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SAMSONPLAB

ACADEMY LIMITED Email: info@samsonplab.co.uk Tel: 07940433068 CVS SINGLE BEST ANSWER 2013
A frail 65 year old man presents with difficulty in starting micturition associated with poor stream. He has no history of weight loss and denies any dysuria. On examination a blood pressure of 130/90 mm//hg is found. Choose the SINGLE most useful medication. A. lisinopril B. timetaphan camsilate C. Terazosin D. Imipramine followed by propranolol E. Verapamil A 34 year old known diabetic with chronic renal failure is examined and found to have a blood pressure of 150/100mmmHg . Choose the SINGLE most useful medication. A. Nifedipine B. Propanolol C. Sodium Nitropruside D. Lisinopril E. Terazosin A 70 year old woman complains of a chronic temporal headache associated with blurring vision. She reports of seeing rings of colour around lights especially at night. Her blood pressure is found to be 135/90mmHg. Choose the SINGLE most useful medication. A. Methyldopa B. Hydralazyne hydrochloride C. Sotalol D. Propranolol followed by phenoxybenzamine E. betaxolol A 55 year od company executive complains of palpitations and episodes of feeling dizzy. A 24 hour EGC tracing reveals episodes of atrial fibrillation which come and go at various times, lasting only 2-3 seconds each time Choose the SINGLE most useful medication. A. Sotalol B. Digoxin C. Glibenclamide D. Phenoxybenzamine followed by propanolol

E. Lisinopril A 26 old gravida 3 para 1 + 1 is found to have a blood pressure of 150/100mmHg at 30 weeks gestation on routine antenatal screening. Choose the SINGLE most useful medication. A. Timetaphan camsilate B. Terazosin C. Methyldopa D. Imipramine followed by propanolol E. Verapamil A 45 year old man has been treated for panic attacks by his GP for over 6 months without much improvement. He complains of excessive sweating, flushing and diarrhea. On examination he is found to have a blood pressure of 160/110mmHg. In the outpatient clinic the following day he is found to have a glycosuria and a blood pressure of 130/80mmHg. Choose the SINGLE most useful medication. A. Nifedipine B. Phenoxybenzamine followed by propanolol C. Propanolol D. Sodium Nitropruside E. Lisinopril A 25 year old woman has palpitations, diarrhea, weight loss anxiety and insomnia increasing over the last six weeks. She has a pulse rate of 120 beats/minute and a fine tremor of her hands. Choose the Single most appropriate management. A. 24 hour electrocardiogram (ECG) monitoring B. Adenosine or Verapamil C. Amiodarone D. Thyroid function tests E. Atenolol A 30 year old man who has asthma experiences palpitations when his asthma worsens. During a recent attack he has a regular pulse rate of 130 beats/minutes despite a peak expiratory flow rate (PEFR) of 400l/minute. Choose the Single most appropriate management. A. Cardioversion B. Digoxin C. Review of medication D. Lifestyle advice E. Relaxation exercises A 64 year old woman develops a supraventricular tachycardia 24 hours after admission to a coronary care unit. Although her blood pressure is maintained, chest pain recurs. She does not respond to carotid massage and Valsalva maneuver. Choose the Single most appropriate management. A. Adenosine or verapamil B. Thyroid function tests

C. Verapamil D. 24 hour electrocardiogram E. Amiodarone A 50 year old man who smokes 40 cigarettes a day and drinks more than 36 units of alcohol per week describes episodic racing of the heart. Examination is normal and a 24 hour electrocardiogram (ECG) monitoring is normal. Choose the Single most appropriate management. A. Atenolol B. Cardioversion C. Digoxin D. Relaxation Exercises E. Lifestyle advice An 89 year old man with ischaemic heart disease gives a four week history of shortness of breath, peripheral oedema and general weakness. His apex rate is 130 beats/minutes and his blood pressure is 120/80 mmHg. Choose the Single most appropriate management. A. Review of medication B. Digoxin C. Thyroid function tests D. Verapamil E. 24 hour electroicardiogram (ECG) monitoring An 80 year old woman suffers repeated drop attacks. N ECG reveals ventricular hypertropiv. Left axis deviation, artrial ectopic and artrial tachycardia. Choose the most likely diagnosis for the ECG. A. Valve defect B. Digoxin Toxicity C. Myocarditis D. Dextrocardia E. Wolf-parkinson-white syndrome An elderly man is tired and nauseous. On examination of his ECG traces you find deep waves an elevated ST segment and T wave inversion. Choose the most likely diagnosis for the ECG. A. ventricular aneurysm B. Valve defect C. Recent myocardial infarction D. Hypothyroidism E. Complete heart block A 56 year old woman is drowsy and confused. Her ECG findings are a profound bradycardia, absent P waves, Q waves, tall T waves and a long QT interval. Choose the most likely diagnosis for the ECG. A. Hypokalaemia B. Sick sinus syndrome C. Pericarditis D. Digoxin toxicity

E. Hyperkalaemia A 65 year old man has a irregular pulse. His ECG shows a saw-tooth pattern. The QRS complexes are irregularly spaced. Choose the most likely diagnosis for the ECG. A. Myocarditis B. Digoxin toxicity C. Dextrocardia D. Wolf Parkinson white syndrome E. Ventricular aneurysm A patients ECG shows bradycardia, a prolonged PR interval, and ventricular ectopics. Choose the most likely diagnosis for the ECG. A. Valve defect B. Recent myocardial infarction C. Digoxin toxicity D. Complete heart block E. Hypertension A 46 year old woman is found to have blood pressure of 152/104 mmHg on three separate occasions. She is an ex-smoker and her body mass index (BMI) is 23, she admits to drinking 50 units of alcohol per week. Choose the single most effective preventive measure. A. Alcohol reduction B. Angiotensin converting enzyme (ACE) inhibitor C. Anticoagulant D. Beta blocker E. Exercise A 38 year old Asian woman has 1 type 1 diabetes. Her blood pressure today is at 135/88 mmHg and she has micro albuminuria. Choose the single most effective preventive measure. A. Fish oil B. Hormone replacement therapy (HRT) C. Wt reduction D. Smoking cessation E. Angiotensin converting enzyme (ACE) inhibitor A 50 year old woman presents for review of her hypertension. She is well controlled with a blood pressure of 135/88 mmHg. On reviewing her cholesterol, her total cholesterol is 7.8 mmol/l and her high-density lipoprotein (HDL) is 0.8 mmol/l. Choose the single most effective preventive measure. A. Weight reduction B. Stress management C. Stalin D. Alcohol reduction E. Angiotensin converting enzyme (ACE) inhibitor

A 45 year old woman is found to have a blood pressure of 160/95 mmHg on three seperte occasions. She smokes 20 cigarettes a day. Her total cholesterol high-density lipoprotein (HDL) cholesterol ratio is 4. Choose the single most effective preventive measure. A. Anticoagulant B. Smoking cessation C. Beta Blocker D. Exercise E. Fish oil A 30 year old woman, who is otherwise in good health, is found after a routine medical examination to have a blood pressure of 160/100 mmHg on three separate occasions. She is on no medication. Her BMI is 28 and she drinks 2-3 units of alcohol per week. Choose the single most effective preventive measure. A. Hormone replacement therapy (HRT) B. Smoking cessation C. Stalin D. Wt reduction E. Stress management A 70 year old woman presenting with recent onset of dyspnea has signs of cardiac failure. Her electrocardiogram (ECG) shows atrial fibrillation with a ventricular rate of 130 beats/minute. Choose the single most appropriate management. A. Accessory pathway ablation B. Amiodarone C. Digoxin D. Aspirin E. Caffeine exclusion A 22 year old final year university student presents with anxiety related symptoms including palpitations. She does not wish to take medication so close to the time of her examinations. A. Diazepam B. Digoxin C. Direct current (DC) cardio version D. Nifedipine E. Caffeine exclusion A 58 year old woman presents with palpitations and faintness. Her blood pressure is 90/50 mmHg and her ECG shows supraventricular tachycardia (SVT). This has been resistant to adenosine. Choose the single most appropriate management. A. Direct current ( DC ) cardio version B. Propanolol not for asthmatic B C. Valsalva man oeuvre D. Verapamil E. Accesory pathway ablation

A 48 year old man develops recurrent ventricular tachycardia following a myocardial infarction. This arrhythmia has been resistant to initial medical treatment. He has bronchial asthma. During the attacks his cardiovascular system is stable. Choose the single most appropriate management. A. Direct current (DC) cardio version B. Amiodarone C. Aspirin D. Caffeine exclusion E. Diazepam A 32 year old man with Wolf Parkinson-White syndrome presents with recurrent palpitations due to atrial fibrillation. This has been resistant to all drug treatments. Choose the single most appropriate management A. Digoxin B. Accessory pathway ablation C. Direct current (DC) cardio version D. Nifedipine E. Propanolol not for asthmatic B A 67 year old man complains of a retrosternal chest pain associated with increased sweating lasting 45 minutes. He is recovering from pancolectomy from serve ulcerative colitis pain. Choose the SINGLE most useful investigation. A. Chest X-ray B. Abdominal ultrasound C. Echocardiography D. ECG E. Computed tomography (CT) scan of the abdomen A 67 year old man is recovering form laparoscopic cholecystectomy. He is tachypnoeic and is found to have a tener abdomen. He complains of a cough associated with chest pain. Choose the SINGLE most useful investigation. A. Serum amylase B. Coelic axis angiography C. Sigmoidoscopy D. Barium enema E. Chest x-ray Four hours after surgery to repair a ruptured abdominal aneurysm, a 78 year old woman complains of difficulty in breathing and serve abdominal pain radiating to her back. Her blood pressure is 100/70mmHg. Choose the SINGLE most useful investigation. A. double contrast enema B. Laparotomy C. Chest x-ray D. Abdominal ultra sound E. Computed tornography (CT) scan of the abdomen

A 34 year old woman presents with abdominal pain, vomiting and constipation. She has a total abdominal hysterectomy 3 weeks ago. Choose the SINGLE most useful investigation. A. Echocardiography B. ECG C. Chest x-ray D. Serum amylase E. Coelic axis angiography What is the single most likely cause of hypertension for overproduction of catecholamines. A. Analgesic nephropathy B. Phaeochromocytoma C. Chronic glomerulonephritis D. Chronic pyelonephrits E. Coarctation of the aorta What is the single most likely cause of hypertension for autosomal dominant inheritance. A. Polycystic disease of the kidney B. Cushings syndrome C. Conns syndrome D. Diabetes mellitus (DM) E. Gout What is the single most likely cause of hypertension for overproduction of aldosterone. A. Conns syndrome B. Medullary sponge kidney C. Phaeochromocytoma D. Polycystic disease of the kidney E. Analgesic nephropathy What is the single most likely cause of hypertension for deposition of antibody complexes in the glomerular basement membrane. A. chronic pyelonephrits B. coarctation of the aorta C. conns syndrome D. Chronic glomerulonephrits E. Cushings syndrome A 67 year old man with a history of rheumatic heart disease complains of dysnoea. On examination his JVP is found to be raised with a large a wave. No cannon waves were visible. Choose the single most likely cause of a raised JVP. A. Cardiomyopathy B. Essential Hypertension C. Ischaemic heart disease D. Osteoarthrosis E. Pulmonary hypertension

A 43 year old man with a chronic history of cough and weight loss complains of dysnoea. His JVP raised with a pattern showing an abrupt x and y descent. A pericardial knock was clearly audible on auscultation. Choose the single most likely cause of a raised JVP. A. Rheumatoid arthritis B. Cardiomyopathy C. Tuberculosis D. Essential hypertension E. Ischaemic heart disease A 54 year old woman with a 2 year history of symmetrical Joint pains presents with a 3 month history of dysponoea and cough is found to a raised JVP. Choose the single most likely cause of a raised JVP. A. Pulmonary Hypertension B. Osteoarthrosis C. Tuberculosis D. Rheumatoid Arthritis E. Cardiomyopathy A 32 year old women presents with hypertension. She has loin discomfort and bilaterally palpable kidneys. Choose the single investigation most likely to indicate a cause for hypertension. A. 24 hour urinary free cortisol concentration B. 24 hour urinary metanephrines concentration C. Autoantibody screen D. Ultrasound scan of the abdomen E. Plasma aldosterone concentration A 45 year old woman presents with weight gain 7 kg over nine months. She has developed acne and is bruising more easily. She is obese, hypertensive and plethoric. Choose the single investigation most likely to indicate a cause for hypertension. A. 24 hour urinary free cortisol concentration B. Radionuclide reno gram C. Serum calcium concentration D. Serum Cortisol concentration E. Serum growth hormone concentration A 55 year old man is referred following a visit to the optician. He has blood pressure of 210/110 mmHg with hypertensive retinopathy but no other abnormalities. His serum potassium is 2.9 mmol/l. He is on no medication. A. Ultrasound scan of the pelvis B. 24 hour urinary free cortisol concentration C. Plasma aldosterone concentration D. Autoantibody screen E. Radionuclide reno gram

A 56 year old man complain of palpitation. He reports 2 episodes of sudden loss of consciousness in the past 2 weeks. 24 hour ECG recording shows episodes of tachycardia with interviewing periods showing a prolonged OI interval. Choose the SINGLE most likely diagnosis. A. Ventricular ectopics B. Ventricular fibrillation C. Atrial fibrillation D. Ventricular tachycardia E. Torsade de pointes An obese 55 year old man with a 2 year history of palpitations is brought to the accident and emergency department unconscious. He is pulses and his respiration is progressively becoming shallower. The ECG shows disorganized complexes. Choose the SINGLE most likely diagnosis. A. Complete heart block B. Ventricular fibrillation C. Phaeochromocytoma D. Wolf Parkinson white syndrome E. Wenckebach phenomenon A 45 year old man with a history of palpitations complains of difficulty in breathing associated with chest pain. His ECG tracing shows a tachycardia of 100 beast/minute and a wide QRS complex, which begins with a slur. Choose the SINGLE most likely diagnosis. A. Wenckebach phenomenon B. Torsade de points C. Wolf Parkinson white syndrome D. Diabetic neuropathy E. Ventricullar ectopics A 33 year old women with a history of weight loss despite an increased appetite complains of palpitations and diarrhea. Choose the SINGLE most likely diagnosis. A. Ventricular ectopics B. Ventricullar fibrillation C. Atrial fibrillation D. Ventircular tachycardia E. Complete heart block A 52 year old man presented with serve chest pain. An acute myocardial infarction was confirmed. Four days after admission he develops acute breathlessness. He is tachypnoeic, a fabric and has a raised jugular venous pressure (JVP) and scanty, bilateral basal lung crackles. Electrocardigram (ECG) shows no new changes. Choose the SINGLE most likely diagnosis. A. Pleaural effusion B. Pneumonia C. Pneumothorax D. Pulmonary edema

E. Pulmonary embolism A 65 year old lady in cardiac failure wants long term treatment for her condition. Echocardiography shows global hypokinesia and loss of contractility. Choose the SINGLE most appropriate management strategy. A. ACE inhibitors B. Heart transplant C. Aortic valve replacement D. Thiazide diuretics E. IV furosemide A 45 year old man with suspected alcoholic has biventricular cardiac failure. He has deranged liver function tests. Choose the SINGLE most appropriate management strategy. A. Nitrates (oral) B. Thiamine IV C. Nitrates IV D. Pericardiocentesis E. ACE inhibitors A 49 year old man with suspected heart failure has a blood pressure of 90/60mmHg and pulse rate of 110 beats/minute. Chest X-ray shows a huge globular heart. Choose the SINGLE most appropriate management strategy. A. Pericardiocentesis B. ACE inhibitors C. Heart transplant D. Aortic valve replacement E. Thiazide diuretics A 16 year old boy is examined and found to have a severe congestive cardiac failure. Choose the SINGLE most appropriate management strategy. A. Nitrates (oral) B. Thiamine IV C. Nitrates IV D. Pericardiocentesis E. IV furosemide A 42 year old man with cardiac failure is found to have a palpable thrill in the right second intercostal space, which radiates to the neck. Choose the SINGLE most appropriate management strategy. A. ACE inhibitors B. Heart transplant C. Thiazide diuretics D. Aortic valve replacement E. Thiazide diuretics

A 25 year old house wife develops lassitude, breathlessness, purulent sputum and palpitations over a 24 hour period. She has a pulse rate of 88 beats/minute. Electrocardiogram (ECG) shows sinus rhythm. Choose the SINGLE most appropriate management strategy. A. Blood glucose concentration B. Cardiac enzymes C. Chest x ray D. Echocardiogram E. Serum urea and electrolytes concentration A 45 year old house wife presents with a history of weight loss over 12 months she has also noticed that she loses her temper easily. She has a regular pulse rate of 60 beats/ minute. Her ECG shows sinus rhythm. Choose the SINGLE most appropriate management strategy. A. Thyroid auto- antibodies B. 24 hour ambulatory taped electrocardiogram ECG C. Thyroid functions test D. Blood glucose concentration E. Cardiac enzymes A 60 year old man is referred to out-patient with frequent episodes of breathlessness and chest pin associated with an irregular heartbeat. He has a regular pulse rate of 60 beats/ minute. His EGC shows sinus rhythm. Choose the SINGLE most appropriate management strategy. A. 24 hour ambulatory taped electrocardiogram ECG B. Blood glucose concentration C. Cardiac enzymes D. Chest x ray E. Echocardiogram A 35 year old women has woken up five times in the previous month with a feeling of thumping in the chest. On sitting up for about two minutes and taking a few deep breaths the sensation subsides over a further minute. Her ECG shows sinus rhythm. Choose the SINGLE most appropriate management strategy. A. Blood glucose concentration B. Cardiac enzymes C. Chest x ray D. Echocardiogram E. Serum urea and electrolytes concentration A 25 year old footballer is examined by his GP and found have pulse rate of 50 beats/minutes. He is otherwise well. Choose the SINGLE most likely diagnosis. Choose the SINGLE most likely diagnosis. A. Atrial flutter B. Atrial fibrillation C. Ventricular tachycardia D. Ventricular Extrasystoles (ectopics) E. Sinus bradycardia

A 56 year old man, post myocardial infarction in ITU, is found to have a pounding heartbeat which then disappeared spontaneously. The patient remains conscious. Choose the SINGLE most likely diagnosis. A. Heart block B. Sinus tachycardia C. Supraventricular tachycardia D. Blood loss E. Ventricular tachycardia A 60 year old man is found to have an irregularly irregular pulse, with a rate of 110 beats/minute. Choose the SINGLE most likely diagnosis. A. Wenckebachs phenomenon B. Atrial flutter C. Atrial fibrillation D. Ventricular tachycardia E. Sinus bradycardia A 70 year old man, post myocardial infarction is found to have a regular pulse, with a rate of 110 beats/minute. Choose the SINGLE most likely diagnosis. A. Atrial Fibrilation B. Supraventricular tachycardia C. Sinus bradycardia D. Complete heart block E. Atrial flutter A 55 year old man with palpations is treated with a carotid massage. He now has no other complaints. Choose the SINGLE most likely diagnosis. A. ventricular extrasystole B. Suptraventricular tachycardia C. Sinus tachycardia D. Wenckebach phenomenon E. Complete heart block Following a road traffic accident, a 26 year old man is brought to the A & E. He is found to have a pulse rate of 120 beats/minute and a blood pressure of 90/50 mmHg A. Atrial flutter B. Supraventricular tachycardia C. Stoke Adams D. Ventricular tachycardia E. Blood loss

A 72 year old man with type 2 diabetes has a body mass index (BMI) of 24 has evidence of left ventricular dysfunction. Choose the SINGLE most effective intervention. A. Beta blockers B. Calcium channel blockers C. Angiotensin converting enzyme inhibitor D. Salt reduction E. Aspirin A 58 year old woman has suffered an uncomplicated acute inferior Myocardial infarction (MI) within the past week. Her blood pressure is 132/78 mmHg. She has a BMI of 23.6 and she has been started on aspirin. A recent cholesterol measurement was reported as 4.7 mmol/l. Choose the SINGLE most effective intervention. A. Simvastatin B. Aspirin C. Calcium channel blockers D. Thiazide diuretics E. Loop diurectics A 74 year old woman has a blood pressure of 172/80 mmHg. She has a BMI of 21.6 is a non smoker and shows no evidence of end organ damage. Choose the SINGLE most effective intervention. A. Loop diuretics B. Thiazide diuretics C. Beta blockers D. Angiotensin converting enzymes E. Weight reduction A 47 year old woman has a BMI of 36.4 and a blood pressure of 158/98 mmHg. She is a non smoker and has a total cholesterol of 5.1 mmol/l. Choose the SINGLE most effective intervention. A. Weight loss B. Statins C. Salt reduction D. Angiotensin converting enzymes E. Aspirin A 56 year old woman has a strong family history of heart disease. She takes daily aspirin. Her blood pressure is 130/75 mmHg and her total cholesterol level is 7.8 mmol/l. Choose the SINGLE most effective intervention. A. Angiotensin converting enzymes B. StatinsElectrocardiogram C. Approved exercise programme

D. Smoking cessation E. Weight reduction

A 70 year old man has had a fever and general malaise for a day. He also complains of a cough and is found to have stony dullness on percussion of his right lung base. Choose the SINGLE most appropriate investigation. A. Electrocardiogram B. Exercise ECG C. Chest X-ray D. Sputum culture E. MRI chest A 50 year old man who has just returned to the UK from Australia by air complains of chest pain and breathlessness. Choose the SINGLE most appropriate investigation. A. Verntilation perfusion scan B. Electrocardiogram C. Exercise ECG D. Cardiac enzymes E. CT scan of the chest A tall, thin 23 year old man has sudden chest pain and breathlessness while cycling. Choose the SINGLE most appropriate investigation. A 45 year old manual labourer presents with a 2 hour history of central chest pain. He is found to have a normal ECG. Choose the SINGLE most appropriate investigation. A. Sputum culture and sensitivity B. Chest X-ray C. MRI chest D. CT chest E. Electrocardiogram An obese 52 year old man has episodic chest epigastric pain, particularly at night. Choose the SINGLE most appropriate investigation. A. Chest X-ray B. Cardiac enzymes C. Gastroesophageal endoscopy D. Cardiac enzymes E. Exercise ECG A 34 year old man complains of severe epigastric chest pain, relieved by eating food. Choose the SINGLE most appropriate investigation. A. Gastroscopy with biopsy B. Oesophago-gastro-duodenoscopy

C. Chest X-ray D. MRI abdomen E. CT scan chest A 70 year old man complains of a dull epigastric pain and weakness. He has lost considerable weight. Choose the SINGLE most appropriate investigation. A. Electrocardiogram B. Exercise ECG C. Chest X-ray D. Gastroscopy and biopsy E. Duodenogastroscopy A 45 year old manual worker present with 2 hour history of chest pain radiating to left arm. ECG is normal. A. Chest X-ray B. CT chest C. Exercise ECG D. Electrocardiuogram