GOMAL MEDICAL COLLEGE, MTI, D.I.

KHAN (BLOCK-O)
Q#1: A man undergoes a pneumonectomy. After surgery, invs show hyponatremia. What could be the cause of the
Biochemical change?
a) Removal of hormonally active tumor d) Excessive κο
b) excess dextrose e) Hem dilution
c) Excess colloid
Q#2: A 74yr man who has been a smoker since he was 20 has recently been de with SCLC What serum electrolyte
picture will confirm the presence of SIADH?
a) High serum Na, low serum oumplarity, high urine osmolarity
b) Low serum Na, low serum osmolarity, high urine osmolarity
c) Low serum ta, high serum osmolarity, high wine osmolanty
d) High serum Na, low serum osmolarity, low urine osmolarity
e) High serum Na, high serum axmolarity, low urine asymmetry
Q#3: A man brought into the CD after being stabbed in the chest. Chest is bilaterally clear with muffled heart
sounds 6P 60/n Pulse is 1200pm. JVP raised. What is the most likely dx?
a) Pulmonary embolism d) Hem thorax
b) Cardiac tamponade e) Presumptuous
c) Precordial effusion
Q#4: A 26yr man unresent to ED with increasing SOB on left side and chest pain. He has been a heavy sunoker for
the past 4 years. He doesn't have any past med he. What is the likely dx?
a) Pulmonary embolism d) Pleural effusion
b) MI e) Pneumothorax
c) Asthma
Q#5: A 35yr man presents with progressive breathlessness. He gave a hx of polyarthraigia with painful lesions on
the shin. CXR: bilateral hilar lymphadenopathy. What's the most likely dx?
a) Bronchial asthma d) Bronchiectasis
b) Cystic fibrosis e) pneumonia
c) Sarcoidosis
Q#6: A 70yr man admits to asbestos exposure 20yrs ago and has attempted to quit smoking. He has noted weight
loss and hoarseness of voice. Choose the single most likely type of cancer a.w risk factors present.
a) nasal cell carcinoma d) Nasopharyngeal carcinoma
b) Bronchial carcinoma e) Oral carcinoma
c) Esophageal carcinoma
Q7: A PT who came from India presents with cough, fever and enlarged cervical LN. Exam: caseating granulomata
found in LN. What is the most appropriate dx?
a) Lymphoma d) Goiter
b) T8 adenitis e) Thyroid cyst
c) Thyroid carcinoma
Q8: A 55yr woman was found collapsed at home, paramedics revived her but in the ambulance she had a cardiac
arrest and couldn't be saved. The paramedic's report tells that the woman was immobile lately due to hip pain
and that they found ulcers on the medial side of ankle. She had DM and was on anti-diabetics. What is the cause
of her death?
a) Acute MI d) Acute pericarditis
b) DKA e) Cardiac tamponade
c) Pulmonary embolism
Q#9: A 30yr female attends DPD with a fever and dry cough. She says that she had headache, myalgia and joint
pain like one week ago. Exam: pulse 100bpm, temp-37.SC. CXIR: bilateral patchy consolidation. What is the single
most likely causative organism?
a) Pneumococcal pneumonia
b) Legionella
c) Mycoplasma
d) Kiebsiella
e) Chlamydia pneumonia
Q#10: A 45yr drug abuser is brought into the ED with complaint of fever, shivering, malaise, SOB and productive
Cough. Exam: temp 39C, pulse-110bpm, BP-100/70mmHg. Inv: CXR-bilateral cavitatige bronchopneumonia. What
is the single mast lively causative organism?
a) Mycoplasma
b) Staphylococcus
c) Chlamydia pneumonia
d) Botha & b
e) None of the above
Q#11: A 53yr man with a persistent tough and ha of smoking develops left sided chest pain exacerbated by dreg
breathing with or and located stickles What is the single most appropriate de?
a) Dissecting aneurysm
b) Pernardian
c) Prehumen’s
d) Pneumothorax
e) Pulmonary embolism
Q#12: A bur man complains of increased vet et sputum with specks of blood and chest pain he has a hx of
DVT.exam hobbling what in the cause of blood in tis sputum?
a) Pulmonary thrombosis
b) Bronchial carcinoma
c) Brenchiectau
d) Pulmonary TB
e) None of the above
Q#13: A 32yr lemur has a his et SOB and fever. Pre-Broncho-elation test was done and it was 2/3.5 and post
bronchodilator was 3/1.7. The it was da el crema and TB. What is the possible dx?
a) COPD
b) Asthma
c) Pneumonia
d) Bronchiectasis
e) None of the above
Q#14: A 74 yr lady called an ambulance for an acute chest pain. She has a hx of DM and HTN, and is a heavy
smoker Paramestics mentioned that she was overweight and recently immobile because of a hip pars. She
collapsed and died in the ambulance What is the most likely cause of death?
a) Pulmonary embolism
b) MI
c) Stroke
d) Cardiac arrhythmia
e) Cardiac failure
Q#15: A man presents with significant weight loss and complains of tough 5GB und chest pain exam: left pupil
constricted, drowsing of left eyelid. What is the must Exely dx?
a) Pancoast tumor
b) Thoracic outlet syndrome
c) Cervical
d) Pneumonia
e) Bronchogenic
Q16: A lady from Asia presented with umo in her neck. FNAC has been done and revealed lesions with cautious
material in the center surrounded by fibrosis. What is the most probable da?
a) Thyroid carcinoma
b) TB lymphadenitis
c) Lymphoma
d) Inf Mona
e) Mesothelioma
Q#17: A 34yr (VIDA presents with a 4m hx of productive cough. He has last sings. What is the single most
appropriate inv ?
a) Sputum for AFB
b) Laryngoscopy
c) Bronchoscopy
d) CT scan
e) CXR
Q#18: A 12yr man working in a shipyard comes with SOB. Exam: dullness on left side of the chest, pain in left side
of chest, pleuritic ruls and crackles been heard on the same side. What is the single most likely ds?
a) Pericarditis
b) Pleurisy
c) Pleural effusion
d) CCF
e) TB
Q#19: A 20yr student who recently visited Asia take to the OPD with complains of low grade lever, night sweats,
anorexia and productive cough. Inv: CXR citatory lesions in upper lobes. What is the single most kilt causative
organism?
a) Mycoplasma
b) Klebsiella
c) TB
d) PCP
e) Viral pneumonia
Q#20: A PT comes back from India and presents with night sweats and lymphadenopathy. XR: cavitation’s. What
inv should be done next?
a) CT scan
b) AFB stain
c) Blood culture
d) Bronchoscopy
e) None of the above
Q#21: According to WHO criteria, other than fast breathing which other second sign is more critical and sensitive,
for diagnosis of pneumonia?
a) Vomiting
b) Flu
c) lower chest in drawing
d) Chest pain
e) Prolong Fever.
Q#22: Steep in sign X-ray of soft tissue of Neck lateral view_reveals subglottic narrowing is present in which of the
following condition?
a) Croup
b) Acute Epiglottitis
c) Pneumonia,
d) Acute Bronchiolitis
e) Acute bronchitis
Q#23: Which of the following bacteria causes Acute Epiglottitis?
a) Streptococcus Pneumonia
b) I-Coli
c) H.influenza type b
d) Nesstra Meningitis
Q#24: 2year child presented with acute onset of high grade fever, drooling from mouth, stridor, instability lab
Investigation shows leukocytosis, thumb printing sign" Sign is seen on lateral film x-ray of Neck. What is your
Diagnosis?
a) Acute Bronchiolitis.
b) Acute Epiglottitis
c) Pneumonia.
d) Foreign Body
e) Croup
Q#25: Which of the following is main treatment option in Croup acute larygeo trachea bronchitis)
a) Iv ceftriaxone (antibiotic)
b) iv paracetamol.
c) Ventolin Nebulization.
d) Steroid Nebulization
e) Racemic Epinephrine Nebulization
Q26: 2 year child presented with recurrent sinu pulmonary infection and chronic diarrhea there is faltering
growth. Other sibling is also Alfie from same condition investigation shows: ESR+CBC-Normal, CXR Bilateral
haziness, Sweat chloride test shows more than 60mEq/L. Keeping in view history/Examination and investigation.
What is your Diagnosis?
a) Tuberculosis
b) Cystic fibrosis.
c) Immuno deficiency.
d) Celiac Disease.
e) Reactive airway Disease
Q#27: Which of the following is the most comma congenital heart Detect?
a) TGA
b) TOF
c) VSO
d) ASD
e) PDA
Q#28: The investigation of choice in diagnosis of congenital heart Disease is.
a) CXR
b) Echo cardiography
c) electro cardiography
d) ABG's
e) USG (ultrasound)
Q#29: Cyanotic baby with clubbing and history of squatting. What will be on LCG.
a) Right ventricular hypertrophy
b) Left ventricular hypertrophy
c) Right atrium hypertrophy
d) Left atrium hypertrophy
e) Congestive heart failure
O#30: Name the condition in which aorta arises from Right ventricule and pulmonary artery arises from the left
ventricule.
a) PDA
b) TOF
c) TGA
d) Coarctation
e) VSD
Q#31: Egg on string Appearance is the x-ray finding of which CHD Condition?
a) TGA
b) TOF
c) VSD
d) ASD
e) PDA
Q#32: Box shaped heart on x-ray is found in which of the following congenital heart Disease.
a) TOF
b) TGA
c) Ebstein Anomaly
d) VSD
e) PDA
Q#33: What is the primary indication for balloon valvuloplasty in children with valvular aortic stenosis?
a) Prevention of LV dysfunction
b) Prevention of aortic insufficiency
c) Prevention of coronary artery stenosis
d) Prevention of LV dilation
e) Prevention of LVH
Q#34: What is the recommended peak-to-peak systolic gradient between the left ventricle and aorta at rest for
balloon valvuloplasty in children with valvular aortic stenosis?
a) 30-40 mm Hg
b) 40-50 mm Hg
c) 50-60 mm Hg
d) 60-70 mm Hg e) 70-80 mm Hg
Q#35: Which procedure involves using the patient's own pulmonary valve to replace the abnormal aortic valve?
a) Balloon valvuloplasty
b) Aortic valve replacement
c) aortopulmonary translocation (Ross procedure)
d) Homograft valve replacement
e) Mechanical prosthetic valve replacement
Q#36: What is the recommended approach for prophylaxis against infective endocarditis in patients with aortic
stenosis?
a) Regular monitoring and intervention
b) Antibiotic prophylaxis
c) Baton valvuloplasty
d) Aortic valva replacement
e) No longer recommended
Q#37: What the primary defect in Tetralogy of fallot?
a) Aortic valve regurgitation
b) Anterior demation of the infundibular septum
c) Atrial septal defect
d) Ventricular septal defect
e) Mitral valve stenosis
Q#38. Which component of Tetralogy of Fallot is responsible for cyanosis?
a) Pulmonary stenosis
b) Ventricular septal defect
c) Dextroposition of the aorta
d) Right ventricular hypertrophy
e) All of the above
Q#39: What is the typical radiologic configuration seen in Tetralogy of Fallot?
a) Enlarged left heart border
b) Prominent right heart border
c) Boot shaped cardiac silhouette
d) Narrow aortic arch
e) None of the above
Q#40: What is the characteristic position assumed by children with Tetralogy of Fallot during episodes of dyspnea?
a) Supine position
b) Standing position
c) Lying down position
d) Squatting position
e) Prone passion
Q#41: What intervention can be performed to break a severe hypoxic spell in Tetralogy of Fallot?
a) Administration of oxygen
b) Injection of morphine
c) Intravenous sodium bicarbonate
d) Intubation and anesthetic sedation
e) All of the above
Q#42: What is the primary defect in Ebstain anomaly?
a) Aortic valve stenosis
b) Mitral valve regurgitation
c) Tricuspid valve displacement
d) Pulmonary valve atresia
e) Ventricular septal defect
Q#43: What is the cause of cyanosis in patients with Ebstain anomaly?
a) Atrial septal defect (ASD)
b) Ventricular septal defect (VSD)
c) Pulmonary valve stenosis
d) Tricuspid valve regurgitation
e) Right-to-left shunting through the foramen ovule
Q#44: What is the characteristic auscultator finding in Ebstain anomaly?
a) Diastolic murmur at the right sternal border
b) Systolic murmur at the left sternal border
c) Continuous murmur throughout the precarcium
d) Split $2 heart sound
e) injection click at the apex
Q#45: What is the diagnostic imaging modality of choice for Ebstein anomaly?
a) Chest radiography
b) electrocardiogram (LCG)
c) Echocardiography
d) Cardiac catheterization
e) Magnetic resonance imaging (MRI)
Q#46: What is the potential risk associated with cardiac catheterization in patients with Ebstein anomaly?
a) Ventricular arrhythmias
b) Pulmonary hypertension
c) Aortic valve regurgitation
d) Right bundle branch block
e) Increased right precordial voltage
Q#47: What is the most common form of aortic stenosis?
a) Valvular aortic stenosis
b) Subvalvular aortic stenosis.
c) Supravalvular aortic stenosis
d) Bicuspid aortic valve
e) Critical aortic stenosis
Q#48: Which diagnostic test can confirm the severity of aortic stenosis?
a) Electrocardiogram (ECG)
b) Chest radiograph
c) Echocardiography
d) Left-sided heart catheterization
e) Magnetic resonance imaging (MRI)
Q#49: Which of the following is the most common cause of acute rheumatic lever?
a) Streptococcus pyogenes infection
b) Influenza virus infection
c) Staphylococcus aureus infection
d) Human immunodeficiency virus (HIV) infection
e) Hepatitis B virus (HBV) infection
Q#50: Which of the following is the most common congenital heart defect?
a) Ventricular septal defect
b) Atrial septal defect
c) Patent ductus arteriosus
d) Tetralogy of Fallot
e) Coarctation of the aorta
Q#51: Which of the following is a common symptom of aortic stenosis?
a) Chest pain
b) Shortness of breath
c) Palpitations
d) Hypertension
e) None of the above
Q#52: Which of the following is a diagnostic test used to evaluate heart function?
a) Echocardiography
b) Computed tomography (CT) scan
c) Magnetic resonance imaging (MRI)
d) Positron emission tomography (PET) scan
e) None of the above
Q#53: Which of the following is a common symptom of mitral valve prolapse?
a) Chest pain d) Syncope
b) Palpitations e) All of the above
c) Shortness of breath
Q#54: Which of the following is a potential complication of untreated infective endocarditis?
a) Heart failure
b) Stroke
c) Aortic aneurysm
d) Pulmonary embolism
e) All of the above
Q#55: Which of the following is a type of cyanotic congenital heart disease?
a) Ventricular septal defect
b) Atrial septal defect
c) Coarctation of the aorta
d) Tetralogy of Fallot
e) Patent ductus arteriosus
Q#56: What is the most common cause of croup?
a) Bacterial Infection
b) Allergic reaction
c) Viral infection
d) Chronic lung disease
e) Environmental pollution
Q#57: Which of the following symptoms is characteristic of croup?
a) Sore throat
b) Productive cough
c) High grade fever
d) Inspiratory stridor
e) Watery eyes
Q#58: Which of the following symptoms is characteristic of acute epiglottitis?
a) Barking cough
b) Rhinorrhea
c) Sore throat with mild fever
d) Rapidly progressing respiratory obstructions
e) Hoarseness and inspiratory stridor
Q#59: What is the typical sture assumed by a child with acute epiglottitis?
a) Lying flat on the back
b) Leaning backward with the neck hyperextended
c) Sitting upright with the head tilted forward-Tripod position
d) Curling up in a fetal position
e) Leaning forward with the chin down & mouth closed
Q#60: Which radiographic sign is characteristic of epiglottitis?
a) Steeple sign
b) Thumb sign
c) C-shaped airway
d) Honeycomb appearance
e) Butterfly appearance
Q#61: What is the recommended approach for establishing an airway in patients with epiglottitis?
a) Administering bronchodilators
b) Initiating oxygen therapy
c) Performing tracheostomy
d) Endotracheal or nasotracheal intubation
e) Administering corticosteroids
Q#62: what percentage of children with epiglottitis without an artificial airway may die?
a) <1% d) 5-6%
b) 1-2% e) >6%
c) 3-4%
Q#63: Which of the following is the leading Infectious cause of death globally among children under 5 years of
age?
a) Malaria
b) Tuberculosis
c) Pneumonia
d) Measles e) Diarrhea
Q#64: Which of the following factors is closely linked to pneumonia mortality?
a) Age
b) Gender
c) Urbanization
d) Poverty
e) Vaccination coverage
Q#65: Which bacterial pathogen is the most common cause of pneumonia in children aged 3 weeks to 4 years?
a) Streptococcus pneumonia
b) Haemophilus influenza
c) Staphylococcus aureus
d) Mycoplasma pneumonia
e) Chlamydophila pneumonia
Q#66: The Immediate treatment of choice in most cases of flail chest is
a) Analgesics
b) Positive pressure ventilation
c) Tracheostomy
d) Breathing exercises
e) Fixation of fractured ribs
Q#67: A 25year old male patient receives chest intubation on left side chest following firearm Injury. After 3 hours
trauma surgeons plan to undertake emergency thoracotomy on him due to following observation:
a) Initial drainage of blood more than 1000 ml.
b) Initial drainage of more than 500 ml
c) Hemothorax associated with pneumothorax
d) flail chest
e) Ongoing hemorrhage of more than 200 ml/ hour over 3 hours
Q#68: A 26 year old male is brought to emergency department following road traffic accident. He is dyspneic and
complains of pain in his right leg (Right tibo-fibular fracture) and right side chest with abrasions evident over his
right side chest. His BP in 120/70, pulse is 125/min, respiratory rate is 36 breaths/min while his oxygen saturation
is 87% The rapid response team physician should take following next step to treat this patient:
a) Send the patient to X-ray room for X-ray chest
b) Positive pressure ventilation
c) Needle thoracentesis right side chest in mid clavicular line
d) Right side chest intubation
e) intravenous fluids
Q#69: A 35 year old female dies suddenly after an automobile collision. Which of the following is the most likely
cause of her death.
a) Fracture of her three ribs
b) Pelvic fracture
c) Tracheobronchial injury
d) Thoracic aorta rupture
e) Pulmonary contusion
Q#70: A 40 years old female patient with closed burn injury is admitted in surgical unit. She has signs of
inhalational Injury such as burnt nasal hairs, facial burn, hoarseness of voice. What is the best way to maintain
airway in her suspect development of airway obstruction due to laryngeal edema.
a) Cricothroidotomy
b) Transtracheal ventilation via needle
c) Endotracheal intubation
d) Tracheostomy
e) Provision of oxygen via facemask
Q#71: A 59-year-old man is admitted to the hospital after out ofhospitalcardiac arrest. He is successfully
resuscitated. and atthe hospital is found to have acute it elevation across chestlead v1 through v4, a suggestion of
anterior wall myocardial infarction, and increased cardiac enzyme values. Revascularization with a stent placed at
the left anterior descundingartery is successful, on day 03, clinical examination shows normal venous pressure and
heart sounds and clear lung fields. No peripheral edema is present his 12-lead electrocardiogram shows changes
consistent with anterior wall myocardial infarction On telemetry, however, several ventricular premature
contractions, both singly and in couplets, give a bigeminal pattern. bedside echocardiography shows an ejection
fraction of 55% with mild anterior wall motion abnormalities consistent with the previous infarction, predisharge
exercise treadmill test shows appropriate workload without evidence of ischemia. At this time you advise:
a) Prophylactic Cardioverter-Defibrillator Implantation
b) diagnostic electro physiologic study and implantable cardioverter-defibrillator if inducible ventricular
tachycardia nodules of small mature lymphocytes
c) amiodarone loading dose and maintenance dose of 200mg daily for at least 3 months
d) assessment and treatment of modifiable cardiac risk factors
e) holter monitoring at 1 month after dismissal and electro physiologic study if results are positive
Q#72: A 17-year-old boy comes for evaluation of a syncopal spell that occurred while he was waiting in the
dentist's
office. Although the spell was sudden, he remembers feeling hot and claramyand having a sensation of tunnel son
and of "not being there shortly before losing consciousness. Afterward, he came around quickly and was fully
oriented -versed although he felt some what fatigued. On examination in the office, there were no abnormal
physical findings. No orthostatic symptoms of signs were apparent. peripheral pulse and neurologic evaluation
were normal, Your next step is:
a) Order a tilt table test
b) Give a B-adrenergic blocker to prevent further episodes of syncope X
c) Perform awake and steep electroencephalography to rule out epilepsy
d) Reassure the patient
e) Advise an increased salt intake in the diet
Q#73: A 65-year-old man who had his first myocardial Infarction 10years ago comes for evaluation. His most
recent echo car diogramshews an ejection fraction of 25%. He denies syncope or palpitations. There is no history
suggestive of angina or congestive heart failure. He is receiving maximal medical therapy. The 12-lead
electrocardiogram is normal you recommend:
a) cardiac catheterization and possible revascularization
b) exercise perfusion study to assess for ischemia
c) implantation of a cardioverter-defibrillator
d) prolonged holter monitoring to assess for malignant arrhythmias
e) reassure the patient and arrange for outpatient follow-upin 6 months
Q#74: An 80-year-old woman presents to the emergency department with palpitations, dizziness, and shortness of
breath. In the past similar episodes have terminated spontaneously or with a valsalvamaneuver. apart from
increased cholesterol level and hypertension, which are both under good control, her health is otherwise
excellent, when seen, she is mildly distressed but fully conscious and alert, you note that an electrocardiogram
obtained in the past, when she was asymptomatic, was entirely normal which of the following is most likely?
a) Sinus tachycardia
b) Supraventricular tachycardia due to atrioventricular node reentry
c) Atrial fibrillation
d) Ventricular tachycardia
e) Pacemaker-mediated tachycardia
Q#75: A 48-year-old man is admitted to the coronary care unit with an acute inferior myocardial infarction. Two
hours after admission, his blood pressure is 86/52 mmhg, his heart rate is 40 beats per minute with sinus rhythm,
which of the following would be the most appropriate initial therapy?
a) immediate insertion of a temporary transvenouspacemaker
b) intravenous administration of atropine sulfate,0 6 mg
c) administration of normal saline, 300 ml over 15 min
d) intravenous administration of dobutamina 35 mg/min
e) intravenous administration of isoproterenol,5.0_g/min
Q#76: In A Cigarette Smoker With A History Of Intermittent Claudication And Newly Diagnosed Htn, A Doubling Of
Serum Creatinine Concentration Immediately After the Addition Of An Ace Inhibitor Suggests.
a) Hemodynamically significant bilateral renal artery stenosis
b) Pheochromocytoma
c) Primary aldosteronism
d) Emboli from arteriosclerosis obliterans of the descending aorta
e) Secondary aldosteronism
Q#77: A 35-year-old female presents for evaluation of chest pain. She describes "central chest pressure" that
comes on when she is angry at her students or when she swims. The discomfort is accompanied by shortness of
breath and is relieved within a few minutes by leaving the classroom or by rest. She denies any chest pain at rest
or at night. She has never used ntg. She has no history of dm orhtn. She smokes one pack per day of cigarettes.
She feels that she is overweight and is trying to follow a low-fat diet and to lose weight. Her cholesterol has never
been checked. Her father died of an ami at age of on physical exam, her bp is 120/70 mmhg and hr is 72 bpm and
regular. Her cardiac exam is normal. Her resting ecg Is normal. What is the preferred initial diagnostic test on this
patient according to acc/aha practice guidelines?
a) Trademill exercise testing
b) Exercise mpi
c) Adenosine mpi
d) Exercise echocardiography
e) Dobutamine echocardiography
Q#78: A 56-year-old man comes to the office a few days after an episode of chest pain this was his first episode of
pain, and he has no risk factors. In the emergency department, he had a normal ekg and normal ck-mb and was
Released the next day. Which of the following is most appropriate in his further management?
a) Repeat ck-mb
b) Statin
c) LdL level
d) Stress (exercise tolerance) testing
e) Angiography
Q#79: A 63-year-old woman is in your office for evaluation of an abnormal stress test that shows an area of
reversible Ischemia. She has no risk factors for cad. What is the most accurate diagnostic test, or what is the best
next step in further management?
a) Troponin level
b) Angiography
c) Coronary bypass
d) Echocardiogram
e) Nuclear ventriculogram (muga scan)
Q#80: A patient admitted 5 days ago for a myocardial infarction has a new episode of chest pain which of the
following is the most specific method of establishing the diagnosis of a new infarction?
a) Ck mb
b) Tropanin
c) Echocardiogram
d) Stress testing
e) Angiography
Q#81: A 72-year-old man comes to the emergency department having had chest pain for the last hour. His initial
ekg shows st segment elevation in leads v2-v4, aspirin has been given, Which of the following will most likely
benefit this patient?
a) Ck-mb
b) Stress test
c) Angioplasty
d) Metoprolol
e) Statin
#82: A 54-year-old man with a history of diabetes and hypertension comes to the emergency department with
brushing, substernal chest pain that radiates to his left arm. The pain has been on and off for several hours, with
this last episode being 30 minutes, in duration. He has had chest pain on exertion before, but this is the first time
it has developed at rest. The ekg is normal. Aspirin, oxygen, and nitrates have been given. Troponin levels are
elevated. Which of the following is most likely to benefit this patient?
a) Low molecular weight heprarin
b) Thrombolytics
c) Diltiazem
d) Morphine
e) Ck-mb levels
Q#83: many medication, such asa stains, cholestyramine, gemfibrozil, ezetimibe, and niacin, lower ldl, lower
triglyceride and total cholesterol, and raise hdl, which of the following is the most important reason for using
statins?
a) Fewer adverse effects
b) Lower cost
c) Greater patient acceptance
d) Greatest mortally benefit
e) Greatest effect on lowering ldl
Q#84: A 63-year old woman comes to the emergency department with acute, severe shortness of breath, rales on
lung exam S3 gallop, and orthopnea. Which of the following is the most important step?
a) Chest ray
b) Oxygen, furosemide, nitrates, and morphine
c) Echocardiogram
d) Digoxin
e) Beta blockers
Q#85: A 80-year-old woman is admitted to the intensive care unit for acute pulmonary edema. She has rales to
the apices and jugulovenous distention. Her ekg shows ventricular tachycardia. Which of the following is the best
therapy?
a) Synchronized cardioversion
b) Unsynchronized cardioversion
c) Cocaine
d) Amiodarone
e) Metoprolol
Q#86: A 42 years old man present to emergency with acute chest pain. All of the following may be potential cause
of chest discomfort except?
a) Myocardial ischemic
b) Aortic dissection
c) Pneumothorax
d) Herpes zoster
e) VSD
Q#87: Which of the fallowing cause continuous murmur?
a) VSD
b) ASD
c) Aortic stenosis
d) Mitral regurgitation
e) PDA
Q#88: All of the following can occur as complication of myocardial infarction EXCEPT:
a) Mitral regurgitation
b) Mitral stenosis
c) Ventricle septal rapture
d) AF
e) VT
Q#89. Which of the following can be given to increase heart rate in sinus bradycardia?
a) Verapamil
b) Digoxin
c) Amiodarone
d) Atropine
e) Metoprolol
Q#90: A known case of copd & congestive heart failure presents to you with shortness of breath, which of the
following blood test is useful to differentiate between radiac & respiratory causes of copd?
a) BNP
b) S-calcium
c) Serum alkaline phosphatase
d) Serum electrolytes
e) Arteral blood gases (abgs)
Q#91. All of the following can cause high output cardiac failure except
a) Hypertrophic cardiomyopathy
b) Carcinoid syndrome
c) Beriberi
d) Hyperthyroidism
e) Severe anemia
Q#92: A known patient of ischemic heart disease who has reduced ejection fraction presents with shortness of
breath with minimal physical activities. Which nyha class is he in?
a) Nyha i
b) Nyha ii
c) Nyha iii
d) Nyha iv
e) Ccs iii
Q#93: A 60 years old male presented with sudden onset of palpitation. ECG in emergency showed fast atrial
fibrillation. Its BP dropped from 120/80 to 70 systolic. Which is the most appropriate action to be taken in
emergency department?
a) iv metoprolol
b) iv digoxin
c) iv amiodarone
d) Normal saline and then oral calcium chamnelblodia
e) DC cardioversion
Q#94: In second degree mobilize type 1 block, the basic pathology lies in
a) Sa node
b) Atria
c) Av node
d) Right bundle branch
e) Left bundle branch
Q#95: A 65 years old male with diabetes, developed heart failure after anterior wall mi, which is the preferred
drug for treatment of his diabetes?
a) Biguanides
b) Sulfonylurea
c) Thiazolidinedione
d) Sgit2 inhibitors
e) Acrabose
Q#96: A 70 years old male presents with acute cp and diaphoresis fo 2 hours to er department. diagnosis of acute
stemi is made which of the following is definitive treatment?
a) Primary pci
b) Thrombolytic
c) Antiensentation
d) Dual autiplatelets
e) Beta blockers
Q#97: A 55 year old diabetic female admitted as a case of acute inferior wall mi with iv infect, dropped bp to
90/50 what 1st management step will you do ?
a) IV dopamine support
b) IV dobutamine support
c) IV fluid
d) IV adrenaline
e) Beta blocker
Q#98: What is the ideal door to balloon time in stemi patient?
a) <90 mints
b) 120 mints
c) 180 mints
d) 60 mints
e) 30 mints
Q#99: What is the ideal door to needle time in stemi?
a) 30 mints
b) 60 mints
c) 90 mints
d) 120 mints
e) 180 mints
Q#100: What is rescue pci?
a) Pci after failed thrombolysis
b) Pci after useful thrombolysis
c) Pci after anticoagulation
d) Pci after hospital discharge
e) Pci without thrombolysis
Q#101: Which patients should be treated with beta blocker
a) Patient in acute heart failure
b) Asthmatic
c) Patients with 1" degree
d) Extensive mi
e) Complete heart block
Q#102: Which is the mechanical complication of ml?
a) Ventricular septal rupture
b) Complete heart block
c) Ventricular tachycardia
d) Atrial fibrillation
e) Asystole
Q#103: Other than plaque rupture which of the following cannot cause mi?
a) Coronary vasospasm
b) Coronary embolism
c) Spontaneous coronary artery dissection
d) Deep vein thrombosis
e) Coronary artery severe bridging
Q#104: 60year old female diabetic presented with chest pain that increased with breathing and was relieved with
leaning forward. ecg showed st elevation in i avl, li, lil, avf and precordial leads, What is the diagnosis?
a) Plevritis
b) Pericarditis
c) Extensive mi
d) Inferior ml
e) Lateral mi
Q#105: What is the most important hemodynamic criteria of cardiogenic shock?
a) Sbp <70mm hg for > 30mints
b) Cardiac index >202 1/mm/m2
c) Pulmonary artery pressures 15-18mm hg
d) Heart rate 50bpm
e) Dyspnea nyha iii
Q#106: 70 year old male admitted with acute awini suddenly dropped sbp <90mmhg. on auscultation he has a pan
systolic murmur. What is the cause of psm?
a) Aortic regurgitation
b) Aortic stenosis
c) Mitral regurgitation
d) Mitral regurgitation
e) Tricuspid regurgitation
Q#107: All of the following can cause systolic murmur except.
a) Murmur stenosis
b) Mitral regurgitation
c) Tricuspid regurgitation
d) Ventricular septal rupture
e) Aortic regurgitation
Q#108: 28 years old male with 11 days history of fever with viral prod Rome, arthralgia's and myalgia’s presented
with chest pain, dyspnea-iii and ventricular arrhythmias, what is the diagnosis?
a) Myocarditis
b) Acute mi
c) Cardiac failure
d) Ventricular tachycardia
e) Rheumatic mitral stenosis
Q#109: A 30 yare old footballer was admitted with acute myocarditis on discharge what advice will you give for
rejoining a football team?
a) After 3 months
b) After 3 weeks
c) After 6 months
d) After 3 weeks e) After 1 year
Q#110: What are the pharmacologic treatments of hypertrophic cardiomyopathy?
a) Septal myectomy d) Beta blocker
b) Alcohol septal ablation e) Cabg
c) Dual chamber pacing
Q#111:27year young boy with history of iv drug abuse developed high grade fever with chest discomfort and
dyspnea despite antibiotic therapy fever did not subside echocardiography showed a small vegetation on the
septal
leaflet of tricuspid valve what is the diagnosis?
a) Infective endocarditis d) Phlebitis
b) Plevritis e) Enteric fever
c) Pneumonia
Q#112: A 27year old male is diagnosed as infective endocarditis. what empirical therapy shall be given to the
patient till report is available?
a) Ceftriaxone vibramycin d) Metronidazol + ceftriaxone
b) Vancomycin gentamycin e) Ciprofloxacin metronidazole
c) Levofloxacin gratifloxacin
Q#113: 35year old female known case of copd p/w c/o palpitation and dyspnea, o/e she had bp of 100/70 and
pulse 110bpm, ecg showed narrow complexes hr 123, irregular and absent p wave. What is the da?
a) VT d) AF
b) SVT e) VF
c) SINUS TACYCARDIA
Q#114: 40year male with hr of RIGHT FEMUR FRACTURE followed by DEEP VEIN THROMBOSIS p/w c/o temporary
sudden LOSS of CONSCIOUSNESS, severe chest pain and dysne a O/E SP 02 70% pulse 110bpm B.P 100/60 silent
chest and S1+52 available What is the diagnosis?
a) Acute MI d) Acute severe Arrhythmia
b) Pneumonia e) Cardiac Failure
c) Pulmonary embolism
Q#115:17year boy p/w high grade fever rigors and chills. dx of infective endocarditis was made, which criteria is
used for dx of infective endocarditis?
a) Modified dukes criteria d) Back walls criteria
b) Modified jhones criteria--Rhaetic fever. e) Wells criteria
c) Rukfield criteria
Q#116: A 50-year-old smoker male with COPD develop aching in the distal extremities specially the wrist joints, he
has a 10 kg weight loss and clubbing. X-ray Hand show periosteal thickening. You would:
a) Ciprofloxacin d) Start DMARD
b) Get a chest X-Ray e) None of the above
c) Aspirate Joint
Q#117: 20year old patient present with fever weight loss and night sweat, on examination he has decrease chest,
moments with dull percussion notes and absent breath sound. The likely Diagnosis is.
a) Pneumothorax d) Atelectasis
b) Pleural effusion e) None of the above
c) Consolidation
Q#118: 50year old female with history of UTI, COPD and Asthma present with bilateral infiltrates and eosinophil
count of 15%. The least likely diagnosis is
a) Allergic Bronchopulmonary aspergillus’s (ABPA) d) Strongyloides infection
b) Hypersensitivity Pneumonitis e) None of the above
c) Side effect of nitrofurantoin
Q#119:50year old patient develops cough and fever chest X-ray show air fluid level in the superior segment of the
right lower lobe. The mostly likely etiologic agent is.
a) Strep Pneumonia d) Anaerobes
b) H.influenza e) None of the above
c) Legionella
Q#120: Which of the following does not indicate a poor prognostic finding in asthma?
a) Altered mental status. d) Pulses paradox us of 5 mmhg
b) Silent chest e) None of the above
c) Hypercapnia