Cardiovascular system (1099320)รายDชา

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Choice the best answer

A couple of days of stabilization, underwent a cardiac operation. His heart valve

was resected and sent for pathological examination. What is the most likely
pathological finding? *

Degenerative change of the leaflets

Atherosclerotic change of the leaflets

Vegetation on the leaflets

Rheumatic fusion of the leaflets

Severe calcification of the leaflets

A 64-year-old female presented with a few episodes of sudden lightheadedness

and syncope when changing position supine to upright. Her medical history
includes hypertension and dyslipidemia, both of which are well controlled. Her
medications include aspirin, amlodipine, hydrochlorothiazide, atorvastatin, and
doxazosin. On examination, her heart rate (HR) was 66 bpm, blood pressure was
127/82 mm Hg, and body mass index (BMI) was 34 kg/m2. Blood pressure when
upright position was 105/70 mm Hg and has presyncope. Which of the following
is most likely responsible for her symptoms? *

Deconditioning

Volume depletion

Baroreceptor response

Medication side effect

Autonomic failure

A 37-year-old Thai male presented with fever, mild dyspnea on exertion and leg
edema for 1 week. He had a body temperature of 38.5 degrees Celsius. Physical
examination revealed a systolic murmur at the left lower parasternal border. Both
lungs were clear. The liver was 3 fingerbreadth below right costal margin with a
span of 12 cm. There was bilateral leg edema.What is the most likely involved
cardiac structure? *

Mitral valve

Tricuspid valve

Pulmonic valve

Aortic valve

Eustachian valve

A 65-year-old male presented with fever for 2 weeks prior to admission. The vital
signs were, BP 160/90 mmHg, PR 90/min, RR 20/min, and BT 38 degrees Celsius.
Physical examination revealed good consciousness, systolic murmur at left
parasternal area, bilaterally equal and clear breath sounds. Abdominal and
Neurological examination were within normal limits. CXR revealed mild
cardiomegaly. Echocardiogram showed vegetation size 1.5x1.5 cm at aortic valve
leaflets.The patient was admitted to the hospital. Unfortunately, he developed
paraplegia in the next morning. What is the most likely cause of the paraplegia? *

Encephalitis

Thromboembolism

Lateral myelitis

Septicemia

Myocarditis

Why does the heart shadow on chest x-ray AP view is usually larger than on PA
view? *

Angulation

Inspiration

Penetration

Rotation

Magnification

Which of the following essential amino acids are precursors for carnitine
synthesis? *

Glutamine and Asparagine

Lysine and Methionine

Alanine and Aspartate

Histidine and Cysteine

Proline and Valine

Which type of EKG was used for identified transmural infarct of myocardial? *

Inversion of T wave

PR segment prolong

ST segment depression

ST segment elevation

Widening of QRS

Which of the following conditions is associated with increased left ventricular

preload? *

Right ventricular infarction

Pulmonary embolism

Sepsis

Mitral regurgitation

Dehydration

Which is the best biomarker for acute coronary syndrome? *

Troponin

LDH

Myoglobin

CK

CK-MB

Which of the following must be treated hypertension with medication? *

56 years old man, average BP 140/90mmHg, Thai CV-risk score 8.5%

65 years old woman, average BP 160/100mmHg, no DM

40 years old woman, average BP 160/100 mmHg, impaired fasting glucose

45 years old woman, average BP 150/100 mmHg, Thai CV-risk score 7%

60 years old man, average BP 150/90mmHg, LVH

A 32-years old man with a history of prior syncope notices an odd odor, after
which he falls to the ground. He awakens 5 minutes later, confused and
disoriented, and is found to be incontinent of urine. Which following clinical
scenarios are the most likely cause of this patient? *

Cardiac syncope

Psychogenic pseudosyncope

Seizure

Orthostatic hypotension

Vasovagal Syncope

Which of the following is not the sign of left atrial enlargement? *

Posterior displacement of esophagus on lateral view Barium study

Enlarged left atrial appendage

Downward displacement of the cardiac apex in PA view

Widening carinal angle

Double contour sign

Which of the following clinical features is suggestive of cardiac syncope? *

Physical injury related to syncope

Family history of syncope

Syncope after exercise

Syncope in supine position

Recurrent syncopal episodes during last year

A 65-year old male with past history of dyslipidemia, is prescribed with statin to
inhibit cholesterol synthesis. What is the target enzyme of this drug? *

Acetyl coA carboxylase

HMG coA reductase

Malonyl coA decarboxylase

Lipase

Adenosine monophosphate activated protein kinase

A 30-year-old female visited to emergency department due to severe chest

pain. Her laboratory examination revealed hypercholesterolemia. She was
diagnosed with Type II hyperlipidemia. Which of the following molecules
defects? *

Apolipoprotein A-1

Low density lipoprotein receptor

Apolipoprotein C

High density lipoprotein receptor

Lipoprotein lipase

What is the main mechanism of vasculature that caused hypertension? *

Increase of prostaglandin

Increase of nitric oxide

Increase of endothelins

Decrease of calcification

Decrease of stiffness

A 25-years-old woman with history epilepsy, becomes warm, diaphoretic and

pale after donating blood, then suffers frank syncope while seated upright in a
chair. After being helped to the floor, she awakens embarrassed and alert. Which
following clinical scenarios are the most likely cause of this patient? *

Orthostatic Syncope

Reflex Syncope

Seizure

Cardiac syncope

Psychogenic pseudosyncope

Which of the following statements does not contain an essential condition for
defining syncope? *

Post recovery confusion

Spontaneous recovery

Rapid onset

Global cerebral hypoperfusion

Short duration

Which of the following that is not the sign of pulmonary edema from congestive
heart failure? *

Bat wing sign

Kerley A line

Cephalization

Kerley B line

Butterfly appearance of pulmonary opacities

Which of the following not associated with high blood pressure? *

Tachycardia

High systemic vascular resistance

Low cardiac output

Low end-systolic volume

High total peripheral resistance

A 42-year-old man presents with shortness of breath while jogging and a 4.5-kg
weight gain over the last month. On examination he has moderate pitting edema
in the lower extremities and a third heart sound. X-ray of the chest reveals
cardiomegaly. What findings must be present in order to confirm this man’s
underlying diagnosis? *

Myocardial thickening and hepatojugular reflux

Left ventricular dilation and systolic dysfunction

Myocardial thickening and diastolic dysfunction

Pulmonary congestion and diastolic dysfunction

Left ventricular dilation and aortic insufficiency

A 62-year-old man has progressive symptoms of dyspnea, and more recently

noticed difficulty lying supine. Examination shows an elevated JVP at 8 cm, with
a third heart sound, pitting edema, and crepitation both lower lungs. Which one
of the following may be implicated in fluid retention for this condition? *

Increased growth hormone

Decreased vasopressin

Increased estrogen

Increased aldosterone

Decreased renin

Which of the following is the most proper blood pressure measurement in the
clinic? *

Taking blood pressure in one arm, in the seated and standing positions.

Using the same cuff size for all patients.

Taking the blood pressure in one arm with the patient standing.

Taking the blood pressure in both arms with the patient seated and resting.

Using the brachial artery pressure as a substitute for central aortic pressure.

What is the pathophysiology of acute coronary syndrome? *

Plaque rupture

Monocyte differentiation

LDL migrate to endothelial

Smooth muscle proliferation

Endothelial activation

What is the cause of atherosclerosis? *

Low level of low-density lipoprotein

High level of blood monocyte

Low level of high-density lipoprotein

High level of high-density lipoprotein

High level of low-density lipoprotein

A 45-year-old Thai female presented with fever and dyspnea for 2 weeks. The
patient’s body temperature was 38 degrees Celsius. Physical examination
revealed a grade 4/6 systolic murmur at the Lt. apical area. There were bilateral
basal rales at both lungs with bilateral leg edema.Which of the following is the
most likely diagnosis? *

Viral myocarditis

Lobar pneumonitis

Infective endocarditis

Acute pericarditis

Rheumatic arthritis

A 45-year-old man presented with dyspnea during minimal activities for 1 month.
He denied chest pain but could not sleep well. His physical examination revealed
no edema, fine crepitation at both lower lungs, S3 gallop. What is the most likely
diagnosis? *

Congestive heart failure NYHA class II

Congestive heart failure NYHA class III

Congestive heart failure NYHA class I

Congestive heart failure NYHA class IV

Congestive heart failure NYHA class V

A 35-year-old female presented with high fever and signs of acute heart failure.
The vital signs were, BP 150/45mmHg, PR 95/min, RR 16/min, and BT 38.7 degrees
Celsius. Physical examination revealed good consciousness. Diastolic murmur
grade 5/6 was heard at right upper sternal border. There was bilateral rales from
chest auscultation. Infective endocarditis was suspected. What is the most likely
cardiac pathology in this patient? *

Ventricular septal defect

Tricuspid valve regurgitation

Mitral valve stenosis

Aortic valve insufficiency

Pulmonic valve stenosis

A 60 years-old male presented at the emergency room due to acute chest pain
for 3 hours. He has been a Type II DM for 10 years. His vital signs were BP 130/80
mmHg, RR 24 and pulse 80 bpm. ECG was done and shown below. Which is the
most likely diagnosis of this patient? *

Peptic ulcer disease

Subendocardial infarction

Costochondritis

Aortic dissection

Transmural infarction of myocardial

A 26-year-old female presented with fever and dyspnea for 2 weeks. Past history
revealed that she had her left upper molar tooth removed a week before the
symptoms occurred. At the ER, her body temperature was 38 degrees Celsius.
Physical examination revealed a grade 4/6 systolic murmur at the left apical area.
There was bilateral basal rales at both lungs. The CXR showed mild cardiomegaly.
Hemoculture was taken and the patient was hospitalized. What is the likely
organism that will show on the hemoculture report? *

Candida

Aeromonas spp.

SARS-CoV-2

Streptococcal spp

Mycobacterium tuberculosis

On chest x-ray PA upright, what is the normal value of the cardiothoracic ratio in
adult? *

< 0.65

< 0.50

< 0.45

< 0.55

< 0.60

A 40-year-old male visited to hospital with concerning about his risk in coronary
heart disease because his parent died with heart attack. The physician
recommended diet food supplements containing essential fatty acid (ω-3).
Which of the following fatty acids is ω-3? *

Linoleic

Stearic

Linolenic

Oleic

Palmitic

A 60 years old woman presents to the hospital for check up. Her examination is
notable for a blood pressure of 160/100 mmHg. She wants to know about factors
that would predispose her to hypertension. Which of the following is not
associated with hypertension? *

Obesity

Increasing age

Excess potassium intake

Excess sodium intake

Stress

What is the most common cause of dilated cardiomyopathy (DCM)? *

Infectious disease

Ischemia

Hypertension

Alcohol

Valvular heart disease

A 30-year-old woman presents for the first time with untreated congestive heart
failure (CHF). What is less likely to precipitate her condition? *

Thyrotoxicosis

Dyslipidemia

Anemia

Pregnancy

Infections

According to this ECG, which area of myocardial was involved? *

Posterior wall

Lateral wall

Superior wall

Anteroseptal wall

Inferior wall

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