Cardio MCQs

1. A 70 year old man has a 6-month history of exertional chest tightness relieved by rest.
Which of the following would you recommend to confirm a diagnosis of stable angina?
a. Exercise electrocardiography
b. Stress echocardiography
c. Myocardial perfusion scintigraphy
d. Invasive coronary angiography
e. No testing is required

2. Which of the following is the most appropriate next management step for a patient with
anginal symptoms despite two anti-anginal medications?
a. Add isosorbide mononitrate to the current drug regimen
b. Perform invasive coronary angiography and offer coronary revascularisation if
appropriate
c. Refer for transcutaneous electrical nerve stimulation (TENS)
d. Advice more weight loss and regular exercise
e. Refer for acupuncture

3. A 55 year old man with ischaemic heart disease and ischaemic cardiomyopathy is
maintained on lisinopril, bisoprolol, digoxin, aspirin and atorvastatin. He is currently
asymptomatic. Which of the following medications can be safely discontinued without
compromising his survival?
a. Digoxin
b. Lisinopril
c. Aspirin
d. Atorvastatin
e. Bisoprolol

4. A 65 year old man presented with severe retrosternal chest pain for 1 hour duration. ECG
showed ST- elevation in the anterior leads. He is diabetic, underwent laser
photocoagulation 6 months ago. He had haemorrhagic stroke one year ago. On
presentation his BP is 160/110 mmHg. Which of the following will be a contraindication to
thrombolytic therapy?
a. His age
b. Diabetic retinopathy
c. History of haemorrhagic stroke
d. High BP
e. Late presentation
5. Which of the following symptoms has the worst prognosis in a patient with severe aortic
stenosis?
a. Palpitation
b. Fatigue
c. Syncope
d. Chest pain
e. Shortness of breath

6. A 30- year old man is admitted with pyrexia and found to have infective endocarditis.
Which of the following is associated with a good prognosis?
a. Staphylococcus aureus infection
b. Culture negative endocarditis
c. Streptococcus viridians infection
d. Low complement level
e. Prosthetic valve endocarditis

7. A 65 year old woman was admitted with severe retrosternal chest pain. Her BP was 90/60
mmHg, pulse 45 beat /minute. ECG showed ST- elevation in leads II, III and aVF. Which
vessel is most likely to be occluded?
a. Left anterior descending artery
b. Right coronary artery
c. Posterior descending artery
d. Left main artery
e. Left circumflex artery

8. On physical examination a 60-year old man is found to have pulsus alternans. Which of
the following conditions is most likely the diagnosis?
a. Aortic stenosis
b. Cardiac tamponade
c. Hypertrophic cardiomayopathy
d. Severe left ventricular failure
e. Mitral stenosis

9. A 25 year old female admitted with dyspnoea, palpitation and haemoptysis is noted to
have a murmur suggestive of mitral stenosis. The presence of which of the following
clinical signs suggest that the mitral stenosis is severe?
a. A loud S1
b. Tapping apex beat with a diastolic thrill
 c. The presence of a third heart sound
d. Short mid-diastolic murmur at the apex with presystolic accentuation
e. A palpable P2 in second left sternal area

10. Which of the following would be the most likely cause of dilated cardiomyopathy in a 20
year Sudanese Male?
a. Coronary artery disease
b. Hemochromatosis
c. Beriberi
d. Viral myocarditis
e. Alcohol

11. Which of the following is a characteristic clinical sign of constrictive pericarditis?

a. S3 gallop
b. A paradoxical rise in jugular venous pressure (JVP) on inspiration
c. Pulsatile hepatomegaly
d. Slow rising pulse
e. Traube’s sign

12. A 70 year old female with history of hypertension and diabetes is diagnosed with atrial
fibrillation.
Which of the following statements best describes her condition?
a. Warfarin anticoagulation is strongly indicated
b. Aspirin is the drug of choice for thromboembolism prevention
c. She remains at low risk for thromboembolism
d. Her age strongly contraindicates use of warfarin
e. Rheumatic valvular disease is the most likely cause of her atrial fibrillation
13. Which of the following agents reduces mortality in patients with congestive heart failure?
a) Digoxin
b) Enalapril
c) Amiodarone
d) Aspirin
e) Furosemide
14. A 16-year old boy presented with fever, knees and wrists pain. Had a history of severe
sore throat several weeks ago. Physical examination showed pea-sized swellings over the
elbows and wrists. Laboratory investigations showed normal WBC and ESR 100mm/1st
hour. ASO titer was 500units with negative throat culture. At this point the appropriate
therapy would be?
a) Non- steroidal anti-inflammatory drugs
b) Parenteral penicillin
c) Parenteral penicillin and steroids
d) Parenteral penicillin and high dose aspirin
e) Parenteral penicillin, aspirin and diazepam

15. A 25- year old female was admitted with dyspnoea, palpitations and haemoptysis, was
noted to have a murmur suggestive of mitral stenosis. Severity of mitral stenosis is
indicated by:
a) A loud first heart sound
b) Tapping apical impulse with a diastolic thrill
c) The presence of a third heart sound
d) Loud mid-diastolic murmur at the apex with presystolic accentuation
e) Closer opening snap to the second heart sound

16. A 70-year-old man has a 6-month history of exertional chest tightness relieved by rest.
Which of the following would you recommend to confirm a diagnosis of stable angina?
a) Exercise electrocardiography
b) Stress echocardiography
c) Myocardial perfusion scintigraphy
d) Invasive coronary angiography
e) No testing is required

17. A 40 years old female patient was noted to have elevation of the jugular venous pressure
during inspiration, this is most likely:
a) A normal physical finding
b) Cardiac tamponade
c) Constrictive pericarditis
d) Dilated cardiomyopathy
e) Myocarditis
18. A patient with dyspnoea developed attacks of central chest pain. His pulse is small and
slow rising. The most likely diagnosis is:
a) Severe mitral stenosis
b) Unstable angina
c) Mitral regurgitation
d) Aortic stenosis
e) Pulmonary stenosis

19. A patient with a prosthetic heart valve develops signs of endocarditis one month
following surgical valve replacement. The organism responsible is most likely:
a) Staphylococcus aureus
b) Escherichia coli
c) Candida albicans
d) Staphylococcus epidermidis
e) Streptococcus viridians

20. The electrocardiogram in a patient with chest pain showed ST segment elevation in leads
V2 to V5. This indicates:
a) Unstable angina
b) Acute inferior myocardial infarction
c) Acute anterior myocardial infarction
d) Stable angina
e) Severe aortic regurgitation
21. A 65 year old male patient presented with central chest pain that is relieved by leaning
forward and associated with Concave ST segment elevation in most leads in the ECG. The
most likely diagnosis is:
a) ST elevation acute myocardial infaction
b) Bundle branch block
c) Acute pericarditis
d) None ST elevation myocardial infarction
e) Unstable angina
22. A 70 year old female patient, presented with breathlessness and bilateral basal lung
crackles, pulse was 78 bpm, regular, of pulsus alternans character; the diagnosis is:
a) Right sided heart failure
b) Left sided heart failure
c) Congestive heart failure
d) Systolic heart failure
e) Diastolic heart failure
23. Which of the following agents reduces mortality in patients with congestive heart failure?
a) Digoxin.
b) Enalapril.
c) Amiodarone.
d) Aspirin.
e) Furosemide.
24. A 16-year old boy presented with fever, knees and wrists pain. Had a history of severe
sore throat several weeks ago. Physical examination showed pea-sized swellings over the
elbows and wrists. Laboratory investigations showed normal WBC and ESR 100mm/1st
hour. ASO titer was 500units with negative throat culture. At this point the appropriate
therapy would be?
a. Non- steroidal anti-inflammatory drugs.
b. Parenteral penicillin.
c. Parenteral penicillin and steroids.
d. Parenteral penicillin and high dose aspirin.
e. Parenteral penicillin, aspirin and diazepam.

25. A 25- year old female was admitted with dyspnoea, palpitations and haemoptysis, was
noted to have a murmur suggestive of mitral stenosis. Severity of mitral stenosis is
indicated by:
A) A loud first heart sound.
B) Tapping apical impulse with a diastolic thrill.
C) The presence of a third heart sound.
D) Loud mid-diastolic murmur at the apex with presystolic accentuation.
E) Closer opening snap to the second heart sound.
26. A75-year old male presented with exertional shortness of breath, chest pain and
syncope. O/E: pulse is of small volume with slow rising carotid impulse. Auscultation
showed a harsh ejection systolic murmur at the aortic area, fourth heart sound and
bilateral basal crackles. Which of the following statements is true regarding the
management of this patient?
a) Nitrates are indicated for the treatment of angina.
b) High doses of diuretics and angiotensin converting-enzyme inhibitors are useful in the
treatment of heart failure.
c) Aortic valve replacement is contraindicated because of his age.
d) Aspirin and statins have no role in the treatment.
e) Coronary angiogram is mandatory before aortic valve replacement.
27. A 40 years old female patient was noted to have elevation of the jugular venous pressure
during inspiration, this is most likely:
f) A normal physical finding.
g) Cardiac tamponade.
h) Constrictive pericarditis.
i) Dilated cardiomyopathy.
j) Myocarditis.

28. A 75- year old male patient, who is not diabetic, and with no significant past medical
history was noted to have a blood pressure of 175/55 mmHg, in more than one occasion.
The best treatment for this patient is:
a) Beta blockers.
b) Alpha blockers.
c) Angiotensin converting -enzyme inhibitors.
d) Angiotensin receptor blockers.
e) thiazide diuretics.
29. A 35-year old patient presented to the outpatient clinic with chronic nonproductive
cough and chest pain. He had poor appetite and weight loss. O/E: Pulse 100/minute,
regular & normal character. Blood Pressure, 100/60 mmHg. JVP was elevated with rapid y
descent. There is early third heart sound hepatomegaly and ascites, lungs were clear. The
most likely diagnosis is:
a) Cardiac tamponade.
b) Restrictive cardiomyopathy.
c) Constrictive pericarditis.
d) Abdominal tuberculosis.
e) Dilated cardiomyopathy
30. Auscultation of praecordium in a 23 year old male patient, with mitral stenosis revealed
loud first heart sound, loud second pulmonary sound, mid diastolic rumbling murmur with
presystolic accentuation, opening snap. The following morning he developed a completely
irregular pulse. The sign that disappears is:
a) Loud first heart sound
b) Opening snap
c) Presystolic accentuation
d) Mid diastolic murmur
e) Loud second pulmonary sound
31. A 65 year old male patient presented with central chest pain that is relieved by leaning
forward with breath hold on inspiration; the ECG would reveal:
a) Q waves in the anterior chest leads
b) T –wave inversion
c) Concave ST segment elevation in most leads
d) Convex ST segment elevation in chest leads
e) Bundle branch block
32. A 70 year old female patient, presented with symptoms and signs of heart failure, pulse
was 78 bpm, regular, of pulsus alternans character; the diagnosis is:
f) Right sided heart failure
g) Left sided heart failure
h) Congestive heart failure
i) Systolic heart failure
j) Diastolic heart failure
33) A 75- year old man presented with chest pain and syncope. Clinical examination showed a
harsh ejection systolic murmur at the aortic area.What is the most likely aetiology of his
valvular disorder?
a) Degenerative calcific valve.
b) Infective endocarditis.
c) Bicuspid aortic valve.
d) Rheumatic heart disease.
e) Subvalvular aortic stenosis.

34) A 68-year old man presents for a medication review.Blood pressure is

recorded as 180/65 mmHg.This is confirmed on two further occasions.What is
the most appropriate first line therapy?
a) Ramipril.
b) Losartan.
c) Frusemide.
d) Hydrochlorthiazide
e) Atenolol.
 35) A 50- year old diabetic woman presented with a two- hour history of severe
retrosternal chest pain.ECG showed 2 mm ST- elevation in the anterior chest
leads. Which of the following markers will first rise following myocardial
infaction ?
a) Aspartate aminotransferase (AST).
b) Troponin –I.
c) Creatine-kinase –MB( CK-MB).
d) Myoglobin.
e) Lactate dehydrogenase.(LDH).

36) A 25- year old man presented with fever, anorexia and weight loss. He has chronic kidney
disease and was started on regular haemodialysis for the past two months. On
examination he was pale, febrile and not clubbed. There is pansystolic murmur at the left
sterna edge. The most likely organism responsible for his illness is:-
a) Streptoccus viridians.
b) Beta-haemolytic streptococcus.
c) Staphyloccus aureus.
d) Streptococcus bovis.
e) Pseudomonus auroginosa.

37) A 30- year old woman is evaluated for a sharp left precordial chest pain
preceeded by 2-3 days of sore throat and diffuse myalgia. On physical
examination temperature 36.8 oC BP 110/70 mmHg. Pulse 100/minute.
Cardiac auscultation showed intermittent systolic sound along the left sternal
border.The lungs are clear. What is the most appropriate initial treatment in
this patient?

a) Prednisolone.
b) Aspirin.
c) Clopidogrel.
d) Indomethicin.
e) Antibiotics.
 38) A 15- year old female presented with chest pain, fever and skin rash following
sore throat. Examination revealed a diastolic murmur at the apex. The ASO
titre is high. Which of the following is a major criterion for the diagnosis of
rheumatic fever?
a) Fever
b) Raised ESR.
c) Polyarthritis.
d) Migratory erythema.
e) Prolonged PR interval.

39) The most common cause of acute pericarditis is:-

a) Coxsackie A & B, Echo and Adenoviruses.
b) Mycobacterium tuberculosis.
c) Streptococcus pneumoniae.
d) Staphylococcus aureus.
e) Histoplasmosis.

40) Severity of mitral stenosis is indicated by:

a) Presence of atrial fibrillation.
b) Loud mid-diastolic murmur.
c) Decreased distance of the opening snap from the second heart sound.
d) Absence of the signs of pulmonary hypertension.
e) Disappearance of the opening snap.

41) In a patient with ST-elevation anterior myocardial infarction:

a) The initial step of management is high flow oxygen, chewable aspirin, nitrates and
morphine.
b) Thrombolytic treatment can be given if the patient has a recent stroke within the
previous two months.
c) Nitrates are contraindicated if the patient has pulmonary oedema.
d) Angiotensin convertiong enzyme inhibitors have no role in the management.
e) The best combination of treatment is aspirin, B-blocker, heparin and nitrate.
 42) In Dilated Cardiomyopathy:-
a) The Idiopathic type is a disease of the elderly
b) β blockers are contraindicated in the management
c) Commonly follows infection with Brucellosis
d) Can be seen in AIDS patients
e) Patients have excellent long term prognosis

43. A 70-year-old man has a 6-month history of exertional chest tightness relieved by rest.
Which of the following would you recommend to confirm a diagnosis of stable angina?
f) Exercise electrocardiography
g) Stress echocardiography
h) Myocardial perfusion scintigraphy
i) Invasive coronary angiography
j) No testing is required

44. A patient with dyspnoea developed attacks of central chest pain. His pulse is small
and slow rising. The most likely diagnosis is:
f) Severe mitral stenosis
g) Unstable angina
h) Mitral regurgitation
i) Aortic stenosis
j) Pulmonary stenosis

45. The electrocardiogram in a patient with ischaemic chest pain showed ST segment
elevation in leads ll, lll, aVF. This indicates:
f) Unstable angina
g) Acute inferior myocardial infarction
h) Acute anterior myocardial infarction
i) Stable angina
j) Severe aortic regurgitation

46. The organism most commonly associated with prosthetic valve endocarditis during
the first 2 months following surgical valve replacement is?
f) Staphylococcus aureus
g) Escherichia coli
h) Candida albicans
i) Staphylococcus epidermidis
j) Streptococcus viridians
47. Which of the following is a serious ECG finding in acute hyperkalaemia?
a) Decrease in the PR- interval
b) Shortening of the QT- interval
c) Prominent U wave
d) QRS widening
e) T- wave flattening

48. 65 years old is admitted with heart failure. His echocardiogram shows features
consistent with restrictive cardiomyopathy with structurally normal valves. Which
of the following is the most likely underlying cause?
a) Amyloidosis
b) Post viral myocarditis
c) Alcoholic cardiomyopathy
d) Ischaemic heart disease
e) Tuberculosis.

49. A 30 year old female admitted with dyspnoea is noted to have a murmur suggestive
of mitral stenosis. The presence of which of the following clinical signs suggests that
the mitral valve is mobile?
a) Fourth heart sound
b) Loud second heart sound
c) Opening snap
d) Third heart sound
e) Soft first heart sound

50. A 55- year old diabetic man presented with fatigue, dyspnoea and lethargy.
Examination revealed patches of vitiligo, pallor and a tinge of jaundice.
Investigations: Haemoglobin 6 g/dL MCV 109 fL( N 80- 96) White cell count
2x109/L, Platelets count 45x109/L. Urine analysis showed increased urobilinogen.
What is the next appropriate investigation?
a) Bone marrow examination
b) Direct globin test
c) Endoscopy
d) Serum haptoglobib
e) Vitamin B12 concentration
 51. A 70 year old female patient, presented with symptoms and signs of heart failure,
pulse 78 bpm, regular, of pulsus alternans character; the diagnosis is:
k) Right sided heart failure
l) Left sided heart failure
m) Congestive heart failure
n) Systolic heart failure
o) Diastolic heart failure

61. The apical impulse is heaving in character in the following conditions EXCEPT:
a) Severe mital stenosis
b) Severe mital regurgitation
c) Essential hypertension
d) Aortic stenosis
e) Hypertrophic cardiomyopathy

62. A 20 years old student is diagnosed to have acute pericarditis, the following are true:
a) The chest pain is dull in nature and radiates to the neck
b) The chest pain is relieved by lying down
c) The ECG will show ST segment depression in all leads
d) A pericardial friction rub may be heard
e) The most likely cause is bacterial infection

63. A 65- year old male is admitted with an acute anterior ST- segment elevation
myocardial infarction. He received streptokinase with good resolution of the ECG
findings. Which of the following subsequent medications does not reduce future
morbidity and mortality in this patient?
a) Aspirin
b) Atenolol
c) Atorvastatin
d) Lisinopril
e) Nifedipine
64. In a patient with severe aortic stenosis which of the following has the worst prognostic
feature?
a) Angina
b) Syncope on exertion
c) Heart failure
d) Low pulse pressure
e) Loud ejection systolic murmur at aortic area
65. A 75-year old patient with exertional chest pain and dyspnoea.
O/E he has small volume pulse and a harsh ejection systolic murmur at aortic area.
a) Aortic stenosis in this patient is most likely rheumatic.
b) Chest pain is invariably due to concomitant ischaemic heart disease.
c) A wide pulse pressure is an expected finding.
d) Sudden death may be the first manifestation.
e) aortic sclerosis is most likely.
66. In treatment of chronic heart failure:
a) Digoxin is indicated only if the patient has atrial fibrillation.
b) Angiotensin-receptor blockers do not reduce mortality and are not useful
alternative for ACE- inhibitors.
c) The only role of spiranolactone in combination with loop diuretics is to reduce
urinary potassium loss.
d) ACE-inhibitors should be used only if the patient is hypertensive.
e) B-blockers increase the ejection fraction, improve symptoms and reduce
mortality.

67. Severity of mitral stenosis is indicated by:

a) Presence of atrial fibrillation.
b) Loud mid-diastolic murmur.
c) Decreased distance of the opening snap from the second heart sound.
d) Absence of the signs of pulmonary hypertension.
e) Disappearance of the opening snap.

68. In a patient with ST-elevation anterior myocardial infarction:

a) The initial step of management is high flow oxygen, chewable aspirin, nitrates and
morphine.
b) Thrombolytic treatment can be given if the patient has a recent stroke within the
previous two months.
c) Nitrates are contraindicated if the patient has pulmonary oedema.
d) Angiotensin convertiong enzyme inhibitors have no role in the management.
e) The best combination of treatment is aspirin, B-blocker, heparin and nitrate.
69. A 15- year old female presented with chest pain, fever and skin rash following sore
throat. Examination revealed a diastolic murmur at the apex. The ASO titre is high. Which of
the following is a major criterion for the diagnosis of rheumatic fever?
a) Fever
b) Raised ESR.
c) Polyarthritis.
d) Migratory erythema.
e) Prolonged PR interval.

70. A 25 year old male was diagnosed with rheumatic valvular heart disease. His
echocardiogram showed severe mitral regurgitation and moderate mitral stenosis.

Which of the following is a strong indication for surgical intervention?

a) Atrial fibrillation
b) Pulmonary edema
c) Thrombo-embolic stroke
d) Acute glomerulonephitis
e) Recurrent lower respiratory tract infection.

71. In Dilated Cardiomyopathy:-

a) The Idiopathic type is a disease of the elderly
b) β blockers are contraindicated in the management
c) Commonly follows infection with Brucellosis
d) Can be seen in AIDS patients
e) Patients have excellent long term prognosis

72. A 24 year old female presented to the outpatient clinic, with fever for the last 6 weeks.
She received antibiotic treatment for enteric fever without improvement. On
examination, you discovered she has a temperature of 39° C, a loud pansystolic murmur
at the apex and the tip of the spleen is just palpable. Her Hb was 13g/dl. Choose the best
management plan for this patient?

a) Prophylactic antibiotics for Rheumatic fever

b) Consider treatment for Brucellosis.
c) Start the patient on artemether injections
d) Ask the patient to obtain an echocardiogram for the next outpatient clinic.
e) Admit the patient to hospital and obtain immediate echocardiogram and blood cultures.
73. A 35-year- old male complains of palpitations and dyspnea on exertion. His examination is
significant for collapsing pulse, BP 130/30 and early diastolic murmur heard at the left
sternal border.
Which of the following statements is correct?

a) The presence of a mid-diastolic murmur at the apex indicates that the patient has mitral
stenosis.
b) The patient symptoms are most likely due to anemia.
c) Rheumatic heart disease is an unlikely cause.
d) Thyroid function test should be ordered immediately
e) A long history of back pain and stiffness is important in this patient

74. A 52-year-old man was diagnosed as chronic heart failure due to ischemic heart disease.
Echocardiogram showed significant left ventricular hypertrophy.

Which of the following drugs is proven to help to remodel his left ventricle?
a) Enalapril
b) Frusemide
c) metoprolol
d) Digoxin
e) Thiazide diuretics

75. Which of the following agents reduces mortality in patients with congestive heart failure?
f) Digoxin.
g) Enalapril.
h) Amiodarone.
i) Aspirin.
j) Furosemide.
76. A 16-year old boy presented with fever, knees and wrists pain. Had a history of severe
sore throat several weeks ago. Physical examination showed pea-sized swellings over the
elbows and wrists. Laboratory investigations showed normal WBC and ESR 100mm/1 st
hour. ASO titer was 500units with negative throat culture. At this point the appropriate
therapy would be?
f) Non- steroidal anti-inflammatory drugs.
g) Parenteral penicillin.
h) Pareneral penicillin and steroids.
i) Parenteral penicillin and high dose aspirin.
j) Parenteral penicillin, aspirin and diazepam.
77. A 25- year old female was admitted with dyspnoea, palpitations and haemoptysis, was
noted to have a murmur suggestive of mitral stenosis. Severity of mitral stenosis is
indicated by:
f) A loud first heart sound.
g) Tapping apical impulse with a diastolic thrill.
h) The presence of a third heart sound.
i) Loud mid-diastolic murmur at the apex with presystolic accentuation.
j) Closer of the Opening snap to the second heart sound.

78. A75-year old male presented with exertional shortness of breath, chest pain and syncope.
O/E: pulse is of small volume with slow rising carotid impulse. Auscultation showed a
harsh ejection systolic murmur at the aortic area, fourth heart sound and bilateral basal
crackles. Which of the following statements is true regarding the management of this
patient?
f) Nitrates are indicated for the treatment of angina.
g) High doses of diuretics and angiotensin converting-enzyme inhibitors are useful in the
treatment of heart failure.
h) Aortic valve replacement is contraindicated because of his age.
i) Aspirin and statins have no role in the treatment.
j) Coronary angiogram is mandatory before aortic valve replacement.

79. A female patient of 40 years old, was noted to have elevation of the jugular venous
pressure during inspiration, this is most likely:
k) A normal physical finding.
l) Cardiac tamponade.
m) Constrictive pericarditis.
n) Dilated cardiomyopathy.
o) Myocarditis.
80. A 75- year old male patient, who is not diabetic, and with no significant past medical
history was noted to have a blood pressure of 175/55 mmHg, in more than one occasion.
The best treatment for this patient is:
f) Beta blockers.
g) Alpha blockers.
h) Angiotensin converting -enzyme inhibitors.
i) Angiotensin receptor blockers.
j) thiazide diuretics.
81. A 35-year old patient presented to the outpatient clinic with chronic nonproductive cough
and chest pain. He had poor appetite and weight loss. O/E: Pulse 100/minute, regular &
normal character. Blood Pressure, 100/60 mmHg. JVP was elevated with rapid y descent.
There is early third heart sound hepatomegaly and ascites, lungs were clear. The most
likely diagnosis is:
f) Cardiac tamponade.
g) Restrictive cardiomyopathy.
h) Constrictive pericarditis.
i) Abdominal tuberculosis.
j) Dilated cardiomyopathy
82. Auscultation of praecordium in a 23 year old male patient, with mitral stenosis revealed
, loud first heart sound, loud second pulmonary sound, mid diastolic rumbling murmur
with presystolic accentuation, opening snap, the following morning this patient
developed a completely irregular pulse, the sign that disappears is:
f) loud first heart sound
g) opening snap
h) presystolic accentuation
i) mid diastolic murmur
j) loud second pulmonary sound

83. A 65 year old male patient presented with central chest pain that is relieved by leaning
forward with breath hold on inspiration; the ECG would reveal:
f) Q waves in the anterior chest leads
g) T –wave inversion
h) Concave ST segment elevation in most leads
i) Convex ST segment elevation in chest leads
j) Bundle branch block
84. A 70 year old female patient, presented with symptoms and signs of heart failure, pulse
was 78 bpm, regular, of pulsus alternans character; the diagnosis is:
p) right sided heart failure
q) left sided heart failure
r) congestive heart failure
s) systolic heart failure
t) diastolic heart failure
85. Which of the following symptoms has the worst prognosis in severe aortic stenosis?
a) Palpitation.
b) Fatigue.
c) Syncope.
d) Chest pain.
e) Shortness of breath.

86. A 65- year- old male presented to the emergency room with severe ongoing central chest
pain, nausea and vomiting for the last hour. His ECG showed ST segment elevation from
lead V2 to V6. Choose the most appropriate statement?
a) This patient has acute myocardial infarction involving the right coronary artery.
b) This patient should not receive thrombolysis because of his age.
c) The patient should be sent immediately to the biochemistry lab to check for cardiac
enzymes.
d) The patient should receive immediate thrombolysis if there is no contra-indication.
e) There is no role for aspirin in the management of this patient.

87. A 24 year old female presented to the outpatient clinic, with fever for the last 6 weeks.
She received antibiotic treatment for enteric fever without improvement. On
examination, you discovered she has a temperature of 39° C, a loud pansystolic murmur
at the apex and the tip of the spleen is just palpable. Her Hb was 13g/dl. Choose the best
management plan for this patient?

a) Prophylactic antibiotics for Rheumatic fever

b) Consider treatment for Brucellosis.
c) Start the patient on artemether injections
d) Ask the patient to obtain an echocardiogram for the next outpatient clinic.
e) Admit the patient to hospital and obtain immediate echocardiogram and blood cultures.
88. A 35-year- old male complains of palpitations and dyspnea on exertion. His examination
is significant for collapsing pulse, BP 130/30 and early diastolic murmur heard at the left
sternal border.
Which of the following statements is correct?

a) The presence of a mid-diastolic murmur at the apex indicates that the patient has mitral
stenosis.
b) The patient symptoms are most likely due to anemia.
c) Rheumatic heart disease is an unlikely cause.
d) Thyroid function test should be ordered immediately
e) A long history of back pain and stiffness is important in this patient
89. A 65 year old male patient sustained an acute inferior wall Myocardial infarction 24 hours
ago. He suddenly developed acute shortness of breath with sweating. His BP was 80/40 mm
Hg and he developed a new pansystolic murmur over the precordium with crepitations up
to half of the chest l. A repeat ECG did not show any new changes. The most likely diagnosis
is:

a) Cardiac tamponade from LV rupture.

b) Acute pulmonary embolism.
c) Re-infarction.
d) Acute Mitral Regurgitation. With pulmonary edema
e) Hospital acquired pneumonia

90. A hypertensive patient was admitted to ICU with severe headache and a blood pressure of
220/ 140. Which, of the following drugs is the best choice for his initial management?

a) Intra venous Beta blockers.

b )Intravenous Sodium nitroprusside
c) Sublingual Nifidipine.
d) Intravenous hydralazine.
e) Intravenous frusemide

91. A 40 years old lady had undergone cholecystectomy 24 hours ago. She developed sudden
chest pain and became very breathless. Temperature is 38.0° C. White blood count is 9000/
C.mm. Oxygen saturation is 82% at room air. ECG shows sinus tachycardia. Chest x-ray was
unremarkable. What is the most likely diagnosis?

a) Hospital acquired pneumonia

b) Pulmomary embolism
c) Arrhythmia.
d) Sepsis.
e) Pneumothorax

92. In a 13- year-old boy with a recent throat infection and fever the diagnosis of Rheumatic
Fever is likely if he has:

a) Convulsions and swollen knee joints

b) Headache and pleural effusion
c) Pericardial effusion and swollen wrist
d) Haemoptysis and tachycardia
e) Tremor and tachycardia
93. Which of the following is true regarding arterial pulse?
a) A jerky pulse occurs with mitral stenosis
b) A paradoxical pulse is characteristic with ventricular septal defect (VSD)
c) A slow rising pulse occurs in mitral regurgitation
d) A collapsing pulse occurs with patent ductus arteriosis (PDA)
e) Pulsus alternans indicates good left ventricular contraction

94. In Dilated Cardiomyopathy :

a) idiopathic dilated Cardiomyopathy is a disease of the elderly
b) B blockers are contraindicated in the management
c) commonly follows infection with Brucellosis
d) can be seen in AIDS patients
e) patients have excellent long term prognosis

95. Heart failure:

a) is Diagnosed by echocardiography
b) can be easily differentiated from asthma by absence of wheezes.
c) BNP ( B type natueritc peptide) is low in the blood
d) can be precipitated by thyrotoxicosis
e) ACEI (angiotensin converting enzyme inhibitors) should be avoided

96. An 18 year old girl had a syncopal attack at her college during a class test. Examination showed a
small volume jerky pulse, an ejection systolic murmur at the left sternal edge and a prominent
fourth heart sound. The most likely diagnosis is:

a. Ventricular septal defect

b. Mitral regurgitation
c. Aortic stenosis
d. Hypertrophic obstructive Cardiomyopathy
e. Aortic regurgitation
97. The following are known complications of infective endocarditis except:
a. Renal failure
b. Hepatic failure
c. Subarachnoid haemorrhage
d. Subdural haematoma
e. Toe gangrene
98. In a patient with chest pain, in the accident and emergency unit, acute myocardial infarction is
suspected. The most appropriate first investigation is:
a. ECG
b. Echocardiography
c. Troponin level
d. Isotope scanning
e. Chest X ray
99. Dilated cardiomyopathy may result from the following except:
a. Thyrotoxicosis
b. Doxorubicin treatment
c. Coxackie virus infection
d. Amyloidosis
e. Phaeochromocytoma
100. Which one of the following statements is correct:
a. The third heart sound is always a normal finding
b. A loud S1 is diagnostic of mitral stenosis
c. An ejection click is present in sub-aortic stenosis
d. A loud P2 is present with pulmonary stenosis
e. The fourth heart sound is always an abnormal finding
101. Cannon a wave in the JVP is seen in:

a. Complete Heart Block.

b. Tricuspid Stenosis.
c. Pulmonary Stenosis.
d. Pulmonary Regurgitation.
e. Premature ventricular contractions
102. Wide and fixed splitting of second heart sound is suggestive of:

a. Coarctation of aorta.
b. Ventricular Septal Defect.
c. Atrial Septal Defect.
d. Mitral Stenosis.
e. Fallot's tetralogy
103) A 65 year old male presents to the emergency room with severe ongoing central chest pain,
nausea and vomiting for the last hour. His ECG showed ST segment elevation from lead V2 to V6.
Choose the most appropriate statement
f) This patient has acute myocardial infarction involving the right coronary artery.
g) This patient should not receive thrombolysis because of his age.
h) Blood sample should be sent immediately to the biochemistry lab to check for cardiac
enzymes.
i) The patient should receive immediate thrombolysis if there is no contra-indication.
j) There is no role for aspirin in the management of this patient.

104) A 24 year old female presents to the outpatient clinic with fever for the last 6 weeks.
She received antibiotic treatment for enteric fever without improvement. On examination
, you discover she has a temperature of 39 degrees C, a loud pansystolic murmur at the
apex and the tip of the spleen is just palpable. Her Hb was 13g/dl. Choose the best
management plan for this patient?
a) Prophylactic antibiotics for Rheumatic fever
b) Consider treatment for Brucellosis.
c) Start the patient on artemether injections
d) ask the patient to obtain an echocardiogram for the next outpatient clinic.
e) Admit the patient to hospital and obtain immediate echocardiogram and blood cultures.

105) A 35 year old male complains of palpitations and dyspnea on exertion. His
examination is significant for collapsing pulse, BP 130/30 and early diastolic murmur
heard at the left sternal border.
Which of the following statements is correct?

a) The presence of a mid-diastolic murmur at the apex indicates that the patient main
problem is mitral stenosis.
b) The patient symptoms are most likely due to anemia.
c) Rheumatic heart disease is an unlikely cause.
d) Thyroid function test should be ordered immediately
e) A long history of back pain and stiffness is important in this patient
106) A 65 year old male patient sustained an acute inferior wall MI 24 hours ago. He suddenly
developed acute shortness of breath with sweating. His BP was 80/40 mm Hg and he
developed a new pansystolic murmur over the precordium with rales up-to half of the chest
wall. A repeat ECG did not show any new changes. What is the most likely diagnosis :

a) Cardiac tamponade from LV rupture.

b) Acute pulmonary embolism.
c) Re-infarction.
d) Acute Mitral Regurgitation. With pulmonary oedema
e) Hospital acquired pneumonia

107) A hypertensive patient is admitted to ICU with severe headache and a blood pressure
of 220/ 140. Which of the following drugs is the best choice for his initial management :

a) IV Sodium nitroprusside.
b) IV Beta blockers.
c) Sublingual Nifidipine.
d) IV hydralazine.
e) IV frusemide 20mg

108) A 40 years old lady had undergone cholecystectomy 24 hours ago. She develops sudden
chest pain and becomes very breathless. Temperature is 38.0 C. White blood count is 9000/
C.mm. Oxygen saturation is 82% at room air. ECG shows sinus tachycardia. Chest x-ray was
unremarkable. What is the most likely diagnosis?

a) Hospital acquired pneumonia.

b) Pulmonary embolism.
c) Arrhythmia.
d) Sepsis.
e) Pneumothorax

109) In a13 years old boy with a recent throat infection and fever, the diagnosis of Rheumatic
Fever is likely if he has:

a) Convulsions and swollen knee joints

b) Headache and pleural effusion
c) Pericardial effusion and swollen wrist
d) Haemoptysis and tachycardia
e) Tremor and tachycardia
110) The following are true regarding arterial pulse:

a) A jerky pulse occurs with mitral stenosis

b) A paradoxical pulse is characteristic with ventricular septal defect (VSD)
c) A slow rising pulse occurs in mitral regurgitation
d) A collapsing pulse occurs with patent ductus arteriosis (PDA)
e) Pulsus alternans indicates good left ventricular contraction

111) Which of the following would warrant urgent referral for endoscopy in a 40-year old
male with recent onset dyspepsia?

a) History of paracetamol use

b) Intermittent heartburn
c) Previous gastric surgery
d) Recurrent vomiting
e) Family history of peptic ulcer disease

112. A 25 year old patient presented with chest pain, which of the following is important in
diagnosis :
a) Positive family history of sudden death
b) History of hematuria as a child
c) Large volume collapsing pulse
d) Male sex
e) Female sex

113. Characteristic feature of chest pain due to angina is:

a) Relived by exercise
b) Aggravated by swallowing
c) Duration of few minutes
d) Associated with vomiting
e) Localized to the left side of the chest

114. A 70-year-old man has a 6-month history of exertional chest tightness relieved by rest. Which
of the following would you recommend to confirm a diagnosis of stable angina?
a) Exercise electrocardiography
b) Stress echocardiography
c) Myocardial perfusion scintigraphy
d) Invasive coronary angiography
e) No testing is required
 115) A heaving apical impulse :
a) Is seen in mitral stenosis
b) Is noted in normal persons
c) Indicates right ventricular dilatation
d) Is a feature of pressure overload on the heart
e) Is associated with mitral valve prolapse

116) A mid diastolic rumbling murmur at the apex:

a) Is Indicative of infective endocarditis
b) Is seen in severe aortic stenosis
c) Is common in pregnancy
d) Rarely radiates to the axila
e) Its length determines the severity of mitral stenosis

117) Palpable second pulmonary sound indicates:

a) Soft pulmonary sound on auscultation
b) Pulmonary stenosis
c) Pulmonary hypertension
d) Pulmonary regurgitation
e) Splitting of the second heart sound

118. Small volume pulse is seen in:

a) Thyrotoxicosis
b) Aortic incompetence
c) Febrile illness
d) Pregnancy
e) Aortic stenosis

119. In atrial fibrillation:

a) The pulse rate is rapid
b) The volume is large
c) The character is collapsing
d) The pulse deficit is more than 10
e) The pulse is not synchronous

120. The jugular venous pressure reflects the pressure in the:

a) Left atrium
b) Right atrium
c) Left ventricle
d) Right ventricle
e) Left atrium & left ventricle