1) A healthy 80-year-old man has participated in a longitudinal study over the past 30 years to

study the effects of aging on overall cardiovascular status. He has undergone annual testing
with echocardiography and his left ventricular ejection fraction has remained stable throughout
the 30 years. Which of the following changes is most likely responsible for the preserved left
ventricular ejection fraction in this patient?
a) A. Cardiomyocyte hypertrophy
b) B. Increased arterial reserve capacity
c) C. Increased left ventricular compliance
d) D. Increased left ventricular diastolic volume
e) E. Stable ventricular myocyte number
.

2) A 67-year-old man is brought to the emergency department by his son after a syncopal
episode. The son was helping his father clean out the garage when the father said he felt dizzy.
As the son was helping him into a chair, the patient lost consciousness. He woke up
spontaneously about a minute later without any disorientation or confusion. ECG demonstrates
bradycardia with a regular rhythm and narrow QRS complexes. There is complete
desynchronization between the P waves and QRS complexes. Which of the following locations
is most likely pacing this patient's ventricles?
a) A. His bundle
b) B. Left bundle branch
c) C. Left ventricular muscle
d) D. Purkinje system
e) E. Sinoatrial node
.

3) A 69-year-old man is brought to the emergency department with sudden onset palpitations and
dyspnea. His medical history is significant for hypertension and gastroesophageal reflux
disease. ECG reveals a heart rate of 120/min with an irregularly irregular rhythm, narrow QRS
complexes, and no organized P waves. Which of the following physiologic factors most likely
determines the ventricular contraction rate in this patient?
a) A. Atrial muscle depolarization rate
b) B. Atrioventricular node refractory period
c) C. Bundle branch conductivity
d) D. Purkinje system pacemaker activity
e) E. Sinoatrial node discharge rate
f) F. Ventricular muscle refractory period
.
4) A 66-year-old man comes to the office for a follow-up appointment. The patient has a history of
heart failure with reduced ejection fraction and has had persistent dyspnea despite taking the
maximal dosage of his heart failure medications. He has had no lightheadedness or chest pain.
Blood pressure is 133/72 mm Hg and pulse is 76/min. Physical examination shows normal lung
sounds and no lower extremity edema. His medical treatment is modified with the addition of a
combination pill that inhibits neprilysin and blocks angiotensin II receptors. Which of the
following is the most likely effect of this medication?
a) A. Decreased renal free-water reabsorption
b) B. Decreased venous compliance
c) C. Increased myocardial contractility
d) D. Increased peripheral arterial resistance
e) E. Increased urinary sodium excretion
.

5) S3 heart sound is normal in which individuals?

a) Mitral regurgitation
b) Aortic regurgitation
c) Heart failure
d) Children
.

6) S4 heart sound is normal in which individuals?

a) Hypertrophic ventricles
b) Myocardial infarction
c) Older adults
d) Heart failure patients
.

7) Pace maker of heart is?

a) AV node
b) SA node
c) His bundles
d) Purkinji
.

8) Egg on string appearance on chest x ray present in which pathological condition?

a) TOF
b) Ebstein anamoly
c) Transposition of great vessels
d) Tricuspid atresia
.

9) In hypertensive urgency the systolic and diastolic BP is?

a) 120/80
b) 100/60
c) 350/120
d) 180/120
.
10) Xanthelasma means?
a) Lipid laden histiocytes in neck
b) Lipid laden histiocytes in eyelids
c) Lipid laden macrophages in ear
d) None of these
.

11) Aortic dissection is due to tear in which layer?

a) Media
b) Intima
c) Adventitia
d) Connective tissues
.

12) A 45-year-old female presents with a swollen, painful area on her left forearm.

She reports fever and chills. On examination, there is an abscess with surrounding erythema.
Pus culture reveals Staphylococcus aureus. Which of the following statements regarding
Staphylococcus aureus is correct?
a) A) It is a gram-negative bacterium.
b) B) It produces coagulase, distinguishing it from other staphylococci.
c) C) It is usually sensitive to vancomycin.
d) D) It forms smooth, shiny colonies on blood agar.
.

13) A 30-year-old male presents to the clinic with a painful, swollen right knee. He reports recent
skin trauma to the area. On examination, there is warmth, erythema, and limited range of
motion of the affected joint. Aspiration of the knee joint yields purulent fluid, and culture reveals
Staphylococcus aureus.

Which of the following virulence factors is primarily responsible for the pathogenesis of
Staphylococcus aureus in this scenario?
a) A) Exfoliative toxin
b) B) Coagulase
c) C) Protein A
d) D) Hemolysins
.

14) A 25-year-old female presents with a severe sore throat, fever, and difficulty swallowing. On
examination, her throat appears erythematous, with tonsillar exudates. Rapid antigen detection
test from a throat swab is positive for Streptococcus pyogenes. Which of the following
characteristics is NOT typically associated with Staphylococcus aureus, another common
bacterial cause of sore throat?
a) A) Catalase-positive
b) B) Coagulase-positive
c) C) Gram-negative cocci in clusters
d) D) Produces beta-hemolysis on blood agar
.
15) A 35-year-old male presents to the emergency department with muscle stiffness, jaw cramping,
and difficulty swallowing. He reports stepping on a rusty nail a week ago. Physical examination
reveals trismus and generalized muscle rigidity. Which of the following statements regarding
Clostridium tetani, the causative agent of tetanus, is correct?
a) A) It produces botulinum toxin, leading to muscle spasticity.
b) B) It is an aerobic bacterium.
c) C) Its neurotoxin blocks the release of inhibitory neurotransmitters, causing muscle
spasms.
d) D) Tetanus toxoid vaccination provides passive immunity against tetanus infection. T
People
.

16)

50-year-old female presents with sudden onset fever, productive cough with rust-colored
sputum, and pleuritic chest pain. Chest X-ray reveals lobar consolidation suggestive of
pneumonia. Sputum culture grows Streptococcus pneumoniae. Which of the following
statements regarding Streptococcus pneumoniae, the causative agent of pneumococcal
pneumonia, is correct?

a) A) It is a gram-negative bacterium.
b) B) It is catalase-positive.
c) C) Its capsule is an important virulence factor.
d) D) Optochin resistance is a distinguishing characteristic.
.

17) A 7-year-old child presents with a sore throat, low-grade fever, and malaise. On examination,
there are grayish-white pseudomembranes covering the tonsils and pharynx. A throat swab
culture grows Corynebacterium diphtheriae. Which of the following statements regarding
Corynebacterium diphtheriae, the causative agent of diphtheria, is correct?
a) A) Its toxin inhibits protein synthesis by ADP-ribosylation of elongation factor-2.
b) B) It is a gram-negative bacterium.
c) C) It produces exotoxin that causes diarrhea.
d) D) Diphtheria is primarily transmitted through fecal-oral route.
.
18) A patient with a history of cardiac valve replacement presents with signs and symptoms
suggestive of infective endocarditis. Blood cultures reveal Staphylococcus epidermidis. Which
of the following statements regarding Staphylococcus epidermidis, a common cause of
nosocomial infections, is correct?
a) A) It produces coagulase, aiding in clot formation.
b) B) Biofilm formation on medical devices is a key virulence factor.
c) C) It is typically sensitive to methicillin.
d) D) It causes acute, severe infections such as pneumonia.
.

19) A 60-year-old male presents with fever, chills, and dysuria. Urinalysis reveals pyuria and
bacteriuria. Urine culture grows Enterococcus faecalis. Which of the following statements
regarding Enterococcus faecalis, a common cause of urinary tract infections, is correct?
a) It is a strict anaerobe.
b) ferments lactose.
c) Vancomycin is typically the first-line treatment.
d) It forms spores for survival in harsh environments.
.

20) A 65-year-old male with a history of colonic adenomas presents with fever, chills, and fatigue.
Blood cultures reveal Streptococcus gallolyticus. Which of the following associations is most
commonly observed in patients with Streptococcus gallolyticus bacteremia?
a) A) Chronic obstructive pulmonary disease (COPD)
b) B) Endocarditis
c) C) Urinary tract infections
d) D) Meningitis
.