Physiology :

1-Which of the following is not a vasodilator ? a) b) c) d) H+ Ca+2 K+ Mg+2

Ans : B , Ca+2 is a vasoconstrictor 2- Which of the following is false ? a) Brain capillaries have no pores b) Interstitial fluid is actually a free fluid that allow substances to flow easily through it c) Not all capillaries are opened d) Precapillary sphincters play an important role in controlling blood flow Ans : b , bcz interstitial fluid is a fluid GEL 3- All can cause edema except : a) b) c) d) Kidney failure Liver cirrhosis Decrease protein from diet Vasoconstrictor drugs

Ans : D 4- What is Mean Arterial Blood Pressure for a patient with B.P = 160/100 mmHg ? a) b) c) d) 130 120 110 153

Ans : B , MABP = 100 + 1/3(160-100)

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5- After standing up suddenly from a supine position , what is the most likely to occur ? a) Baroreceptors will sense the decreased BP and send signals to vasomotor center in the brain to stimulate sympathetic response . b) Baroreceptors will sense the decreased BP and send signals to vasomotor center in the brain to inhibit parasympathetic response . c) Baroreceptors will sense the increased BP and send signals to vasomotor center in the brain to inhibit parasympathetic response. d) Baroreceptors will sense the increased BP and send signals to vasomotor center in the brain to inhibit sympathetic response . Ans : A 6- BP evaluations are mostly related to: a) b) c) d) Peripheral resistance which is related to systolic pressure . Peripheral resistance which is related to diastolic pressure . Blood flow which is related to systolic pressure . Blood flow which is related to diastolic pressure .

Ans : B, bcz systolic pressure is mostly related to cardiac output , heart rate , sympathetic stimulation , and BP is related to resistance not to blood flow . 7- What are the additional tests should you do if you suspect Cushings Syndrome ? a) b) c) d) Check epinephrine and norepinephrine . 2 answers are correct. Check cotisol level. Check if he/she has a moon face

Ans : B 8- During Exercise : a) b) c) d) There is an increase in both systolic and diastolic pressure . Increase in diastolic but decrease in systolic . Increase in systolic and decrease in diastolic . Both systole and diastole are decreased . Ans : C , increase in systole is due to increase in blood flow , cardiac output and sympathetic stimulation and increase in diastolic due to vasodilation .

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9- After losing large amounts of blood due to an accident , what will be the most efficient way to re-establish a normal BP? a) b) c) d) Chemoreceptors . Low pressure receptors. Macula densa . Capillary shift fluid .

Ans : c 10- What is the example of volume loading hypertension ? a) b) c) d) V will later lead to TPR (as a 2ed mechanism ). V will later lead to TPR (as a 2ed mechanism ). V will later lead to no change to TPR. None of the above . Ans: A , V will later lead to C.O which will B.P (which cause baroreceptors to R by vasodilation ) but the kidneys are more efficient and so will urine output BP (which will be sensed by baroreceptors and so will R so BP ( as a 2ed mechanism ), therefore maintaining BP high ) .

11- From the curve shoeing the relation btw urinary volume output , BP , water and salt intake , if you keep intake constant but with a renal disease that has the urine output , what will happen to the curve : a) b) c) d) Shifts to the left Shifts to the right Shifts upward Shifts downward

Ans : B 12- Your friend is feeling dissy , you ask him to lay down on the floor and raise his legs up , after staying in this position for several minutes , he still feels dizzy , what does it mean ? a) b) c) d) He has malignant HTN He has labile HTN due to some ADS of drug . He has hypoglycemia , and you offer him some sweets . It is too sever , he need to go to the hospital .

Ans : c
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13- During exercise , what is the most likely to happen? a) Nervous control is stronger than local metabolic one . b) Sympathetic (nervous control) causes vasoconstriction of coronary blood vessels but indirect increased metabolism is more dominant and so result in vasodilation. c) 2 answers are correct . d) Parasympathetic nervous control will cause vasodilation and therefore increase blood flow in vessels. Ans :B 14- A patient suffers from retrosternal pain and an ECG that shows ST depression in addition to enzymatic changes , what is the more likely the cause of his pain ? a) b) c) d) Angina pectoris 2 answers are correct . MI. Heart attack.

Ans: C 15- we expect stable angina , we decide to do an exercise ECG , when do we stop ? a) b) c) d) When we reach 85% of max heart rate . When the patient is exhausted . When we start to observe ECG changes . All of the above.

Ans : d 16- All are present in aortic arch and carotid bodies , EXCEPT : a) b) c) d) Chemoreceptors . Baroreceptors . Low-presser receptors. None of the above.

Ans : C , it is present in atria and pulmonary arteries.

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17- In cerebral ischemia , what will be the mechanism ? a) CNS ischemic response which will cause extreme sympathetic response to save vital organs . b) Baroreceptors will sense that the vasomotor center is not receiving enough blood , and so will increase BP. c) Chemoreceptors will sense the decreased PO2 and send signals to vasomotor centre to cause vasoconstriction. d) Low pressure receptors will sense the decreased volume and so less blood to the kidney , will cause increase reasbsorption and so increase BP . Ans : A , it is an emergency case, no baroreceptors will be working and there is renal shut down bcz arterial BP is too low . 18- the maximum excitation that can be passed through AV node : a) 220 b) 240 c) 300 d) 100 Ans : A 19- ECG changes in ventricular arrhythmia include: a) ST elevation. b) wide QRS. c) T-inversion. d) both b & c. Ans :D 20- increase in K ions concentration will cause: a) increased HR. b) decreased HR. c) decreased contraction. d) both b&c. Ans : D
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21- calculate the CO if oxygen consumption in the lungs = 250ml/min, O2 concentration in venous blood = 50ml/L , O2 concentration in arterial blood = 100ml/L. answ: 5 L/min 22- the highest tendency of turbulent blood flow is when Reynold's number = a ) 1000 b) 100 c) 900 d) 3000 Ans : D 23- critical closing pressure will be at its highest value : a) in isolated veins. b) in normal body veins. c) during sympathetic stimulation. Ans :C 24- the abnormal sound produced at aortic valve during diastole is due to:: a) mitral valve stenosis. b) aortic stenisis. c) aortic incompetence (regurgitation ). d) both b & c. Ans :C 25- the reference point in the heart at which BP will not change if we change the position of the body, is: a) level of aortic valve. b) level of tricuspid valve. c) left atrium . d) right ventricle.
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Ans :B 26- one of the following is not considered as reservoir of blood: a)spleen. b) liver. c) plexus of GIT. d) brain. Ans : D 27- one of the following is considered as both acute and long term regulator of local blood flow : a) collateral circulation formation . b) angiogensis . c) oxygen lack theory. Ans : A 28- pathological Q wave (more than 3 mm) on ECG indicates: a) stable angina b) unstable angina. c) old MI. d) heart failure. Ans : C 29- during exercise : a) blood flow to all body parts is equal. b) sympathetic stimulation will cause vasoconstriction all over the body including skeletal muscles. c) systolic and diastolic BP will increase . d) only systolic BP will increase. Ans : D

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30- one of the following will happen in left sided heart failure: a) increase in renin secretion. b) decrease in aldosteron secretion. c) increase in venous return. d) peripheral edema. Ans : A 31- congestive heart failure is failure of: a) left ventricle. b) right ventricle. c) both a & b. Ans : C 32-The extrasystolic beat would produce : a) b) c) d) e) increased pulse pressure because contractility is increased. increased pulse pressure because heart rate is increased. decreased pulse pressure because ventricular filling time is increased. decreased pulse pressure because stroke volume is decreased. decreased pulse pressure because the PR interval is increased.

Ans : D 33- Depending on the following ECG, answer the following 3 questions :

34- The end of systole is at the end of : a) b) c) d) e)

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C D A E F

Ans : D 35- Which of the following is correct : a) b) c) d) e) The Second heart sound is caused by the opening Aortic Valve. The First heart sound can be heard during E. The Second heart sound can be heard during C. The First heart sound is caused by the opening Aortic Valve. The First heart sound can be heard during C.

Ans :E 36- Which of the following is false : a) Both Ventricular pressure & Volume do not change significantly during F because of diastasis. b) The period during which Ventricular pressure increases without a change in its volume occurs in C . c) The period during which Ventricular pressure decreases without a change in its volume occurs in E. d) The period of ejection occurs during C. e) All of the above mentioned choices is correct. Ans : D 37- The Resting potential of atrium is represented by:a) b) c) d) ST segment. ST segment + T wave + TP segment. QRS complex. TP segment.

Ans : B 38- Regarding the second heart sound : a) its heard by the end of ST segment . b) its heard during QRS complex. c) An abnormal second heart sound may indicate a mitral valve regurgitation .
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d) An abnormal second heart sound may indicate a mitral valve insufficiency. Ans : A 39- According to Dr. Mohammad jaafar, during the plateau phase of ventricular action potential, which of the following is false : a) The opening of slow Na-Ca channels maintain the membrane in a depolarized state. b) No further slow Na-Ca channels can be opened . c) Potassium channels are closed . d) Potassium channels are partially opened . e) During the plateau, the myocyte is in an absolute refractory period. Ans :D 40- Regarding precordial leads, which of the following is NOT correct : a) b) c) d) e) An S wave cannot be seen in precordial lead V6. The greatest R wave is seen in precordial lead V6. A Q wave is note seen in precordial lead V1. An R wave is not seen in precordial lead V6. Precordial lead V2 is located at the level of the 4th intercostal space left to the sternum.

Ans : D 41- Regarding bipolar limb leads, which of the following is NOT correct : a) b) c) d) Normally, the minimal voltage is recorded in lead I. Normally, The minimal voltage is recorded in lead III . Normally, The maximal voltage is recorded in lead II. Lead I records an ECG based on the electrical activity measured between the red & yellow electrodes. e) To record limb lead II, the positive terminal is connected to the left leg. Ans : A 42- Which of the following is not correct: a) Prolonged increase in the temperature increases the heart rate. b) All waves are seen negative in unipolar lead aVR.
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c) A high concentration of Ca +2 in the extracellular fluid prolongs the plateau. d) A high concentration of K+ ions in the extracellular fluid causes Bradycardia. e) A high concentration of K+ ions in the extracellular fluid causes the membrane to remain partially depolarized. Ans : A

Biochemistry

1- Glycogenolysis : A- Conversion of glycogen to glucose. B- Conversion of pyruvate to glucose. C- Breakdown of glycogen to glucose. D- Breakdown of glycogen to pyruvate. ans: C

2- Gluconeogenesis: A- Conversion of pyruvate to glucose. B- Conversion of glucose to glycogen. C- Is an exact reverse to glycogenolysis. D- Mainly occurs in muscles. ans: A 3- Which of the following is TRUE about cardiac muscles: A- They perform both aerobic and anaerobic metabolism. B- They store large amounts of glycogen and lipids. C- Lipoprotein lipase is one of their enzymes. D- Glycolysis is the major pathway that provides them with energy.

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ans: C 4- All of the following are true regarding ketone bodies and their synthesis. EXCEPT: A- They are the major fuel during starvation state. B- Synthesis increases when B-oxydation decreases. C- Synthesized in hepatic mitochondria. D- Synthesis increases when insulin release decreases. ans: B 5- All of the following are Ketone bodies. EXCEPT: A- Acetone. B- Acetate. C- Acetoacetic acid. D- B-hydroxybutyric acid. ans: B 6- Which of the following statements regarding ketone bodies is CORRECT: 1- In extrahepatic tissue, to be utilized B-hydroxbutyrate reoxidized to acetate. 2- Thiolase cleaves acetoacetyl-COA to form 2 molecules of acetone. 3- Succinyl-COA donates COA for acetoacetate. 4- Succinyl-COA:3-Ketoacid-COA transferase is highly available in the liver. ABCDAll are correct. 1and 3. 1, 2 and 3. 2 and 3. ans: B 7- The major source of cholesterol is : A- Diet. B- De novo synthesis in the intestine. C- De novo synthesis in the skin.
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D- De novo synthesis in the liver. ans: D 8- Regarding cholesterol all true, EXCEPT: A- Only half of the cholesterol ingested is absorbed. B- Increase intake of cholesterol decreases its absorbtion. C- Lowering cholesterol in diet significantly decreases cholesterol levels in the blood. D- Insignificant amount of cholesterol is excreted in bile. ans: C

9- Cholesterol synthesis: A- Occurs in mitochondria. B- Requires NADH and ATP. C- The rate limiting enzyme in the pathway of cholesterol synthesis is HMGCOA synthase. D- The rate limiting enzyme in the pathway of cholesterol synthesis is HMGCOA reductase. ans: D 10-one of the following is responsible for long term regulation of cholesterol synthesis: A- Glucagon. B- Epinephrine. C- SREBP-2. D- Insulin. ans: C

11- Saturated fats: A- Increase LDL. B- Increase HDL. C- Decrease total cholesterol.
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D- All are correct. ans: A 12-Regarding Omega 3, all are correct EXCEPT: A- A polyunsaturated fat. B- A monounsaturated fat. C- Found in oily fish. D- Lowers serum triglycerides. ans: B

13-Lipid levels were measured for a patient. And found as the following: LDL 165 HDL 30 Triglycerides 140 This patient has: ABCDELow HLD High LDL Normal triglycerides ALL are correct Only A and B are correct ans: D 14-Regarding lipoproteins. Which are atherogenic: ABCDOnly VLDL Both LDL and VLDL All lipoproteins Only LDL ans: B 15- All are true about HDL, EXCEPT:
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A- Contains cholesteryl esters at its core surrounded by phospholipids and proteins. B- Is a scavenger of cholesterol C- High levels indicate higher risk of coronary artery disease. D- Is a good lipoprotein. ans: C 16-The gold standard marker for MI diagnosis is: A- CKMB B- Troponin C- Myoglobin D- Aspartate transaminase ans:B

17-Regarding Troponin all are correct, EXCEPT: A- Rises 4-6 hours after infarction. B- Elevated levels persist in the blood for weeks. C- cTnI is specific for the heart. D- All are correct. ans: D 18- All of the following markers are specific for heart diseases, EXCEPT: A- Myoglobin. B- Troponin C- CKMB D- All are specific ans: A 19-Which of the following markers is the first to be elevated after infarction: A- CKMB B- Troponin C- Myoglobin
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D- LDH ans: C

Pathology
1. Any two of the following findings can be used to diagnose infected endocarditis except : A. valver reguregation B. ECHO findings C. splinter hemorrhages D. positive blood culture for staph aureus answ : C , all of them are major criteria except C 2. Which of the following valvular diseases is least likely to show high titers of acute phase reactents ( inflammatory markers ) A. infected endocarditis B. non bacterial thrombotic endocarditis C. libman sacks diseases D. rheumatic heart disease answ : B 3. A 10 years old boy presented with fever and joint pains , physical examination showed nodules on the extensor surface of his forearms and uncontrollable limb movements . the history of the patient will probably reveal : A. IV drug abuse B. previous upper respiratory tract infection C. recurrent UTI D. recent dental procedure

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ans : B, this presentation fits rheumatic fever 4. The above patient was admitted to the hospital , after one day he developed symptoms of LHF , the most likely cause of these symptoms is : A.amyloidosis B. perecarditis C. cardiac tamponade D. mitral valve insufficiency ans :D , rheumatic fever usually leads to mitral regurgitation 5. Which of the following is the least likely complication of Takayasu disease : A. systemic hypertension B. myocardial infarction C. lower limbs ischemia D. pulmonary hypertension ans : C

6. A 30 years old male presented with abdominal pain , BP was 160/100 and history revealed dark black stool , recent hepatitis infection and some sort of mild itches . further analysis is most likely to show : A. high C-ANCA titers B. high P-ANCA titers C. eosenophilic infiltrate on histological examination of his renal arteries D. fibrnoid necrosis on histological examination of his renal arteries ans : D, all clues point to PAN . 7. The most common cause of acquired heart diseases in newborns is : A. rheumatic fever B. atherosclerosis C. Kawasaki disease
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D. ventricular septal defect answ : C 8. Which of the following vasculitic diseases is more likely to show granulomatic pattern on histological examination : A. Kawasaki B. burger C. PAN D. microscopic polyartetites ans : B 9. All of the following are correct regarding microscopic polyarteritis except : A. high titers of P-ANCA B. can present with lung involvement C. shows temporal pattern on histological examination (old and new insults can be seen in the same area) D. usually doesnt show immune complexes on histological examination ans : C , it is typical for PAN not microscopic polyarteritis 10. All of the following are major risk factors for atherosclerosis except : A. hyperlipedemia B. hypertension C. diabetes mellitus D. stress ans : D. 11. Which of the following is correct regarding fatty strikes: A. they starts to form at adultness in the presence of high lipid diet B. shows high numbers of lymphocytes and foamy cells C. the presence of smooth muscles in them is considered a land mark . D. they are highly associated with Ischemic heart diseases E. non of the above
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ans : E 12. The key step in the development of atherosclerosis is injury to which of the following cells : A. endothelial cells B. monocytes C. smooth muscles D. platelets ans: A 13. Which of the following atherosclerotic changes is least likely to cause MI : A. medial thinning B. thrombus formation C. hemorrhage inside the plaque D. ulceration of the plaque ans: A. all other leads to occlusion except medial thinning which leads to Aneurysms 14. On a regular check up of a 40 years old male , X-ray showed a central mass in the abdomen inferior to the renal arteries , further investigations revealed a pulsating 2 Cm dilation in the abdominal aeorta . diagnosis was an abdominal aeortic aneurysm ,, the physician should : A. ask the patient to go home and come regularly for follow up B. operate on the patient immediately C. treat the patient with steroids D. put the patient on a heavy course of warfarin ans: A. Aneurysms less than 4 Cm should be followed up only . 15. Which of the following is the least likely complication of Varicose veins in the legs : A. pulmonary embolism B. stasis dermatitis C. Edema
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D. pain ans : A. 16. This 30 years old male presented with complains of recurrent chest pain , cardiac enzymes where normal and further investigations revealed 40% narrowing of his LAD , his physician suspects some sort of angina , if it was so , the best thing to do is : A. put the patient on Ca channels blockers B. do catheterization C. do a bypass surgery D. put the patient on statins ans: A, this is mostly vasospastic angina which should be treated with Ca blockers 17. The most common cause of acute MI is : A. embolism B. thrombosis C. vasospasm D. amyloidosis ans : B 18. A Jewish patient was admitted to KAUH in Jordan , he was diagnosed with Kaposi sarcoma , this patients history doesnt show any previous surgery of any trip of of Jordan , the type of the Kaposi sarcoma is mostly : A. classic Kaposi B. endemic Kaposi C. epidemic Kaposi D. post transplant Kaposi ans : A 19. a person died suddenly of acute thrombosis in his coronary arteries without any previous chest pain , he was placed in a refrigerator and
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the next day autopsy was done on him , a histological section of his cardiac tissue will show : A. loss of nuclei B. contraction bands C. macrophages infiltrate D. non of the above ans: D, he died suddenly , which means it is an acute cardiac death caused by arrhythmia , these changes happens in MI and needs time to develop .

anatomy
1- Tranverse pericardial sinus is formed by_________, and oblique pericardial sinus is formed by ____________

a-development of arteries...development of veins b-development of veins...development of arteries c-development of endocardium...development of hunter's canal d-development\folding of heart tube...development of veins

2- Azygos vein empties into: a-inferior vena cava b-hemiazygos vein c-superior venous duct of Connor d-superior vena cava

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3- Musculi pectini can be found in ___________, Trabeculae carneae can be found in ___________ a-R. renal artery... L. anastomsis of femoral sheath b-R. atrium... R. ventricle c-interventricular septum... L. ventricle d-Howel's muscular trabecules...posterior atrioventricular groove

4- Where do I put my stethoscope to hear the mitral valve a-apex of heart, 9 cm to left of midline b-apex of heart, 8 cm to right of midline c-anterior to root of lung, 9 cm left of midline d-base of heart, 9 cm left of midline

5-What do vitelline veins drain? a-body of embryo b-head of embryo c-both of the above d-umbilical vesicle (yolk sac)

6-What stops the ventricles from continued dilation downward in the developing embryo? a-diaphragm b-septum transversarum c-bulbis cordis d-truncus arteriosis
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7-The interventricular septum of heart is: a- 1/4 membranous, 3/4 muscular b-all of it muscular c-all of it membranous except a tiny part d-1/4 muscular, 3/4 membranous

8-What are the points used to "draw" the surface projection of the heart?

9-The temporal pulse can be felt at: a-posterior to auricle of left atrium b-posterior to occipital putara c-in Henry's fossa d-anterior to auricle of ear e-posterior to auricle of ear

10-In what percentage of people does the left coronary artery give rise to a posterior interventricular artery of the heart? a-67% b-60% c-33% d-40%

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11-In which paired vein and artery does blood flow in the same direction? a-part of the great cardiac vein and circumflex artery b-radial vein, radial artery c-truncated vein of the Adromeda and aorta d-none of the above

12-Vertebral artery arises from: a-aorta b-thoracic artery c-subclavian artery d-vertebrae

13-Which of these pass in Hunter's canal (adductor canal): a-femoral artery b-artery of Lewis c-subclavian artery d-radial artery

14-From what pharyngeal arches do the pulmonary trunk and arch of aorta (and their subdivisions) arise? a-1,2,5 b-3,4,6 c-2,6,4

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d-3,2,6

15-Endocardial space contains: a-purkinje cells (fibers?) b-WBCs c-tunica media d-ulnanis conjunctiva

16-Purkinje fibers are pale staining because they don't contain a lot of: a-mitochondria b-cytoplasm c-contractile myofilaments d-elastic lamina

17-Arterioles contain _________ layer(s) of smooth muscles a- 2-3 b- more than 10 c- 2-10 d- 1

18-The vagus nerve is __________, while the phrenic nerve is ___________ a-posterior to root of lung...posterior to root of lung b-posterior to vertebrae...anterior to root of lung c-posterior to root of lung...anterior to root of lung
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d-cranial nerve X (10), cranial nerve XII (12)

1-d 13-a

2-d

3-b

4-a

5-d

6-b

7-a

8-.... 9-d

10-c 11-a 12-c

14-b 15-a 16-c 17-d 18-c

Community
1. the Framingham experiment was started: A. 20 years ago. B. 50 years ago. C. 10 years ago. D. 5 years ago.

2: the method of study in the Framingham heart study is: A. Case control. B. Cohort. C. Random control. D. Survey.

3: All of the following are risk factors for CVD except: A. Smoking.
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B. quite personality. C. Alchoholism. D. hyperlipidemia. E. DM.

4: The major cause of death in females between 25-64 years is: A. Cancer. B. Cardiovascular diseases. C. Congenital anomalies. D. external incident. ANSWERS: BBBB

Pharma
1.Which of the following should be administered to a patient with very high triglyceride? A. Niacin B. Atorvastatin C. Cholestaramine D. Gimfibrozil ans: D 2.Which of the following is the most important effect by which nitrates relieve angina pain?

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A.Decreased preload B.Decreased afterload C.Dilation of coronary arteries D. decrease in sympathetic tone Answer: C

3.Which of the following drugs is an alpha and beta receptor blocker that can be used in pregnancy : A. Labetalol B. propranolol C. metaprolol D. atenolol ans : A

4-Which is the LEAST likely adverse effect of nitrates when the drug is used in angina treatment? A. Burning under the tongue during sublingual administration B.Hypotension C.Bronchial constriction D. Headache E. Palpitation ans: C

5-Which of the drugs can be given to a patient with Congestive HF? A.Digoxin B.Thiazides C.Captopril
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D.Hydralazine E. All of the listed drug ans : E

6-Beta-adrenoreceptor blocker: A.Reduces the automaticity in the heart B.Reduces myocardial contractility C.Reduces the hepatic blood flow D.Reduce rennin release from the kidney E.Are characterized by all the listed action Ans: E 7-Whats wrong about digoxin A.long half life B.cause cardiac arrythmia C.must not be given with diuretics D. works on Na-K pump ans : C

Good luck

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