36. A 75 years old woman returns to the clinic for follow up.

BP 160-170/70-0 at
presentation and now 1!0-150/60-70 on amlodipine 5 m"/day. #he as$s if she
can stop her medication %ecause she thin$s it&s ma$in" her tired and her feet
are swellin"' ma$in" it difficult to wear her %est shoes. BP 1!(/6). P!.
*uestion. +hat should you tell her ,
A. #top her medication
B. -educe the dose of amlodipine.
.. .om%ine amlodipine eith /.01.
2. -ecommend salt restriction and wei"ht loss.
3. .han"e her medication with other calcium anta"onist.
37. A 6) y.o. woman presents to your office concerned a%out shortness of %reath'
while wal$in" and when tryin" to sleep' one month after a non * wa4e 56.
#he is ta$in" atenolol and 6#27. #he has not had chest pain or palpitations
since her 56.
*uestion 8 +hat physical e9am findin"s would confirm it,
A. 0achypnea with pulsus alternans.
B. :;P < cm at !50 position = irre"uler rhytm
.. 0he :;P < cm at 300 position = "allop rhythm
2. .rac$les %i%asilar lun" = :;P < cm at supine position.
3. Parado9ical systolic mo4ement seen %y inspection or palpitation
3 A 60 y.o. man with a history of chronic sta%le an"ina de4elops an$le swellin" and
increasin" shortness of %reath and cou"hin" durin" his daily wal$s. P5/ 8 type )
25' hyperlipidemia' >uit smo$in" 5 years a"o. /e ta$es metformin' pro4astatin'
A#A' and nitro"liserin. :;P is 10 cm at 300 position' = #3 without murmurs' )=
edema. /is 3.? shows old * wa4es in 66' 666' and a;@.
*uestion 8 +hat is the %est medication for this patient ,
A. 2i"o9in with %isoprolol
B. 2i"o9in with furosemide.
.. @urosemide with captopril
2. @urosemide with %isoprolol
3. .aptopril with spironolactone
3(. 6n order to support dia"nosis and to predict pro"nosis in this patient' we need
la%oratory e9amination. +hich one ,
A. 0roponin 0
B. ?lucose tolerance test.
.. Brain natriuretic peptide.
2. .reatine $inase 5B isoenAyme
3. /i"h-sensiti4ity .-reacti4e protein
!0. Bn a routine office 4isit' a !5 y.o. man is found to ha4e a%normal le4els of lipid
profile. 0he le4el of C2C-. was )30 m"/dl' tri"lyceride was )0 m"/dl' and
serum le4el of /2C-. was 30 m"/dl. /is mea"er attempts a diet and e9ercise do
not alter his lipid profile si"nificantly' and he is started on sim4astatin. Before he
ta$es the first dose' his li4er enAymes are chec$ed and he is told that this test will
%e repeated in 3 months.
*uestion 8 Besides sim4astatin you can choose the more potent a"ent to optimiAe
the impro4ement of lipid profile of this patient. +hich dru" ,
A. 3Aitimi%e
B. @enofi%rate
.. ?emfi%roAil
2. 7icotinic acid
3. Bile se>uesterin" resin.
!1. An 0 y.o. male presents to your clinic with 5 month history of pro"ressi4e
shortness of %reath' dyspnea on e9ertion' orthopnea' and lower e9tremity edema.
/e notes Dchest pressureE while wal$in" up that is relie4ed with rest. Bn e9am'
:;P8-=! at supine position. 0here is an audi%le "rade 6; systolic eFection
murmur heard at the %ase with radiation to the carotid arteries. An 3.? shows
e4idence of C;/. 3chocardio"ram shows stenotic' calcified aortic 4al4e with an
estimated 4al4e area of 0'7 cm). 3@ !0 G.
*uestion 8 +hat mana"ement step should you recommend to impro4e lon"-term
sur4i4al ,
A. #ur"ical 4al4ulotomy
B. A.3 inhi%itor = /.01
.. 2i"o9in = @urosemide
2. Ballon 4al4uloplasty
3. Aortic 4al4e replacement.
!). @rom the last 3.? of this patient we can descri%e the site of a%normal process'
that is ,
A. .onduction in CBB
B. Atrial depolariAation
.. .onduction in A; node.
2. ;entricle depolariAation
3. .onduction in Pur$inye&s cells
!3. A ! y.o. woman come to the hospital with complain of chest pain durin"
clim%in" two fli"hts of ladder and the symptom relie4ed at rest. 0his symptom
has %een e9perienced since 3 months a"o. Post medical history 8 hipertension
since 10 years a"o with captopril therapy ) 9 )5 m"/day re"ularly. @i4e months
later the result of echocardio"raphic e9amination re4ealed diastolic dysfunction.
0he result of 3.? recordin" within normal limit.
*uestion 8 +hat is the most appropriate e9amination for e4aluatin" the patient&s
A. 0ransoesopha"eal echocardio"raphy.
B. 39ercise 3.? test
.. #erial 3.?
2. .oronary an"io"raphy
3. /olter monitorin".
!!. -e"ardin" this case' the #0-se"ment ele4ation in the initial 3.? %ac$ to the
normal after chewin" 6#27 is caused %y ,
A. 0he collateral system is not fully de4elop
B. #pontaneous lysis of the arterial throm%us.
.. 6t is a non-#0 ele4ation myocardial infarction
2. 0he cause of #0-se"ment ele4ation Fust of coronary spasm.
3. 0he throm%us released from the %ranch of the coronary artery.
!5. A woman admitted to the hospital with paleness' ner4ous and disorientation.
Physical e9am H cool e9tremities' BP undetecta%le' and pulseless. 3.? recordin"
re4eals CBBB. Ca% 8 Positi4e troponin 0 test' and .I-5B 100 J/C
*uestion 8 +hat is the most li$ely dia"nosis in this patient ,
A. A56 with acute lun" edema
B. A56 with cardio"enic shoc$.
.. A56 with 4entricular tachycardia
2. Bld infarct with cardio"enis shoc$
3. Bld infarct with supra4entricular tachycardia.
!6. A !5 y.o. male with ./@ caused %y se4ere ischemis heart disease was admitted to
the hospital. Bn physical e9am 8 /- 1109/min' BP 100/0 mm/?' - 30/min. /e
was then "i4en aspirin 50 m"' low molecular wei"ht heparin ) times 0'6 m"/day'
nitro"lycerine 6; ) m"/min and captopril ) times 6')5 m"/day.
*uestion 8 +hat is the reason for "i4in" him captopril ,
A. 0o decrease heart rate
B. 0o pre4ent fluid retention
.. 0o sta%iliAe %lood pressure
2. 0o reduce symphatetic acti4ity
3. 0o pre4ent remodellin" of the C;
!7. A )0 y.o. woman complains a%out se4eral episodes of palpitation and faintin"
sensation. 0his symptom has ne4er occurred in the past. #he has no any disease
and ne4er ta$in" medication. +or$in" dia"nosis is dysrhythmia.
A. Atrial fi%rillation
B. 0hird de"ree A; %loc$.
.. ;entricular tachycardia
2. #upra4entricular tachycardia
3. Premature 4entricular contraction.
!(. A )6 y.o. woman presented to the hospital with palpitation. #he had history of
thyroid disease ) years a"o and had not %een ta$en thyroid medication since last
wee$. Bn physical e9amination' BP 1!0/70 mm/"' pulse 135 %pm' and no si"ns
of heart failure.
*uestion 8 +hat is the most accurate and rational medication for tFis patient ,
A. Propanolol
B. 2iltiaAem
.. 7ifedipin
2. 3nalapril
3. 2i"o9in
50. A 5) y.o. fat man came to the emer"ency department with chief complaint
shortness of %reath alon" with su%sternal cahest pain which he felt ! hours a"o.
Bn physical e9amination' BP 150/(0 mm/"' no si"n of heart failure. 3.?
showed #0-se"ment ele4ation and in4erted 0-wa4e in precordial leads. 0he pain
was su%scri%ed afetr ) m" of intra4enous morphin sulphate administration.
*uestion 8 +hat is the oral medication that this patient should ta$e immediately ,
A. 2ypiridamol
B. Propanolol
.. .ilostaAol
2. Aspirin.
3. #tatin.
51. 0he patient a%o4e should %e "i4en intra4enous throm%olytic. +hat is the main
purpose of throm%olytic administration in clinical condition as shown a%o4e ,
A 0o pre4ent arrhythmyas.
B. 0o reduce chest pain immediately.
.. 0o pre4ent acute pulmonary edema.
2. 0o reduce the coronary artery stenosis.
3. 0o pre4ent e9tention of the infarction site.
5). A woman came to the nutrition clinic consultin" a%out appropriate daily diet. #he
had %een hospitaliAed in 6..J %ecause of unsta%le an"ina. Bn physical
e9manination' BP 130/0 mm/"' pulse 70 %pm. 0he patient now is on medication
of aspirin' statin' captopril and ticlopidin. #he was su""ested to ha4e more
unsaturated fatty acids instead of saturated fatty acids in her diet.
*uestion 8 what is the reason to chan"e her daily diet as su""ested %y the
nutrionist ,
A. 0o stimulate cata%olism rate of C2C.
B. 0o pre4ent cholesterol con4ersion in intestine.
.. 0o stimulate the formation of small dense ;C2C.
2. 0o stimulate cholesterol o9idation into %ile acid.
3. 0o pre4ent cholesterol o9idation into %ile acid.
53. A 50 y.o. man came to the pu%lic health center with chief complaint of chest pain
which occurred ! hours a"o. 0he pain was radiated to the Faw and left arm. 0he
patient seemed se4erily ill. Physical e9amination showed BP 100/70 mm/"' pulse
100 %pm. 3.? 8 #0-se"ment ele4ation in ;1 K ;5. 0he patient was admitted to
6..J immediately for more ad4ance treatment. .oronary an"io"raphy was
conducted and showed total occlusion in left anterior descendin" artery.
*uestion 8 +hich %acterias %elow that related to coronary artery occlusion ,
A. 5icoplasma pneumoniae.
B. .hlamydia penumoniae.
.. .hlamydia trachomatis.
2. 5icoplasma hominis.
3. .hlamydia psittaci.
5!. A 10 y.o. %oy enter the hospital %ecause of cyanosis on his lips and his fin"ers
since he was a %a%y. 0his situation worsen when he cries or plays. After he is tired
playin"' he often ha4e to sit on his $nees. Physical e9amination shows a small and
s$inny %oy. 0hora9 e9amination re4eals ri"ht 4entricle acti4ity increases. #ystolic
eFection murmur' "rade 3/6 p.m/ C#B! is found. 2rum stic$ fin"ers were also
*uestion 8 0he clinical dia"nosis of this patient is ,
A. 0B@
B. 0?A
.. Aortic 4al4e stenosis.
2. Pulmonary 4al4e stenosis
3. 3isenmen"er&s syndrome.
55. 0he non-cyanotic 0B@ occurs in the situation of ,
A. -i"ht to left shunt.
B. 6ncrases of pulmonary stenosis.
.. -eduction /% of concentration < 5 "r/dl.
2. 5ild o%struction in %lood outflow of ri"ht 4entricle.
3. 2ecreases of resistance systemic circulation associated with increase of ;#2
56. 0o confirm the dia"nosis of 0B@ you should e9plore the e9amination of ,
A. #cinti"raphy.
B. An"io"raphy.
.. .hest radio"raphy
2. 3chocardio"raphy.
3. .hest .0 scannin".
57. 0he aim of s>uattin" position in 0B@ is ,
A. 0o increase pressure in ri"ht 4entricle.
B. 0o increase directly o9y"en saturation.
.. 0o increse the %lood flow from ri"ht to left shunt.
2. 0o decrease resistance systemic circulation in upper part of the %ody.
3. 0o decrease systemic circulation in lower e9tremities' so more %lood flow to
pulmonary circulation due to increase of 4ascular systemic resistance.
5. Polycytemic occurs in 0B@ if ,
A. ./@ occurs.
B. 0he %lood o9y"en saturation increases.
.. 0he %lood o9y"en saturation decreases.
2. 0he %lood flow from ri"ht to left shunt.
3. /emoconcentration of the patient decreases.
5(. A 7 month-old %oy comes to the hospital %ecause of cou"h and hard to %reath.
0hese symptoms occur fre>uently since he was a ) month %a%y. Bn physical
e9amnination murmur is heard "rade !/6 p.m. at C#B! spread to -#B' a9illary
and suprasternal.
*uestion 8 0he dia"nosis will %e ,
A. A#2
B. P2A
.. 0B@
2. 0?A
3. ;#2
60. 0he shunt will %e ri"ht to left if ,
A. -o"er&s disease is found
B. 2iamtere of ;#2 is small.
.. Ceft 4entricular hypertrophy occurs.
2. -o"ht and left 4entricle acti4ities increases.
3. ;ascular pulmonary resistance hi"her than systemic resistance.
61. .hest radio"raphy shows ,
A. D.oer en sa%otE
B. DCi$e an e"" on its sideE
.. -i"ht atrium hypertrophy
2. 2ecreases of pulmonary circulation.
3. Cun" 4ascularisation increases with prominent pulmonary artery.

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