Dr.

PP Y1 MET CVS 2024

CVS
Anatomy
UM 2
1. Which of the following comprises the large portion of the sternocostal surface of the heart in chest X‐ray PA view?
A. Base of the heart
B. Left atrium
C. Left ventricle
D. Right atrium
E. Right ventricle

Ans: E

2. Which part of the heart contributes to the apex of the heart?

A. Left atrium
B. Left auricle
C. Left ventricle
D. Right atrium
E. Right ventricle

Ans: C

3. During cardiac catheterization of the 6‐year‐old child, the radiologist noticed that the contrast medium released
the arch of aorta is visible immediately in the left pulmonary artery. What is the most likely examination on the
finding?
A. Atrium septal defect
B. Mitral regurgitation
C. Patent ductus arteriosus
D. Patent ductus venosus
E. Ventricular septal defect

Ans: C

4. A unit of 4 parallel structures lie posteriorly to arch of aorta in mediastinum. Which of the following structure is
not included in that unit?
A. Left Recurrent laryngeal nerve
B. Left vagas nerve
C. Oesophagus
D. Thoracic duct
E. Trachea

Ans: B

5. Which of the following pulses can be palpated medial to biceps brachii tendon in the cubital fossa?
A. Axillary pulse
B. Brachial pulse
C. Palmar pulse
D. Radial pulse
E. Ulnar pulse

Ans: B

6. A 10‐year‐old boy falls off his bike, has difficulty in moving his shoulder, and is brought to the emergency
department. His radiograph and angiography reveal a fracture of the surgical neck of his humerus and bleeding from
the point of the fracture. Which of the following arteries is most likely injured as a result of this accident?
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Dr. PP Y1 MET CVS 2024
A. Anterior circumflex humeral artery
B. Axillary artery
C. Posterior circumflex humeral artery
D. Profunda brachii artery
E. Superior Ulnar collateral artery

Ans: C

UMM
7. What is the branch of external carotid artery?
A.Facial artery
B.inferior thoracic artery
D.
E.

8. The heart
A. has its interventricular supplied mainly by the right coronary artery
B. has mitral valve which posses three
C. right border formed by right ventricle
D. SA node lies at upper sulcus terminalis
E. Lies in anterior mediastinum formed by fibrous and serous pericardium

9. Which of the following is the branch of external carotid artery?

A. Facial artery
B. Inferior Thyroid artery
C. Internal thyroid artery
D. Suprascapular artery
E. Vertebral Artery

10. Regarding to the descending part of thoracic aorta

A. it is the beginning from the arch of aorta
B. at the level of lower border of TV 4
C. it is in middle mediastinum
D. passes through the abdomen at TV 10

UMTGI
11. A 38‐year‐old men come clinic weakness and shortness of breath. He rapid pulse after flight the stairs. Which of
the following retain normal Mitral valve function?
Ans; maintain regurgitation of blood during ventricular relaxation

12. A 63‐year‐old man experiences myocardial infarction and found blockage of LAD left aortic descending artery.
Which region of heart is affected by blockage of left aortic descending artery
A. Interventricular septum
B. Left atrium
C. Left ventricle
D. Right atrium
E. Right ventricle

13. 19 years old boy reached emergency department and agiogram showed bleeding from vein by posterior
intravenous vein. Which vein is most affected from the following?
A. Great venous vein
B. small venous vein
C. middle venous vein

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Dr. PP Y1 MET CVS 2024
14. A 3‐year‐old male patient presents with a clinically significant atrial septal defect (ASD). The ASD usually results
from incomplete closure of which of the following structures?
A. Foramen ovale
B. Ligamentum arteriosum
C. Ductus arteriosus
D. Sinus venarum
E. Coronary sinus

15. artery supply foregut and stomach

a. coeliac trunk
b. superior mesenteric
c. inferior mesenteric

16. A patient bleeding from shoulder secondary to a knife wound is in fair bcz there is vascular anastomosis around
the shoulder, which of the follow artery is most likely a direct branch of axillary artery that is involved.
A. Dorsal artery
B. Subscapular
C. suprascapular
D. Thyrocervical
E. transverseceeical

17. Following the severe blunt trauma to the side of the head develops pseudoaneuryam.which external carotid
artery involve in this complication.
A. Ascending pharyngeal artery
B. Maxillary artery
C. Posterior auricular artery
D. Superficial temporal artery
E. Superior thyroid artery

Physiology
UM 2
1. On examining jugular venous pressure, which of the following vessels will be inspected?
A. Left internal jugular vein
B. Right external jugular vein
C. Right brachiocephalic vein
D. Left external jugular vein
E. Right internal jugular vein
Ans: E

2. A 40 years old man undergo Electrocardiography for regular medical checkup. The propagation of electrical
impulses is highest in which of the cardiac part?
A. Atrial muscle
B. Atrioventricular node
C. SA node
D. Purkinje fibres
E. Ventricular muscle
Ans: D

3. A ventricular depolarization wave when travelling 60° in the frontal plane there will cause a large positive
deflection in which of the following lead?
A. aVL
B. aVR
C. lead I
D. lead II
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E. lead III
Ans: D

4. Third heard sound is most likely to occur at which phase of the cardiac cycle?
A. Atrial systole
B. Early of diastole
C. Just after systole
D. Mid third of diastole
E. Start of systole
Ans: D

5. Which one of the following is associated with the etiology of the abdominal aneurysm?
A. Atherosclerosis
B. Fibromuscular dysplasia
C. Hypertension
D. Trauma
E. Vasculitis
Ans: A

6. A 55‐year‐old man with elevated blood pressure is given the drug which dilate the vessels. Which of the following
is increased after taking the drug?
A. Afterload
B. Blood volume
C. Stroke volume
D. Myocardial contractility
E. Total peripheral resistance
Ans: C

7. Which cardiac parameters best describe a negative‐inotropic effect on a Frank‐Starling curve?

A. Decreased stroke volume for a given end‐diastolic volume
B. Decreased stroke volume for a given sarcomere length
C. Increased end‐diastolic volume for increased venous return
D. Increased stroke volume for a given end‐diastolic volume
E. Increased stroke volume for increased venous return
Ans: A

8. Which of the following vessels has normally about 65% of total blood volume?
A. Arteries
B. Arterioles
C. Arteriovenous anastomoses
D. Capillaries
E. Veins
Ans: E

9. Vascular tone is regulated by the balance between vasoconstrictors and vasodilators signals. Increased local
concentration of which of the followings causes increased vascular tone?
A. Angiotensin II
B. Atrial natriuretic peptide
C. Beta agonists
D. Hydrogen ion
E. Nitric oxide
Ans: A

10. Which of the following receptor mediates slowing of the heart rate?
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A. M1 muscarinic receptor
B. M2 muscarinic receptor
C. Alpha 1 receptor
D. Beta 1 receptor
E. Beta 2 receptor
Ans: B

11. Coronary blood flow is mainly regulated by

A. Autonomic nerve
B. Diastolic aortic pressure
C. Heart rate
D. Hormones
E. Local mechanisms
Ans: E

12. A 60‐year‐old woman with myocardial infarction comes to her physician for routine checkup. She undergoes
echocardiogram. Which measurement would be the best index of preload in this woman?
A. Cardiac output
B. End systolic volume
C. End diastolic volume
D. Mean aortic pressure
E. Stroke volume
Ans: C

13. Flow of fluid through lymphatic is decreased if there is increased in

A. Capillary oncotic pressure
B. Capillary permeability
C. Capillary pressure
D. Central venous pressure
E. Interstitial protein concentration
Ans: D

UMM
14. According to Bernoulli's principle, how does increase in velocity of blood flow affect the pressure within the
blood vessel?
1.causes pressure fluctuation
2.increase pressure
3.No change pressure
4. Decrease pressure

15. Which of the following decreases heart rate through parasympathetic activation?
A. Exercise
B. stimulation of vagus nerve
C.
D.
E.

16. What indicate ventricular muscle depolarization

1.p wave
2.QRS complex
3.PR intervall
4.T wave
5.U wave

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17. Which of the following anatomical structures involved in regulation of blood pressure and
context of hypertension
A.adrenal glands
B.Aortic arch
C. Baroreceptors
D. Carotid Arteries
E.Renal Arteries

18. Role of AV node in cardiac conducting system

A. acts as pacemaker of the heart
B. delay electrical impulse to ensue atrial contracts before ventricle
C. generate action potential with autonomic nervous system influence

19. Which sound appears when semilunar valves are closed

A. Click
B. S1
C. S2
D. S3
E. S4

20. QRS complex

A. Ventricular depolarization
B. Atrial depolarization
C.Ventricular depolarization
D.

21. Which component of Frank‐starling law includes to regulate blood flow?

A)Preload
B)Afterload
C Heartrate
D)Blood viscosity
EJANS

22. Which sound appears when semilunar valves are closed?

A. click
B. 1st sound
C. 2nd sound
D. 3rd sound
E. 4th sound

23. What is the effect of regular isotonic exercise on resting heart rate?
Ans: decrease heart rate

24. What physiological mechanism causes lowering of blood pressure during isometric exercise?
A. decreased heart rate
B. increased cardiac output
C. increased peripheral vascular resistance
D. vasodilatation of peripheral blood vessels

UMTGI
25. blood vessels arranged in circuit, exchange vessels?
A. arteries
B. arterioles
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C. capillaries
D. veins
E. none of these
Ans: C

26. Which is true about cardiac cycle?

A. At heart rate 200 beats per minute, duration of systole is 0.15s
B. At heart rate 70/min, cardiac cycle is 0.8s
C.
D.
E.
Correct‐ A

27. A 40yr old man has a murmur that cease with onset of the second heart sound. Which phase of the cardiac cycle
is the second heart sound heard
A. atrial systole
B. Isovolumetric contraction
C. Isovolumetric relaxation
D. Protodiastole
E. Ventricular ejection
Ans: D

28. Which cardiovascular reflex increase both heart rate and blood pressure?
A. Bainbridge reflex
B. Coronary chemoreflex
C. Lung inflation reflex
D. Oculoreflex
E. Somatoreflex
Ans: E

29. passive ventricular filling

A. a wave
B. c wave
C. v wave
D. x descent
E. y descent
Ans: E

30. Baroreceptor reflex responsible for regulation of blood pressure. Which one of the following compensatory takes
places when arterial blood pressure sudden drop.
A. Decreased contractility
B. Decreased firing rate of vagus nerve
C. Decreased heart rate
D. Decreased sympathetic outflow to the heart
E. Decreased vasopressin secretion
Ans: B

31. During neurosurgery procedure, the patient cerebral blood flow remains constant despite variation in mean
atrial pressure. Which of the following mechanisms maintain this auto regulatory?
A. baroreceptor reflex to maintain overall cardiovascular system
B. Central modulations to sympathetic nervous system activity
C. CNS ischemic response (Cushing reflex) to maintain cerebral blood flow
D. Myogenic response of vascular smooth muscle to changes in vessel wall stretch
E. Systemic activation of renin‐angiotensin‐aldosterone system
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Ans: D

32. About 24L of fluid are filtered through the capillaries, the rate of flow movement is governed by a balance of
starling forces; which of the following statements is true for fluid filtration of the capillary wall of the smooth muscle?
A. hydrostatic pressure of capillary blood is decreasing
B. hydrostatic pressure of capillary blood is increasing
C. hydrostatic pressure of ISF is increasing
D. Oncotic pressure of capillary blood is increasing
E. Oncotic pressure of ISF is increasing
Ans: B

Biochemistry
UM 2
1. During aerobic metabolism in cardiac muscle cell, which of the following process generates a majority of ATP?
A. Increased glycolysis
B. Decreased Glycolysis
C. Fatty acid oxidation
D. Oxidative stress
E. Oxidative phosphorylation
Ans: E

2. In failing myocardium, which metabolic disorder cause mitochondrial dysfunction?

A. Decrease glycolysis
B. Enhance glycolysis
C. Enhance oxidative stress
D. Increased fatty acid oxidation
E. Increased ATP
Ans: C

3. Degradation of TAG to fatty acids and glycerol by the process of lipolysis. The TAG in plasma lipoproteins
hydrolyzed by:
A. Colipase
B. Hormone sensitive lipase
C. Liqual lipase
D. Lipoprotein lipase
E. Pancreatic lipase
Ans: D

4. Most lipids are transferred in the circulation by different types of lipoprotein. Triglycerides are transfer from the
liver to extrahepatic tissues by lipoprotein,
A. Chylomicrons
B. HDL
C. IDL
D. LDL
E. VLDL
Ans: E

5. Apolipoprotein is the protein portion of lipoprotein. HDL has the highest protein content. Which of the following is
not a component of HDL?
A. Apo A1
B. Apo B100
C. Apo C
D. Apo E
E. CETP
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Ans: B

6. A 35‐year‐old woman with serum levels of cholesterol‐700 mg/mL has familial hypercholesterolemia. Which of the
following biochemical effect is correct?
A. IDL receptor
B. LDL receptor
C. Less concentration of HSL receptor
D. More conversion of VLDL to LDL
E. VLDL receptor
Ans: B

UMM
7. HMG‐CoA is a Statin.By inhibiting HMG‐COA reductase,it decreases the cholesterol synthesis.By helping to inhibit
HMG‐CoA reductase, it reduces the risk of cardiovascular disease.HMG CoA not only involved in the synthesis of
cholesterol but also plays in role in ketone bodies. Which of the following sites
occurs cholesterol synthesis?
A.both cytosol and mitochondria
B.Endoplasmic reticulum of all mammalian.
C.Cytoplasm of all nucleated mammalian cells
E. only mitochondria

UMTGI
8. Cholesterol is synthesized from Acetyl CoA by HMG CoA reductase. HMG CoA reductase is regulated by sterol
regulatory binding protein (SRE‐BP). SRE‐BP is regulated by the following mechanism.
A.by phosphorylation
B.by dephosphorylation
C.by cleavage
D. when it joins with SRE element of DNA
E. when it joins cholesterol

9. Which of human serum lipoprotein has the highest cholesterol content?

a. apolipoprotein
b. chylomicrons
c. pre‐B‐HDL
d. beta‐HDL
e. alpha‐HDL

10. Which is the value of LDL cholesterol according to Fried Ewald formula?
A. 120
B.190
C. 200
D. 280
E. 300

11. NO is endothelium derived relaxing factors. Which of the following amino acid is involved in synthesis of NO in
initial step?
A. Arginine
B. Aspartate
C. Glycine
D. Leucine
E. Methionine

Pathology
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Dr. PP Y1 MET CVS 2024
UM 2
1. Which of the following characteristics is true for malignant hypertension?
A. 90% of hypertensive patients lead to death due to severe hypertension.
B. Severe blood pressure elevations, i.e., systolic pressure more than 200 mmHg and diastolic pressure more
than 120 mmHg.
C. Secondary hypertension superimposed on benign hypertension.
D. Severe hypertension, systolic blood pressure more than 200mmHg and diastolic blood pressure more than
120mmHg.
E. Superimposed on heart failure and retinol haemorrhage.
Ans: B

2. Which one of the following mechanisms is a cause regarding hypertension in renal artery stenosis?
A. Reduced blood pressure
B. Reduced renin in angiotensin aldosterone system
C. Decreased glomerular flow
D. ‐
E. Increased vascular resistance in afferent arteriole of glomerular capillary.
Ans: C

3. Which one of the following is non‐modifiable risk factor to cause atherosclerosis?

A. Cigarette smoking
B. Diabetes
C. Hyperlipidemia
D. Hypertension
E. Male gender
Ans: E

4. Which one of the followings is the most sensitive and specific marker?
A. CK MM
B. CK MB
C. CK BB
D. Immunoglobulin
E. Troponin T and Troponin I

Ans: E

5. Gross morphology of Rheumatic Endocarditis

A. Aortic stenosis
B. Aschoff bodies
C. MacCallum plaques
D. Mitral stenosis
E. Verrucae
Ans: C

6. Rheumatic fever is the consequences of Streptococcal throat infection. The pathogenic mechanism of Rheumatic
carditis is:
A. Capsular polysaccharides of microbes
B. Direct invasion of microbes
C. Immunologic cross reactivity
D. Microbial proliferation in the heart
E. Toxigenicity of microbes
Ans: C

7. The term "Cor Pulmonale" refers to

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A. Ischemic heart disease
B. Hypertension
C. Isolated right‐sided heart failure
D. Valvular disease
E. Myocardial disease
Ans: C

8. Elevated jugular venous pressure is commonly associated with which of the following cardiovascular disorder?
A. Aortic stenosis
B. Hypertension
C. Mitral valve prolapses
D. Peripheral artery disease
E. Right‐sided heart failure
Ans: E

9. Which one of the following cell injuries is seen in the various types of shock?
A. Congestion
B. Hypovolemia
C. Hypoxia
D. Impaired nutrients
E. Reduced perfusion
Ans: E

10. Which cytokines does not include in gram negative septicemia?

A. Interleukin 1
B. Interleukin 6
C. Interleukin 8
D. Interferon
E. Tumour necrosis factor
Ans: D

UMM
11.Which type of heart failure is characterized by the inability of heart to relax and fill during diastole?
A. Diastolic heart failure
B. Systolic heart failure
C. High output heart failure
D. Left sided heart failure
E. Right‐sided heart failure
Ans: A

12. Left untreated, one third of hypertensive patients can die of which of the following?
A. Aortic dissection
B. Congestive heart failure
C. ischemic heart disease
D. renal failure
E. stroke
Ans:

13. Biomarker in atherosclerosis and precursor for cardiovascular events

A. BNP
B. Hb A1c
C. Fibrinogen
D. Lipoprotein lipase mediated phospholipase A2
E. Amylase
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Ans: C

14. Major manifestation for acute rheumatic fever is

A. Arthralgia
B. elevated Streptolysin O
C. erythema marginatum
D. increase C reactive protein
E. prolong PR interval
Ans: C

15. With any infarct, which one is the potent leading cause of left‐sided thromboembolism?
A. Mural thrombus in left ventricle
B. Myocardial rupture
Ans: A

16. A reduced stroke volume due to impaired diastolic filling as a consequence of reduced chamber size as well as
reduced compliance of the massively hypertrophied LV. On auscultation, it discloses a harsh systolic ejection murmur
caused by the ventricular outflow obstruction. What’s possible diagnosis?
A. dilated cardiomyopathy
B. HF
C. hypertrophic cardiomyopathy
D. pericarditis
E. restrictive cardiomyopathy
Ans: C

UMTGI
17. Chest pain referred to left arm ECG: ST elevation in lead 2, lead 3, avF reciprocal changes in lead 1 and avL.
Which one?
A. Superior MI
B. Inferior MI
C. Lateral MI
D. Anterior MI
E. Posterior MI
Ans: B

18. A 72‐year‐old man has a history of hypertension and smoking. He came to the emergency department
complaining of sudden tearing abdominal pain. The abscess felt as palpating mass. What is the most likely diagnosis.
A. Abdominal aortic aneurysm
B. Acute myocardial infarct
C. Bowel ...
D. Acute pancreatitis
ANS: A

19. A 55‐year‐old man, comes to emergency department with chest pain radiating to left arm and back for 2 hours
ago. EGG reveals ST elevation and elevation of lead 2,3 and aVF. What is the diagnosis?
Ans: Acute myocardial infarction

35. 50yrs old woman chest pain and no smoke. no past medical and no ST elevation. What pathological changes
occur?
A. microbalant angina
B. Vasospastic coronary
C. Atherosclerosis
Ans:

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Dr. PP Y1 MET CVS 2024
20. 62 year old woman with long standing history of hypertension with gradual worsening renal function. Biopsy
from kidney, thickness, eosinophilia material wall of arterioles.
What is most likely histologic finding?
A. Arthrosclerosis
B. Fibrinoid necrosis
C. Hyaline arteriolosclerosis
D. Hyperplastic Arteriolosclerosis
E. interstitial nephritis
Ans: C

21. 45 years old man came to the hospital with headache and vomiting. Blood pressure‐220/130.What pathologic
changes occur in his kidney?
A. Acute tubular necrosis
B. Chronic glomerulonephritis
C. Flea bitten kidney
D. Granular contracted kidney
E. Renal Artery Stenosis
Ans: C

22.58yrs old woman, RHF, ECG ST elevation, Mitral valves stenosis,

A. Congenital Mitral valves stenosis
B. Degenerate Mitral valves
E. Rheumatic fever induced leaflet thickening and fusion
Ans: E

Pharmacology
UM 2
1. Which of the following drugs is used for hypertensive emergency pregnant woman with eclampsia?
A. Hydralazine
B. Enalapril
C. Diazoxide
D. Prazosin
E. Metoprolol
Ans: A

2. Which is the most appropriate route of Adrenaline administration in anaphylactic shock?

A. Inhalation
B. Intracardiac
C. Intramuscular
D. Intravenous
E. Subcutaneous
Ans: C

3. A 60‐year‐old man noticed that his ankles swollen than usual. 2 weeks ago, he took antihypertensive medication.
Which of the drugs cause the symptoms?
A. Amlodipine
B. Atenolol
C. Propranolol
D. Ramilfem
E. Telmisartan
Ans: A

4. Drug for prophylaxis of vasospastic angina is

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A. Aspirin
B. Atenolol
C. Clopidogrel
D. Metoprolol
E. Verapamil
Ans: E

5. Patients with high serum levels of cholesterol‐270 mg/mL and Triglycerides‐630 mg/dl. Which
hyperlipoproteinemic agents can be chosen?
A. Atorvastatin and Cholestyramine
B. Atorvastatin and Gemfibrozil
C. Evolocumab and Ezetimibe
D. Gemfibrozil and Niacin
E. Simvastatin and Ezetimibe
Ans: B

6. Which of the following drugs is the most appropriate for the prophylaxis of rheumatic heart disease?
A. Amoxicillin
B. Carbenicillin Indanyl
C. Crystalline Penicillin
D. Phenoxymethyl penicillin
E. Procaine Penicillin G
Ans: E

7. A 36‐year‐old woman came to dental clinic for tooth extraction. Post medical reveals that she has been suffering
from mitral stenosis with mild cardiac insufficiency for 3 year. Which of the following antibiotics would be
appropriate to this patient before and after the extraction?
A. Amikacin
B. Amoxicillin
C. Chloramphenicol
D. Norfloxacin
E. Tetracycline
Ans: B

8. In heart failure, which drug would be the choice of short‐term use in Acute Heart Failure, but not the long‐term
use in congestive heart failure?
A. Digoxin
B. Dobutamine
C. Ramipril
D. Spironolactone
E. Enalapril
Ans: B

9. Choose one of the most appropriate drugs which reduces over‐sympathetic activity on myocardium and prolong
life survival in a controlled congestive heart failure patient.
A. Amrinone
B. Carvedilol
C. Digoxin
D. Frusemide
E. Inamrinone
Ans: B

UMM

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Dr. PP Y1 MET CVS 2024
10. A 59 year old man recently exertional angina, heavy smoker suffering from chronic obstructive pulmonary
disease for 15 years and gastroesophageal reflex disease for 3 years. Which of the following drug would be
appropriate to prevent angina attack in this patient?
A. Isosorbide mononitrate
B. Nifedipine
C. Verapamil
D. diltiazem
E. propranolol
Ans: A

11. A 60old man has found third degree heart block. He is taking captopril, frusemide and
digoxin for 2months,condition is well controlled. The physician believe that heart block is due to digoxin
therapy.What is appropriate therapy?
A add atropine
B.add dobutamine
C.stop digoxin
D.start metoprolol
Ans: C

12.42 years old ,staphylococcus endocarditis developed hypertension, tachycardia generalized puruitus ,facial
flushing, 15 mins after IV infusion of antibiotics. Which of the following drugs is most likely to cause patient's
A. ampicillin
B. cefazolam
C. cefepime
D. oxacillin
E. vancomycin

13.52 yr old male, stage 1 hypertension and stage 1 heart failure, which antihypertensive drug?
A)Frusemide and methyldopa
B)Hydrochlorothiazide and verampamil

14. Mechanism of action of gemfibrozil

A. increase triglyceride hydrolysis by lipoprotein lipase
B. bile acid to salt
C. high affinity LDL receptor
Ans: A

15. Best answer with concerning anaphylactic shock

A. adrenaline antagonize histamine by blocking adrenaline receptor
B. adrenaline is the drug of choice
C. corticosteroids give anti‐inflammatory effects within minutes
D. crystalloids like normal saline is drug of fluid in anaphylactic shock
Ans: B

UMTGI
16. 64 years old man, emergency department, prolong hypertension, severe sharp chest pain, which drug should be
given IV to him?
(A) Clonidine and Captopril
(B) Hydralizine and Diazoxide
(C) Hydroclorothiazide and Labetalol
(D) Minoxidil and Nifedipine
(E) Prazosin and —
Ans:

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Dr. PP Y1 MET CVS 2024
17. 62 years old man pruritus swelling of eyelids, nose, lips, hand and feet. The person has been discharged after
acute myocardial infarction. He has been administered with multiple drugs. He noticed the symptoms was come
after the treatment. What is the most likely possible cause the symptoms?
A. Atenolol
B. Captolapril
C. capidogrel
D. losartan
Ans: B

18. 55years old woman with long history of poorly controlled of essentials hypertension recently added atenolol in
her therapeutic regime What is the most likely primary mechanism mediated by the anti‐hypertensive effect of
atenolol in this patient
A blockade of beta2 receptor on vascular wall
B decrease cardiac output
C decrease sympathetic outflow from vasomotor center
D decrease total blood volume
E inhibiting release of epinephrine from renal medulla
Ans: B

19. A 63 years old man came to emergency department with the history of heart failure, severe dyspnea and edema
in legs, thigh, and lower abdominal wall. Glomerular filtration rate is 20L/min. A diuretic with which of the following
mechanisms appropriate to relieve edema in this patient?
A. Blockade of Na+ channels in the collecting tubule.
B. Blockade of Na+ reabsorption in the proximal tubules
C. Blockade of Na+/CL‐ symport in the early diastole
D. Blockade of Na+/K+/2CL‐ symport in the loop of Henle
E. Inhibition of aldosterone action in the collecting tubules
Ans: D

20. A 32year old woman with hypercalciuria has urinary stone at her right renal pelvis area. In order to remove
calculus and prevent another stone formation which drug of choice would be used?
A thiazide
B furosemide
C hydrochlorothiazide
D spironolactone
E Triamterene
Ans: A

21. 46 years old man complains of his physician about insomnia, fatigue, nightmare, diminished libido and balancing
of fingers exposed to cold. He has a history of exertional angina and takes Anti exertional drugs for one month.
Which of the following drug is likely to cause above symptoms?
A. Isosorbide mono nitrate
B. Nitroglycerin
C. Nephedipine
D. Propranolol
E. Verapamil
Ans: D

22. The patient is suffering from papilloma and flashing of face. What drug causes these?
A. Verapamil
B. Diltiazem
C. Triglyceride
D. Propranolol
E. Rifampicin
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Ans:

23. 56‐year‐old man with exertional angina inhalation of nitroglycerin and oral isosorbide mono nitrate. Molecular
action of these drugs in this patient

50. Lovastatin and ezetimibe were given which drug target cellular compartment of liver.
A. Alteplase
B. Ezetimibe
C. Heparin
D. lovastatin
Ans: D

Microbiology
UM 2
1. For the case of subacute infective endocarditis (SBE), it is caused by the members of streptococci viridians. Which
is the most likely site to infect?
A. Skin
B. Oropharynx
C. Vagina
D. Ureter
E. Gastrointestinal tract
Ans: B

2. Based on diagnostic criteria of infective endocarditis, the two most important parameters for diagnosis of this
infection?
A. Positive blood culture and ECG changes
B. Positive blood culture and Echocardiographic changes
C. Positive blood culture and increased physical findings
D. Positive blood culture and rise in ASO titer
E. Positive blood culture and rise in Dimer
Ans: B

3. Blood culture should be taken

A. After the antibiotics are administered
B. Before the antibiotics are administered
C. When the patient has normal temperature
D. ‐
E. ‐
Ans: B

UMM
4. What is the most serious consequence of group A beta hemolytic streptococcal infection?
A. acute rheumatic fever
B. streptococcal gangrene
C. streptococcal toxic like syndrome
D. streptococcal fasciitis
E. acute glomerulonephritis

5. subacute bacterial endocarditis caused by

A. staphylococcus aureus
B. staphylococcus epidermidis
C. staphylococcus lugdunensis
D. staphylococcus saprophyticus
E. staphylococcus hemolyticus
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UMTGI
6. A 45 years old woman has dental extractions for severely decayed teeth, develops fevers, chills, night sweats,
dyspnea for 3 weeks duration which start 1 week after the procedure. Which organisms cause this illness.
A. Stap. Aureus
B. Stap. epidermidis
C. Poststreptococcal
D. Streptococcus mutans
E. Streptococcus pneumonia

7. 22years old pregnant woman‐3rd trimester‐fever ‐UTI. MacConkey agar ‐ gram negative rod ‐pink colonies. What
bacteria?
A. brucella abortus
B. Clostridium Perrigins
C. E. coli
D. Listeria monogeneses
E. S. faecalis

8. True infection should be suspected EXCEPT

A. If different isolates show the same booties and antibiotics susceptibility profiles
B. If different organisms grow in cultures from two bottles of the same species
C. If growth is rapid (within 48 hours)
D. If the same organisms grow in three bottles of the same species
E. If the same organisms grow in cultures from more than one specimen

Others
UM 2
1. During CPR, what is recommended ratio of heart compressions to rescue breaths?
A. 10 compressions 1 to rescue breath
B. 15 compressions 1 to rescue breath
C. 20 compressions 2 to rescue breaths
D. 25 compressions 3 to rescue breaths
E. 30 compressions 2 to rescue breaths

Ans: E

2. A 65‐year‐old man is administered to the hospital with ankle edema in competent tricuspid valve. Which part of
the heart blood regurgitation?
A. Right atrium
B. Left atrium
C. Pulmonary trunk
D. Left ventricle
E. Aorta
Ans: A

3. Which of the following condition causes a diastolic murmur accompanied by an increased preload?
A. Aortic regurgitation
B. Aortic stenosis
C. Mitral regurgitation
D. Mitral stenosis
E. Tachycardia
Ans: A

4. The following about informed consent in medical practice is unacceptable

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A. Informed consent is based on autonomy of the patient.
B. Informed consent could not be deniable.
C. One of the essential elements of informed consent is describing the treatment being proposed and
explanation for its likely course.
D. The patient needs to understand the information being shared and that they are consenting to.
E. Written informed consent must not be described in technical terms.
Ans: B

5. Confidentiality in medical practice best refers to

A. Absolute right with no exceptions to prevent unnecessary intrusion into patient's lives.
B. Non‐medical patient's information could be shared freely.
C. Only information of patient's choice could be shared.
D. Promise on the part of health care providers to keep patients' information private.
E. Rights of patients, under all circumstances, to keep information out of court.
Ans: D

6. The primary focus of incentive theory explaining motivation is

A. The influence of unconscious desires and conflicts on behavior.
B. The impact of external stimuli and rewards on behaviour.
C. The importance of personal goals and aspirations in motivation behaviour.
D. The need of physiological and maintaining homeostasis.
Ans: B

7. Which of the following statement is correct about Iceberg's phenomenon?

A. Iceberg concept differs from spectrum of disease concept (not a single shot).
B. The hidden mass of disease is unimportant and can be negligible.
C. The waterline represents demarcation between apparent and inapparent diseases.
D. What physicians do not see are symptomatic diseases.
E. What physicians see are asymptomatic diseases.
Ans: C

8. The prevention of the emergence or development of risk factors in the population is known as;
A. Primordial prevention
B. Primary prevention
C. Rehabilitation
D. Secondary prevention
E. Tertiary prevention
Ans: A

9. The strategy, which is through the socio‐economical, environmental and lifestyle changes are directed to the
whole community?
A. Disability limitation
B. High risk strategy
C. Integrated approach
D. Population strategy
E. Screening strategy
Ans: D

10. What is a key component of scientific research method?

A. Analyzing results
B. Collecting data
C. Communication of findings
D. Developing hypothesis
E. Drawing oorlaten
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Ans: B

11. Which of the followings is the element of specific objectives?

A. Affordable
B. Impact
C. Memorable
D. Relevant
E. Standardized
Ans: D

12. The 55‐year‐old patient is to undergo coronary bypass operation. The artery of primary concern is the vessel that
supplies much of left ventricle and left and right bundle branches of cardiac conducting system. Which artery is most
surgeon concern?
A. Anterior interventricular artery
B. Artery to SA node
C. Circumflex artery
D. Posterior interventricular artery
E. Marginal artery
Ans: A

13. Which of the followings is one of the types of literature that researchers commonly search in
A. Google
B. Magazines
C. Newspapers
D. Social media
E. Thesis, dissertation
Ans: E

UMM
14. Effect of rescue breaths CPR
A. decrease HR
B. increase BP
C. supply oxygen
D. arrhythmia
e. increase HR

UMTGI
15. Select one most appropriate answer that WHO prodromas the prevention and control of NCD in the country level?

16. NCD contribute to about 80% of premature death in developing countries.

The prevention and control of these diseases are difficult due to
Ans‐D multifactorial causations

17. One of the following is irrelevant reason for the doing literature reviewing in the conducting research.
1. To copy the relevant findings of the previous research
2.To avoid errors in previous research
3.To enhance the knowledge of subject area

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3.To prevent duplicating words that has been done before

18. Which of the following searches provide many articles in search?

A Asthma
B Asthma and bronchitis
C Asthma or bronchitis
D Asthma not bronchitis
E Bronchitis

19: What barrier can distort effective communication?

Ans Psychological barrier

20. Which diet is recommended for coronary heart disease?

A. High fat
B. Low sodium
C. Low protein
D. Low calcium
E. High lipid
Ans: B

21. Limbic system is part of the brain involved in

A. concentration and problem solving
B. language
C. muscle contraction
D. regulating emotion and memory

Extended matching questions

UM 2
Extended Matching Questions (EMQs)
Options:
Help the heart to force blood forward.
A. Prevent the blood from flowing backward.
B. Prevent the blood from flowing left to right atrium after birth.
C. Prevent the blood from flowing right to left atrium after birth.
D. Prevent the regurgitation of blood flow inward the left ventricle.
E. Prevent the regurgitation of blood flow outward the left ventricle.
F. Prevent the regurgitation of blood flow inward the right ventricle.
G. Prevent the regurgitation of blood flow outward the right ventricle.

1 Aortic valve Ans: F

2 Mitral valve Ans: E
3 Pulmonary valve Ans: H

Options:
A. Biphasic T waves
B. Irregular R‐R intervals
C. P waves do not follow by QRS complex
D. P waves ‐ inverted in aVR and upright in lead II
E. P‐R intervals prolonged
F. ST depression, T waves inversion, prominent U waves
G. ST elevation, T waves inversion, deep Q wave
H. Tall slender peaked T waves

Sinus arrythmia Ans: B

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Sinus rhythm Ans: D
Second‐degree heart block Ans: C

Choose pharmacological basis of each drug from the list for the respective shock syndrome.
A. As a nonspecific hemodynamic support
B. As a positive chronotropic agent
C. As a positive inotropic agent
D. As a replacement for fluid loss
E. As a replacement for possible adrenal insufficiency
F. As a specific therapy for underlying cause
G. As a treatment for complications of the disease
H. As a vasopressor

1. Dobutamine for cardiogenic shock Ans: C

1. Adrenaline for anaphylactic shock Ans: F
1. Noradrenaline for septic shock Ans: A

Options:
A. Aneurysm formation
B. Arteriolosclerosis
C. Atheroembolism
D. Atherosclerosis
E. Hemorrhage into plaque
F. Infraction
G. Rupture, ulcer, erosion
H. Vasoconstriction

1. The surface of an atheromatous plaque exposes highly thrombogenesis substances and leads to the thrombosis
which partially or completely occlusive the vessel lumen.
Ans: G

2. Rupture of the overlying fibrous cap, or of the thin‐walled vessels in the areas of neovascularization, can cause
intra‐plaque hemorrhage; a contained hematoma may expand the plaque or induce plaque rupture.
Ans: E

3. Atherosclerotic‐induced pressure or ischemic atrophy of the underlying media with loss of elastic tissue cause
weakness and potential reptile.
Ans: A

Options:
A. Aspergillus fumigattus
B. Blastomyces dermatitidis
C. Candida albicans
D. Cryptococcus neoformans
E. Histoplasma capsulatum
F. Mucor species
G. Dermatophytes
H. Penicillium

1. Blood culture of a heart valve transplant patient revealed fungus of septate, acutely branching hyphae.
Ans: A
1. A 40‐year‐old male HIV patient came to the hospital and his blood cultures show oval shaped yeast cells and
pseudo hyphae.
Ans: C
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1. A 25‐year‐old IVDU man came to the hospital with fever, chills, rigor and shortness of breath for 5 days. On
examination, new heart sound (murmur) can be heard and diagnosed as infective endocarditis. His blood culture
shows fungus of branching hyphae with chain of conidia spore.
Ans: B

UMTGI
EMQ (1)
Options
A. Cardiac output
B. Duration of cardiac cycle
C. Ejection fraction
D. Fick principle
E. Law of Laplace
F. Mean arterial pressure
G. Reynolds number
H. Velocity of blood flow
Items
1 Density of fluid x diameter of blood vessels x velocity of fluid / viscosity of fluid
2 DBP + 1/3 x pulse pressure
3 Blood flow / area conduit

EMQ 2
Apolipoprotein required by chyclomicron to enter the lymph.
Ans ;Apo B‐48

Options
Acute myocardial infarction
Stable angina
Unstable angina
Crescendo angina
Silent ischemia
Variant angina
Sudden cardiac death

1. 62 years old man has chest pain even at rest and radiates to his arm and not release on rest and nitroglycerin. ECG
results show ST elevation.
2.55 years old woman has chest pain on exertion but release on rest and with nitroglycerin. This pain has been 3
months but ECG results are normal.
3.45 years old man with chest pain even at rest and his ECG show transient ST elevation but not permanent.

EMQ 5
Options
Chlorthalidone
Metolazone
Frusemide
Acetazolamide
Mannitol
Spironolactone

1. Nephrolithiasis due to idiopathic hypercalcemia

2. Hypercalcemia
3. Nephrogenic diabetes insipidus

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