Test in General Therapy

1. Which three of the following statements is true concerning COPD? (select all
correct answers)

A. Chronic airway inflammation characterized by reversible airflow

obstruction
B. Obstructive pulmonary disease characterized by a chronic progressive
airflow obstruction
C. The majority of patients have atopy (atopic dermatitis and/or allergic
rhinitis) and childhood-onset disease.
D. Cigarette smoking is the leading cause of disease which is commonly
diagnosed in middle-aged or older adults.
E. Disease exacerbation are more frequent as disease progresses and are most
often triggered by bacterial infections.
2. Which three of the following statements is true concerning COPD? (select three
correct answers)

A. Disease is characterized by bronchial hyper-responsiveness to a variety of

different triggers
B. Airflow limitation is slowly progressive and irreversible
Common symptoms include chronic productive cough (3 months a year, 2
successive years) with phlegm production, exertional dyspnea, chest
tightness

C. Common symptoms include chronic productive cough (3 months a year, 2

successive years) with phlegm production, exertional dyspnea, chest tightness
D. Common symptoms include recurrent wheezing, dyspnea and cough
particularly at night and early morning, chest tightness
 Most people with disease have both emphysema and chronic bronchitis.
3. Which three of the following statements is true concerning Lung function test
findings in COPD patient? (select all correct answers)

A. Spirometry test shows reduction in FEV 1 (forced expiratory volume in 1s) and
FEV1/ FVC (forced vital capacity) ratio (<0.7)
B. Bronchodilator reversibility test after a short-acting β agonist (albuterol) shows
increase in FEV1 by ≥200 ml and ≥ 12% from baseline FEV1 in 15 min
C. Bronchodilator reversibility test after a short-acting β agonist (albuterol) shows
an increase in FEV1 < 12% from baseline FEV1 in 15 min
D. The Peak Expiratory Flow rate (PEF) can be used by the patient to track
diurnal or day-to-day variability of airway obstruction at home
4. Which three of the following statements is true concerning Lung function test
findings in COPD patient? (select all correct answers)

A. Spirometry test shows reduction in FEV 1 (forced expiratory volume in 1s)

and FEV1/ FVC (forced vital capacity) ratio (<0.7)
B. Bronchodilator reversibility test after a short-acting β agonist (albuterol)
shows increase in FEV1 by ≥200 ml and ≥ 12% from baseline FEV1 in 15
min
C. Bronchodilator reversibility test after a short-acting β agonist (albuterol)
shows an increase in FEV1 < 12% from baseline FEV1 in 15 min
D. The Peak Expiratory Flow rate (PEF) can be used by the patient to track
diurnal or day-to-day variability of airway obstruction at home
E. Increases in total lung capacity (TLC), residual volume (RV), and reduced
diffusing capacity for carbon monoxide (DLCO) are typically seen in
COPD with emphysema.

5. Expected physical examination findings in the patient with COPD include the
presence of:(select two correct answers)
 A. Increased anterior-posterior chest diameter (Barrel chest) and poor
diaphragmatic excursion
B. Increased tactile fremitus and dull percussion tones
C. Hyper-resonant percussion tones and decreased breath sounds with expiratory
wheezes
D. Bronchial breath sounds and crackles
E. Increased or altered transmitted voice sounds (bronchophony, egophony,
pectoriloquy)

6. Which three of the following statements is true concerning Lung function test
findings in COPD patient? (select all correct answers)

A. Spirometry test shows reduction in FEV 1 (forced expiratory volume in 1s) and
FEV1/ FVC (forced vital capacity) ratio (<0.7)
B. Bronchodilator reversibility test after a short-acting β agonist (albuterol) shows
increase in FEV1 by ≥200 ml and ≥ 12% from baseline FEV1 in 15 min
C. Bronchodilator reversibility test after a short-acting β agonist (albuterol) shows an
increase in FEV1 < 12% from baseline FEV1 in 15 min
D. The Peak Expiratory Flow rate (PEF) can be used by the patient to track diurnal or
day-to-day variability of airway obstruction at home
E. Increases in total lung capacity (TLC), residual volume (RV), and reduced
diffusing capacity for carbon monoxide (DLCO), are typically seen in COPD with
emphysema.

7. Which three of the following statements is true concerning Lung function test
findings in Asthma patient? (select all correct answers)

A. Spirometry test shows reduction in FEV 1 (forced expiratory volume in 1s) and
FEV1/ FVC (forced vital capacity) ratio (<0.7).
B. Bronchodilator reversibility test after a short-acting β agonist (albuterol) shows
 increase in FEV1 by ≥200 ml and ≥ 12% from baseline FEV1 in 15 min
C. Bronchodilator reversibility test after a short-acting β agonist (albuterol) shows
an increase in FEV1 <12% from baseline FEV1 in 15 min
D. Airway hyper-responsiveness after exposure to direct bronchoconstrictors
(methacholine or histamine) shows increased manifestation of symptoms
E. The diffusing capacity for carbon monoxide (DLCO) is reduced.
8. Which three of the following statements is true concerning Asthma?(select all
correct answers)

A. Chronic airway inflammation characterized by reversible airflow obstruction

B. Obstructive pulmonary disease characterized by a chronic progressive airflow
obstruction
C. The majority of patients have atopy (atopic dermatitis and/or allergic rhinitis)
and childhood-onset disease.
D. Cigarette smoking is the leading cause of disease which is commonly
diagnosed in middle-aged or older adults.
E. Disease can be exacerbated by triggers including allergens, viral infection,
drugs, exercise, air pollution, stress and emotions.
9. Which three of the following statements is true concerning Asthma? (select all
correct answers)

A. Disease is characterized by bronchial hyper-responsiveness to a variety of

different triggers
B. Airflow obstruction is reversible either spontaneously or with age, season of
the year and therapy
C. Common symptoms include chronic productive cough (3 months a year, 2
successive years) with phlegm production, exertional dyspnea, chest tightness
D. Common symptoms include recurrent wheezing, dyspnea and cough
particularly at night and early morning, chest tightness
E. Most people with disease have both emphysema and chronic bronchitis.
10. Which three of the following statements is true concerning Asthma? (select all
correct answers)

A. Disease is characterized by bronchial hyper-responsiveness to a variety of

different triggers
B. Airflow obstruction is reversible either spontaneously or with age, season
of the year and therapy
C. Common symptoms include chronic productive cough (3 months a year, 2
successive years) with phlegm production, exertional dyspnea, chest
tightness
D. Common symptoms include recurrent wheezing, dyspnea and cough
particularly at night and early morning, chest tightness
E. Most people with disease have both emphysema and chronic bronchitis.
11. Expected physical examination findings in the patient with Asthma include the
presence of:(select three correct answers)

A. Increased tactile fremitus and dull percussion tones

B. Use of accessory respiratory muscles and decreased breath sounds
C. Wheezing and rhonchi throughout the chest, more prominent in expiration than
inspiration
D. Bronchial breath sounds and crackles
E. Signs of airflow obstruction are often absent between asthma attacks

12. Which three of the following statements is true concerning Lung function test
findings in Asthma patient? (select all correct answers)

A. Spirometry test shows reduction in FEV 1 (forced expiratory volume in 1s)

and FEV1/ FVC (forced vital capacity) ratio (<0.7).
B. Bronchodilator reversibility test after a short-acting β agonist (albuterol)
shows increase in FEV1 by ≥200 ml and ≥ 12% from baseline FEV1 in 15
 min
C. Bronchodilator reversibility test after a short-acting β agonist (albuterol)
shows an increase in FEV1 <12% from baseline FEV1 in 15 min
D. Airway hyper-responsiveness after exposure to direct bronchoconstrictors
(methacholine or histamine) shows increased manifestation of symptoms
E. The diffusing capacity for carbon monoxide (DLCO) is reduced.

13. Which three of the following statements is true concerning Pleural effusion? (select
all correct answers)

A. Defined as a collection of air or gas in the pleural space due to spontaneous,

traumatic or iatrogenic causes
B. Defined as excess fluid accumulation in the pleural space with transudative or
exudative effusion
C. Defining symptom include a dull pain on the affected side, tachypnea, dyspnea,
cough
D. Physical examination reveals asymmetrical chest expansion, absent tactile
fremitus, hyper resonant percussion tones, reduced or absent breath sounds on
affected side
E. Physical exam may reveal asymmetrical chest expansion, dullness on
percussion, absent breath sounds over affected side

14. Which three of the following statements is true concerning Exudative Pleural
Effusion(select all correct answers)

A. Effusion is caused by systemic influences on pleural fluid formation or

resorption
B. Effusion is caused by local influences on pleural fluid formation and
resorption
C. Effusion is caused by infectious diseases
 D. Effusion is caused by left ventricular heart failure
E. Effusion is caused by pulmonary embolism

15. INVASIVE DIAGNOSTIC PROCEDURES in respiratory diseases include: (select

three correct answers)

A. Percutaneous needle aspiration (PCNA) of the lung

B. Spirometry
C. Thoracentesis
D. Chest computed tomography (CT)
E. Bronchoscopy

16. Which three of the following statements is true concerning Pneumothorax? (select
all correct answers)

A. Defined as a collection of air or gas in the pleural space due to spontaneous,

traumatic or iatrogenic causes
F. Defined as an excess fluid accumulation in the pleural space with transudative
or exudative effusion
B. Common symptoms include sudden sharp chest pain on affected side with
chest movement, tachypnea, dyspnea, dry cough
C. Physical exam may reveal asymmetrical chest expansion, dullness to
percussion, absent breath sounds over affected side
D. Physical examination reveals asymmetrical chest expansion, absent tactile
fremitus, hyper resonant percussion tones, reduced or absent breath sounds on
affected side

17. Which three of the following statements is true concerning Transudative Pleural
Effusion(select all correct answers)
 A. Effusion is caused by local influences on pleural fluid formation and resorption
B. Effusion is caused by systemic influences on pleural fluid formation or
resorption
C. Effusion is caused by infectious diseases
D. Effusion is caused by left ventricular heart failure
E. Effusion is caused by cirrhosis

18. SPIROMETRY is the most useful test to:(select three correct answers)

A. Differentiate obstructive and restrictive lung diseases

B. Diagnose Pneumonia
C. Diagnose Asthma and COPD
D. Identify reversibility of airways obstruction
E. Diagnose pleural effusion

19. Expected physical examination findings in the patient with Lobar Pneumonia
include the presence of:(select three correct answers)

A. Increased tactile fremitus and dull percussion tones over the involved area
B. Wheezing and rhonchi throughout the chest, more prominent in expiration than
inspiration
C. Bronchial breath sounds and crackles over the involved area
D. Absent transmitted voice sounds and hyper-resonant percussion tones
E. Increased or altered transmitted voice sounds (bronchophony, egophony,
pectoriloquy)

20. Which of the following is a common sign of Respiratory distress: (select three
correct answers)

A. Bradycardia
B. Tachypnea
C. Use of accessory muscles of respiration
D. Pallor
E. Cyanosis
21. Which three of the following statements is true concerning Bronchiectasis? (select
all correct answers)

A. Irreversible dilation of portions of bronchi resulting from damage to the airway

wall due to infectious or noninfectious causes or rarely congenital
B. A localized area of suppuration and cavitation in the lung usually as a result of
bacterial infection
C. Common symptoms include chronic productive cough with purulent sputum
usually worse in mornings, hemoptysis, dyspnea, wheezing
D. Physical exam reveals rhonchi, crackles or wheezing on auscultation and
occasionally digital clubbing
E. Chest X-ray shows unilateral, sharp cavity with air-fluid level inside,
involving posterior segments of the upper lobes and apical segment of the
lower lobes

22. NONINVASIVE DIAGNOSTIC PROCEDURES in respiratory diseases include:

(select three correct answers)

F. Chest X-ray
G. Thoracentesis
H. Sputum exam
I. Bronchoscopy
J. Chest computed tomography (CT)

23. Which three of the following statements is true concerning Lung Abscess? (select all
correct answers)

A. A localized area of suppuration and cavitation in the lung usually as a result of

bacterial infection
 B. Irreversible dilation of portions of bronchi resulting from damage to the airway
wall due to infectious or noninfectious causes or rarely congenital
C. Common symptoms include a cough with foul-smelling purulent or
mucopurulent sputum, fever, dyspnea, chest pain, weight loss
D. Physical exam reveals signs of consolidation such as localized dullness on
percussion, bronchial breath sounds, coarse crackles, and digital clubbing
E. Radio-graphic findings include bronchial wall thickening, or cysts emanating
from the bronchial wall,parallel "tram tracks;” “ring-shadows”

24. A 19-year-old college student presents to your office for a regular check-up. She has no
medical problems. She does not smoke. On auscultation of her heart, you hear a split of S2
sound during inspiration at the 2nd left parasternal interspace. What is the most likely cause
of this split? (select the correct answer)
A. Pulmonic stenosis
B. Pulmonary hypertension
C. Physiologic
D. Mitral regurgitation

25. A 75-year-old woman presents to your office for a checkup. She informs you that she has
shortness of breath on exertion, orthopneaand fatigue. She had rheumatic fever in her
childhood. Upon auscultation of her heart, you hear a loud S1 and low-pitched rumbling mid-
diastolic murmur as well as early diastolic opening snap at the apex. What is your most likely
diagnosis? (select the correct answer)

A.Pulmonic stenosis
B.Tricuspid regurgitation
C.Mitral Stenosis
D. Aortic stenosis

26. A 50-year-old man presents to the office for a checkup. He is doing well except that he has
noticed increasing shortness of breath with physical exertion, so he has cut down on his
exercise activities. On auscultation of the heart, you hear a blowing, medium-pitched pan-
systolic murmur at the apex. It radiates to the left axilla and does not change with
inspiration. This murmur is most likely due to: (select the correct answer)

A. Mitral stenosis
B. Mitral regurgitation
C. Aortic stenosis
 D. Aortic regurgitation

27. Which of the following statements regarding ECG is correct?(select the correct answer)

A. QRS complex reflects right and left ventricular depolarization with duration
>0.10sec
B. The PR interval is the time between onset of atrial depolarization and onset of
ventricular depolarization with duration 0.12-0.20 sec.
C. QT interval is the time between atrial depolarization and end of ventricular
depolarization.
D. Normal Q waves are narrow(<0.04 sec) and small (<25% the amplitude of the R
wave) and appearing in all limb and chest leads
E. PP interval is a duration of ventricular cardiac cycle

1. Which of the following statements regarding ECG is correct?(select the correct answer)

A. P wave reflects right and left atrial depolarization with duration > 0.1 sec and
amplitude > 2.5 mm.
B. QT interval is the time between onset of ventricular depolarization and end of
ventricular re-polarization with duration <0.40 sec
C. Q wave is the initial upward deflection reflecting normal septal activation (beginning
on the LV septum);
D. The PR interval is the time between onset of atrial depolarization and end of
ventricular re-polarization.
E. RR interval is a duration of atrial cardiac cycle (an indicator of atrial rate)

28. Which of the following statements regarding Heart’s Electrical Axis is correct?(select the
correct answer)

A. Normal axis: -30° to -90°

B. Left axis deviation: -90° to -180°
C. Right axis deviation: +90° to +180°
D. Extreme axis deviation: -30° to +90°
29. Which of the following statements regarding Heart’s Electrical Axis is correct?(select the
correct answer)

A. Normal axis: -90° to -180°

 B. Left axis deviation: -30° to -90°
C. Right axis deviation: -30° to +90°
D. Extreme axis deviation: +90° to +180°
30. Which of the following statements regarding ECG features of Left Axis Deviation is
correct?(select the correct answer)

A. The QRS are both positively deflected in Lead I and AVF

B. The QRS complex for Lead I is positively deflected but the QRS in AVF is
negatively deflected
C. The QRS in Lead I and in AVF are both negatively deflected
D. The QRS complex in Lead I is negatively deflected but the QRS in AVF is positively
deflected

31. Which of the following statements regarding ECG features of Right Axis Deviation is
correct?(select the correct answer)

E. The QRS are both positively deflected in Lead I and AVF

F. The QRS complex for Lead I is positively deflected but the QRS in AVF is
negatively deflected
G. The QRS in Lead I and in AVF are both negatively deflected
H. The QRS complex in Lead I is negatively deflected but the QRS in AVF is positively
deflected

32. Which three of the following statements regarding ECG features of Left Atrial
hypertrophy is correct?(select all correct answers)

A. P wave biphasic with larger negative deflection (>0.04 sec and > 1mm) in V1
B. High, pointed P wave or biphasic with prominent first positive phase in V1
C. Prolonged P wave duration (>0.12 sec)
D. Tall, peaked P-wave (>2-2.5 mm) in II, Ill, AVF leads
E. Notched (M shape) P wave in II lead with the inter-peak duration >0.04 sec

33. Which three of the following statements regarding ECG features of Right Atrial
Hypertrophy is correct?(select all correct answers)

A. P wave biphasic with larger negative deflection in V1

 B. High, pointed P wave or biphasic with prominent first positive phase in V1
C. Notched (M shape) P wave in II lead with the inter-peak duration >0.04 sec
D. Tall, peaked P wave (> 2.5 mm) in II, Ill, AVF leads
E. P wave duration <0.12 sec
34. Which three of the following statements regarding Left Ventricular Hypertrophy is
correct? (select all correct answers)

A. Sokolow & Lyon criteria: - SV1 + RV5 or RV6>35mm

B. Right axis deviation
C. R in AVL > 11-13 mm
D. ST depression and negative T waves in V5, V6 leads
E. RV1>SV1

35. Which three of the following statements regarding Right Ventricular Hypertrophy is
correct?(select all correct answers)

A. RV1>SV1 with R > 7 mm and S <2mm

B. Left axis deviation
C. “Strain” T wave inversion in V1-V3, II, III, AVF
D. R/S ratio in V5 or V6 <1 with R<5mm and S >7mm
E. R in AVL > 11-13 mm

36. Which two of the following statements regarding Sinus Bradycardia is correct?(select all
correct answers)

A. Sinus bradycardia is an impulse conduction disorder

B. Sinus bradycardia is a sick sinus syndrome
C. P wave follows QRS complex
D. Heart rate <60 bmp and rhythm is regular
E. Heart rate <60 bmp and rhythm is irregular

37. Which three of the following belongs to Sick Sinus Syndrome?(select all correct answers)

A. Sinus arrest
 B. AV block
C. Sino-atrial block
D. His Bundle Branch Block
E. Tachy-bradycardia

38. Which two of the following statements regarding Sinus arrest is correct?(select all correct
answers)

A. In sinus arrest impulse is fired but the impulse does not conduct to the pathways
B. In sinus arrest failure of sinus node discharge results in pause (asystole) with absent P
wave and QRS complex
C. Sinus arrest is complete dissociation between P and QRS waves.
D. Sinus arrest is followed by junctional or ventricular rhythm

39. Which three of the following belongs to Sick Sinus Syndrome?(select all correct answers)

A. Sinus arrest
B. AV block
C. Sino-atrial block
D. His Bundle Branch Block
E. Tachy-bradycardia

40. Which of the following statements regarding AV block is correct?(select the correct
answer)

A. First degree AV block is defined by prolonged PR interval(> 0.20 s) and irregular

rhythm
B. In the second degree Mobitz II AV Block PR interval is progressively increases until
QRS is dropped
C. In the third degree AV block there is complete dissociation between P and QRS
complexes
D. In the second degree Mobitz I AV block PR interval is prolonged and
 constant/invariable

41. Which three of the following statements regarding Right Bundle Branch Block(RBBB) is
correct?(select all correct answers)

A. Large (mostly terminal) R wave in V1 lead ( R, rR', rsR', rSR' or qR)

B. In complete RBBB the QRS is narrow (< 0.12 sec)
C. Wide S wave in I and V6 leads
D. QS or RS complex in V1 lead
E. QRS complex and T wave are discordant in V1

42. Which three of the following statements regarding Left Bundle Branch Block (LBBB) is
correct?(select all correct answers)

A. In complete LBBB the QRS is narrow (< 0.12 sec)

B. Wide R (maybe notched) or RSR wave in V6 lead
C. Wide S wave in I and V6 leads
D. QS or RS complex in V1 lead
E. QRS complex and T wave are concordant in V6 lead

43. Which three of the following statements is true concerning Non-conducted Premature
Atrial Contraction (Blocked PAC) (select all correct answers)

A. PACs arriving very early in the cycle may not be conducted to the ventricles
B. P wave is followed by abnormal QRS complex
C. PAC is not followed by a QRS complex
D. QRS< 0.10 sec
E. Non-conducted PAC is the most common cause of an unexpected pause in rhythm
44. Which three of the following statements is true concerning Normally-conducted
Premature Atrial Contraction (PAC) (select all correct answers)

A. A premature beat arising from an ectopic focus within the atria

B. P wave typically precedes QRS complex
C. PAC is not followed by a QRS complex
D. QRS complex is normal (< 0.10 sec)
 E. QRS complex is abnormal (> 0.10 sec)

45. Which three of the following statements is true concerning Premature Ventricle
Contraction (PVC) (select all correct answers)

A. A premature beat arising from an ectopic focus within the ventricles

B. Narrow QRS complex (< 0.12 sec) with abnormal morphology
C. P wave precedes QRS
D. Complete compensatory pause
E. Discordant ST segment and T wave changes

46. Which three of the following statements is true concerning Premature Ventricle
Contraction (PVC): (select all correct answers)

A. Uni-focal PVCs arising from a single ectopic focus, each PVSs are identical
B. Multifocal PVCs arising from two or more ectopic foci resulting in multiple QRS
morphologies
C. Quadrigeminy is the occurrence of four consecutive PVCs
D. Triplet is the occurrence of three consecutive PVCs
E. Bigeminy is the occurrence of two consecutive PVCs

47. Which three of the following statements is true concerning a Compensatory Pause:(select
all correct answers)

A. A compensatory pause is measured using the interval between the R wave preceding
the extra-systole to the R wave following the extra-systole
B. Compensatory pause is complete if it is equal to 2 R-R intervals of the underlying
rhythm
C. Compensatory pause is complete if it is less than to 2 R-R intervals of the underlying
rhythm
D. Compensatory pause is incomplete if it is less than to 2 R-R intervals of the
underlying rhythm

48. Which three of the following statements is true concerning Premature Junctional
Contraction (PJC)(select all correct answers)

A. A premature beat arising from an ectopic focus within the AV junction

B. P wave precedes, follows or coincides QRS complex
C. Compensatory pause is complete
D. Atria is depolarized retrograde causing an inverted P wave if it precedes QRS
 E. QRS duration > 0.10 sec

49. Which three of the following statements is true concerning Premature Ventricle
Contraction (PVC) (select all correct answers)

A. Uni focal PVCs arising from a single ectopic focus, each PVSs are identical
B. Multifocal PVCs arising from two or more ectopic foci resulting in multiple QRS
morphologies
C. Bigeminy is the occurrence of two consecutive PVCs
D. Couplet is the occurrence of a PVC every other beat
E. Trigeminy is the occurrence of every third PVC

50. Which three of the following statements is true concerning Premature Ventricle
Contraction (PVC) (select all correct answers)

A. A premature beat arising from an ectopic focus within the ventricles

B. Widened QRS complex (≥ 0.120 sec) with abnormal morphology
C. P wave precedes QRS
D. Complete compensatory pause
E. Concordant ST segment and T wave changes

51. Which three of the following statements is true concerning Aberrantly-conducted

Premature Atrial Contraction (PAC) (select all correct answers)

A. A premature beat arising from an ectopic focus within the atria

B. PAC is not followed by a QRS complex
C. P wave is followed by abnormal QRS complex usually with right bundle branch
block (RBBB) morphology
D. QRS duration < 0.10 sec
E. QRS duration >0.10 sec

52. Mechanisms of Arrhythmia include:(select three correct answers)

A. RE-entry (common)
B. Decreased normal automaticity
C. Abnormal mechanisms of automaticity
 D. Triggered activity
E. Increased vagal tone

53. Regular Tachyarrhythmias with wide complexes include:(select two correct answers)

A. Sinus Tachycardia and Paroxysmal supra-ventricular tachycardia with bundle

branch block

B. Polymorphic ventricular tachycardia

C. Monomorphic ventricular tachycardia

D. Multifocal atrial tachycardia with bundle branch block

E. Atrial fibrillation

54. Irregular Tachyarrhythmias with narrow complexes include: (select three correct
answers)

A. Atrial Fibrillation

B. Atrial Flutter

C. Sinus tachycardia

D. Paroxysmal supra-ventricular tachycardia

E. Multifocal atrial tachycardia

55. Regular Tachyarrhythmias with narrow complexes include:(select two correct answers)

A. Atrial Flutter

B. Sinus tachycardia

C. Atrial Fibrillation

D. Paroxysmal supra-ventricular tachycardia

E. Monomorphic ventricular tachycardia

56. Irregular Tachyarrhythmias with wide complexes include:(select two correct answers)

A. Polymorphic ventricular tachycardia

 B. Monomorphic ventricular tachycardia

C. Atrial Fibrillation, Atrial Flutter, Multifocal atrial tachycardia with bundle branch
block

D. Paroxysmal supra-ventricular tachycardia

E. Sinus Tachycardia with bundle branch block

57. Which three of the following statements is true concerning Tachyarrhytmias? (select all
correct answers)

A. Atrial flutter is characterized by extremely disorganized, chaotic ventricular rhythm

(~300-600 bmp) with no P waves and QRS complexes (fibrillatory baseline).

B. Atrial fibrillation is characterized by extremely rapid and disorganized pattern of

atrial activity (400-600 bmp) with slower (110-160) irregular ventricular rate (QRS
<0.10 sec)

C. Ventricular paroxysmal tachycardia is characterized by rapid, regular heart rate (150-

250 bmp) made up of ventricular beats with wide QRS (>0.12 sec), AV dissociation
and fusion beats

D. Ventricular fibrillation is characterized by rapid (250-400 bmp) regular atrial rhythm

with “saw tooth” flutter waves and slower irregular (rarely regular) ventricular
rhythm with QRS < 0.10 sec

E. Supraventricular tachycardia is a fast (>150 bmp) regular rhythm with narrow QRS
complexes and P wave mostly hidden in the previous T wave

58. Which three of the following statements is true concerning Tachyarrhytmias? (select all
correct answers)

A. Ventricular fibrillation is characterized by extremely disorganized, chaotic ventricular

rhythm (~300-600 bmp) with no P waves and QRS complexes (fibrillatory baseline).

B. Atrial Fibrillation is characterized by rapid (250-400 bmp) regular atrial rhythm with
“saw tooth” flutter waves and slower irregular (rarely regular) ventricular rhythm
with QRS < 0.10 sec

C. Ventricular paroxysmal tachycardia is characterized by rapid, regular heart rate (150-

250 bmp) made up of ventricular beats with wide QRS (>0.12 sec), AV dissociation
 and fusion beats

D. Supra-ventricular Tachycardia is a fast (>150 bmp) regular rhythm with narrow QRS
complexes and P wave mostly hidden in the previous T wave.

E. Atrial flutter is characterized by extremely rapid and disorganized pattern of atrial

activity (400-600 bmp) with slower (110-160) irregular ventricular rate

59. Which three of the following statements is true concerning Tachyarrhytmias? (select all
correct answers)

A. Ventricular fibrillation is characterized by extremely disorganized, chaotic ventricular

rhythm (~300-600 bmp) with no P waves and QRS complexes (fibrillatory baseline).

B. Ventricular paroxysmal tachycardia is characterized by rapid, regular heart rate (150-

250 bmp) made up of ventricular beats with wide QRS (>0.12 sec), AV dissociation
and fusion beats

C. Atrial Fibrillation is a fast (>150 bmp) regular rhythm with narrow QRS complexes
and P wave mostly hidden in the previous T wave.

D. Atrial flutter is characterized by rapid (250-400 bmp) regular atrial rhythm with “saw
tooth” flutter waves and slower irregular (rarely regular) ventricular rhythm with
QRS < 0.10 sec

E. Supra-ventricular Tachycardia is characterized by extremely rapid and disorganized

pattern of atrial activity (400-600 bmp) with slower (110-160) irregular ventricular
rate (QRS <0.10 sec)

60. A 6-year-old child presents with his parents for a regular checkup. He has normal growth
and development and is appropriately physically active. On auscultation of his heart, you
hear with you bell of stethoscope a low-pitched S3 sound at the apex. What is the most likely
cause of this sound? (select the correct answer)
A. Mitral regurgitation
B. Physiologic
C. Aortic regurgitation
D. Mitral stenosis

61. A 68-year-old man presents to your office for evaluation of fatigue. He also complains
of shortness of breath on exertion. Upon auscultation of his heart, you hear a crescendo-
decrescendo (diamond shaped) mid-systolic murmur at the right second interspace that
radiates to the neck. It has a medium pitch and a harsh quality. It is best heard when
you sit the patient up and lean him forward. What is your most likely diagnosis? (select
 the correct answer)

A. Mitral regurgitation
B. Pulmonic stenosis
C. Aortic stenosis
D. Mitral stenosis

62. A 66-year-old man presents to your office for evaluation of fatigue. He has an elevated
blood pressure with a widened pulse pressure. Upon auscultation of his heart, you hear a soft
S2 and blowing, high-pitched, decrescendo early diastolic murmur. It is best heard when the
patient is leaning forward, with breath held at end-expiration. What is your most likely
diagnosis? (select the correct answer)

A. Pulmonic stenosis
B. Aortic regurgitation
C. Aortic stenosis
D. Tricuspid regurgitation

63. A 19-year-old college student presents to your office for a regular check-up. She has no
medical problems. She does not smoke. On auscultation of her heart, you hear a split of S2
sound during inspiration at the 2ndleft parasternal interspace. What is the most likely cause of
this split? (select the correct answer)

A. Pulmonic stenosis
B. Pulmonary hypertension
C. Physiologic
D. Mitral regurgitation

64. A 75-year-old woman presents to your office for a checkup. She informs you that she has
shortness of breath on exertion, orthopnea and fatigue. She had rheumatic fever in her
childhood. Upon auscultation of her heart, you hear a loud S1 and low-pitched rumbling mid-
diastolic murmur as well as early diastolic opening snap at the apex. What is your most likely
diagnosis? (select the correct answer)
A. Pulmonic stenosis
B. Tricuspid regurgitation
C. Mitral Stenosis
D. Aortic stenosis

65. A 50-year-old man presents to the office for a checkup. He is doing well except that he has
 noticed increasing shortness of breath with physical exertion, so he has cut down on his
exercise activities. On auscultation of the heart, you hear a blowing, medium-pitched
pansystolic murmur at the apex. It radiates to the left axilla and does not change with
inspiration. This murmur is most likely due to: (select the correct answer)
A. Mitral stenosis
B. Mitral regurgitation
C. Aortic stenosis
D. Aortic regurgitation

66. Unmodifiable risk factors for Coronary Artery Disease (CAD)include: (select all correct
answers)

A. Obesity
B. Sex
C. Diabetes
D. Sedentary lifestyle
E. Heredity

67. Modifiable risk factors for Coronary Artery Disease (CAD)include: (select all correct
answers)

A. Hypertension
B. Age
C. Smoking
D. Heredity
E. Dyslipidemia

68. Which of the following three criteria is true with regard to Metabolism Syndrome? (select all
correct answers)
A. Abdominal obesity: waist circumference for men >40 inch and women >35 inch
B. Triglycerides <150 mg/dl
C. HDL: men <40 mg/dl and women <50 mg/dl
D. BP <130/85 mm Hg
E. Fasting glucose >100 mg/dl

69. Which of the following three criteria is true with regard to Metabolic Syndrome? (select all
correct answers)
A. Abdominal obesity: waist circumference for men >40 inch and women >35 inch
B. Triglycerides >150 mg/dl
 C. HDL: men >40 mg/dl and women >50 mg/dl
D. BP >130/85 mm Hg
E. Fasting glucose <100 mg/dl

70. Which of the following statements concerning Dyslipidemia is true? (select all correct
answers)

A. Decreased LDL and increased HDL cholesterol levels are associated with an increase
in CAD risk
B. Increased LDL and decreased HDL cholesterol levels are associated with an increase
in CAD risk
C. Best single predictor for CVD risk is TC/HDL ratio with intermediate risk = 3-5
D. Best single predictor for CVD risk is TC/HDL ratio with ideal ratio >3

71. Which of the following statements concerning Dyslipidemia is true? (select all correct
answers)

E. Decreased LDL and increased HDL cholesterol levels are associated with an increase
in CAD risk
F. Increased LDL and decreased HDL cholesterol levels are associated with an increase
in CAD risk
G. Best single predictor for CVD risk is TC/HDL ratio with high risk <5
H. Best single predictor for CVD risk is TC/HDL ratio with ideal ratio <3

72. A 65-year-old woman presents to your office for a checkup. She informs you that she has
burning sensation behind sternum while walking or climbing stairs rapidly, which lasts about
5 min and is relieved by rest. Exercise (treadmill) test findings show exercise induced
downsloping ST depression (>1mm below baseline). What is your most likely diagnosis
according to Canadian Cardiovascular Classification System?(select the correct
answer)
A A. Angina pectoris
B.Myocardial infarction
C. Peptic ulcer
D. Diffuse esophageal spasm

73. A 54-year-old man presents to your office for a checkup. He informs you that he has pressure
in his chest during any physical activity and sometimes at rest. It lasts 5-10 min and relieves
by rest or and/or nitrates within minutes. Exercise (treadmill) test findings show exercise
induced ST horizontal depression (>1mm below baseline). What is your most likely?
(select the correct answer)
A. Angina pectoris
B.MI
C. peptic ulcer
 D. Achalasia

74. Which of the following is true with regard to Acute Coronary Syndrome? (select all
correct answers)

A. STEMI
B. Sudden cardiac death
C. Chronic stable angina
D. Unstable angina
E. Silent ischemia

75. Which of the following is true with regard to Acute Coronary Syndrome? (select all
correct answers)

A. Silent ischemia
B. Unstable angina
C. Sudden cardiac death
D. Chronic stable angina
E. NSTEMI

76. Myocardial infarction is best differentiated from acute myocardial ischemia by the
following:(select two correct answers)

A. History

B. Duration of chest pain

C. The Ultrasound

D. Troponin and cardiac enzyme levels

E. The Electrocardiogram combined with troponin and enzyme levels

77. Myocardial infarction is best differentiated from acute myocardial ischemia by the
following: (select correct answers)

A. History

B. Character and duration of chest pain

C. Electrocardiogram

D. Troponin and cardiac enzyme levels

E. Electrocardiogram combined with troponin and enzyme levels

78. Which two of the following statements regarding ECG features of Myocardial Infarction is
correct?(select all correct answers)

A. ST segment elevation or depression (<1 mm above or below baseline)

B. QRS abnormalities, QS complex
C. T wave abnormalities (inversion or tall, peaked and symmetrical, discordant) indicate
irreversible myocardial damage
D. Pathological Q wave (>0.04 sec and >25% the amplitude of the R wave)
79. A 65-year-old woman presents to your office for a checkup. She informs you that she has
burning sensation behind sternum while walking rapidly (200-500m) or climbing stairs (2-3
floors) , which lasts about 5 min and is relieved by rest. Exercise (treadmill) test findings
show exercise induced downsloping ST depression (>1mm below baseline). What is your
most likely diagnosis according to Canadian Cardiovascular Classification System?
(select the correct answer)
A. Angina pectoris class I
B. Angina pectoris class II
C. Angina pectoris class III
D. Angina pectoris class IV

80. Which two of the following statements regarding ECG features of Myocardial Ischemia is
correct?(select two correct answers)

A. ST segment elevation <1 mm above baseline

B. ST depression > 1 mm below baseline and 0.04 sec after the J point
C. Pathological Q wave (> 0.04 sec and >25% the amplitude of the R wave)
D. T wave abnormalities (inversion or tall, peaked and symmetrical, discordant)
E. QRS abnormalities, QS complex

81. Which of the following characteristics of chest pain meets Typical Angina?(select all correct
answers)

A. Substernal chest discomfort of characteristic quality and duration 10-20min

B. Substernal chest discomfort of characteristic quality and duration>20min

C. Provoked by exertion or emotional stress

D. Relieved by rest and/or nitrates within minutes

 E. Typical angina meets two of these chest pain characteristics

82. Which of the following characteristics of chest pain meets Typical Angina?(select all correct
answers)

F. Substernal chest discomfort of characteristic quality and duration 10-20min

G. Substernal chest discomfort of characteristic quality and duration>20min

H. Provoked by exertion or emotional stress

I. Relieved by rest and/or nitrates within minutes

J. Typical angina meets one of these chest pain characteristics

83. Which of the following is true with regard to Unstable Angina? (select all correct answers)

A. New onset angina

B. ST elevation
C. Acute angina at rest within 48h
D. Troponin or CK-MB elevation
E. Crescendo angina

84. Which of the following is true with regard to Unstable Angina? (select all correct answers)

A. Crescendo angina
B. Troponin or CK-MB elevation
C. Subacute angina at rest within past month but not within preceding 48h
D. Pathological Q wave
E. New onset angina

85. Which of the following is true with regard to Myocardial Infarction? (select all correct
answers)

A. Detection of a rise and/or fall of cardiac biomarker values with at least one value
above the 99th percentile URL for cardiac troponin (cTn)

B. Chest pain is always present in patients with diabetes mellitus (DM) or in elderly
C. New or presumed new significant ST-segment–T wave (ST–T) changes

D. Transient diastolic murmur due to mitral regurgitation

E. Amount of myocardial damage depends uponpartial/total occlusionof supplying

vessel

F. 2D echocardiographyreveals regional wall motion abnormality (RWMA)

86. Which of the following is true with regard to Myocardial Infarction? (select all correct
answers)

A. New left bundle branch block (LBBB)

B. Those with anterior MI may have para-sympathetic overactivity

C. Amount of myocardial damage depends uponcollateral circulation

D. Radionuclide imaging is used routinely in the diagnosis of acute MI

E. Development of pathological Q waves in the ECG.
F. Identification of an intracoronary thrombus by angiography or autopsy

87. Which of the following is true with regard to Myocardial Infarction? (select all correct
answers)

A. Detection of a rise and/or fall of cardiac biomarker values with at least one value
above the 99th percentile URL for cardiac troponin (cTn)
B. Those with inferior MI may have sympathetic overactivity
C. Amount of myocardial damage depends uponterritory supplied by the occluded vessel
D. Development of pathological Q waves in the ECG.
E. Transient diastolic murmur due to mitral regurgitation

F. 2D echocardiographyreveals regional wall motion abnormality (RWMA)

88. Which of the following is true with regard to Myocardial Infarction? (select all correct
answers)

A. New or presumed new significant ST-segment–T wave (ST–T) changes

B. Amount of myocardial damage depends upon duration of occlusion of supplying
vessel
C. Confusion, syncope and profound weakness are typical presentation of myocardial
infarction
D. New left bundle branch block (LBBB) in ECG
E. Radionuclide imaging is used routinely in the diagnosis of acute MI
F. Identification of an intracoronary thrombus by angiography or autopsy

89. A 58 year-old woman presents to the Emergency Department with acute chest pain
describing as squeezing and ST elevation in the anterior chest leads of the ECG. The pain has
been present for about an hour and there is no previous history. Lab findings reveal
elevatedenzyme and troponin(> 99th percentile URL) levels. Ultrasound examination shows
new regional wall motion abnormality.What is your most likely diagnosis?(select the
correct answer):
A. STEMY/NQMI
B. STEMY/QwMI
C. NSTEMY
 D. Unstable Angina

90. A 45 year-old man presents to the Emergency Department with acute chest pain describing as
crushing and ST elevation withpathological Q waves in the anterior chest leads of the ECG.
The pain has been present for more than 1½ hours and there is no previous history. Lab
findings reveal elevated enzyme and troponin (> 99th percentile URL) levels. Ultrasound
examination shows newregional wall motion abnormality. What is your most likely
diagnosis?(select the correct answer):
A. STEMY/NQMI
B. STEMY/QwMI
C. NSTEMY
D. Unstable Angina

91. Which of the following is true with regard to Hypertension(select all correct answers)

A. Frequently asymptomatic until target organ disease occurs

B. Blood tests include measuring fasting lipids, creatinine, potassium
C. ECG shows right ventricular hypertrophy
D. Sudden and liable or severe BP elevation is suggestive of pheochromocytoma or a
sleep disorder
E. The urine albumin test or albumin/creatinine ratio (ACR) is used to identify the
very early stages of renal complication (microalbuminuria) of hypertension.
F. Retinal arteriolar constriction and sclerosis correspond to grade IV hypertensive
retinopathy

92. Which of the following is true with regard to Hypertension(select all correct answers)

A. Often recognized only on routine screening

B. High blood potassium level is suggestive of hyperaldosteronism
C. Common non-specific symptoms include headache, tinnitus, dizziness,
shortness of breath
D. Hypertension is a major risk factor for cerebral atherosclerosis and stroke
E. Papilledema corresponds to grade IIhypertensive retinopathy
F. Hypertension is one of the leading causes of end stage renal disease

93. Which of the following is true with regard to Hypertension(select all correct answers)

A. Essential hypertension is related to high sodium intake and water retention

B. Pathogenic mechanisms involve decreased cardiac output (CO) and increased total
peripheral resistance (TPR)
C. Increased intracellular Na due to defective or inhabited Na-K pump makes the cell
more sensitive to sympathetic stimulation
D. Vasodilator (bradykinin, nitric oxide) deficiency due to kidney disease or endothelial
dysfunction greatly affects BP
E. High normal BP level is defined as (ESH/ESC) SBP- 140-159 mmHg and DBP – 90-
99 mmHg
94. Which of the following is true with regard to Hypertension(select all correct answers)

A. Secondary hypertension is related to chronic kidney disease,renovascular disease,

endocrine disorders, coarctation of aorta
B. Pathogenic mechanisms involve increased cardiac output (CO) and decreased
total peripheral resistance (TPR)
C. Renin-angiotensin-aldosterone system (RAAS) activation is responsible for
regulating blood volume and systemic vascular resistance
D. Sympathetic stimulation increases BP usually more in normotensive patients than
in patients with prehypertension
E. Prehypertension is defined (JNC 7, AHA 2015) as SBP – 120-139 mmHg and
DBP - 80-89 mmHg

95. Which of the following is true with regard to Hypertension(select all correct answers)

A. A hypertensive emergency is severe hypertension with signs of damage to

target organs
B. Hypertensive urgency may lead to preeclampsia and eclampsia
C. Hypertensive emergency may cause acute left ventricular failure with
pulmonary edema
D. Hypertensive urgency may cause myocardial ischemia
E. Damage caused by hypertensive emergency is rapidly progressive and often
fatal

96. Which of the following is true with regard to Hypertension(select all correct answers)

A. A hypertensive urgencyis characterized with very high blood pressure (e.g, diastolic
pressure > 120 to 130 mm Hg) without target-organ damage
B. Hypertensive urgency may cause acute aortic dissection and renal failure
C. Target-organ damage caused by hypertensive emergency includes hypertensive
encephalopathy, preeclampsia and eclampsia
D. Damage caused by hypertensive urgency is rapidly progressive and often fatal
E. Hypertensive emergency may cause acute left ventricular failure with pulmonary
edema and myocardial ischemia

97. A 68-year old female patient presents to your office with worsening dyspnea on exertion and
history of hypertension. She states that she occasionally has a dry cough, but denies any
recent chest pain or fevers. Patient states that she usually can get up a flight of stairs if she
stops half-way, but over the last several days, has not been able to climb them at all. Physical
exam: HR: 99/min, BP 168/72 mm Hg, RR -28/min. Jugular venous pressure is mildly
elevated. No peripheral edema. Cardiac examination reveals regular rhythm, normal S1 and
S2. Lung examination reveals a few bibasilar crackles. An electrocardiogram shows Left
ventricular hypertrophy. An echocardiogram is significant for left ventricular hypertrophy
 and preserved systolic function (left ventricular ejection fraction: 57%).What is your most
likely diagnosis?(select all correct answers)

A. Left ventricular failure

B. Right ventricular failure
C. Left and Right ventricular failure
D. Systolic heart failure
E. Diastolic heart failure

98. A 57-year old obese man with diabetes mellitus is evaluated for a 1-month history of
progressive shortness of breath, palpitation and fatigueon exertion.One of his siblings has
“heart problems” and his mother died suddenly and unexpectedly at age 55 years.On
examination his heart rate is 90/min and his blood pressure is 175/100 mm Hg. BMI is 32.9.
Jugular venous pressure is mildly elevated. Lung examination reveals a few bibasilar
crackles. Cardiac examination reveals regular rhythm, normal S1 and S2 and the presence of
an S3. There is mild peripheral edema. An echocardiogram is significant for left ventricular
hypertrophy and decreased systolic function (left ventricular ejection fraction: 30%). An
electrocardiogram shows a previous MI.What is your most likely diagnosis?(select all
correct answers)

A. Left ventricular failure

B. Right ventricular failure
C. Left and Right ventricular failure
D. Systolic heart failure
E. Diastolic heart failure

99. Which of the following is true with regard to causes of Left ventricular failure? (select all
correct answers)

A. Volume overload: regurgitate valve, high output status

B. Pulmonary embolism and other causes of pulmonary hypertension
C. Pressure overload: systemic hypertension, outflow obstruction
D. Loss of muscles: post myocardial Infarction, chronic ischemia, infection, alcohol
E. Mitral stenosis

100. Which of the following is true with regard to causes of Right ventricular failure?
(select all correct answers)

A. Most common cause if left sided failure

B. Volume overload: regurgitate valve, high output status
C. Mitral stenosis
D. Pulmonary embolism and other causes of pulmonary hypertension
E. Loss of muscles: post myocardial Infarction, chronic ischemia, infection, alcohol

101. Which of the following is true with regard to Dysphagia? (select all correct answers)
 A. Dysphagia is pain during swallowing of liquids, solids, or both
B. Oropharyngeal dysphagia is difficulty of initiating swallowing accompanied by
nasal regurgitation and tracheal aspiration followed by coughing
C. Esophageal dysphagia occurs in patients with neurologic conditions or muscular
disorders that affect skeletal muscles
D. Oropharyngeal dysphagia is difficulty passing food down the esophagus due to a
motility disorder or a mechanical obstruction
E. Achalasia, esophageal cancer or substernal thyroid may cause esophageal
dysphagia

102. Which of the following is true with regard to Dysphagia? (select all correct answers)

F. Dysphagia is difficulty of swallowing of liquids, solids, or both

G. Oropharyngeal dysphagia occurs in patients with neurologic conditions or
muscular disorders that affect skeletal muscles
H. Esophageal dysphagia is difficulty of initiating swallowing accompanied by nasal
regurgitation and tracheal aspiration followed by coughing
I. Esophageal dysphagia is difficulty passing food down the esophagus due to a
motility disorder or a mechanical obstruction
J. Achalasia, caustic ingestion or thoracic tumor may cause oropharyngeal
dysphagia

103. Esophageal motility disorders include:(select all correct answers)

A. Achalasia
B. Caustic ingestion
C. Diffuse esophageal spasm
D. Systemic sclerosis
E. Esophageal cancer
F. Extrinsic compression due to enlarged atrium

104. Esophageal mechanical obstruction includes:(select all correct answers)

A. Achalasia
B. Caustic ingestion
C. Thoracic tumor
D. Diffuse esophageal spasm
E. Eosinophilic esophagitis
F. Extrinsic compression due to aortic aneurysm

105. Which of the following is true with regard to Achalasia?(select all correct answers)
A. Failure to relax of LES of uncertain etiology mostly in young adulthood
 B. Pocket-like structure that protrudes outward in a weak portion of the esophageal
lining anywhere between the throat and stomach
C. Progressive dilation above LES, normal or ulcerated mucosa with thickened
muscular wall
D. Herniation or protrusion of part of the stomach through the esophageal hiatus of
the dyaphragm
E. Characterized by progressive dysphagia, nocturnal regurgitation with aspiration
F. Risk for squamous cell carcinoma

106. Which of the following is true with regard to Esophageal diverticulum?(select all
correct answers)
A. Failure to relax of LES of uncertain etiology mostly in young adulthood

B. Pocket-like structure that protrudes outward in a weak portion of the esophageal

lining anywhere between the throat and stomach
C. Herniation or protrusion of part of the stomach through the esophageal hiatus of the
diaphragm

D. Epiphrenic diverticula is located in the mid-chest

E. Zenker’s diverticula (most common) is usually located in the back of the throat, just
above the esophagus

F. Characterized by three patterns: sliding (most common), rolling, or mixed

107. Which of the following is true with regard to Gastroesophageal reflux disease
(GERD)?(select all correct answers)
A. Heartburn, dysphagia and food and liquid regurgitation with sore throat are
common symptoms of GERD
B. Odynophagia, weight loss, anorexia and fatigue are common symptoms of GERD
C. 24 –hour ph monitoring reveals composite pH score or DeMeester<14.72
D. 10% of patients with long-standing GERD may develop Barret’s esophagus
E. Intestinal metaplasia (Barret’s esophagus) is most important risk factor of
squamous cell carcinoma

108. Which of the following is true with regard to Gastroesophageal reflux disease
(GERD)?(select all correct answers)
A. Heartburn, dysphagia and food and liquid regurgitation with sore throat are
common symptoms of GERD
B. Odynophagia and oropharingeal dysphagia are common symptoms of GERD
C. 24 –hour ph monitoring reveals composite pH score or DeMeester>14.72
D. 50% of patients with long-standing GERD may develop Barret’s esophagus
F. Intestinal metaplasia (Barret’s esophagus) is most important risk factor of
esophageal adenocarcinoma
109. Which of the following is true with regard toPain in Epigastrium in relation of food
intake? (select all correct answers)
A. Early pain - 30-60min after food intake is indicative of chr gastritis, peptic ulcer,
carcinoma
B. Pain Soon after food intake is indicative of duodenal ulcer, duodenitis
C. Late pain – 1-3 h after food intake is indicative of subcardial location of lesion
D. Night pain is indicative of duodenal ulcer
E. Fasting pain which reveals after food intake is indicative of chr gastritis

110. Which of the following is true with regard to Pain in Epigastrium in relation of food
intake? (select all correct answers)
A. Early pain - 30-60min after food intake is indicative of duodenal ulcer, duodenitis
B. Pain Soon after food intake is indicative of subcardial location of lesion
C. Late pain – 1-3 h after food intake is indicative of duodenal ulcer, duodenitis
D. Night pain is indicative of chr gastritis, peptic ulcer, carcinoma
E. Fasting pain which reveals after food intake is indicative of duodenal ulcer

111. Which of the following is true with regard to Acute Gastritis? (select all correct
answers)
A. Acute gastritis refers to neutrophylic infiltrate
B. Acute gastritis refers to mono-nuclear cell (particularly lymphocytes and
macrophages) infiltrate
C. H pillory gastritis is classified as acute gastritis
D. Chemical – reflux gastritis is classified as acute gastritis
E. Type A (autoimmune), Type B (h pillory related), Type AB (environmental)
gastritis are classified as acute gastritis
F. Bacterial, viral, fungal and parasitic infective gastritis are classified as acute
gastritis

112. Which of the following is true with regard to Duodenal ulcer? (select all correct
answers)
A. Chronic gastritis refers to neutrophylic infiltrate
B. Chronic gastritis refers to mono-nuclear cell (particularly lymphocytes and
macrophages) infiltrate
C. H pillory gastritis is classified as chronic gastritis
D. Bacterial, viral, fungal and parasitic infective gastritis are classified as chronic
gastritis
E. Chemical – reflux gastritis is classified as chronic gastritis
F. Type A (autoimmune), Type B (h pillory related), Type AB (environmental)
gastritis are classified as chronic gastritis

113. Which of the following is true with regard to Duodenal ulcer? (select all correct
answers)
 A. Most common in 50-60 age male population
B. Abdominal pain starts 2-3 hours after eating and relieves by eating
C. Characterized by 1-2 months duration
D. Weight loss as patient is afraid of eating
E. Hematemesis 40%
F. Melena 40%

114. Which of the following is true with regard to Duodenal ulcer? (select all correct
answers)
A. Most common in 30-40 age male population
B. Abdominal pain starts immediately after eating and relieves by lying down
and vomiting
C. Characterized by few weeks duration
D. Appetite is good and no weight loss
E. Hematemesis 60%
F. Melena 60%

115. Which of the following is true with regard to Crohn’s disease? (select all correct
answers)
A. Chronic trans-mural inflammation of the bowel wall with patchy distribution of
disease typically involving the terminal ileum and/or proximal colon
B. Chronic inflammation of the mucosa and submucosa of the rectum and colon with
ulceration of unknown cause
C. Common symptoms include abdominal pain, diarrhea and weight loss
D. Common symptoms include diarrhea with gross bleeding and tenesmus
E. May be accompanied with loss of vision, skin rush, arthritis
F. Colonoscopy is approximately 70% effective in diagnosing the disease

116. Which of the following is true with regard to Ulcerative Colitis? (select all correct
answers)
A. Chronic inflammation of the mucosa and submucosa of the rectum and colon with
ulceration of unknown cause
B. Chronic regional inflammation (patchy distribution of disease) of the bowel wall,
typically involving the terminal ileum and/or proximal colon
C. Common symptoms include diarrhea with gross bleeding and tenesmus
D. Common symptoms include abdominal pain, diarrhea and weight loss
E. Patients with inflammation of rectum and short segment of adjusted colon have
mild symptoms and better prognosis
F. May be accompanied with loss of vision, skin rush, pernicious anemia

117. Which of the following is true with regard to Diarrhea? (select all correct answers)
A. Characterized by consistently large diarrheal stools often in small bowel or
proximal colon disorders
 B. Secretory Infections are the cause of acute diarrhea
C. Irritable bowel syndrome is the cause of acute diarrhea
D. Drug-Induced diarrhea is classified as acute diarrhea
E. Malabsorption syndromes are the cause of acute diarrhea
F. Inflammatory infections with colonization or invasion of intestinal mucosa
are the cause of chronic diarrhea

118. Which of the following is true with regard to Diarrhea? (select all correct answers)
A. Characterized by small frequent stools with urgency of defecation in left colon
or rectal disorders
B. Inflammatory infections with colonization or invasion of intestinal mucosa
are the cause of chronic diarrhea
C. Ulcerative colitis and Crohn’s disease are the cause of chronic diarrhea
D. Cancer of the sigmoid colon is the cause of chronic diarrhea
E. Drug induced diarrhea is classified as chronic diarrhea
F. Voluminous diarrheas due to Osmotic diarrheas, Zollinger–Ellison syndrome
and Malabsorption syndromes, vasoactive intestinal peptide [VIP])are
classified as chronic diarrhea

119. A 32 years old woman presents to your office with complaints of cramping, abdominal
pain, bloating and diarrhea with frequent watery stool. She states that symptoms started 6
month ago due to emotional stress and reoccurring at least 3 days in each of the last 3 month.
Abdominal pain is relieved with defecation. She denies abuse of laxatives, weight loss, fever
or bleeding. What would be your working diagnosis? (select one correct answer):

A. IBS D
B. IBS C

C. Osmotic diarrhea
D. Cancer of colon

120. A27 years old woman presents to your office with complaints of cramping, abdominal
pain, bloating and constipation with hard stool and feeling of incomplete evacuation. She
states that symptoms started 6 month ago after eating too much chocolate. Symptoms
reoccurring at least 3 days in each of the last 3 month. Abdominal pain is relieved with
defecation. She denies weight loss, fever or bleeding. What would be your working
diagnosis? (select one correct answer):

A. IBS D
B. IBS C
C. Malabsorption syndrome
D. Ulcerative colitis
121. Unconjugated Hyperbilirubinemia is caused by: (select all correct answers)
A. Increased production most commonly due to hemolytic anemia
B. Dysfunction of hepatocytes (hepatocellular dysfunction)
C. Decreased conjugation due to glucuronic acid deficiency (Gilbert's syndrome)
D. Slowing of bile evacuation from the liver (intrahepatic cholestasis)
E. Obstruction of extra-hepatic bile flow (extra-hepatic cholestasis)
F. Decreased hepatic uptake most commonly due to heart failure

122. Conjugated Hyperbilirubinemia is caused by: (select all correct answers)

A. Decreased hepatic uptake most commonly due to heart failure
B. Dysfunction of hepatocytes (hepatocellular dysfunction)
C. Increased production most commonly due to hemolytic anemia
D. Slowing of bile evacuation from the liver (intrahepatic cholestasis)
E. Decreased conjugation due to glucuronic acid deficiency (Gilbert's syndrome)
F. Obstruction of extra-hepatic bile flow (extra-hepatic cholestasis)

123. Which of the following is true with regard to causes of Jaundice? (select all correct
answers)
A. Drugs, toxins, viral hepatitis resulting in hepatocellular dysfunction or
intrahepatic cholestasis
B. Alcoholic liver disease resulting in extra-hepatic cholestasis
C. Hemolysis resulting in increased bilirubin production
D. Heart failure resulting in decreased hepatic bilirubin uptake
E. Gylbert syndrome resulting in hepatocellular dysfunction

124. Which of the following is true with regard to causes of Jaundice? (select all correct
answers)
A. Bile duct stone, pancreatic cancer resulting in extra-hepatic cholestasis
B. Drugs, toxins, viral hepatitis resulting in increased bilirubin production
C. Gilbert syndrome resulting in decreased hepatic conjugation
D. Hemolysis resulting in decreased hepatic bilirubin uptake
E. Alcoholic liver disease resulting in intrahepatic cholestasis

125. Which of the following is true with regard to Lab tests for Liver Diseases? (select all
correct answers)
A. Cholestasis -> High serum and urine conjugated bilirubin, low or absent urine
urobilinogen
B. Liver cell damage ->High serum alkaline phosphatase
C. Hepatitis A ->detect IgG (previous exposure) and IgM (recent exposure)
antibodies
D. Hepatitis B -> detect Anti-HBs antibody as an indicator of resolution of active
infection
E. Hepatitis B ->detect HBs AG for acute or chronic infection
F. Hepatitis B -> detect Anti-HBe antibody as nearly indicator of acute infection

126. Which of the following is true with regard to Lab tests for Liver Diseases? (select all
 correct answers)
A. Bile duct obstruction ->High serum ALT, AST
B. Cholestasis -> High serum and urine conjugated bilirubin, low or absent urine
urobilinogen
C. Hemolysis -> increased serum unconjugated bilirubin and urine urobilinogen
D. Hepatitis B -> detect Anti-HBe antibody as an indicator of immunity (post
infection or vaccine)
E. Hepatitis B -> detect HBe AG as an indicator of high degree of infectivity
F. Hepatitis B -> detect Anti-HBs antibody as an indicator of resolution of active
infection

127. Which of the following is true with regard to Liver diseases? (select all correct
answers)
A. Chronic Hepatitis refers to inflammation, necrosis and fibrosis for at least 6
months
B. Acute hepatitis refers to acute severe impairment of liver function with
encephalopathy and coma in patients who had liver disease for less than 8
weeks
C. Common cause of Cirrhosis is ABC (Alcohol, B and C Hepatitis)
D. Ascites refers to the accumulation of excessive volumes of fluid within the
peritoneal cavity
E. Portal or splenic vein occlusion is a cause of presinusoidal portal hypertension

128. Which of the following is true with regard to Liver diseases? (select all correct
answers)
A. Acute hepatitis refers to inflammation, necrosis and fibrosis for at least 6
months
B. Hepatic encephalopathy is metabolic disorder of the of the CNS system and
neuromuscular system with slight changes in the brain
C. Necrosis, regenerating nodules and fibrosis is an etiology triad of Chronic
hepatitis
D. Testicular atrophy, gynecomastia, palmar erythema and spyderangiomas are
clinical features of hepatic failure caused by hyperestrogenism
E. Cirrhosis and alcoholic hepatitis are causes of postsinusoidal portal
hypertension

129. Which of the following is true with regard to Symptoms and Signs of Kidney
disorders?(select all correct answers)
A. Dysuria is a painful or difficult urination
B. Polyuria is a complaint that the individual has to wake up at night one or more
times for voiding
C. Oliguria is a low output of urine
D. Nocturia is an excessive or abnormally large production or passage of urine
(greater than 2.5 or 3 L over 24 hours in adults)
E. Haematuria refers topresence of RBC (erythrocytes) in the urine
130. Which of the following is true with regard to Symptoms and Signs of Kidney
disorders? (select all correct answers)
A. Dysuria is a low output of urine
B. Polyuria is an excessive or abnormally large production or passage of urine (greater
than 2.5 or 3 L over 24 hours in adults)
C. Oliguria is a painful or difficult urination
D. Nocturia is a complaint that the individual has to wake up at night one or more times
for voiding
E. Haematuria refers to presence of RBC (erythrocytes) in the urine

131. Which of the following is true with regard to Nephrotic syndrome? (select all correct
answers)
A. Proteinuria (>3.5g day)
B. Hematuria
C. Oedema
D. Oliguria
E. Primary causes include minimal change glomerulonephritis (GN), membranous GN,
focal segmental glomerulosclerosis
F. Primary causes include rapidly progressive glomerulonephritis (GN), membranous
GN, focal segmental glomerulosclerosis

132. Which of the following is true with regard to Nephritic syndrome? (select all correct
answers)
A. Hypertension
B. Hypoalbuminaemia (<30g/L)
C. Uremia
D. Hyperlipidemia (elevated LDL and cholesterol)
E. Primary causes include minimal change glomerulonephritis (GN), membranous
GN, focal segmental glomerulosclerosis
F. Primary causes include rapidly progressive glomerulonephritis (GN),
membranous GN, focal segmental glomerulosclerosis

133. Which of the following is true with regard to Acute Renal Failure? (select all correct
answers)
A. Significant deterioration in renal function occur over hours or days
B. Long-standing and usually progressive impairment in renal function
C. Primary disease process is irreversible
D. Clinically no symptoms and signs except for oliguria (<400 ml/day), which occurs
in 70% of patients, and no long-term complications
E. Produces symptoms when glomerular filtration rate falls below 30 ml/min with
initial manifestation of uremia
F. Kidney per-fusion failure, hypovolemia and renal artery obstruction are prerenal
causes of acute renal failure
G. Renal manifestations include nocturia, polyuria

134. Which of the following is true with regard to Chronic Renal Failure? (select all correct
 answers)
A. Significant deterioration in renal function occur over hours or days
B. Long-standing and usually progressive impairment in renal function
C. Injury to kidney is reversible within days/weeks
D. Clinically no symptoms and signs except for oliguria (<400 ml/day), which occurs
in 70% of patients, and no long-term complications
E. Produces symptoms when glomerular filtration rate falls below 30 ml/min with
initial manifestation of uremia
F. Renal manifestations include nocturia, polyuria

135. Acquired Coagulation disorders include: (select all correct answers)

A. Vitamin K deficiency
B. Hemophilia A (factor VIII deficiency)
C. Liver disease
D. Anti-coagulation with warfarin or heparin
E. Hemophilia B (factor IX deficiency)

136. Hereditary Coagulation disorders include: (select all correct answers)

A. Vitamin K deficiency
B. Liver disease
C. Hemophilia A (factor VIII deficiency)
D. Anti coagulation with warfarin or heparin
E. Hemophilia B (factor IX deficiency)

137. Which of the following is true with regard to Anemia? (select all correct answers)
A. Anemia is a decrease in the number of RBCs, Hct, or Hb content
B. Iron-deficiency anemia is characterized by predominant number of
megaloblastic erythroblasts and relatively few normoblasts among the
hyperplastic erythroid cells in the bone marrow
C. Hemolytic anemia refers to increased rate of erythrocytes destruction.
D. Megaloblastic (pernicious) anemia is a hypochromic microcytic anemia
characterized by low serum iron, increased serum iron-binding capacity,
decreased serum ferritin and decreased marrow iron stores.
E. Diagnostic tests include CBC with WBC and platelets,RBC indices and
morphology, Reticulocyte count, Peripheral smear,Sometimes bone marrow
aspiration and biopsy
F. There is an increased risk of thrombosis and, rarely, acute leukemia and
myelofibrotic transformation.

138. Which of the following is true with regard to Polycythemia vera (PV)? (select all
correct answers)
A. Polycythemia vera is an-idiopathic chronic myeloproliferative disorder
characterized by an increase in RBC mass, which often manifests as an increased
 Hct.
B. Polycythemia vera is a malignant proliferation of cells of the lymphoreticular
system, primarily involving lymph node tissue, spleen, liver, and bone marrow.
C. Polycythemia is a genetic condition where blood cannot clot
D. There is an increased risk of thrombosis and, rarely, acute leukemia and
myelofibrotic transformation as well as hepatosplenomegaly
E. Diagnostic tests include CBC with WBC and platelets,RBC indices and
morphology, Reticulocyte count, Peripheral smear, sometimes bone marrow
aspiration and biopsy
F. Diagnosis is made by CBC, testing for JAK2 mutations, and clinical criteria.

139. Which of the following is true with regard to Leukemia ? (select all correct answers)
A. Leukemia is cancer of blood cells
B. High number of mature lymphocytes is typical abnormality for
acute myeloid Leukemia
C. Diagnosis of Acute myeloid Leukemia based on increased number
of immature white blood cells.
D. Leukemia referred to abnormality of platelets.

140. Which of the following is true with regard to Hodgkin’s lymphoma (select all correct
answers)
A.Biopsy reveals Reed-Sternberg cells (large, binucleated cells)

B.In Hodgkin’s Lymphoma primarily involved lymph node tissue, spleen, liver, and bone
marrow.

C. Hodgkin’s Lymphoma is disorder of coagulation.

D. It is typical for Hodgkin’s Lymphoma of single lymph node involvement

141. Which of the following is true with regard to non-Hodgkin’s lymphoma (select all
correct answers
A. Biopsy reveals Reed-Sternberg cells (large, binucleated cells)

B. Non-Hodgkin,s lymphomas (NHL) are a heterogeneous group of disorders involving

malignant monoclonal proliferation of lymphoid cells in lymphoreticular sites, including
lymph nodes, bone marrow, the spleen, the liver, and the GI tract

C. Non-Hodgkin’s lymphoma is one of types of Anemia.

D. Diagnosis is usually based on lymph node or bone marrow biopsy or both.

 2. Which of the following statements is true concerning Lipid lowering medication? (select
all correct answers)
A. Mechanism of action of Statins is inhibition of HMG –CoA reductase.
B. Pleitropic effects of Statins include: improvement of endothelial dysfunction,
increased nitric oxide bioavailability, inhibition of inflammatory responses, and
stabilization of atherosclerotic plaques.
C. Pleitropic effects of Statins include: decrease of preload and BP
D. Statins should be administered to all patients with documented atherosclerotic
diseases

3. Targets for treatment with Statins are(select correct answers);

A. LDL
B. Blood pressure
C. Triglycerides
D. Heart rate

4. Mechanisms of action Beta –blockers include ( select all correct answers):

A. Dilation of epicardial coronary vessels
B. Platelet aggregation inhibition
C. Reduction of myocardial oxygen demand
D. Inhibition of adrenergic activation
E. Reduction of heart rate

5. Angina drug treatment include (select all correct answers):

A. beta –blockers
B. Nitrates
C. Diuretics
D. Calcium blockers
E. Anxiolytics
6. Secondary prevention of CAD include(select correct answers); :
A.Statins
B. Diet modification
C.Smoking cessation
D. Antibiotics
 E.Nitrates
F.Aspirin
7. LDL Targets levels of lipid lowering treatment are (select all correct answers):
1. LDL < 70 mg/dl for very high risk individuals
2. LDL <130 mg/dl for patients with documented atherosclerotic disease
3. LDL < 70 mg/dl for patients with documented atherosclerotic disease
4. LDL <100 for high risk patients

8. Main mechanisms of action of nitrates include (select correct answers):

A. Reduction of inflammation
B. Systemic venodilation with concomitant reduction in left ventricular end-diastolic
volume
C. Dilation of epicardial coronary vessels
D. Increased blood flow in collateral vessels
150. Antihypertensive drug groups include ( select all correct answers):
A. ECE –inhibitors
B. Clopidogrel
C. Indapamide
D. Calcium blockers
E. diuretics
E. beta-blockers

151. Which of the following statements is true concerning management of Atherosclerosis ?

(select all correct answers)

A. The goals of lipid lowering treatment are : reducing LDL, Total cholesterol,
trigycerides ;increasing HDL cholesterol.
B. Diet modification is the component of preventive treatment in atherosclerosis
C. Tipple antibiotic theraphy is needed to prevent atherosclerosis progression
D. Nitrates are the component of preventive drug treatment in atherosclerosis