81- A 60-year-old man's echocardiogram shows a dilated left ventricular cavity with the remainder of the other chamber sizes normal. The most likely diagnosis is which of the following?
1) aortic regurgitation
2) aortic stenosis
3) hypertensive heart disease
4) mitral regurgitation
5) mitral stenosis
Answer-1
82- Left axis deviation is seen on the ECG in which of the following conditions?
1) atrioventricular canal defects.
2) Ebstein's anomaly.
3) large ventricular septal defect.
4) patent ductus arteriosus.
5) tetralogy of Fallot.
Answer-1
83- Which of the following is true regarding the action of Clopidogrel?
1) It inhibits cyclo-oxygenase
2) It is an ADP receptor antagonist
3) It is a glycoprotein IIb/IIIa inhibitor
4) It is a selective factor Xa inhibitor
5) It is Hydroxymethyl Coenzyme A inhibitor
Answer-2
84- Which ONE of the following is associated with Marfan's syndrome?
1) Autosomal recessive inheritance
2) increased upper : lower body ratio
3) Mental retardation
4) Pulmonary stenosis
5) Retinal detachment
Answer-5
85- A 30-year-old intravenous drug abuser develops acute aortic regurgitation due to infective endocarditis. Which of the following is least likely to be found on clinical examination?
1) decreased cardiac output
2) decrescendo diastolic murmur
3) hypotension
4) mitral valve pre-closure
5) peripheral vasodilatation
Answer-5
86- A 67 year old man presents with sudden onset atrial fibrillation (ventricular rate of 150/minute). His serum creatinine concentration was 250 umol/L (70-110). What is the main factor that determines the choice of loading dose of digoxin in this patient?
1) Absorption
2) Apparent volume of distribution
3) Lipid solubility
4) Plasma half-life
5) Renal clearance
Answer-5
87- A 17-year-old girl is short in stature for her age. She has not shown any changes of puberty. She has a webbed neck. Her vital signs include Temperature 36.6°C Respiratory rate 18/min Pulse 75 bpm and BP 165/85 mmHg. On physical examination, she has a continuous murmur heard over both the front of the chest as well as her back. Her lower extremities are cool with poor capillary filling. A chest radiograph reveals a prominent left heart border, no oedema or effusions, and rib notching. Which of the following pathologic lesions best explains these findings?
1) Constriction of the aorta past the ductus arteriosus
2) Lack of development of the spiral septum and partial absence of conus musculature
3) Shortening and thickening of chordae tendineae of the mitral valve
4) Single large atrioventricular valve
5) Supravalvular narrowing in the aortic root
Answer-1
She has coarctation of the aorta, and the constriction is postductal, allowing prolonged survival. Her physical characteristics also suggest Turner syndrome
(monosomy X).
88- Elevation of the jugular venous pressure during inspiration is most likely to be found in which of the following situations?
1) a normal physical exam
2) cardiac tamponade
3) constrictive pericarditis
4) dilated cardiomyopathy
5) myocarditis
Answer-3
89- 75 year-old man with a history of anterior MI is taking amiodarone 400mg/day for history of VT. He has a prolonged QT interval on his ECG.What is the most appropriate management?
1) Admit to hospital for monitoring.
2) Atenolol.
3) Change amiodarone to flecainide.
4) Continue with amiodarone.
5) Discontinue amiodarone immediately.
Answer-5
90- A 58-year-old man has had an enlarging abdomen for several months. He has experienced no abdominal or chest pain. On physical examination he has a non-tender abdomen with no masses palpable, but there is a fluid thrill. An abdominal Ultrasound Scan shows a large abdominal fluid collection with a small cirrhotic liver. A chest X-ray shows a globally enlarged heart. Which of the following conditions is most likely to be present?
1) Dilated cardiomyopathy
2) Lymphocytic myocarditis
3) Myocardial amyloid deposition
4) Nonbacterial thrombotic endocarditis
5) Severe occlusive coronary atherosclerosis
Answer-1
This man has alcoholic liver cirrhosis with ascites. The cardiomyopathy of alcoholism is a dilated or congestive form.
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1) aortic regurgitation
2) aortic stenosis
3) hypertensive heart disease
4) mitral regurgitation
5) mitral stenosis
Answer-1
82- Left axis deviation is seen on the ECG in which of the following conditions?
1) atrioventricular canal defects.
2) Ebstein's anomaly.
3) large ventricular septal defect.
4) patent ductus arteriosus.
5) tetralogy of Fallot.
Answer-1
83- Which of the following is true regarding the action of Clopidogrel?
1) It inhibits cyclo-oxygenase
2) It is an ADP receptor antagonist
3) It is a glycoprotein IIb/IIIa inhibitor
4) It is a selective factor Xa inhibitor
5) It is Hydroxymethyl Coenzyme A inhibitor
Answer-2
84- Which ONE of the following is associated with Marfan's syndrome?
1) Autosomal recessive inheritance
2) increased upper : lower body ratio
3) Mental retardation
4) Pulmonary stenosis
5) Retinal detachment
Answer-5
85- A 30-year-old intravenous drug abuser develops acute aortic regurgitation due to infective endocarditis. Which of the following is least likely to be found on clinical examination?
1) decreased cardiac output
2) decrescendo diastolic murmur
3) hypotension
4) mitral valve pre-closure
5) peripheral vasodilatation
Answer-5
86- A 67 year old man presents with sudden onset atrial fibrillation (ventricular rate of 150/minute). His serum creatinine concentration was 250 umol/L (70-110). What is the main factor that determines the choice of loading dose of digoxin in this patient?
1) Absorption
2) Apparent volume of distribution
3) Lipid solubility
4) Plasma half-life
5) Renal clearance
Answer-5
87- A 17-year-old girl is short in stature for her age. She has not shown any changes of puberty. She has a webbed neck. Her vital signs include Temperature 36.6°C Respiratory rate 18/min Pulse 75 bpm and BP 165/85 mmHg. On physical examination, she has a continuous murmur heard over both the front of the chest as well as her back. Her lower extremities are cool with poor capillary filling. A chest radiograph reveals a prominent left heart border, no oedema or effusions, and rib notching. Which of the following pathologic lesions best explains these findings?
1) Constriction of the aorta past the ductus arteriosus
2) Lack of development of the spiral septum and partial absence of conus musculature
3) Shortening and thickening of chordae tendineae of the mitral valve
4) Single large atrioventricular valve
5) Supravalvular narrowing in the aortic root
Answer-1
She has coarctation of the aorta, and the constriction is postductal, allowing prolonged survival. Her physical characteristics also suggest Turner syndrome
(monosomy X).
88- Elevation of the jugular venous pressure during inspiration is most likely to be found in which of the following situations?
1) a normal physical exam
2) cardiac tamponade
3) constrictive pericarditis
4) dilated cardiomyopathy
5) myocarditis
Answer-3
89- 75 year-old man with a history of anterior MI is taking amiodarone 400mg/day for history of VT. He has a prolonged QT interval on his ECG.What is the most appropriate management?
1) Admit to hospital for monitoring.
2) Atenolol.
3) Change amiodarone to flecainide.
4) Continue with amiodarone.
5) Discontinue amiodarone immediately.
Answer-5
90- A 58-year-old man has had an enlarging abdomen for several months. He has experienced no abdominal or chest pain. On physical examination he has a non-tender abdomen with no masses palpable, but there is a fluid thrill. An abdominal Ultrasound Scan shows a large abdominal fluid collection with a small cirrhotic liver. A chest X-ray shows a globally enlarged heart. Which of the following conditions is most likely to be present?
1) Dilated cardiomyopathy
2) Lymphocytic myocarditis
3) Myocardial amyloid deposition
4) Nonbacterial thrombotic endocarditis
5) Severe occlusive coronary atherosclerosis
Answer-1
This man has alcoholic liver cirrhosis with ascites. The cardiomyopathy of alcoholism is a dilated or congestive form.
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