Hypertension (HTN)
1. Regarding systemic hypertension
a) Low birth weight is associated with adult hypertension
b) Peripheral vascular disease is a complication
c) Can be caused by excessive intake of alcohol
2. A 25 yr old male presents with a BP of 180/110 mmHg. WOTF investigations will help to find out a cause
a) ECG
b) USS abdomen
c) Estimation of urinary catecholamines
d) Serum Electrolytes
e) Chest X ray
3. Regarding malignant hypertension,
a) Headache is a typical feature
b) Papilledema is common
c) Intravenous nitrate is contraindicated
d) Blood pressure should be brought down to normal levels within 10 minutes
e) Essential to look for secondary causes
4. Following drugs are appropriate for management of chronic hypertension,
a) Captopril
b) Verapamil
c) Spironolactone
d) Digoxin
e) Metaprolol
5. Treatment of hypertension.
a) Calcium Chanel blockers are contraindicated in patients over 65 y.
b) Spironolactone is recommended in resistant HT
c) Combination of ACEI & ARB best avoided
d) Methyl dopa is contraindicated in pregnancy
e) Weight reduction alone decrease BP
6. Which of the following statements regarding hypertension is/are true?
a) ACEI is drug of choice in HTN associated with systemic sclerosis
b) ARB is contraindicated in diabetic nephropathy
c) Prazocin causes postural hypotension
d) CCB are safe during pregnancy
e) Thiazides are contraindicated in elderly
7. 22 yr old girl with BP-160/100 mmHg. Which of the causes are correctly matched,
a) Hypokalemia – Crohn’s disease
b) Café au lait spots – pheochromocytoma
c) Short lower limbs – coarctation of aorta
d) Presence of red cells – renal artery stenosis
8. Review of the patient's medical records showed that her systolic blood pressure was greater than 140 mmHg at both of her last clinic appointments. Her medical history is otherwise significant only for diabetes mellitus. Today her blood pressure is 160/90 mmHg. What is the best next step in her blood pressure management?
a) Ask the patient to keep written records of her blood pressure and bring with her to the next appointment
b) Advise the patient to begin a heart healthy, low sodium diet and refer to a nutritionist.
c) Prescribe an ACE inhibitor in addition to heart healthy life.
d) Prescribe a calcium channel blocker in addition to a heart healthy diet.
e) Arrange for echocardiogram to assess for end organ damage.
9. A 67 years old male patient presents to your clinic to establish primary care. He is asymptomatic and he has a history of hypertension for which he takes a thiazide. His father had a myocardial infarction at age of 62. The patient smoked until 5 years ago, but has been abstinent from tobacco since then. His blood pressure is 130/80 mmHg. Aside from being over-weight, the remainder of the physical examination is unremarkable. Which of the following preventive health interventions would be most appropriately offered to him today?
a) Carotid ultrasound to evaluate for carotid artery stenosis.
b) Abdominal ultrasound to evaluate for aortic aneurysm.
c) Lipoprotein assay to evaluate coronary heart disease risk.
d) Exercise (treadmill) stress testing to evaluate for coronary artery disease.
e) Homocysteine level to evaluate coronary heart disease risk.
10. A 25 year old previously healthy school teacher underwent pre employment screening and found to have elevated blood pressure. Her blood pressure recording for 2 weeks in various occasions ranged from 160/90 to 170/90 mmHg. Her other examinations were normal what is the least Important preliminary Investigation?
a) ECHO
b) ECG
c) Serum creatinine
d) Serum electrolytes
e) Urine albumin and sediments
Arrhythmia
1. Following is/are true of atrial fibrillation?
a) ASD is a known cause
b) has saw-toothed 'p' wave in ECG
c) often asymptomatic
2. Regarding atrial fibrillation
a) is more common with thyrotoxicosis due to Graves disease
b) Irregularity of the pulse is corrected after exercise
c) Presents as broad complex tachycardia
d) May occur in young individuals with no cardiac disease
e) Pneumonia is a known cause
3. Recognized features of atrial fibrillation are
a) Irregular pulse volume
b) Variable first heart sound
c) Fixed splitting of heart sound
d) Mid diastolic murmur at the apex
e) 4th heart sound
4. Features of a complete heart block,
a) Irregular cannon 'a' waves
b) Dissociation of P waves and QRS complexes on ECG
c) Varying intensity of first heart sound
d) Mid diastolic murmur at apex
e) Presents with syncopal attacks
5. T/F regarding complete heart block
a) Cannon waves seen in JVP
b) Digoxin improves the survival
c) Increase the incidence of systolic embolism
d) Insert a pace maker if anterior MI occurs
e) Can occur due to inferior MI
6. An 80 year old woman was admitted to the ward with dizziness. Cardiac monitoring initially revealed atrial fibrillation with rapid ventricular response. Her ventricular rate was controlled with beta blocker. An echocardiogram revealed an enlarged left atrium and an ejection fraction of 50%. No evidence of diastolic heart dysfunction was noted. She is now asymptomatic, with blood pressure 130/80 mmHg, heart rhythm irregularly irregular, and heart rate around 80 beats/min. Which of the following is the best management strategy of this patient's arrhythmia?
a) Electrical cardioversion plus prolonged anticoagulation
b) Electrical cardioversion without anticoagulation
c) Chemical cardioversion plus prolonged anticoagulation
d) Chemical cardioversion without anticoagulation
e) Continued rate control plus prolonged anticoagulation.
7. Which of the following suggest a VT than a SVT as the likely cause
a) QRS >0.14 s
b) Presence of capture beats
c) Irregular rhythm
d) Q waves in V1
e) History of angina pectoris
8. A 30 year old male had a blackout while exercise at the gymnasium and remained unconscious for about 2 min till he was revived by cardiac massage. Most appropriate investigation(s) to arrive at a diagnosis is/was?
a) Plain CT
b) ECG
c) ECHO
d) EEG
e) Holter monitoring
Valvular heart diseases
1. Regarding aortic stenosis
a) Pulse pressure is widened
b) Loud 2nd heart sound
c) Thrusting apex
d) Can present with angina
e) ECG may show LVH
2. Regarding aortic stenosis
a) Manifest as syncope
b) Is a complication of bicuspid valve
c) Associated with low volume pulse
d) Is the commonest valve involved in Rheumatic fever
e) Can manifest as angina
3. Mitral stenosis
a) Causes left ventricular failure
b) Heaving apex
c) Presystolic accentuation is prominent with atrial fibrillation
d) Slow rising pulse
e) Common in rheumatic fever
4. Mitral regurgitation
a) Acute rheumatic carditis can be a cause
b) Third heart sound signifies bad prognosis
c) Thromboembolism is less common than in MS.
d) May occur due to aortic valve disease
e) Murmur may radiate to the neck
5. Recognized signs of mitral regurgitation include,
a) Loud S1
b) Rumbling mid diastolic murmur at apex
c) Third heart sound
d) Parasternal heave
e) Reversed splitting of second heart sound
6. 55 year old patient with rheumatic valvular heart disease is admitted in confused state. Pulse is irregularly irregular. Pulse rate is 160. BP is 70/50. What is the most appropriate management of this patient?
a) IV amiodarone
b) DC cardioversion
c) IV digoxin
d) Infusion of Normal Saline
e) Infusion of dobutamine
7. 28 yr old man with known valvular heart disease presented with fever for 2 weeks duration and SOB. O/E temperature -38.3 C, harsh pansystolic murmur and mild bibasal crepitations. Blood cultures were taken. What is the most appropriate next step in Management,
a) ECG
b) IV antibiotics
c) throat swab
d) furosemide
e) 2D-Echo
8. A 79 year old female presents with recurrent falls and transient loss of consciousness for a few minutes. Most of these episodes occurred while she was walking. Examination does not show any focal neurological signs. Her pulse is regular and blood pressure is 110/90 mmHg. There is no cardiomegaly. Auscultation reveals an ejection systolic murmur best heard over the aortic area which radiates to carotids, what is the most appropriate investigation to find the cause for her presentation?
a) Contrast enhanced CT brain
b) EEG
c) ECG
d) Echocardiogram
e) Holter monitoring
ECG
1. Which of the following ECG abnormalities usually no need for specific treatment
a) First degree heart block
b) Sinus arrhythmia
c) Atrial flutter
d) Mobitz II 2° heart block
e) Wenckebach 2° heart block
2. Which of the following are correctly paired
a) ST depression & T inversion - digoxin toxicity
b) Short QT interval - hypo Ca2+
c) Prominent U wave - hypokalemia
d) Subarachnoid hemorrhage - T inversions in v2-v5
e) Tall p waves - hyper K+
3. Causes of tall R waves in V1
a) Wolf Parkinson white syndrome
b) LBBB
c) Right ventricular hypertrophy
d) Atrial fibrillation
e) Posterior MI
4. A 37 year old male with CKD presents with shortness of breath. His ECG reveals tall T wave and wide QRS complex. What is the next step in the management?
a) Dextrose IV
b) Hemodialysis
c) Calcium gluconate
d) Nebulize with salbutamol
e) Oral resin
Cardiomyopathies
1. True or false regarding dilated cardiomyopathy
a) Characterized by right ventricular dilation
b) Associated with thyrotoxicosis
c) Fourth heart sound
2. Regarding Infective Endocarditis
a) Staph epidermidis the commonest cause
b) Treated for 2 weeks
3. Causes of pericarditis
a) Uraemia
b) SLE
c) hypothyroidism
d) Dressler’s syndrome
4. Infective endocarditis (IE)
a) Acute IE cannot occur in normal valves
b) More common with increasing age
c) Staphylococcus is the commonest agent after cardiac surgery
d) Almost always leads to macroscopic hematuria
e) Manifest with hypochromic microcytic blood picture
CVS clinical signs
1. In JVP
a) ‘a’ wave indicates atrial contraction
b) There are 3 positive waves
c) V wave Indicates TR
d) V wave indicates SVC obstruction
e) a wave absent in atrial fibrillation
2. Regarding JVP
a) Increase with inspiration in constrictive pericarditis.
b) С wave correspond to iso volumetric contraction of the ventricles
c) Large V wave occur in tricuspid stenosis
d) a wave coincide with p wave in the ECG
e) Easily seen when the patient is supine if the patient has heart failure
3. Which of the following is compatible with BP 120/50 mmHg in right upper arm?
a) Aortic stenosis
b) MR
c) AR
d) PDA
e) VSD
4. Central cyanosis is more likely than peripheral cyanosis
a) If cyanosis is in pinna
b) cyanosis of nails at warm extremities
c) If cyanosis disappears with O2 therapy
d) If clubbing is present
e) SPO2<95 mmHg in
5. Clinical features of cardiac tamponade
a) Reduced JVP
b) muffled heart sounds
c) hypotension
d) bradycardia
e) pulses paradoxes
6. Regarding CVS examination
a) Pulses alterance – HOCM
b) Loud SI - 1st degree heart block
c) Reverse splitting of S2 - LBBB
d) Third heart sound – hypertension
e) Double impulse at the apex - aortic stenosis
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