Cardiovascular System BCQS

1.    A 65 year old gentleman presents with headache which is most common along the course of superficial temporal artery. On palpation the temples are tender. The patient also complaints of transient visual loss. Biopsy of the temporal artery would show:

a)       Transmural inflammation demonstrating neutrophils, mononuclear cells with fibrinoid necrosis

b)       Necrotizing granulomas rimmed by lymphocytes, plasma cells macrophages and giant cells

c)       Granulomatous inflammation with lymphocyte and multinucleate giant cells with fragmentation of internal elastic lamina

d)       Onion skin, concentric, laminated thickening of the arterioles

e)       Homogeneous pink hyaline thickening with loss of underlying structural detail

2.    C-ANCA is seen in

a)       PAN

b)       Wegners granulomatosis

c)       Microscopic polyangiitis

d)       Churg strauss syndrome

e)       Takayasu arteritis

3.    Following component has a pro coagulant effect:

a)       Prostacyclin

b)       Plasminogen activator

c)       Plasminogen activator inhibitor

d)       Thrombomodulin

e)       Heparin like molecules

4.    Use of lipid lowering drugs (statins) and antiplatelet drugs in a patient suffering from ATH and coronary artey disease is and example of:

a)       Primary prevention

b)       Secondary prevention

c)       Tertiary prevention

d)       Both primary and secondary

e)       Both secondary and tertiary

5.    The commonest vessel involved in myocardial infarction is:

a)       Right coronary artery

b)       Left circumflex artery

c)       Left anterior descending artery

d)       Posterior descending artery

e)       Left interventricular artery

6.    A 60 year old man died secondary to coronary artery disease. At the time of autopsy marked atherosclerotic changes were present within his coronary arteries. Section from these abnormal areas revealed complicated atheroscelrotic plaques with calcification and hemorrhage. Within these plaques were cellular zones composed of smooth muscle cells and macrophages and a central core with foam cells and cholesterol clefts. Which one the following substances promotes atherosclerosis by stimulating smooth muscles cells to proliferate, phagocytize lipids and excrete extracellular matrix material.

a)       Alpha interferon

b)       Beta transforming growth factor

c)       Interleukin 1

d)       Platelet derived growth factor

e)       Tumor necrosis factor

7.     A 30 year old male smoker presents with gangrene of his extremities. Which one of the following histologic findings from the biopsy of blood vessels supplying this area would be most consistent with a diagnosis of Beurgers disease:

a)       Granulomatous inflammation with giant cells

b)       Fibriniod necrosis with overlying thrombosis

c)       Focal aneurysmal dilatation

d)       Fragmentation of neutrophils

e)       Thrombosis with micro abscesses

8.    During a routine physical examination a 67 year old man is found to have a 5 cm pulsatile mass in his abdomen. Angiography reveals a marked dilatation of his aorta distal to his renal arteries. Which of the following is the most likely cause of his aneurysm:

a)       Atherosclerosis

b)       A congential defect

c)       Hypertension

d)       Trauma

e)       A previous syphilitic infection

9.    A 56 year old man presents with a sudden onset of excrutiating pain. He describes the pain beginning in the anterior chest, radiatind to the back and then moving downwards to the abdomen. His blood pressure is found to b 160/115 mm Hg however no changes are seen on ECG. X ray abdomen shows a double barrel aorta. Which of the following is basiuc cause of his abnormality:

a)       A microbial infection

b)       Loss of elastic tissue in the media

c)       A congential defect in the wall of aorta

d)       Atherosclerosis of the aorta

e)       Abnormal collagen synthesis

10.    A known patient of Stable Angina visits his cardiologist with the complaints of breathlessness and tightness in chest at rest. He says these symptoms are progressively worsening. What is the likely mechanism underlying his new development?

a)       Dissolution of atherosclerotic plaque

b)       Fibrosis in plaque

c)       Vasoconstriction

d)       Acute plaque change

e)       Aneurysm development in plaque

11.    Foam cells are formed by phagocytosis of:

a)       Free fatty acids

b)       Triglycerides

c)       LDL

d)       HDL

e)       VLDL

12.    Plaque change includes all of following except one, which?

a)       Rupture

b)       Fibrinoid necrosis

c)       Thrombosis

d)       Haemorrhage

e)       Aneurysmal dilation

13.    A patient has presented in ER with severe chest pain for the last 4

days. On examination he is breathless with weak thready pulse. His ECG shows T wave inversion. Which of the following cardiac enzymes will be diagnostic of myocardial infarction at this stage.

a)       CPK

b)       CK-MB

c)       LDH

d)       Troponin I

e)       AST

14.    Injury after myocardial ischemia is reversible for:

a)       01 hour

b)       30 – 40 min

c)       10 – 20 min

d)       1 – 2 hrs

e)       01 day

15.     Granulation tissue appears after infarction on day:

a)       5 - 6

b)       1 - 3

c)       7 - 10

d)       12 - 15

e)       After 15 days

16.     Rheumatic fever is caused by:

a)       Streptococus pyogenes

b)       Streptococcus Viridans

c)       Staphylococcus aureus

d)       Streptococcus pneumonae

e)       Staphylococcus epidermidis

17.    A 30 years old heroin drug addict starts having fever with chills, weight loss and fatigue. On investigations he is diagnosed to be suffering from infective endocarditis. The most likely cause for his infection is:

a)                   Streptococus viridans

b)                   Streptococcus pyogenes

c)                   H Influenza

d)                   Streptococcus pneumonae

e)                   Staphylococcus aureus

18.    The commonest site for myxoma is:

a)       Right atrium

b)       Inter ventricular septum

c)       Left atrium

d)       Left ventricle

e)       Inter ventricular septum

19.  A 10 year boy is brought to the physician for routine physical examination. The physician notes a 2 cm spongy dull red circumscribed lesion on the upper left arm. The parents state that this lesion has been present since infancy. On excision the lesion shows dilated endothelial lined spaces filled with RBCs. Which of the following is the likely diagnosis

a)       Kaposi sarcoma

b)       Angiosarcoma

c)       Lymphangioma

d)       Telengiectasia

e)       Hemangioma

22. A pharmaceutical company is developing an anti atherosclerotic agent. An experiment investigates mechanism of actions of several potential drugs to determine their efficacy in reducing atheroma formation. Which of the following mechanism of action is likely to have the most effective anti atherosclerotic effect:

a)       Inhibits the release of platelet derived growth factor(PDGF) and macrophage mediated lipoprotein oxidation

b)       Promotes the release of PDGF and inhibits macrophage mediated lipoprotein oxidation

c)       Inhibits the release of PGDF and promotes macrophage mediated lipoprotein oxidation

d)       Decreases the level of HDL and inhibits  macrophage mediated lipoprotein oxidation

e)       Increases the level of intercellular adhesion molecule 1 (ICAM-1) and VCAM-1

23. Lipoprotein fraction which contains the highest concentration of triacylglycerol is:

a)       Chylomicron

b)       Intermediate density lipoprotein

c)       High density lipoprotein

d)       Low density lipoprotein

e)       Very low density lipoprotein

       24.    Which one of the following is the one of the most common cause of death in young individual:

a.        Dilated cardiomyopathy

b.       Restrictive cardiomyopathy

c.        Hypertrophic cardiomyopathy

d.       Amyloidosis

e.       ASD

  25.  Nonbacterial thrombotic endocarditis is most frequently associated with which of the following conditions?

a)    Terminal neoplastic disease   

b)    Systemic Lupus erythematosus (SLE)

c)     Old rheumatic endocarditis

d)    Subdiaphragmatic abscess

e)    Congenital Heart disease.

26.    “Tree barking” appearance of aorta is seen in:

a)       Atherosclerosis

b)       Inflammatory aortic aneurysms

c)       Syphilitic aortitis

d)       Mycotic aneurysms

e)       Aortic dissection