5

e. Phenelzine

Ans. The key is C. Citalopram. [Among SSRIs Sertraline is the drug of choice for ischemic heart disease.
Next choice is citalopram (as it is often related to torsades de pointes it is not 1st choice). If SSRI cannot
be used Mirtazapine is recommended as next antidepressant].

3. A 75 year old man collapsed while walking in his garden. He recovered fully within 30 minutes
with BP 110/80 mmHg and regular pulse of 70bpm. He has a systolic murmur on examination.
His activities have been reduced lately which he attributes to old age. What is the definitive
diagnostic investigation that will assist you with his condition?
a. ECG
b. Echo
c. 24h ECG monitoring
d. 24h BP monitoring
e. Prv CIN

Ans. The key is B. Echo. [2 mainD/D of exertional syncope are Aortic stenosis and hypertrophic
cardiomyopathy. Aortic stenosis – more likely in elderly. And hypertrophic cardiomyopathy – more
likely in young and less likely at this age. Echocardiography will reveal the condition of aortic stenosis in
this patient].

4. A 65 year old man with hypertension presents with lower abdominal pain and back pain. An
expansive abdominal mass is palpated lateral and superior to the umbilicus. What is the single
most discriminating investigation?
a. Laparascopy
b. KUB XR
c. Pelvic US
d. Rectal exam
e. Abdominal US

Ans. The key is E. Abdominal US. [Features like i) hypertension ii) abdominal pain iii) back pain iv)
expansile abdominal mass lateral and superior to the umbilicus are very much suggestive of abdominal
aortic aneurism. Single most discriminating investigation is abdominal ultrasound].

5. A 54 year old man has recently been diagnosed with moderate depression. He has history of MI
and is suffering from insomnia. What is the drug of choice for him?
a. Citalopram
b. Lofepramine
c. ECT
d. Haloperidol
e. Diazepam

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