Cardio <3 sinus rhythm, LVH on voltage criteria, Q in III, T

1. What is the best prognostic indicator for wave inversion in aVL. Diagnosis:
pregnancy in a patient in the first trimester with a. HOCM
mitral stenosis? b. normal
a. symptoms prior to pregnancy c. coarctation of aorta
b. long murmur d. bicuspid aortic valve
c. displaced apex beat
d. loud murmur 6. Young male who was at work, previously well,
e. MVA<0.6 cm2 suddenly collapsed. BP 80/40. Had continuous
systolic murmur with diastolic accentuation.
2. A male patient, on amiodarone 200 mg daily, Catheter performed:
who is post myocardial infarct and has VT RA sat was 55% RA pressure 8
resistant to sotalol. Now has neuropathy from RV 85% PA 85% RV pressure 40
the amiodarone – what do you do next? wedge sat 95% Wedge pressure 7
a. continue amiodarone 200 mg daily and add LV 95% LV pressure 80/12
pyridoxine PA pressure 40
b. stop amiodarone for 4 days and decrease to 100 What is the cause?
mg / day a. VSD and Aortic incompetence
c. decrease amiodarone to 100 mg daily b. ASD
d. stop amiodarone for 4 weeks, then restart 100 c. dissection
mg / day d. right sinus of valsalva rupture
e. change to flecainide e. coarctation of aorta

3. Runner with palpitations. ECG shown: 7. Young male with broad complex tachycardia
wenckebach. What next? after drinking alcohol. BP 100/70 How would
a. Insertion of permanent pacemaker you treat?
b. coronary angiography a. lignocaine
c. reassurance b. iv digoxin
d. Stress ECG c. flecainide
e. stress thallium d. adenosine
e. carotid sinus massage
4. Pressure trace question: elderly male, history of
heart failure, one episode of syncope, a few 8. Male admitted with pain in neck with 40 mmHg
episodes of pulmonary oedema resistant to lasix BP difference. (Clinical picture of dissection).
and digoxin. Started on captopril, had syncope, Best management?
pressure tracing shown (left ventricular pressure a. beta blocker and nitrate
up to 200, aortic pressure 120/80). What is the b. anticoagulate
best management? c. thrombolysis
a. increase frusemide d. d urgent angiogram
b. balloon valvuloplasty e. close observation.
c. aortic valve replacement.
9. Lady with hypertension for investigation,: K+ 3.2,
5. Young 24 year old male, saw LMO, found to have urinary adrenaline of 500, urinary noradrenaline
1/6 systolic murmur, BP 120/70. ECG shown: of 700. Next investigation?
a. CT adrenals
1
b. venous sampling of adrenals
c. angiogram
10. Middle aged man long history of increasing
dyspnoea, orthopnoea, PND and ankle oedema.
Examination confirms CCF. CXR shown -
calcified pericardium. Cardiac catheterisation is
likely to show:
a. giant CV waves
b. equal RV and LV systolic pressures
c. equal RA and PCW pressures
d. RV diastolic pressure > LV diastolic pressure
e.  PCWP with inspiration
f.  early diastolic filling
11. 56 year old with ischaemic chest pain. Smoker,
CK 800. Given tPA with rapid decrease in
symptoms. Q waves and idioventricular rhythm.
What would you see on angiography?
a. Occluded left circumflex
b. Occluded LAD with poor LV function
c. 70% LAD and 40% circumflex and 40% RCA
d. Normal LAD, occluded RCA.
12. With respect to estimation of diastolic heart
failure which of the following statements are
true:
a. reversal of the E/A ratio is a common finding in
elderly patients
b. diastolic heart failure is usually absent in
significant impairment of systolic function
c. estimation of systolic function (ejection fraction
measurements) correlate better with symptoms
of dyspnoea than estimates of diastolic function
d. myocardial fibrosis is a significant contributor to
reduction in compliance
e. reduced diastolic function during the rapid filling
phase is due dependent active myocardial
relaxation in overall chamber to reduced energy
13. With respect to coronary vein graft disease
a. early graft failure of approximately 10% in the
first year post-surgery is due to accelerated
atheroma in the post-operative period
b. at ten years post coronary bypass grafting about
70% of patients will not show major disease
progression in the bypass grafts
c. aggressive LDL lowering with statin drugs has
been documented to result in reduction of
disease progression in coronary bypass grafts.
d. screening patients with bypass grafts greater
than ten years old with exercise testing would be
expected to have a low rate of detection of
recurrent disease
e. all patients after coronary bypass surgery should
be treated with a HMG-CoA reductase inhibitor
14. A 60 yo female had an acute myocardial
infarction 12 months ago, following which she
had life-threatening ventricular tachycardia. She
has been noted to have very poor LV function.
On 200 mg per day of amiodarone, which has
been controlling the arrhythmias, she has
developed a peripheral neuropathy. The next
step in her management:
a. Decrease dose to 100 mg od after stopping for 4
weeks
b. Leave 200 mg and add pyridoxine
c. Change to flecainide
d. Decrease to 100 mg immediately
15. A young male with recent viral illness complains
of palpitations. He is found to have a systolic
murmur and an ECG is shown LVH by voltage
criteria, high take-off Vl, V3, I, aVL. The most
likely diagnosis is:
a. Normal variant
b. Hypertrophic cardiomyopathy
c. Dilated cardiomyopathy
d. Pericarditis
e. Aortic stenosis
16. A fit 40 yo male presents with palpitations. An
ECG is taken during sleep shows Wenkebach and
rate >40/min. Your management would be:
a. Insertion of pacemaker
b. Reassure
c. Perform EPS
2
d. coronary angiography e. coarctation
e.  blocker
20. In which of the following situations would it be
17. A cardiac catheter study is shown of an elderly most appropriate to use adenosine:
male with increasing episodes of CCF. He was a. Asthmatic with a narrow-complex tachycardia
trialled on an ACE inhibitor and experienced pre- b. 44 yo male in AF with no history of heart disease
syncope. The carotid pulse is noted to be c. 58 yo male with previous infarct and narrow-
diminished. (Cath tracing shows large LV to complex tachycardia
aortic gradient 100 mmHg at peak, only one d. Patient with IHD and wide-complex tachycardia
heart beat shown but ECG shows an ectopic).
The best management would be: 21. A young person is described with ECG showing
a. Aortic valve replacement wide-complex AF. Which of the following would
b.  blocker you use:
c. Balloon aortic valvuloplasty a. Digoxin
d. Frusemide b. Verapamil
c. Adenosine
d. Flecainide
18. An ECG is shown with a wide complex e. Metoprolol
tachycardia. Patient is conscious with slightly
low BP. History of alcohol use is given. ECG 22. A patient suffers an infarct, with ECG showing ST
controversial (either AF with aberrancy, or VT). elevation V2-V5. Shortly after receiving tPA,
The best treatment would be: there is a short run of ventricular tachycardia but
a. Carotid sinus massage then the ST segments return to baseline. The
b. Adenosine most likely findings on coronary angiogram are:
c. Flecainide a. Partial occlusion RCA
d. Lignocaine b. 70% LAD stenosis and 40% circumflex and RCA
e. iv Digoxin stenosis
c. Complete occlusion LAD with poor LV function
19. A young male experiences sudden onset of chest d. Partial circumflex occlusion
pain on lifting. BP 80/40. Continuous murmur e. Severe triple vessel disease
with diastolic accentuation. Catheter study
shown: 23. A young female presents in first trimester of
Sats Pressures pregnancy with mitral stenosis. Which of the
RA 55% 8 following is the best predictor of outcome?
RV 85% 40 a. Length of the murmur
PA 85% 40 b. Pre-pregnancy symptoms
wedge 95% 7 c. Valve area on echocardiography
LV 95% 80/12 d. Displacement of apex beat
e. Severity of symptoms
The most likely diagnosis?
a. VSD + AR
b. Ruptured sinus of Valsalva 24. Which of the following is most likely to prolong
c. ASD the QT interval?
d. dissection a. Low K+
b. High Ca2+
3
c. Flecainide b. P wave morphology
d. Digoxin c. P - QRS dissociation
d. QRS width
e. Ventricular rate
25. Concerning cardiovascular physiology:
a. Difference in arterial and venous oxygen 29. Pregnancy induced hypertension:
saturation is inversely proportional to blood a. Is caused by the trophoblast
flow. b. Associated with increased intravascular volume
b. Valve area in aortic stenosis is proportional to c. Involves genetic predisposition
the square of the pressure gradient across the d. Is more likely in young primigravida
valve. e. Increased pressor sensitivity
c. Peripheral vascular resistance is primarily
determined by resting arterial tone. 30. HOCM associated with
d. Nitric oxide stimulates adhesion of platelets to a. X-linked recessive
the vascular endothelium. b.  ventricular volume
e. Adrenergic activity increases myocardial c. Pulmonary venous congestion
contractility via an increase in cGMP levels d. Diastolic dysfunction
within the myocyte leading to an increase in e. Abnormal myosin
intracellular ionised calcium.
31.Pharmacokinetics in CCF
26. Concerning atherosclerosis a. If high hepatic extraction  clearance
a. Oxidation of LDL in the bloodstream is necessary b. If low hepatic extraction  oral availability
for foam cells to form c. IV administration produces  volume of
b. A vasoconstrictor rather than a vasodilator distribution
response to endothelial dysfunction indicates d.  binding to albumin
acetylcholine
c. A deficiency of nitric oxide has been measured in 32. Which of the following is not consistent with
atherosclerotic plaques pure diastolic dysfunction?
d. The absence of smooth muscle cell proliferation a. Elevated end diastolic pressure
indicates it is primarily a disease of the intima b. Chamber of normal size.
e. Plaques are more likely to rupture if they are c. Abnormal-sized heart on xray
concentric d. May be part of any type of left ventricular
disease
27.Mitral regurgitation: e. Reduced ejection fraction
a.  afterload
b.  myocardial O2 consumption
c. Circumferential LV shortening 33. With regard to myocardial infarction, which of
d. Systolic anterior motion associated with mitral the following statements is incorrect?
valve prolapse a. Right ventricular infarcts are with reduced
e. Associated with Marfan’s morbidity and mortality rates compared with left
ventricular events
28. Which of the following are associated with b. Individuals with an inferior infarct have a
haemodynamic compromise in SVT? reduced 30-day mortality, compared with those
a. Long QT suffering anterior infarctions

4
c. In patients with a right-sided infarct in whom
there is early revascularisation of the infarct-
related artery, in-hospital mortality is
considerably less than in patients who are not
adequately reperfused.
d. In right ventricular infarction there is a marked
improvement in haemodynamic arid mechanical
parameters of right ventricular infarction
following revascularisation in contrast with left-
sided myocardial infarction
e. Mortality following non-Q wave infarction is
significantly reduced in patients treated with
beta-blockade.
34. The inherited long QT syndrome is characterised
by a history of syncope arid sudden cardiac
death. Regarding the genetic basis of this
disorder, which of the following statements is
incorrect?
a. This syndrome may be associated with
congenital blindness
b. Potassium supplementation corrects the
repolarisation abnormality in some cases of the
long QT syndrome.
c. The long QT syndrome may be associated with
an abnormal potassium channel.
d. Long QT syndrome may be caused by mutations
in cardiac sodium channels.
e. Acquired and inherited long QT syndromes may
both cause ventricular arrhythmias arid may
have a similar molecular basis.
35. Familial hypertrophic cardiomyopathy (HOCM) is
a disorder largely affecting cardiac myocytes. It
is characterised by unexplained ventricular
hypertrophy and histological evidence of
myofibrillar disarray. With respect to the
molecular genetic basis of HOCM, which of the
following statements is true?
a. A genetic abnormality can be inherited in the
absence of ventricular hypertrophy
b. Missense mutations that result in an amino acid
with a change in charge appear to be associated
with a more benign prognosis.
c. Only candidate genes encoding myosin proteins
have been associated with familial HOCM.
d. Patients without extensive myocardial
hypertrophy or aortic outflow obstruction have a
benign prognosis.
e. The prognosis is similar irrespective of the
mutation location in the P myosin heavy chain
gene.
36. A 45 yo man with known IHD presents with
hypertension. He has been getting infrequent
angina and is currently on atenolol 50 mg daily.
Next best treatment?
a. thiazide
b. imdur
c. enalapril
d. prazosin
e. diltiazem
37. 65 yo man with history of CVA in past now on
warfarin for AF. INR usually stable but now
presents with melaena and INR >8. The co-
administered medication most likely to cause
this is;
a. phenytoin
b. enalapril
c. erythromycin
d. propranolol
e. verapamil
38. 45 yo old pilot undergoes routine annual physical
examination and MEST. The EST shows 1.5 mm
upsloping ST depression laterally in the absence
of pain. An exercise-thallium is shown – there
are reversible perfusion defection in the
anterior, lateral and apical regions. The
diagnosis is?
a. false positive stress test
b. 3v CAD
c. evidence of anterior ischaemia
d. old posterior infarct
e. HOCM
f. tricuspid valve disease
5
39. A 40 yo marathon runner complains of an b. AVR
occasional irregular heartbeat. A 12 lead ECG is c. balloon valvuloplasty
normal. A holter strip is shown, demonstrating d. heart transplant
wenckebach. The most appropriate mgt is?
a. I/O PPM 43. 30 yo woman, 2nd trimester. History of mitral
b. angiography stenosis, now in AF. Systolic and mid-diastolic
c. reassurance murmurs heard. Echo shows mild MR, MV valve
d. stress ECG area 0.6 cm2 without calcification, fusion at
e. stress thallium commisure, non-redundant leaflet, and a pliable
valve with moderately severe pulmonary
40. A 22 yo female presents with SOB. She has a hypertension. Best mgt is:
BMI of 30 (150% of predicted), a history of a. open heart MV replacement
rheumatic fever, and a cleft palate. The b. balloon valvuloplasty
following cardiac results were obtained; c. medical therapy
O2 sats d. termination
SVC 71% e. open MV valvuloplasty
IVC 77%
RA 76%
RV 79% 44. Elderly man with past history of AMI and
femoral artery 97% recently-inserted VVD pacemaker presents with
palpitations. An ECG is shown – broad complex,
You would: negative concordance, dissociated p waves at a
rate of 300/min, irregularly irregular rate 60 –
a. close the sinus venosus ASD 100 with no pacing spikes. Diagnosis is/
b. correct the VSD a. pacemaker-induced tachycardia
c. give diuretics b. VT
d. encourage weight loss c. AF
e. give penicillin prophylaxis d. Aflutter
e. AIVR
41. A 14 yo boy presents with a systolic murmur with f. re-entrant tachycardia
normal splitting of S1 and S2 during inspiration.
It is pansystolic and loudest at the LSE. The
murmur becomes softer wit valsalva manoeuvre. 45. 70 yo man with a history of TIA, hypertension
CXR normal, JVPNE. Murmur has been present and no other risks for IHD presents with AF.
since age 2. The cause is? best mgt would be:
a. MVP a. warfarin with INR 2 - 3
b. HOCM b. warfarin with INR 1.5 – 1.8
c. VSD c. warfarin with INR 1.5 – 2.5
d. ASD d. aspirin alone
e. congenital aortic stenosis e. heparin
f. digoxin
42. An elderly man with known aortic stenosis has g. persantin
now become symptomatic. Peak grad 44
mmHg, LVEF 30%. Best mgt is?
a. antifailure medications
6
46. An elderly woman who has hypertension, AF, b. CK-Mb is elevated in 5% of patients 4 hours after
CCF and arthralgia presents with nausea and onset of symptoms in AMI
vomiting. Medications include digoxin, c. LDH remains elevated for the longest duration
frusemide, slow K. Recently commenced on after MI
enalapril and NSAID. BP 130/80, HR 100. Creat d. TNF levels indicate size of infarct
has gone from 0.14 to 0.22. Digoxin level 2.8. e. TnT levels are non-specific following
Best mgt? rhabdomyolysis
a. stop digoxin and enalapril and check digoxin
level in 2/7
b. decrease digoxin dose and check digoxin level in 50. A 78 yo man is admitted with purulent sputum,
6/7 chest pain and SOB. CXR shows LLL pneumonia.
c. stop digoxin, enalapril and lasix CK rises to 850 on day 2, and TnT at days 4 & 6 is
d. stop digoxin, enalapril, lasix and NSAID and check <0.02 (NR <0.02). The SOB improves with
digoxin level in 24 hours antibiotics and frusemide. He continues to
e. stop digoxin complain of chest pain, relieved by morphine.
f. halve digoxin and stop NSAID There are no ischaemic changes on his ECG.
Repeat TnT on days 8 and 10 are 0.03. Which is
47. A diabetic, hypertensive male with IHD and the most likely diagnosis?
frequent angina is referred for management of
his hypertension. He is on atenolol 50 mg daily a. AMI
and has BP 166/98 and HR 64. Next drug to b. Dressler syndrome
add? c. UAP
a. ACE inhibitor d. PE
b. imdur e. Empyema
c. diltiazem
d. prazosin 51. A 54 yo hypertensive presents with sever chest
e. bendrofluazide pain. He is sweaty and pale. BP 180/100.
There is a 2/6 murmur of AI. The CXR is normal.
48. 65 yo male presents in pulmonary oedema. ECG shows 1 mm ST elevation in V2 – V4. Best
Current Rx is digoxin and a diuretic. Echo shows initial management?
LV hypertrophy and dilatation with  systolic a. iv nitrates and heparin
function and a peak aortic gradient of 43 mmHg, b. TTE
with a mean gradient of 30 mmHg. Best therapy c. thrombolysis
is? d. urgent angiogram
a. AVR e. morphine and monitor regular 12 lead ECGs
b. ACE inhibitor
c. balloon valvuloplasty
d. nitrates 52. A CCU patient develops VF. You are called to
e. transplant run the resus. Which of the following is
incorrect?
49. With regard to serum markers of myocardial a. The chances of successful defibrillation decline
injury, which of the following is true? by approx 2 – 7% for each minute the patient
a. TnI and TnC regulate the calcium-independent remains in cardiac arrest
interactions between actin and myosin

7
b. The ABCs of basic life support slow the rate of
depletion of myocardial high energy phosphate
stores
c. Overall survival in hospital after CPR averages
14%
d. Cardiac filling during CPR occurs passively during
the upstroke of compression
e. Forward flow during external cardiac
compression is due to direct compression of the
heart between the sternum and vertebral bodies
1. A 30 years old man fell from the tree. He feel
painfull on his upper left back. He went to the
hospital, and was taken for an X ray photograph.
It showed a fracture of his left ribs 4 and 5 near
the vertebral column. The heart surgeon open
the thorax to stop bleeding.
What vessel is injured by the bone fracture?
A. Aorta ascendens
B. Thoracica interna artery
C. Posterior Intercostalis artery
D. Anterior Intercostalis artery
E. Subclavia artery
2. What vessel is the origin of the injured vessel
above:
A. Aorta thoracalis
B. Arcus aorta
C. Right coronary artery
D. Thoracica interna artery
E. Subclavian artery
3. A 53 year old man comes to emergency room,
complaint about chest pain since 4 hours ago.
Pain is radiating to his jaw and left arm. ECG
shows acute myocardial infarct in his left
ventricle. What artery is responsible for
myocardial infarct above?
A. Right marginal a
B. Interventricular anterior a
C. Circumflexa a
D. Left marginal a
E. Pulmonary a
4. What vein is run paralely with this artery in the
anterior interventricular sulcus?
A. Great cordis vein
B. Middle cordis vein
C. Marginalis vein
D. Minima cordis vein
E. Coronary sinus
5. A 60 year old man comes to heart clinic,
complaint about short of breath for 5 months.
Physical examination on auscultation shows
early diastolic and decrescendo murmur. After
looked for the result of ECG, the cardiologist
diagnosed him with Aortic valve stenosis. Which
part of the heart influenced?
A. atrium sinistra
B. atrium dextra
C. ventricle sinistra
D. ventricle dextra
E. pulmonary veins
6. A neonate becomes short of breath and
tachycardia after birth. The doctor sent him to
radiology department, then a chest X-ray reveals
an enlarged cardiac and increased blood flow to
the lungs. It is a particular sign of Persisten
Ductus Arteriosus Botalli
What vessel is connected in this congenital defect?
A. V. Pulmonalis and A. Pulmonalis
B. Arcus Aorta and V. Pulmonalis
C. V. Cava superior and inferior
D. Aorta and V. Azygos
E. A. Pulmonalis and Arcus aorta
8
1. A 40 year old man thinks that his heart is beating too fast. So he
goes to dr. Ira’s clinic for consultation. Dr. Ira records his electrocardiogram (EKG). The EKG shows a complete record
of P, Q, R, S, T waves in every cycle with RR interval is 500 msec.
How fast is heart frequency of dr. Ira’s patient?
A. 100
B. 120
C. 150
D. 160
E. 180

2. In the laboratory of electrophysiology, the researcher wants to

record an action potential of a pace maker cell. The record looks like the following figure:
What current/currents (I) participate in producing prepotential
(spontan depolarization) phase(phase 4)?
A. ICa and INa
B. ICa and IK
1 C. INa and IK
D. INa and ICl
E. ICa and ICl

3. In a physiological laboratory work, the students 4. The above difference make the heart muscle has:
want to know the characteristic difference of A. Automaticity
the action potential of the heart muscle and the B. Rhythmicity
skeletal muscle. According to you, which one of C. Syncytium
these characteristic is prominently different? D. Very long refractory period
A. Resting membrane potential E. Spontaneous depolarization
B. Fast depolarization
C. The amplitude
D. Duration of repolarization
E. The hyperpolarization phase

9
 5. Below is the length-tension relationship for the cardiac muscle.
Pressure mmHg

50 100 150 ml
End diastolic volume

The curve shows systolic intraventricular pressure. According to you, how will be the curve of the diastolic
intraventricular pressure?
A. increase exponentially
B. increase linearly
C. decrease exponentially
D. decrease linearly
E. same in every end diastolic volume

6. In a systolic phase, the left ventricular pressure E. Myoglobin.

is higher than the aortic pressure. What supply
the blood for the left ventricular subendocardial 8. A 40-year old man was diagnosed with Ischemic heart
muscle in systolic phase? disease.
A. right coronary artery Which of the following is the most appropriate
B. left coronary artery laboratory examination to determine the
C. right and left coronary artery independent risk factor for advance
D. no blood supply atherosclerosis?
E. direct from the heart chamber A.HDL Cholesterol
B.LDL Cholesterol
7. A 60 year old man came to emergency unit with C.Lp (a)
complain chest pain since 9 days ago. In physical D.Trigliseride
examination: unremarkable, ECG reveal : ST-segment E.Apo A 1
depression .Which of the following is the most
appropriate laboratory examination do you need for 9. A 27-year-old man came to your private practice with
this patient ? laboratory result. Cholesterol total 190 mg/dL ( N <
A. CPK serum 200), Triglyceride : 170 mg/dL ( N < 150 ). What is
B. CK MB serum your initial management according to the case
C. Troponin I and T above?
D. SGOT/AST
10
 A.Advicing the patient to take drug for lowering D. Endothelial cells
triglyceride level E. Nerve axons
B.Advicing the patient to reduce consumption of
carbohydrates 13. While examining a tissue with a light microscope,
C. Advicing the patient to reduce consumption of you notice a small vessel that has 2 circular layers of
protein smooth muscle in its tunica media. The lumen of this
D. Advicing the patient to reduce consumption of vessel is only slightly larger than the diameter of an
fat erythrocyte.
E. Advicing the patient to take anti oxidant Which of the following types of vessels are you
examining?
10. A 60 year old man came to emergency unit with A. Venule
complain chest pain since 4 days ago. Physical B. Fenestrated capillary
examination : EKG Normal. What is your initial C. Arteriole
laboratory examination according to the case above? D. Muscular artery
A.Obtain Troponin examination at 0 , 8 and 16 E. Large vein
hours
B.Obtain Troponin examination at 0 ,12 and 24 14. While examining a tissue with a light microscope,
hours you notice a vessel that has a lamina elastica interna
C.Obtain CPK examination at 0, 8 and 16 hours and a lamina elastica externa in its wall. The lumen of
D.Obtain CPK examination at 0, 12 and 24 hours this vessel is round to oval.
E.Obtain CPK examination at 0, 18 and 36 hours Which of the following types of vessels are you
examining?
11. A 7 year old boy, have injury falls from bicycle and A. Venule
had wound and bleeding at the lower extremity . What B. Fenestrated capillary
is the most appropriate sequence of the body to stop C. Arteriole
bleeding ? D. Muscular artery
A. Vascular spasm – Blood coagulation – Platelet E. Large vein
plug formation
B. Vascular spasm - Platelet plug formation - 15. While examining a tissue with a light microscope,
Blood coagulation you noticed a vessel that is characterized by many
C. Platelet plug formation - Blood coagulation – elastine membranes throughout its wall. You also
Vascular spasm detect a few vas vasis in its adventitial layer.
D. Blood coagulation - Vascular spasm - Platelet Which of the following types of vessels are you
plug formation describing?
E. Blood coagulation – Platelet plug formation – A. Venule
Vascular spasm B. Lymphatis vessel
C. Large vein
12. While examining a heart muscle tissue section with D. Muscular artery
a microscope, you notice a cluster of cells in the E. Aorta
subendocardial layer, that have what appears to be
glycogen within their cytoplasm. 16. A 69 year old man sees you in the office for follow
Which of the following are you describing? up of his chronic congestive heart failure. He has
A. Fibroblasts ejection fraction 40 % following a myocardial infarction.
B. Purkinje fibers His symptoms include dyspnea on exertion, orthopnea,
C. Cardiac muscles paroxysmal nocturnal dyspnea and peripheral edema.
11
The BP 100/70 mmHg, HR 110X/m, RR 18x/m. What is
the most likely cause of the above condition?
A. Decreased systemic vascular resistance
B.Decreased sympathetic tone
C. Decreased cardiac output
D. Decreased stroke volume and cardiac output
E. Decreased neural effects
17. A 8 month baby boy, came to emergency rooms
with cyanotic at his lips and nails if crying.If the crying
longer his eye looking ahead with stop the respiration
and sometimes convulsion. This is for the second times.
During 8 months the baby is rarely get fever or cough.
The baby is the second child born aterm,
spontan,weight 2500 g, now 5000 gr.What is the baby’s
specific problem?
A. Cyanotic baby
B.Rarely get cough and fever
C. Spell hypoxia
D. Squating
E. Crying
18. What is the most likely diagnosis for the case
above?
A. Ventricular Septal Defect
B.Atrial Septal Defect
C. Patent Ductus Arteriosus
D. Tetralogy of Fallot
E. Pulmonary Stenosis Valvar
19. A girl, 6 years old come to clinic complaint short of
breath after get wet on rainy session one week later.
She have cough with yellow sputum and fever. Her
mother told that she often get the problem like this (
more than twice a month). No cyanotic. When she was
a baby the doctor said that she have congenital heart
disease (CHD)
What is the pathophysiology of this problem?
A. CHD cyanotic with high pulmonary flow
B. CHD cyanotic with low pulmonary flow
C. CHD non cyanotic with high pulmonary flow
D. CHD non cyanotic with outflow tract
obstruction.
E. No relation CHD with the case above
20. A 17- year old girl comes for check up. She
complains often fatigue. When she was a child, she
often coughs and fever.
On examination S1 normal, S2 wide fix split with
loudly P2 component, no murmur. On ECG: QRS
axis to the right and right ventricle hypertrophy.
Chest Xray enlargement of right ventricle,
plethora and prominent pulmonal segment.
What is the most likely diagnose?
A. Ventricular Septal Defect
B. Patent Ductus Arteriosus
C. Atrial Septal Defect
D. Pulmonary Stenosis
E. Tetralogy of Fallot
21. A 3 month old baby come with shortness of breath,
sweating, pallor and poor weight gain because of
he always crying when breast feeding. RR is
40x/min. HR is 130x/min. Auscultation show pan-
systolic murmur. SpO2 95%.
What is the gold standard examination to support
the diagnosis?
A. X-Ray
B. Spirometry
C. Echocardiograph
D. Electrocardiograph
E. CT-Scan
22. A 50 years old man comes to emergency room,
complaint that he has felt shortness of breath, and
dyspnea on physical activity since 6 month ago. He must
use 3 pillows if he went to sleep and he very often
wakes up in the night because of the dyspnea and rough
coughing. BP 100/70 mmHg, HR 70x/m, RR 30x/m, S
36,3oc. JVP 5+4 cm H2O. S1 increase and loudest, mid-
diastolic rumble grade 3/6 at apex, radiating to left
axilla and opening snap. What is the most probable
diagnosis of this case?
A. Mitral Insuficiency
B. Mitral stenosis
C. Aortic stenosis
D. Aortic regurgitation
E. Ventricular septal defect
12
23. A 60 year old man comes to heart clinic, complaint
about short of breath and dyspnea on exertion for 5
months. Physical examination on auscultation shows S3
gallop, early diastolic and decrescendo murmur, best
hear at intercostal 3-4 parasternal sinistra and her head
is always nodding in time with the heart beat. What is
the most probable diagnosis?
A. Aortic stenosis
B. Aortic regurgitation
C. Mitral stenosis
D. Mitral regurgitation
E. Tricuspid regurgitation
24. A 53 year old woman presents a pressing chest
discomfort. She has had this on and off for 3 months. It
usually occurs when she goes up the stairs, but never
when resting. Tonight, the discomfort began while
walking to buy cigarettes, and lasted from 40 min. Her
father died of heart attack when he was 74 years old.
Her BP is 135/85 and HR 74. JVP is 5+2 cm H2O at 30
degree supine position, and her lungs are clear to
percussion and auscultation. Cardiac exam is normal. An
EKG shows normal sinus rhythm without abnormalities.
What further examination do you need to make
diagnosis?
A. Echocardiography
B. Coronary angiography
C. Treadmill exercise test
D. Serial electrocardiography recordings
E. Holter electrocardiography monitoring

25. A 60 year old woman comes to emergency room, complaining

about dyspnea, dizziness, fatigue, lightheadedness and palpitation. After a few second, the patient collapse. ECG
shows on Lead II

What is the initial treatment for this patient?

A. Aspirin
B. Defibrillator
C. Echocardiograph
D. Heart surgery
E. Dopamin

26. A 15 year old boy comes to internist with fever and pain on knee
joint that sometimes the pain can moves to other site like ankle, arm. Warm (+), edema (+) on his knee joint. He
also complaint about chest pain and discomfort. Physical examination finding nodul subcutaneous and eritema
marginatum. Sistolic murmur grade II heard. What is the most common pathogen that causes the disease?
A. Staphylococcus aureus
B. Streptococcus beta haemolyticus group A
C. Streptococcus viridans
D. Streptococcus epidermidis
E. . Methicilin Resistance Staphylococcus aureus

13
27. Mrs.A, 38 years old, comes with palpitation about 3 hours ago, no fever, no nausea, but she has diarrhea 15 times
one day before.She has not chest pain but mild short of breath and weakness. No history of hypertension, diabetes and
hypercholesterolemia.

What is the diagnose on ECG?

A. PVC Bigeminy
B. PVC Trigeminy
C. PAC Bigeminy
D. PAC Trigeminy
E. SVT

28. What is the cause of this arrythmia on the case above ?

A. Hipokalemia
B. Hipoglikemia
C. Hipoalbuminemia
D. Hipocalcemia
E. Hiponatremia

29. Mr.B. 59 years old, comes with chest pain like pressing and
sweaty 5 hours ago when he played badminton. He is look limp but not short of breath. No hypertension and
diabetes. He has hypercholesterolemia and heavy smoking.

14
 What is the diagnose ?
A. AMI anterior
B. AMI inferior
C. AMI posterior
D. AMI lateral
E. AMI antero septal

30. A 61 years old man comes with vomitting, dispepsia and

sweating. He feels cool when he plays tennis and fainting for a few minute. He has hypertension and diabetes,
no smoking and no hypercholesterolemia.

What is the diagnose?

A. AMI Inferior
B. AMI Posterior
C. AMI Anterior
D. AMI Lateral
E. AMI Anteroseptal

31. A 42 years old lady comes to general check up, no chest pain, no short of breath or palpitation.

15
 How much the frequency of the heart rate?
A. 50 x/min
B. 75 x/min
C. 100 x/min
D. 125 x/ min
E. 60 x/ min.
32.
A 30 year-old female has been complaining of
exertional dyspnea, swelling of the ankles and cough
with expectoration of mucoid sputum for past 6
months. As a child, she used to have frequent sore
throats and once had a prolonged fever with join pains.
On examination she had diastolic murmur at apex. Her
heart rate was 120/min, regular and there was a right
parasternal heave. Which one of following prosthetic
valve is most common in this patient?
A. Mechanical valve with Bi Leaflet
B. Bioprosthetic valve
C. Homograft valve
D. Ross procedure
E. Mechanical valve with ball caged
33. Which one of the following is true concerning
transformation of the great arteries ( TGA)
A. The aorticopulmonary septum fails to pursue
a spiral course during partitioning of the bulbus
cordis and Truncus Arteriosus (TA)
B. Abnormal resorption of the septum primum
during the formation of the foramen secundum
C. Failure of an extension of sub endocardial
tissue to grow from the right side of endocardial
cushion
D. Abnormal involution of a small segment of
the left dorsal aorta
E.Incomplete absorption of the sinus venosus
into the right atrium and abnormal
development of the secundum defect
34. A 78-year-old woman with a history of old
myocardial infarction is admitted to the
hospital. She looks dispneic and sweaty. On
examination her heart rate fast and on the lung
have rales.
What is mechanism of left heart failure that
developed from infarct myocard ?
A.Impaired of contractility
B.Pressure overload
C.Volume overload
16
 D.Impaired ventricular relaxation 36. The uptake of Ca++ by the sarcoplasmic
E.Obstruction of left ventricular filling reticulum (SR) depends on the enzyme.
Depressed activity of this enzyme leading to
35. Extravasation of fluid to the alveoli in heart defect in Ca++ accumulation by the SR, could
failure may caused lung edema. What is the certainly play a role in the development of
cause of extravasation ? inadequate relaxation ,i.e., diastolic heart
A.Vasoconstricton of arteriola failure. What kind of enzyme can make the
B.Vasodilatation of arteriola mechanism?
C.Increased hydrostatic pressure A. Na-K ATP Ase
D.Increased oncotic pressure B. Ca Activated ATP Ase
E.Rupture of alveoli C. Renin
D. Angiotensin
E. Aldosteron

37. A 53 year old woman, a known hypertensive for 5 years,

presented to the ER with a history of recurrent palpitations and dizziness for two years. On the day of admission,
she developed palpitations which progressively increased in severity. On physical examination, she looked ill,
sweating, not dyspnoeic at rest and she had no pedal oedema. Her respiratory rate was 24 breaths/ minute; the
radial pulse was very rapid and thready. The systolic blood pressure was 60 mmHg by palpation and the diastolic
blood pressure was not recordable. The other examination was normal. An urgent 12-lead ECG was done.

What is the most likely diagnosis?

A.Sinus tachycardia with haemodynamic instability
B.Atrial tachycardia with haemodynamic instability
C.Supraventricular tachycardia with haemodynamic instability
D.Ventricular tachycardia with haemodynamic instability
E.Multifocal atrial tachycardia with haemodynamic instability

17
38.
What should you advise?
A. Vagal maneuver
B. Adenosine
C. Verapamil
D. Procainamide
E. Cardioversion
39. A 47-year-old man reports a six-month history
of intermittent chest discomfort while playing squash.
He describes lower substernal tightness with numbness
of the left upper arm only during exertion. He does not
smoke. His father died suddenly at the age of 49 years.
BP 138/84 mm Hg. Total cholesterol is 261
mg/dl(N<200), LDL 172 mg/dl (N <100), HDL 50 mg/dl
(N>45), and the triglyceride level is 113 mg/dl. The
result of an exercise test is positive, with pain and 1.5
mm of horizontal ST-segment depression at stage 4 of
the Bruce protocol.
What is the most likely diagnosis?
A. Unstable angina
B. Chronic stable angina
C. STEMI
D. NSTEMI
E. Printzmetal angina
40. A 68-year-old accountant visits his physician. He
told a year
earlier his blood pressure was somewhat
elevated and was advised to reduce salt intake
and increase physical activity. No history or
signs of cardiovascular or renal disease. On
physical examination, his blood pressure is
178/72 mm Hg, with no clinically significant
differences between arms or on standing. He
has a body-mass index of 28.4. The examination
is otherwise unremarkable.
What is the most likely diagnosis?
A. Primary hypertension
B. Secondary hypertension
C. Resistant hypertension
D. Exercisie hypertension
E. Isolated systolic hypertension
41. What is the cause of condition above?
A. As a result from another condition
B. Excessive elevation in blood pressure during
exercise
C. No medical cause can be found
D. Reduced elasticity of conduit arteries
E. Failure to reduce blood pressure after taking
a reduction of salt.
42. What is recommended as an initial drug therapy
based on JNC7?
A.ACE inhibitors
B. Thiazide
C.Beta blockers
D.Angiotensin-receptor blocker
E.Calcium-channel blockers
43. A 78-year-old woman with a history of
hypertension is admitted to the hospital. Physical
examination reveals a BP of 180/90 mm Hg, increased
jugular venous pressure, peripheral edema, and
pulmonary rales. A chest radiograph shows pulmonary
edema and mild cardiomegaly. What is the most likely
diagnosis?
A. Diastolic heart failure
B. Systolic heart failure
C. Acute heart failure
D. Right heart failure
E. Left heart failure
44. A 64 years old man presents with recurrent
chest pain that develop whenever he attempts to mow
(cutting the grass) his yard. He relates that the pain
goes away after a couple of minutes if he stops and
rests. He also states that the pain has not increased in
frequency or duration in the last several months. Which
of the following is the most likely diagnosis?
A. Stable angina
B. Unstable angina
C. Coronary artery disease
D. Prinzmetal’s angina
E. Myocardial infarction
18
45. A 71 years old woman presents with increasing
chest pain and occasional syncopal episodes, especially
with physical exertion. She has trouble breathing at
night and when she lies down. Physical examination
reveals a crescendo-decrescendo midsystolic ejection
murmur with a paradoxically split second heard sound.
Pressure studies reveal that the left ventricular pressure
during systole is markedly greater than the aortic
pressure. Which of the following is the most likely
diagnosis?
A. Aortic regurgitation
B. Aortic stenosis
C. Constrictive pericarditis
D. Mitral regurgitation
E. Mitral stenosis
46. A 59 years old man admitted to the ICU, where
ECGs find evidence of myocardial infarction with ST-
segment elevation. His condition rapidly worsens as he
develops severe heart failure and dies 2 days later. An
autopsy a large necrotic area is found that involves the
anterior left ventricle. What is the most likely cause of
this patients’s myocardial infarction?
A. Coronary artery embolism
B. Coronary artery thrombosis
C. Coronary artery vasospasm
D. Coronary amyloid depositon
E. Coronary macroscopic arteritis
47. A 59 years old woman presents with increasing
shortness of breath. Physical examination reveals signs
of left heart failure. She is admitted to the hospital to
workup her symptoms, but she dies suddenly. A section
from her heart at the time of autopsy reveals marked
thickening of the wall of the left ventricle. The left
ventricular cavity is noted to be decreased in size. What
is the most likely cause of this cardiac pathology?
A. Carcinoid heart disease
B. Cor pulmonale
C. Eccentric hypertrophy
D. Systemic hypertensive
E. Volume overload
48. A 25 year young woman was hospitalized with
symptoms of palpitations.On ECG was supraventikular
tachycardia with a heart rate of 180 x / min. Blood
pressure 110/70 mmHg. The drugs were given
immediately:
A.Nifedipine
B.furosemide
C.Verapamil
D.Captopril
E.Disopiramide
49. What kinds of heart rhythm disturbance that
experienced by patient above ?
A.interference in the formation of sinus
impulses
B.interference in the atrial impulse formation
C.impulse formation in the ventricles
D.conduction block of impulse
E.impuls formation in the bundle of his
50. 25-years-old woman, 6 months pregnant, came
to a doctor after she checked her blood pressure at the
midwife and found that her blood pressure rose to
160/90 mmHg. She never had hypertension before.
What is the most appropriate drugs for this patient ?
A.Methyldopa
B.Furosemide
C.Lisinopril
D.Hydralazine
E.Atenolol
51. A 75-year-old man comes to your office for a
check up.He takes no medications. The nurse
immediately notifies you that his blood pressure
190/100 mmHg. He states, “oh, don’t worry about
that; I check it at the grocery store and it has been
high for 10 years. That is normal for me”. Which
of the following ECG findings would you expect?
A. A tall R wave in V1 with right axis deviation
B. A wide ORS complex consistent with left or
right bundle branch block
C. ST segment elevation in most leads
D. Tall left precordial R waves and deep right
precordial S waves
E. Q-T interval prolongation
19
 52. A 30 years old woman comes to 24 hours clinic, several oxidoreductases involved in this system.
complaint about headache and acute blurred Normally, this system also produces toxic waste,
vision since 4 hours ago. One day before, she ate such as H2O2. Which enzyme of the ETS generates
10 sticks of lamb satays on her friend’s birthday H2O2?
party. Her mother has chronic hypertension. On A NAD+-activated dehydrogenase
examination BP 210/110 mmHg, HR 90x/min, RR B Cu-activated oxidase
14x/min, visus OD 3/6. Another examination C Cytochromes
unremarkable. What is the most likely diagnose? D Peroxidases
A. Hypertensive Urgency E Oxygenases
B. Secondary Hypertension
C. Hypertensive Encephalopathy 56. Cardiac muscle has high energy demand. Most
D. Hypertensive Emergensy ATP is obtained from the ETS. ATP consumption is made
E. Renovascular Hypertension more efficient by an energy buffering and shuttle
system, which is also present in the brain. What is the
53. A 59 years old man presents with increasing enzyme that plays a major role in this ATP shuttle?
shortness of breath and problems sleeping. He A ATP-ADP translocase
has a long history of poorly controlled B Pyruvate dehydrogenase
hypertension. Physical examination finds C Succinate dehydrogenase
distention of his neck veins, crepitant rales in D Creatine kinase
both lower lungs, and bilateral edema of his feet. E ATP synthase
A chest X-ray reveals his heart to be dilated and
enlarged. Which of the following is the basic 57. The consequence of ischemia and anoxia is less
mechanism that caused these clinical signs? oxygen available for ETS activity, resulting in less ATP
A. Volume overload production. This will cause weakness of cardiac muscle
B. Pressure overload and in more serious circumstances, degradation of
C. Restricted filling membrane lipids.
D. Loss of muscle What is the immediate cause of membrane
E. Connective tissue disease. degradation?
A Na+ influx
54. In anaerobic state, a person relies on the B Ca2+ influx
hydrolysis of high-energy phosphates for energy C Tissue swelling
supply. This involves a coupling process, to D TCA stimulation
transfer energy from an exergonic to an E Phospholipase activation
endergonic system. There is always more energy
released than needed by the endergonic system 58. Cell injury, including endothelial cell, is initiated by
What happens to the energy that is not absorbed various factors, such as pollution, radiation, ischemia,
by the endergonic system? and Reactive Oxygen Species. Cellular defense
A Converted to heat mechanism include endogenous and exogenous
B Converted to free radicals antioxidants, directed to protect specific targets.
C Used for activation process Which antioxidant selectively give protection to
D Recycled for ATP production mitochondria?
E Utilized for biosynthesis process A Vitamin E
B Vitamin C
55. Most energy utilized in humans is derived from C β-carotene
the Electron Transport System (ETS). There are D NADPH-reductase
20
 E Superoxide dismutase E. Dilthiazem

59. Reduced glutathione performs antioxidative 63. A 35-year-old woman complains of paroxysmal
action, due to its tachycardia and was given a drug to control the
content of a reducing group symptoms, after a month she developed blue-gray
What is the reducing group in glutathione? discoloration of her skin especially in area expose to sun
A Sulfhydryl on cysteine light. Which of the following drug is the most likely to
B Sulfhydryl on methionine cause that symptom?
C Hydroxyl on tyrosine A. Lidocaine
D Hydroxyl on serine B. Amiodarone
E Amino group on glutamate C. Sotalol
D. Verapamil
60. A 55 year old man with essential hypertension E. Quinidine
complains of pain in the left chest while Climbing
up the stairs to his office which is in the 3rd floor. 64. A 65-year-old patient with heart failure and
The pain subside after 10 minutes. chronic atrial fibrilation is treated with 0,25 mg digoxin
Which of the following drug is the most daily. Which of the following substance constitutes an
appropriate to be taken added risk of digoxin toxicity ?
during the attack? A. spironolactone
A. Nitroglycerin sublingually B. quinidine
B. verapamil C. captopril
C. nifedipin D. magnesium
D. propranolol E. calcium
E. diltiazem
65. A 47 year old male has had poorly controlled
61. Which of the following is the most likely hypertension in the range 160/100 mm Hg. For the past
mechanism of the drug that you choose for the 3 months, his blood pressure has increased to 200/100
patient above to alleviating his pain ? mmHg. Now, he has serum creatinine level of 3.8 mg/dl
A. Blocking symphatic action on the heart (Normal : < 1,2 mg/dl) and Ureum 70 mg/dL (Normal :
B. Blocking the Calcium channel of the myocardium < 23 mg/dl). An abdominal USG reveals that the left
C. causing bradycardia leading to decrease cardiac kidney is smaller than the right. Which of the following
work vascular lesions is most likely to be found in the
D. reducing blood pressure glomerulus of left kidney ?
E. reducing venous return leading to decrease A. Obliterative endarteritis
cardiac work B. Medial calcific sclerosis
C. Hyperplastic arteriolosclerosis
62. A 50-year-old woman recover from of a D. Granulomatous arteritis
myocardial infarction. E. Giant Cell Arteritis
Which of the following class of drug have an
evidence to decrease recurent infarction and
sudden death:
A. ACE inhibitors
B. Heparin 66. A 65 year old man went into shock and collapsed
C. Angiotensin receptor blockers suddenly. He died shortly after reaching the hospital.
D. Beta-blockers He has a long hystory of severe hypertension. A clinical
21
autopsy was performed and a ruptured abdominal E. A. Pulmonalis and Arcus aorta
aortic aneurysm was found. Which of the abnormallity
of aortic wall is most closely correlated to the 70. A 53 years old patient complained chest pain
occurence of ruptured aneurysm ? admitted to Emergency room. After performed a series
A. Medial calcific sclerosis of physical examination, an ECG test revealed an
B. Mild aterosclerosis anterior myocardial infarction. What artery is the most
C. Arteriolosclerosis responsible for that condition?
D. Hyperplastic arteriolosclerosis A. Circumflexa artery
E. Atherosclerosis B. Left Coronary Artery
C. Right Coronary Artery
67. A 60 year old male presents myocardial infarction D. Posterior Descending Coronary Artery
by ECG examination.Coronary angiography reveals a E. Marginal Coronary Artery
80% narrowing of the anterior descending branch of
the left coronary artery.By Pass collateral operation was 71. A 20 years old man has a car accident. An Xray
performed.His serum cholesterol level of 220 mg/dL. showed fracture
Which of the following cells is most likely to be involved of os sternum. The heart surgeon open the thorax
in the pathogenesis of his coronary artery lesions ? to stop bleeding. What vessel is injured in this
A. Epithelial cells mediastinum anterior space?
B. Smooth muscle cells F. Aorta ascendens
C. Fibroblastic cells G. Thoracica interna artery
D. Glandular cells H. Pulmonary artery
E. Endothelial cells I. Intercostalis artery
J. Subclavia artery
68. A patient with severe chest pain and bradycardia
brought to you 72. What vessel is the origin of the injured vessel above:
in Emergency room. An ECG results revealed a F. Aorta thoracalis
conduction block of AV node. What is the most G. Arcus aorta
likely coronary artery involved? H. Right coronary artery
A. Right Coronary Artery I. Intercostalis artery
B. Left Coronary Artery J. Subclavian artery
C. Anterior Descending Coronary Artery
D. Posterior Descending Artery 73. A 50 years old man comes to the cardiology
E. Marginal Coronary Artery office two weeks after acute myocardial
infarction. The doctor do echocardiography.
69. A neonate becomes short of breath and Which of the echocardiography examination do
tachycardia after birth. The doctor sent him to you expect?
radiology department, then a chest X-ray reveals A.Reduced contraction in the adjacent area
an enlarged cardiac silhouette and increased B.Compensatory hyperfunction of the involved
blood flow to the lungs. It is a particular sign of myocardium.
Persisten Ductus Arteriosus Botalli What vessel is C.Synergic contraction
the most abnormal in this problem: D.Prolaps mitral Valve
A. V. Pulmonalis and A. Pulmonalis E.Relaxation of myocard wall
B. Aorta and V. Pulmonalis
C. V. Cava superior and A. Cava superior 74. A 30 years old woman came to the emergency
D. Aorta and V. Azygos room with complaint dyspnea on effort. She
22
 was diagnosed as a myoma uteri. 10 days later last 45 minute, after playing tennis. No history
she got menstruation and continue until this of hypertension, diabetes,
day. On exam. she looks pale, sweaty, BP hypercholesterolemia. Physical exam
110/70 mmHg, HR 106x/m, RR 24x/m. Hb.7.1 unremarkable. The doctor make an ECG reveals
g%. Cardiac exam S1/S2 normal, hear S3 gallop, ST segment elevation suggesting an acute
no murmur, mild rales on lungs. What is the infarction. He gives her O2 canule 2 l/m and
most likely diagnosis? nitrate sublingual. Chest pain relieves. Cardiac
A. Hyperthyroidism enzyme normal. After one hour doctor make
B. Anemia the ECG and reveal normal ECG.
C. Hypovolemic shock What is the most likely diagnose?
D. High output failure A. Angina equivalent
E. Angina equivalent B. Unstable angina
C. Prinzmetal angina
75. A 45 years woman comes to emergency with D. Chronic stable angina
suppressing chest pain radiated to the neck, E. Transient angina

WEEK II
1. Describe the classification and complications of hypertension!
2. Explain about the algorithm of hypertension management!
3. Explain about the following drug classification (drug names, mechanism of action, side effect):
a. Diuretic (thiazide, potassium
sparing, loop)
b. Adrenergic blocking agents
(alpha, beta, alpha-beta)
c. Calcium channel blockers
d. ACE inhibitors
e. Angiotensin receptor
f. Aldosterone antagonist
g. Renin Inhibitor
h. Vasodilators
i. Dopamine agonist
j. Alpha adrenergic agonist

23
 4. Describe about malignant hypertension

WEEK III
1. A 42-year-old man comes to emergency department because of chest pain since approximately
2 hours ago. He said the pain is located at his lower central chest and radiating to his epigastric
area. He describes the pain as if someone is squeezing his heart. On examination he appears
bluish and looks hard to breath. Blood pressure is 115/80 mm Hg; heart rate, 65 beat per
minute; and respiration rate, 30 breaths per minute. Neck veins are markedly distended; lung
fields are clear.
a. Describe briefly about the underlying pathophysiology of this condition!
b. Describe your initial treatment to help this patient!
c. What are the laboratory examinations would you order to establish diagnosis? Describe
your expected result!
d. You ordered a 12-lead ECG reading and the result comes as follow, which coronary
artery is most likely to be affected in this case?

e. Explain your treatment plan for this patient!

f. While waiting for the further consultation, the patient becomes unresponsive. He is not
breathing and you found no pulse in his carotid, his ECG reading is as follows. Explain
your actions to help this patient!

WEEK IV
1. Describe what you know about the pharmacology of anti-arrythmic drugs (drug names,
mechanism of action, side effect), [see no.4, you don’t have to rewrite the same drug twice)
2. Describe the definition of relative and absolute refractory period!
3. Name and describe the interpretation of following Lead II ECG readings:

24
a.

b.

c.

d.

e.

f.

25
 g.

h.

i.

j.

k.

l.

4. A 52-year-old man collapsed on the floor while he was waiting for lab result in a hospital. He is
not responding nor having pulse at carotid artery. He was brought to emergency department,
while resuscitating the nurse successfully place ECG monitor on him and the result of Lead II is
as follow

26
a. Describe the steps that you must take to help this patient!
b. Describe briefly the mechanism of action and side effects of drugs that have been used
in the steps above and below!
c. After the fourth DC shock he is still not recovering, there is still no pulse at carotid
artery. However the ECG reading has changed into the following reading. What are the
steps you must take to help this patient?

27