You are on page 1of 5

ICM II Cardiovascular Q stream

A 2 yrs girl, born premature presents with shortness of breath after playing.
On examination you detect, a pulse pressure of 80 and a loud continuous
machinery murmur at Lt first to third intercostal space. She has no
cyanosis. What drug can be gven to treat this condition?
o Indomethacin

Cardiac catherization of a baby born with a murmur reveals the following

oxygen saturation levels Rt atrium 65% Rt ventricle 85% Left atrium 95% Left
ventricle 95 Pulmonary artery 85%. Which of the following is the most likely
diagnosis based on the given data

A big baby(5kg) born of a diabetic mother, is found to be breathless,
tachypnec and cyanotic right from birth. A systolic murmur is present on
auscultation of the heart. Prostaglandin E is given as the child is prepared for
surgery. A defect in Which of the following embryological processes resulted
in this condition?
o Spiraling of A/P septum
A 2 yrs old child presents with spells of dyspnea, cyanosis, and squatting
after play. O/E, you detect clubbing, lt parasternal heave and an ejection
systolic murmur in the pulmonic area. Xray chest reveals a boot shaped
heart. Which of the following is he also likely to have?

A 16 yrs old girl presents with failure to begin her menstrual periods and past
history of frequent severe headaches and nosebleeds. On examination her Bp
is 180/120 in the upper extremity and 100/60 in the lower. pulsatile vessels
are seen in the neck and palpated along the ribs. She has a webshaped neck
and increased carrying angle of the elbow. Xray shows notching of ribs. Which
of the following is the most likely diagnosis?

Coarctation of the aorta

An 80 yrs old woman presents with scalp pain and jaw claudication of 6
weeks duration. On examination you detect a tender, cord like artery in the
temple region. Lab work reveals a raised ESR. Which of the following
conditions is she likely to develop with her present disease?

Decreased pulmonary blood flow

Polymyalgia rheumatic

A 30 yrs old female presents with fever, weight loss, joint pains, lower limb
claudication and myalgia. You detect absent/weak carotid/radial pulses but
femoral pulse is normal. Which of the following is the most likely diagnosis?

A 40 yrs old lady presents with fever and weight loss of 10 pounds in 4
months.She has a past history of hep B and multiple skin lesions suggestive
of ischemia and gangrene. biopsy reveals a necrotising vasculits involving
medium sized arteries. Which of the following is the most likely diagnosis?
o Polyarteritis nodosa
An 8 yrs old boy is brought to hospital with an acute onset of skin rash, abdo
pain and swollen joints. He dies in hospital a week later from renal failure. o/e
you detect palpable reddish purple skin lesions on his legs.Which of the
following will you find on biopsy of kidney and skin vessels?
o IgA deposits
A 40 yrs old male patient presents with recurrent attacks of sinusitis. one
week back he had a bout of cough with hemoptysis. he also recalls an
episode of haematuria one month ago. on examination you detect nasal
ulceration. lab work shows RBC casts in urine. xray chest: lung nodules,
biopsy reveals granulomatous vasculitis of small arteries. Which of the
following is the most likely diagnosis?

Aortic stiffening

A 60 yrs old female is seen in the ER with severe chest pain of 2 hrs duration.
An ECG recording demonstrates a tachycardia with wide QRS complexes but
no P waves. Which of the following is the most likely cardiac pacemaker
location in this patient?

Systemic vascular resistance

A 75 yrs old man presents with headache and light headedness. On

examination he is noted to have a Blood pressure of 180/70 and heart rate of
75 beats per minute.Which of the following is the most likely cause of his

Wegeners granulmatosis

A 20 yrs old marathon runner has a mean arterial pressure of 95 mm hg at

rest. His pulse is 50bpm and a systolic murmur is detected on auscultation.
After a one hr race his MAP has risen to 105. A decrease in which of the
following during his running most likely accounts for the observed finding?

Takayasu arteritis


A 25 yrs old female patient presents with a 6 month history of Paroxysms of

severe headache associated with palpitations, sweating and anxiety. Bp is
200/120 and you note it to be 140/100, 3 hrs later. Which of the following is
the most likely mechanism underlying the hypertension?

o Severe vasoconstriction
A 20 yrs old man sustains a gunshot injury to his right groin and is treated at
the hospital with surgery. 3 months later he presents with a boggy swelling in
that region. A thrill is felt over this swelling and a bruit is detected on
auscultation. Which of the following is the most likely cause?
o a/v fistula
A 35 yrs old man presents to his cardiologist for evaluation of recurrent
episodes of lightheadedness and chest pain for 6 months. one week earlier
he got a syncopal(fainting) attack whilst walking up his stairs. On
examination you detect a crescendo-decrescendo midsystolic murmur at the
right second intercostal space and over the carotid artery. Which of the
following is this condition often assosiated with?
o Congenital bicuspid valve
A 60 yrs old man complaints of fatigue, shortness of breath and pounding in
the head for 2 yrs. Past history is significant for syphilis at age 23.O/E you
notice his head bobbing (titubation), prominent neck pulsations, a
waterhammer pulse, quinckes pulse(alternating blanching and erythema of
nailbeds) and a decrescendo diastolic murmur at the left sternal border.
Which of the following hemodynamic changes will maintain his cardiac
o Increased left ventricular preload
A 33 yrs old female, from India presents with shortness of breath of 6 months
duration. Recently she has been unable to walk up a flight of stairs and last
few nights she wakes up suddenly gasping for air. she was diagnosed with
rheumatic fever as a teenager. O/E pulse:100,RR24.JVP is raised, diffuse
crackles heard at lung base, ankle edema bilaterally. Loud S1 and a low pitch
rumbling middiastolic murmur is heard at the mitral area following an
opening snap. Which of the following chambers will be enlarged
consequentialy in this patient?
o Left atrium
A 22 yrs old waitress presents to your clinic for evaluation of non exertional
chest pain of recent onset. She appears anxious and gets skipped beats
occasionally. O/E you detect a midsystolic click and late systolic murmur at
apex. This condition is assosiated with a disease involving which of the
following tissues?
o Connective tissue
A 50 yrs old diabetic patient presents with an acute MI. On examination, a
Pansystolic murmur is detected at the apex radiating to the axilla. Which of
the following complications of an MI has resulted in this condition?
o Papillary muscle necrosis
An i/v drug addict presents with fatigue, swelling of legs and abdominal
bloating. On examination you detect a raised JVP with large V waves, a
holosystolic murmur at the left lower sternal border and a pulsating liver.
Which of the following is the most likely diagnosis?
o Tricuspid regurgitation

A 50 yrs old woman complains of recurrent transient loss of consciousness

and dizziness for 3 months. she has fever and severe wt loss. O/e she is
febrile, pale, and has clubbing. A plopping sound is heard in diastoli followed
by a rumbling murmur at the apex. Echocardiogram shows an oscillating
lesion near the mitral valve. Findings vary with body position. What is the
most likely diagnosis?
o Atrial myxoma
A 25 yrs old pregnant female patient in her first trimester of pregnancy
presents with cough, shortness of breath and fatigue for 6 months. Cardiac
catheterization reveals a PCWP of 30 mm and left ventricular pressures of 5
mm end diastolic and 130mm systolic. Which of the following is the most
likely diagnosis?
o Mitral stenosis
An IV drug addict presents with one week history of fever, rigors and
dyspnoea. On examination, petechial hemorrhage, roth spots, oslers nodes,
splinter nail hemorrhage and a new blowing pansystolic murmur at the apex
is auscultated. Echocardiogram shows an oscillating mass attached to the
mitral valve. Which of the following tests is most likely to confirm your
o Blood culture
A 65 yrs old man presents with chest pain of acute onset. He is diagnosed
with a Myocardial infarct and 4 weeks later is found to have a pansystolic
murmur at the lower left parasternal border. Which of the following is the
most likely complication that he has developed?

Examination of a patients carotid pulse reveals 2 impulses or peaks in a

patient during ventricular systole. Echo cardiogram reveals a diagnosis of
hypertrophic cardiomyopathy. Which of the following physical findings will
also be present?
o Mid systolic murmur at left parasternal border
A 6 months old baby is seen with difficulty in breathing and appears on
examination to be floppy and has weak muscles. Chest x-ray reveals
cardiomegaly. which of the following enzyme deficiencies is causal?
o Acid maltase (alpha glucosidase)
During exercise, it is seen that coronary blood flow increases to meet the
increased demand of oxygen and nutrients. This is facilitated by drop in
coronary vascular resistance. Which of the following factors will limit this
increased flow during exercise?

Septal rupture

Duration of diastole

A young medical student suddenly develops palpitations and light

headedness. He had consumed 10 cups of coffee before this episode. On
examination, his pulse is 160/minute and regular, Bp is 110/80 and his heart

sounds are normal. Carotid sinus massage is done and he immediately feels
better. HR after massage is 80/mt. Which of the following mechanisms caused
this improvement?

A 40yrs old male patient complains of sudden onset palpitations after a party
where he consumed a lot of alcohol. Examination confirms the presence of
tachycardia with an irregular rythm. which of the following EKG findings is
most likely in this patient?
o Absent P waves
A neonate is seen to be cyanosed and has multiple craniofacial abnormalities,
hypoparathyroidism, hypoplastic thymus and o/e an ejection systolic murmur.
You explain to the mother that this condition is because of abnormal
development of neural crest cells. Which of the following is the most
commom congenital heart disease seen in patients with this syndrome?
o Persistent truncus arteriosus
A 30 yrs old woman with Marfans syndrome presents with episodes of
palpitation,non exertional chest pain and severe anxiety. Examination reveals
a midsystolic click and late systolic murmur at the apex. Which of the
following is the most likely diagnosis?

Prolonging the AV node refractory period

Mitral valve prolase

A 30 yrs old man presents with painful hands and feet. He also feels tingling
and pain that is worse in the winters. He has noticed that his fingers get
abnormally cold and pale around that time. P/E reveals weaker distal pulses
compared to the proximal in the extremities. His condition is likely to be
because of which of the following addictions?