pmdc step 1 formative assessment day-5

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1. A 28-year young staff Nurse presents with progressive dyspnea in 2 nd trimester of her 1 st pregnancy. She had rheumatic fever at the age of 10 and her family physician advised long acting penicillin for rest of her life, which she refused. A thorough work-up revealed left atrial hypertrophy and raised pulmonary capillary wedge pressure. Which one of the following conditions is responsible for her presentation? A. Aortic Stenosis B. Mitral Stenosis C. Pulmonary Stenosis D. Aortic Regurgitation E. Tricuspid Regurgitation

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Page 1: Pmdc step 1 formative assessment day-5

1. A 28-year young staff Nurse presents with progressive dyspnea in 2nd

trimester of her 1st pregnancy. She had rheumatic fever at

the age of 10 and her family physician advised long acting penicillin for rest of her life, which she refused. A thorough work-up

revealed left atrial hypertrophy and raised pulmonary capillary wedge pressure. Which one of the following conditions is

responsible for her presentation?

A. Aortic Stenosis

B. Mitral Stenosis

C. Pulmonary Stenosis

D. Aortic Regurgitation

E. Tricuspid Regurgitation

Page 2: Pmdc step 1 formative assessment day-5

2. During OSPE, a final year medical student was asked to auscultate aortic valve. She will place her stethoscope in one of the

following intercostal spaces along sternal margin:

A. 2nd

on the right

B. 2nd

on the left

C. 3rd

on the right

D. 3rd

on the left

E. 4th

on the right

Page 3: Pmdc step 1 formative assessment day-5

3. A 45-year old hypertensive smoker presents in ER with severe left sided chest pain radiating to left shoulder. ECG revealed

ischemic changes in chest leads. Perfusion scan revealed impaired arterial supply to posterior third of interventricular septum.

Occlusion of one of the following arteries is most likely cause of his presentation:

A. Right marginal

B. Left coronary

C. Right coronary

D. Anterior interventricular

E. Posterior interventricular

Page 4: Pmdc step 1 formative assessment day-5

4. A patient of ischemic heart disease presented in ER with complete heart block. The most probable site of pathology is:

A. Crista terminalis

B. SA node

C. AV node

D. Bundle of His

E. Moderator band

Page 5: Pmdc step 1 formative assessment day-5

5. A 20-year old female in her third trimester of pregnancy presents with dyspnea and dysphagia. Barium Swallow revealed

esophageal compression in midthorax. One of the following structures is responsible for this esophageal compression:

A. Thoracic Aorta

B. Right Atrium

C. Right Ventricle

D. Left Atrium

E. Left Ventricle

Page 6: Pmdc step 1 formative assessment day-5

6. An 18-year old boy during a street fight suffered a stab wound in the left 5th

intercostal space in mid claviclular line. The structure

most likely be injured is:

A. Arch of aorta

B. Left auricle

C. Pulmonary trunk

D. Left ventricle

E. Left atrium

Page 7: Pmdc step 1 formative assessment day-5

7. A 4-year old boy presented in OPD with blue discoloration of lips and nails, and clubbing. Chest X-ray showed enlarged right

ventricle. These findings are consistent with which one of the following:

A. Atrial Septal defect

B. Patent ductus artreosus

C. Coarctation of aorta

D. Mitral valve regurgitation

E. Fallot’s tetrology

Page 8: Pmdc step 1 formative assessment day-5

8. Ayela Malik, a first year medical student was studying the blood supply of heart on a specimen. While studying the venous

drainage of heart, she found that one of the following veins did not open into the coronary sinus:

A. Great cardiac

B. Middle cardiac

C. Small cardiac

D. Anterior cardiac

E. Posterior vein of left ventricle

Page 9: Pmdc step 1 formative assessment day-5

9. The membranous interventricular septum during early cardiac development is derived from:

A. Septum primum

B. Septum secondum

C. Septum spurium

D. Endocardial cushions

E. Ventricular ingrowth

Page 10: Pmdc step 1 formative assessment day-5

10. A unique and distinguishing characteristic feature of cardiac muscle is the:

A. T tubule

B. Myofibril

C. Sarcoplasmic reticulum

D. Intercalated disk

E. Cross striations

Page 11: Pmdc step 1 formative assessment day-5

11. An adult male presented with H/O hypertension. On examination there was notable difference in blood pressure in upper and

lower limbs along with radio-femoral delay. These findings are typical of:

A. Atrial septal defect

B. Patent ductus arteriosus

C. Coarctation of aorta

D. Tetralogy of Fallot

E. Pulmonary stenosis

Page 12: Pmdc step 1 formative assessment day-5

12. A 45-year old hypertensive smoker presented in ER with severe left sided chest pain radiating to the left shoulder. ECG revealed

changes in all anterior leads. Perfusion scan revealed impaired arterial supply to anterior 2/3 of interventricular septum including

sternocostal surface of left ventricle. Occlusion of which one of the following arteries is most likely cause of this presentation:

A. Diagonal

B. Left coronary

C. Obtuse marginal

D. Circumflex

E. Left anterior descending

Page 13: Pmdc step 1 formative assessment day-5

13. Which of the following is the least likely part of the specialized conduction system of the heart?

A. SA node.

B. AV node.

C. Myocardial cells

D. Purkinje fibers

E. Bundle of His

Page 14: Pmdc step 1 formative assessment day-5

14. Which of the following vessels has the largest effect on total peripheral resistance?

A. Arteries

B. Arterioles

C. Veins.

D. Venules

E. Capillaries

Page 15: Pmdc step 1 formative assessment day-5

15. Atherosclerosis of the anterior interventricular branch of left coronary artery causes dysfunction of ventricular and papillary

muscles resulting in a systolic murmur. Where will you place the stethoscope to hear this murmur?

A. Left 5th ICS at the apex

B. Right 2nd ICS at sternal edge

C. Left 4th ICS at left sternal edge

D. Left 2nd ICS at sternal edge

E. Right 4th ICS at sternal edge

Page 16: Pmdc step 1 formative assessment day-5

16. The ventricles are completely depolarized during which phase of the ECG?

a. PR interval

b. QRS complex

c. QT interval

d. ST segment

e. T wave

Page 17: Pmdc step 1 formative assessment day-5

17. Which of the following ECG manifestation suggest intra-ventricular conduction block:

a. Inversion of P wave

b. Inversion of T wave

c. Prolongation of QRS

d. Prolongation of P-R interval

e. Prolongation of Q-T interval

Page 18: Pmdc step 1 formative assessment day-5

18. The strength of contraction of cardiac muscle depends to a great extent on the concentration of calcium ions in:

a. Sarcoplasmic reticulum

b. T- tubules

c. Extracellular fluid

d. Intracellular fluid

e. Rough endoplasmic reticulum

Page 19: Pmdc step 1 formative assessment day-5

19. One of the following structures is located in the posterior mediastinum and empties into the superior vena cava:

a. Azygos vein

b. Brachiocephalic artery.

c. Left brachiocephalic vein

d. Right brachiocephalic vein

e. Thoracic duct

Page 20: Pmdc step 1 formative assessment day-5

20. Ten minutes after undergoing liver biopsy, a patient develops moderately severe pain on the tip of right shoulder. Which one of

the following nerve mediates this pain

a. Axillary.

b. Intercostobrachial

c. Right phrenic

d. Right sympathetic chain.

e. Right vagus.

Page 21: Pmdc step 1 formative assessment day-5

21. Structure arching over root of right lung is

a. Azygos vein

b. Right phrenic nerve

c. Right vagus nerve.

d. Aortic arch.

e. Esophagus.

Page 22: Pmdc step 1 formative assessment day-5

22. Which one of the following costal cartilages does not articulate directly with the body of sternum

a. 1st

b. 2nd

c. 3rd

d. 4th

e. 5th

Page 23: Pmdc step 1 formative assessment day-5

23. Which structure accompanies esophagus while passing through esophageal opening of diaphragm

a. Rt phrenic nerve

b. Ant. and post. trunks of vagus

c. Left phrenic nerve

d. Greater splanchnic nerve

e. Subcostal nerve

Page 24: Pmdc step 1 formative assessment day-5

24. The muscle which primarily increases the anteroposterior diameter of thoracic cage is

a. Sternocleidomastoid

b. Scalenes anterior

c. Internal intercostal

d. External intercostal

e. Diaphragm

Page 25: Pmdc step 1 formative assessment day-5

25. Structures winding around the root of left bronchus is

a. Aortic arch

b. Azygos vein

c. Vagus nerve

d. Recurrent laryngeal nerve

e. Esophagus.

Page 26: Pmdc step 1 formative assessment day-5

26. While draining a pleural effusion, the reason behind putting the needle above the upper border of lower rib is to avoid injury to

a. Intercostal nerve

b. Intercostal artery

c. Intercostal vein

d. Neurovascular bundle

e. Long thoracic nerve.

Page 27: Pmdc step 1 formative assessment day-5

27. Pain felt by patient during thoracocentesis is carried along

a. Intercostal nerve

b. Greater splanchnic nerve

c. Phrenic nerve

d. Subcostal nerve

e. Vagal nerve

Page 28: Pmdc step 1 formative assessment day-5

28. A 20 year old female in her third trimester of pregnancy presents with dyspnea and dysphagia. Barium Swallow revealed

esophageal compression in midthorax. Which of following structures may be responsible for this esophageal compression?

a. Thoracic Aorta

b. Right Atrium

c. Right Ventricle

d. Left Atrium

e. Left Ventricle

Page 29: Pmdc step 1 formative assessment day-5

29. In Hemopericardium, extravasated blood collects between:

a. Fibrous & Parietal Pericardium

b. Parietal & Visceral Pericardium

c. Visceral Pericardium & Myocardium

d. Fibrous & Visceral Pericardium

e. Parietal pericardium & Myocardium

Page 30: Pmdc step 1 formative assessment day-5

30. A female inhales peanut while laughing. The foreign body would lodge most likely in segmental bronchus of one of the

followings Bronchopulmonary segments?

a. Right superior apical

b. Right inferior apical

c. Left superior apical

d. Left inferior apical

e. Left inferior lingular

Page 31: Pmdc step 1 formative assessment day-5

31. A middle aged man received iatrogenic injury to left phrenic nerve during operation for tumor at root of neck. His chest

radiograph will show the affected dome of diaphragm as:

a. Raised

b. Depressed

c. Flattened

d. Unchanged

e. Shifted