2. Q.1. A 56 year old gentleman was brought to the hospital with
mild retrosternal chest pain – 3 days after sudden demise of his
son in a car accident. His wife reports that he was stressed and
worried about the incident. ECG shows ST elevation but
coronary angiography is absolutely normal. On examination,
apical impulse is diffuse and echo shows a bulged out Left
ventricle. What is the treatment for the presenting condition?
A. Alpha blockers with beta blocker
B. Aspirin
C. Clopidogrel
D. Alpha agonists followed by beta agonists
3. Ans. A : Alpha blocker followed by beta blocker
Diagnosis : Stress Cardiomyopathy/Takotsubo
Cardiomyopathy
Reference
Harrison’s textbook of internal Medicine – 20th ed – Page –
1790-91
4. Q2. Following is the specimen of heart showing important
landmarks. Which of these structure is present inside the area
marked X?
A. Sinoatrial Node
B. Atrioventricular node
C. Bundle of His
D. Right Bundle Branch
5. Ans. B
X in the image is Triangle of Koch.
AV Node lies beneath the triangle of Koch.
Reference – Gray’s anatomy – Thorax
Image reference -
https://i.pinimg.com/originals/63/59/b8/6359b86f29d
8750df338e1031a592d8c.jpg
6. Q 3. A known case of HOCM comes for routine survey. On
examination, JVP is raised and a large ‘a’ wave is noted. This
finding is because of :
A. Tricuspid stenosis
B: Septal Bulge
C: Pulmonary hypertension
D: Aortic Regurgitation
7. Ans: B
This is Bernheim’s effect – Rise in JVP due to a bulge
of the hypertrophic septum into the right ventricle.
Reference -
Harrison’s textbook of internal Medicine – 20th ed
Page – 1795
8. *Q4. A gentleman was brought to OPD with nausea, loss of appetite,
headache and some chest pain after recent intake of a drug. An ECG
was done under routine protocols. A sign named after the personality
shown in the given image is found on the ECG. This is associated with
which of the following drugs?
A: Procainamide
B: Digoxin
C: Amiodarone
D: Propafenone
9. Ans: B : Digoxin
‘Salvador Dali sign’ or ‘Reverse tick Sign’ of Digoxin toxicity.
Reference- Harrison's Principles of Internal Medicine 20th
edition
10. Q5. Which of these is a correct match for the shown
procedures?
A: A - Modified Blalock Taussig Shunt
B: B - Pott's Shunt
C: C - Classic Blalock Taussig Shunt
D: D - Waterston Shunt
11. Ans:B
These are the different shunts used
for tetralogy of fallot.
Reference –
Nelson’s textbook of Pediatrics
Image -
https://i0.wp.com/thoracickey.com/
wp-
content/uploads/2017/09/A322400_
1_En_19_Fig4_HTML.gif?w=960
12. Q6. Which of the marked mechanisms is followed by Valsartan?
A:A
B:B
C:C
D:D
13. Ans: C- Valsartan is a angiotensin receptor blocker
Reference – Essentials of Medical Pharmacology – K.D Tripathi
14. Q7. A 32-year-old gentleman with diabetes presents to his physician with
orthostatic hypotension. This suggests a deficiency in the normal physiologic
response carried out by arterial baroreceptors located in the aortic arch and the
carotid sinus. What is the normal physiologic response to hypotension?
A: Decreased baroreceptor afferent firing in the aortic arch leads to increased
sympathetic efferent firing
B: Decreased baroreceptor afferent firing in the carotid sinus leads to increased
parasympathetic efferent firing
C: Decreased baroreceptor afferent firing in the carotid sinus leads to increased
sympathetic efferent firing
D: Increased baroreceptor afferent firing in the aortic arch leads to increased
parasympathetic efferent firing
15. Ans: C
The carotid sinus baroreceptor sends an afferent signal via the
glossopharyngeal nerve to the medulla, which in turn responds
with a sympathetic efferent signal that causes vasoconstriction,
increased heart rate, increased contractility, and increased
blood pressure.
Reference – Ganong’s Review of Medical Physiology
16. Q8. A 24 year old young is being evaluated for progressive
weakness and fatigue. His brother had a sudden cardiac death
at a young age. Following is the echocardiographic finding in
this patient. What is the drug of choice for the following
condition?
A : Propranolol
B : Procainamide
C : Verapamil
D : Nitroglycerine
17. Ans: A
Image shows asymmetric septal hypertrophy and a ‘Banana
shaped LV’.
Diagnosis – HOCM
Drug of Choice - Propranolol
Reference
Harrison’s textbook of internal Medicine – 20th ed
Page – 1794
18. Q9. An 87 year old gentleman was admitted to the cardiac ICU with
ascites, shortness of breath and peripheral edema. After cardiac
catheterization, pulmonary venous oxygen is 20 ml/100ml blood,
oxygen consumption is 280ml/min , pulmonary arterial oxygen is 12
ml/100 ml blood and stroke volume is 40 ml. What is his cardiac output?
A: 7 L/min
B: 3.5 L/min
C: 3 L/min
D: 8 L/min
19. Ans: B
Fick’s Principle :
Cardiac output =
𝑂2 𝑐𝑜𝑛𝑠𝑢𝑚𝑝𝑡𝑖𝑜𝑛
𝑂2 𝑜𝑓 𝑃𝑢𝑙 𝑉𝑒𝑖𝑛 −𝑃𝑢𝑙 𝑎𝑟𝑡𝑒𝑟𝑦
Reference – Ganong’s Review of Medical Physiology
20. *Q 10. Mode of Inheritance of the condition shown in the given
condition is:
A: Autosomal dominant
B: X linked Dominant
C: Autosomal Recessive
D: X linked Recessive
21. Ans: C
Images – Histopathology of ARVD
- Wooly Hair
- Palmar Keratoderma
- Epsilon waves in ECG (ARVD)
Diagnosis – Naxos Syndrome
Reference – Harrison’s Internal Medicine
Page no 1787
22. Q11. Following are the classical general examination findings in a child with
congenital heart disease. What is the most common congenital heart disease
associated with it?
A: Ventricular Septal defect
B: Atrial Septal defect
C: Transposition of great arteries
D: Ebstein's anomaly
23. Ans: B
Diagnosis – Ellis Van Creveld Syndrome
Most common congenital heart disease in this syndrome is
ASD.
Reference – Nelson’s textbook of Pediatrics
Image -
https://media.springernature.com/lw785/springer-
static/image/prt%3A978-3-540-29676-
8%2F5/MediaObjects/978-3-540-29676-8_5_Part_Fig1-
546_HTML.jpg
24. Q.12. Hey! You having angina? Using me in a patient with
bradyarrhythmia worsens his situation. Beware to use me if you
have visual problems. Funny currents are enemies for me.
Who am I ?
A: Fasudil
B: Ranolazin
C: Ivabradine
D: Nicorandil
25. Answer – C
Ivabradine is an anti-angina drug that inhibits funny sodium
channels.
Its side effects include Bradyarrhythmias and Visual disturbances.
Reference – Essentials of Medical Pharmacology – K.D Tripathi
26. *Q 13. Before the 19th century, physicians could listen to the heart only by applying
their ear directly to the chest. This “immediate auscultation” suffered from social
and technical limitations, which resulted in its disfavor. This great physician
contributed to bring a new era in the science of Medicine , made it easy and more
specific to identify the various conditions of the heart. Identify this great
personality!!!!
A: William Harvey
B: René Laennec
C: Jacques Alexandre
D: Leopold Auenbrugger
27. Ans. René Laennec, who invented Stethoscope
Reference - https://www.ajconline.org/article/S0002-
9149(02)02465-7/fulltext
28. Q 14. What can you conclude from the following chest radiogram?
A: Prosthetic Aortic Valve
B: Prosthetic Pulmonary Valve
C: Prosthetic Mitral Valve
D: Prosthetic Tricuspid Valve
29. Ans. C
A Ring like opacity within the cardiac shadow. Lies below
the line joining left hilum and right cardiophrenic angle is
suggestive of mitral valve.
Reference
https://prod-images-
static.radiopaedia.org/images/7
453192/d1865125fe4da916522
c71574d6f8e.png
30. Q 15. An IV drug abuser complaining of diminution of vision
shows following findings. Which of these explains the reason
for this pathology?
A: Type 1 Hypersensitivity Reaction
B: Type 2 Hypersensitivity Reaction
C: Type 3 Hypersensitivity Reaction
D: Type 4 Hypersensitivity Reaction
31. Ans. C
Roth Spots seen in Infective Endocarditis.
- Occur because of immune-complex vasculitis.
Reference – Parson’s textbook of Ophthalmology
- Harrison’s Textbook of Internal medicine
32. Q 16. 56-year-old lady presents to her physician because of recent
onset of chest pain and dyspnea. Six weeks earlier the patient
suffered an MI. Her physical examination is remarkable for a friction
rub over the fifth intercostal space in the mid-clavicular line
together with an elevated jugular venous pressure. Which of the
following myocardial complications is this individual most likely
suffering from?
A: Cardiac arrhythmia
B: Dressler’s syndrome
C: Left ventricular failure
D: Thromboembolism
34. Q.17.All of the following is following about the cardiovascular
examination of this patient is true except:
A: Loud S1 with an opening snap
B: Mid-diastolic murmur with presystolic accentuation
C: RV Heave
D: Loud A2
35. Ans: D
Mitral facies in Mitral stenosis
Mitral stenosis has loud P2, not loud A2
Reference – Harrison’s Internal Medicine
36. *Q 18. Following are the two plots of RV and LV pressure changes ,
comparing the normal with that of the patient. What is the most
likely condition the patient suffers from?
A: Pericardial effusion
B: Restrictive Cardiomyopathy
C: Constructive Pericarditis
D: LV Pseudoaneurysm
38. Q.19. Which of these areas of your hand is to be
used to feel a heave?
A
B
C
D
39. Ans: D : Hypothenar eminence is used to feel the heave.
Reference : Macleod’s manual of clinical examination.
40. Q 20. A child was born with congenital heart disease to a 35
year old lady taking Lithium for bipolar disease. Which of
these JVP changes is likely to be seen in the baby?
A: Absent x descent
B: Deep x descent
C: slow y descent
D: Absent y descent
41. Ans – A
Ebstein’s anomaly is associated with Tricuspid regurgitation
that leads to absent x-descent in JVP waveform.
Reference – Harrison’s Textbook of Internal Medicine
42. Q 21. This murmur is heard in left upper parasternal area. Which
of these conditions is most commonly implicated with it ?
A: AR
B: PR
C: PDA
D: ARF
46. Q 23. A 36 year old gentleman was brought to the hospital after an event of loss of
consciousness. There is no history of seizures, tongue bite, nausea or vomiting. His
brother died because of sudden cardiac death. ECG is as shown. Diagnosis?
A: Ventricular fibrillation
B: Anterior wall MI
C: Ventricular Tachycardia
from base of heart
D: Ventricular tachycardia
from apex
47. Answer: C
Monomorphic VT with positive concordance.
Ref: Harrison’s Internal Medicine – page no. 1757
48. Q 24. A 40 year old gentleman, a known case of HIV came to the opd
with periorbital puffiness and had urine protein of 5.5 gm/day. He was
prescribed appropriate medications 6 months ago. He is now brought
to you in the emergency department with sudden onset dyspnea and
persistently reducing SPO2. ECG findings are as shown below. What is
the further investigation of choice for his condition?
A: Chest Radiogram
B: CT Angiogram
C: MR Angiogram
D: Trans-esophageal echocardiogram
49. Answer: B
History suggestive of Nephrotic syndrome predisposing to
thromboembolism and ECG (S1Q3T3 pattern) suggestive of
pulmonary embolism.
Investigation of choice is CTA.
Ref: Harrison’s Internal Medicine
ECG Image -
50. *Q 25. A 26 year old lady was brought to the opd with dyspnoea on ten steps,
hemoptysis and pedal edema. She has a history of recurrent episodes of
upper respiratory tract infections in the past. On examination, respiratory
system examination is normal apart from some audible crepitations. S1 is
loud and and a mid-diastolic murmur with presystolic accentuation is heard
at the apex and there is an opening snap. Heart rate is 100 bpm and pulse
rate is 140 bpm. Echo shows a MVA of 0.8 cm2. What is the best treatment
for her?
A: Observation
B: Balloon Valvuloplasty
C: MV Repair
D: MV Replacement
51. Answer – D
There is a pulse deficit suggestive of Afib, predisposing the
patient for Left atrial thrombus. Hence, MV replacement is to be
considered
52. Q26. The structure marked in the image below is mainly made up
of ?
A: Elastin
B: Collagen
C: Muscle
D: Endothelial cells
56. Q.28 Which of these is a post-natal derivative of
Umbilical Vein?
A: Ligamentum arteriosus
B: Ligamentum venosum
C: Median umbilical ligament
D: Round ligament of liver
57. Ans: D
Ligamentum teres hepatis or Round ligament of Liver is a
post-natal derivative of Umbilical Vein.
Reference :
Langman's Medical Embryology
58. Q 29. Spot the Diagnosis
A: Supracardiac TAPVC
B: Infracardiac TAPVC
C: Endocardial Cushion Defect
D: Tetralogy of Fallot
59. Answer: A
Snowman/Figure of 8 appearance of Supracardiac TAPVC
Reference : O.P. Ghai Pediatrics
Image :
https://static.wixstatic.com/media/216aeb_34fd6c776c294
735b41b7231401f0225~mv2.png/v1/fill/w_220,h_248,al_c,l
g_1,q_90/216aeb_34fd6c776c294735b41b7231401f0225~
mv2.webp
60. Q.30. All of the following is true with respect to coronary blood flow
except:
A: It is 5% of the cardiac output
B: Flow is maximum during the diastole
C: Is under neural control
D: It is very short, rapid and phasic
61. Answer: C
Coronary Blood flow is not under neural control, it depends
upon the metabolic activity of the myocardium.
Ref: Guyton and Hall Textbook of Medical Physiology
