MODULE 5

Question 1

The delay in the depolarization of impulse through the AV node is due to the

A. fibrous tissue surrounding the AV node
B. intrinsic property of the AV node
C. diminished amount of GAP junctions
D. inherent resistance of AV node to conduction

Answer 1

C. diminished amount of GAP junctions

Question 2

A 60/F who had history of stroke twice was seen at the OPD for regular follow-up check-up. However, she claimed that for the past month she started to experience left leg pain especially during exertion. The physician was highly considering PAD hence, she calculated her ankle-brachial index. The patient’s higher left arm pressure was 130 mmHg while her higher left ankle pressure was 80 mmHg. What is the calculated ABI and its corresponding interpretation?

A. 0.6 – mild to moderate PAD
B. 0.6 – severe
C. 0.8 – normal
D. 0.8 – mild

Answer 2

A. 0.6 – mild to moderate PAD

Question 3

This complication is expected in patients giving Adenosine

A. High grade AV block
B. Transient asystole
C. Transient apnea
D. Complete heart block

Answer 3

B. Transient asystole

Question 4

Masked uncontrolled hypertension is defined as

A. office BP controlled in treated patients but home or ambulatory BP elevated
B. both office BP and home or ambulatory BP are uncontrolled in untreated patients
C. normal BP in the office in untreated patients but home or ambulatory BP elevated
D. office BP elevated in treated patients but home or ambulatory BP controlled

Answer 4

C. normal BP in the office in untreated patients but home or ambulatory BP elevated

Question 5

This represents the time of atrial depolarization and conduction of the impulse through the AV node and the His-Purkinje system

A. PR-interval
B. QRS complex
C. QT-interval
D. ST-interval

Answer 5

A. PR-interval

Question 6

What is the Fontaine classification of the patient with PAD who presents with a claudication at a distance of ≥ 200m?

A. Stage III
B. Stage IIA
C. Stage I
D. Stage IIB

Answer 6

B. Stage IIA

Question 7

Based on ESC guidelines 2018, hypertension is defined as

A. ambulatory 24 hrs BP mean of SBP ≥ 120 and/or DBP ≥ 70 mmHg
B. ambulatory daytime BP mean of SBP ≥ 135 and/or DBP ≥ 85 mmHg
C. office BP of SBP ≥ 140 mmHg and/or DBP ≥ 80 mmHg
D. ambulatory night-time BP mean of SBP ≥ 120 mmHg
and/or DBP ≥ 80 mmHg

Answer 7

B. ambulatory daytime BP mean of SBP ≥ 135 and/or DBP ≥ 85 mmHg

Question 8

Which of the following leads is the perpendicular lead of aVR?

A. II
B. aVF
C. I
D. III

Answer 8

D. III

Question 9

Which of the following associations is paired correctly?

A. V5 – 5th ICS, left posterior axillary line
B. V1 – 5th ICS, right PSB
C. V2 – 5th ICS, right PSB
D. V4 – 5th ICS, left midclavicular line

Answer 9

D. V4 – 5th ICS, left midclavicular line

Question 10

What is the leading cause of PAD in patients > 40 years old?

A. Trauma
B. Vasculitis
C. Atherosclerosis
D. Thrombosis

Answer 10

C. Atherosclerosis

Question 11

What is the pathophysiologic cause of secondary deep venous insufficiency?

A. A consequence of an intrinsic structural or functional abnormality in the vein wall of venous valves
B. An obstruction and/or valvular incompetence from previous DVT
C. Damaged vessels due to physical trauma
D. Occlusion of vein by extrinsic compression

Answer 11

B. An obstruction and/or valvular incompetence from previous DVT

Question 12

This is a major risk factor for Grave’s ophthalmopathy

A. Alcoholism
B. Coronary artery disease
C. Hypertension
D. Smoking

Answer 12

D. Smoking

Question 13

A 45-year-old female had a BP of 140/90 mmHg in two separate clinic visits. Work-up showed presence of left ventricle hypertrophy and moderate chronic kidney disease. Which of the following is the next appropriate step?

A. Confirm first the diagnosis of hypertension by ambulatory BP monitoring
B. Advise for lifestyle intervention only
C. Initiate drug treatment for hypertension after 3-5 months of lifestyle intervention only if BP still not controlled
D. Initiate immediate drug treatment for hypertension

Answer 13

D. Initiate immediate drug treatment for hypertension

Question 14

The following are features of AV Wenckebach, EXCEPT

A. QRS complexes may be narrow or wide
B. Only single P waves are blocked
C. PR interval shortens immediately after the pause
D. PR segment remain the same

Answer 14

D. PR segment remain the same

Question 15

Presence of pathologic Q waves on the chest leads signify

A. prior history of myocardial infarction
B. history of hemorrhagic stroke
C. juvenile pattern and may still be normal
D. heart failure

Answer 15

A. prior history of myocardial infarction

Question 16

A basic screening test for hypertension-mediated organ damage to screen for evidence of lower extremity artery disease

A. Carotid ultrasound
B. Ankle-brachial index
C. Pulse wave velocity
D. Blood creatinine

Answer 16

B. Ankle-brachial index

Question 17

If you see this rhythm strip below in a patient who is hypotensive what would you do? ECG -ventricular fibrillation

A. Call a code and start ACLS
B. Call your senior
C. Apply synchronized cardioversion
D. Appraise the family that the patient will die in the next few minutes

Answer 17

A. Call a code and start ACLS

Question 18

This category of AF defines continuous AF for ≥ 12 months’ duration when it is decided to adopt a rhythm control strategy

A. Chronic AF
B. Lone AF
C. Persistent AF
D. Long-standing persistent AF

Answer 18

D. Long-standing persistent AF

Question 19

Patient NB, 49-year-old/F, obese, consulted at the OPD due to bilateral lower leg pruritus for 5 months which was associated with pressure sensation aggravated by prolonged standing. Upon examination, her vital signs were normal. However, she had edematous lower extremities with skin hyperpigmentation. Which of the following is the next best thing to do?

A. Advise the patient to lose weight
B. Get ABI
C. Give antibiotics
D. Perform Duplex scan of the lower extremities

Answer 19

D. Perform Duplex scan of the lower extremities

Question 20

Based on the ESC guidelines, in which of the following conditions will you consider initiating antihypertensive treatment with monotherapy rather than the single pill dual combination?

A. Never at all
B. When classification is high risk grade 1 hypertension
C. When patient is very old ≥ 80 years old
D. When classification is high normal BP

Answer 20

D. When classification is high normal BP

Question 21

Based on the ESC guidelines 2018, the office blood pressure threshold for treatment in an 80-year-old patient is more than or equal to

A. 130/90 mmHg
B. 160/90 mmHg
C. 140/90 mmHg
D. 130/80 mmHg

Answer 21

D. 130/80 mmHg

Question 22

The following are general principles in management of thyrotoxicosis, EXCEPT

A. thyroidectomy
B. radio-isotope
C. reducing thyroid hormone synthesis
D. anti-thyroid drugs

Answer 22

B. radio-isotope

Question 23

What is the management of sinus tachycardia?

A. Give Ivabradine
B. Observe
C. Give beta-blockers
D. Address the cause

Answer 23

D. Address the cause

Question 24

Atrial fibrillation that is continuously sustained beyond 7 days, including episodes terminated by cardioversion (drug or electrical cardioversion) after ≥ 7 days is categorized as

A. permanent
B. long-standing persistent
C. persistent
D. paroxysmal

Answer 24

C. persistent

Question 25

The 2018 ESC guidelines recommended using CHA2DS2-VASC score to estimate stroke risk in patients with atrial fibrillation. Which of the following parameters is assigned a score of 2?

A. Congestive heart failure
B. Age > 75 years old
C. Hypertension
D. Vascular disease

Answer 25

B. Age > 75 years old

Question 26

In what level of the vascular system does blood flow resistance primarily occur?

A. Postcapillary venules
B. Small arteries
C. Arterioles
D. Capillaries

Answer 26

C. Arterioles

Question 27

Mr. Castro, 50-year-old/M, went to the OPD due to non-healing wound on the left dorsum of his foot. He claimed that a month ago a sharp object fell on his left foot which caused a laceration. Mr. Castro also added that prior to that event, he would experience on and off sharp leg pain especially during sleeping. Mr. Castro is non-hypertensive and nondiabetic. He works as a manager of a sales company and work has been very stressful lately which caused him to increase the frequency of smoking. On PE, he was awake, coherent, NIRD. Vital signs were BP 130/90, HR 75, RR 18, Temp afebrile. Other pertinent PE findings were pale, well-circumscribed ulcer left dorsum of foot, thin and scaly skin. There was no edema or skin discoloration, left dorsalis pedis and posterior tibial pulses were decreased. Which among the following managements will give benefit to the patient?

A. Limit patient’s activity
B. Apply compression stockings
C. Give anticoagulation
D. Risk factors modification

Answer 27

D. Risk factors modification

Question 28

Which of the following statements about premature atrial complexes is true?

A. Most require therapy with anti-arrhythmics
B. In general, PACs have a benign prognosis
C. If refractory to medical therapy, surgery may be recommended
D. Lidocaine may be used in symptomatic patients

Answer 28

B. In general, PACs have a benign prognosis

Question 29

The mechanism of arrhythmia in atrial fibrillation is by

A. R on T
B. re-entry
C. enhanced automaticity
D. afterdepolarizations

Answer 29

B. re-entry

Question 30

Patient Z, 28 years old, female, went to a medical clinic for physical examination as part of the requirement for a job
application. Her average BP after 3 takings was 180/90 mmHg. This was her first time she had her BP measurement.
What is the next appropriate step?

A. Diagnose patient as hypertensive and evaluation for hypertensive-mediated organ damage
B. Additional measurements should be performed if the first two readings differ by more than 5 mmHg
C. Confirm diagnosis of hypertension only if there is presence of hypertensive mediated organ damage
D. Advise patient to come back in the clinic for repeat BP to confirm hypertension

Answer 30

A. Diagnose patient as hypertensive and evaluation for hypertensive-mediated organ damage

Question 31

Which of the following is FALSE about atrial fibrillation?

A. Prevalence increases with age
B. Hypertension and CAD are the most common underlying disorders
C. Common in 4% of population over 60%
D. Patients with AF do not have increased mortality

Answer 31

D. Patients with AF do not have increased mortality

Question 32

The standard ECG calibration or amplitude height is

A. 10mm
B. 5mm
C. 15mm
D. 20mm

Answer 32

A. 10mm

Question 33

A common test for all potential causes in the diagnostic work-up for patients presenting with hypertensive emergency

A. Echocardiography
B. Fundoscopy
C. CT scan of the brain
D. Urine drug specimen

Answer 33

B. Fundoscopy

Question 34

The orientation of the limb leads is the

A. transverse plane
B. coronal plane
C. sagittal plane
D. frontal plane

Answer 34

D. frontal plane

Question 35

Which of the following coronary artery is the major arterial supply of the AV node?

A. Septal branches of the LAD
B. Posterior descending branches
C. RCA
D. LCx

Answer 35

C. RCA

Question 36

The following are features of Mobitz Type II, EXCEPT

A. Fixed PR interval
B. PR interval may prolong or shorten before or after a pause
C. Two or more consecutive P waves are conducted
D. Only single P waves are blocked

Answer 36

B. PR interval may prolong or shorten before or after a pause

Question 37

Which of the following is the initial choice of treatment of atrial flutter?

A. Amiodarone
B. Defibrillation
C. Cardioversion
D. Carvedilol

Answer 37

C. Cardioversion

Question 38

A 12-lead ECG shows irregular RR intervals and you noticed flutter waves on V1. Which is the correct reading?

A. Atrial fibrillation
B. Atrial fibrillation with aberrancy
C. SVT with aberrancy
D. Atrial flutter

Answer 38

D. Atrial flutter

Question 39

Mr. A went to the outpatient department and asked the doctor when should his children be screened for hypertension. At what age should they have their BP recorded in their medical record and be aware of their BP?

A. At 18 years old and above
B. At 40 years old and above
C. At 20 years old and above
D. At 30 years old and above

Answer 39

A. At 18 years old and above

Question 40

The following influences the ventricular response of patients with atrial fibrillation, EXCEPT

A. Presence of anti-arrhythmics
B. Heightened sympathetic tone
C. Heightened parasympathetic tone
D. None of the options are correct

Answer 40

A. Presence of anti-arrhythmics

Question 41

The T wave occurs at the same time with which part of the cardiac cycle?

A. Isovolumetric contraction
B. Ejection
C. Rapid inflow
D. Isovolumetric relaxation

Answer 41

C. Rapid inflow

Question 42

Which among the following is TRUE about veins?

A. Only the deep and superficial veins contain one way valves
B. Perforating veins connect the saphenous system with the deep venous system
C. The deep veins of the leg carry about 80% of the venous return from the lower extremities 90%
D. Superficial veins are located intradermal

Answer 42

B. Perforating veins connect the saphenous system with the deep venous system

Question 43

The chemical energy used to provide the work of contraction predominantly comes from

A. lactate breakdown
B. creatine phosphate oxidation
C. glucose oxidation
D. oxidative metabolism of fatty acids

Answer 43

D. oxidative metabolism of fatty acids

Question 44

An ST-elevation in leads V3 to V4 is consistent with occlusion of which coronary artery?

A. Left circumflex artery
B. Septal branches of the LAD
C. LAD
D. Right coronary artery

Answer 44

C. LAD

Question 45

Sudden onset and sudden termination is most depicted by which of the following?

A. Mobitz Type I
B. Atrial Fibrillation
C. Sinus Tachycardia
D. AVNRT

Answer 45

D. AVNRT

Question 46

Patient EP, 56/M, who is a known diabetic consulted the OPD due to on and off right leg cramps for 3 months which he noted to experience every time he goes for a morning jog but spontaneously subsides whenever he stops to rest. On examination, there were no skin lesions, edema, or hyperpigmentation. However, it was noted that the right dorsalis pedis and posterior tibial pulses were both decreased. Management of which of the following conditions will most likely benefit this patient?

A. Chronic venous insufficiency
B. Lymphedema
C. Diabetic neuropathy
D. Peripheral arterial disease

Answer 46

D. Peripheral arterial disease

Question 47

Which among the following is TRUE about peripheral arterial disease?

A. The primary sites of involvement are the brachial and femoral arteries
B. The site of claudication is proximal to the location of the occlusive site
C. Physical findings include presence of bruits over the narrowed vessel and muscle atrophy
D. Most common symptom is constant claudication

Answer 47

C. Physical findings include presence of bruits over the narrowed vessel and muscle atrophy

Question 48

A 20-year-old female had a BP of 130/85 mmHg in two separate clinic visits. Patient had no risk factors for cardiovascular disease. Based on the ESC guidelines 2018, what advice should a clinician give to this patient?

A. Do regular aerobic exercise
B. Monitor BP every month
C. Modify diet with salt restriction < 15g per day
D. Initiate immediately drug treatment for hypertension

Answer 48

A. Do regular aerobic exercise

Question 49

An infra-Hirisian or infra-nodal block is significant because of which of the following reasons?

A. Propensity to degenerate to severe types of block
B. Propensity to spontaneously resolve
C. Can be reversed using beta blockers
D. Can be managed medically

Answer 49

A. Propensity to degenerate to severe types of block

Question 50

A 70-year-old grandmother was accompanied by her grandson to the OPD clinic for consultation. She was complaining of pain in her lower extremities which she describes as a dull ache sometimes cramping in character, with onset of pain observed after walking a short distance from her house to her friend’s house about 200 meters away. The pain severity was 6/10 which was relieved when she sat down and rested. She is a known diabetic, hypertensive and dyslipidemic, and had a significant history of tobacco smoking. The BP was 140/90 mmHg, the rest of the vital signs were within normal limits. Focused physical examination of the lower extremity pulses were noted to be diminished. There were no lesions noted on the foot. You as the clinician performed a non-invasive diagnostic test to confirm your initial impression. The ankle blood pressure reading was noted to be 100 mmHg. How would you grade the patient’s condition based on the Fontaine classification?

A. Stage III
B. Stage I
C. Stage IIB
D. Stage IIA

Answer 50

D. Stage IIA

Question 51

A 10-year-old boy is brought to the clinic by his mother for the evaluation of lower extremity swelling. The child had recently recovered from pharyngitis 3 weeks ago. On examination, there is bilateral pedal edema. Lung auscultation reveals fine crackles. Cardiac auscultation reveals pericardial rub. Which of the following is the underlying hypersensitivity reaction seen with the condition?

A. Type IV hypersensitivity reaction
B. Type I hypersensitivity reaction
C. Type III hypersensitivity reaction
D. Type II hypersensitivity reaction

Answer 51

B. Type I hypersensitivity reaction

Question 52

Rheumatic heart disease can be diagnosed on the basis of

A. vegetations along the lines of closure of valves
B. follows skin and throat infection
C. endocardial involvement only
D. Aschoff bodies

Answer 52

D. Aschoff bodies

Question 53

Therapies for intermittent claudication and critical limb ischemia include supportive measures, medications, exercise training, endovascular interventions, and surgery. Which among these supportive measures is correct?

A. It includes meticulous care of the feet, which should be kept clean and protected against excessive moisture with drying creams
B. Elastic support hose is highly advised, as it promotes blood flow to the skin
C. Well-fitting and protective shoes are advised to reduce ischemia rest pain
D. In patients with critical limb ischemia, shock blocks under the head of the bed together with a canopy over the feet
may improve perfusion pressure and ameliorate some of the rest pain

Answer 53

C. Well-fitting and protective shoes are advised to reduce ischemia rest pain

Question 54

The pathognomonic feature of acute rheumatic fever is

A. mitral stenosis
B. myocarditis
C. pericarditis
D. Aschoff’s nodules

Answer 54

D. Aschoff’s nodules

Question 55

A 17-year-old male is diagnosed with a heart condition after an upper respiratory tract infection. Physical examination reveals a heart murmur. There is bilateral pedal edema. What is the most common valvular lesion associated with his condition?

A. Aortic stenosis
B. Mitral regurgitation
C. Mitral stenosis
D. Aortic regurgitation

Answer 55

C. Mitral stenosis

Question 56

The clinical uses of a lipid profile laboratory tests include which of the following?

A. Monitor the effectiveness of drug therapy like the use of statins
B. Assessment of the risk of developing cardiovascular disease
C. Evaluate the success of the lipid-lowering lifestyle changes
D. All of these options are clinical uses of lipid profile

Answer 56

D. All of these options are clinical uses of lipid profile

Question 57

What is the expected histologic vascular changes in the small arteries and arterioles in patients with chronic hypertension?

A. The vascular walls are hyalinized
B. Vascular aneurysms is present
C. Presence of cholesterol plaques
D. The vascular walls are calcified

Answer 57

D. The vascular walls are calcified

Question 58

These refer to superficial, small dilated veins less than a millimeter in diameter that form blue purple or red linear, branching or web patterns

A. Varicosities
B. Chronically insufficient veins
C. Telangiectasis
D. Reticular veins

Answer 58

C. Telangiectasis

Question 59

An 8-year-old girl had sore throat following which she developed severe joint pains. She has been diagnosed with Acute Rheumatic Fever. Instead of recovering as expected, her condition worsened, and she died. Which of the following is the most likely cause of death?

A. Streptococcal sepsis
B. Endocarditis Associated with RHD
C. CNS involvement
D. Myocarditis

Answer 59

D. Myocarditis

Question 60

The two cardiac antigens that are targets of the body’s autoimmune response in Rheumatic Fever

A. Cell wall polysaccharide : cytoplasm of basal ganglia nuclei
B. Myosin : valvular endocardium
C. Actin : vascular endothelium
D. All of the options are correct

Answer 60

B. Myosin : valvular endocardium

Question 61

Based on CEAP classification of Chronic Venous Disease, which of the following can be used as a clinical parameter for classification?

A. Ulceration
B. Reflux
C. Congenital anomaly
D. Thrombosis

Answer 61

A. Ulceration

Question 62

Which of the following refers to a chronic inflammatory disorder of large to small-sized arteries that principally affects arteries in the head, especially the temporal arteries?

A. Giant cell arteritis
B. Polyarteritis nodosa
C. Kawasaki disease
D. Takayasu arteritis

Answer 62

A. Giant cell arteritis

Question 63

Aschoff bodies in Rheumatic Heart Disease show all of the following features, EXCEPT

A. epithelioid cells
B. fibrinoid necrosis
C. giant cells
D. Anitschkow cells

Answer 63

A. epithelioid cells

Question 64

Which of the following chronic vascular disorders is believed to be associated with hepatitis B infection?

A. Kawasaki disease
B. Temporal arteritis
C. Polyarteritis nodosa
D. Takayasu arteritis

Answer 64

C. Polyarteritis nodosa

Question 65

Which of the following vascular disorders is characterized by calcification of the walls of muscular arteries, typically involving the internal elastic membrane, and are typically seen in older women?

A. Monckenberg medial sclerosis
B. Hyaline arteriosclerosis
C. Atherosclerosis
D. Arteriosclerosis

Answer 65

A. Monckenberg medial sclerosis

Question 66

A 70-year-old grandmother was accompanied by her grandson to the OPD clinic for consultation. She was complaining of pain in her lower extremities which she describes as a dull ache sometimes cramping in character, with onset of the pain observed after walking short distance from her house to her friend’s house about 200 meters away. The pain severity was 6/10, which was relieved when she sat down and rested. She is a known diabetic, hypertensive and dyslipidemic, and had a significant history of tobacco smoking. The BP was 140/90 mmHg, the rest of the vital signs were within normal limits. Focused physical examination of the lower extremity pulses were noted to be diminished. There were no lesions and wounds noted on the left foot. You as the clinician performed a non invasive diagnostic test to confirm your initial impression. The ankle blood pressure reading was noted to be 100 mmHg. Among the modifiable risk factors of the patient, which one could benefit from counseling with adjunctive drug therapy such as bupropion and varenicline?

A. Hyperglycemia
B. Dyslipidemia
C. Tobacco consumption
D. Hypertension

Answer 66

C. Tobacco consumption

Question 67

A 17-year-old male is diagnosed with a heart condition after an upper respiratory tract infection. Physical examination reveals a heart murmur. There is bilateral pedal edema. The valvular lesion in this case is due to

A. an abnormal immune response
B. granulomatous inflammation in myocardium
C. deposition of fibrous tissue
D. All options lead to the development of the valvular lesions

Answer 67

C. deposition of fibrous tissue

Question 68

The most important clinical condition that should be first rule out in the use of C-reactive protein as a marker of coronary heart disease

A. Presence of anemia
B. Obvious source of infection or inflammatory condition
C. Renal insufficiency
D. Vitamin B12 deficiency

Answer 68

B. Obvious source of infection or inflammatory
condition

Question 69

The clinical clerk is doing a pre-operative assessment and was asked to secure informed consent from a patient who is to undergo endovenous thermal ablation for varicose veins on her leg. He then proceeded to describe possible complications arising from the procedure such as the possibility of chest pain and difficulty breathing. The clinical clerk was particularly referring to a possible consequence of which complication?

A. Deep vein thrombosis
B. Presentation
C. Bruising
D. Hematoma formation

Answer 69

A. Deep vein thrombosis

Question 70

Which of the following patients has the highest risk for developing peripheral arterial disease?

A. A 50-year-old male who just started smoking for a week
B. A 40-year-old female with a family history of diabetes mellitus in the maternal side
C. A healthy 64-year-old grandmother
D. A 50-year-old male with coronary artery disease

Answer 70

D. A 50-year-old male with coronary artery disease

Question 71

An LD1/LD2>1.0 and a CK-MB/total CK ratio more than 2.5% in the serum is likely seen in which of the following conditions?

A. Progressive muscular dystrophy
B. Acute myocardial infarction
C. Alcoholism
D. Cerebrovascular accidents

Answer 71

B. Acute myocardial infarction

Question 72

The most characteristic component of the lesion (picture) in a young girl with a history of pharyngitis 2 weeks prior to consult is the presence of

A. monocyte
B. neutrophil
C. Aschoff giant cell
D. lymphocyte

Answer 72

C. Aschoff giant cell

Question 73

A 50-year-old woman with chronic venous insufficiency followed up at the Wound Care Clinic. The clinical clerk on duty noted that, other than the visible superficial varicosities, the edema and ulceration seen from the previous visit has already resolved. What pressure of graduated compression stockings should the clerk prescribe for his patient?

A. None, compression stocking are no longer indicated
B. 20-30 mmHg
C. 10-20 mmHg
D. 30-40 mmHg

Answer 73

A. None, compression stocking are no longer indicated

Question 74

A 70-year-old male who was rescued unconscious after suffering from a one car crash that has him hitting a concrete
fence. It was assumed he blacked out and subsequently lost control of the car. He was not wearing a seatbelt and suffered
a broken leg, multiple contusions and cuts in his face and extremities. Blood samples taken upon reaching the emergency room revealed the following:

Test Upon arrival - After 6 hours - After 12 hours - Reference range
Myoglobin: 57 - 140 - 281 - 30-90 ng/mL
Total CK: 112 - 170 - 390 - 15-160 u/L
CK-MB: 3 - 6 - 8 - 0-5 ng/mL
Troponin I: 0.10 - 0.12 - 0.11 - <0.40 ng/mL

What do the above results suggest?

A. The elevated results are due to the skeletal muscle injuries sustained during the accident
B. The man had myocardial infarction which caused the accident
C. The elevated total CK and CK-MB results indicate that the man had a stroke
D. Results contradict each other and likely due to laboratory error

Answer 74

A. The elevated results are due to the skeletal muscle injuries sustained during the accident

Question 75

A 50-year-old man with a BMI of 32 has the sudden onset of substernal chest pain. The pain persists for the next three hours. He then becomes short of breath and diaphoretic. He goes to the emergency department and on physical examination has vital signs include T 37⁰C, P 100/minute, RR 26/minute, and BP 130/90 mmHg. A chest x-ray shows a slightly elevated heart and mild pulmonary edema. An EKG shows ST segment elevation in anterior leads V1-V6. Which of the following serum laboratory test findings is most likely to be present in this man?

A. LDL of 160 mg/dL
B. Homocysteine more than 15 umol/L
C. Troponin of 32 ng/mL
D. All of these findings are expected in this case

Answer 75

C. Troponin of 32 ng/mL

Question 76

Which of the following is the initial diagnostic test to confirm the diagnosis of peripheral arterial disease (PAD)?

A. Transcutaneous oximetry
B. Magnetic resonance angiography
C. Ankle brachial index
D. Duplex ultrasonography

Answer 76

C. Ankle brachial index

Question 77

Which of the following statements about the risk factors and clinical manifestations of Peripheral Arterial Disease is
CORRECT?

A. Fewer than 90% of patients with PAD are symptomatic, although any have a slow or impaired gait
B. The most common symptom is ischemic rest pain that occurs during exercise and is relieved by rest
C. Symptoms are far more common in the upper than in the lower extremities because of the higher incidence of obstructive lesions in the former region
D. Atherosclerosis is the leading cause of PAD in patients older than 40 years old

Answer 77

D. Atherosclerosis is the leading cause of PAD in patients older than 40 years old

Question 78

Which of the following is a useful diagnostic marker that mirror clinical severity and is predictive of disease recurrence
in autoimmune vasculitis?

A. ANA
B. CRP
C. Anti-CCP
D. ANCA

Answer 78

D. ANCA

Question 79

A patient is said to have an increased risk of atherosclerotic disease if he/she has

A. frequent systolic pressure of more than 120 mmHg
B. diastolic and systolic pressure of more than 100/80 mmHg
C. intermittent systolic blood pressure of more than 139 mmHg
D. sustained diastolic pressure of more than 89 mmHg

Answer 79

D. sustained diastolic pressure of more than 89 mmHg

Question 80

It is defined as a clinical disorder in which there is stenosis or occlusion in the aorta or the arteries of the limbs

A. Acute limb ischemia
B. Chronic venous disease
C. Thromboangitis obliterans
D. Peripheral artery disease

Answer 80

D. Peripheral artery disease

Question 81

Which of the following differentials for chronic venous insufficiency presents with bilateral leg swelling?

A. Cellulitis
B. Lymphedema
C. Popliteal cysts
D. Pretibial myxedema

Answer 81

D. Pretibial myxedema

Question 82

Which of the following would predispose to the development of primary deep venous insufficiency?

A. Extrinsic compression from the overlapping veins
B. Arteriovenous fistulas
C. Intrinsic structural abnormality of venous valve
D. Obstruction from previous deep vein thrombosis

Answer 82

C. Intrinsic structural abnormality of venous valve

Question 83

An elderly woman came into the local health center complaining of pain in her right lower leg. The clinical clerk assigned to the area saw the varicose veins in the affected leg. The clerk proceeded to raise the affected leg with the patient supine until the veins collapsed. He then placed a tourniquet on the proximal part of the thigh and instructed the patient to stand. With the tourniquet in place he noted that the saphenous vein remained collapsed throughout the 30 seconds observation but rapidly filled up with blood from above after the tourniquet was removed. Which of the following venous valves are incompetent?

A. Deep veins
B. Superficial saphenous veins
C. Both the superficial and deep veins
D. Communicating veins

Answer 83

B. Superficial saphenous veins

Question 84

Which of the following statements about the cardiac troponins is TRUE?

A. Levels in the blood rise as early as 4 hours from the onset of acute MI symptoms, peaks in 24 to 48 hours, and remain elevated for multiple days thereby making them useful for detecting initial ischemic events but not reliable to detect re-infarction
B. Have prognostic significance with high levels suggesting an elevated risk for adverse cardiac events
C. May be elevated in cases unrelated to cardiac ischemia
D. All of the choices are true of troponin

Answer 84

B. Have prognostic significance with high levels suggesting an elevated risk for adverse cardiac events

Question 85

Which of the following is the most important pre-analytical variable that can affect the measurement of cardiac
enzymes in the blood sample of the patient?

A. Hemoconcentration
B. Presence of hemolysis
C. Lipemia
D. Clotting of blood

Answer 85

B. Presence of hemolysis

Question 86

Match the biomarkers that best fits the descriptions provided. Refer to the diagram below

• Rapidly released from the myocardium during the injury and is rapidly excreted from the kidneys within 24 hours
• Rises in the first 30 minutes in the early period after the onset of an acute event due to its rapid kinetics
• Considered an important biomarker for early detection and/or exclusion of cardiac damage
• Since it has no specificity, negative values are important in the clinics, rather than positive values

A. LDH
B. Cardiac Troponins
C. Myoglobin
D. Creatine Kinase

Answer 86

C. Myoglobin

Question 87

Match the biomarkers that best fits the descriptions provided. Refer to the diagram below

• With the discovery of a radioimmunoassay in 1970, it was considered a better predictor of heart muscle damage and an indispensable parameter of laboratories in the diagnosis of AMI for 20 years before being superceded by a more specific and sensitive marker
• Increasing level during trauma and inflammation reduces its specificity
• Reaches its highest point within 24 hours, starting to increase 4-9 hours after myocardial injury and decreasing to the normal range after 48-72 hours
• Levels are correlated with infarct size and are important predictors of prognosis

A. LDH
B. Cardiac Troponins
C. Myoglobin
D. Creatine Kinase

Answer 87

D. Creatine Kinase

Question 88

Match the biomarkers that best fits the descriptions provided. Refer to the diagram below.

• Considered nowadays as the most important cardiac proteins involved in the diagnosis of AMI
• Currently the first-line test for evaluating patients with suspected acute MI
• Although their sensitivity and specificity are significantly higher in detecting coronary ischemia, there are several clinical conditions (a number of which are non-cardiac causes) that presents with elevated levels, therefore, elevated levels in serum should not always be interpreted in favor of coronary ischemia
• Blood levels increase within 2-4 hours after acute myocardial damage and reach peak levels in 24 hours and remina high for 2-3 weeks

A. LDH
B. Cardiac Troponins
C. Myoglobin
D. Creatine Kinase

Answer 88

B. Cardiac Troponins

Question 89

Patient complains of the sudden onset of excruciating pain, usually beginning in the anterior chest, radiating to the back between the scapulae, and moving downward. What is the most likely vascular event that has occurred?

A. Cardiac tamponade
B. Vasculitis
C. Aortic dissection
D. Thoracic aortic aneurysm

Answer 89

C. Aortic dissection

Question 90

This refers to hypertension that generally results from an underlying renal adrenal disease, renal artery stenosis, or
other identifiable cause

A. Essential hypertension
B. Secondary hypertension
C. Malignant hypertension
D. Renovascular hypertension

Answer 90

B. Secondary hypertension

Question 91

A 17-year-old female comes in a clinic with a complaint of shortness of breath. She had an upper respiratory infection a few weeks back. On examination, there is bilateral pedal edema. Lung auscultation reveals bilateral crackles. Which of the following histological findings can be seen in cardiac muscles with this condition?

A. Eosinophils
B. Fibrinoid necrosis
C. Neutrophils
D. All of these features are found in histologic findings in this case

Answer 91

B. Fibrinoid necrosis

Question 92

Which of the following structure/s is typically seen at the center of an atherosclerotic plaque?

A. Smooth muscles
B. Neutrophils
C. Neurovascularized channels
D. Necrosis

Answer 92

D. Necrosis

Question 93

A 55-year-old woman comes in for a consult due to changes on her skin of her lower legs over the past 5 months. She has no other associated symptoms. She was diagnosed with hypertension and is compliant with her medications. She denies being a diabetic or having food and drug allergies. She neither smokers nor drinks alcohol. Pertinent physical exam of the extremities revealed patches of erythema and scaling on both lower legs down to the ankles with background skin being darker than the rest of the lower extremities. ABI was 0.99. There was a note of lipodermatosclerosis, atrophie blanche and 2cm x 2cm ulcer at the medial malleolar area. The latter has erythematous and tender, raised borders, with exudates. Based on CEAP, what is the clinical classification of the patient’s bilateral lower extremity lesions?

A. C5
B. C3
C. C6
D. C4

Answer 93

C. C6

Question 94

A clinical clerk was assisting a patient undergoing Doppler studies of the leg veins. He saw that one of the veins failed to collapse when the sonographer applied pressure on it. The clerk noted on the patient’s chart the presence of

A. intraluminal thrombus
B. congenital deep vein agenesis
C. arteriovenous fistula
D. incompetent valves of the deep veins

Answer 94

A. intraluminal thrombus

Question 95

Which of the following statements about the prognosis of patients diagnosed with Peripheral Arterial Disease is correct?

A. Approximately 50-60% of non-diabetic patients who present with mild to moderate claudication remain symptomatically stable
B. The likelihood of symptomatic progression of PAD is higher than the chance of succumbing to CAD
C. Patients with peripheral arterial disease have a 5-15% 5-year mortality rate
D. Patient with peripheral arterial disease have a twoto six-fold increased risk of death from coronary heart disease

Answer 95

D. Patient with peripheral arterial disease have a twoto six-fold increased risk of death from coronary heart disease

Question 96

A 70-year-old grandmother was accompanied by her grandson to the OPD clinic for consultation. She was complaining of pain in her lower extremities which she describes as a dull ache, sometimes cramping in character, with onset of the pain observed after walking a short distance from her house to her friend’s house about 200 meters away. The pain severity was 6/10 which was relieved when she sat down and rested. She is a known diabetic, hypertensive, and dyslipidemic, and had a significant history of tobacco smoking. The BP was 140/90 mmHg, the rest of the vital signs were within normal limits. Focused physical examination of the lower extremity pulses were noted to be diminished. There were no lesions and wounds noted on the foot. You as the clinician performed a non-invasive diagnostic test to confirm your initial impression. The ankle blood pressure was noted to be 100 mmHg. What is your interpretation of the result you computed?

A. Borderline results
B. Abnormal, diagnostic of PAD
C. Non-compressible artery
D. Within normal limits

Answer 96

B. Abnormal, diagnostic of PAD

Question 97

Which of the following is most accurate regarding the clinical presentation of Chronic Venous Disease?

A. Atrophie blanche when present is usually located near the lateral malleolus
B. Non-pitting edema is a benign finding and is due to venous stasis
C. Dermopathy may be in the form of eczema or hyperpigmentation
D. Most patients complain of claudication

Answer 97

A. Atrophie blanche when present is usually located near the lateral malleolus

Question 98

It is a fatigue, discomfort, cramping, or pain of vascular origin in the muscles of the lower extremities that is consistently induced by exercise and consistently relieved by rest

A. Cramps
B. Claudication
C. Impaired walking function
D. Ischemic rest pain

Answer 98

B. Claudication

Question 99

This mechanism rules out the cause of essential hypertension

A. Genetic factors
B. Vasoconstrictive influence
C. Reduction of renal potassium excretion
D. Environmental factors

Answer 99

C. Reduction of renal potassium excretion

Question 100

Blockade of alpha 1 adrenergic receptors lead to

A. increased urine outflow resistance
B. inhibition of vasodilation
C. increased peripheral resistance
D. inhibition of vasoconstriction

Answer 100

D. inhibition of vasoconstriction

Question 101

A 45-year-old female consults with you and complains of persistent leg cramps which have been worsening in intensity over the last two or three days. Her left leg seems to be swollen, erythematous, and is slightly tender upon palpation. Which among the following is true regarding this condition?

A. Plain MRI is an excellent imaging modality
B. The quantitative plasma d-dimer ELISA rises due to breakdown of fibrin
C. Echocardiography is reliable as a diagnostic tool
D. Six months of anticoagulation therapy is warranted

Answer 101

D. Six months of anticoagulation therapy is warranted

Question 102

A 76-year-old man comes to the ER with complaints of exertional dyspnea and bipedal edema for about 1 week. On
the interim, he states that he had decreased urine output for the past 2 weeks. He is a known hypertensive and diabetic and compliant to his medications. He had history of prior ACS. On arrival, he was in mild respiratory distress with use of accessory muscle. Vital sings: BP of 160/80, HR of 120, RR of 28 cpm and O2 sat of 95% while on 2 LPM via nasal cannula. Pertinent PE: engorged neck veins with JVP of 12, (+) hepato-jugular reflux. Coarse crackles and mid-base bilateral were heard on auscultation. The PMI is at the 6th ICS left anterior axillary line, regular rhythm distinct S1 and S2, audible S3, no S4, no murmurs appreciated. Extremities showed pitting edema grade. Which of the following is your LEAST choice to control the heart rate?

A. Ivabradine
B. Verapamil
C. Beta blocker
D. Digoxin

Answer 102

B. Verapamil

Question 103

Aortic dissection is the major cause of morbidity and mortality in patient with

A. Marfan syndrome
B. Takayasu arteritis
C. coarctation of the aorta
D. deceleration injury

Answer 103

A. Marfan syndrome

Question 104

A 66-year-old male is brought to the ER complaining of severe headache and dizziness. He is a known hypertensive for around 20 years with poor compliance to medications, which he and his family was not able to recall. Initial BP at the ER was 200/130 mmHg. ECG done reveals left ventricular hypertrophy. Which of the following findings may also manifest
in this patient?

A. Serum creatinine of 0.5 mg/dL
B. Pulmonary edema
C. Papilledema or optic nerve edema
D. Glucosuria

Answer 104

C. Papilledema or optic nerve edema

Question 105

Which of the following is true of aortic dissection?

A. Its peak incidence is in younger adults
B. It presents with gradual onset of pain which often is described as mild to moderate in intensity
C. Acute aortic regurgitation is an important and common (more than 50%) complication of proximal dissection
D. The dissection usually propagates proximally to the descending aorta and into its major branches

Answer 105

C. Acute aortic regurgitation is an important and common (more than 50%) complication of proximal dissection

Question 106

. A 76-year-old man comes to the ER with complaints of exertional dyspnea and bipedal edema for about 1 week. In the interim he states that he had decreasing urine output for the past 2 weeks. He is a known hypertensive and diabetic and compliant with his medications. He had a history of prior ACS. On arrival he was in mild respiratory distress with the use
of accessory muscles. Vital signs BP of 160/80, HR of 120, RR of 28 cpm, and O2 sat of 95% while on 2 LMP via nasal
cannula. Pertinent PE: engorged neck veins with JVP of 12, (+) for hepato-jugular reflux. Coarse crackles mid-base bilateral were heard on auscultation. The PMI is at 6th ICS left anterior axillary line regular rhythm distinct S1 and S2, audible S3 no S4, no murmurs appreciated. Extremities showed pitting edema grade 2. He was then admitted to the ICU. On the 5th day, he complained of palpitations but he denied having chest pain. A review of the telemetry unit showed the
following on long lead II:
Which of the following is the most likely diagnosis?

A. Atrial flutter
B. Frequent PACs
C. SVT
D. Atrial fibrillation

Answer 106

D. Atrial fibrillation

Question 107

Laboratory workup for hypertension includes

A. 24-hour urine collection for catecholamines, to test for Cushing syndrome
B. serum potassium since hyperkalemia prompts workup for hyperaldosteronism or renal artery stenosis
C. dexamethasone suppression test, if pheochromocytoma is suspected
D. chest radiography which may show rib notching

Answer 107

D. chest radiography which may show rib notching

Question 108

Which of the following is a sympatholytic agent?

A. Carbonic anhydrase inhibitors
B. Angiotensin II receptor blocker
C. Beta receptor antagonists
D. ACE inhibitors

Answer 108

C. Beta receptor antagonists

Question 109

An adult patient was admitted due to aortic dissection. Based on the diagnostic tests conducted, an intimal tear was only seen in the ascending aorta. Under which type of DeBakey classification does this patient belong?

A. II
B. IV
C. III
D. I

Answer 109

A. II

Question 110

Which of the following is not part of the Virchow’s triad?

A. Endothelial injury
B. Embolization
C. Hypercoagulability
D. Inflammation

Answer 110

B. Embolization

Question 111

A 76-year-old man, known diabetic and hypertensive, and with a previous ACS event, is admitted to the ICU due to congestive heart failure and renal insufficiency. On the 5th day of ICU stay, he complained of palpitations without chest pain. A long lead II tracing shows ECG. A few minutes later his BP dropped to 70/60 and his heart rate is at 130 bpm. Which of the following interventions is best for this patient?

A. Cardiovert 120J (Sync)
B. Give IV Esmolol (to control HR)
C. Give 150mg Amiodarone IV push
D. Defibrillate 120J

Answer 111

C. Give 150mg Amiodarone IV push

Question 112

John came in to the clinic complaining of bipedal edema and decreased urine output. You noted icteresia and
excoriations on his upper extremities. There was bulging of the abdominal flanks. BP 150/90 mmHg. On further interview, John has Hepatitis B for 15 years now. You are considering the possibility of liver cirrhosis with renal insufficiency. Which of the following agents will you give in order to address his BP elevation and bipedal edema at the same time being cautious of the renal insufficiency?

A. Aliskiren
B. Hydralazine
C. Spironolactone
D. Perindopril

Answer 112

C. Spironolactone

Question 113

Which of the following is the least perfused region of the myocardium and is the most vulnerable to any reduction in coronary flow?

A. Transmural
B. Subendocardial
C. Inferior
D. Anteroseptal

Answer 113

B. Subendocardial

Question 114

Which of the following drugs may alter the efficacy of aspirin and clopidogrel?

A. Carvedilol
B. Pantoprazole
C. Sotalol
D. Amiodarone

Answer 114

B. Pantoprazole

Question 115

Which of the following is a requirement for the diagnosis of acute myocardial infarction?

A. ST elevation followed by Q wave formation
B. Decreased serum CPK-MB
C. Retrosternal chest pain lasting for less than 30 minutes
D. Elevated BNP

Answer 115

D. Elevated BNP

Question 116

Which of the following is an absolute contraindication to fibrinolytic therapy?

A. Intracranial arteriovenous malformation
B. Recent (within 2-4 weeks) of internal bleeding
C. Trauma
D. Active peptic ulcer

Answer 116

C. Trauma

Question 117

A 50-year-old male patient was diagnosed with acute ascending aortic dissection. Which of the following treatment modalities is preferred in this case?

A. Parenteral beta-adrenergic blocker
B. Calcium channel antagonist
C. Isolated use of a direct vasodilator
D. Urgent surgical correction

Answer 117

D. Urgent surgical correction

Question 118

A 55-year-old female with congestive heart failure, hypertension, and diabetic nephropathy will most benefit from which antihypertensive medication?

A. Angiotensin Receptor Blockers
B. Direct Renin Inhibition
C. Diuretics
D. Beta Blockers

Answer 118

A. Angiotensin Receptor Blockers

Question 119

Alpha 1 adrenergic receptor antagonists are antihypertensive agents that can also be used to alleviate some symptoms of benign prostatic hyperplasia. Which of the following has a selectivity for alpha 1A subtype resulting to its effectivity in the treatment of BPH with little effect on blood pressure?

A. Doxazosin
B. Tamsulosin
C. Finasteride
D. Prazosin

Answer 119

B. Tamsulosin

Question 120

Which of the following clinical features is Prasugrel contraindicated?

A. Persistent AF
B. Age more than 75 years old
C. History of bruises
D. Prior stroke

Answer 120

B. Age more than 75 years old

Question 121

Which of the following may be a risk factor for pulmonary embolism?

A. Primary disorders of hypercoagulability
B. Frequent alcohol intake
C. Sedentary lifestyles
D. Cardiothoracic surgery

Answer 121

D. Cardiothoracic surgery

Question 122

Hypertension due to volume overload is best addressed by which of the following medications?

A. Beta receptor antagonists
B. Calcium channel blockers
C. Direct renin inhibitor vasodilators
D. Loop diuretics

Answer 122

D. Loop diuretics

Question 123

An unconscious 59-year-old male is rushed to the ER. On the ride to the hospital, watchers say he seemed to have sudden difficulty breathing and was progressively weak before becoming unconscious. Pertinent physical examination at
the ER revealed hypotension and cyanosis. Based on the history and examination findings, he most likely has pulmonary embolism. Which of the following should you prioritize?

A. Anticoagulation and IVC filler
B. Anticoagulation and thrombolysis
C. Anticoagulation
D. IVC filler

Answer 123

C. Anticoagulation

Question 124

A 76-year-old man, known diabetic and hypertensive and with previous ACS event, is admitted at the ICU due to congestive heart failure and renal insufficiency. On the 5th day of ICU stay, he complained of palpitations without chest pain. A long lead II tracing shows: ECG
A few minutes later his BP dropped to 70/60 and his heart rate is at 130 bpm. You decided to give 150 mg Amiodarone IV push. Three minutes later, this is what you see in the cardiac monitor: ECG
Which of the following is the next best step for this patient?

A. Give Epinephrine 1 amp IV
B. Give another 150 mg Amiodarone IV push
C. Give Magnesium IV immediately
D. Call a Code Blue and start ACLS, while preparing to give IV Magnesium

Answer 124

D. Call a Code Blue and start ACLS, while preparing to give IV Magnesium

Question 125

Agents under this class of antihypertensives are used to treat dialysis disequilibrium syndrome

A. Direct renin inhibitors
B. Loop diuretics
C. Osmotic diuretics
D. Thiazide-like diuretics

Answer 125

C. Osmotic diuretics

Question 126

A 26-year-old was admitted to the ER due to worsening back pains. She is on her 38th week of gestation and claimed to have watery vaginal discharges at home. Upon physical examination, BP is 160/90 mmHg. Repeated BP takings showed persistent elevations with highest at 170/90 mmHg. Which of the following is the most appropriate in this case?

A. Aliskiren
B. Methyldopa
C. Losartan
D. Enalapril

Answer 126

B. Methyldopa

Question 127

Which of the following is an absolute contraindication to fibrinolytic therapy?

A. Recent internal bleeding
B. Prior intracranial hemorrhage
C. Active peptic ulcers
D. Current use of warfarin

Answer 127

B. Prior intracranial hemorrhage

Question 128

A 60-year-old patient was admitted in the hospital due to acute myocardial infarction. Several drugs were administered. During his course in the ward, he began to complain of persistent headache. Which of the following drugs given is most likely to cause this side effect?

A. Heparin
B. Nitroglycerin
C. Clopidogrel
D. Atorvastatin

Answer 128

B. Nitroglycerin

Question 129

Which of the following possible causes of morbidity and mortality should most likely be expected in patients with aortic dissection?

A. Myocardial infarction
B. Pulmonary embolism
C. Gastrointestinal bleeding
D. Hemiplegia

Answer 129

A. Myocardial infarction

Question 130

A 55-year-old male came into the ER complaining of severe crushing chest pain associated with diaphoresis. He is a
known hypertensive and diabetic but poorly compliant to his medication. Interim history showed that he has been experiencing intermittent chest pain lasting around 10 minutes but abates when activity is decreased. The 12-lead ECG showed. The above patient required Heparin as part of ACS regimen. Which of the following is the recommended dose of Enoxaparin in patients with ACS (given every 12 hours)?

A. 0.5 mg/kg
B. 2 mg/kg
C. 1.5 mg/kg
D. 1 mg/kg

Answer 130

D. 1 mg/kg

Question 131

Which among the following is correct regarding the physical examination findings in a patient with chronic hypertension?

A. Neurologic assessment may reveal absent deep tendon reflexes
B. Examination of the abdomen may reveal enlarged kidneys and abdominal aortic pulsations
C. Body mass index may be below normal
D. Examination of the back may reveal masses

Answer 131

B. Examination of the abdomen may reveal enlarged kidneys and abdominal aortic pulsations

Question 132

A postmenopausal woman with symptoms suggestive of ACS was referred to a cardiologist for further evaluation and management. After 12 hours from the onset of symptoms, she complained of recurrent ischemic pain. Which of the following management plans is best for this patient?

A. Outpatient follow-up
B. Admit to hospital
C. Treat as chronic stable angina
D. Request for stress study

Answer 132

B. Admit to hospital

Question 133

Which of the following statements is true regarding goals of treatment in patients with arrhythmia?

A. Asymptomatic patient may not receive drug therapy
B. Increase ventricular response in patients with atrial fibrillation
C. Fleicainide or Amiodarone can be used to maintain sinus rhythm
D. Maintenance of AF rhythm for best outcome

Answer 133

A. Asymptomatic patient may not receive drug therapy

Question 134

A mineralocorticoid receptor antagonist used for resistant hypertension due to primary aldosteronism as a consequence of adrenal adenoma

A. Furosemide
B. Metolazone
C. Captopril
D. Spironolactone

Answer 134

D. Spironolactone

Question 135

A 29-year-old obese patient came in for consult due to nape pain and history of BP elevations with a highest reading of 138/90 mmHg. Part of your intervention is to educate the patient on the non-pharmacologic interventions which include

A. isometric and dynamic resistance exercise on most days of the week
B. optimal goal of delivery potassium less than 1500 mg/day
C. ketogenic diet with most content of saturated fat and dairy products
D. enhanced intake of dietary sodium

Answer 135

A. isometric and dynamic resistance exercise on most days of the week

Question 136

A 66-year-old male is brought to the ER complaining of severe headache and dizziness. He is a known hypertensive for around 20 years with poor compliance to medication, which he and his family are not able to recall. Around three years’ prior, patient recalled having a “mild stroke” for which he consulted but was lost to follow-up. Initial BP at the ER is 200/130 mmHg. ECG done reveals left ventricular hypertrophy. Which among the following will be your primary working impression?

A. Hypertensive urgency
B. Cerebrovascular disease
C. Hypertensive crisis
D. Hypertensive emergency

Answer 136

D. Hypertensive emergency

Question 137

Which of the following is the most congenital cardiovascular cause of hypertension?

A. Mitral valve prolapse
B. Coarctation of the aorta
C. Pheochromocytoma
D. Tetralogy of Fallot

Answer 137

B. Coarctation of the aorta

Question 138

A 55-year-old male came to the ER complaining of severe, crushing chest pain associated with diaphoresis. He is a known hypertensive and diabetic but poorly compliant to medications. Interim history showed that he has been experiencing chest pain lasting around 10 minutes but abates when activity is decreased. Which of the following is the next best option for the patient?

A. Give ASA and P2Y12 inhibitor
B. Give heparin intravenously
C. Give pharmaco-invasive therapy (thrombolysis)
D. Transfer to a PCI-capable hospital 50 km away

Answer 138

NO answer

Question 139

Which of the following IV medications can be given in unstable patients with PSVT?

A. Intravenous beta blockers
B. Diltiazem
C. Diazepam
D. Adenosine

Answer 139

D. Adenosine

Question 140

Which of the following is true of the epidemiology of atrial fibrillation (AF)?

A. It is more prevalent among Blacks than in Whites
B. It is more common in women than in men
C. Smoking is a risk factor for the development of AF
D. Its prevalence increases with age with a sharp incline after age of 64 years

Answer 140

C. Smoking is a risk factor for the development of AF

Question 141

A 56/M with a recent diagnosis of heart failure has been assessed for his functional capacity. He is still comfortable at rest but ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain. What is the classification of the patient according to the New York Heart Association (NYHA)?

A. Class III
B. Class IV
C. Class I
D. Class II

Answer 141

D. Class II

Question 142

What is the classic Wolff-Parkinson-White electrocardiogram?

A. Short PR, QRS less than 120 ms, delta wave
B. Prolonged P, normal QRS, delta wave
C. Short PR, QRS more than 120 ms, delta wave
D. Prolonged PR, QRS more than 120 ms, delta wave

Answer 142

C. Short PR, QRS more than 120 ms, delta wave

Question 143

What causes Group 5 Pulmonary Hypertension according to the World Health Organization classification?

A. Sarcoidosis
B. Left-sided heart disease
C. Human immunodeficiency virus
D. Interstitial lung disease

Answer 143

A. Sarcoidosis

Question 144

The heart undergoes cardiac remodeling during the initial phase of heart failure in response to a series of complex events that occur at the cellular and molecular levels. Which ventricular geometric change occurs during heart failure?

A. Wall thickening
B. Constriction
C. Atrophy
D. Hyperplasia

Answer 144

A. Wall thickening

Question 145

Which of the following factors can precipitate an acute episode of AF?

A. Hypothyroidism
B. Hypertension
C. Diabetes
D. Alcohol intoxication

Answer 145

D. Alcohol intoxication

Question 146

How does Ebstein anomaly lead to a symptomatic WPW?

A. It has connective tissue disease mutation of fibrillin
B. They frequently have multiple accessory bypass tracts
C. It has valvular flaps of the mitral valve which causes excitation
D. It has ventricular septal defects which causes symptoms

Answer 146

D. It has ventricular septal defects which causes symptoms

Question 147

Which of the following is a risk factor for the development of sustained AF?

A. Alcoholism
B. Smoking
C. Sleep apnea
D. Nutrition

Answer 147

C. Sleep apnea

Question 148

Janine is a 55/F with a history of COPD and hypertension. She has marked limitation with physical activity and must stop to rest several times when completing a 6-minute walking test. According to the World Health Organization, functional classification for pulmonary hypertension, how would this patient be classified?

A. Class II
B. Class I
C. Class IV
D. Class III

Answer 148

D. Class III

Question 149

A 60/M has Group II Pulmonary Hypertension classification. What can you expect to see in his medical history?

A. Left-sided heart disease
B. Sarcoidosis
C. Human immunodeficiency virus
D. Interstitial lung disease Group

Answer 149

A. Left-sided heart disease

Question 150

Which of the following diagnostic tests for Pulmonary Hypertension can show signs of venous congestion including centrilobular ground-glass infiltrate and thickened septal lines?

A. Chest x-ray
B. CT angiogenesis
C. High-resolution computed tomography
D. Echocardiography

Answer 150

C. High-resolution computed tomography

Question 151

A patient is admitted to the hospital with right-sided heart failure. Which clinical manifestation would we expect the patient to exhibit?

A. Dependent edema
B. Orthopnea
C. Cough
D. Cyanosis

Answer 151

A. Dependent edema

Question 152

A 65-year-old male, known diabetic and hypertensive who is poorly compliant to his medications and follow-up comes to the ER complaining of dyspnea that started a few hours ago. He denies having cough or colds but his daughter said he had fever 2 days ago. He has irregularly irregular rhythm, tachycardic, and rales on both lung fields, and bipedal edema. ECG showed AF. Which of the following interventions should be prioritized in this case?

A. Cardioversion
B. Rate control
C. Antibiotic coverage
D. Anticoagulation

Answer 152

A. Cardioversion

Question 153

Which of the following is the most common etiology of myxomatous degeneration of the mitral valve?

A. Idiopathic cause
B. Connective tissue disease
C. X-lined recessive inheritance
D. Autosomal dominant

Answer 153

A. Idiopathic cause

Question 154

MVP patients with myxomatous degeneration commonly involve what heart valve?

A. Tricuspid valve
B. Aortic valve
C. Pulmonic valve
D. Mitral valve

Answer 154

D. Mitral valve

Question 155

Which physical findings are characteristic of Wolff-Parkinson-White Syndrome?

A. Resting tachycardia on examination with minimal symptoms
B. Hyperflexible extremities
C. Murmur located at 5th ICS parasternal area
D. Usually present with pectus excavatum

Answer 155

A. Resting tachycardia on examination with minimal symptoms

Question 156

Which of the following CTD is commonly associated with MVP that is due to fibrillin-1 mutation?

A. Osteogenesis imperfect
B. Fabry’s disease
C. Marfan’s syndrome
D. Ehler-Danlos syndrome

Answer 156

C. Marfan’s syndrome

Question 157

A 42yo was brought to the Emergency Room due to syncope. V/S BP 70/40, HR 160, RR 24. ECG 12 leads done noted narrow QRS PSVT. What is the best treatment option?

A. Synchronized cardioversion
B. Vagal maneuvers
C. Intravenous beta blockers
D. IV verapamil

Answer 157

A. Synchronized cardioversion

Question 158

A diagnosed case of MVP came in at the ER. ECG noted Atrial Fibrillation. Which of the following agents are the most appropriate drugs to be given?

A. Antibiotics
B. Anticoagulants
C. Diuretics
D. Beta blockers

Answer 158

D. Beta blockers

Question 159

It is the most important screening test for the diagnosis of Pulmonary Hypertension?

A. Chest x-ray
B. High-resolution computed tomography
C. Echocardiography
D. CT angiogram

Answer 159

C. Echocardiography

Question 160

Which of the following factors will influence the decision to initiate urgent intervention for AF?

A. Hemodynamic status
B. Patient preference
C. Risk factors for sustained AF (DM, hypertension)
D. Age

Answer 160

A. Hemodynamic status

Question 161

Heart failure may result from systolic or diastolic dysfunction. Which of the following disease entities could result in systolic dysfunction?

A. Ischemic heart disease
B. Amyloid deposition
C. Constrictive pericarditis
D. Myocardial fibrosis

Answer 161

A. Ischemic heart disease

Question 162

In heart failure, arterial pressure fails, stimulating the baroreceptor reflex to increase sympathetic nervous system activity. An increased sympathetic activity will produce which response?

A. Bradypnea
B. Hypoglycemia
C. Hypotension
D. Tachycardia

Answer 162

C. Hypotension

Question 163

A 24 yo male had penetrating wound in the abdomen 3 years ago. He consulted a physician because he complained of a vibrating sensation in the area. Bruit was heard on auscultation. What vascular change has most likely occurred?

A. Autoimmune vasculitis formation
B. Formation of arteriovenous fistula
C. Obstruction of the renal artery
D. Rupture of the abdominal aorta

Answer 163

B. Formation of arteriovenous fistula

Question 164

A small-vessel necrotizing vasculitis classically associated with asthma, allergic rhinitis, lung infiltrates, peripheral hypereosinophilia, and extravascular necrotizing granulomata?

A. Churg-Strauss syndrome
B. Kawasaki disease
C. Polyarteritis nodosa
D. Takayasu arteritis

Answer 164

A. Churg-Strauss syndrome

Question 165

The simplest diagnostic modality in evaluating patients with chronic hypertension having increase risk of ischemic heart disease is:

A. Serum LDL
B. ECG
C. Serum cholesterol
D. Serum C-reactive protein

Answer 165

D. Serum C-reactive protein

Question 166

Which of the following murmurs is 2D echo indicated?

A. Grade II systolic murmur
B. Mid-systolic murmur
C. Soft systolic murmur
D. Continuous murmur

Answer 166

D. Continuous murmur

Question 167

A 17-year-old female comes into a clinic with a complaint of shortness of breath. She had an upper respiratory infection a few weeks back. Vital signs were PR 90/min, BP 112/62mmHg, RR 22/min, Temp. 37.5/C. On examination, there is bilateral pedal edema. Lung auscultation reveals bilateral crackles. Which of the following histological findings can be seen in cardiac muscles with this condition?

A. Polymorphonuclear neutrophilic leukocyte
B. Eosinophils
C. Lymphocytes and macrophages
D. Platelets

Answer 167

C. Lymphocytes and macrophages

Question 168

An 20-year old man comes to the ERD due to intense chest pain. Which of the following clinical features from the physical examination is suggestive of a benign condition?

A. Tenderness over the upper ribs
B. Weight loss
C. Muscle wasting in the upper extremity ipsilateral to the source of pain
D. Tachycardia, decreased breath sounds, diaphoresis

Answer 168

A. Tenderness over the upper ribs

Question 169

Which of the following valvular disease has a diastolic timing?

A. Aortic stenosis
B. Mitral regurgitation
C. Tricuspid regurgitation
D. Aortic regurgitation

Answer 169

D. Aortic regurgitation

Question 170

A 10-year-old boy is brought to the clinic by his mother for evaluation of lower extremity swelling. The child had recently recovered from pharyngitis 3 weeks ago. Vital sign: PR 125, BP 98/60, RR 30, and Temp 37.7/C. On examination, there is bilateral pedal edema. Lung auscultation reveals fine crackles. Cardiac auscultation reveals pericardial rub. Which of the following is the underlying hypersensitivity reaction seen with this
condition?

A. Type III
B. Type I
C. Type IV
D. Type II

Answer 170

D. Type II

Question 171

What is the likely etiology in this vascular disease showing segmental, thrombosing, acute and chronic inflammation of medium-sized and small arteries, principally the tibial and radial arteries, with occasional secondary extension into the veins and nerves of the extremities?

A. Sepsis
B. Hepatitis
C. Diabetes
D. Smoking

Answer 171

D. Smoking

Question 172

True of Aschoff nodule EXCEPT:

A. Lymphoid aggregates of both T and B lymphocytes and occasional macrophages are seen in later stages
B. Results from inflammation and consist of
coagulative necrosis and inflammatory cells
C. Nodules begin to heal in 3-4 months with
regression and fibrosis of the nodule
D. Seen in myocardium, endocardium, occasionally the pericardium, and valves of patients with rheumatic fever

Answer 172

B. Results from inflammation and consist of
coagulative necrosis and inflammatory cells

Question 173

The cell type that play important role in stabilization of an atheroma:

A. T-cell
B. Eosinophil
C. Monocyte
D. Smooth muscle cell

Answer 173

D. Smooth muscle cell

Question 174

What is the expected histologic vascular changes in the small arteries and arterioles in patients with chronic hypertension?

A. The vascular walls are hyalinized
B. Presence of cholesterol plaques
C. The vascular walls are calcified
D. Vascular aneurysm is present

Answer 174

B. Presence of cholesterol plaques

Question 175

Which of the following statement is true?

A. No link between atherosclerosis and
arteriosclerosis
B. Arteriosclerosis is a type of atherosclerosis
C. Arteriosclerosis is the same atherosclerosis
D. Atherosclerosis is a type of arteriosclerosis

Answer 175

D. Atherosclerosis is a type of arteriosclerosis

Question 176

A useful diagnostic marker that mirrors clinical severity and predictive of disease recurrence in autoimmune vasculitis is:

A. ANCA
B. Anti-CCP
C. CRP
D. ANA

Answer 176

A. ANCA

Question 177

A 66-year-old woman has a “Stroke”. She has smoked a pack of cigarettes a day for the past 45 years. Vital signs are T 37.1°C, P 80/minute, RR 16/minute, and BP 160/100 mm Hg. A cerebral angiogram reveals occlusion of a branch of her middle cerebral artery. Laboratory findings include a hemoglobin A1C 9%. Which of the following components of blood lipids is most important in contributing to her disease?

A. VLDL
B. Chylomicrons
C. HDL cholesterol
D. Oxidized LDL

Answer 177

D. Oxidized LDL

Question 178

Which of the following is TRUE of Austin-Flint murmur?

A. Underlying valvular problem is mitral stenosis
B. Often mistaken for aortic regurgitation
C. A mid-systolic to pre-diastolic murmur
D. Intensity decreases in the presence of
vasodilators

Answer 178

D. Intensity decreases in the presence of
vasodilators

Question 179

Most murmurs decrease in intensity and length during Valsalva maneuver EXCEPT on which of the following conditions?

A. Pulmonic stenosis
B. Mitral regurgitation
C. Mitral Valve Prolapse
D. Diastolic murmur of HOCM

Answer 179

D. Diastolic murmur of HOCM

Question 180

Which of the following is TRUE regarding possible cardiac causes of an adult patient presenting with chest discomfort?

A. Unstable ischemic heart disease results from a gradual narrowing of the coronary arteries
B. Ischemic heart disease becomes unstable with coronary thrombosis caused by erosion of atherosclerotic lesions
C. Irreversible cellular injury may occur with myocardial ischemia within as short as thirty minutes of diminished oxygen supply to the heart
D. Ischemic heart disease may be caused by conditions such as aortic valve disease or congenital abnormalities of the coronary blood vessels

Answer 180

B. Ischemic heart disease becomes unstable with coronary thrombosis caused by erosion of atherosclerotic lesions

Question 181

According to the American College of Cardiology Foundation (ACCF)/ American Heart Association (AHA) guidelines, which of the following are the cardinal symptoms of heart failure?

A. Dyspnea and Fatigue
B. Edema and Rales
C. Increasing abdominal girth and Pleural Effusion
D. Chest pain and Paroxysmal Nocturnal Dyspnea

Answer 181

A. Dyspnea and Fatigue

Question 182

A 20 y.o. male has a huge mediastinal mass. The patient had a bilateral pleural effusion and the surgeon was able to drain via thoracostomy 1000 cc of milky, turbid fluid. What vascular channel is being involved/invaded/obstructed by the tumor?

A. Aorta
B. Lymphatics
C. Pulmonary vein
D. Pulmonary artery

Answer 182

B. Lymphatics

Question 183

A 50 yo male complained of blurring of vision with absence of pulses in the upper extremities. The patient died thereafter. Autopsy was done and vascular channels were collected for histopathologic studies. What is the expected histologic changes in the blood vessels of the patient if the patient died of Takayasu arteritis?

A. Intraluminal vascular plaques and thrombus
B. There is irregular thickening of the aortic wall with intimal hyperplasia. The vessel lumina is markedly narrowed and obliterated
C. Segmental fibrinoid necrosis of the media and focal transmural necrotizing lesions with no granuloma
D. Acute and chronic vascular inflammation, accompanied by luminal thrombosis

Answer 183

B. There is irregular thickening of the aortic wall with intimal hyperplasia. The vessel lumina is markedly narrowed and obliterated

Question 184

Which of these scenarios given below does not describe the quality of pain presented by a patient suspected of having myocardial ischemia?

A. A patient who reported of a sudden and intense sharp pain when inhaling with radiation to the shoulder
B. A patient who described the chest pain as discomfort to tightness
C. A patient who presented with a steady severe pressure in the chest
D. A patient who complained of a burning pain in the chest

Answer 184

A. A patient who reported of a sudden and intense sharp pain when inhaling with radiation to the shoulder

Question 185

Which of the following cardiac markers is preferred in cases of re-infarction?

A. Total CK
B. Cardiac troponins
C. LD-1
D. CK-MB

Answer 185

D. CK-MB

Question 186

Role of macrophage in atherosclerotic plaque does NOT include:

A. Production of toxic oxygen species to oxidized LDL
B. Binding to oxidized LDL via scavenger receptor
C. Production of cytokines and chemotaxins for leukocyte migration and adhesion
D. Recruitment of macrophage responsible for
growth of atherosclerotic plaque

Answer 186

D. Recruitment of macrophage responsible for growth of atherosclerotic plaque

Question 187

Which of the following is the characteristic murmur of aortic stenosis?

A. Austin Flint murmur
B. Opening snap
C. Diastolic murmur
D. Systolic ejection murmur

Answer 187

D. Systolic ejection murmur

Question 188

Which of the following findings is often associated with left ventricular dysfunction from severe ischemia?

A. S4 on auscultation
B. Sinus tachycardia on ECG
C. Pulmonary edema on radiography
D. Levine’s sign

Answer 188

C. Pulmonary edema on radiography

Question 189

Which of the following is TRUE of chest pain caused by Acute Pericarditis?

A. Due to the impulses transmitted by the nerve endings present in the visceral and parietal surface of the pericardium
B. Commonly referred to the interscapular area
C. Relieved by change in position
D. Associated with inflammation of the pleura

Answer 189

D. Associated with inflammation of the pleura

Question 190

The following are examples of high-output states that may cause heart failure, EXCEPT:

A. Chronic Anemia
B. Cor Pulmonale
C. Thyrotoxicosis
D. Systemic Arteriovenous Shunting

Answer 190

B. Cor Pulmonale

Question 191

Which of the following is associated with the chest pain experienced by patients with Acute Aortic Syndrome?

A. May cause disruption of the aortic valve, leading to aortic stenosis
B. Proximal aortic dissections can lead to rupture of the hematoma into the pericardial space, causing tamponade
C. Tends to be steady, deep and radiates to the neck and jaw
D. Localized in the midline of the anterior chest if it involves the descending aorta

Answer 191

B. Proximal aortic dissections can lead to rupture of the hematoma into the pericardial space, causing tamponade

Question 192

A 25 yo male, chronic smoker and had intermittent claudication of the lower extremities followed by pain on exercise. What is the histologic finding of this patient on biopsy of vascular channels in the lower extremity?

A. Hyalinized and hyperplastic vascular wall
B. Loos of elastic lamina of the arterial wall
C. Venous vascular occlusion by thrombus with wall abscess
D. Segmental fibrinoid necrosis of the small arterial wall

Answer 192

C. Venous vascular occlusion by thrombus with wall abscess

Question 193

A 35-year old female complained of exertional dyspnea associated with fatigue. On examination, systolic thrill over PMI is noted and a pansystolic murmur maximal at the apex radiating to the axilla was also appreciated. Which of the following is the expected valvular lesion?

A. Mitral Regurgitation
B. Mitral Stenosis
C. Aortic stenosis
D. Pulmonary Regurgitation

Answer 193

A. Mitral Regurgitation

Question 194

Which of these findings is seen in patients with acute MI?

A. Profound hypotension
B. Low grade fever
C. Hypoxemia
D. Sinus tachycardia

Answer 194

B. Low grade fever

Question 195

A 10-year-old female is brought by her mother for the evaluation of abrupt, irregular movements. Developmental and birth history is insignificant. Vital signs PR 118/min, BP 108/62 mmHg, RR 23/min, and Temp 37.6/C. On examination, she has a milkmaid sign and darting tongue. The healthcare provider suspects rheumatic heart disease. Which of the following investigations should be performed in this patient?

A. Streptozyme test
B. MRI of the brain
C. Cardiac echocardiography
D. Serum ceruloplasmin level

Answer 195

C. Cardiac echocardiography

Question 196

What is the common cause of death in pediatric patients with vasculitis who presented with conjunctival and oral erythema and blistering, edema of the hands and feet, erythema of the palms and soles, desquamative rash, and cervical lymph node enlargement?

A. Myocardial infarction
B. Dehydration
C. Cerebral hemorrhage
D. Sepsis

Answer 196

A. Myocardial infarction

Question 197

What most common serious clinical complication of DVT and is often the first manifestation of thrombophlebitis with increase in serum D-dimer?

A. Cerebral infarction
B. Gangrene of the affected extremity
C. Myocardial infarction
D. Pulmonary embolism

Answer 197

D. Pulmonary embolism

Question 198

A postgraduate medical intern assigned to screen possible blood donors heard a holosystolic murmur in one of the volunteers. Which of the following should this intern do next?

A. Refer immediately to a cardiologist
B. Request for a 2D echocardiography
C. Obtain an ECG and Chest Xray
D. Perform a stress test

Answer 198

B. Request for a 2D echocardiography

Question 199

A mid-systolic murmur, crescendo-decrescendo, heard best in the left second intercostal space, introduced by an ejection sound in younger adults is heard in this valvular heart disorder:

A. Severe Pulmonic Stenosis
B. Tricuspid Stenosis
C. Mild-moderate Pulmonic Stenosis
D. Tricuspid Regurgitation

Answer 199

C. Mild-moderate Pulmonic Stenosis

Question 200

A 12-year-old girl is brought to the clinic due to fever, lethargy, anorexia, and pain in multiple joints for the past two days. Her parents report that she complained of pain in her right ankle yesterday while today, her left knee is hurting. She recovered from a sore throat about three weeks ago. On examination, she is vitally stable, with a temp. 37.4nC. The precordial examination is significant for a holosystolic murmur at the cardiac apex that radiated to the left axilla. This murmur has most likely resulted from which of the following?

A. Mitral regurgitation
B. Pulmonary regurgitation
C. Mitral stenosis
D. Tricuspid regurgitation

Answer 200

A. Mitral regurgitation

Question 201

Bechet disease is a small- to medium-vessel neutrophilic vasculitis and is usually ruled out if this clinical sign is present?

A. Viral hepatitis with jaundice
B. Genital ulcers
C. Recurrent oral aphthous ulcers
D. Uveitis

Answer 201

A. Viral hepatitis with jaundice

Question 202

Chest pain, one of the most common cause of ER visits, maybe due to various conditions. Which of the following is the most common underlying problem that are eventually seen following work-up of cases?

A. Ischemic heart disease
B. Gastrointestinal causes
C. Chest wall problems
D. Pulmonary conditions

Answer 202

B. Gastrointestinal causes

Question 203

Patient complains of the sudden onset of excruciating pain, usually beginning in the anterior chest, radiating to the back between the scapulae, and moving downward. What the most likely vascular event that
has occurred?

A. Aortic dissection
B. Cardiac tamponade
C. Vasculitis
D. Thoracic aortic aneurysm

Answer 203

A. Aortic dissection

Question 204

What is the most common effect of tumors in patients having superior vena cava syndrome?

A. Superior vena cava torsion
B. Compression or invasion of the tumor of the superior vena cava
C. Vascular rupture secondary to tumor invasion
D. Aneurysm secondary to tumor invasion

Answer 204

B. Compression or invasion of the tumor of the superior vena cava

Question 205

There is a propensity for atheromas to form at muscular arterial branch points, such as the carotid and aortic bifurcations. Which of the following events in the arteries at these locations is most likely to initiate atherogenesis?

A. Cholesterol breakdown
B. Lactic acidosis
C. Hypoxemia
D. Endothelial dysfunction

Answer 205

D. Endothelial dysfunction

Question 206

Which of the following is TRUE regarding laboratory tests for patients presenting with chest pain?

A. ST segment and T-wave abnormalities may be associated with panic disorder, hyperventilation, pericarditis, pulmonary embolism, and metabolic disorders
B. Cardiac troponin determination on admission is a must to diagnose acute coronary syndrome
C. Echocardiography is most essential for identifying disease processes involving pulmonary cases, such as pneumonia or pneumothorax
D. The chest radiograph is diagnostic in patients with mechanical complications of myocardial infarction and in patients with pericardial tamponade

Answer 206

A. ST segment and T-wave abnormalities may be associated with panic disorder, hyperventilation, pericarditis, pulmonary embolism, and metabolic disorders

Question 207

What serum marker would increase in patients with microscopic polyangiitis and Churg-Strauss disease?

A. Anti-endothelial cell antibodies
B. Anti-CCP
C. Anti- myeloperoxidase
D. Anti-proteinase 3

Answer 207

C. Anti- myeloperoxidase

Question 208

A chronic smoker presents with severe and unrelenting chest pain which on investigation turned out to be more of shoulder pain that radiates to the ulnar side of his right arm. There is also note of weakness and muscle atrophy of the muscles in his right hand. The attending physician is suspecting a malignancy. Which of the following systems is the most likely source of the malignant process?

A. Gastrointestinal
B. Neuromuscular
C. Pulmonary
D. Cardiovascular

Answer 208

C. Pulmonary

Question 209

Which of the following cardiac markers is most helpful in cases of late diagnosis of myocardial infarction (i.e. levels remain elevated several days after onset of chest pains)?

A. Cardiac troponins
B. Lactate dehydrogenase isoenzyme-1
C. Total CK
D. Myoglobin

Answer 209

B. Lactate dehydrogenase isoenzyme-1

Question 210

A 30-year-old patient’s office SBP treatment target range is 130 to <140mmHg as advised by the attending physician. Aside from hypertension, what other condition is present in the patient?

A. Diabetes
B. CKD
C. CAD
D. TIA

Answer 210

B. CKD

Question 211

Patient N.B., 49F, G5P5, obese, consulted at the OPD due to bilateral lower leg pruritus for 5 months which was associated with pressure sensation aggravated with prolonged standing. Upon examination, her vital signs were normal. However, she had edematous lower extremities with skin hyperpigmentation. What is the
clinical classification of the patient?

A. C6
B. C0
C. C2
D. C4

Answer 211

D. C4

Question 212

A patient came in with Limb Ischemia. Based on your assessment, the limb can be salvaged if prompt treatment is done. There were no sensory loss and muscle weakness noted. His doppler arterial signal is inaudible. Based on Rutherford’s ALI Classification. The patient is classified as:

A. Category I
B. Category II Intermediate
C. Category II Marginal
D. Category III

Answer 212

C. Category II Marginal

Question 213

What drug is a vasodilator with an antiplatelet property?

A. Pentoxifylline
B. Cilostazol
C. Rivaroxaban
D. Clopidogrel

Answer 213

B. Cilostazol

Question 214

Which among the following dermatologic lesions associated with venous insufficiency is correctly described?

A. Phlebectasia corona - inflammation, ulcers, and itchy skin on the lower legs
B. Lipodermatosclerosis – induration, hemosiderin deposition and inflammation, usually in the upper part of the leg
C. Atrophie blanche – white patch of scar tissue with hyperpigmented border and focal telegiectasias
D. Stasis dermatitis – shallow, irregular border, with tissue granulation and exudates

Answer 214

C. Atrophie blanche – white patch of scar tissue with hyperpigmented border and focal telegiectasias

Question 215

Which among the following is an operative procedure for femoral-popliteal artery disease?

A. Axillofemoral bypass
B. Thromboendarectomy
C. Femoro-femoral bypass
D. Atherectomy

Answer 215

B. Thromboendarectomy

Question 216

A 60-year-old male with a history of hypertension is diagnosed with atrial fibrillation following a transient ischemic attack. He is started on calcium channel blocker for hypertension and beta blocker for atrial fibrillation. Presently, he is asymptomatic and hemodynamically stable. On discharge from the hospital, which of the following should be added to the treatment plan?

A. Oral anticoagulant
B. Pacemaker placement
C. Electrical cardioversion after two weeks
D. Enteric-coated aspirin

Answer 216

A. Oral anticoagulant

Question 217

How should office BP measurement be done?

A. BP cuff should be positioned at the level of the heart
B. Measure BP in one arm at least at the first visit
C. Take two BP measurements 1-2 minutes apart
D. Let the patient seat comfortably for 3 minutes before BP measurement

Answer 217

A. BP cuff should be positioned at the level of the heart

Question 218

How many large squares are there in a 6-second strip?

A. 20
B. 30
C. 40
D. 10

Answer 218

B. 30

Question 219

A 60/F who had a history of stroke twice was seen at the OPD for regular follow-up check-up. However, she claimed that for the past month she started to experience left leg pain especially during exertion. The physician was highly considering PAD hence, she calculated for the patient’s ankle-brachial index. The patient’s higher left arm pressure was 130 mmHg while her higher left ankle pressure was 80 mmHg. What is the correct interpretation?

A. Mild
B. Severe
C. Normal
D. Mild to moderate PAD

Answer 219

D. Mild to moderate PAD

Question 220

Angelo, 18 years old, male, sought consult with an Internist due to occasional abdominal pain noted for 6 months and just recently associated with vomiting. Upon physical examination, his BP was recorded as 180/100mmHg. What could cause the BP elevation in this case and should be investigated further through laboratory work-up?

A. Thyroid disease
B. Primary Aldosteronism
C. Renal parenchymal disease
D. Fibromuscular dysplasia

Answer 220

C. Renal parenchymal disease

Question 221

Which among the following statements regarding the electrophysiology of cardiac conduction and its relation to ECG is TRUE?

A. At the resting state, the cells have predominantly positive charges
B. The wave of repolarization across adjoining cells produces a positive deflection on the ECG
C. The spread of depolarization toward the positive electrode produces a negative deflection on the ECG
D. Once all of the myocardial cells are in their depolarized state, the ECG recording returns to its baseline level

Answer 221

D. Once all of the myocardial cells are in their depolarized state, the ECG recording returns to its baseline level

Question 222

Which among the following statements regarding the factors of increased automaticity is TRUE?

A. Decreased sympathetic nervous system activity can dramatically increase the rate of firing of SA nodal cells, producing sinus tachycardia with rates 200 beats/min
B. Hypokalemia and ischemia may reduce the activity of Na, K-ATPase, thereby reducing the background repolarizing current and enhancing phase 4 diastolic depolarization
C. The effect of the beta receptors augmenting L-type Ca currents is decreasing the slope of phase 4
D. Augmentation of the sympathetic nervous system tone decreases myocardial catecholamine concentrations, which activate both α- and β- adrenergic receptors

Answer 222

B. Hypokalemia and ischemia may reduce the activity of Na, K-ATPase, thereby reducing the background repolarizing current and enhancing phase 4 diastolic depolarization

Question 223

Patient E.P., 56/M, who is known diabetic sought consult at the OPD due to on and off right leg cramps for 3 months which he started to experience every time he goes for a morning jog but spontaneously subsides whenever he stops to rest. On examination, there were no noted skin lesions and hyperpigmentation. There was no presence of edema. However, it was noted that the right dorsalis pedis and posterior tibial pulses were both decreased. What could be the closest diagnosis?

A. Peripheral arterial disease
B. Diabetic neuropathy
C. Chronic venous insufficiency
D. Lymphedema

Answer 223

A. Peripheral arterial disease

Question 224

What tips on palpation will help you decide if the pulses felt are yours or the patient?

A. Press the pulse deeper and raise hand upward
B. Count your heart rate and compare it with the patient
C. Rub your fingers and palpate
D. Let the patient lean forward

Answer 224

B. Count your heart rate and compare it with the patient

Question 225

PVCs are most dangerous if they:

A. Are multiformed and increase in frequency
B. Occur after a T wave
C. Are uniform and wide
D. Appear wide and bizzare

Answer 225

A. Are multiformed and increase in frequency

Question 226

A rapid, irregularly irregular rhythm with varying PP, PR and RR intervals with at least 3 distinct P-wave morphologies:

A. Multifocal atrial tachycardia
B. Atrial fibrillation
C. Wandering atrial pacemaker
D. Ventricular tachycardia

Answer 226

A. Multifocal atrial tachycardia

Question 227

Your patient who is a diabetic complained of intermittent pain and fatigue in her calves especially noted upon exercise. Which of the following does this patient most likely have?

A. Raynauds Phenomenon
B. Tissue necrosis
C. Acute Limb Ischemia
D. Claudication

Answer 227

D. Claudication

Question 228

Which of the following is most accurate regarding the clinical presentation of Chronic Venous Disease?

A. Lipodermatosclerosis is the presence of induration, hemosiderin deposition, or inflammation, and typically occurs in the leg just around the popliteal angle
B. Atrophie blanche is the combination of induration, hemosiderin deposition, and inflammation, and typically occurs in the lower part of the leg just above the ankle
C. The edema, which is usually non-pitting, may be confined to the ankles, extend above the ankles to the knees, or involve the thighs in severe cases
D. Patients with venous varicosities are often
asymptomatic but still concerned about the cosmetic appearance of their legs

Answer 228

D. Patients with venous varicosities are often
asymptomatic but still concerned about the cosmetic appearance of their legs

Question 229

Which among the following is true about the pathology of lesion of PAD?

A. Thickening of the media
B. Unfragmented internal elastic lamina
C. Atherosclerotic plaque with potassium deposition
D. Thrombi composed of platelets and fibrin

Answer 229

D. Thrombi composed of platelets and fibrin

Question 230

At what office DBP should BP-lowering drug treatment be initiated in 80 years old and above? BP greater than or equal to ____ mmHg.

A. 90
B. 110
C. 80
D. 100

Answer 230

A. 90

Question 231

In ventricular fibrillation, which of the following is easier to convert to normal rhythm?

A. Small fibrillatory waves
B. Medium fibrillatory waves
C. Coarse fibrillatory waves
D. Ventricular fibrillation that has evolved to asystole

Answer 231

C. Coarse fibrillatory waves

Question 232

A 70-year-old male with congestive heart failure develops the rhythm (shown below) 2 days post-surgery. BP 90/60mmHg, PR 135 bpm, RR 22cpm. What is the best treatment for this patient?

A. Lidocaine
B. Digoxin
C. Epinephrine
D. Amiodarone

Answer 232

D. Amiodarone

Question 233

A 21/F, G1P0, underwent emergency Cesarean Section for Pre-eclampsia, severe. 1 hour post-op, she was noted to have palpitations. BP 120/80 mmHg, with a very rapid pulse. GCS 15. Rhythm strip noted on cardiac monitor as shown below. What is the next best step in the management of this case?

A. Perform synchronized cardioversion at 100 J
B. Perform synchronized cardioversion at 50 J
C. Start Adenosine 6 mg IV
D. Perform carotid massage

Answer 233

D. Perform carotid massage

Question 234

A 50-year-old male presents to the clinic for a routine checkup. A review of systems reveals negative chest pain/tightness, shortness of breath, cough, or pedal edema. On further inquiry, the patient mentions that he has had a weird “fluttering” sensation in his chest once or twice in the past month. He does not smoke or drink alcohol. His recent medical history is significant for dyspepsia managed with diet. Vitals show a temp 37.0° C, BP 130/75mmHg, PR 85/min, RR 13/min. Exam shows the apex beat on the 6th ICS, anterior
axillary line. Auscultation reveals S1, S2, S3, and a murmur that the physician cannot identify. Echocardiography reveals backflow of blood from the left ventricle to the left atrium. Which of the following murmurs should the physician have appreciated?

A. Crescendo-decrescendo murmur maximal on the 3rd intercostal space left lateral to the sternum
B. Crescendo systolic murmur maximal on the 6th intercostal space, anterior axillary line
C. Midsystolic murmur maximal on the 3rd intercostal space left lateral to the sternum
D. Holosystolic murmur maximal on the 6th intercostal space, anterior axillary line

Answer 234

D. Holosystolic murmur maximal on the 6th intercostal space, anterior axillary line

Question 235

Which among the following factors may trigger delayed after depolarizations?

A. Hypomagnesemia
B. Class I antiarrhythmics
C. Ischemia
D. Bradycardia

Answer 235

C. Ischemia

Question 236

What is the key difference between complete AV dissociation and 3rd degree AV block?

A. In complete AV dissociation, the atrial rate is faster than the ventricular rate
B. In 3rd degree AV block, the atrial rate is faster than the ventricular rate
C. In 3rd degree AV block, the ventricular rate is faster than the ventricular rate
D. In 3rd degree AV block, the atrial and the ventricular rate is about the same

Answer 236

B. In 3rd degree AV block, the atrial rate is faster than the ventricular rate

Question 237

A 71-year old male, was rushed to the ER due to sudden onset of left-sided weakness associated with aphasia. Vital signs as follows: BP 110/80 mmHg, HR 130’s bpm, RR 23 cpm, afebrile. E4V1M5. A stat 12- lead ECG was taken as shown below. Identify the arrhythmia noted on this ECG and its corresponding mechanism:

A. Atrial fibrillation – functional reentry
B. Atrial flutter – anatomic reentry
C. Torsades des pointes – triggered automaticity
D. Ventricular fibrillation – functional reentry

Answer 237

A. Atrial fibrillation – functional reentry

Question 238

Patient N.B., 49F, G5P5, obese, consulted at the OPD due to bilateral lower leg pruritus for 5 months which was associated with pressure sensation aggravated with prolonged standing. Upon examination, her vital signs were normal. However, she had edematous lower extremities with skin hyperpigmentation. What is
the next best thing to do?

A. Get ABI
B. Advise patient to lose weight
C. Perform duplex scan of the lower extremities
D. Give antibiotics

Answer 238

C. Perform duplex scan of the lower extremities

Question 239

A 35-year-old female with past medical history of type 2 diabetes mellitus and hyperlipidemia presents to the clinic with symptoms of dizziness and palpitations. On P.E., HR 110bpm, BP 120/70mmHg, RR 18cpm, Temp 37.4e C. ECG shows a narrow QRS complex tachycardia with an irregular rhythm. What is the most likely diagnosis?

A. Atrial fibrillation
B. Atrial flutter
C. Atrioventricular nodal tachycardia
D. Sinus tachycardia

Answer 239

A. Atrial fibrillation

Question 240

Which among the following statements regarding early afterdepolarizations is TRUE?

A. Reactivation of L-type Ca currents further prolonging action potential duration provides the inward current driving EADs
B. When action potentials are prolonged, cystolic calcium decreases
C. A fundamental condition that underlies the development of EADs is the presence of shortened QT interval
D. In general, the amplitude of an EAD is augmented at fast rates when action potentials are shorter

Answer 240

A. Reactivation of L-type Ca currents further prolonging action potential duration provides the inward current driving EADs

Question 241

This is a graphic representation which demonstrates the polarities exhibited by the limb leads:

A. Wilson’s Terminal
B. Einthoven’s Triangle
C. Roentgen’s Triangle
D. Berger’s Terminal

Answer 241

B. Einthoven’s Triangle

Question 242

Absence of nocturnal BP dipping causes include:

A. Obesity
B. Low salt intake in salt-sensitive patients
C. Young age
D. White coat hypertension

Answer 242

A. Obesity

Question 243

A 55-year old male, known case of Non-Hodgkin’s Lymphoma, presents at the ER with multiple bouts of vomiting and abdominal pain. Vital signs as follows: BP 100/60 mmHg, HR 120 bpm, RR 18 cpm, afebrile. Total serum calcium was elevated at 13.5 mg/dL. As senior clerk on duty, you were asked by your resident to
compute for the QT interval. Which of the following statements is TRUE regarding QT interval?

A. In general, the normal QT interval is 0.40 to 0.54 seconds
B. QTc is prolonged if > 440ms in men or > 460ms in women
C. If heart rate is abnormal, the corrected QT interval should be computed using the Gazett Formula
D. QTc is abnormally short if < 450ms

Answer 243

B. QTc is prolonged if > 440ms in men or > 460ms in women

Question 244

Mrs. Zalora, 32 years old female, no known comorbidities and no history of major hospitalization, had her first annual physical examination as part of the requirement where she works. Upon visiting an Internist for the annual physical examination, her Bp was recorded as 129/80mmHg. When should the next BP monitoring for this patient?

A. Repeat BP at least every 3 years
B. Repeat BP at least annually
C. Advise out-of-office BP measurement
D. Repeat BP at least every 5 years

Answer 244

A. Repeat BP at least every 3 years

Question 245

Mr. M, 56/M, who is known hypertensive went to the OPD due to on and off left calf pain for 2 months which he started to experience every time he goes for a morning jog but spontaneously subsides whenever
he stops to rest. There were no associated symptoms such as fever and swelling. Mr. M claimed that he quit smoking for a year now and that he works as a security guard at a mall. You are suspecting of a peripheral vascular disease probably arterial. What physical examination finding will help you establish your diagnosis?

A. Decreased right femoral pulses
B. ABI result of 1
C. Left femoral artery bruit
D. Hyperpigmentation on both legs

Answer 245

C. Left femoral artery bruit

Question 246

A 25-year old male, was admitted due to Traumatic Brain Injury secondary to VA. Few hours upon admission, patient was noted to have unappreciated vital signs. On cardiac monitor, an arrhythmia was noted
as shown below. Identify the arrythmia and its corresponding mechanism:

A. Atrial fibrillation – functional reentry
B. Atrial flutter – anatomic reentry
C. Ventricular fibrillation – functional reentry
D. Torsades des pointes – triggered automaticity

Answer 246

C. Ventricular fibrillation – functional reentry

Question 247

A 65 year old man is found unresponsive. He has no central pulse and is making no respiratory effort. The emergency response team has arrived with a portable ECG, they checked his rhythm and it looked like this. What should they do to the patient?

A. The patient’s ECG shows ventricular fibrillation therefore they should start chest compressions and defibrillate the patient
B. The patient’s ECG shows asystole therefore they should start chest compressions and Advanced Life Support immediately
C. The patient’s ECG shows supraventricular tachycardia therefore they should start chest compressions and do cardioversion
D. The patient’s ECG shows pulseless electrical activity therefore they should start chest compressions and Advanced Life Support immediately

Answer 247

D. The patient’s ECG shows pulseless electrical activity therefore they should start chest compressions and Advanced Life Support immediately

Question 248

Mrs. Shein, 55 years old female, known hypertensive, maintained on Telmisartan plus Hydrochlorothiazide plus Amlodipine in a single pill for 6 months already. However, upon follow-up, out-office-BP measurement showed BP 150/90 over 24hrs. Given that secondary causes of hypertension, poor adherence, brachial artery calcification and clinician inertia are excluded, what is the next appropriate management for this patient?

A. Change medication to Captopril plus chlorthalidone plus verapamil
B. Continue present medication and let patient followup once every year
C. Add spironolactone as second pill to current management
D. Add Captopril as second pill to current
management

Answer 248

C. Add spironolactone as second pill to current management

Question 249

This marks the transition of QRS complex to ST segment

A. U wave
B. Delta wave
C. J point
D. QT interval

Answer 249

C. J point

Question 250

A 60-year old male, diagnosed with chronic hypertension, was admitted for acute stroke, presenting with sudden onset of left-sided weakness associated with dysarthria. Baseline 12-lead ECG was done as follows: What are the major pathologic findings pertinent in this ECG?

A. Left Axis Deviation; Left Atrial Enlargement
B. Left Axis Deviation; Left Ventricular Hypertrophy with strain pattern
C. Normal Axis; Right Ventricular Hypertrophy
D. Right Axis Deviation; Right Ventricular Hypertrophy with strain pattern

Answer 250

B. Left Axis Deviation; Left Ventricular Hypertrophy with strain pattern

Question 251

In cases when SBP more than or equal to140 and DBP less than 90, the most important
pathophysiological determinant is:

A. Small artery stiffness
B. Medium-sized artery stiffness
C. Carotid plaques
D. Large artery stiffness

Answer 251

D. Large artery stiffness

Question 252

Which of the following descriptions of bundle branch blocks is most accurate?

A. In left bundle branch block (LBBB), the initial impulse activates the interventricular septum from left to right, just as in normal activation. Next, the left bundle branch activates the left ventricle. The impulse then crosses the interventricular septum to activate the right ventricle
B. In right bundle branch block (RBBB), the impulse first travels down the right bundle branch. Then the impulse activates the interventricular septum from
right to left, the opposite of normal activation. Finally, the impulse activates the left ventricle
C. In left bundle branch block (LBBB), the impulse first travels down the left bundle branch. Then the impulse activates the interventricular septum from right to left,
the opposite of normal activation. Finally, the impulse activates the left ventricle
D. In right bundle branch block (RBBB), the initial
impulse activates the interventricular septum from left to right, just as in normal activation. Next, the left bundle branch activates the left ventricle. The impulse then crosses the interventricular septum to activate the right ventricle

Answer 252

D. In right bundle branch block (RBBB), the initial
impulse activates the interventricular septum from left to right, just as in normal activation. Next, the left bundle branch activates the left ventricle. The impulse then crosses the interventricular septum to activate the right ventricle

Question 253

Mr. Castro, 50M, went to the OPD due to non-healing wound on the left dorsum of his foot. He claimed that a month ago a sharp object fell on his left foot which caused a laceration. Mr. Castro also added that prior to that event, he would experience on and off sharp leg pain especially during sleeping. Mr. Castro is non-hypertensive and non-diabetic. He works as a manager of a sales company and work has been very stressful lately which caused him to increase the frequency of smoking. ON PE, he was awake, coherent, NIRD. Vital signs were BP 130/90, HR 75, RR 18, Temp afebrile. Other pertinent PE findings were pale well circumscribed ulcer left dorsum of foot, thin and scaly skin. There was no edema or skin discoloration, left dorsalis pedis and posterior tibial pulses were decreased. Which among the following managements will give benefit to the patient?

A. Risk factors modification
B. Limit patient’s activity
C. Give anticoagulation
D. Apply compression stockings

Answer 253

A. Risk factors modification

Question 254

Repolarizing current/s in cardiac action potential include/s

A. Sodium
B. Potassium
C. Sodium and calcium
D. Calcium

Answer 254

B. Potassium

Question 255

In a patient with atrial fibrillation and a high ventricular rate, what drug is recommended before cardioversion?

A. Amiodarone
B. Lidocaine
C. Metoprolol
D. Captopril

Answer 255

C. Metoprolol

Question 256

Which of the following anti-arrhythmic drugs is correctly paired with its effects on the action potential?

A. Disopyramide: Prolongs cardiac action potential
B. Verapamil: Decreased rate of phase 4
spontaneous depolarization
C. Lidocaine: Lengthens the AP duration
D. Metoprolol: Shortens AV conduction

Answer 256

B. Verapamil: Decreased rate of phase 4 spontaneous depolarization

Question 257

Mr. S is a 60 y.o / M, with a history of smoking (current), alcohol consumption (claims he no longer drinks), and a history of heart failure with preserved ejection fraction. Ejection fraction (EF) by echocardiography was 50% last 2003. Echocardiogram on this recent visit revealed left ventricular hypertrophy. He has 2 pillow orthopnea but no paroxysmal nocturnal dyspnea. Mr. S. has fatigue with activities of daily living. He denies chest pain, palpitations, lightheadedness, dizziness, nausea, edema, or difficulties with eating (states his appetite is fair). Mr. S has no known allergies. Physical exam: alert, cooperative, no jugular venous distension, no hepatojugular reflux, no peripheral edema. Lungs clear, abdomen is soft and nontender. Heart rate and rhythm are regular, has a 2/6 systolic murmur at the left lower sternal border, PMI: 6th ICS AAL, BMI: 28kg/m2 , BP, 142/64 mm Hg; pulse, 64 bpm; weight, 60 kg; NYHA FC III. Patient’s medication regimen was later adjusted and considering the 2017 ACC/AHA guidelines you advised patient to:

A. Aim for ideal body weight, or at least start with 1kg reduction
B. Dietary sodium of at least 2000mg/day
C. Engage in aerobic exercises with goal increase in heart rate of 150bpm, 150-200 mins/week
D. Consume diet rich in fruits, whole grains, dairy products, and saturated fats

Answer 257

A. Aim for ideal body weight, or at least start with 1kg reduction

Question 258

Eugene, a 52 year old male visited you in the clinic due to complaints of 4 days onset of tinnitus. This was associated with blurred vision, flushed skin, sweating, confusion and headache. The patient’s condition started when he took a medication prescribed to him as an anti-arrhythmic drug for his atrial fibrillation.
Which of the following drugs is usually associated with these side effects?

A. Amiodarone
B. Quinidine
C. Carvedilol
D. Procainamide

Answer 258

B. Quinidine

Question 259

Marco, a 50 year old male was admitted due to ruptured aneurysm 2 days ago. Upon doing the daily rounds you noticed that the patient had neurologic deterioration. CT angiography was done which then showed cerebral vasospasms. Which of the following drugs could have helped prevent this complication?

A. Verapamil
B. Nimodipine
C. Nifedipine
D. Amlodipine

Answer 259

B. Nimodipine

Question 260

Which of the following medications of ischemic heart disease reduce the mortality decreasing the incidence of sudden cardiac death associated with myocardial ischemia and infarction?

A. ASA
B. Carvedilol
C. ISMN
D. Amlodipine

Answer 260

B. Carvedilol

Question 261

Gerard, a 50 year old male visited you in the clinic due to dizziness. BP was taken and showed bp of 190/130. What is the average pressure of the patient throughout the cardiac cycle?

A. 150
B. 140
C. 200
D. 160

Answer 261

A. 150

Question 262

Which of the following is the MOA of Sildenafil?

A. Causes increased levels of cGMP resulting in smooth muscle relaxation and inflow of blood to the corpus cavernosum
B. Decrease the intracellular calcium by inhibiting the calcium channels pumps of smooth muscles in the corpus cavernosum
C. Inhibits the ATPase pump thus decreasing the depolarizations of smooth muscles in the corpus cavernosum
D. Activates the soluble isoform of guanylyl cyclase→increasing intracellular levels of cGMP which then causes reduction of cytosolic Ca2+ and leads to the relaxation of smooth muscle cells

Answer 262

A. Causes increased levels of cGMP resulting in smooth muscle relaxation and inflow of blood to the corpus cavernosum

Question 263

Among the parental anticoagulant which of the following has a predominant Anti-factor Xa activity?

A. Enoxaparin
B. Fondaparinux
C. Subcutaneous Heparin
D. LMWH

Answer 263

B. Fondaparinux

Question 264

These diuretics act on both proximal tubule and loop of Henle (the primary site of action); In the proximal tubule these act as non-reabsorbable solutes that limit osmosis of water into the interstitial space and thereby reduce the luminal Na concentration.

A. Carbonic Anhydrase Inhibitors
B. Loop Diuretics
C. Osmotic Diuretics
D. Loop diuretics

Answer 264

C. Osmotic Diuretics

Question 265

A patient with poorly controlled hypertension and dyslipidemia comes in with complaints of sudden intense tearing chest pain that radiates to the back. BP 150/100 mmHg, HR 110/min, RR 25 cpm. There is diaphoresis but the rest of the PE findings were unremarkable. The attending physician is entertaining Aortic Dissection. While waiting for the CT scan to free up, which of the following interventions must be prioritized?

A. Propranolol to lower cardiac contractility
B. Hydralazine to relieve arterial blood pressure
C. Furosemide to lessen the blood volume going into the false lumen
D. Enalaprilat to reduce both preload and afterload

Answer 265

A. Propranolol to lower cardiac contractility

Question 266

Which of the following goals is immediately achieved upon the administration of supplemental oxygen to a patient with acute MI?

A. Identify candidates for reperfusion therapy
B. Relieve ischemic pain
C. Prevent arrhythmia
D. Treat life-threatening pulmonary edema

Answer 266

B. Relieve ischemic pain

Question 267

Which of the following anti-arrhythmic drugs will most likely be associated with anti-histone antibody?

A. Carvedilol
B. Quinidine
C. Procainamide
D. Amiodarone

Answer 267

C. Procainamide

Question 268

Which of the following is most accurate regarding clinical clues to secondary causes of hypertension?

A. Presence of abdominal bruits, especially if a diastolic component is present may suggest renovascular disease.
B. Cramps, body malaise and hypokalemia suggest possible Cushing’s syndrome.
C. Truncal obesity with purple striae points to hyperaldosteronism.
D. Neck mass with bruit, lid lag, tremors; with or without exophthalmos suggests phaeochromocytoma as secondary cause of HPN.

Answer 268

A. Presence of abdominal bruits, especially if a diastolic component is present may suggest renovascular disease.

Question 269

A 63-year-old female known hypertensive came in the emergency room due to severe headache, nausea, and projectile vomiting. Upon examination, patient is stuporous with BP of 240/120mmHg. What is the best intervention for this case?

A. Insert a nasogastric tube and give Losartan 100mg and Amlodipine 10mg
B. Watchful observation and allow permissive
hypertension
C. Provide intravenous access and start Nicardipine drip
D. Administer Captopril 25mg tab sublingually

Answer 269

C. Provide intravenous access and start Nicardipine drip

Question 270

The list below includes the tests to be carried out on all patients with documented hypertension. Which of these, when abnormal, would prompt further investigation by requesting for a Duplex renal artery Doppler or magnetic resonance angiography?

A. Serum potassium
B. Urinalysis
C. Chest radiograph
D. ECG

Answer 270

A. Serum potassium

Question 271

The loop diuretics are also called:

A. Inhibitors of Na-Cl Symporter
B. Inhibitors of Na-K-2Cl Symport
C. K+ sparing diuretics
D. Aldosterone antagonists

Answer 271

B. Inhibitors of Na-K-2Cl Symport

Question 272

A 20 year old female was brought to the ERD due to seizures. On history, she is a known case of Lupus Nephritis on multiple antihypertensive medications in addition to her immunosuppressants. Few hours prior,
she has been complaining of headache, vomiting, and blurring of vision. At the ER she was examined drowsy with a BP of 200/150 mmHg. Which of the following does this patient have?

A. Hypertensive crisis
B. Uncontrolled HPN
C. Hypertensive urgency
D. Hypertensive emergency

Answer 272

D. Hypertensive emergency

Question 273

Which of the following is a hemodynamic effect of low doses of Nitrates?

A. Coronary perfusion unchanged
B. Bradycardia
C. Decreased systemic resistance
D. Tachycardia

Answer 273

A. Coronary perfusion unchanged

Question 274

A 63-year-old man with type 2 diabetes has an average BP of 150/90 over the span of several weeks of measuring at home and in the clinic. He also has albuminuria. His total cholesterol is 260 mg/dL, HDL 42 mg/dL, and LDL 165 mg/dL. Aside from its effective AT1 receptor blockade, this drug’s renoprotective effect in DM type 2 cases, is your antihypertensive medication of choice:

A. Sympatholytics
B. Mineralocorticoid receptor blockers
C. Angiotensin Receptor Blockers
D. Adrenergic receptor antagonists

Answer 274

C. Angiotensin Receptor Blockers

Question 275

A 69-year-old man known diabetic and hypertensive and recently diagnosed with heart failure (with reduced ejection fraction) comes to the clinic with the following findings: BP 150/90 mmHg, Heart Rate 60 bpm not in respiratory distress. Which of the following is the most appropriate antihypertensive agent for this particular patient to maintain?

A. Valsartan
B. Hydralazine
C. Metoprolol
D. Hydrochlorothiazid

Answer 275

A. Valsartan

Question 276

Which of the following peptides stimulates renal vasoconstriction which eventually leads to stimulation of aldosterone release?

A. Angiotensin I
B. Renin
C. Angiotensin II
D. Angiotensinogen

Answer 276

C. Angiotensin II

Question 277

A 28-year-old male was admitted due to chest pain after snorting cocaine with friends. Diagnostic tests revealed a reduced coronary blood flow. Which of the following mechanisms is most likely responsible for this effect?

A. Ischemia
B. Vasospasm
C. Thrombosis
D. Emboli

Answer 277

B. Vasospasm

Question 278

A clinical clerk had his BP at the ER while on duty and noted that it is at 130/100mmHg. He reviewed his modules on hypertension and repeated the BP takings several times the following week yielding a systolic BP range of 120-130 mmHg but with a DBP persistently at 100mmHg. Based on the 2018 ESC Guidelines, he can be categorized as

A. Normotensive
B. Grade 1 hypertension
C. Having high normal blood pressure
D. Grade 2 hypertension

Answer 278

D. Grade 2 hypertension

Question 279

Demetri, a 45 year old male came in due to active epistaxis which started 2 hours ago. Upon reviewing his history it was noted that he was maintained on warfarin due to atrial fibrillation sec coronary artery disease. Stat INR was ordered which showed INR of 6. What is the next step in managing the patient?

A. Transfuse platelet concentrate
B. Transfuse four-factor prothrombin complex concentrate + vitamin K1 IV
C. Give protamine sulfate
D. IV Vitamin K1

Answer 279

B. Transfuse four-factor prothrombin complex concentrate + vitamin K1 IV

Question 280

A 48 year old female came into your clinic due to an erythematous rash that appeared on her cheeks and her extremities associated with arthralgia and myalgia. Upon taking her past medical history, she said that she just started taking maintenance medications for paroxysmal ventricular fibrillation about 2 months ago, but she cannot recall the name of the drug. Which of the following is most likely causing her current condition?

A. Quinidine
B. Procainamide
C. Amiodarone
D. Lidocaine

Answer 280

B. Procainamide

Question 281

A 55-year-old woman known hypertensive, who presented with pedal edema, 2 pillow orthopnea and exertional dyspnea last week, now returns to the clinic with complaints of fullness in the ears after been given a week’s trial dose of an antihypertensive agent. Written record of ambulatory BP readings reveals BP ranges of 150/90mm Hg; 145/85 mmHg; 156/90 mmHg. Her current BP is 140/90 mmHg in both arms after resting for 5 minutes in the exam room. Which of the following agents is she most likely taking for the past week?

A. Alpha adrenergic receptor blockers
B. Loop Diuretics
C. Calcium channel blockers
D. Sympatholytics

Answer 281

B. Loop Diuretics

Question 282

Which of the following is the single most important bedside measurement from which to estimate the volume status?

A. Pulse Rate
B. Abdominojugular Reflex
C. Blood Pressure
D. Jugular Venous Pressure

Answer 282

D. Jugular Venous Pressure

Question 283

Warfarin has no effect on the fully γ-carboxylated clotting factors (factor II, VII, IX, X) already in the circulation, and these must be cleared before it can produce an anticoagulant effect. What is the half-life of clotting factor II?

A. 36 hours
B. 72 hours
C. 50 hours
D. 48 hours

Answer 283

C. 50 hours

Question 284

In heart failure these medications reduce ventricular dilation and tend to restore the heart to its normal elliptical shape; may reverse ventricular remodeling via changes in preload/afterload by preventing the growth effects of Ang II on myocytes and by attenuating cardiac fibrosis induced by Ang II and aldosterone.

A. Inhibitors of Carbonic Anhydrase
B. Sympatholytics
C. Vasodilators
D. ACE inhibitors

Answer 284

D. ACE inhibitors

Question 285

Most attacks of myocardial infarction occur in the early hours of the morning. Which of the following factors may have contributed to this phenomenon?

A. Diurnal variation of steroid secretion with higher levels in the morning
B. Increased parasympathetic activity
C. Decreased circulating blood volume
D. Increased acetylcholine release

Answer 285

C. Decreased circulating blood volume

Question 286

A 78-yo male is brought to you at the ER for complaints of epigastric discomfort, with mild-to-moderate chest pain, dyspnea, and diaphoresis. He has poorly controlled hypertension and diabetes. BP is 90/50 mmHg, HR is 118, RR is 24, O2Sat is 91%, which improves to 96% after oxygen supplementation. Which of the following diagnostics is best to do right away?

A. Chest X-ray
B. 2D Echo/cardiac ultrasound/cardiac MRI
C. ECG
D. Recommend for endoscopy to rule out
gastritis/GERD

Answer 286

C. ECG

Question 287

Agents in this class of diuretics are useful in treatment of resistant hypertension due to primary hyperaldosteronism and are considered the diuretic of choice in patients with hepatic cirrhosis:

A. Thiazide diuretics
B. Mineralocorticoid Receptor Antagonists
C. Carbonic Anhydrase Inhibitors
D. Natriuretic Peptides

Answer 287

B. Mineralocorticoid Receptor Antagonists

Question 288

Which of the following is the major underlying cause of ischemic heart disease?

A. Platelet activation
B. Atherosclerosis
C. Tear in the intima
D. Blood clot

Answer 288

B. Atherosclerosis

Question 289

When activated, what RAS Peptide & Receptor result to Hypertensive effects?

A. Ang II/ Ang (1-9), AT2
B. Ang (3-7), AT4
C. Ang (1-7), MAS
D. Ang II/ Ang (1-12), AT1

Answer 289

D. Ang II/ Ang (1-12), AT1

Question 290

Which of the following is a consequence of alpha 1 adrenergic receptor activation?

A. Increased smooth muscle permeability
B. Vasodilation
C. Vasoconstriction
D. Decreased Peripheral Resistance

Answer 290

C. Vasoconstriction

Question 291

Aside from decreasing rate of aqueous humor formation, these antihypertensive agents increase delivery of solutes to the macula densa triggering the tubuloglomerular feedback mechanism.

A. Angiotensin receptor blockers
B. ACE inhibitors
C. Carbonic anhydrase inhibitors
D. Vasodilators

Answer 291

C. Carbonic anhydrase inhibitors

Question 292

Which of the following combination of drugs can be safely given to Heart failure with an LV ejection fraction of 15% who came in due to chronic stable angina and elevated BP?

A. Enalapril + Amlodipine
B. IV Verapamil + IV Betablocker
C. Valsartan + IV nifedipine
D. Losartan + IV Verapamil

Answer 292

A. Enalapril + Amlodipine

Question 293

A 60-year old male was brought to the ER due to chest pain. His heart rate reached 190bpm. ECG was done and showed inferior myocardial infarction and ventricular tachycardia. The ER Resident gave the patient Amiodarone IV bolus and started him on Amiodarone drip. Amiodarone:

A. Reduces resting potential
B. Decreases PR interval in normal sinus rhythm
C. Increases action potential duration
D. Increases contractility

Answer 293

C. Increases action potential duration

Question 294

Which of the following is a component of Bezold-Jarisch reflex?

A. Hyperpnea
B. Hypotension
C. Tachycardia
D. Increased pulse pressure

Answer 294

B. Hypotension

Question 295

A second year male medical student was tasked to take the BP of both upper extremities of a patient. He noted that there is a difference of 10 mmHg between both arms. When he relayed this to the patient, the later became anxious and asked, “Will I be OK?” Which of the following would be an appropriate response to the patient?

A. “No. You might be at high risk for aortic dissection. I suggest we get a CXR.”
B. “I am not sure. Let me auscultate your heart to check for valvular problems.”
C. “Maybe. We need to investigate for possible congenital anomaly just to be sure.”
D. “Yes. This is a normal finding.”

Answer 295

D. “Yes. This is a normal finding.”

Question 296

Yuri, a 42 year old male was admitted due to pulmonary embolism. Upon hospitalization parental anticoagulant was started. 5 days later the patient developed acute limb ischemia and there was noted thrombocytopenia of 100,000/ml. As the attending physician what is the next best step in managing the patient?

A. Stop heparin and start Fondaparinux
B. Start platelet transfusion
C. Continue heparin for 3 days and start warfarin bridging
D. Shift heparin to LMWH

Answer 296

A. Stop heparin and start Fondaparinux

Question 297

You have a newly-diagnosed hyperthyroid patient whose usually heart rate is 90-110 beats per minute. You already started the patient on Propranolol, but he came for a follow-up check-up because he has been coughing always. He described that he could hear a wheezing sound on his chest especially at nighttime. Which drug will you replace Propranolol with?

A. Labetalol
B. Bisoprolol
C. Nadolol
D. Carvedilol

Answer 297

B. Bisoprolol

Question 298

Pathophysiology of essential hypertension may include:

A. Genetic defects affecting enzymes involved in aldosterone metabolism (e.g. 11b-hydroxylase)
B. Genetic factors such as polymorphisms in angiotensinogen and angiotensinogen II receptors
C. Dysregulation in the RAA system leading to natriuresis and vasoconstriction
D. Decrease vascular resistance leading to vasoconstriction and structural changes in the blood vessels

Answer 298

B. Genetic factors such as polymorphisms in angiotensinogen and angiotensinogen II receptors

Question 299

Which of the following drugs have class I, II, III and IV actions as well as alpha-blocking activity?

A. Sotalol
B. Dofetilide
C. Dronedarone
D. Amiodarone

Answer 299

D. Amiodarone

Question 300

Calcium channel inhibitors cause vasodilation (arteriolar smooth muscle), decrease in peripheral vascular resistance, decreased automaticity, & decreased AV Conduction thus lowering the blood pressure. Which of the following belongs to this class of antihypertensive agents?

A. Acetazolamide
B. Methyldopa
C. Verapamil
D. Tamsulosin

Answer 300

C. Verapamil

Question 301

A 40-year old male with diabetes was started on antibiotic therapy for chronic osteomyelitis in the hospital. He was found unresponsive by the nursing staff suddenly. His electrocardiogram is shown here. Normal sinus rhythm was restored with electrical cardioversion. A 12-lead ECG is notable for prolonged QT interval. Besides stopping the offending drug, the most appropriate management for this rhythm disturbance should include IV administration of which of the following?

A. Amiodarone
B. Magnesium
C. Potassium
D. Lidocaine

Answer 301

B. Magnesium

Question 302

A 48 year old female came into your clinic due to an erythematous rash that appeared on her cheeks and her extremities associated with arthralgia and myalgia. Upon taking her past medical history, she said that she just started taking maintenance medications for paroxysmal ventricular fibrillation about 2 months ago, but she cannot recall the name of the drug. Which of the following is most likely causing her current condition?

A. Procainamide
B. Quinidine
C. Lidocaine
D. Amiodarone

Answer 302

A. Procainamide

Question 303

A 55-year-old man comes to his physician for a follow-up visit, after being hospitalized 2 weeks earlier for an inferior wall myocardial infarction (MI). The patient has a history of coronary artery disease. No complaints of palpitations, dizziness, chest pain, or shortness of breath were reported. What medication will you add to his maintenance medications given he has this ECG?

A. Metoprolol
B. Propranolol
C. Carvedilol
D. No need for beta-blockers

Answer 303

D. No need for beta-blockers

Question 304

Which of the following anti-arrhythmic drugs is a very good option in the chronic treatment to prevent recurrent atrial fibrillation in patients already in sinus rhythm due to its very long half-life which could last up to several months?

A. Quinine
B. Sotalol
C. Amiodarone
D. Propafenone

Answer 304

C. Amiodarone