1. Which of the CVS exam is least informative?

a. Inspection
b. Percussion
c. Auscultation
d. Palpation
Correct: B
2. Which of the CVS exams has highest yield for Diagnosis?
a. Percussion
b. Inspection
c. Palpation
d. Auscultation
Correct: D
3. Tapping beat is diagnostic in:
a. Aortic Stenosis
b. Mitral Stenosis
c. Aortic Regurgitation
d. Mitral insufficiency
Correct: B
4. Thrill in CVS exam indicates:
a. Severe stenotic lesion
b. Pulmonary HTN
c. Valvular regurgitation
d. LV enlargement
Correct: C
5. Increased JVP indicates:
a. Hypertension
b. Increased pressure in Rt atrium
c. Increased pressure in Lt atrium
d. Increased pressure in Lt ventricle
6. Second heart sound is loud in:
a. Pulmonary HTN
b. Aortic valve insufficiency
c. Severe HTN
d. Coarctation of aorta
7. The commonest cause of ACS is:
a. Aortic stenosis
b. Atherosclerosis
c. Coronary vasospasm
d. Thrombosis
8. Which of the following is not included in ACS?
a. Prinzimetal’s angina
b. STEM 1
c. NSTEM 1
d. Unstable Angina
9. 35-year-old smoker known Hypertension experienced severe central chest pain, when he was
rushing to market the most important step for initial management of this case is:
a. Oxygenation
b. Metoprolol
c. Aspirin
d. Powerful analgesic
10. Which of the following is definitive case of Myocardial infarction?
a. ST elevation
b. Significant Q wave
c. ST depression
d. T wave inversion
11. Which of the following leads represent lateral wall MI in ECG?
a. Lead 1, 2
b. Lead 1, AVR
c. Lead 1, AVL
d. Lead 1, V1
12. Tachycardia in ACS is better be controlled by:
a. Metoprolol
b. Propanolol
c. Esmolol
d. Nebivolol
13. 38-year-old smoker, hypertensive experienced severe central chest pain for the last 6 hours.
Which is most diagnostic investigation scenario at tertiary care hospital on first arrival?
a. Cardiac enzymes
b. X-rays chest PA view
c. ECG
d. Sodium scan*
14. The right atrial enlargement on 12 led ECG is better judged by:
a. Broadening P-wave
b. Absence of P-wave
c. Lengthening of P- wave
d. Duplication of P- wave
15. The ventricular activity on ECG represented by:
a. ST- segment
b. R- wave
c. QRS- T
d. PR- segment
16. All of below are major diagnostic criteria in acute- rheumatic fever EXCEPT:
a. Erythema marginatum
b. Pan carditis
c. Arthralgia
d. St. Vitus dance (Syndenham chorea)
17. A 7-year boy is recently diagnosed acute rheumatic fever with mitral valve involvement.
According to WHO long-acting penicillin is advised foe which age?
a. 2 years
b. 7 years
c. 10 years
d. 13 years
18. A 35-year-old business man who had known diabetes for 5 years, recently had BP 166/90.
According to JNC this case is classified as:
a. Normotensive
b. Stage 1 HTN
c. Stage 2 HTN
d. Pre HTN
19. All of below are recognize as the cause of secondary HTN except:
a. Aortic stenosis
b. Coarcation of aorta
c. Polycythemia
d. Renal artery stenosis
20. An old man experiences crushing substernal chest pain after arriving at work one morning. Over
the last 4 hours, the pain persists and radiates to left arm. He becomes diaphoretic and short of
breath, but waits until the end of his 8-hour shift to go to hospital. An elevated serum value of
which of the following laboratory test would be helpful in diagnosis of this patient on admission
to hospital?
a. Lipase
b. AST
c. CK-MB fraction
d. C-reactive protein
21. Which of following drug is an alpha and Beta adeno-receptor blockers?
a. Esmolol
b. Labetalol
c. Carvedilol
d. Metoprolol
22. All of the statement regarding Angiotensin-2 are true EXCEPT:
a. It is peptide hormone
b. It stimulates the secretion of aldosterone
c. Angiotensin-1 is almost potent as angiotensin-2
d. It is a potential vasoconstrictor
23. Digoxin is a drug of choice for:
a. AV nodal arrythmias
b. Atrial fibrillations
c. Ventricular fibrillations
d. Ventricular Tachycardia
24. Digoxin:
a. Poorly lipid soluble
b. Is extensively metabolize
c. Has a half-life of 40 hours?
d. Has minimal GI toxicity
25. Correct statement regarding digoxin is:
a. It is a beta receptor agonist
b. It inhibits Ns/K ATPase in the heart
c. It inhibits phosphor diestrase enzymes in the heart
d. It is a beta adreno receptor blocker
26. Which ONE of the following drug is not used in treatment of heart failure?
a. Angiotensin receptor blockers
b. Calcium Channel Blocker
c. Cardiac Glycoside
d. Diuretics
27. An experiment study early atheroma. Lipid streaks on arterial wall are studied microscopely and
biochemically to determine their cellular and chemical constituents and the factors promoting
their formation. Early lesions show increased attachment of monocytes on endothelium. The
monocytes travel sub endothelially and become macrophages; these macrophages transform
themselves into foam cells. Which of the following is most likely to produce this effect?
a. C-reactive protein
b. Homocysteine
c. Lp(a)
d. Oxidized LDL
28. A 30-year-old school teacher is known to be a strict disciplinarian in the classroom. She has
angina pectoris of 6 months’ duration. On physical examination, her blood pressure is 135/85
mm Hg. She is 168cm (5ft 5in) tall and weighs 82 Kgs (BMI-29). Coronary angiography shows
75% narrowing of the anterior descending branch of the left coronary artery. Angiography by
stent placement is performed. Which of the following is the major risk factor associated with
these finding?
a. Obesity
b. Type A personality
c. Diabetes Mellitus
d. Sedentary lifestyle
29. The major cause of death in myocardial infarction is:
a. Rupture of mitral papillary muscle
b. Congestive failure
c. Ventricular aneurysm
d. Arrhythmia
30. In a person having a lacerated wound on forehead showing under dermis edge on left side,
which indicate that direction of forces, is:
a. From above
b. From left side
c. From right side
d. Subsequently directed force
31. Which type of atrial septal defect (ASD) is more common?
a. Secundum ASD
b. Primum ASD
c. Sinus venosus ASD
d. Coronary Sinus defect ASD
32. Which risk factor doubles the risk of developing arteriosclerosis?
a. Hypertension
b. Diet
c. Hyperlipidemia
d. Smoking
33. Aneurysm is more common in:
a. Down syndrome
b. Cystic fibrosis
c. Marfan syndrome
d. Edward syndrome
34. What is the most potent stimuli for ANP?
a. Decrease Na+
b. Volume overload
c. Vasodilation
d. Increased Na+
35. 68-year-old man has had progressive dyspnea for past year. On physical examination, extensive
rales are heard in all lung fields. An echocardiogram shows that the left wall is markedly
hypertrophied. A chest radiograph shows pulmonary edema and a prominent left-sided heart
shadow. Which of the following conditions has most likely produced these findings?
a. Centrilobular emphysema
b. Systemic hypertension
c. Tricuspid valve regurgitation
d. Chronic alcoholism
36. Flaying is a term used for:
a. Avulsion
b. Contused laceration
c. Split laceration
d. Tear
37. A lacerated wound may stimulate an incised wound if inflicted upon:
a. Chest
b. Dorsum of hand
c. Scrotum
d. Scalp
38. A male about 25 year of age was produced before medicolegal officer with multiple superficial
incised wounds over abdomen and extremities, these wounds were long with tail and clothes
showed no corresponding cut marks. The wounds are:
a. Accidental
b. Fabricated
c. Defense
d. Suicidal
39. The color change in contusion:
a. Starts at the periphery and extends towards the center.
b. Starts at the center extends towards periphery.
c. Starts uniformly all over.
d. Varies depending upon the size.
40. Graze is synonymous with:
a. Crushing abrasions
b. Friction abrasions
c. Imprint abrasions
d. Scraping abrasions
41. In abrasions, reddish brown scab is formed in:
a. 6-12 hours
b. 12-24 hours
c. 1-2 days
d. 2-3 days
42. Brush burn is due to:
a. Chemical burn
b. Electrical burn
c. Friction
d. Radiation burns
43. Which of the following lesion is the earliest in atherosclerosis?
a. Adhesion of Blood vessels
b. Adhesion of Platelets
c. Development of fatty streaks
d. Inflammation
e. Migration of smooth muscle cells
44. Correct statement regarding alteplase:
a. It is anticoagulant drug.
b. It is synthesized by streptococci.
c. It has a very long half-life.
d. It is used in the management of acute myocardial infarction.
45. Rheumatic fever occurs after an infection by which of the following bacteria?
a. E. coli
b. Pneumococcal
c. Pseudomonas
d. Staphylococcus aureus
e. Streptococcus
46. In the normal electrocardiogram:
a. The PR interval is measured from the end of the P wave to the beginning of the R wave.
b. Each small square represents 0.2 sec at a standard paper speed of 25mm/sec.
c. R waves- become progressively smaller from leads V1-V6.
d. ST segment- from the end of QRS complex to the end of T wave.
e. The PR interval is affected by the velocity of conduction through the AV node.
47. All of the following are the principal components of atherosclerotic plaques except:
a. Extracellular matrix
b. Intracellular and extracellular lipids
c. Iron
d. Macrophages
e. Smooth muscle cells
48. A drug that belongs to class 1C antiarrhythmic is:
a. Lidocaine
b. Flecainide
c. Mexiletine
d. Tocainide
e. Phenytoin
49. Unstable angina:
a. Chest pain occurs for the first time on moderate extension.
b. Chest pain occurs after meals.
c. Chest pain occurs during sleep.
d. Chest pain on inspiration.
e. Chest pain at rest.
50. Mechanism by which digoxin exerts positive ionotropic effect is:
a. Increase in the activity of Na+ and K+ pump.
b. Increase in the expulsion of calcium ions from the cells.
c. Decrease in the entry of calcium ions through voltage gated Ca++ channels.
d. Release of Ca++ ions from sarcoplasmic reticulum.
e. Decrease in calcium entry through voltage gated sodium channels.
51. A dead body of 35 years old male recovered from river, all signs of antemortem drowning is
present. The cause of death in such drowning is:
a. A tried fibrillation
b. Ballooning of lungs
c. Convulsions
d. Ventricular fibrillation
e. Vagal Inhibition
52. Systematic hypertension can lead to heart failure due to which one of the following
pathologies?
a. Failure of pump
b. Obstruction of blood flow
c. Regurgitant flow
d. Disordered cardiac conduction
e. Necrosis of ventricular wall
53. Identify the rhythm in the rhythm strip:

a. Ventricular fibrillation
b. Ventricular Tachycardia
c. Paroximal supra ventricular tachycardia
d. Sinus tachycardia
e. 3rd degree heart block
54. Which of the following part of aorta is usually much more involved in the characteristic
distribution of the atherosclerotic plaques in humans?
a. Ascending aorta
b. Abdominal aorta
c. Aortic knuckle
d. Coronary part of the aorta
e. Thoracic aorta
55. Which of the following is true concerning nitrates?
a. They constrict meningeal blood vessels causing headaches.
b. They are more effective as a prophylactic measure taken daily than taken to relieve an
anginal attack.
c. They usually decrease venous return.
d. They are selective coronary dilators with little if any effect elsewhere.
e. Nitroglycerine is administered under the tongue since if swallowed it would be destroyed by
the gastric juice.
56. Which of the following drug is Beta adrenoreceptor blocker?
a. Labetalol
b. Prazosin
c. Atenolol
d. Propranolol
e. Timolol
57. Which is the correct statement regarding chronic copper poisoning?
a. Most of the cases of chronic copper poisoning occurs due to fluoride salt of copper.
b. Food cooked in galvanized vessels can be the cause of chronic copper poisoning.
c. Haemochromatosis can occur from chronic copper absorption.
d. In females, reproductive system is mostly affected.
58. Following pathology leads to maximal cardiac hypertrophy:
a. Aortic regurgitation
b. Angina pectoris
c. Aortic stenosis
d. Systemic hypertension
e. Pulmonary hypertension
59. A fifty-year-old male presents in the ER with center chest pain. On examination his blood
pressure is 90/60 mmHg and his pulse is 106/min. He is pale and sweating profusely. The most
likely diagnosis is:
a. Myocardial Infarction
b. Esophagitis
c. Pleural effusion
d. Pericarditis
e. Pneumothorax
60. A 45-year-old male is admitted with center chest pain and sweating. His ECG shows ST segment
depression in anterior leads. A previous ECG he brought is normal. Troponin T test is ordered
which comes positive. What is the most likely diagnosis?
a. Unstable angina
b. Stable angina
c. Thrombolytic therapy is indicated
d. NSTEM1
e. Variant angina
61. Which of the following is NOT a risk of factor for coronary heart disease according to
Framingham Heart study?
a. Alcoholism
b. Hypertension
c. Diabetes
d. Black coffee
e. Smoking
62. A class I-A (sodium channel blocker) antiarrhythmic agent will produce:
a. Increase in threshold for excitability.
b. Decrease in conduction velocity.
c. Decrease in in duration of action potential.
d. Increase in phase-4 slope.
e. Decrease in refractoriness of the sodium channels.
63. Which of the following drug is directly acting anticoagulant?
a. Aspirin
b. Heparin
c. Dicumarol
d. Phenprocoumon
e. Warfarin
64. Extensive burning of neck muscle and eclymosis of subcutaneous tissue in neck is characteristics
of:
a. Hanging
b. Strangulation
c. Throttling
d. Burking
e. Smothering
65. All of the following are the clinical complication of atherosclerosis in the coronary arteries
except:
a. Aneurysm
b. Carcinoma
c. Critical stenosis
d. Occlusion by thrombus
e. Rupture
66. 42-year-old women suffers from chronic dyspnea and recurrent hemoptysis. A mid diastolic
murmur is heard in the left lateral chest wall. The diagnosis is:
a. Acute myocardial infarction
b. Mitral stenosis
c. Acute bacterial endocarditis
d. Systemic lupus erythematosus
e. Aortic regurgitation
67. Of the following, the congenital cardiac anomaly most commonly associated with cyanosis is:
a. Ventricular septal defect
b. Atrial septal defect
c. Teratology of Fallot
d. Coarctation of aorta
e. Patent ductus arteriosus
68. Which of the following is the most common among the congenital cardiac defect identified in
children?
a. Bicuspid aortic valve
b. Coarctation of aorta
c. Mitral atresia
d. Ventricular septal defect
e. Atrial septal defect
69. Which one of the following is not a feature of Teratology of Fallot?
a. Atrial septal defect
b. Pulmonic stenosis
c. Hypertrophy of right ventricle
d. Rightward displacement of aorta
e. Ventricular septal defect
70. Of the following, which is not a cyanotic congenital heart lesion?
a. Transportation of large arteries
b. Teratology of Fallot
c. Tricuspid atresia
d. Atrial septal defect
e. Pulmonary atresia
71. Based on the infective endocarditis diagnostic criteria, the most important diagnostic parameter
of this infection is:
a. Laboratory abnormalities
b. Positive blood culture and echocardiogram changes
c. Positive physical findings and positive blood culture
d. Microbiological evidences
e. ECG changes and positive physical findings
72. Which is the common form of systemic vasculitis in adults:
a. Takayasu arteritis
b. Giant cell (temporal) arteritis
c. Polyarteritis nodosa
d. Kawasaki disease
e. Wagener granulomatosis
73. A 50-year-old male working is safety match factory complain of toothache swelling jaw,
loosening of teeth sequestration of bone in the mandible, other features are weakness, weight
loss, anemia. What is of cause of poisoning?
a. Antimony
b. Mercury
c. Sodium
d. Lead
e. Phosphorus
74. Most of the congenital heart disease arise from faulty embryogenesis during gestational weeks:
a. 2-6
b. 2-7
c. 3-6
d. 3-7
e. 3-8
75. An unknown dead body recovered from an abandoned house showed abrasion on face having
red scab. These abrasions are:
a. 2-3 days old
b. 4-5 days old
c. 12-24 hours old
d. More than 5 days old
e. Postmortem abrasions
76. An antiarrhythmic dug which produces adverse effect as nausea, tinnitus, diplopia, prolongation
of QRS and increased QT interval is:
a. Quinidine
b. Procaine
c. Procainamide
d. Verapamil
e. Disopyramide
77. Which of the following year was Framingham Heart study was conducted?
a. 1915
b. 1920
c. 1935
d. 1947
e. 1949
78. Which of the following drug is alpha and beta adrenoreceptor blocker?
a. Esmolol
b. Labetalol
c. Propranolol
d. Timolol
e. Metoprolol
79. Identify the axis deviation in this ECG:

a. Normal axis
b. Left axis deviation (Correct)
c. Right axis deviation
d. Extreme superior deviation
e. Extreme right axis deviation
80. A family was suffering from metallic taste in mouth, abdominal colic, black line on gums and
behavioral changes. Lead levels were found elevated. Which is the correct treatment?
a. Stomach wash with 10% sodium or magnesium sulphate.
b. Removing the source of lead will cure the symptoms.
c. Acidosis causes rapid de-leading of lead stores.
d. Producing positive calcium level balance is very helpful.
e. Penicillamine is used for both acute and chronic toxicity.
81. The commonest site for myxoma is:
a. Right atrium
b. Inter ventricular septum
c. Left atrium
d. Left ventricle
e. Inter ventricular septum
82. Which one of the following is not a feature of Tricuspid regurgitation?
a. Prominence of wave
b. Pulsatile liver
c. Left parasternal heave
d. Pan-systolic murmur
e. Right atrial enlargement
83.