1.A 60-year-old obese man who recently returned from a long flight, presents to your clinic with a day’s history of painful swelling of the left leg. He has a history, tobacco smoking. Which of the following is the most likely diagnosis?
A. Cellulitis
B. Deep Vein Thrombosis
C. Tibia fracture
D. Osteomyelitis of left Tibia
E. Achilles Tendinitis
2. Hypertension is defined as
A. SBP >150, DBP >100
B. SBP >140, DBP >100
C. SBP >150, DBP >90
D. SBP > 140 DBP >90
E. e. SBP >160, DBP >100
3.A 75-year-old woman who has a history of coronary artery disease (CAD) and using warfarin is brought to the emergency department with left-sided weakness and eye deviation to the right. Which of the following is the most appropriate emergent test to obtain?
A. Magnetic resonance imaging (MRI) scan of the brain
B. Computed tomography (CT) scan of the brain
C. Electroencephalogram
D. Carotid duplex
E. Spinal tap
4.The following are secondary causes of hypertension, except
A. Pheochromocytoma
B. Pregnancy
C. Aortic dissection
D. Hyperthyroidism
E. Coarctation of aorta
5.A reversible ventricular dysfunction that persists following an episode of ischemia when blood flow returns to normal is called
A. Hibernating Myocardium
B. Elastic Myocardium
C. Stunned Myocardium
D. Apoptotic Myocardium
E. Insulating Myocardium
6.Heart failure may arise from the following, EXCEPT
A. Valvular heart disease
B. Chronic obstructive pulmonary disease
C. Anemia
D. Constrictive pericarditis
E. Thrombocytosis
7.Orthopnea, dyspnea, paroxysmal nocturnal dyspnea and a raised jugular venous pressure are characteristic of
A. Right sided heart failure
B. Congestive cardiac failure
C. Hepatic encephalopathy
D. Left sided heart failure
E. Deep vein thrombosis
8. A 42year old obese woman who recently underwent a surgery presents to your facility with breathlessness, diaphoresis, hemoptysis and pleuritic chest pains. Examination of the left limb revealed a tender calf swelling with differential warmth. What is your likely diagnosis?
A. Pulmonary tuberculosis
B. Deep venous thrombosis
C. Hospital acquired pneumonia
D. Pulmonary embolism
E. Intra-operative barotrauma
9.What investigation likely to be conducted will include the following, except
A. Arterial Blood Gases
B. Abdominal CT scan
C. Chest X-ray
D. Doppler USG
E. Serum Troponin
10.Ama Osei, a 56-year-old has stage 1 hypertension. Treatment of lifestyle modifications was started (6) months ago, and at today’s visit you see no improvement in her blood pressure. What is the next step in her treatment?
a. Another 6 months of life style changes
b. Start a diuretic, a calcium channel blocker, a beta blocker and an ACE-inhibitor
c. Admit to hospital and start IV Hydralazine
d. Refer to a higher level of healthcare
e. Start a low dose diuretic and reassess her BP in 4-6 weeks
11.A person with a BMI of 30.3kg/m2 is classified as:
a. Morbidly obese
b. Normal
c. Obese
d. Overweight
e. Underweight
12.Clinical features of acute coronary syndrome include the following, except
a. Squeezing precordial pain relieved by Glyceryl Trinitrate (GTN)
b. Nausea and Vomiting
C. Diaphoresis
d. Dyspnea and Palpitation
e. Loss of consciousness
13. A reversible left ventricular dysfunction due to an ongoing myocardial ischemia is called
a. Hibernating Myocardium
b. Elastic Myocardium
C. Stunned Myocardium
d. Apoptotic Myocardium
e. Insulating Myocardium
14.Which of the following enzymes is highly sensitive and selective in acute
myocardial infarction?
a. Creatinine kinase
b. Myoglobin
c. Troponins
d. Cardiac lipase
e. Lactate dehydrogenase
15 .Clinical features of stable angina include the following, except
a. Squeezing precordial pain relieved by Glyceryl Trinitrate (GTN)
b. Nausea and Vomiting
C. Diaphoresis
d. Dyspnea and Palpitation
e. None of the above
16.A raised jugular venous pressure (JVP) is suggestive of
a. Deep vein thrombosis
b. Left sided heart failure
c. Myocardial infarction
d. Right sided heart failure
e. None of the above
17. The classical presentation of stable angina pectoris is
a. Retrosternal pain that radiates to the neck, shoulder, jaw and arms and worsens even at rest
b. Retrosternal pain that radiates to the neck, shoulder, jaw and arms that worsens on exertion.
c. Retrosternal pain that radiates to the neck, shoulder, jaw and arms that is not relieved by glyceryl trinitrate.
d. Retrosternal pain that radiates to the neck, shoulder, jaw and arms that worsens on lying supine.
e. None of the above
18. All are risk factors for stable angina pectoris except
a. Cigarette smoking
b. Chronic hypertension
c. Hyperlipidaemia
d. Physical exercise
e. Diabetes mellitus
19. Non-pharmacological management of stable angina pectoris does not include
a. Modified dietary habit
b. Regular exercise
c. Weight gain
d. Cessation of cigarette smoking
e. Reduction in alcohol consumption
20. Which of the following drugs must be avoided in a bronchial asthma patient?
a. Glyceryl trinitrate
b. Beta blockers
c. Calcium channel blockers
d. Angiotensin-Converting-Enzyme inhibitors
e. Paracetamol
21. If after administering first doses of soluble aspirin and glyceryl trinitrate to a patient diagnosed of stable angina pectoris, there is no improvement, what will be your next line of action?
a. Repeat medications
b. Observe patient for 2 hours
c. Refer to the cardiologist or physician specialist
d. Start intravenous fluid resuscitation
e. Discharge patient to go home
22. Features of acute coronary syndrome does not include
a. Chest pain relieved by glyceryl trinitrate
b. Chest pain persisting for more than 30 minutes
c. Chest pain or discomfort which is restrictive in nature
d. Bilateral crepitation in the chest
e. Peripheral or central venous cyanosis
23. Which of the following investigative procedures will you consider most appropriate and order for a patient who you suspect to have acute coronary syndrome?
a. Full blood count
b. Cardiac enzymes
c. Chest x-ray
d. Electrocardiography
e. Coronary angiography
24. Initial treatment of a patient diagnosed with acute coronary syndrome include the following except
a. Intranasal oxygen
b. Aspirin
c. Enoxaparin
d. Metoclopramide
e. Morphine
25. Common risk factors for deep vein thrombosis does not include
a. Obesity
b. Smoking
c. Prolonged immobility
d. Minor surgery
e. Pregnancy
26. Which of the following is not a common feature of deep vein thrombosis?
a. Pitting edema of the affected limb
b. Bilateral leg swelling
c. Differential warmth
d. Redness of the affected limb
e. Prominent superficial veins of the affected limb
27. One of the following is not a parameter in the Well’s scoring for deep vein thrombosis probability
a. Paralysis, paresis or recent orthopaedic casting of lower extremity
b. Pitting edema greater in the affected limb
c. Alternative diagnosis less likely than deep vein thrombosis
d. Recent bed ridden of more than 3 days or major orthopaedic surgery in the last 1 month
e. Localized tenderness in deep vein system
28. Well’s score of 3-8 points for deep vein thrombosis indicate
a. Low probability of deep vein thrombosis
b. Moderate probability of deep vein thrombosis
c. High probability of deep vein thrombosis
d. All of the above
e. None of the above
29. Well’s score of 1-2 points for deep vein thrombosis indicate
a. Low probability of deep vein thrombosis
b. Moderate probability of deep vein thrombosis
c. High probability of deep vein thrombosis
d. All of the above
e. None of the above
30. Well’s score of -2-0 points for deep vein thrombosis indicate
a. Low probability of deep vein thrombosis
b. Moderate probability of deep vein thrombosis
c. High probability of deep vein thrombosis
d. All of the above
e. None of the above
31. Which of the following investigations is recommended for a patient with low probability for deep vein thrombosis using the Well’s scoring?
a. Doppler ultrasound
b. Full blood count
c. D-Dimer test
d. Protein S
e. C reactive proteins
32. Patients with moderate-high probability for deep vein thrombosis after Well score assessment should undergo
a. Full blood count and liver function test
b. Fasting lipid profile
c. Blood urea, electrolyte and creatinine
d. D-Dimer test and Doppler ultrasound scan
e. C reactive proteins and protein S
33. Preventive measures for deep vein thrombosis in high risk group include the following except
a. Avoidance of prolonged recumbency and dehydration
b. Avoidance of excessive coffee, tea, or alcohol consumption during long journeys
c. Wearing of elastic compression stockings
d. Avoiding cross legs for long periods when on long journeys
e. Reduced hydration and regular exercise during long journeys
34. Which of the following does not form part of the Well’s scoring for pulmonary embolism?
a. Family history of pulmonary embolism
b. Symptoms of deep vein thrombosis
c. No alternative diagnosis that better explains the illness
d. Tachycardia
e. History of deep vein thrombosis or pulmonary embolism
35. Well’s score of > 6 points for pulmonary embolism indicates
a. Low probability of pulmonary embolism
b. Moderate probability of pulmonary embolism
c. High probability of pulmonary embolism
d. All of the above
e. None of the above
36. Well’s score of 2-6 points for pulmonary embolism indicates
a. Low probability of pulmonary embolism
b. Moderate probability of pulmonary embolism
c. High probability of pulmonary embolism
d. All of the above
e. None of the above
37. Well’s score of 0-1.5 points for deep vein thrombosis indicate
a. Low probability of pulmonary embolism
b. Moderate probability of pulmonary embolism
c. High probability of pulmonary embolism
d. All of the above
e. None of the above
38. Which of the following investigations is recommended for a patient with low probability for pulmonary embolism using the Well’s scoring?
a. Doppler ultrasound
b. Chest x-ray
c. D-Dimer test
d. Protein S
e. C reactive proteins
39. Patients with moderate-high probability for pulmonary embolism after Well score assessment should undergo
a. Full blood count and liver function test
b. Chest x-ray
c. Blood urea, electrolyte and creatinine
d. D-Dimer test and CT pulmonary angiography
e. C reactive proteins and protein S
40. Choose the odd one with regards to NYHA functional classification of heart failure
a. Class I – slight limitation to physical activity
b. Class II – No marked limitation to physical activity
c. Class III – Symptoms of cardiac insufficiency present at rest
d. Class IV – Marked limitation to physical activity
e. Class I – No limitation of physical activity
SUGGESTED SOLUTION
- B 11.C 21.C 31.C
- D 12.A 22.A 32.D
- B 13.A 23.D 33.E
- C 14.C 24.C 34.A
- C 15.A 25.D 35.C
- E 16.D 26.B 36.B
- B 17.B 27.C 37.A
- D 18.D 28.C 38.C
- E 19.C 29.A 39.D
- E 20.B 30.A 40.C