The-clinical features of acute myocardial infarction inc-tide

a) nausea and vomiting

b) breathlessness and angor animi

c) hypotension and peripheral cyanosis 4

d) sinus tachycardia or sinus bradycardia

e) absence of any symptoms or physical signs

Findings consistent with an acute anterior myocardial Infarction Include

a) hypertension and raised jugular venous pressure

b) rumbling low-pitched diastolic murmur at the cardiac apex

c) ST elevation > 2 mm in leads II, III and AVF on ECG

d) gallop rhythm and soft first heart sound

e) an increased serum gamma-glutamyl transferase activity > 306 e­

Drug therapies which improve the long-term prognosis after myocardial infarction include

a) aspirin

b) nitrates

c) calcium antagonists

d) ACE inhibitors

e) B-blockers

Recognised causes of secondary hypertension include

a) persistent ductus arteriosus

b) primary hyperaldosteronismi

c) acromegaly

d) oestrogen-containing oral contraceptives

e) thyrotoxicosis

Complications of systemic hypertension include

a) retinal microaneurysms

b) dissecting aneurysm of the ascending aorta

c) renal artery stenosis

d) lacunar strokes of the internal capsule

e) subdural haemorrhage

Accelerated phase or malignant hypertension Is suggested by hypertension and

a) a loud second he art sound

b) a heaving apex beat

c) headache

d) retinal soft exudates or haemorrhages

e) renal or cardiac failure

Important explanations for hypertension refractory to medical therapy include

a) poor compliance with drug therapy

b) inadequate drug therapy

c) phaeochromocytoma

d) primary hyperaldosteronism

e) renal artery stenosis

Clinical features compatible with.hypertrophic cardlomyopathy Include

a) family history of sudden death

b) angina pectoris and exertlonal syncope

c) jerky pulse and heaving apex beat

d) murmurs suggesting both aortic stenosis and mitral regurgitation

e) soft or absent second heart sound

Typical features of acute pericarditis include

a) chest pain identical to that of myocardial infarction

b) a friction rub that is best heard in the axilla in mid-expiration

c) ST elevation on, the ECG with upward concavity

d) elevation of the serum creatine kinase

e) ECG changes that are only seen in the chest leads

The typical features of constrictive pericarditis Include

a) severe breathlessness

b) a normal chest X-ray

c) a previous history of tuberculosis

d) tachycard'a and a loud third heart sound

e) marked elevation of the jugular venou pressure with a steep x and y descent

In atrial septa) defect

a) the lesion is usually of secundum type

b) the initial shunt is right to left.

c) splitting of the second heart sound Increases in expiration

d) the ECG typically shows right bundle branch block

e) surgery should be deferred until shunt reversal occurs

32. In right-to-left shunt reversals of congenital heart disease (Elsenmenger's syndrome)

a) pulmonary, arterial hypertension is usually present

b) closure of the underlying lesion produces symptomatic relief

c) the chest X-ray is typically normal

d) central cyanosis and finger clubbing are often present

e) physical signs of the underlying lesion parsist unchanged

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