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SECTION A: Read each question carefully and record the answer "TRUE" or "FALSE":
4. The auscuitatory findings listed below are associated with the following
phenomena:
a) Third heart sound-opening of mitral valve.
b) Varying intensity of first heart soupd-atrioventricular dissociation.
c) Soft first heart sound-mitral stenosis.
d) Reversed splitting of second heart sound-left bundle branch lock.
e) Fourth heart sound-atrial fibrillation.
5. The cardiac drugs listed below are associated with the following
adverse effects:
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a) Digoxin-acute confusional state.
b) Verapamil-constipation.
c) Amiodarone-photosensitivity.
d) Propafenone-comeal microdeposits.
e) Lignocaine-convulsions.
11. Digoxln
a) shortens the refractory period of conducting tissue
b) usually converts atrial flutter to sinus rhythm
c) acts primarily on 'cell membrane Ionic pumps
d) effects are potentiated by hyperkalaemia
e) is a recognised cause of ventricular arrhythmias
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b) breathlessness and angor animi
c) hypotension and peripheral cyanosis 4
d) sinus tachycardia or sinus bradycardia
e) absence of any symptoms or physical signs
22. Findings consistent with an acute anterior myocardial Infarction Include
a) hypertension and raised jugular venous pressure
b) rumbling low-pitched diastolic murmur at the cardiac apex
c) ST elevation > 2 mm in leads II, III and AVF on ECG
d) gallop rhythm and soft first heart sound
e) an increased serum gamma-glutamyl transferase activity > 306 e
23. Drug therapies which improve the long-term prognosis after myocardial
infarction include
a) aspirin
b) nitrates
c) calcium antagonists
d) ACE inhibitors
e) B-blockers
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d) retinal soft exudates or haemorrhages
e) renal or cardiac failure
27. Important explanations for hypertension refractory to medical therapy
include
a) poor compliance with drug therapy
b) inadequate drug therapy
c) phaeochromocytoma
d) primary hyperaldosteronism
e) renal artery stenosis
28. Clinical features compatible with .hypertrophic cardlomyopathy Include
a) family history of sudden death
b) angina pectoris and exertlonal syncope
c) jerky pulse and heaving apex beat
d) murmurs suggesting both aortic stenosis and mitral regurgitation
e) soft or absent second heart sound
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32. In right-to-left shunt reversals of congenital heart disease
(Elsenmenger's syndrome)
a) pulmonary, arterial hypertension is usually present
b) closure of the underlying lesion produces symptomatic relief
c) the chest X-ray is typically normal
d) central cyanosis and finger clubbing are often present
e) physical signs of the underlying lesion parsist unchanged
36. The autoantibodies listed below are associated with the following
diseasas
a) antinuclear antibodies-rheumatoid arthritis
b) anti-topoisomerase-progressive systemic sclerosis -(P$,S)
c) anti-SSA (anti-Roy--Sjog.en's syndrome
d) anti-centromere anti bodies--.dermatomyositis
e) antinuclear, cytoplasmic antibodies-CREST syndrome
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37. The following features suggest a mechanical rather than Inflammatory
cause of back pain
a) radiation of pain down the back of one teg to the ankle
b) an elevated C-reactive protein (CRP)
c) localised tenderness over the greater sciatic notch
d) gradual mode of onset in an elderly patient
e) back pain and stiffness exacerbated by resting
38. Osteoarthritis is
a) evident radiologically in at least 80% of patients > 65 years old
b) more likely to be generalised and severe in males
c) characterised by degeneration of cartilage and synovial inflammation
d) associated with increased collagen synthesis in the affected cartilage
e) best managed with anti-inflammatory doses of NSAIDs
39. In the treatment of gout
a) NSAID therapy increases urinary urate excretion
b) salicylates control symptoms and accelerate resolution of the acute attack
c) allopurinol inhibits xanthine oxidase and hence urate production
d) tophi should resolve with control of hyperuricaemia
e) allopurinol or probenecid should be given within 24 hours of onset of the acute attack
40. The following statements about shock syndromes are correct
a) in severe hypovolaemia, a source of blood/fluid loss is Invariably apparent clinically
b) in cardiogenic shock, the peripheries are characteristically warm
c) massive pulmonary embolism typically presents with shock
d) anaphylactic shock is associated with profound alleigen-induced systemic vasoconstriction
e) arteriovenous shunting is a significant contributory factor in septic shock
41. Typical clinical features of acute circulatory failure due to anaphylactic
shock include
a) elevated jugular venous pressure
b) warm'dry skin
c) stridor
d) confusion
e) polyuria
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42. Acute circulatory failure with an elevated central venous pressure are
typical findings in
a) acute pancreatitis
b) massive pulmonary embolism
c) ruptured ectopic pregnancy
d) acute right ventricular infarction
e) pericardial tamponade
43. In a patient with suspected septic shock
a) the lower urinary tract is the commonest source of infection
b) a normal transthoracic electrocardiogram excludes endocarditis
c) intravenous access sites need only be changed if cutaneous evidence of infection is visible
d) prior treatment with histamine receptor antagonists makes pneumonia a more likely cause
e) corticosteroid therapy is of no proven benefit
44. The expected effects of the following vasoactive
drugs Include
a) sodium nitroprusside - reduction in systemic vascular resistance
b) prostacyclin - Increased pulmonary vascular resistance
c) isoprenaline - sin-is tachycardia
d) dopamine - sinus bradycardia
e) adrenaline - increased splanchnic blood
45. Echocardiography is the most sensitive method of diagnosing
a) presence and degree of mitral stenosis
b) evaluation of left ventricular function
c) detection of valvular vegetations
d) detection of pericardial effusion
e) assessing the degree of coronoray stenosis
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47. Percussion of the heart may be useful in the diagnosis of the following
conditions EXCEPT:
a) Pulmonary hypertension
b) Angina pectoris
c) Pericardial effusion
d) Right atrial enlargement
e) Aortic aneurysm
48. Splitting of the second heart sound occurs In:
a) Mitral incompetence
b) Left bundle branch block
c) Severe aortic stenosis
d) Atria[ septal defect
e) All of the above
49. The following signs are indicative of a massive pericardial effusion EXCEPT:
a) Ewart's sign
b) Kussmaul's sign
c) Pulsus paradoxus
d) Harsh pericardial rub
e) Rotch's sign
50. Stokes - Adams attack Is characterized by, except:
a) Sudden fall to the ground.
b) Loss of consciousness.
c) Slow or absent pulse.
d) Rapid week pulse.
51. Orthostatic syncope is characterized by, except.
a) Common in elderly.
b) Change < 20 mmHg in systolic B.P in supine and standing.
c) Change > 20 mmHg in systole in supine and standing.
d) Vasodilators should be better avoided.
52. An abnormal early diastolic sound heard at the apex and lower sternal
border can be:
a) Loud P2.
b) S3 gallop.
c) Opening snap.
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d) All of tho above.
e) None of the above.
53. Graham Steell murmur is:
a) An early diastolic murmur.
b) A pansystolic murmur,
c) An Austin Flint murmur.
d) A subvalvular murmur.
e) A pericardial murmur.
54.In severe mitral stenosis , the following occurs except:
a) Pulmonary hypertenelon,
b) Wider A2 -OS time Interval.
c) Long mid-diastolic murmur.
d) Low cardiac output,
e) Valve area less than approximately 1.0 cm2/m2 body surface area.
55.In aortic regurgitation , the following occur except:
a) Quincke's sign.
b) Duroziez's sign.
c) Traube's area.
d) Corrigan's sign.
e) Austin Flint murmur.
56.Diastolic heart failure Is characterized by all the following except:
a) Poor ventricular contractility.
b) impaired compliance of the ventricle.
c) High pulmonary venous pressure.
d) High EDP.
57.Cardiac transplantation Is absolutely contraindicated in:
a. Patients with ejection fraction < 0.20.
b. Patients with congestive cardiomyopathy.
c. Patients with high pulmonary resistance.
d. Patient with post infraction cardiomyopathy.
58.ACEI Is regarded the first line of treatment in heart failure because It:
a) decreases preload.
b) decreased both pre and after load.
c) increased contractility.
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d) potent loop diuretic.
59. ACEIs are contraindicated in:
a) Bilateral renal artery stenosis.
b) Hypokalemia.
c) Ejection fraction < 40%.
d) Diastolic heart failure.
60. Beta blockers in heart failure:
a) Absolutely contrainedicated in CHF.
b) Prescribed only in patients with class IV heart failure.
c) Can be prescribed with ACEIs in class II & III heart failure.
d) Safe and beneficial in corpuimonal with respiratory failure.
61. The commonest clinical manifestation of MEN-1 is:
a. Glucaigonoma.
b. Hyperpttrathyroidism
c. Cushing disease
d. Medullary carcinoma thyroid
62. One of the following features is pathgnomonic to MEN-2B:
a. Pheochrarnocytoma
b. Hyperparathyroidism
c. Insulinoma
d. Mucosal neuromas
63. The followings are true about PAS- I except:
a. An autosornal recessive disorder
b. Equally affects both sex
c. Hypopuratityroidism is very common
d. Autoimmune thyroid disease is more frequent than in type II APS
65. The following features are present in APS- II except:
a) Addison's disease
b) Typa-1 diabetes
c) Mucocutanenus candidiasis
d) Pernicious anaemia
66. Pregnant lady In her last trimester presented to the emergency room
with clinical,signs of acute deep venous thrombosis of her left leg
;initial treatment for this lady:
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a) Heparin followed immediately by oral anticoagulants.
b) 13- Oral anticoagulants without heparin .
c) Heparin during pregnancy followed by oral anticoagulants in the post-partum period.
d) Thrombolysis
Match each of the following Items marked by letters with those marked by
numbers. Do not use any item more than once:
a] Late systolic mitral murmur
b] Early diastolic basal murmur
c] Short mid-diastolic mitral murmur
d] Short presystolic mitral murmur
e ] Short mesosystolic pulmonary murmur
67 Austin Flint
68 Carry Coomb
69 Still's
70 Mitral Valve Prolapse
71 Graham Steel
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Good Luck
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