1) A 52-year-old man is brought to the emergency department for evaluation of fever, chills, and

malaise. Cardiopulmonary examination reveals a new holosystolic heart murmur that radiates
toward the axilla. Blood cultures are obtained, and the patient undergoes transesophageal
echocardiography. The ultrasound probe is placed in the midesophagus facing anteriorly, and
the cardiac chambers are interrogated.
Which of the following chambers is closest to the probe?
a) Left atrium
b) Left ventricle
c) Right atrium
d) Right ventricle
.

2) Location of SA node in heart ?

a) Junction of left atrium and atrial appendage
b) Left atrium near the opening of pulmonary veins
c) Right atrium near the opening of inferior vena cava
d) Right atrium near the opening of superior vena cava
e) Right atrium near the septal cusp of tricuspid valve
.

3) A 59-year-old African American male presents to the emergency room with crushing chest
pain, sweating, and lightheadedness. His blood pressure is 90/60 mm Hg and his heart rate is
48 beats per minute. Electrocardiogram (ECG) shows sinus bradycardia and ST segment
elevation in leads II, III, and aVF. Occlusion of which of the following coronary arteries is most
likely responsible for this patient's symptoms?
a) Left main coronary artery
b) Left anterior descending artery
c) Left circumflex artery
d) Right coronary artery
e) Intramural arteries
.

4) A 21-year-old man comes to the office due to multiple episodes of syncope. The patient has no
chest discomfort or dyspnea. He has no known medical problems and does not use tobacco,
alcohol, or illicit drugs. The patient is a computer analyst and leads a mostly sedentary lifestyle.
He reports that several family members have died of sudden cardiac death. Genetic analysis
reveals an ion channel defect. Due to the defect, cardiac cells show decreased outward
potassium flow and resultant prolongation of the action potential. Which of the following is the
most likely consequence of this patient's disease?
a) Abnormal anatomic communication between cardiac chambers
b) Asymmetric hypertrophy of the left ventricle
c) Ischemic myocardial necrosis followed by scarring
d) Left ventricular dilation and systolic dysfunction
e) Ventricular tachycardia and sudden death
.
5)
A 45-year-old man comes to the emergency department because of severe chest pain,
diaphoresis, and palpitations. The patient dies two hours after the onset of his symptoms.
Autopsy reveals 100% occlusion of the left anterior descending artery. At the time of the
patient's death, light microscopy of the affected myocardium would most likely demonstrate
which of the following?

a) Edema and punctate hemorrhages

b) Myocyte hypereosinophilia
c) Dense interstitial neutrophil infiltrate
d) Extensive macrophage phagocytosis of the dead cells
e) Fibrovascular granulation tissue with neovascularization
f) Dense collagen scar
g) Normal myocardium
.

6) Stable angina is feature of which of the following pathology?

a) Atherosclerotic plaque obstructing 50% of the coronary artery lumen, no thrombus
b) Atherosclerotic plaque obstructing 80% of the coronary artery lumen, no thrombus
c) Ruptured atherosclerotic plaque with fully obstructive thrombus
d) Significant coronary artery vasospasm causing flow obstruction
e) Ulcerated atherosclerotic plaque with partially obstructive thrombus
.

7) A 56-year-old man comes to the clinic for a routine checkup. Medical history includes
hypertension, type 2 diabetes mellitus, hyperlipidemia, and mild intermittent asthma. The
patient currently takes no medications and has not seen a physician in 7 years. He reports
feeling well. Blood pressure is 152/101 mm Hg and pulse is 87/min. Waist circumference is 110
cm (43 in). Laboratory results are as follows:
Low-density lipoprotein161 mg/dLFasting blood glucose201 mg/dLHemoglobin A1c7.4%
Which of the following vascular beds is most likely to carry the highest atherosclerotic burden in
this patient?
a) Coronary arteries
b) Internal thoracic arteries
c) Mesenteric arteries
d) Popliteal arteries
e) Renal arteries
.

8) After a myo cardial infarction macrophages enters heart tissue at which day?

a) 0-24 hours
b) 3-14 days
c) 2 weeks to several months
d) 1-3 days
.
 9) A 45-year-old woman collapses and dies despite appropriate resuscitation efforts. Prior to the
episode, she reported substernal chest pressure brought on by exertion, as well as episodes of
palpitations and light-headedness. An autopsy is performed, and myocardial histology is shown
myocardial disarray.Which of the following is the most likely cause of this woman's condition?
a) Genetically mediated abnormality in cell junctions
b) Genetically mediated abnormality in ion channels
c) Genetically mediated abnormality in sarcomeres
d) Infiltrative disease due to deposition of amyloid fibrils
e) Infiltrative disease due to deposition of granulomas
.

10) In Hypertrophic cardio myopathy mutation of genes takes place which codes for ?
a) Beta-myosin heavy chain
b) Dystrophin
c) Fibrillin-1
d) Membrane potassium channel
e) Transthyretin
.

11) A 53-year-old man comes to the emergency department due to fever and progressive
weakness over the last 2 weeks. Yesterday, he also developed shortness of breath. The
patient emigrated from Eastern Europe 2 years ago and says he was diagnosed with "heart
disease" in the distant past, but he does not recall any details. He does not use tobacco,
alcohol, or illicit drugs. Despite receiving appropriate medical care, the patient expires during
hospitalization. On autopsy, gross examination of his heart shows large, friable masses on the
mitral valve with extensive destruction of cuspal tissue.
Which of the following is the most likely predisposing factor for this patient's presenting
condition?
a) Myocardial hypertrophy
b) Myocardial thinning and fibrosis
c) Pericardial effusion
d) Rupture of chordae tendineae
e) Valvular inflammation and scarring
.

12) liebman sack endoendocarditis is feature of ?

a) Bacterial endocarditis
b) Churg-Strauss syndrome
c) Granulomatosis with polyangiitis
d) Systemic lupus erythematosus
e) Thromboangiitis obliterans
.

13) In atrial fibrillation the ecg finding is?

a) Irregularly irregular rate an rhythm
b) Regular rhythm
c) St segment elevation
d) T wave inversion
.
14) Pericardium is inervated by?
a) Accessory nerve
b) Splancnic nerve
c) Cranial nerve
d) Phrenic nerve
.

15) A 4-month-old boy is brought to the cardiology clinic by his parents for follow-up of tetralogy of
Fallot. The diagnosis was made during routine antenatal sonography, and the pregnancy and
delivery were otherwise uncomplicated. The patient has been seen frequently in the clinic and
has had no cyanosis, respiratory distress, or difficulty feeding. The parents become concerned
when their son's surgical plan is discussed because he does not have the clinical signs
demonstrated by other children with tetralogy of Fallot. Which of the following is the greatest
determinant of symptom severity in this condition?
a) Degree of aortic valve insufficiency
b) Degree of right ventricular outflow tract obstruction
c) Degree of tricuspid valve insufficiency
d) Presence of associated pulmonary parenchymal malformations
e) Size of ventricular septal defect
.

16) A term newborn is evaluated for cyanosis immediately after birth. On examination, the patient's
oxygen saturation is 70% in all 4 extremities and does not change despite 100% oxygen
administration. The lungs are clear to auscultation and there are no heart murmurs or gallops.
Peripheral pulses are normal. A chest radiograph reveals clear lungs and a normal cardiac
silhouette but a narrowed mediastinal shadow. Which of the following is the most likely cause
of cyanosis in this patient?
a) Impairment of alveolar-capillary gas diffusion
b) Impairment of left ventricular contractility
c) Inability of hemoglobin to bind oxygen
d) Mismatch of pulmonary ventilation and perfusion
e) Parallel pulmonary and systemic circuits
.

17) Increase in stroke volume id due to decrease in which of the following parameters?
a) Contractility
b) Preload
c) Afterload
d) Increase sympathetic activity
.

18) Electrical alterans with muffled heart sound is feature of?

a) Heart failure
b) TOF
c) VSD
d) Cardiac temponade
.
19) ANP and BNP is going to increase which of the following parameters ?
a) Acid content of the urine
b) Glomerular filtration rate
c) Renal sodium reabsorption
d) Renal water reabsorption
e) Vascular resistance
.

20) A 44-year-old man with progressive dyspnea is diagnosed with dilated cardiomyopathy.
Despite optimal medical therapy, he continues to have symptoms and disease progression is
noted. He undergoes cardiac transplantation after a suitable donor becomes available.
Permission is obtained from the patient to study his diseased heart for intracellular calcium
regulation. Microelectrodes placed into cardiac muscle cells detect a rapid decrease in
cytoplasmic calcium level immediately preceding relaxation. Which of the following proteins is
most likely responsible for the observed change in electrolyte levels?
a) A. Calmodulin
b) B. Na+/Ca2+ exchanger
c) C. Ryanodine receptors
d) D. Troponin C
e) E. Voltage-dependent calcium channels
.