1.

Sgarbossa criteria in patient , with LBBB,SUGGESTING WITH ACUTE

MI, include just one of followings:
a. Wide QRS complex more than 0.14ms.
b. ST segment elevation >1mm in any lead concordant with QRS COMPLEX.
c. Deep S wave in lead V1/
d. ST depression in leads V5,V6.
e. M shape R wave in leads V1,V2.

2. Regarding systolic murmurs one of the following statements is false.

a. VSD causes pansystolic murmur.
b. Aortic stenosis produces ejection systolic murmur.
c. Atrial setal defect produces ejection systolic murmur.
d. Mitral valve prolapse produces click and systolic murmur.
e. Aortic regurge produces early systolic murmur.

3. A 65 years old male patient presents to the emergency room with epigastric
pain associated with nausea and vomiting , found to be hypotensive . what is
the first investigation to be done :
a. Random blood sugar.
b. Serum amylase.
c. ECG.
d. Abdominal ultrasound.
e. Abdominal X ray.

4. Regarding the JVP one of the following is true

a. It is low in cardiac tamponade.
b. It is raised in left ventricular failure.
c. Large v wave will occur in mitral regurgitation.
d. Cannon waves occur in complete heart block.
e. It is increases with inspiration.

5. A 72 years old woman admitted to the ICCU ,with an acute inferior

myocardial infarction, during ECG recording its noticed that heart rate is 35
bpm and blood pressure 100/60mmhg. The most appropriate immediate
action is:
a. Intravenous streptokinase.
b. Give intravenous atropine 1 mg.
c. Insert temporary pacemaker.
d. Keep monitoring the pulse and blood pressure.
e. Emergency DC shock.

6. angina and syncope are commonly associated with:

a. mitral stenosis.
b. Atrial fibrillation
c. Aortic stenosis
d. Pulmonary stenosis.
e. Aortic regurgitation.
7.A characteristic feature of fundus examination in infective endocarditis is :
a. hard exudates
b. silver wiring .
c. Roth spots.
D. Papillioedema.
e. congectival hemorrhage.

8. Which of the following conditions can lead to finger clubbing:

a. Mitral stenosis
b. Infective endocarditis.
c. Aortic regurgitation.
d. Pulmonary stenosis.
e. Dilated cardiomyopathy.

9. All of the following are considered as mechanical complication of

myocardial infarction , except:
a. Rupture papillary muscle.
b. Rupture septum.
c. Pseudoaneurysm.
d. True aneurysm.
e. Rupture free wall.(tamponade ).

10. 30 years old male patient , admitted with chest pain , worse on lying flat ,he
claims that he has had flu like illness 2 weeks ago , by auscultation he has
friction rib . which one of the following ECG changes is most characteristic
for this disorder:
a. ST segment depression.
b. PR prolongation.
c. PR depression.
d. Peaked , tall T wave.
e. Prominent U wave.

11. IN a patient with long standing history of mitral stenosis , who developed
recently atrial fibrillation , all of the following auscultatory finding can
present , except :
a. Irregular heart sounds.
b. Accentuated 1st heart sound .
c. Middiastolic murmur.
d. Presystolic accentuation of the murmur.
e. Opining snap.

12. The most common cause of aortic stenosis in elderly patient is:
a. Rheumatic heart disease.
b. Degenerative changes of the valve.
c. Ischemic heart disease.
d. Congenital stenosis.
e. Inflammatory.
13. The most prominent feature of jvp in a patient with complete heart block is:
a. Absent a wave .
b. Dominant v wave .
c. Giant a wave .
d. Cannon a wave.
e. Severely congested veins.

14. In a patient with cardiac tamponade all of the following can be seen except:
a. Congested neck veins.
b. Muffled heart sounds.
c. Paradoxic pulse.
d. Pulsus alternans.
e. High BP.

15. All of the following are features of severe aortic regurge except:
a. DE MUSE sign.
b. Corrigan carotid pulsations.
c. Capillary pulsation.
d. Pistol shoot.
e. Narrow pulse pressure.

16. 75 years old male patient, presented to emergency room, with dyspnea ,
orthopnea, sweating , high BP , by auscultation his lung fields full of
crepitations, and wheezy all of the following drugs can be used as
emergency management for this patient , except:
a. Verapamil.
b. Morphine.
c. Frusemide.
d. Nitroglycerin.
e. Aminophilline.

17. 76 years old male patient , admitted to emergency room , with retrosternal
burning chest pain , sweating , vomiting , his 12 leads ECG reviled ST
segment elevation in leads V1-V4, which of the following is the most
accurate diagnosis, and which coronary artery ,is occluded.:
a. Acute non ST elevation anteroseptal MI , LAD IS occluded.
b. Acute inferior MI , right coronary artery.
c. Acute inferior ST elevation MI , LAD.
d. Acute anteroseptal ST elevation MI , LAD.
e. Acute pulmonary embolism.

18. 70 years old female patient , admitted to ICCU , with acute anteroseptal MI
of one hour duration, which of the following conditions is considered as
absolute contraindication for streptokinase administration.:
a. High BP .
b. Active peptic ulcer disease.
c. Prolonged CPR.
d. Surgery one year ago.
e. Brain hemorrhage 6 months ago.
 19. Which of the following is not a life threatening cause of chest pain.
a. Acute MI.
b. Dissecting aortic aneurysm.
c. Pulmonary embolism.
d. Dry Pericarditis.
e. Tension pneumothorax.

20. All of the following drugs are evidence based class A, in acute MI , except:
a. Aspirin.
b. Digoxin.
c. Heparin .
d. B. blockers.
e. Statins.

21. All of the following are features of left ventricular hypertrophy on ECG,
except:
a. Left axis deviation.
b. R wave in lead avl > 13mm.
c. R wave in V 5 plus S wave in V2 > 35mm.
d. R WAVE IN LEAD V 1 > 7mm.
e. R wave in lead V 5 > 25mm.

22. All of the following are considered types of pericarditis , except:

a. Dry pericarditis.
b. Constrictive pericarditis.
c. Effusive pericarditis.
d. Adhesive pericarditis.
e. Restrictive pericarditis.

23. 50years male pt , diabetic , hypertensive , admitted to ICCU,with

retrosternal chest pain,sweating , his 12 lead ECG revieled ST segment
elevation in leads II , III , AVF , with HR 40bpm , BP 70/40 , HIS JVP –is raised
, his lung fields are clear .
This patient diagnosis is .
a)acute anterior MI .
b) Acute inferior MI , complicated by RV infraction, complete heart
block,hypovolemic shock.
.c)Acute inferior MI , complicated by left ventricular failure
.d) Acute non ST elevation MI.
e) Unstable angina.

24- the mainstay in the management of this patient is:

a) Clexane , Aspirin.
b)IV lasix.
c) IV dopamine.
d) IV fluid , atropine.
e) ACE inhibition and B blockers..
25- 73 years old male patient admitted to ICCU with chest pain , heaviness in
character, sweating , vomiting , his ECG – showed ST elevation in leads I –
AVL V1----V6 , 3 hours later the patient started to C/O dyspnea , orthopnea
chest –full of crepitation, BP 70/30 mmHg , this patient diagnosis is:
a) Acute anterolateral MI , complicated by LVF , Killip class II .
b) Acute anterolateral MI complicated by cardiac tamponade .
c) Acute anterolateral MI complicated by LVF , Killip class IV.
d) Acute anterior MI , complicated by pulmonary embolism.
e)Acute anterolateral MI complicated by RV infarction.

26- The mainstay in this patient management should include.

a)Streptokinase , IV fluids , Aspirin.
b) Streptokinase , ACE , inhibitors , B-blocker.
c) IV dopamine , possible inraaortic balloon.
d) clexane , fluid, B block.
e) B.blockers aspirin , nitroglycerin.

27- 32 years old female patient , complaint of localized chest pain, fever 2 weeks
after acute viral flu like illness and she diagnosed to have dry pericarditis, her
ECG findings characterized by all of the the following, except:
a)concave upward ST elevation
b) diffuse ST elevation
c)PR depression.
d)Tall R wave V1---V2.
e) late dy namic changes..

28 -75 years old female patient , diabetic , hypertensive , and known to have
dyslipidemia , she was maintained on atenolol , B-Aspirin and atorvastatin , she
was admitted to ICCU with unstable angina , her 12 leads ECG pre admission
showed ST depression V1---V4 , she has continuous angina despite treatment ,
here cardiac enzymes - normal , this patient T I MI score is:
a) 1
b) 2
c) 5.
d) 8.
e) 9.

29- 50 years old female patient diagnosed as DCM , all of the following are
features of dilated cardiomyopathy by Echo Doppler except:
a) Dilated all chambers.
b) global hypokinesia.
c) low EF.
d) pulmonary regurge.
e) MR , TR.

30-Optimal medical therapy in the treatment of congestive heart failure, include

all of the following except:
a) Frusemide.
B ) Aldactone.
c) ACE inhibitors..
d) b. blockers.
e) Aspirin.

31 -all of the following are echo findings in patient with HCOM except:
a) Asymmetrical septal hypertrophy ( ASH).
B) Systolic anterior motion ( SAM ).
c) low EF .
d) MR.
e) obstruction of left ventricular out flow tract( high gradient)

32-Indication for ICD implantation in a patient with HOCM include all of the
following except:
a) Family history of sudden cardiac death.
b) resuscitated VT of VF.
C)VT on Holter monitor.
d) chest pain on effort.
e) Peak pressure drop during exercise.

33- 45 years old male patient hypertensive on ACE inhibition admitted to

cardiology department with palpitation started 2 weeks ago , his ECG showed
AF with fast HR , his BP was 130/80 , the best management for this patient is :
a) DC-Shock synchronized 200J.
B) DC-Shock as synchronized 150J.
c) Rate control and Rhythm control by amiodarone infusion.
d)Rate control, warfarin for 3 weeks, then trans esophageal echo.
e) Rate control and aspirin for life.

34- All of the following can be used in management of HOCM except:

a) propronolol.
b) Verapmil.
c) ICD.
d) Amiodarone.
e) Digoxin.

35- 45 years old male patient , admitted to emergency room , with Wide
complex irregular tachycardia ,his deferential diagnosis include all of the
following except:
a) AF , with LBBB.
b) AF , with RBBB.
c) AF with aberrant conduction.
d) ventricular tachycardia .
e) AF . with WPW syndrome

36- the most common cause of MS is :

a) degenerative.
b) Rheumatic.
c) congenital
d) collagen D.
e) Inflammatory
37-paradoxical pulse can be seen in which of the following :
a)hypertensive encephalopathy.
b)acute MI .
c)Massive pulmonary embolism.
d)pulmonary stenosis.
e)Dilated cardiomyopathy.

38- 75 years old male patient , complaining of dizziness , dyspnea on effort by

examination , he has ejection systolic murmur at 2d Rt intercostal space ,
radiating, to the carotids all of the following can be heart by auscultation except:
a) Muffled 2d heart sound.
b) Mid systolic murmur at the aortic area.
c)accentuated 2d heart sound.
d)S4.
e)Ejection systolic click.

39-All of the following are the auscultatory findings in a patient with ASD ,
except:
a)Ejection systolic murmur over pulmonary area.
b)Wide splitting of S2.
c)Fixed spitting of S2.
d)Ejection systolic murmur, due to shunt through atrial septal defect.
e)The murmur in not very loud.

40- When you measure the JVP of a patient with congestive heart failure , it was
4 cm above sternal angel , which calculated JVP has this patient :
a)12cm.
b)10cm.
c)9cm.
d)7cm.
e)6cm.

41- 75 years old male patient , known to have , IHD , ischemic cariomyopathy,
presented with palpitation , dizziness , dyspnea , profuse sweating , his 12 leads
ECG –wide complex regular tachycardia , HR 220 bpm , BP 70/30 , the best
management is
a)Verapamil IV.
b)DC shock 50J assynchronized.
c)DC shock200 J synchronized.
d)Amiodarone IV.
e)Lidocaine IV.

42-all of the followings drugs , can cause prolongation of QT interval , except:

a) amiodarone.
b) digoxin.
C) Quinidin.
d) erythromycin.
e) antihistamines.
43. 32 YEARS OLD FEMALE PATIENT , ADMITTED TO
CARDIOLOGY DEPARTMENT WITH PULMONARY OEDEMA , BY
EXAMINATION SHE FOUND TO HAVE MITRAL STENOSIS , BY
ECHO DOPPLER : THERE IS MITRAL STENOSIS , VALVE AREA 0.9 ,
PEAK PRESSURE GRADIENT 30 MMHG , THE LEAFLETS ARE
PLIABLE , SEVERE MITRAL REGURGE, , THE BEST
MANEGEMENT FOR THIS PT IS :
A. MEDICAL TREATMENT.
B. MITRAL VALVE REPLACEMENT .
C. OPEN COMMISSURETOMY.
D. BALLOON VALVOPLASTY.
E. NO TREATMENT AT THIS MOMENT.

44. A28 YEARS OLD FEMALE PATIENT, WITH A HISTORY OF

RHEUMATIC HEART DISEASE, ALL OF THE FOLLOWINGS ARE
AUSCULLTATORY FINDINGS IN MITRAL STENOSIS EXCEPT:
A. LOUD S1 .
B. MIDDIASTOLIC MURMUR.
C. WIDE SPLIT 2d HEART SOUND.
D. PRESYSTOLIC ACCENTUATION OF THE MURMUR.
E. OPENING SNAP.

45. A 50 YEARS OLD MALE PATIENT , ADMITTED TO ICCU ,WITH

MASSIVE ANTERIOR MI, COMPLICATED by RUPTURE OF THE FREE
WALL , ALL OF THE FOLLOWING , ARE SIGNS OF CARDIAC
TAMPONADE , EXCEPT:
A. CONGESTED NECK VEINS .
B. MUFFELED HEART SOUNDS .
C. WATER HUMER PULSE.
D. HYPOTENSION.
E. PARADOXICAL PULSE.

46. EARLY COMPLICATIONS OF MYOCARDIAL INFARCTION ,

INCLUDE ALL OF THE FOLLOWING EXCEPT:
A. TRUE LV ANEURYSM.
B . VENTRICULAR TACHYCARDIA.
C. VF.
D. LEFT VENTRICULAR FAILURE.
E. EARLY PERICARDITIS.

47 . 35 YEARS OLD FEMALE PATIENT , PRESENTED WITH

COMPLAINT OF DYSPNEA , ORTHOPNEA, LL OEDEMA, THESE
SYMPTOMS STARTED FEW WEEKS AFTER DELEVARY, BY
EXAMINATION SHE HAS IRRIGULARY IRRIGULAR PULSE , RAISED
JVP, CHEST X RAY , SHOWED CARDIOMEGALY AND CONGESTED
LUNGS, ECG – AF. ECHODOPPLER – GLOBAL HYPOKINESIA, EF 18%,
MR, TR, THIS PATIENT DIAGNOSIS AND MANEGMENT IS :
A.IDIOPATHIC DILATED CARIOMYOPATHY, FRUSEMIDE, B BLOCKERS ,
ASPIRIN.
B. PERIPARTIUM CARIOMYOPATHY, FRUSEMIDE , ALDACTONE,
DIGOXIN, RAMIPRIL WARFARIN.
C. PERIPARTIUM CMP, FRUSEMIDE, VERAPAMIL ,ASPIRIN.
D. IHD, OLD MI.
E. POST VIRAL CMP , CRT D IMPLANTATION.

48. ICD IMPLANTATION, IS INDICATED FOR ALL THESE

PATIENTS EXCEPT:
A. HOCM,WITH FAMILY HISTORY OF SUDDEN CARDIAC
DEATH.
B. DCM , WITH RECCURENT VT, VF.
C. VF, DUE TO HYPERKALEMIA,WHICH WAS CORRECTED.
D. HOCH, WITH SUSTAINED VT.
E. RECURENT VT, VF OF UNKNOWN CAUSE.

49. 68 YEARS OLD FEMALE PATIENT , ADMITTED TO ICCU

WITH, PROLONGED ANGINAL PAIN , SWEATING, HIS 12
LEADS ECG, SHOWED ST SEGMENT DEPRESSION IN
ANTEROSEPTAL LEADS, CARDIAC ENZYMES, INCLUDING
TROPONIN WAS HIGH, THIS PATIENT DIAGNOSIS AND
TREATMENT IS :
A. ACUTE ST ELEVATION MI, GIVE STREPTOKINASE.
B. NON ST ELEVATION MI, ASPIRIN 300 MG, CLOPIDOGREL
300MG, CLEXANE 2MG /KG/ DAY, B BLOCKERS,STATINS.
C. UNSTABLE ANGINA, ASPIRIN 300 MG , CLOPEDOGREL 300MG ,
CLEXANE AND STATINS.
D. NON ST ELEVATION MI, STREPTOKINASE.
E. DISSECTING AORTIC ANEURYSM, URGENT SURGERY.

50. SIGNS OF RESTRICIVE CADIOMYOPATHY BY ECHO

DOPPLER , INCLUDE ALL OF THE FOLLOWING , EXCEPT:
A. DILATED BOTH ATREA.
B. RIGID WALLS.
C. RESTRECTIVE PATTERN DIASTOLIC DYSFUNCTION.
D, MR , TR.
E . VERY LOW EJECTION FRACTION.
 ANS:
1. B
2. E
3. C
4. D
5. B
6.C
7.C.
8.B
9.D
10. C
11.D
12.B
13.D
14.E
15.E
16.A
17.D
18.E
19.D
20.B
21.D
22.E
23.B
24.D
25.C
26.C
27.D
28.C
29.D
30.E
31.C
32.D
33.D
34.E
35.D
36.B
37.C
38.C
39.D
40.C
41.C
42.B
43.B
44.C
45.C
46.A
47.B
48.C
49.B
50.E