Renal MCQ - Part II - Renal Failure - with answers

Acute Kidney Injury

01. Increase serum Creatinine seen in 

a) Pregnancy
b) Myocardial infarction
c) Treatment with cimetidine
d) Early DM nephropathy
e) Russell’s Viper bite

02. Increased blood urea is seen in 

a) Na valproate treatment,
b) Rhabdomyolysis.
c) Addison's disease
d) Severe liver disease
e) Tetracycline therapy

03. In acute renal failure, due to a pre-renal cause WOTF can be true, 

a) BP = 80/60 mmHg
b) Severely dehydrated patient
c) Concentrated urine
d) Serum K+ level of 6.2 mmol/l.
e) Sepsis

04. Acute renal failure 

a) Commonest cause is acute tubular necrosis
b) Presence of anemia should raise the suspicion of Rhabdomyolysis
c) Small kidneys on USS
d) May have prolonged bleeding time
e) Long QT syndrome may be a rare cause of death

05. Regarding a patient with acute renal failure, the following are correctly paired, 

a) Red cell casts - acute glomerular nephritis
b) Field full of pus cells - pyelonephritis
c) Microscopic haematuria - Leptospirosis d) Jaundice and bleeding - Hepato renal syndrome
e) Hypernatremia - acute tubular necrosis

Chronic Kidney Disease 

06. Expected findings in CKD 

a) Sclerosed glomeruli in biopsy
b) 15.5cm sized kidneys
c) Pallor
d) Increased serum potassium level
e) A negative mantoux despite exposure to TB

07. Typical biochemical abnormalities of CKD

a) Hyperglycemia

b) Hypophosphatemia
c) Hypercalcaemia
d) Metabolic acidosis
e) Proteinuria> 3.5g/l

08. Features suggestive of CKD

a) Intravascular volume constriction
b) Hypophosphatemia
c) Hyperuricaemia
d) Hypertriglyceridemia
e) Hypernatremia

09. Which of the following helps in diagnosis of CKD over AKI? 

a) Raised S.Cr
b) Small kidneys
c) Normochromic normocytic anemia
d) Raised urea with normal S.Cr
e) Osteodystrophy

10. Factors that help to differentiate CKD from AKI

a) B/L small kidneys
b) Increase in creatinine level
c) Anemia
d) Hyperkalemia
e) Bilateral ankle oedema

11. Regarding treatment of CKD

a) Blood transfusions are best avoided in treatment of anemia
b) Osteoporosis is a complication due to treatment
c) Glycosuria is an indication to start anti DM drugs
d) Moderate protein restriction may have a value
e) Blood pressure should be reduced to 130/90mmHg

Answers 

01. a) F b) - c) T d) F e) T

02. a) F b) F c) T d) F e) T

03. a) T b) T c) T d) F e) T

04. a) T b) - c) F d) T e) F

05. a) T b) T c) T d) T e) F

06. a) T b) F c) T d) T e) T

07. a) F b) F c) F d) T e) -

08. a) F b) F c) T d) T e) F

09. a) F b) T c) T d) F e) T

10. a) T b) F c) T d) F e) F

11. a) T b) T c) F d) F e) F

Renal MCQ - Part I - Glomerular Diseases - with answers

01. Regarding proteinuria in glomerular diseases 

a) Is between 150mg/day and 2g/day in glomerular leakage 
b) Is > 3.5g/day is invariably due to glomerular disease 
c) Is usually greater in the night than during the day 
d) In patients with suspected myoglobinuria appositive dipstick maybe produced 
e) In early diabetic nephropathy typically predominantly albumin is present


02. RBC casts can be seen in 

a) Diabetes mellitus 
b) Chronic GN 
c) Bladder carcinoma 
d) Renal stone 
e) BPH


03. Microscopic hematuria is expected in

a) DM nephropathy 
b) Minimal change disease 
c) Focal segmental glomerulonephritis 
d) Membranous proliferative nephropathy e) AKI


04. Microscopic hematuria features of 

a) G6PD deficiency 
b) DM nephropathy, 
c) Krait bite. 
d) Malignant HT. 
e) OP poisoning


05. 32 year old male presented with haematuria for 1 day duration. There is a past history of haematuria 1 month back. He is on treatment for DM. No oedema. BP elevated. UFR, RBC-200, Pus cells - 3-4, protein- nil. No dysmorphic RBC or hyaline casts. Serum creatinine - Normal. Urinary protein - high. Possibilities are:-

a) Post streptococcal GN 
b) UTI 
c) Renal cell CA 
d) IGA nephropathy 
e) CKD


06. Causes of Nephrotic syndrome are 

a) Infective endocarditis 
b) Gold 
c) Penicillamine 
d) Amyloidosis 
e) Falciparum malaria


07. Which of the following are more favor of minimal change nephritic syndrome? 

a) Highly selective proteinuria 
b) Plasma volume increased 
c) Increased risk of thromboembolism 
d) Mainly peri-orbital oedema 
e) Microscopic haematuria


08. Clinical and biochemical features of minimal change disease are 

a) Proteinuria >3g/24hrs 
b) Gross oedema 
c) Microscopic haematuria 
d) High LDL cholesterol 
e) Venous thrombosis


09. 36 year old male has facial and ankle swelling for 3 weeks. Which is more suggestive of nephritic syndrome?

a) UFR +++ protein
b) Serum albumin- 2.8 
c) 24hour urine protein- 4g 
d) Serum cholesterol- 328 
e) Serum creatinine- 1.6


10. 36 year old female presented with B/L ankle oedema. Her BP is 130/80mmHg. Her Ix results are as follows
S.Cr. Normal UFR - protein 3+
Red cell/hyaline granular casts 24 hr. urinary protein - 3.4g What is the most likely histological type in renal biopsy? 

a) Minimal change GN 
b) Post streptococcal GN 
c) Membrano-proliferative GN 
d) Chronic interstitial nephritis 
e) Diffuse mesangioproliferative with crescent formation

Answers

01. a) F b) T c) F d) T e) T

02. a) F b) T c) F d) F e) F

03. a) F b) F c) T d) T e) T

04. a) F b) F c) F d) T e) -

05. a) F b) T c) T d) T e) -

06. a) F b) T c) T d) T e) T

07. a) T b) F c) T d) T e) F

08. a) T b) T c) F d) T e) T

09. e

10. a

Rheumatology MCQ - Medicine - with answers

 1. Characteristic Features of RA.

a) Atlanto -axial subluxation.
b) Bone cyst formation.
c) Juxta-ordicular osteopenia.
d) Calcification of the spinal ligament.
e) Poriarticular bone erosion.


2. Pulmonary findings in rheumatoid arthritis.

a) Fibrosing alveolitis.
b) Pleural effusion.
c) Caplan syndrome.
d) Bronchoalveolar carcinoma.
e) Chronic Obstructive Pulmonary Disease


3. Regarding Rheumatoid arthritis.

a) Back ache is a common presentation.
b) DIP joints are involved.
c) Erethyma of the affected joints predominates.
d) May present with pyramidal signs.
e) Pleural effusions with high glucose content.


4. Characteristic features of rheumatoid arthritis.

a) Plantar fasciitis.
b) Atlanto-axial subluxation.
c) Scleritis.
d) Subcutaneous nodules.
e) Involvement of DIP joint.


5. Characteristic features of rheumatoid arthritis.

a) Asymmetrical arthritis.
b) Morning stiffness.
c) Male predominance.
d) Onset after 60 years.
e) Involvement of thoracolumbar spine.


6. In a patient with polyarthritis, the diagnosis is more likely to be rheumatoid arthritis than OA in the presence of.

a) Elevated ESR.
b) Symmetrical involvement of PIPjoints.
c) Involvement of temporo mandibular joints.
d) Presence of rheumatoid factor.
e) Symptomatic response to steroids.


7. Following statements about infective arthritis are true.

a) The onset is typically insidious.
b) Pre existing arthritis is a recognized predisposing factor.
c) Small peripheral joints are involved more commonly than larger joints.
d) H-influenzae is the commonest organism in adult patients.
e) Joint aspiration should be avoided due to risk of septicaemia.


8. In psoritic arthritis

a) DIP are involved.
b) Sacroilitis.
c) Oligoarthritis.
d) Arthritis mutilans.
e) Bamboo spine.


9. Clues for the cause of arthritis

a) Scaly lesions over extensors of knee
b) History of dysentery


10. A 50 year old lady presented with two weeks of right knee joint pain and swelling. Which of the following favours a diagnosis of osteoarthritis?

a) ESR 100/1st hour
b) pain on walking
c) history of trauma to knee joint
d) loss of joint space
e) .Neutrophil count over 10000


11. Polyarthragia is a common presenting complain in

a) Rubella
b) Depression
c) tuberculosis
d) Hypothyroidism
e) Chickungunya


12. Joint erosions seen in

a) Osteoarthritis
b) Psoriatic arthritis
c) Gout
d) SLE
e) Rheumatoid arthritis


13. Recognized causes of osteoporosis are,

a) Cushing's syndrome
b) Acromegaly
c) Long term steroid use
d) Early menopause
e) Acute renal failure


14. Tram line calcification in a skull x-ray can be seen in,

a) Thalassaemia
b) Tuberous sclerosis
c) Rickets
d) Sturge weber syndrome
e) Congenital toxoplasmosis


15. 56 yr old man presented with tender swollen 1 metatarsophalangeal joint. He was on frusemide for ankle oedema. Investigation revealed Hb-10.1g/dl, WBC-19,000; ESR -95 , S.cr-3.42. what is the most likely diagnosis,

a) Gouty arthropathy
b) cellulitis
c) TB arthropathy
d) Rheumatoid arthritis
e) Septic arthritis


16. A 41 year old male presents with pain and swelling in left knee for 3 days. He was a hypertensive patient started on HCT and amilodipine recently. On examination, knee joint is tender, warm and swollen, What is the appropriate investigation to get specific. diagnosis?

a) ESR
b) FBC
c) Joint aspiration
d) Rheumatic factor
e) X-ray knee joint


17. T/F

a) Duchenne's muscular dystrophy present at birth as a floppy baby
b) Dystrophiamyotonica patients can develop baldness & cataract
c) Patient with Duchenne's muscular dystrophy live longer than beckers
d) Cardiomyopathy is a recognized complication of Duchenne's muscular dystrophy
e) Chromosomal studies are needed for the diagnosis of Duchenne's muscular dystrophy


18. T/F regarding Duchenne's muscular dystrophy,

a) X linked recessive disorder
b) Has low level of dystrophin
c) Has good prognosis
d) Associated with learning difficulties
e) Serum creatine phosphokinase is elevated

Answers

01. a) T b) F c) T d) - e) T

02. a) T b) T c) T d) F

03. a) F b) F c) T d) T e) -

04. a) F b) T c) T d) T

05. a) F b) T c) F d) F e) F

06. a) T b) T c) F d) T e) F

07. a) T b) T c) F d) F e) F

08. a) T b) F c) T d) T e) F

09. a) T b) T

10. b

11. N/A

12. a) T b) T c) T d) F e) T

13. a) T b) F c) T d) T e F

14. d

15. a

16. c

17. a) F b) T c) F d) T e) F

18. a) T b) T c) F d) T e) T

Cardiovascular system (CVS) MCQ - Part II - Medicine

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

Cardiovascular system (CVS) MCQ - Part I - Medicine

Ischemic Heart Disease (IHD)

1) 55 years old man presented with severe central chest pain for 2 hours duration. ECG showed dome shaped (convex upward) ST elevations in the anterior chest leads. An ECG taken on the previous day was normal. Regarding this patient,

a) Acute myocardial infarction is a likely diagnosis 
b) CK-MB levels will be elevated 
c) Streptokinase is indicated 
d) Pethidine is the drug of choice for analgesia 
e) Aspirin improves mortality due to its anticoagulant effect


2. T/F regarding myocardial infarction 

a) Bradycardia common in anterior MI than inferior MI 
b) Streptokinase is indicated in normal ECG with typical symptoms 
c) Beta blocker improves survival rate 
d) Aspirin is with held until diagnosed by ECG 
e) Statin is given even in normal LDL level


3. What are the treatment options in patient with NSTEMI? 

a) Streptokinase 
b) Heparin 
c) Clopidogrel 
d) Warfarin 
e) Atorvastatin


4. Regarding stable angina 

a) Resting ECG is abnormal in 50% 
b) Upward sloping ST segment depression is more suggestive of ischemia 
c) May undergo spontaneous improvement with time 
d) Treatment with nitrates improve the survival 
e) Aortic stenosis may have a similar presentation


5. Regarding unstable angina 

a) Hypothyroidism is a risk factor 
b) Thrombolytic therapy is indicated in severe disease 
c) Men & women are equally affected 
d) Troponin T elevated in most cases


6. Regarding thrombolysis in MI 

a) If LBBB is present, ST elevation should be confirmed before thrombolysis 
b) Arrhythmias during the thrombolysis carry a worst prognosis 
c) Q waves may not develop if successful thrombolysis occurs 
d) Can be repeated if chest pain recur within 1 week 
e) Has a long term mortality benefit


7. Regarding MI 

a) Sub-endocardial Ml manifest in specific leads 
b) Pericardial rub occurs simultaneously with 1st ECG changes 
c) Pansystolic murmur at apex may signify papillary muscle dysfunction 
d) Breathlessness may be the only symptom 
e) Vomiting is more common with anterior MI


8. A 56 year old male with a past history of myocardial infarction is admitted with sudden onset palpitations. ECG shows a broad complex tachycardia. The patient is conscious with blood pressure of 110/80 mmHg. What is the most appropriate treatment?

a) Carotid massage 
b) Intravenous adenosine 
c) Intravenous amiodarone 
d) DC cardioversion 
e) Intravenous digoxin


9. A 45y old male complains of recurrent episodes of left sided chest pain on exertion. Resting ECG is normal, the next most appropriate ix to arrive a diagnosis is

a) Coronary angiogram 
b) Brain natriuretic peptide 
c) Echo 
d) Exercise ECG 
e) Troponin I


10. 75 year old woman who has recurrent angina on GTN spray, aspirin, atorvastatin, enalapril and verapamil came to clinic. On examination her BP was 130/80, Pulse 60 bpm. To prevent the above problem what is your appropriate next management?

a) Changing verapamil to diltiazem 
b) Changing enalapril to captopril 
c) Add beta-blocker d) Give daily oral GTN 
e) Reassure that it is normal


11. 55 year old female with diabetes mellitus and hypertension presented to ETU with retrosternal chest pain for 1 hour. ECG reveals 4 mm ST elevation in V1-V6. After excluding all contraindications, streptokinase 1.5 units were given. 2 hours later pain was persistent and there was 3 mm ST elevation in same leads of ECG. What is the best management?

a) Urgent coronary artery bypass graft 
b) Rescue PCI 
c) Repeat streptokinase 
d) S/C enoxaparin 
e) IV GTN

Heart Failure (HF)

1. Heart failure 

a) MI is the commonest cause of LVF 
b) Increased preload can maintain the cardiac output in severe heart failure
c) Rennin angiotensin mechanism is activated 
d) Diastolic dysfunction is more common in elderly 
e) Pansystolic murmur that best heard in inspiration may occur in LVF

2. Regarding chronic heart failure

a) Arrhythmias is the commonest cause of death in class II of NYHA classification 
b) Angiotensin levels are elevated 
c) Survival benefit of Furosemide is well proved in clinical trials


3. A 30 year old man who presented with progressive shortness of breathing. He found to have a blood pressure of 80/50 mmHg and elevated JVP with muffled heart sounds. Which of the following are expected findings,

a) Ankle oedema 
b) Pulses paradoxes 
c) Bilateral basal crepitations of the lungs 
d) ECG showing small complexes 
e) Globular heart in chest x-ray


4. In heart failure 
a) ACE inhibitors are the 1st choice in management 
b) Treatment with furosemide reduces the cardiac output 
c) Beta blockers are prescribed to relieve the symptoms 
d) Calcium channel blockers has special role in diastolic dysfunction 
e) Implanted devices has no place in the management f) Digoxin is given only if atrial fibrillation is present


5. Which of the following has mortality benefit in CCF? 

a) spironolactone 
b) captopril 
c) Isosorbide mononitrate 
d) furosemide 
e) metaprolol


6. Which of the following give survival benefit in cardiac failure 

a) Captopril 
b) HCT 
c) Carvedilol 
d) Digoxin 
e) Spironolactone


7. A 50 year old man develops shortness of breath and leg swelling while away on a business trip. He was told that he had congestive cardiac failure, but asymptomatic now, with normal vital signs & physical examination. An echocardiogram shows an estimated ejection fraction of 38%. The patient likes to keep medications to a minimum. He is currently on aspirin and simvastatin. Which would be the most appropriate additional treatment?

a) Begin an ACE inhibitor and a beta-blocker on a scheduled basis. b) Begin digoxin plus furosemide on a scheduled basis. 
c) Begin spironolactone on a scheduled basis. 
d) Begin furosemide plus nitroglycerin.
e) Given his preferences, no other medication is needed unless shortness of breath and swelling occur.

8. A 60 year old previously well male complained of progressive breathlessness, abdominal discomfort and swelling of the legs. On examination there was a gross ascites, elevated JVP, bibasal crepitations and enlarged liver. BP - 180/80 mmHg, RR-25/min, PR - 36 bpm. On ECG heart rate is 96 bpm. What is the best management option?

a) Digoxin 
b) Digoxin + Furosemide 
c) Furosemide 
d) Abdominal paracentesis 
e) Transthoracic pacemaker


9. 54 y old man treated for heart failure had SOB in exertion. Had P/Hx of MI back. PR=80 regular, BP=130/90 mmHg. RS Ex normal. CXR-cardiomegaly he is on Furosemide 40 mg, Enalapril 10 mg. next drug?

a) Digoxin 
b) Metoprolol 
c) HCT 
d) Atenolol 
e) Losartan


10. 35 year old male with a previous history of STEMI presented with SOB & ankle Oedema after 2/52. Echo showed scarring of the L/ventricle. What is the best drug with survival benefit for this patient?

a) ISMN 
b) Carvedilol 
c) Diltiazem 
d) Warfarin 
e) Furosemide