Cardiovascular System - Past exam questions and answers PDF

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Cardiovascular System - 101 Past exam questions and answers. Includes ECG questions, CVS pharmacology, embryology, anatomy, physiology, pathology...

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1. An ECG of a patient with crushing chest pain shown ST segment elevation in lead II,III and aVF. The part of the heart most likely to be affected by the pathological process is a. Anterior septal region b. Anterior surface c. Lateral surface d. Posterior surface e. Inferior surface 2.

Acethylcholine causes vasodilation. The action is mediated by a. Nitride oxide b. Bradykinin c. Histamine d. Vasoactive intestinal peptide e. Substance p

3. An ECG can reflect delayed or accelerated conduction of cardiac impulse from atria to ventricles. When the AV nodal conduction is partially blocked, there will be prolongation of a. P wave b. PQ segment c. PR interval d. QRS duration e. ST segment 4. The rennin -angiotensin –aldosterone system is a powerful system for blood pressure and volume homeostasis. The system is activated by a. Right atrial distension b. An increase in renal perfusion pressure c. An increased sympathethic discharge d. A decreased parasympathethic discharge e. Stimulation of alpha adrenergic receptors in the renal juxtaglomerular cells 5. The Frank –Starling curve relates stroke volume and preload. The curve is shifted upwards and to the left when there is a decrease in a. Sympathetic discharge b. End-diastolic volume c. Venous return d. Venoconstriction e. Vagal tone

6. Vasodilator metabolites are important in the metabolic theory of aotoregulation of tissue blood flow. Which of the following will cause vasodilation in the above setting? a. A fall in PO4 b. A fall in PCO3

c. A fall in [H+] d. A fall in temperature e. A fall in plasma osmolarity 7. Norepinephrine causes contraction of the vascular smooth muscle cells under IP3-coupled signal transduction mechanism. This effect is mediated when norepinephrine binds to a. Alpha-adrenoceptors b. Beta 1-adrenoceptors c. Beta 2-adrenoceptors d. Beta 3-adrenoceptors e. Muscarinic receptors 8. An elderly male suffers from embolism of the circumflex branch of left cononary artery. Assuming he has a typical cononary circulation. The area of the heart most likely to be ischaemic is a. Anterior part of left ventricle b. Anterior part of interventricular septum c. posterior part of interventricular septum d. Anterior part of right ventricle e. posterior part of right ventricle 9. The lungs and liver do not function fully until after birth and hence certain bypass mechanism exist to divert bloodstream Which of the following is a channel that bypass blood around the liver? a. Ductus arteriosus b. Ductus venosus c. Left umbilical vein d. Portal vein e. Sinus venosus 10. The great saphenous vein is one of the blood vessels of the lower limbs. This vein a. arises from the lateral end of dorsal venous arch b. lies anterior to saphenous nerve in the ankle c. in subcutanenous in the lower part of the leg d. has 3 perforating veins in leg and thigh e. may be affected by deep vein thrombosis 11. The right atrium of the heart shows some distinctive features that are not seen in the left atrium . Which of the following is a unique feature of this chamber of the heart? a. Bicuspid opening b. Chordae tendinae c. Fossa lunata d. Crista terminalis e. Muscli pectinati

12. A radiological examines the postero-anterior chest radiograph of a victim of a car accident. Which of the following structure forms part of the right border of the cardiovascular sillihovette? a. Arch of aorta b. Pulmonary trunk c. Superior vena cava d. Ascending aorta e. Left ventricle 13. The sinoatrial node is located within the wall of the right atrium. Which of the following is the normal location of the SAnode? a. Near the entrance of the superior vena cava b. Near the entrance of the inferior vena cava c. Near the opening of the cononary sinus d. Near the tricuspid opening e. In between the inferior vena cava and the tricuspid valve 14. One of the valvular lesions causes a characteristic ballooning of the valve leaflets into the left atrium during systole. Which of the following is most likely to have the above fature? a. Aortic stenosis b. Aortic regurgitation c. Mitral valve prolapsed d. Fallot of tetralogy e. Mitral stenosis 15. Hypertension causes structural changes in the wall of blood vessels. The typical onion-skin. Thickening of the walls of arterioles with progressive narrowing of the lumen is called a. Hyaline arterioscelosis b. Hyperplastic arterioscelosis c. Vascular hypertrophy d. Benign nephrosclerosis e. Concentric vasculopathy 16. A 34 year old male complained of sudden onset of severe pain I his chest and extending down his back. The pain was not relieved by analaesics. He had no history of smoking. A diagnosis of Marfans syndrome was made. What is the most likely cause of severe pain in his patient a. Acute MI b. Acute pancreatitis c. Prolapsed intervertebral disc d. Acute dissection of the aorta e. Atherosclerosis 17. A 45 yr old man was rushed to the hospital following the sudden onset of an episode of the crushing substernal chest pain. He died 4 days later. At autopsy, which of the following microscopic findings is most likely to be present? a. Fibroblast and collagen b. Granulation tissue

c. Necrotic muscle and neutrophils d. Granulomatous inflammation e. Diffuse chronic inflammation 18. Beta-adrenoblockers are indicated in many cardiovascular diseases. However, these type of drugs are no recommended for a. thyrotoxic heart disease b. stable heart failure c. heart block d. hypertension e. stable angina 19. Many anti-arrhythmic drugs act on the calcium channel in the sarcolemma of the cardiac myocytes. Which of the following acts by blocking the calcium channel? A. digoxin b. dildiazem c. dofetillide d. disopyramide e. quinidine 20. Nitrates are useful in the management of angina pectoris. This is because these drugs a. Cause venous dilatation and reduced cardiac output b. Decompose to form NO c. Cause arterial dilatation reducing the blood pressure d. Cause dieresis and reduction of BP e. Decrease cardiac workload by decreasing myocardial contractility 21. 45 year old man is admitted with severe chest pain since 1 hour back. He is diagnosed to have an acute anterior myocardial infarction. Which of the following is recommended to rapidly restore the patency of the occluded artery? a. Streptokinase b. Heparin c. Aspirin d. Atenolol e. Enclopril 22. Cononary heart disease I a major public health problem in Malaysia in terms of morbidty and mortality. The most powerful independent risk factor for cononary heart disease is a. Hereditary b. Increasing age c. Gender d. Ethnicity e. Dyslipidemia 23. Patients psychological elements could serve as pathogenic factor contributing to cononary heart disease. Which of the following psychological state is most strongly associated with cononary heart disease event such as myocardial infarction?

a. b. c. d. e.

Stress Depression Anxiety Hostility Poor self-esteem

24. A 12 year old boy presents with migratory polyartritis and chest pain. He gives a history of sor throat3 weeks prior to present condition. The most useful investigation in this case will be a. Antistreptolysin (ASO) titre b. C-reactiveprotein c. Blood culture d. Echocardiography e. ECG tracing 25. Palpation of axillary lymph node is a useful clinical examination, in this context, which one of the following statements is most relevant? a. A boil over the forearm may cause enlargement of posterior group b. Carcinoma of breast may present with enlarged pectoral group. c. Nodes of the apical group may be found above the clavicle d. Skin infection over the back of axilla may cause enlarged lateral group e. Anterior group is palpated along the upper border of pectoralis minor 26. An 18 year old man is found with blood pressure in upper limb higher than that in lower limb. Imaging reveals bilateral erosion of anterior and lateral parts of the ribs. Agiography reveals a coarctation of aorta. Which of the following will show a retrograde flow of blood? a. Anterior intercostral arteries b. Posterior intercostral arteries c. Internal thoracic arteries d. Right subclavian artery e. Descending thoracic aorta

27. A 61-year-old woman is diagnosed with a complication of right sided heart failure due to primary pulmonary hypertension. She is diagnosed with cor pulmonale. What is the most important diagnostic feature in this case?Choose one answer. A. Right ventricular hypertrophy B. Raised jugular venous pressure C. Congested spleen D. Nutmeg liver E. Pitting oedema of legs 28. A woman is bleeding from the uterus after giving birth. The doctor estimates the blood loss to be about two litres. In response to this, there is decreased

Choose one answer. A. release of vasopressin from the posterior pituitary B. discharge rate of efferent sympathetic fibres to the heart C. release of renin from the JG cells D. discharge rate of efferent vagal fibres to the heart E. stimulation of vasomotor centre 29. Anti-arrhythmic drugs generally act by inhibition of sodium, calcium and potassium ion channels involved in cardiac action potentials. Which ONE of the following drugs acts by blocking sodium ion channels? Choose one answer. A.Dofetilide B.Acebutolol C.Lidocaine D. Digoxin E.Adenosine

30. The right and the left chambers of the heart can be regarded as two separate pumps arranged in series. As such, a left ventricular cardiac output under normal resting conditions is A. the same as pulmonary blood flow B. twice the venous return to the right heart C. reduced to 1/16th of its original value when the pulmonary resistance is halved D. halved when the systemic vascular resistance increases two fold E. three times greater than that of the right ventricle

31. A 48-year-old, known hypertensive presents with tachycardia, breathlessness and has signs of cardiac failure. The heart is most likely to show A. calcified valves B. concentric left ventricular hypertrophy C. thickened interventricular septum(IVS) D. increase left ventricular cavity E. fused chordae tendinae

32. Infective endocarditis is microbial infection of a cardiac valve or the endocardium. Acute Infective endocarditis is most commonly caused by A. Leigonella species B. Staphylococcus aureus C. Streptococcus viridans D. Pseudomonas aeruginosa E. Herpes simplex

33. ECGs of an adult woman taken 2 years apart are shown below. She is suffering from A. first degree heart block B. second degree heart block C. SA nodal disease D. right bundle branch block E. third degree heart block 34. A man was discharged after suture of the stab wound in the medial border of the forearm. After 2 days he presented with swelling of arm and upper forearm. No signs of paralysis were found. Which is the most likely structure to be damaged? A. Flexor carpi ulnaris B. Basilic vein C. Ulnar nerve D. Ulnar artery E. Cephalic vein 35. A 29-year-old women is diagnosed with essential hypertension. She has been a known asthmatic. A class of antihypertensive drugs that is most INAPPROPRIATE for her is A. beta adrenoceptor blockers B. Thiazide diuretics C. Angiotensin-receptor blockers (ARBs) D. ACE inhibitors (ACEIs) E. Ca2+ - channel blockers 36. An ECG of a patient suffering from chest pain indicates coronary ischaemia in the anterior part of the interventricular septum. Which of the following arteries is most likely to be involved? A. Right coronary artery B. Anterior interventricular artery

C. Posterior interventricular artery D. Left coronary artery E. Marginal artery

37. The surface of the heart shows grooves (sulci) which lodge many blood vessels. Which ONE of the following vessels is located in the anterior interventricular sulcus? A. Atrioventricular (AV) nodal artery B. Small cardiac vein C. Middle cardiac vein D. Sinoatrial nodal (SA) artery E. Great cardiac vein

38. A 60-year-old man with history of ischaemic heart disease experienced chest pain after climbing a flight of stairs. A drug effective in quickly relieving an acute attack of angina is A. Atenolol B. Isosorbide mononitrate C. Diltiazem D. Verapamil E. Glyceryl trinitrate

39. A 12-year-old boy presents with migratory polyarthritis and chest pain. He gives a history of sore throat three weeks prior to the present condition. The most useful investigation in this case will be A. C-reactive protein(CRP). B. blood culture C. ECG tracing D. Anti-streptolysin (ASO) titre E. echocardiography 40. A fall in right ventricular output can result in congestion and oedema in many organs. In this condition, oedema is primarily due to A. an increase in capillary permeability B. a fall in ISF hydrostatic pressure C. disruption of lymphatics D. a fall in plasma oncotic pressure

E. a rise in capillary hydrostatic pressure 41. A woman who had her third baby noticed that the child was bluish. The paediatrician who examined the child stated that the baby might have a hole in the heart. A hole in the heart is an embryonic defect due to the faulty development of the partitions of the chambers. Which of the following is NOT a structure associated with a hole in the heart? A. Aorticopulmonary septum B. Fossa ovalis C. Septum primum D. Endocardial cushion E. Interventricular septum 42. The wound penetrates the superficial vein that terminates in popliteal vein. Which of the veins has to be sutured to control bleeding? A. Short saphenous vein B. Posterior tibial vein C. Great saphenous vein D. Anterior tibial vein E. Peroneal vein 43. An ECG of a patient with crushing chest pain shows ST segment elevations in leads II, III and aVF. The part of the heart most likely to be affected by the pathological process is A. lateral surface B. inferior surface C. anterior surface D. anteroseptal region E. posterior surface

44. A 45-year-old man is admitted with severe chest pain since one hour back. He is diagnosed to have an acute anterior myocardial infarction. Which of the following is recommended to rapidly restore the patency of the occluded artery? Choose one answer. A. Atenolol B. Aspirin C. Heparin D. Enalapril

E. Streptokinase

45. A 24-year-old male presents with angina and is diagnosed with hypertrophic cardiomyopathy, based on echocardiography. The diagnostic feature in this patient would be A. dilated left atrium B. subaortic stenosis C. banana like configuration of left ventricular cavity D. concentric hypertrophy of the left ventricle E. asymmetric thickening of interventricular septum 46. A patient is presented with pansystolic murmur at apex radiating to the axilla. Which of the following is the most probable diagnosis ?

A. B. C. D. E.

mitral stenosis mitral regurgitation aortic stenosis aortic regurgitation mitral valve prolapse

47. A patient is presented with sharp, pleuritic pain relieved by sitting up and leaning forward. Which of the ECG finding most probably would be found in this patient ?

A. B. C. D. E.

Shorten QT interval Depressed PR segment Depressed ST segment Flattened T wave U wave

48. A patient with ventricular septal defect suddenly developed fever, night sweat and new valvular regurgitant murmur. Which of the following is the most probable causative microorganism in this case ?

A. B. C. D. E.

Streptococcus viridans Staphylococcus aureus Klebsiella Actinobacillus Cardiobacterium

49. A patient is presented with acute chest pain radiating to the jaw and left arm 4 hours ago before being admitted into the hospital. Which of the

following is the most useful cardiac marker in this case ?

A. B. C. D. E.

Creatine Kinase MB Cardiac troponin I Myoglobin Total creatine kinase Lactate dehydrogenase

50. A patient is presented with sudden onset of chest pain, diaphoresis and cool clammy extremities one week ago. Which would you expect to observe on gross examination of the heart ?

A. B. C. D.

Gray white granulation tissue Pallor of myocardium Maximally soft and yellow-tan with red margins Hyperemic border with softening yellow tan center

51. Which of the following is the most possible complication of myocarditis ?

A. B. C. D. E.

Hypertrophic cardiomyopathy Dilated cardiomyopathy Restrictive cardiomyopathy Cardiac tamponade Rheumatic heart disease

52. Which of the following pathological finding is not diagnostic for the condition ?

A. Myocarditis – lymphocytic infiltration with necrosis of myocytes B. Restrictive cardiomyopathy – biatrial dilation with patchy diffuse interstitial fibrosis C. Dilated cardiomyopathy – dilation of all four chambers of the heart D. Hypertrophic cardiomyopathy – extensive hypertrophy of myocytes without ventricular dilation E. Rheumatic heart disease – fusion of mitral valve leaflets

53. Which of the following is not the major criteria in Framinghams criteria fo heart failure ?

A. B. C. D.

Paroxysmal nocturnal dyspnea Distension of jugular vein Acute pulmonary edema Rales

E. Hepatomegaly

54. Which of the following valvular disorders is associated with bounding pulse and wide pulse pressure ?

A. B. C. D. E.

Aortic stenosis Aortic regurgitation Mitral stenosis Mitral regurgitation Mitral valve prolapsed

55. A child is presented with fever, cervical lymphadenopathy, conjunctiva and oral erythema. Echocardiogram shows coronary artery aneurysm. Which of the following is the most possibly diagnosis for this child ?

A. B. C. D. E.

Takayasu arteritis Microscopic polyangiitis Wegeners granulomatosis Polyarteritis nodosa Kawasaki disease

56. Clinical case. Pt. was given treatment for hypertension and later has an asthmatic attack. What was the possible offending drug? A: Pronanolol B. Enalapril C. Losartan D. Captopril 57. Clinical case. Hypertensive Pt. with heart failure. Which 2 drugs should be given? A: Enalapril and furosemide B. Thiazides and Loop diuretics C. Verapamil and Metoprolol D. Carvedilol and metoprolol 58. Clinical case. Pt. presents with acute attack of stable angina. What is the drug you give him A. Aspirin B. Glyceryl Trinitrate C. Heparin D. Propanolol 59. Left Ventricular Failure. Most likely symptom? A. Haemopptysis B. Hepatomegaly C. Pulmonary oedema D. Splenomegaly

E. Ascites 60. TB patient present with pallor and ECHO cardiogram shows thicken heart walls. (hint: low cardiac output). What is the likely cause? A. constrictive pericarditis B. Myocarditis C. Left ventricular hypertrophy D. Infective Endocarditis 61. 3 months old baby turns blue when crying. On echo, a boot shaped heart is seen. What is the abnormality? A. Atrial Septal Defect B. tetralogy of fallot C. Patent Ductus Arteriosus D. Dextrocardia 62. pt. with hypertension develops dyspnoea, cough. What is the most probable abnormality seen on his heart? A: concentric left heart hypertrophy B. Eccentric Left Heart hypertrophy C. concentric right heart hypertrophy D. Eccentric right Heart hypertrophy

63. The vein used as graft for coronary vessel bypass. A Great saphenous vein B Small saphenous vein C Cephalic vein D Basilic vein

64. Lateral end of dorsal venous arch of lower limb. A Great saphenous vein B Small saphenous vein C Cephalic vein D Basilic vein

65. Connects superficial and deep veins. A Great saphenous vein B Small saphenous vein C Cephalic vein

D Perforating Vein

66. The artery which continues as dorsalis pedis artery. A Anterior Tibial Artery B Posterior Tibial Artery C Popliteal Artery D Femoral Artery

67. The vein used for intravenous injection and blood sample collection. A Marginal Vein B Median Cubital Vein C Cephalic Vein D Basilic Vein

68. The vein which runs along lateral border of biceps brachii. A Marginal Vein B Median Cubital Vein C Cephalic Vein D Basilic Vein

69. Anastomosis of arteries which gives rise to four digital arteries. A Superficial Palmar Ach B Deep Palmar Arch C Venae Committent D Radial Artery Branch

70. The main trunk of artery in superficial ...