For Questions Number 1-5, Refer To Scenario Below

For questions number 1-5, refer to scenario below:
A 62-year-old man came to emergenct room last night with chief complaint severe left chest
pain. After history taking, physical exam, lab tests and ECG, he was dx as having Myocardial
infarction. The blood test revealed :
Total cholesterol: 285 mg/dL

HDL: 20 mg/dL
LDL: 185 mg/dL
Triglyceride: 235 mg/dL
CKMB 28 IU
He was hospitalized and given Atorvastatin 20mg once daily, low carbo low fat diet.
1.
Which blood test result is the most likely to determine his dx?
A. Cholesterol total
B. HDL
C. LDL
D. Triglyceride
E. CKMB
2. What is the cause of increasing CKMB level?
A. The undamaged part of the heart produces some enzymes to compensate
the dysfx of the damaged part
B. Increasing this enzymes synthesis is needed to maintain the undamaged
heart muscle metabolism optimally
C. The damaged part of the heart releases the intracellularly enzymes into the
blood stream
D. The growth factors stimulate this enzymes production in order to repair the
damaged part of the heart
E. Heart dysfx causes physical inactivity that leads to less degradation of this
enzymes
3. Tha patient must increase the HDL level bcoz HDL facilitates cholesterol uptake by
the liver. This uptake can be done bcoz liver is an organ that:
A. Has ability to synthesize bile acid using cholesterol as its precursor
B. Secretes HDL cholesterol into the bile duct
C. Filtrates cholesterol from portal venous blood that enter to the liver
D. Has receptors that suite to HDL apoprotein
E. Can synthesize endogen cholesterol
4. In atherogenesis process, which of the cells below are mostly responsible for
appearance of more ECM inside the atheroma plaque?
A. Smooth muscle celss
B. Foam cells
C. PMN cells
D. Macrophages
E. Endothelial cells
5. Atorvastatin is given to reduce cholesterol level by:
A. Inhibits HMG CoA synthetase
B. Inhibits HMG CoA reductase
C. Stimulates cholesterol degradation
D. Stimulates bile acids synthesis from cholesterol
E. Stimulates cholesterol excretion into the bile
6. Human tissues use cholesterol to build cell membranes and also steroid hormone
synthesis. Which of the following lipoprotein below that transport cholesterol to the
tissue?
A. HDL
B. LDL
C. IDL
D. VLDL
E. Chylomicron
For questions no 7-12, refer to scenario below:
Mr. A, 52 y/o man was hospitalized with left chest pain as his chief complaint and was dx as
having a myocardial infarction. His lab exam revealed high blood cholesterol level, high
blood triglyceride level, high LDL level, and low HDL level.
7. This disease was basically caused by atherosclerosis of his heart blood vessel. Which
of these options below is the first step that initiates the development of the
atherosclerosis?
A. Oxidation of LDL
B. Endothelial injury
C. Foam cell formation
D. Fibrin clot formation
E. Monocyte recruitment
8. Foam cell formation also played an important role in developing this condition. This
formatio was mostly caused by:
A. Fusion of macrophages
B. Uptake of cholesterol through LDL receptors
C. Uptake of cholesterol thru scavenger receptors
D. Increase of cholesterol synthesis inside the macrophages
E. Increase of ECM synthesis inside the macrophages
9. The pain was most probably caused by:
A. Lack of ATP
B. Lack of oxygen
C. Accumulation of lactate
D. Cardiac muscle cell lysis
E. Cardiac muscle cell spasm
10. The most possible factor that lead to
A. His high cholesterol level
B. His high triglyceride level
C. His high LDL level
D. His low HDL level
E. His old age
Mr. A condition was:
11. Mr. As blood CK-MB level might be increased, bcoz:

A. Lack of oxygen decreased the CKMB degradation
B. Increased of CKMB synthesis by cardiac muscle cells
C. Increased CKMB synthesis by skeletal muscle cells
D. Liver hypoperfusion decreased the CKMB degradation
E. Cardiac muscle cells lysis released the cell content, including CKMB, into the
blood circulation
12. If you measured the CKMB level 10hrs and 24hrs after Mr. A felt the pain, what was
the most possible result?
A. 10hrs and 24hrs CKMB level were both normal
B. 10hrs and 24hrs CKMB were both increased
C. 10hrs CKMB level was normal but 24hrs CKMB level increased
D. 10hrs CKMB level was increased but 24hrs CKMB level was back to normal
E. 10hrs CKMBlevel was increased but 24hrs CKMB level was less than normal
13. The thorax is the superior part of the trunk between the neck and abdomen. The
thoracic skeleton takes the form of a domed birdcage, the thoracic cage.
Which of the following structures is most likely osteocartilaginous thoracic cage?
A. Clavicles
B. Scapulae
C. Diaphragm
D. Pectoral girdle
E. Costal cartilage
14.Thoracic cavity have the shape of a truncated cone, being narrowest superiorly, with the
circumference increasing inferiorly, reaching its maximum at the junction with the
abdominal portion of the trunk. The thoracic cavity is divided into three major spaces.
Which of the following structures is most likely thoracic cavity?
A. Diaphragm
B. Esophagus
C. Sternal angle
D. Costal cartilages
E. Transverse thoracic plane
15. Ribs are curved, flat bones that form most of the thoracic cage. They are remarkably
light in weight yet highly resilient. Each rib has a spongy interior containing bone marrow
(hematopoietic tissue), which forms blood cells.
The typical ribs have the following components, EXCEPT:
A. Head
B. Neck
C. Shaft
D. Lamina
E. Tubercle
16. Some muscles attached to and/or covering the thoracic cage are primarily involved in
serving other regions. Several muscles extend from the thoracic cage to bones of the upper
limb. Similarly, some muscles of the anterolateral abdominal wall, back and the neck
muscles have attachments to the thoracic cage.
Which of the following are muscles of the thoracic wall?
A. Pectoralis major
B. Pectoralis minor
C. Scalene muscles
D. Seratus anterior
E. Serratus porterior
17. These muscles occupy the intercostal space from the tubercles of the ribs posteriorly to
the costochondral junctions anteriorly. These muscles run inferioanteriorly from the rib
above to the rib below. Each muscle attaches superiorly to the inferior border of the rib
above
and
inferiorly
to
the
superior
border
of
the
rib
below.
Which of the following muscles is correct?
A. External intercostal
B. Internal intercostal
C. Innermost intercostal
D. Levator costarum
E. Transverse thoracic
18. A group of medical students were asked to observe on an open thorax surgery. After
removing the sternum, the surgeon come upon an organ slightly larger than a clenched fist,
lies in the middle of it.
Which of the following statement is correct regarding the organ?
A. It lies obliquely in the middle mediastinum
B. Its base is directed anteriorly and slightly posteriorly
C. Its apex is directed posteriorly and slightly inferiorly
D. Two-thirds of its mass lies to the right of the midline of the sternum
E. It lies bare without fibrous cover on its outer surface
19. Which one is correct statement about the membranes that cover the said organ above?
A. The pericardium is an open sac composed of two layers
B. The epicardium is a fibroserous membrane that covers the heart and the roof og
great vessels
C. The tough external layer, the serous pericardium is in continuation to central tendon
of diaphragm
D. The internal surface of pericardium is glistening with fibrous membrane
E. The fibrous epicardium is composed mainly of mesothelium, a single layer of cells
For Q number 20 to 22, refer to scenario below:
A 56-year-old man with a history of hypertension came to the ER complaining sustained
chest pain. The pain felt dull on his left chest and felt to his left neck as well, he felt it for the
last 1 hour. He said he had chest pain before but dissipates within 10 minutes. You were
told to perform ECG examination and found ST segment elevation on lead V4-V6
20. Which arterial occlusion is most possible cause of his symptoms?
A. The SA nodal branch of the left coronary artery
B. The AV nodal branch of the right coronary artery
C. The marginal branch of the right coronary artery
D. The anterior descending branch of the left coronary artery
E. The circumflex branch of the left coronary artery

21. Which of the vessel below is supplying venous blood from the affected area?
A. Several marginal veins emptying into great cardiac vein
B. The anterior ascending vein into left coronary vein
C. The middle cardiac vein
D. The anterior coronary vein
E. The small cardiac vein
22. What is the correct sentence regarding the patients pain?
A. The heart is sensitive to touch, cutting, cold and heat
B. Accumulation of metabolic products stimulate pain endings in myocardium
C. Afferent pain fibers runs laterally in the left and anterior cervical branches of
symphathetic trunk
D. The axons of these primary sensory neurons enters the spinal cord segments C5-C8
on the left side
E. A reffered pain is a phenomenon where the pain is felt because the noxious stimuli is
not strong enough
For Q number 23 to 27, refer to image given below:
23. What number is pointing to atrioventicular valves?

A. Number 11
B. Number 13
C. Number 5
D. Number 9
E. Number 1
24. Where would you find the trabeculae carnae?
A. Number 11
B. Number 12
C. Number 13
D. Number 2
E. Number 9
25. What is the function of the structure pointed by number 5?
A. To pump oxygenated blood to the whole body
B. To receive deoxygenated blood from the whole body
C. To prevent backflow to atrium during diastole
D. To prevent backflow to ventricle during systole
E. To deliver blood to the aorta
26. What is the correct explanation about structure pointed by number 9 ?

A. It forms most of the apex of the heart
B.The valveness pairs of right and left pulmonary veins enter its smooth-wall chamber
C. The tubular auricle with trabeculaecarnae forms the inferior part of its border
D. It has slightly thinner wall compared to its right counterpart
E. It is separated with the left ventricle by tricuspid valve
27. What is the correct sentence regarding structure pointed by number 6?
A. Receives blood from superior and inferior vena cava
B. Deliver blood to the aorta
C. Its blood drain to great cardiac vein
D. Has pectinate muscles on its wall
E. Supplied mainly by the right coronary artery
28. A 49 year old main complained of palpitation. He had history of hypertension since 4
years ago. On thoracic examination, you found the point of maximal impulse is at the level
of 5th intercostal space 2 cm to the left of the midclavicular line. Which part was being
actually assessed in the examination ?
A. Apex of the heart
B. Superior vena cava
C. Right ventricle
D. SA node
E. The base of the heart
29. A 55 year old woman was brought to the emrgency room. she complained chest pain for
the ast hour. The pain was dull and it won't dissipate even after she rested. She also
complained breathing difficulty and excessive sweating. She has no history of having chest
pain, but usually lasted for 10 minutes then dissipates after taking rest. Her ECG record
shows sinus rythm with ST elevation in lead I, aVL. V4-V6. She was diagnosed with acute
myocardial infarct. Where is her electrical impulse originated ?
30. A. From the node in junction of the superior vena cava and the right atrium
B. From the node located in posteroinferior region of interatrial septum
C. From the walls of the ventricles
D. From the junction between atrial and ventricular myocardium
E. From the fibers that penetrated deep into subendocardial layer in ventricles
31. The pericardium is an enclosed sac covering the heart. During development, it has
formed reflections. Which of the sentences below is TRUE ?
A. The transverse sinus is found at the anterior surface of the heart
B. The oblique sinus connects the anterior and posterior part of the heart
C. The tranverse sinus separates the veins and arteries
D. The oblique sinus accessible by sliding one finger between the venous and arterial outlet
E. The oblique and tranverse sinus has a passage that connects them
32. A 2 year old girl came to the clinic with swelling in the leg and abdomen as a chief
complaint. her mother explained that at 8 month old, she was taken to a doctor because of
blusih lips and fingertips. She was diagnosed TOF. her parents refused operative treatment
then, and had chosen the conservative treatment. Where would you look for murmur?
A. At the elft parasternal line 3rd or 4th ICS
B. At the left midclavicular line, 5th ICS level
C. At the right parasternal line, 2nd ICS level
D. At the left parasternal line, 2nd ICS level
E. At the right midclavicular line, 5th ICS level
33. A 34 year old man was brought to the outpatient clinic complaining of shortness of
breath. He had shortness of breath even during rest since 3 days ago. He uses 3 pillows to
sleep, urinating more frequently than usuals especially at night. He noticed his feet become
swollen. He had history of rheumatic fever in his childhood, but didngt comply after the
initial visit. His physical exam shows T: 100/70, RR : 34x/min, PR: 112 x/min , JVP 5+3
cmH2O, PMI was found in the 5th intercostals space at the left midvlavicular line, S3 gallop,
holosystolic murmur at the apex, bilateral rales at the basal area in lung auscultation. Which
structure isrelated to his murmur ?
A. The semilunar aortic leaflets

B. The double leaflet mitral valves
C. Chordae tendinae
D. Papillary muscles
E. The anterior and posterior cusps of tricuspid valve
34. After birth, when lungs circulation begins and obliterating the the oval foramen and
separating the right and left atria. Which of the following is the most likely caused of
obliterating the oval foramen after birth?
A. Premature closure of the oval foramen
B. the valve of the oval foramen is pressed against the septum primum
C. Excessive cell death andresorption of the septum primum
D. Pressure in the left atrium increases and the valve of the oval foramen is pressed against
the septum secundum\
E. Extensions of the superior and inferior endocardial cushions grow along the edge of the
septum primum, closing the foramen ovals
35. A 9 year old boy present with complaints of numbness and tingling in both feet.
Examintaion reveals no pulse in the femoral artery, increased blood pressure in the arteries
of the upper extremities and enlarged intercostal veins. Which of the following congenital
heart diseases should be suspected?
A. Patent ductus arteriousus
B. Pre ductal coarctation of the aorta
C. Post ductal coarctation of the aorta
D. Double aortic arch
E. TOF
36. A 6 week old infant has a pulmonary infundibular stenosis, a large defect of the
interventricular septum and the right aorta arises directly above the septal defect from both
ventricular cavities and hypertrophy of the right ventricular wakk. The infant is cyanosis.
Which of the following congenita; heart disease is the most likely to be present ?
A. Patent ductus arteriosus
B. Ventricular septal defect
C. Coaarctaiom of the aorta
D. Dextrocardia
E. Tetrallogy of fallot
37. During the fifth week, pairs of opposing ridges appear in the truncus. These
ridges twist around each other, foreshadowing the spiral course of the future septum.
After complete fusion, the ridges form the aorticopulmonary septum, dividing the
truncus into an aortic and a pulmonary channel. When the conotruncal ridges fail to
fuse and to descend toward the ventricles, which of the following congenital heart
diseases is the most likely to be present?
A.
B.
C.
D.
E.
Transposition of the great vessels

Ventricular septal defect
TOF
PDA
Persistent Truncus Arteriosus
38. The aortic arches and the dorsal aorta perform transformation into the definitive
vascular pattern. Which of the following aortic arch is most likely transform into arch
of aorta?
A. 2nd aortic arch
B. 3rd aortic arch
C. Left 4th aortic arch
D. Right 4th aortic arch
E. Left 5th aortic arch
39. A condition in which the aortic lumen below the origin of the left subclavian artery
is significant narrowed. The aortic narrowing primarily an abnormality in the media of
the aorta followed by intima proliferations. Which of the following congenital heart
diseases is the most likely to be above?
A.
B.
C.
D.
E.
Aortic valvular stenosis

Aortic valvular atresia
Probe patency of the ovale foramen
Coarctation of aorta
Interrupted aortic arch
40. A condition in which the conotruncal septum fails to follow its normal spiral
coarse and runs straight down, as a consequence, the aorta originates from the right
ventricle, and the pulmonary artery originates from left ventricle. It is usually
accompanied by an open ductus arteriosus.
Which of the following congenital heart diseases is the most likely to be present?
A. Transposition of The Great Vessels
B. Ventricular Septal Defect
C. TOF
D. Persistent truncus areriosus
E. PDA
41. After birth, when lung circulation begins and pressure in left atrium increases, the
valve of the oval foramen is pressed against the septum secundum, obliterating the
oval foramen and separating the right and left atria. In about 20% of cases, fusion of
the septum primum and septum secundum is incomplete, and a narrow oblique cleft
remains between the two atria. Which of the following condition is the most likely to
be present?
A.
B.
C.
D.
E.
Atrial Septal Defect

Probe patency of oval foramen
Persistent truncus Arteriosus
Transposition of the Great Vessels
Premature closure of the oval foramen
42. Atrial septal defect is a congenital heart abnormality with an incidence of

6.4/10.000 births. One of the most significant defect is the ostium secundum defect,
characterized by a large opening between the left and right atria. Which of the
following is the most likely caused of the ostium secundum defect?
A.
B.
C.
D.
E.
Probe patency of oval foramen

Hypoplasia endocardial cushion
Excessive cell death and reposition of the septum primum
Inadequate development of the septum primum
43. The aortic arches are embedded in the mesenchyme of the branchial arches and
terminate in the drsal aortae. With the formation of the successive branchial arches
,the aortic sac contributes a branch to each new arch, thus giving rise to a total of six
pairs of aortic arches.
The dorsal aortas and the aortic arches perform transformation into definitive blood
vessels.
Which of the following aortic arch is most likely transfom into ductus arteriosus
during intra uterine life?
A.
B.
C.
D.
E.
Left 2nd aortic arch

First aortic arch
Left 4th aortic arch
The Distal part of the left 6th aortic arch
The distal part of left 4th aortic arch
44. The oval foramen normally closes during afterbirth, when lung circulation begins
and pressure in the left atrium increases. Occasionally, the oval foramen close
during prenatal life. This abnormality, leads to massive hypertrophy of the right
atrium and ventricle and underdevelopment of the left side of the heart. Death
usually occurs shortly right after birth. Which of the following condition is the most
likely to be present?
A.
B.
C.
D.
E.
Oval foramen in premature infant

Probe patency of the oval foramen
Atrial septal defect
Transposition of the great vessels
45. The sudden changes occurring in the vascular system at birth are caused by the
cessation of the placental blood flow and the beginning of the lung respiration. Which
of the following change is not occurring in the vascular system after birth?
A.
B.
C.
D.
E.
Closure of the umbilical arteries

Closure of the umbilical vein and ductus venosus
Closure of ductus arteriosus
Closure of the vitelline artery
Closure of the oval foramen
46. The lining of the inner walls of the hearts chambers is termed the:
A.
B.
C.
D.
E.
Visceral pericardium
Serous pericardium
Epicardium
Myocardium
Endocardium
47. The hearts electrical conduction network found within the ventricular
myocardium is termed the:
A.
B.
C.
D.
E.
SA node
AV node
Bundle of HIS/ AB bundle
Left and right bundle branches
Purkinje fibers
48. Which tunic of an artery contains endothelium?

A. Tunica interna/intima
B. Tunica media
C. Tunica externa
D. Tunica adventitia
E. None of the above is true
49. The exchange of gases and nutrients between blood and tissues is a major
function of :
A. Arterioles
B. Arteries
C. Capillaries
D. Veins
E. Venules
50. Which of the following statements about veins is correct?

A. Venous valves are an extension of the tunica media
B. Up to one third of the total blood volume is stored in the venous circulation at any
given time
C. Veins have a small lumen in relation to the thickness of its wall
D. The flow of venous blood is not a major result of ones blood pressure
E. Veins have valve that prevent the backflow of the blood
51. The most abundant tissue element forming the media of the aorta is:
A. Cardiac muscle
B. Smooth muscle
C. Collagen
D. Elastin
E. Cartilage
52. The most abundant tissue element forming the media of small, muscular arteries
is:
A. Cardiac muscle
B. Smooth muscle
C. Collagen fibers
D. Elastic fibers
E. Cartilage
53. The muscular layer of blood vessels is called:
A. Tunica intima
B. Tunica media
C. Tunica adventitia
D. Endothelium
E. Mesothelium
54. A prominent inner elastic membrane (internal elastic lamina), often appearinf in
cross section as a wavy o sinous line, is characteristic of:
A. Muscular arteries
B. Small veins
C. Large veins
D. Venules
E. Capillaries
55. Vasa vasorum are:
A. Blood vessels of the myocardium
B. Nerves that supply the blood vessels
C. Nerves of the heart
D. Blood vessels within the walls of the blood vessels
E. Blood vessels of he endocardium
56. A 50-year-old male came to Primary Health Care with chief complain discomfort
in his left chest. The doctor asks many question related to risk factor of heart
problem as working diagnosis. If the cholesterol level 250mg/dL, LDL 140 mg/dL and
normal triglyceride level, the nutritional supportive therapy of this patient is:
A. Decrease only animal food sources in his diet
B. Decrease lipid conmposition in his diets without the other nutrient
C. Low cholesterol food sources
D. Decrease total calorie and improve nutrient composition of cholesterol, triglyceride
and carbohydrate
E. Decrease total calorie and give supplementation
57. Sedentary lifestyle and high energy source intake contribute to higher risk factor
for endotel inflammation due to atherosclerosis with myocardia; infarction as
comorbidity. To reduce risk of coonary heart disease and lipid disorders:
A. Reduce fat intake and balance fat composition between SAFA, MUFA and PUFA
B. Reduce protein intake and substitute lipoproteins for saturated fat
C. Fat intake and substitute trans-far for saturated fat
D. Reduce carbohydrate intake and substitute complex carbohydrate for simple
carbohydrate
E. Reduce protein intake and substitute with vegetables
58. Medical Nutrition Therapy for Dyslipidemia include:

A. Low saturated, low trans fat and low cholesterol diet
B. Moderate carbohydrate intake
C. Emphasize soluble fiber and lose weight as needed
D. Emphasize monounsaturated fats
E. All of the above
59. Limitation aof salt intake in heart failure needed for normalize water and
electrolyte balance. The regulation of fluid imbalance that results in cardiac edema,
thiss condition need restriction of specific mineral because it ineral* influence to fluid
balance:
A. Potassium
B. Magnesium
C. Calcium
D. Selenium
E. Sodium
60. Metabolic Disorder, a state of insulin resistance is commonly present in
dyslipidemia patient. Treatment for insulin resistance must direct toward:
A. Without caloric restriction
B. Increased weight training activity and caloric restriction
C. Use drugs designed generally to reduce insulin resistance
D. Moderate fiber intake
E. Increase high intensity training
R, 22 month-old boy came to the clinic and you aret the doctor at the clinic. His
mother complaints with bluish discoloration of the lips, tongue and fingertips which
noticed since 2 months old and seemed to increase as he grows up.The bluish
discoloration is getting worse while cying.He was born as a first child, termed infant
and spontaneous.Birth weight was 3000g. For auscultation you heard a long loud 3/6
systolic ejection murmur best heard at upper left sternal border. You referred to the
pediatric cardiologist, and he diagnosed him TOF.
61. What are the classic descriptions of TOF?
A. overriding aorta, pulmonary vein stenosis, VSD, PDA
B. overriding aorta, pulmonary artery stenosis, VSD, RVH
C. overriding aorta, pulmonary artery stenosis, VSD, LVH
D. ASD, pulmonary artery stenosis, VSD, LVH
62. What are the x-ray showed for TOF?

A. Egg shaped
B. Boot shaped
C. LVH
D. Increase pulmonary vascular marking
E. Heart enlargement
63. Suddenly after defecation this child become paroxysm hyperapnea, what has
happened to this child?
A. Tet spell
B. Breath holding spell
C. Apnea
D. Pneumonia
E. Sudden death
64. What is the first step you should do to treat the patient condition?
A. Knee chest position
B. CPR
C. Diazepam per rectal
D. Sit position and oxygen therapy
E. Adrenaline IV
65. What are the complication for TOF?
A. Rheumatic heart disease, Infective endocarditis
B. Acute rheumatic fever, brain abscess
C. Cyanosis, PDA
D. Brain abscess, Infective endocarditis
E. Polycythemia, patent foramen ovale
66. Systolic ejection murmur from TOF originates from:
A. Pulmonary vein stenosis
B. Infundibular stenosis
C. VSD
D. Overriding aorta
E. Tricuspid regurgitation
67. The following statement are important determinants of Rheumatic Fever and
rheumatic heart disease, EXCEPT
A. Poverty, under nutrition, overcrowding, poor housing
B. shortage of resources for health care
C. in adequate diagnosis and treatment of streptococcal pharyngitis
D. Expertise of health-care providers in tertiary center
E. Low level awareness of the disease in the community
68. The following statement is NOT TRUE for rheumatic fever:

A. Rheumatic fever is delayed suppurative
complication of Group A streptococcal pharyngitis
B. The clinical manifestation and its severity its
determined by host genetic susceptibility, the
virulence of the infecting organism and
conducive environment
C. Streptococci serogroup of B, C, G and F can cause
pharyngitis and have not been linked to the
etiology of RF or Rheumatic heart disease
D. An aoutomimmune response to streptococcal
antigen mediates the developmemt of RF and
RHD in a susceptiblr host
E. The activation of T-cell and B lymphocytes by
streptococcal antigen and superantigens which
Results in the production of cytokines and
antibodies directed against streptococcal
carbohydrate and myosin
69. The major clinical features of RF are, EXCEPT
A. Carditis
B. Sydenham chorea
C. Anthralgia
D. Subcutaneous nodule
E. Erythema marginatum
70. Clinical features of rheumatic carditis which may find on physical examination,
EXCEPT
A. Audible friction rub
B. Unexplained congestive heart failure or cardiomegaly
C. Continuous murmur at ICS II left sternal border
D. Presence of apical holosystic murmur at mitral regurgitation
E. Basal early diastolic murmur
71. the statement are NOT TRUE for secondary prevention of RF
A. The purpose is to prevent the colonization or
infection of the upper respiratory tract with
Group A beta-hemolytic streptococci and the
development of recurrent attacks of RF
B. Life-long IV injection of benzathine
benzylpenicillin every three weeks in patient post
mitral replacement for rheumatic heart disease

C. For patient allergic to penicillin, oral sulfadiazine
or sulfasoxazole are acceptable substitute
D. Life-long Penicillin V 250mg orally taken twice
daily In patient with carditis post initial attack
Rheumatic fever
E. If the patient is allergic both to penicillin and sulfa
drugs, or if these drugs are not available, oral
erythromycin may be used
For question 72 and 73 refer to scenario below:
A 50 year old male was hospitalized with chronic cough and progressive shortness
of breath which have marked increasely since one week. He has been a heavy
smoker since youth. On examination he was dyspneic and slightly cyanotic. His
chest was hyper inflated and wheezing as well as scattered moist rales was heard.
The pulmonic component of his heart sound was increased. His liver was enlarged
and there was bilateral ankle edema.
72. Most likely finding on chest radiography would be:
A. An enlarged left atrium and right ventricle
B. A widened pulmonary artery and pulmonary emphysema
C. Chronic bronchitis and pulmonary emphysema
D. Pulmonary tuberculosis and pericarditis
E. Pulmonary edema
73. Cyanosis in this patient is caused by one of the following factors:
A. Shunting of systemic venous into the arterial circuit
B. Reduced cardiac output
C. Arterial blood oxygen unsaturation
D. Peripheral cutaneous vasoconstriction
E. Ventilation-perfusion inequality
74. A 28-year-old woman came to the emergency unit with complaints of dyspnea on
ordinary activity. Physical findings revealed a diastolic thrill at the apex, an
accentuated P2 and low pitched diastolic murmur at the apex. What is the most likely
diagnosis of this patient?
A. Mitral valve prolapse
B. Pulmonal regurgitation
C. Aorta regurgitation
D. Mitral stenosis
E. Tricuspid stenosis
75. The compliance of the left atrium is an important determinant of the

hemodynamic and clinical picture in mitral regurgitation. Which of the following
statement is TRUE?
A. Moderately increased compliance is most commonly seen in acute mitral
regurgitation
B. In acute mitral regurgitation, the left atrial compliance is normal
C. Markedly increased compliance can be found in chronic mitral regurgitation
D. Slight enlargement of the left atrium is common in chronic mitral regurgitation
patients
E. In chronic mitral regurgitation, the left atrial pressure is markedly elevated
76. Which of the following statements regarding aortic stenosis is NOT TRUE?
A. Atrial contraction plays an important role in filling the left ventricle
B. Atrial contraction prevents pulmonary congestion
C. Atrial fibrillation may precipitate heart failure
D. Left ventricular end-diastolic volume usually remains normal
E. Left ventricular mass decreases in response to the chronic pressure overload
77. The complication of valvular heart disease that can be detected by laboratory is:
A. Genetic anomaly
B. Carcinoid syndrome
C. Bacterial endocarditis
D.Rheumatic fever
E.Congenital defects
78. Unstable angina pectoris is characterized by:
A. Angina during exercise
B. Angina pain relieved with sublingual nitrate
C. Angina of less than 10 minutes
D. First onset angina
E. Angina relieved after rest
79. A patient with symptoms of acute myocardial infarction has ST-segment
depression of 2mm on the ECG in the lead I and aVL. This may reflect:
A. Inferior wall infarction
B. Anterior wall infarction
C. Anteroseptal wall infarction
D. High lateral wall infarction
E. Anterolateral wall infarction
80. A gentleman came to the ER complaining of chest pain of first onset lasting for
10 minutes that occurred 2 hours ago. The ECG did not show any changes
indicating ischemia.
What is the proper management of this patient?
A. Do a treadmill test
B. Treat as a patient with acute coronary syndrome and send him to the in-patient
ward
C. Treat as a patient with acute coronary syndrome and send him to the coronary
care unit
D. Observe patient and do serial cardiac markers and ECG tests
E. Send him home because this is not an emergency case
81. Which of the following statements regarding the mechanism of heart failure is
TRUE?
A. Salt and water retention leads to the long-term maladaptive response of cell death
B. Hyperplasia and apoptosis play a large role in myocardial remodeling
C. A systemic compensatory mechanism for heart failure is decreased oxygen
extraction by tissues
D. Maladaptive remodeling of myocytes occurs long before clinical heart failure
begins
E. The role of neurohormones in heart failure is to protect perfusion pressure
82. All of the following statements regarding the ECG of a patient with history of
coronary disease below are true, EXCEPT:
A. Sinus rhythm with 1st degree AV block
B. Myocardial infarction, age undetermined
C. PVC with on R-on-T phenomenon
D. Pair of PVCs
E. Ventricular tachycardia
83. Which of the following statements regarding atrioventricular block is NOT TRUE?
A. Second-degree AV block type I is usually located at the AV-nodal level
B. Second-degree AV block type II is usually located at the infranodal level
C. Asymptomatic patients with a third-degree AV block at the AV-nodal level should
have permanent pacing
D. There is a slight variation in the P-P interval in patients in sinus rhythm and thirddegree block
E. Pacing is not the indicated in patients with first-degree AV block
84. Which of the following statements regarding electrical abnormalities in the heart
and sudden cardiac death is TRUE?
A. Arrythmic events in patients with long-QT syndrome 1 are often triggered by
auditory stimuli
B. The risk of sudden death in Wollf-Parkinson-White syndrome is high and often
occurs in other healthy individuals
C. Patients with idiopathic polymorphic ventricular tachycardia have a good
prognosis
D. Younger patients who have survived SCD have a higher incidence of idiopathic
ventricular fibrillation
85. Compared with stable atherosclerotic plaque, composition of unstable
atherosclerotic plaque is characterized as consisting of:
A. Thick fibrous cap
B. More inflammatory cells
C. Less foam cells
D. More smooth muscle cells
E. Small lipid core
86. A 64-year-old woman was diagnosed as heart failure for the last 1 year. Last
year she can have her regular work without symptom. But now she
experience shortness of breath in her daily activity. Which functional class
according to the New York Heart Association classification does she has
now?
A. Class I
B. Class II
C. Class III
D. Class IV
E. Between class III and IV
87. A 44-year-old male come to the hospital to have a medical check up. After
completed the test he was told that he has cardiac abnormality. The doctor
showed the electrocardiography.
What is the abnormality in the rhythm strip?

A. Premature junctional contraction
B. Premature atrial contraction with aberrant conduction
C. Premature atrial contraction
D. Premature atrial contraction with sinus arrhythmia
E. Premature ventricular contraction
88. Which of the following is the most likely approach to the older patient with
suspected valvular disease?
A. Physically examination can reliably assess the severity of valvular
lesions in most older patients
B. Doppler echocardiography is the clinical standard for diagnosis and
evaluation of the severity of valve lesions
C. Age is not a predictor of worse outcomes for the natural history of
valvular lesions, as well as surgical approaches
D. Surgery is not definitive therapy for valvular lesions
E. Antibiotic prophylaxis should not be used to prevent bacterial
endocarditis
For questions number 89 to 90, refer to scenario bellows.
Since 3 years ago, Mr. Fahmi usually takes medications when he feels chest pain.
He has been controlling regularly for his blood cholesterol level. He just got the
laboratory result yesterday; his blood cholesterol level was 289mg/dL. The doctor
prescribed some medications and gave dietary program for his cholesterol. The
medications were ISDN, simvastatin and acetylsalicyl acid.
89. When is the best time to consume the drug for lowering the blood cholesterol
level that has been prescribed by the doctor?
A. Morning
B. At the midday
C. Afternoon
D. Evening
E. Midnight
90. How is the mechanism of action of the antiplatelet drug that has been
prescribed by the doctor?
A. Irreversibly inhibits COX1 and COX2
B. Reversibly inhibits COX1
C. Reversibly inhibits COX2
D. Irreversibly inhibits COX1 selectively
E. Irreversibly inhibits COX2 selectively
91. Mr. Zendy, 59 years old man, was admitted to the emergency room because
of shortness of breath. After being interviewed and examined by the doctor,
she was diagnosed as acute heart failure. What is the first line therapy for the
patient?
A. Diuretics and vasodilator
B. Diuretics and ACE inhibitors
C. ACE inhibitors and diuretics
D. ACE inhibitors and angiotensin receptor antagonist
E. Diuretics and aldosterone antagonist
For questions number 92 to 93, refer to scenario below:

Mrs. Xency, 60 years old woman, was admitted to the Emergency Room because of
shortness of breath and cold sensation in extremities. After being interviewed and
examined by the doctor, she was diagnosed as cardiogenic shock and she was
given dobutamin injection, and then referred to intensive cardiac care unit.
92. How is the mechanism of action of the drug given to the patient?
A. Inhibits Na-K-ATPase
B. Reduces Ca expulsion
C. Activities adenylyl cyclase
D. Inhibits angiotensin converting enzyme
E. Reduce aldosterone secretion
93. What will happen if the patient suffered from toxicity of the drug given?
A. Hypokalemic
B. Arrhythmias
C. Cough
D. Diarrhea
E. Hypomagnesia
94. A 54-year-old man came to emergency with dyspnea. From history taking and
physical examination, he was diagnosed with CHF fc. IV. After given O2 and
was put on IV line, the patient needed immediate treatment of digoxin drip,
diuretic was put on IV line, and Calcium Slow Release. Which of the following
is the best diuretic choice for this patient?
A. Furosemide
B. Acetazolamide
C. Hydrochlorothiazide
D. Spironolactone
E. Mannitol
95. A 65-year-old man was brought to the doctor due to shortness of breath. He
notice a shortness of breath when climbing 1 flight of stairs and he frequently
awake at night due to a sensation of lack of air for the last year. Physical
examination revealed: BP 170/60 mmHg, HR 96 bpm, RR 28 x/min, laterally
apex beat, gallop rhythm, heart murmur, hepatomegaly, pretibial pitting
edema, other in normal limits. One of prescribed drug was captopril. What is
the most expected effect of the drug besides decreasing blood pressure?
A. Decrease heart rate
B. Relief dyspnea
C. Countering heart murmur
D. Myocardial remodeling
E. Reduce pretibial edema
96. A 62-year-old man was brought to the doctor with an abrupt of chest pain for
half an hour, it is never lasted longer than 10 minutes. He denied have the
same experiences before. The doctor gave him propranolol. What is the most
expected mechanism of the drug?
A. Negative inotropic and chronotropic effects
B. Vasodilation of coronary artery
C. Decreasing blood pressure
D. Increasing perfusion of the myocardium
E. Its effect on the bronchus
97. A 60 year old man came to emergency with dyspnea. From HT and PE , he was
diagnosed with CHF fc. IV. After given oxygen and was put on IV line , the patient
was planned digoxin and got arrhythmia . Which of the following is the most directly
describes the mechanism of action of the drug ?
A.
B.
C.
D.
E.
Decrease intracellular sodium concentration

Increases the intracellular level of ATP
Inhibit sodium - potassium ATPase
Stimulates production of cAMP
Decreases release of calcium from the sacroplasmic reticulum
98. A 60 year old man got heart attack. He was treated with digoxin and captopril
orally , and must be given furosemide 40 mg8 hr IV immediately. Which of the
following is the most appropriate prescription for the furosemide IV ?
A. R/ Furosemide 40 mg IV /8 hr No I
B.
C.
D.
E.
S.s.d.d I
R/ Furosemide 40 mg / 2 ml Ampl. No III
S.I.m.m
R/ Furosemide 40 mg IV No. Amp. III
S.t.d.d I
R/ Furosemide 40 mg No. Amp. III
S.t.d.d I
R/ Furosemide 40 mg IV No I
S.p.r.n
99. A 3 year old child has been suffering of dyspnea for one year , particularly after
physical activities. His CXR showed the heart is enlarged to the left with apex
downward to the diaphragm, the left upper border of the heart is prominent, the
aortic arch is small, the his are wider and the pulmonary vascular markings are
increased. Which of the following is the most likely diagnosis ?
A. ASD
B. PDA
C. VSD
D. PTA
E. PAPVR
100. Which of the following is found in CXR of CHF patient ?

A.
B.
C.
D.
E.
No cephalisation of vascular markings in upper part of the lungs

Increased pulmonary markings in upper part of the lungs
Increased pulmonary markings in lower part of the lungs
No blurring of vascular markings in lower part of the lungs
There are reticulonodular patterns in lower part of the lungs
101. Which of the following examination is the best to evaluate mitral regurgitation ?
A.
B.
C.
D.
E.
Cardiac CT scan
Mediastinum CT scan
MRI
Thallium scanning
Echocardiography
For question number 102 -103 , refer to scenario below :

Since 3 years ago , Mr. Fahmi usually takes medications when he felt chest pain. He
has been controlling regularly for his blood cholesterol level. He just got the lab result
yesterday ; his blood cholesterol level was 289 mg/dl. The doctor prescribed some
medication and gave dietary program for his cholesterol. The medication was ISDN ,
simvastatin and acetylsalicylic.
102. Which drug was used as anti platelet ?
A. Acetylsalicylic
B. ISDN
C. Simvastatin
D. Verapamil
E. Captopril
103. How is the MOA of drug prescribed by the doctor for lowering the blood
cholesterol level ?
A. Inhibit HMG-CoA reductase competitively
B. Function primarily as ligands for the nuclear transcription receptor
C. Inhibit VLDL secretion
D. Activate guanylyl cyclase
E. Increase the cGMP
104. Post-mortem of histologic examination of the heart of the patient who died of a
confirmed AMI reveals coagulative necrosis of cardimyocytes , multiple small
haemorrhage and prominent PMN infiltration. What is the most likely age of MI in
this patient ?
A. < 4 hr
B. 4 - 12 hrs
C. 12 - 24 hrs
D. 24 - 72 hrs
E. 4 - 7 days
105. Which of the following lab parameter most often associated with a VSD ?
A. Leukopenia
B. Thrombocytopenia
C. Anemia
D. Polycytemia
E. Leukemia
106. Which of the following statements regarding the clinical use of CK-MB is correct
?
A. CK-MB become elevated before myoglobin and Troponin I after MI
B. CK-MB levels are normal in cases of cardiac ischemia
C. Mass unit assay are more sensitive than the enzymatic methods
D. An elevated CK-MB is always accompanied by an elevated CK
E. CK-MB are specific for muscle injury caused by vigorous activity
107. A 46 year old male came to see the doctor complaining of chest pain. He also
sweating, malaise and headache. His BP was 150/105 mm/Hg. Family history
revealed that his father had diabetic and died at the age of 62 years old of AMI
secondary to DM. ECG revealed chafes from one done 6 months earlier. The
following results of the patients blood test ; CK: 400 U/L ( N: 50 - 350 ) , CK-MB : 4.9
ng/ml ( N< 5 ), AST : 35 U/L ( N: 5 - 30 ). What further cardiac markers should be run
on this patient ?
A. CK-MM
B. Troponin
C. ALT
D. Alkaline phosphatase
E. CK-BB
108. Which apolipoprotein is inversely related to risk for coronary heart disease?
A. Apoprotein AI
B. Apoprotein B
C. Apoprotein CII
D. Apoprotein E IV
E. Apoprotein D
109. A 61 year old female comes to the emergency department because of chest
pain. She has history of hypertension & does not take medicine regularly. She also
complaint of chronic fatigue after her daily activity. The doctor finds that she looks
severely ill, her blood pressure 170/110mmHg, pulse120 bpm & the heart sound
muffled. Which of the following is the most appropriate test to support diagnosis of
this patient?
A. CK-MB
B. CPK
C. AST
D. ALT
E. LDH
110. Which of the following laboratory parameters is the most commonly associated
with congestive heart failure?
A. Hyperkalemia
B. Hyponatremia
C. Hypernatremia
D. Hypercalcemia
E. Hypocalcemia
111. which of the following laboratory parameters is most often associated with
Tetralogy of Fallot?
A. Leukopenia
B. Thrombocytopenia
C. Anemia
D. Polycytemia
E. Leukemia
112. A 46 y/o male come to see doctor complaining of chest pain. He has also
sweating, malaise and headaches. Family history reveals that his father had diabetic
& died at age 62 y/o of AMI. ECG reveal inverted T-waves on left precordial leads.
What cardiac maker should be run on this patient?
A. CK-MM
B. Troponin T
C. ALT
D. LDH
E. CK-BB
113. A 45y/o women w complaints of chest pain for more than 30minutes an hour
before entering hospital & not relieved by rest.
What lab support you recommend to support diagnosis of AMI?
A. Myoglobin
B. CK-MB
C. Troponin T
D. Troponin I
E. LDH
114. Several months later after medical checkup, Mr.Y taken to emergency
department because of suddenly left chest painand vague pain on left arm. During
admission in ICU, he was given the streptokinase therapy.
What is the most suitable lab test as monitoring for streptokinase?
A. Activated thromboplastin time & prothrombine time
B. Prothrombin time & thrombocyte count
C. Activated thromboplastin time & thrombocyte count
D. Prothrombin time &D-Dimer
E. Activated thromboplastin time, D-Dimer & prothrombin time
115. A 35y/o man presents to Emergency Department following a car w several
muscle trauma & fracture. The patient getting blacked out while driving the car & now
has chest pain as well al wall tenderness. ECG examination is normal. The lab result
( 12hours after event) shows as below:
CK: 10,000 ng/ml ( N: 50-350 ng/ml), CK-MB : 150 ng/ml ( N: <5.0 ng/ml), Troponin :
0.17 ng/ml ( N< 0.15 ng/ml )
What is the possibility interpretation of this man condition?
A. Acute myocardial infarction
B. Unstable angina pectoris
C. Acute myocardial infarction w muscle trauma
D. Unstable angina pectoris w muscle trauma
E. Mucle trauma without cardiac event
116. A 30y/o male patient is present to emergency department w chest ain that
started 45 minutes ago. Upon emergency room arrival, phlebotomist draws blood for
electrolytes & cardiac markes. The cardiac marker result as follows
Total CK
CK-MB
Troponin I
Myoglobulin
(N:
50-350 (N< 5 ng/ml)
( N: < 0.5 (
N:
0-90
ng/ml)
ng/ml)
ng/ml)
On admission
170
5
0.3
70
4 hours later
220
7
0.8
180
12 hours later
180
27
3.8
150
The interpretation of lab result is :
A. Highly suggestive of AMI
B. Low suggestive of AMI
C. Normal
D. The lab result cant describe AMI because lack of information
E. Other cardiac event beside AMI
Question 117-118 refer scenario below:

A 59 y/oman come to emergency w dyspnea . from HT & PE, he was diagnosed w
CHF fc.IV. After given O2 & was put on IV line, patient needed immediate treatment
of digoxindrip, diureticwas put on IV line & kalium slow release
117. which of following is best diureticchoice for this patient?
A. Furosemide
B. Acetazolamid
C. Hydrochlorothiazide
D. Spironolactone
E. Manitol
118. Which of following is most appropriate prescription for diuretic?
A. R/ Diuretic IV/ 8 hour No I S. s.d.d I
B. R/ Diuretic Amp. No III
S. I.m.m
C. R/ Diuretic IV No.Amp. III
S. 1.d.d.1
D. R/ Diuretic IV No.Amp. III
S. t.d.d.1
E. R/ Diuretic IV tab No. X
S. p.r.n
119. A 33y/o soldier present w a 5 day history of unremitting substrenal chest pain
that radiated to his shoulders. The pain was worse when he was lying down &
improved when he lean forward. He reported having no dyspnea. He had no chest
wall tenderness & had not undergone any recent trauma. Lab analysis revealed no
elevation in white cell count & erythrocyte sedimentation rate. Blood culture
revealedno bacteria growth.
Which of following is most common virus that causethe disease?
A. Herpes virus
B. Parvovirus
C. Coxsackie virus
D. Rubella virus
E. Measles virus
120. fungus & bacteria also can cause acute pericarditis. Which of following fungus
that can cause the disease?
A. Candida sp
B. Aspergillus fumigates
C. Penicillium marnefei
D. Paracoccidioides
E. Cryptococcus
121. Infection of the arteries such as aortitis is rare infection following bacteremia in
older persons with extensive atherosclerotic disease of the aorta. The cause of
infection could be from bacteremic intestinal infection.
Which of the following is the example one?
A. Escherichia coli
B. Salmonella
C. Shigella
D. Vibrio
E. Campylobacter
122. Patient with active tuberculosis can present with cardiac infection that usually
associated with concurrent pulmonary disease.
Which cardiac infection related to tuberculosis?
A. Myocarditis
B. Endocarditis
C. Pericarditis
D. Aortitis
E. Thrombophlebitis
123. A doctor in charge in cardiology ward performs pericardiocentesis to a patient
suspected of chronic infective pericarditis and takes out some some bloody fluid.
What bacteria is most likely the cause?
A. Pseudomonas aeruginosa
B. Mycobacterium tuberculosis
C. Streptococcus pneumoniae
D. Haemophilus influenza
E. Staphylococcus aureus
124. A 45- year- old man admitted to hospital with low grade fever, night sweat,
fatigability, malaise, weight loss and valvular insufficiency. Theres also
erythematous subcutaneous nodules about the tips of digits and hemorrhagic retinal
lesion. After examine the patient, the doctor in charge thought that the man suffered
from subacute bacterial endocarditis.
Whats the common cause if the disease?
A. Staphylococcus aureus
B. Staphylococcus epidermidis
C. Streptococcus viridians
D. Streptococcus non haemolyticus
E. Streptococcus gamma haemolyticus

A 35-year- old man was found dead at home by the apartment manager, who had
been called by the decendents employer because of the failure to report to work for
past 3 days. An examination by the medical examiner showed splinter hemorrhages
under fingernails and no signs of trauma. The autopsy was done and the tissue
sample from the tricuspidal valve was sent for Histopathological examination. The
microscopic appearance of the valve is shown in the figure below.
125. Which of the following laboratory finding is the most likely to provide evidence of
the cause of the disease?
A. Positive ANCA determination
B. Elevated antistreptolysin O titer
C. High double stranded DNA autoantibody titer
D. Positive blood culture for Staphylococcus aureus
E. Increased creatine kinase- MB fraction (CK-MB)
126. Which of the following structure is pointed by the blue arrow?
A. Fibrin
B. Vegetation
C. Dead myocytes
D. Mononuclear cells
E. Polymorphonuclear cells
127. Which of the following structure is pointed by white stars?
A. Fibrin
B. Vegetation
C. Dead myocytes
D. Mononuclear cells
E. Polymorphonuclear cells
Budi, a 55- year- old man experienced crushing substernal chest pain while playing
badminton one morning. His friend suggested that Budi went to hospital immediately,
but Budi wanted to stay at home and take a rest. The pain was not subsided so he
decided to go to the hospital 5 hourslater when it began to radiate to his left arm. He
becomes diaphoretic and short of breath.
128. Which of the following microscopic ( light microscope) change that is most likely
appear in this patients myocardium while he was having rest at home?
A. No Histopathological changes can be seen
B. Beginning coagulation necrosis, edema and hemorrhage
C. Coagulation necrosis with loss of nuclei and dtriations and
interstitial infiltrate of neutrophils
D. Well- established granulation tissue with new blood vessels and
collagen deposition
E. Increased collagen deposition, with decreased cellularity
129. which of the following microscopic (light microscope) change that is most likely
appear in this patients myocardium before the pain radiate to his left arm?
A. No Histopathological changes can be seen
B. Beginning coagulation necrosis, edema and hemorrhage
C. Coagulation necrosis with loss of nuclei and striations and
interstitial infiltrate of neutrophils
D. Well- establish granulation tissue with new blood vessels and
collagen deposition
E. Increased collagen deposition, with decreased cellularity
130. Regarding to the case above, if on echocardiography stiffening of the mitral
valves were found, which of the following statement is appropriate for the case?
A. Large friable vegetation are seen on the mitral valve during
episodes of acute rheumatic fever
B. No fusion of the valve valve commisures may occur
C. Thinning of the chordae tendinae cause limitation of value mobility
D. A valve area of less than 2cm2 is defined as tight mitral stenosis
E. Fibrosis of the valve occurs
131. Postmortem histologic examination of the heart from the patient who died of a
confirmed acute myocardial infarction reveals coagulative necrosis of
cardiomyocytes, multiple small hemorrhages and prominent polymorphonuclear
Infiltration. What is the most likely age of myocardial infarction in this patient?
A. < 4 hours
B. 4- 12 hours
C. 12- 24 hours
D. 24- 72 hours
E. 4-7 days
132. A 46- year- old female came to the outpatient clinic because of dilated veins in
her left leg. Physical examination revealed dilated superficial veins, bluish color in
left leg. Which of the following clinical conditions is most likely to complicate this
condition?
A. Deep vein thrombosis
B. Pulmonary thromboembolism
C. Systemic embolism
D. Gangrene
E. Ulceration
133. A newborn baby boy was observed at birth to be noncyanotic. The mother was
known to have been infected with rubella during the pregnancy. On examination, the
patient is found to have a continuous murmur that is present in both systole and
diastole. A non-steroidal anti-inflammatory drug was prescribed, and on follow-up,
the murmur was found to have disappeared. Which of the following is the most likely
congenital heart defect?
A. Transposition of great arteries
B. Patent ductus arteriosus
C. Coarctation of aorta
D. Tetralogy of fallot
134. A 31 years old Caucasian male dies after seven days of a Dengue Hemorrhagic
Fever. Autopsy reveals a widely distended pericardial sac filled with serous fluid. The
heart is of normal weight. Both ventricular walls are of normal thickness and all
chambers are of normal size. There is no history of cardiac abnormalities prior to
infection and a heart monitor during the course of illness shows no evidence of fatal
arrhythmia. Which of the following is the most likely mechanism for heart failure?
A. Reduced preload
B. Increased preload
C. Increased afterload
D. Decreased afterload
E. Impaired contractility
135. A 1 year old boy is brought to the physician for routine health maintenance
examination. The physician notes a lesion on his cheek (shown in picture). The
lesion is excised and its microscopic appearance is shown in figure. Which of the
following is the most likely diagnosis?
A. Kaposi sarcoma
B. Angiosarcoma
C. Lymphangioma
D. Telangiectasia
E. Hemangioma
136. A 35 years old male who was a very heavy smoker came to outpatient clinic
because of pain in his left fingers. Physical examination showed gangrenous ulcer in
his left finger, Digit II IV. Which of the following histopathologic change is the most
likely occur in this patient?
A. Microabscess and thrombus in medium sized and small arteries
B. Microabscess and thrombus in medium sized and small veins
C. Microabscess and thrombus in large arteries
D. Microabscess and thrombus in large veins
E. Microabscess and thrombus in capillaries
137. In a clinical study of Tetralogy of Fallot, patients are examined before surgery to
determine predictors observed on echocardiography that correlate with the severity
of the disease and the need for more careful monitoring. A subset of patients is
found to have more severe congestive heart failure, poor exercise tolerance and
decreased arterial oxygen saturation levels. Which of the following is most likely to
predict a worse clinical presentation of these patients?
A. Size of left ventricle
B. Diameter of tricuspid valve
C. Degree of pulmonary stenosis
D. Presence of an atrial septal defect
E. Size of the ventricular septal defect
A 55 years old man died suddenly when he was watching a badminton final match. A
few hiurs before the game was started he complained of a chest pain.
138. Which of the following is the most likely type of this mans death?
A. Instant death
B. Not a sudden death
C. Sudden death
D. Natural death
E. Unnatural death
139. Which of the following is the most likely cause of death?
A. Stagnant hypoxia
B. Anemic hypoxia
C. Histotoxic hypoxia
D. Anoxic hypoxia
E. Hypoxic hypoxia
140. A 50 years old man was found lying on the floor at 7.00 am, unawake and was
rushed to the hospital. Doctor found that there was cessation of cardiac function and
breathing. His family told him that he had breathing difficulty and edema in his
extremities since last year, but he seldom wnt to his doctor. The last time he was
seen alive was at 9.00pm last night, while he complained a little bit chest discomfort.
The doctor found no sign of trauma on his body and declared death on arrival (DOA).
Which of the following is the most likely type of this mans death?
A. Unnatural death
B. Natural death
C. Accidental
D. Homicidal
E. Suicidal
141. A 60 years old man was found lying on the floor at 7.00 am, and was rushed to
the hospital. Dr. Green declard him Death on Arrival. His wife told him that her
husband was often suffered from chest pain within the last two years. The last time
he was seen alive was at 9.00 pm last night while he was going to bed. Which of the
following statement is the most likely importance to establish the manner of the
patient death?
A. To file a police report for investigation of death
B. To improve police method in death investigation
C. To improve our knowledge in cardiovascular disease
D. To decide whether a death certificate should be issue
E. To determine factors contributing to the cause of death
Mrs. Brown, a 45 years old man was found lying on the bathroom floor at 6.00 am,
unawake, and was rushed to the hospital. Dr Green examined her vital signs and
declared her death. Her medical record showed that Mrs. Brown suffered from
hypertension for years. Her husband told Dr Green that the last time she was seen
alive was at 12.00 am last night before she was going to bed. Dr Green has a doubt
because he found two round bruises on her neck, just below her left and right jaw.
142. To make sure whether Mrs. Brown is dead or not, the doctor should examine
her pulse, respiration and:
A. Ventilation
B. Pupil reflex
C. Babinsky reflex
D. Electro encephalogram
E. Peripheral nerve reflex
143. What kind of objective examination the doctor has to do to estimate the time of
death?
A. Post mortem rigidity
B. The size of the pupils
C. Electro encephalogram
D. The color of the bruises
E. Information from the family
144. A man, 50 years old, comes to your clinics, complaining fatigue since 1 year
ago with leg swelling. After several examinations and diagnostic tools, he was
diagnosed having Pulmonary Hypertension. What do you expect of his mean
pulmonary artery pressure (mPAP) measured by right heart catheterization (RHC)
procedure?
A. 20 mmHg. His systemic blood pressure is 110/80
B. 15 mmHg. His systemic blood pressure is 130/75
C. 25 mmHg or more, whatever his systolic BP
D. 20 mmHg while exercise
E. More than 15 mmHg if his systemic blood pressure is 150/75
145. A 64 y.o. woman was diagnosed as heart failure for the last 1 year. Last year
she can have her regular work without symptom. But now she experienced
shortness
of
breath
in
her
daily
activity.
Which functional class according to the New York Heart Association classification
does she has now?
A. Class I
B. Class II
C. Class III
D. Class IV
E. Between class III and IV
146. Mr. TS, a 50 y.o. man had suffered for hypertension for last 5 years. To
maintain the hypertension and other related cardiac event, you as his doctor were
given anti hypertension drug and aspirin. Aspirin was known as anti-platelet drug to
inhibit
the
thrombus
formation.
What kind of laboratory examination that you suggest to Mr. TS as monitoring of
aspirin therapy?
A. Prothrombin time
B. Activated partial thromboplastin time
C. Thrombocyte
D. Fibrinogen
E. D-Dimer
147. 8 hours after Mrs. AM chest pain, the blood was drawn and taken to the
laboratory for several examinations. The laboratory results as followed: Hb 12.5 g/dl
(12-16 g/dl), Hct 36% (36-48%). Leukocyte 7000/mm3 (5000 10000/mm3).
Thrombocyte count 220.000/mm3 (150.000-300.000/mm3). CKMB 6 ng/mL (normal:
<5
ng/mL).
LDH
150
U/L
(normal
140-280
U/L)
What is your interpretation of Mrs. AM laboratory result?
A. Unstable angina pectoris
B. Acute myocardial infarction
C. Stable angina pectoris
D. Atypical chest pain
E. Typical chest infarction
148. A 55 y.o. man presents to the Emergency Department following a car accident
with several muscle trauma and fracture. The patient getting blacked out while
driving the car and now has chest pain as well as wall tenderness. ECG examination
is normal. The laboratory results (12 hours after event) shows as below:
CK: 10, 000 ng/mL (normal: 50-350 ng/mL); CK-MB: 150ng/mL (normal: <5.0
ng/mL); Troponin: 0.17 ng/mL (normal <0.15 ng/mL).
A. Acute myocardial infarction
B. Unstable angina pectoris
C. Acute myocardial infarction with muscle trauma
D. Unstable angina pectoris with muscle trauma
E. Muscle trauma without cardiac event
149. When you are working at emergency department, you find a patient with
clinical manifestation acute myocardial infarction. You ordered the troponin T
parameter as your guide to diagnose the patient. Then the laboratory result of
troponin
T
show
as
qualitative
and
quantitative
result.
What is the meaning of qualitative result of cardiac Troponin T?
A. The troponin T will be reported as concentration in ng/mL
B. The troponin T will be reported as positive or negative only
C. The troponin T will be reported as positive or negative and also concentration
in ng/mL
D. The troponin T will be reported as high or low mark with concentration in
ng/mL
E. The troponin T will be reported as range concentration in ng/mL

150. In the normal ECG the average duration of the action potentials of the
ventricular myocardium is indicated by:
A. T wave
B. QRS segment
C. ST segment
D. QT interval
E. PR interval
151. One of the most important functions of nervous control of the circulation is its
capability to cause very rapid increases in arterial pressure. For this purposes the
entire vasoconstrictor and cardio accelerator function of the sympathetic nervous
system are stimulated as a unit, resulting:
A. Almost all arterioles of the body are constricted
B. The veins especially but the other large vessels of the circulation as well are
strongly constrictor
C. The heart itself is directly stimulated by autonomic nervous system
D. Enhancing cardiac pumping and increase heart rate
E. All above
152.
A.
B.
C.
D.
E.
The fourth heart sound is caused by:

Closure of the aortic and pulmonary valves
Vibrations in the ventricular wall during systole
Ventricular filling at the end of diastole
Closure of the mitral and tricuspid valves
Retrograde flow in the vena cava
153. During cardiac cycle, contraction is occurring in the ventricles, but there is no
emptying. This is called:
A. Period of Ejection
B. Period of Isovolemic (Isometric) Contraction
C. Period of Isovolemic (Isometric) Relaxation
D. End Diastolic period
E. End Systolic period
154. A 50 y.o. male came with peripheral edema due to heart failure and kidney
failure.
He
has
shortness
of
breath
and
low
albumin
level.
Which of the following condition most likely cause decreasing of lymph flow?
A. Interstitial hydrostatic pressure
B. Plasma colloid osmotic pressure
C. Capillary hydrostatic pressure
D. Interstitial osmotic colloid pressure
E. Capillary hydraulic permeability

155. On WOTF ventral surface of the chest is the second component of the heart
sound is usually most clearly heard?
A. Second intercostal space to the right (patients right) of the sternum
B. Second intercostal space to the left of the sternum
C. Fifth intercostal space to the left of the sternum
D. Fifth intercostal space at the sternum
E. Ventral tip of the xiphoid process.
156. in young people, the 2nd heart (S2) is often split (has two audibly distinct
components).
A. Increased filling of the left ventricle during inspiration
B. Increased filling of the left ventricle during expiration
C. Decreased ejection from the left ventricle during expiration
D. Increased filling of the right ventricle during inspiration
E. Decreased filling of the right ventricle during expiration
157. A 2y.o male ruptures his spleen in a motorcycle accident. A reduction in blood
pressure would cause a decrease in WOTF?
A. Heart rate
B. Myocardial contractility
C. Total peripheral resistance
D. Venous compliance
E. Venous compliance
158. If cardiac output =5.6L/min, heart rate=70bpm and end systolic volume=100mL;
then end diastolic volume and stroke volume are respectively:
A. 180 and 70
B. 190 and 80
C. 170 and 70
D. 200 and 120
E. 180 and 80
159. WOTF statements concerning mitral valve is CORRECT?
A. It requires the contraction of the papillary muscle in order to initiate closing
B. A systolic murmur is produced when it fails to close properly
C. It closes at the end of isovolumic contraction
D. It normally closes during PR interval
E. It prevents backflow of blood into ventricle during diastole
160. A 30y.o female was admitted to the emergency room with palpitation. The
palpitation started one day before admission, which was felt as rapid and irregular
heart beat. She had also compliant of shortness of breath (SoB) in the last few
weeks, which worsen to dyspnea even at rest, after the palpitation occurred. She
was hospitalized two month ago, due to dyspnea on mild exertion accompanied with
easy fatigability and SoB.
3 month ago she was hospitalized because of heart disease and discharged after 10
days. At home, she continued to take medication a small white tablet which increase
her urination, but d=she refused to follow up. From PE found her pulse was irregular,
unequal, with a rate of 128bpm. Her heart was enlarged; S1 was variable with
normal S2 and no discernible cardiac murmur. The heart rate was irregularly
irregular with a rate 150bpm. The electrolytes examination showed sodium
concentration of 133mEq/L and potassium concentration of 2.5mEq/L. Hypoxemia,
with a normal pH was found in the blood gas analysis.
Sodium enters the cell during the upstroke of the action potential. What is the major
mechanism for removing Na from the cell?
A. It passively diffuses out of the cell
B. It is extruded via an ATP-independent Na-Ca pump
C. It is extruded via an ATP-dependent Na-Ca pump
D. It is extruded via an ATP-independent Na-K pump
E. It is extruded via an ATP-dependent Na-K pump
161. WOTF is the best index of preload?
A. Blood volume
B. Central Venous Pressure
C. Pulmonary Capillary wedge pressure
D. Left Ventricular end-diastolic volume
E. Left ventricular end-diastolic pressure
162. A 24y.o man goes to athletic field to exercise. He runs for 1 hour. WOTF are
physiologic changes of CVS found in that person?
A. Decrease in pulmonary arterial pressure
B. Increase in pulmonary arterial pressure
C. Increase in total peripheral resistance
D. Decrease in diastolic pressure
E. Increase in stroke volume
163. A 50y.o woman came to the cardiology department for cardiac function
evaluation. She was diagnosed having prolapsed mitral valve. WOTF values is the
best index of preload on her heart?
A. Blood volume
B. Central Venous Pressure
D. Left Ventricular end-diastolic volume
E. Left ventricular end-diastolic pressure

164. A 48y.o male came to ER with intermittent chest pain. There was no myocardial
infarction based on ECG and blood test, but there was thickening of the left
ventricular muscle and narrowing aortic valve. The doctor gave him medication to
lower the after load. WOTF values would provide the best measure of the
effectiveness of the medication?
A. Left ventricular end-diastolic pressure
B. Left Ventricular end-diastolic volume
D. Total peripheral resistance
E. Mean arterial blood pressure
165. A 22y.o male ruptures his spleen in a motorcycle accident. Reduction in blood
pressure cause a decrease WOTF?
A. Heart rate
B. Myocardial contractility
C. Total peripheral resistance
D. Venous compliance
E. Cardiac output
166. A 30y.o healthy male just reclining from supine position. WOTF body adaptation
most likely occurred?
A. Decreased peripheral resistance
B. Decreasing heart rate
C. Increasing sympathetic stimulation
D. Decreasing parasympathetic stimulation
E. Increasing calcium plasma
167. A 35 y/o male was brought by the police to the ER due to traffic accident. He
was in hypovolemic condition. The doctor gave him oxygen therapy. Which of the
following reason is most likely correct for oxygen therapy?
A. Inhibit chemoreceptor
B. Basic life support
C. Prevent decrease level of consciousness
D. Increase met Hb
E. Decrease bonding between Hb and CO2
168. The expansion and widespread application of cardiac catheterization has been
established, from just investigate tool, become therapeutic innovations based on
advanced catheter technologies. Which is the best true statement about
interventional procedures and its purposes?
A. Cardiac resynchronization therapy in Acute Coronary Syndrome
B. Trans-venous pacemakers for advanced heart failure
C. Right heart catheterization for LV dysfunction
D. Intra-aortic balloon pump for cardiogenic shock
E. Balloon mitral valvuloplasty for Peripheral Arterial Stenosis

169. The expansion and widespread application of cardiac catheterization has been
established, from just investigate tool, become therapeutic innovations based on
advanced catheter technologies. Which one of the list below is the most frequent
done in the world?
A. Coronary artery stenting / intervention
B. Pacemaker implantation
C. Holes/defect closure or Ductal occlude
D. Pericardiocentesis
E. Septal ablation
Question 170-171 refer:

A 32 y/o man noted the onset of a substernal pressure-like discomfort while doing
some activities as walking up a hill. He has uncontrollable-diabetes for 15 years. An
elective coronary angiography found marked stenosis in 2 vessels. He was stented
with DES (Drug Eluting Stent) rather than BMS (Bare Metal Stent)
170. What is the main reason of DES intervention in 2003?
A. Prevent in-stent thrombosis
B. Prevent restenosis
C. Prevent intra-procedural thrombosis
D. Decrease intra-procedural complication
E. All of the answer above true
171. What is the risk of major complications during coronary angiography?
A. Less than 2%
B. 2 4 %
C. 4 8 %
D. 8 15 %
E. Larger, but benefit is still more than risk
Question 172 173, refer :
A 22 y/o girl with worsening dyspnea come back to the clinics brought
echocardiography result that showed a severe mitral stenosis due to rheumatic
process, without significant mitral and tricuspid regurgitation.
172. What procedures should be performed first on her?
A. Trans catheter Mitral Valvular Intervention (TMVI)
B. Balloon Mitral Valvuloplasty (BMV)
C. Mitral valve replacement (MVR)
D. Mitral Clips Intervention
E. All of the above
173. Complication occur during the procedure; the wire was puncture to high in
septum, making hemopericardium and pericardial effusion. What is the interventional
technique can be done to overcome this situation?
A. Inoue balloon technique
B. Percutaneous Balloon Aortic Valvuloplasty
C. Intra Aortic Balloon Pulsation
D. Pericardiocentesis
E. Pericardiectomy
Question 174 175, refer:

A 88 y/o woman gas worsening dizziness and had loss of consciousness twice. She
denied any chest pain or history of drug consumption. In ER, she was found marked
bradycardia with the ECG as below:
174. What is the diagnosis of ECG?

A. Normal sinus rhythm
B. Atrial rhythm
C. AV Block Mobits type II
D. Total AV Block
E. Ischemic anteroseptal wall
175. What cardiac intervention could be done in this patient?
A. Percutaneous coronary Intervention (PCI)
B. Cardioversion
C. Cardiac Resynchronization Therapy (CRT)
D. Temporary and might be Permanent Pacemaker
E. Intra-Aortic Balloon Pump
176. A 40 y/o healthy male was running on the treadmill for 15 minutes. Which of the
following body adaptation that most likely occurred?
A. GI Tract arterial resistance increase until 20%
B. Blood in the brain decrease 50%
C. Unchanged heart rate
D. 5% increasing CO
E. Increasing RA pressure 10 mmHg
177. A patient with infective endocarditis is diagnosed on clinical grounds but
cultures do not confirm the etiologic agent. This patient is difficult to treat and the
overall prognosis is considered poorer than when a specific etiology has been
determined. The negative culture in this patient is NOT cause by one of all the
following:
A. Prior antibiotics treatment
B. Infection caused by intracellular parasites
C. Other uncommon etiologies
D. Subacute endocarditis involving the right side of the heart
E. Nutritional deficiency
178. WOTF microorganism most commonly cause subacute infective endocarditis?
A. Enterrobacteriaceae
B. Streptococci pneumonia
C. Enterococcus
D. Other streptococci
E. Staphylococcus aures
179. WOTF is NOT a characteristic of haemolytic streptococci?
A. It has a concave colony morphology and specific haemolytic reaction on blood
agar
B. Serology test is by Lancefield classification
C. Group A is sensitive to bacitracin
D. The bacteria grows better in 5% C02 condition
E. It could be cultured on nutrient agar plate
180. A woman had been diagnosed with Rheumatic Fever. She has had symptoms
of swollen joints, fever, and heart murmur of recent onset. Laboratory findings from
blood cultures were obtained and showed positive for Streptococcus viridans. Which
characteristics can be used to identify Streptococcus viridans?
A. haemolytic in colony on BAP
B. bacteria capsules in gram stains/smear
C. non sensitive to optochin
D. lyse negative tested in bile broth medium
E. streptolysine O test positive
181. Streptococcus sp. Cause endocarditis in about 70% of cases. Streptoccous
viridans are the most common pathogen, followed by enterococci. The procedure to
detect this organism is obtaining blood for:
A. bacteria culture
B. microscopic observed
C. specific Ig G detection
D. immune detection
E. haemolytic test
182. Which method is correct to detect A Streptococcal in rheumatic fever?
A. Bacterial culture and identification
B. Anti-streptolysin O test
C. Bacitracin test
D. Lancefield test
E. M. protein test
183. Group A streptococcus which causes rheumatic fever is characterized by one of
the following mechanism:
A. It produces an erythrogenic toxin
B. It causes beta haemolysis
C. Its pathogenicity is by the M.protein
D. It causes anti streptolysin O production
E. It produces haemolysin that dissoves red blood cell
184. The following is one of the major criteria of the Duke Criteria for Clinical
diagnosis of infective endocarditic:
A. Predisposition
B. Fever over 38C
C. Vascular phenomena
D. Immunologic phenomena
E. Positive blood culture
185. Rheumatic fever is often preceded by a bacterial infection, such as:
A. Streptococcus alpha haemolytic
B. Staphylococcus aures
C. Haemophilus influenza
D. Streptococcus beta haemolytic (group A)
E. Pneumococcus
186. A 62y.o man was seen in a hospital for complaint of low grade fever, night
sweats, and fatigue for 3 weeks. The patient had a history of a heart murmur but had
never undergone extensive evaluation. He had been generally excellent health with
normal exercise tolerance. Approximately 6 weeks ago he underwent an
uncomplicated extraction of a wisdom tooth but received noantibiotics prior to
procedure. After performing PE and some lab test, the doctors diagnosis is Infective
Endocarditis. WOTF is most appropriate examination to confirm above diagnosis?
A. Clinical appearance
B. Radiologic examination
C. ECG examination
D. Echocardiography
E. Blood culture
187. A 46y.o male comes to see doctor complaining of chest pain. He has also
sweating, malaise, and headaches. Family history reveals that his father had
diabetes and died at age 62y.o of AMI. ECG reveals inverted T waves on the left
precordial leads. What cardiac marker should be run on this patient?
A. CK-MM
B. Troponin T
C. ALT
D. LDH
E. CK-BB
188. WOTF laboratory results is characteristics of exudative pericardial fluid?
A. Total protein < 0.3gr/Dl
B. Colorless
C. LD fluid/serum ratio > 0.6
D. LD fluid/serum ratio < 0.3
E. Volume is 10-20 MI
189.The method that is now universally used for triglyceride determination is:
A. Electrophoretic method
B. Chemical method
C. Chromatographic method
D. Enzymatic method
E. Immunoassay method
190. A 61 year old female comes to the emergency department because of chest pain. She has
the history of hypertension and does not take medicine regularly. She also complains of
chronic fatigue after her daily activity.The doctor finds that she looks severely ill, her blood
pressure 170/110 mmHg,pulse 120 bpm and the heart sound is muffled.Which of the
following is the most appropriate test to support the diagnosis of this patient?
A. CK-MB
B. CPK
C. AST
D. ALT
E. LDH
191. Which of the following statements regarding the clinical use of CK-MB is CORRECT?
A. CK-MB becomes elevated before myoglobin and Trop. I after MI
B. CK-MB levels are elevated in cases of cardiac ischemia
C. The level of troponin I normalized later than CK-MB in MI
D. An elevated CK-MB is always accompanied by an elevated CK
E. CK-MB are specific for muscle injury caused by vigorous exercise
192.A 61 year old female comes to Emergency Department because of chest pain.She has the
history of hypertension and does not take the medicine regularly. She also complains of
chronic fatigue after her daily activity.he doctor finds that her blood pressure is 170/110
mmHg, pulse 120 bpm, the heart sound is muffled and she looks severely ill.
The result of the blood test (CBC) shows as follow:
Hemoglobin 11,3 g/dL (Normal 12-16 g/dL)
RBC 3,15 million/mm3( Normal 3.8-5.2 million/mm3)
PCV 36% (Normal 36-46%)

Platelets 374000/mm3 (Normal 150000-440000/mm3)
WBC 4800/mm3 (Normal 4000-11000/mm3)
MCV 77fl (Normal 80-100 fl)
MCH 26 pg/dL (Normal 26-34 pg/dL)
MCHC 30% (Normal 31-37%)
What is the most appropriate test chooseto help diagnosis this patient?
A. CK-MB
B. CPK
C. AST
D. ALT
E. LDH
193. Which apolipoprotein is inversely related to risk for Coronary heart disease?
A. Apoprotein A 1
B. Apoprotein B
C. Apoprotein CII
D. Apoprotein E IV
E. Apoprotein D
194. A 46 year old man comes to see a doctor complaining of chest pain.He has also
sweating, malaise and headaches.His blood pressure is 150/105 mmHg.Family history
revealedthat his father has diabetic and died at age of 62 year of AMI secondary to DM.ECG
revealed changes from one done 6 months earlier. The LD: 200 U/L (N : 100-225),AST :35
U/L (N: 5-30)
What further cardiac markers should be run on this patient?
A. CK-MM
B. Troponin
C. ALT
D. Alkaline phosphatase
E. CK-BB
195. A 55 year old white gentleman came to your clinic with complaints of left leg swelling
and painful arising after a flight from New York in economy class.No history of trauma but
his right leg is edematous,pitting,warm,painful in palpation.What is most like diagnosis?
A. Edema due to heart disease
B. Acute lymphedema
C. Cellulitis
D. Deep vein thrombosis (DVT)
E. Acute limb arterial occlusion
196. A 50 year old woman who had been examined reliably excluded calf-limited DVT and
she elected to be followed clinically.She returned 3 days later with persistent swelling right
leg but no new symptoms.She came back 10 days later after she presents with acute onset of
dypsnea and pleuritic chest pain.The best diagnosis for her is:
A. Traumatic swelling
B. Infected swelling
C. Soft tissue tumot
D. Deep vein thrombosis
E. Pulmonary embolus complication
For question number197-198,refer to scenario below:

A 45 year old man came to Hasan Sadikin Hospital with chief complaint chest pain.After
taking anamnesis and physical examination, he refers to Radiology department to take x-ray
examination
197. The position for viewing the heart in chest x-ray
A. Posteroanterior view
B. Left posterior oblique view
C. Supine view
D. Right lateral view
E. All are correct
198. A 45 years old man came to Hasan Sadikin Hospital with chief complaint chest
pain.After taking anamnesis and physical examination, he refers to Radiology Department to
take x-ray examination.Which of the following is the normal right heart border in
posteroanterior chest x-ray?
A. Right ventricle and right atrium
B. Left ventricle and left atrium
C. Right atrium and left atrium
D. Right pulmonary vein and right ventricle
E. Right atrium and superior vena cava
199. Which of the following is the normal left heart border in posteroranterior chest x-ray?
A. Left ventricle, descending aorta and left atrium
B. Left ventricle,appendage of the left atrium,pulmonary trunk,aortic knob
C. Left ventricle,left atrium,superior vena cava and left carotid artey
D. Left ventricle,appendage of left atrium,aortic knob and left subclavian artery
E. Right atrium and superior vena cava
200. The central mediastinum contains:
A. The Aortic arch,the descending aorta
B. The aorta, lymphatic channels, inferior vena cava
C. The aorta, lymphatic channels,abdominal aorta
D. Inferior vena cava,lymphatic channels
E. Inferior vena cava,the aorta

For Questions Number 1-5, Refer To Scenario Below

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For questions number 1-5, refer to scenario below:

Total cholesterol: 285 mg/dL

Mr. A condition was:

11. Mr. As blood CK-MB level might be increased, bcoz:

E. The circumflex branch of the left coronary artery

23. What number is pointing to atrioventicular valves?

26. What is the correct explanation about structure pointed by number 9 ?

A. The semilunar aortic leaflets

Transposition of the great vessels

Aortic valvular stenosis

Atrial Septal Defect

42. Atrial septal defect is a congenital heart abnormality with an incidence of

Probe patency of oval foramen

Left 2nd aortic arch

Oval foramen in premature infant

Closure of the umbilical arteries

48. Which tunic of an artery contains endothelium?

50. Which of the following statements about veins is correct?

58. Medical Nutrition Therapy for Dyslipidemia include:

62. What are the x-ray showed for TOF?

68. The following statement is NOT TRUE for rheumatic fever:

mitral replacement for rheumatic heart disease

75. The compliance of the left atrium is an important determinant of the

What is the abnormality in the rhythm strip?

For questions number 92 to 93, refer to scenario below:

Decrease intracellular sodium concentration

100. Which of the following is found in CXR of CHF patient ?

No cephalisation of vascular markings in upper part of the lungs

For question number 102 -103 , refer to scenario below :

Question 117-118 refer scenario below:

For questions number 125 to 127, refer to scenario below:

E. The troponin T will be reported as range concentration in ng/mL

The fourth heart sound is caused by:

E. Capillary hydraulic permeability

E. Left ventricular end-diastolic pressure

E. Balloon mitral valvuloplasty for Peripheral Arterial Stenosis

Question 170-171 refer:

Question 174 175, refer:

174. What is the diagnosis of ECG?

PCV 36% (Normal 36-46%)

For question number197-198,refer to scenario below:

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