GENESIS

(Post Graduation Medical orientation Centre)

Exam : Cardiology_FCPS_Medicine_Exam_Batch_2022
Class/Chapter :
Total Mark : 100 Time : 90 Min
Pass Mark : 70 Question 26 to End is Based on Single Answers Date : 2021-09-12

1. 2.

Indication for cardiac surgery in infective endocarditis Regarding neprilysin

a). a) Native valve infection a). a) Is an enzyme in circulation

b). b) HF due to valve damage b). b) Produced by atrial myocytes
c). c) No adverse prognostic factors c). c) It breaks ANP,BNP
d). d) Previous advance of systemic embolism d). d) Acts as vasodilator
e). e) Abscess formation e). e) It forms therapeutic target in heart failure
FTFTT TFTFT
Discussion: Discussion:

[Ref: Davidson’s/ 23rd/P-531] Explanation

b) By kidney and other tissues

d) Vasoconstrictor

[Ref: Davidson’s/ 23rd/P-447]

3. 4.

Drugs that block Na+ channel & cause ­action potential- Regarding BNP

a). a) Disopyramide a). a) Is enzyme

b). b) Flecainide b). b) Secreted by atrium
c). c) Lidocaine c). c) NT-pro BNP has more half life
d). d) Mexiletine d). d) Assess response to therapy & prognosis in Pt with HF
e). e) Quinidine e). e) Elevated in pulmonary embolism
TFFFT FFTTF
Discussion: Discussion:

Explanatuion: Explanation:

b)Flecanide blocks Na+ channel with no effect on action Brain natriuretic peptide (BNP) is a peptide hormone of
potential. 32 amino acids with diuretic properties.
It is secreted by the LV as a 108-amino acid
c,d)Lidocaine and Mexiletine block Na+ channel and shorten prohormone(NT-proBNP) which is cleaved to produce
action potential. active BNP.

[Ref: Davidson/23rd/P-479/Box-16.29] Circulating levels are elevated in conditions associated with

LV

(Ref:Davidson 23rd/p-450)

5. 6.

High risk findings of Exercise testing Regarding nerve supply of the heart

a). a) Low threshold for Ischaemia a). a) Adrenergic nerves from the brachial plexus
b). b) Rise in BP on exercise b). b) Parasympathetic nerves from vagus nerves
c). c) Exercise induced arrythmia c). c) Activation of β2-adrenoceptors results in positive ionotropic &
d). d) Widespread marked ischaemic ECG change chronotropic effect
e). e) Exercise induced fatigue d). d) Activation of β1-rceptors causes vasodilatation
TFTTF e). e) Under resting condition vagal inhibitory activity predominates
Discussion: FTFFT
Discussion:
(Ref: Davidson’s 23rd/P-450/box-16.3)
[Ref: Davidson’s/ 23rd/P-445,446]

7. 8.

In case of heart failure Regarding JVP

a). a) ­Ventricular wall thickness a). a) a wave is absent in AF

b). b) ­Number of myocyte b). b) In constrictive pericarditis there is slow Y descent
c). c) Lengthening of sarcomere c). c) X descent occurs by atrial relaxation

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d). d) Focal myocardial necrosis d). d) V wave is Produced by right atrial contraction.
e). e) Due to abnormalities in gene e). e) Y descent reflects atrial emptying
TFFTF TFTFT
Discussion: Discussion:

Explanation: Explanation:

b)Myocyte loss and myocardial fibrosis occurs.
e)HF is not related with genetic abnormality.
(Ref: Davidson’s/ 23rd/P-462/fig-16.25)
b)In Constrictive pericarditis , there is rapid Y descent and in
Cardiac temponade, there is slow Y descent.
d)V wave is produced by right ventricular systole and right
atrial filling pressure.

[Ref: Davidson’s/ 23rd/P-443)[Macleod clinical examination

14th/P-52)

9. 10.

In a patient of acute coronary syndrome- Regarding acute pericarditis

a). a) Aspirin 300mg should be given orally within 1st 12 hours.
b). b) Clopidogrel 300 mg followed by 75mg daily for 1 week confers
a further reduction of ischaemic event
c). c) Aspirin 75 mg continuation causes reduce mortality
d). d) Glycoprotein IIb/IIIa receptor antagonist are of particular
benefit in Pt who undergo PCI
e). e) Ticagrelor is more effective than clopidogrel.
TFTTT
Discussion:
a). a) Hemorrhagic effusion is found in carcinoma of breast or
bronchus
b). b) Typical presentation is retrosternal chest pain which
aggravated by deep breathing or movement
c). c) High grade fever is common
d). d) Pericardiac friction rub is diagnostic
e). e) Antimicrobial therapy always needed
TTFTF
Discussion:

Explanation: [Ref: Davidson’s/ 23rd/P-542]

b)If the patient is intolerant to Aspirin, Clopidogrel is a

suitable alternate(300 mg followed by 75 mg daily) 11.
[Ref: Davidson/23rd/P-500] Drugs used in late management of MI –

a). a) ACEi
b). b) ARB
c). c) Statin
d). d) B- Blocker
e). e) CCB
TTTTF
Discussion:

[Ref: Davidson/23rd/P-498/Box-16.51]

12. 13.

Regarding 2nd Heart sound Regarding acute Rheumatic fever

a). a) Split on expiration a). a) Usually affects children eyes between 5 & 15 years
b). b) Closure of P2 first b). b) Infection ē Group –B streptococci
c). c) Fixed wide splitting ē ASD c). c) Bacterial antigen cross link ē cardiac myocyte & sarcolemmal
d). d) Reversed splitting ē RBBB membrane protein
e). e) Reversed splitting ē LBBB d). d) Aschoff nodules are pathognomonic
FFTFT e). e) Diagnosis is based on 1 major &1 minor criteria
Discussion: TFTTF
Discussion:
[Davidson’s 23rd P-459]
[Ref: Davidson’s/ 23rd/P-515]

14. 15.

Regarding tetralogy of fallot Features of hypertensive retinopathy-

a). a) Affected child become cyanosed often or crying a). a) Micro aneurysm
b). b) In older children fallot’spells are common b). b) Neo vascularization
c). c) Digital clubbing & polycythemia may occur c). c) Cotton wool exudate
d). d) Relief by squatting after exertion d). d) Silver wiring
e). e) Most characteristic feature is pansystolic murmur e). e) Papilloedema
TFTTF FFTTT
Discussion: Discussion:

[Davidson’s 23rd P-537] [Ref: Davidson/23rd/P-510/Box-16.66]

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16. 17.

Regarding cardiac tumor Following are the X-ray findings of left atrial hypertrophy-

a). a) Most primary tumors are malignant
b). b) Majority are fibromas
c). c) Mynomas most commonly arise in LA
d). d) First heart sound usually loud
e). e) Rx is by surgical excision
FFTTT
Discussion:
a). a) Retro sternal mass is seen
b). b) Dilatation of aortic root
c). c) Double cardiac shadow to the right of the sternum
d). d) Heart is not dilated in the lateral view
e). e) Widening of the angle of carina
FFTTT
Discussion:

[Davidson’s 23rd P-542] [Ref: Davidson’s/23rd/P-451/T-16.9]

18. 19.

Regarding cardiac temponade Causes of Prolong QT internal-

a). a) Markedly raise JVP ē a). a) Hypomagnesaemia

b). b) Pulsus paradoxus b). b) Hypocalcaemia
c). c) Echocardiograph is the pivotal investigation c). c) Hypokalaemia
d). d) Hypertension ē bradycardia d). d) Amytriptyline
e). e) It is a medical emergency e). e) B-blocker
TTTFT TTTTF
Discussion: Discussion:

[Davidson’s 23rd P-544] [Ref: Davidson/23rd/Box-16.26/ P-476]

20. 21.

A patient came to you with hypertension. He takes anti- Regarding cardiac troponin (CTn)
hypertensive drug for a long period. Now he develops
gynaecomastia. Which drug is responsible?
a). a) Released normally from cardiac myocyte
b). b) Cornerstone of the diagnosis of MI
a). a) Digoxin c). c) May elevated in pulmonary embolus
b). b) Thiazide d). d) Does not elevated in septic shock
c). c) Amlodipine e). e) It attached to envoy 7th actin molecule
d). d) Verapamil FTTFT
e). e) Spironolactone Discussion:
TFFFT
Discussion: [Davidson’s 23rd P-450]

[Ref: Davidson’s/23rd/P-657/Box-29.1]
22.

Benign heart murmur is characterized by

a). a) Found in left sternal edge

b). b) Grade 5-6 intensity
c). c) Mid-systolic murmur
d). d) No radiation
e). e) Soft,1st heart sound
TFTTT
Discussion:

[Ref: Davidson’s/23rd/P-459/Box-16.9]

23. 24.

Common cause of atrial fibrillation found in cardiology ward In case of ECG reading.
of our country

a). a) Speed is 25 mm/s

a). a) Thyrotoxicosis b). b) Limb leads are unipolar
b). b) MS c). c) V6 is placed in 5th ICS at left mid axillary line
c). c) Alcohol d). d) V1 causes (+ve) deflection
d). d) Chest infection e). e)PR interval represents atrial depolarization
e). e) Cardiomyopathy TFTTF
FTFFT Discussion:
Discussion:
Explanation:
Explanation : Chest infection is not common in cardiology
words b) Limb leads bipolar.Chest leads are unipolar.Augmented
limb leads are also unipolar

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[Ref: Davidson’s/23rd/P-471/Box-16.21] d)Depolarization of IVS occurs first and moves from left to
right, this generates a small negative deflection in lead V6(Q
wave) and an initial positive deflection in lead V1(R wave).

e)Atrial repolarization does not cause any detectable signal.

(Ref:Davidson 23rd/P-448,449/box-16.2)

(ABM Abdullah sir ECG/P-07)

25. 26.

Secondary causes of hypertension- In a patient with significant HF on maximal medical therapy

(ramipril 10 mg OD,Frusemide 80 mg OD,Bisoprolol 10 mg
OD,Spironolactone 25 mg OD)Despite these therapy his
a). a) Conn’s syndrome condition continued deteriorate but criteria for cardiac
b). b) Cushing syndrome resynchronization therapy are not achieved.what is the most
c). c) Coarctation of aorta appropriate next step to improve mortality?
d). d) Pheochromocytoma
e). e) Hypoparathyroidism
a). a) Increase dose of Spironolactone
TTTTF
b). b) Change ACE inhibitor to ARB
Discussion:
c). c) Add Digoxin
[Ref: Davidson’s/23rd/P-509/T-16.65] d). d) Increase dose of Frusemide
e). e) Add Ivabradine
EEEEE
Discussion:

[Ref: Davidson’s/ 23rd/P-467]

27. 28.

What is the poor prognostic sign of heart failure A Man 45 years old man with no known previous IHD
normotensive, non-diabetic come to the emergency after one
episode of palpitation and syncope .On investigation ECG
a). a) Hypokalemia shows short PR interval and broad QR complex with slurred
b). b) Hyperkalemia upstroke. He has a family history of sudden cardiac death. He
c). c) Hyponatremia is a bus driver of local govt primary school. Which of the
following is the most appropriate intervention in this man?
d). d) Renal failure
e). e) Thromboembolism
CCCCC a). a) Radiofrequency catheter ablation
Discussion:
b). b) Flecainide
[Ref: Davidson’s/ 23rd/P-464] c). c) B blocker
d). d) Reassurence
e). e) Long term amiodarone
AAAAA
Discussion:

[Ref: Davidson’s/ 23rd/P-474]

29. 30.

Most specific indicator of acute pericarditis What is the most common cause of aortic aneurysm

a). a) ST elevation a). a) Hypertension

b). b) ST depression b). b) Hyperlipidaemia
c). c) T inversion c). c) Diabetes
d). d) PR depression d). d) Atherosclerosis
e). e) PR prolongation e). e) Marfan’s syndrome
DDDDD DDDDD
Discussion: Discussion:

[Ref: Davidson’s/ 23rd/P-542] [Ref: Davidson’s/ 23rd/ P-505]

31. 32.

Which is highly sensitive & specific test for aortic dissection A 50 years old diabetic patient presented in cardiac
emergency with severe chest pain for 6 hours .His ECG shows
ST elevation in V1 to V6.Before receiving medical treatment
a). a) ECG he was died. What may be the major cause of death of this
b). b) Echocardiography patient
c). c) Chest X-ray
d). d) CT on MRI angiography
a). a) Complete heart block
e). e) Doppler
b). b) Asystole
DDDDD
c). c) Ventricular fibrillation
Discussion:
d). d) Atrial fibrillation

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[Ref: Davidson’s/ 23rd /P-507] e). e) Free wall rupture
CCCCC
Discussion:

Explanation

VF occurs in 5-10% of patients who reach hospital and is

thought to be the major cause of death in those die before
receiving medical attention

[Ref: Davidson’s /23rd/ P –495]

33. 34.

Pathognomic feature of VT Most common congenital cardiac defect

a). a) Tachycardia a). a) ASD

b). b) Broad, abnormal QRS complex b). b) VSD
c). c) Left axis deviation c). c) PDA
d). d) Response to carotid sinus message d). d) Coarctation
e). e) AV dissociation e). e) Pulmonary atresia
EEEEE BBBBB
Discussion: Discussion:

(Ref: Davidson’s/ 23rd/ P –475] [Ref: Davidson’s/ 23rd/ P –531+535/Box-16.99]

35. 36.

A 50 years diabetic patient came to with BP 150/95 mmHg A patient came with ECG change in II,III,aVF lead & there is
.What will be the Choice of drug? mobitz type II second degree heart block .Which artery will
be occluded?

a). a) Amlodipine
b). b) Diltiazem a). a) LAD
c). c) Ramipril b). b) Circumflex artery
d). d) Atenolol c). c) Marginal branches
e). e) Diuretics d). d) Right main coronary artery
CCCCC e). e) Diagonal branches
Discussion: DDDDD
Discussion:
(Ref:Davidson 23rd/P-514/B-16.72)
Explanation:

The circumflex artery gives marginal branches that supply the

lateral,posterior and inferior segments of the LV.The RCA
supplies the AV node in about 90% cases.Proximal occlusion
of RCA often results in sinus bradycardia may also cause AV
nodal block.Abrupt RCA occlusion due to coronary
thrombosis results in infarction in the inferior part of the LV
and often the RV.

(Ref:Davidson 23rd/P-445)

37. 38.

A 70 year old man suddenly collapsed during his morning A 60 years old male come to the EMO with severe chest pain
walk. On examination, patient is unresponsive, pulse is not and dyspnea. Which is the most appropriate initial
palpable, respiration absent. What is the most likely to investigation to diagnosing the condition?
describe the situation?

a). a) CK MB
a). a) Complete heart block b). b) Troponin I
b). b) ACS c). c) 12 lead ECG
c). c) Cardiac arrest d). d) Chest X-ray
d). d) Vasovagal arrest e). e) Echocardiogram
e). e) HF CCCCC
CCCCC Discussion:
Discussion:
Explanation: Considering age and nature of pain 1st line is
[Ref: Davidson’s/23rd/P-456] ECG’S to exclude ACS

[Ref: Davidson’s/23rd/P-178+456]

39. 40.

A female patient of 25 years age, comes to you after 10 days A 70 years old man has history of orthopnoea, tiredness. His
following delivering her baby with dyspnoea. On examination, JVP is raised, bibasal crepitations present, oedema present.
BP-100/70 mmHg, HR- 96 bpm. Examiner is confused about Examination will reveal?

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the JVP. Which is the most appropriate next bedside test for
evaluation? a). a) Pulsus alternans
b). b) Pulsus paradoxus
c). c) Collapsing pulse
a). a) Abdomino jugular reflex
d). d) Anacrotic pulse
b). b) Valsalva Maneuver
e). e) Bradycardia
c). c) To see gallop rhythm
AAAAA
d). d) Bedside urinary protein
Discussion:
e). e) Kussmaul’s sign
AAAAA [Ref: Davidson’s/23rd/P-463/T-16.26]
Discussion:

[Ref: Davidson’s/23rd/P-443] 41.

A 65 years female admitted in hospital. Her CABG done 6

years back. Then she took medication. She developed
hypothyroidism. Which drug is responsible?

a). a) Captopril
b). b) Lisonepril
c). c) Amiodarone
d). d) Ramipril
e). e) Atorvastatin
CCCCC
Discussion:

Explanation:

Thyroid dysfunction is an important side effects of

amiodarone

[Ref: Davidson/23rd/Box-16.30/P-480]

42. 43.

Major criteria of modified DUKE criteria for ineffective Main factors influencing myocardial O2 supply-
endocarditis

a). a) Ventricular filling tine

a). a) Pre existing cardiac disease b). b) Contractility of myocardium
b). b) Osler node c). c) Preload
c). c) New valvular regurgitation d). d) Afterload
d). d) Vasculitic phenomenon e). e) Ventricular contraction
e). e) Varying murmur AAAAA
CCCCC Discussion:
Discussion:
[Ref: Davidson/23rd/P-487/Box-16.38]
[Ref: Davidson/23rd/Box-16.95/ P-1196]

44.

A 8 year old girl presented with fever, fleeting joint pain. He

had history of sore throat 1 weeks ago. Blood examination
detects rise of both ESR and CRP. A soft mid diastolic
murmur was heard during auscultation. What is the typical
reason for this murmur?

a). a) Mitral regurgitation

b). b) Aortic regurgitation
c). c) Valvulitis
d). d) Myocarditis
e). e) Pericarditis
CCCCC
Discussion:

Explanation

A soft mid diastolic murmur ( the Carey Coombs murmur)

typically due to Valvulitis.

[Ref Davidson's/ 23rd/ P-516]

45. 46.

A 75 Yrs old male presented with urinary continence, gout & A patient was diagnosed as heart-failure with EF 30%. He
bronchial asthma. Which anti hypertensive is most now developed altered color vision for 1 month.Which drug is
appropriate responsible

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a). a) Prazosin a). a) Atenolol
b). b) Amlodipine b). b) Digitalis
c). c) Thiazide c). c) Amlodipine
d). d) Atenolol d). d) Thiazide
e). e) Ramipril e). e) Adenosine
BBBBB BBBBB
Discussion: Discussion:

[Ref: Davidson’s/23rd/P-514/Box-16.72] [Ref: Davidson’s/23rd/P-482/Box-16.33]

47. 48.

A 50 Yrs hypertesnsive patient take antihypertensive drug for A 60 yrs old hypertensive patient came to you with chest
a period of time. He developed cough for 1 month. Which anti pain. On examination there was irregularly irregular pulse. He
–hypertensive drug is responsible for this was suspected as atrial fibrillation. Which finding present in
JVP examination

a). a) Lisinopril (ACE inhibitor)

b). b) Atenolol a). a) Abscent ‘a’ wave
c). c) Thiazide b). b) Canon ‘a’ wave
d). d) Amlodipine c). c) Giant ‘a’ wave
e). e) Verapamil d). d) X descent
AAAAA e). e) Prominent ‘y’ wave
Discussion: AAAAA
Discussion:
[Ref: Davidson’s/23rd/P-514/Box-16.72]
[Ref: Davidson’s/23rd/P-470]

49. 50.

A 40 year old woman presented with severe chest pain and A 25 year old man presents with a recent history of an
ECG showing ST elevation. But coronary angiography shows influenza-like illness initially characterised by fever, myalgia
normal vessels. Then Echocardiography advised for the and headache. He develops pleuritic-type chest discomfort
patient. What charecteristic feature you may assume in and breathlessness. On examination, pulse is 105 beats/min
Echocardiography? and regular; BP 105/60 mmHg. The JVP is not elevated. Heart
sounds 1 and 2 are present with a loud to-and-fro harsh
sound present in systole and diastole. Which of the following
a). a) LV dysfunction conditions explains this clinical presentation?
b). b) Akinesia of ventrincles
c). c) Apical ballooning of the LV
d). d) Multiple vegetations a). a) Acute viral pericarditis
e). e) Pericardial effusion b). b) Mitral valve endocarditis
CCCCC c). c) Pulmonary embolism
Discussion: d). d) Aortic valve endocarditis
e). e) Persistent ductus arteriosus
Explanation: Takatsubo cardiomyopathy AAAAA
Discussion:
[Ref Davidson’s/ 23rd /P-541]
Explanation:

Pleuritic chest pain, breathlessness and pericardial rub

associated with features of influenza is present here. So,
acute viral pericarditis is more likely.

[Ref Davidson’s/ 23rd/P-542]

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