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1. ข้อสอบ cvs NL กรี้ดดดดด!!!!
1.a 4 year girl is admitted to the hospital with high fever . Staphylococcus aureus is isolated from her blood culture and
antibiotic therapies is initited. A loud, hash murmur is heard on auscultation. A chest radiograph shows prominent
pulmonary arteries. Echocardiography shows all the valves to be normal. Which congenital heart disease most likely
explains these finding ?
1. atrial septal defect 2. TOF
3. coarctation of aorta 4. PDA 5. aortic atresia
2.a 42 year old is admitted to the hospital with an inability to speak. The patient’s personal history reveals that she has
experienced hoarseness for the past month. A chest radiograph reveals a mass at aorticopulmonary window. Which of
following nerves is most likely compressed?
1. vagus
2. phrenic
3. Lt recurrent laryngeal
4. Rt recurrent laryngeal
5. Greater thoracic splanchnic
3. A 68-year-old male patient in the cardiology ward complains at each mealtime of difficulty in swallowing
(dysphagia). Radiography study reveal significant cardiac hypertrophy. A barium swallow,followed by radiographic
examination of the thorax, reveals esophageal constriction directly posterior to the heart. Which of following is the most
likely cause of the patient’s dysphagia?
1. mitral valve stenosis
2. pulmonary valve stenosis
3. Regurgitation of the aorta
4. Anterior interventricular artery occlusion
5. Posterior interventricular artery occlusion

2. 4. Atherosclerosis is associated with numerous well-known risk factor, such as age, smoking, diabetes, hyperlipidemia,
and a family history of atherosclerosis. LDL cholesterol is believed to be a key factor in the pathway through which
hyperlipidemia cause atherosclerosis. What is most likely the first step in the pathogenesis of atherosclerosis caused by
hyperlipidemia?
1. endothelial dysfunction
2. Foam cell formation
3. LDL cholesterol oxidation
4. Monocyte activation
5. Plaque formation
5.ผู้ชายอายุ20 ปี เป็นไข้มา 2 วัน มีอาการเจ็บหน้าอก และอาการของหัวใจล้มเหลว ต่อมาเสียชีวิต ผล autopsy
พบว่าหัวใจมี lymphocyte จานวนมากกระจายแทรกอยู่ในกล้ามเนื้อทั่วๆไป พยาธิสภาพดังกล่าวเกิดจากไวรัสชนิดใด
1. adenovirus
2. Influenza virus
3. EBV
4. Coxsackie B virus
5. CMV
6.A 25-year old pregnant woman goes to her gynecologist for her 36 week check up. She complain of light-headedness
when she lies down in bed at night. In the office her blood pressure is 120/70 mmHg while sitting upright and 90/50
mmHg while lying supine. Which of the following is the most likely cause of this hypotension?
1. Anemia
2. Cardiogenic shock
3. IVC compression
4. Third space of fluid
5. Vasodilation
7. ช่องระหว่าง aorta กับ pulmonary trunk ที่สามารถสอดนิ้วได้คือ
1. Oblique pericardial sinus
2. Transverse pericardial sinus
3. Anterior mediasternum
4. Medial mediasternum

3. 8.ข้อใดต่อไปนี้ผิดเกี่ยวกับยาขยายหลอดเลือดและผลข้างเคียง
1. Diazoxide อาจทาให้เกิดภาวะกลูโคสในเลือดสูง
2. Hydralazine อาจทาให้เกิด lupus-like syndrome
3. Minoxidil อาจทาให้เกิดขนดก hypertrichosis
4. Clonidine อาจทาให้เกิด rebound hypertension ถ้าหยุดยากะทันหัน
5. Reserpine อาจทาให้เกิดอาการท้องผูก constipation
9. ข้อใดต่อไปนี้กล่าวถูกต้องเกี่ยวกับผลทางเภสัชวิทยาของ captopril และ losartan
1. ยาทั้งสองปิดกั้น angiotensin II receptor
2. ยาทั้งสองยับยั้ง ACE
3. ยาทั้งสองทาให้เกิด hyperkalemia
4. Losartan ยับยั้งการทาลาย bradykinin แต่ captropril ไม่มีผล
5. ห้ามใช้captopril ในสตรีมีครรภ์แต่ใช้losartan ในสตรีมีครรภ์ได้
10. A 17- year-old male high school athlete with no significant medical history. suddenly collapsed
during a football practice and could not be resuscitated. At autopsy, the heart is enlarged and there
is myocyte disarray on histologic evalucation. what is the most likely diagnosis?
a. amyloid heart disease
b. glycogen storage disease
c. hypertrophic cardiomyopathy
d. PDA
e. viral myocarditis
11. A 55-year-old woman had left atrial fibrillation that responded poorly to medical treatment. she
eventually suffered a massive stroke and died a few days later. The autopsy revealed marked left
atrial dilatation and hypertrophy and a stenotic mitral valve. These findings would be best explained
if she had a past history of
a. alcoholism
b. amyloidosis
c. chronic lung disease
d. mucinous adenocarcinoma
e. rheumatic fever

4. Worldwide, the most common cause of subacute infective endocarditis is
a. Candida albicans
b. immune reaction to bacterial toxins
c. Staphylococcus aureus
d. Streptococcus pneumoniae
e. Streptococcus viridans
12. A 32-year-old woman has the onset of fever and chills associated with sublingual, linear, dark-red
streaks, small nodular hemorrhages in the palms and soles, and tender nodules of the finger pads. As
a child, she had streptococcal sore throat followed by a three-week long episode of fever, joint pain,
and a skin rash. The current condition in this patient is most likely
a. bacterial endocarditis
b. floppy mitral valve
c. infiltrative cardiomyopathy
d. systemic lupus erythematosus
e. tuberculosis
13.

5. 14.
15.

6. 16.
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7. 18.
14 16
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8. 20.