myocardial infarction, CK-MB levels become elevated within 3 to 8 hours, peak within 9 to 30 hours, and return to normal after 48 to 72
hours. Although myoglobin has a short half life and rises quickly after an MI and is cleared after an MI, it is not specific enough for diagnostic use.
More Questions & Answers:-
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Page10
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