GENERAL MEDICINE PAPER 3

1. Elective dental extractions on a patient who has had a myocardial infarct two months prior
are best:
a) Performed under oral valium sedation
b) Performed using an epinephrine free local anaesthetic
c) Performed using both of the above
d) Postponed until at least six months have elapsed
2.Patient history reveals dyspnoea, orthopnea, and edema of the ankle and palpitation. Most
likely diagnosis is:
a) Respiratory problem b) Hepatic failure
c) Uremia d) Congestive heart failure
3. T wave in ECG indicates?
a) Atrial depolarisation b) Ventricular depolarization
c) Atrial repolarisation d) Ventricular repolarisation
4. The most important Investigation done in infective endocarditis is?
a) 2-D Echo cardiography b) ECG
c) Serial blood cultures d) ASO titre
5. All of the following are risk factors for atherosclerosis except:
a) Increased waist-hip ratio
b) Hyperhomocysteinemia
c) Decreased fibrinogen levels
d) Decreased HDL levels
6. Aspartate aminotransferase is released
a) by viable cells
b) either a or c
c) after cell necrosis
d) none of the above

7. One of the causes of finger clubbing is:

a) lung carcinoma
b) Myocardial infarction
c) COPD
d) Asthma
8.In a patient with previous history of congestive cardiac failure, during dental treatment if he
shows sign and symptoms. The preferable patient position should be:
a) Trendelenberg position
b) Upright position
c) Reverse trendelenberg position
d) Left lateral position
9. The drug of choice for prompt relief of an ongoing attack of angina precipitated by
exercise or emotional stress is:
a) Propranolol
b) Verapamil
c) Sublingual nitroglycerin
d) Sublingual nifedipine
10. Pulses paradoxus is seen in:
a) Shock
b) Elderly
c) Emphysema/Asthma
d) High output state
11. Which of the following is NOT a predisposing for thrombosis and embolism?
a) Atrial fibrillation
b) Prolonged immobilization
c) Huntington disease
d) Prosthetic cardiac valve

12. Peripheral resistance of arteries measures

a) Systolic pressure
b) Mean pressure
c) Diastolic pressure
d) Pulse pressure
13. Which of the following is associated with cyanotic congenital heart disease?
a) Cor triatriatum
b) Mitral stenosis
c) Tetralogy of fallot
d) Primary pulmonary hypertension
14. After effective cardiopulmonary resuscitation there is:
a) Constriction of pupil
b) Dilation of pupil
c) Elevation of BP
d) None of the above
15. Thickening of ventricular walls is due to
a) Metaplasia
c) Hypertrophy
b) Anaplasia
d) Hyperplasia
16. Cardiac pain may be transmitted to the jaw due to the overlapping of
a) 5th cranial nerve, third cervical nerve and first thoracic nerve
b) 7th cranial nerve, third cervical nerve and first thoracic nerve
c) 5th cranial nerve, second cervical nerve and first thoracic nerve
d) 7th cranial nerve, second cervical nerve and first thoracic nerve

17. Secondary prevention of myocardial infarction management therapy includes

a) Antiplatelet therapy
b) A.C.E. Inhibitor
c) Statins
d) ALL above
18. The region of myocardium most prone for infarction is:
a) Rt. ventricular epicardial
b) Lft. ventricular epicardial
c) Rt. Ventricular sub endocardial
d) Lft. Ventricular sub endocardial
19. Patients with atrial fibrillation have
a) Regular irregular pulse
b) Irregularly irregular pulse
c) Pulsus anacroticus
d) pulsus dicroticus
20. Which one of the following is indicative of cardiac
tamponade?
a) Pulsus paradoxus
c) Kussmaul's sign
b) Wide pulse pressure
d) Forceful apical impulse
21. The main component of hyperlipidemia constituting a major risk factor for atherosclerosis
is
a) high density lipoprotein (HDL) cholesterol
b) VLDL
C) LDL
D) triglycerides

22. A cardiac patient must be asked to stop one of following drugs when he is coughing a lot
a) Diltiazem
c) Enalapril
b) Aspirin
d) Clopidogrel
23. Bacterial vegetations in heart valves are seen in:
a) Rheumatic heart disease
b) Infective endocarditis
c) A-V shunt
d) Corpulmonale
24. Fever, clubbing and Osler's nodes occur in:
a) Typhoid fever
b) Rheumatic fever
c) Infective endocarditis
d) Leptospirosis
25. Infective endocarditis is least likely to occur in:
a) coarctation of aorta
b) Atrial septal defect
c) Ventricular septal defect
d) Persistent ductus arteriosus
26. Commonest congenital heart disease is:
a) coarctation of aorta
b) Atrial septal defect
c) Ventricular septal defect
d) Persistent ductus arteriosus

27. For diagnosis of Acute Rheumatic fever, essential is:

a) Prior h/o rheumatic fever
b) Recent sore throat infection
c) 1 major and 2 minor criteria's
d) Erythema marginatum

28. Patient complaining of retrosternal chest pain for more than half an hour is most likely to
be:
a) Angina c) CHF
b) MI d) Congenital heart problem
29. The organism most common in SABE
a) S. albus
b) S. Aureus
c) S. typhi
d) S. Viridans
30. Troponin T is elevated in:
a) Myxoedema
c) Thyrotoxicosis
b) Myocardial infection
d) Viral Hepatitis
31. Most common cause of sudden death is:
a) Cerebral haemorrhage
b) Arrhythmias
c) Ruptured aortic aneurysm
d) Cancer

32. Physical sign of severe aortic stenosis is:

a) A late peaking holosystolic murmur
b) A delayed carotid upstroke
c) A diastolic rumble
d) An opening snap
33. A patient with multiple loose teeth requires extraction and has mitral stenosis with mild
cardiac insufficiency. He is on enalapril, digoxin, and furosemide. The antibiotic of choice to
prevent bacterial endocarditis is:
a) Amoxicillin
b) Doxycycline
c)metronidazole
d) Gentamicin
34. Most commonly affected value in rheumatic heart disease is:
a) Mitral b) tricuspid
c) Pulmonary d) aortic
35. Which of the following is characterized by increased LDH, fructokinase and serum
transaminase?
a) Angina pectoris
b) Pulmonary embolism
c) Myocardial infarction
d) Atrial tachycardia
36.Pacemaker of the heart is:
a) SA node b) AV node
c) Purkinje fibres d) His bundle
37. Dullness on percussion in the Traube's semilunar area denotes:
a) Cardiomegaly
c) Hepatomegaly
b) Splenomegaly
d) All of the above
38. Most common organism associated with reactive arthritis is?
a) Staphylococcus
b) Chlamydia
c) Shigella
d) Yersinia
39. The recommended level of anti-coagulation for most patients is an INR of
a) 1.0-2.0
b) 2.5-3.5
c) 2.0-3.0
d) 3.0-4.56
40. Sinus tachycardia is seen in
a) Severe anaemia
b) Beta blocker therapy
c) Athletes
d) Hypothyroidism
41. Addison's disease is caused by
a) Tuberculosis
b) HIV
c) Metastatic carcinomas
d) All of the above
42. Parry's disease if left untreated will lead to
a) Cerebro vascular stroke
b) Adrenal crisis
c) Pulmonary damage
d) Hyperthyroid crisis

43. The triad of cirrhosis, hemochromatosis and diabetes

are referred to as
a) Silver diabetes
b) Bronze diabetes
c) Diabetes insipidus
d) Black diabetes
44. Coloboma is a defect in
a) Cornea
b) Lens
c) Choroid
d) Iris
45. In primary immune deficiency, the fraction of plasma protein reduced is
a) a-1-globulin
b) a-2-globulin
c) B-globulin
d) y-globulin
46. Lyme disease is
a) caused by Borrelia vincentii
b) transmitted by flea bite
c) diagnosed by demonstration of specific IgM antibody
d) the etiological agent can be grown in modified Kelley's medium
47. Urticarial lesions are best described as
a) nonpruritic
b) evanescent
c) linear
d) macular

48.The first plasma protein to be generated after severe protein deficiency

a) Albumin
b) Fibrinogen
c) Globulin
d) Thrombin
49. Paraplegia is characterised by involvement of:
a) Both legs only
b) Both hands only
c) one arm and one leg
d) All 4 limbs
50.A 30-year-old highly health conscious woman has been ingesting vitamins and health
foods. She is complaining of hair loss, double vision and headache. Her liver function tests
are abnormal. She may be suffering from-
a) Dry beri beri
b) Hypervitaminosis A
c) vitamin E deficiency
d) Hypervitaminosis D