1.      A 42-year old obese man visits the cardiology clinic with chief complaints of chest tightness and dyspnoea on exertion for the past one week. the symptoms usually disappear on rest. There is no evidence of previous myocardial infarction. The resting ECG is normal. Which of the following changes can be seen during exercise ECG of this patient?

1.      A 45-year-old man faints and loses consciousness suddenly. While he is being resuscitated, his heart rate is found to be 45 bpm. He is given atropine to treat his condition, following which his heart rate increase to 88 bpm. Which is the likely effect on this drug on the action potentials of a pacemaker cell in the SA node of this man to increase his heart rate?

A 19-year-old man with the left main coronary artery (LMCA) arising from the right aortic sinus presents with recurrent episodes of syncope. Between which structures would the course of LMCA be compressed to cause this symptom?

55 years old come to ED with bradycardia. Angiography found blood insufficiency in SA node. What artery is blocked?

A 53-year-old man is treated for hypertension. Recently he consulted a physician with complaints of incomplete urinary evacuation and another anti-hypertensive drug was added to his prescription. After two days, he reports with complaints of dizziness and faint while getting from the bed. Which drug is most likely added to for this patient?

A 35-year-old man is struck by a car. An emergency physician who is passing by evaluates his condition. The man has several lacerations, most of which are still bleeding. He is unconscious, and his breathing is becoming rapid and shallow. The emergency physician thinks that patient will soon enter hypovolaemic shock. If this occurs, what other findings/changes would be expected in this patient?

A 20-year-old man presents with a low-grade fever for 3 weeks. On examination, he is febrile, tachycardic and tachypnoeic. His blood pressure is 100/80mmHG. Needle tracks are seen in his left antecubital fossa. There are splinter haemorrhages under his fingernails and tender haemorrhagic nodules are seen on his palms and soles. A heart murmur is heard on auscultation. A tender spleen is just palpable. Which of the following microorganisms is most likely to be cultured from this patient’s blood?

1.      A 76-year-old man who has had a previous myocardial infarction presents with acute decompensated heart failure. He also complains of a productive cough with pink frothy sputum and is dyspnoeic. There was pedal pitting oedema and raised JVP. On chest examination, third heart sound and rales were heard at both lung bases. Which change best describes the pathophysiology involved in the presentation in this man?

A 50-year-old man visits the clinic for a routine health check-up. His lipid profile shows the following result. The attending physician prescribes a lipid-lowering drug in view of his lipid profile. What drug is prescribed

A 3-day-old infant is admitted to the cardiology unit with sever cyanosis. During the echocardiographic examination, a right-to-left shunt is identified. Which of the following conditions will most likely produce this type of shunt?

A 47-year-old man is admitted with complaints of chest pain which is not relieved by rest and drugs. After investigations, he is diagnosed to have acute myocardial infarction due to occlusion of the left anterior descending artery. He is stable after taking necessary treatment. On the third day of admission, he becomes breathless and his ECG shows ventricular fibrillation. The attending physician injects and intravenous anti-arrhythmic agent to relieve this attack. Which is the mechanism of action of the dug most likely to be administered to the patient?

A 56-year-old woman with a history of chronic heart failure is admitted to the Emergency Department with complaints of breathlessness. She also has a history of posterior myocardial infarction 2 months ago. Her treatment regimen includes a drug which acts by inhibiting an enzyme and delays the ventricular remodelling process. Which drug is most likely to have been prescribed to the patient?

A 3-year-old child presents with a clinically significant atrial septal defect (ASD). This ASD usually results from incomplete closure of which of the following structures?

A 40-year-old man who is a heavy smoker is in hospital on day 4, after myocardial infarction. He develops chest pain, again. Elevation in serum level of which of the following cardiac markers would support a diagnosis of reinfarction in this patient?

1.      A 72-year-old woman presents with recurrent episodes of loss of consciousness for several seconds upon standing. She has a history of hypertension for which she is taking diuretics. Her blood pressure is 130/85 mmHG on supine position and 100/70 mmHG 30 seconds after standing up. No abnormalities were detected on cardiac examination. Which of the following changes is most likely to occur a few seconds after the patient stands up?

A 65-year-old man has a sudden onset of severe abdominal pain that has persisted for 3 hours. Physical examination reveals his heart rate to be 100 bpm and blood pressure is 145/100 mmHg. He has diminished pulses in the lower extremities. There is a pulsatile abdominal mass. His serum creatine kinase is not elevated. Which aetiological factor is most likely to cause his condition? Name the disease as well (tell me)

A 65-year-old hypertensive patient is in the clinic for a routine check-up. In addition to fatigue, he has no other complaints. However, on auscultation, abnormal heart sound during late diastole is heard. Which is the most likely reason for the appearance of this abnormal heart sound?

A 63-year-old woman with a history of hypertension and chronic heart failure visits the clinic for follow up. Her blood pressure is elevated, and pedal oedema is elevated and pedal oedema is noted. She is currently on hydrochlorothiazide and enalapril. The attending physician considers adding spironolactone. Which consequences should the physician be aware due to the addition of spironolactone for this patient?

A 49-year-old man has a sudden onset of substernal chest pain with radiation to his left arm. This persists for the next 6 hours. He goes to the emergency department and on examination he is afebrile. Laboratory studies show raised serum troponin I. angiography reveals thrombosis of the left anterior descending artery. During the next 24 hours, which complication is he most likely to experience?

A 26-year-old woman presents to the clinic for her yearly check-up. She says she feels great and has spent the past few weeks training for an upcoming marathon. The patient appears well, and the physical examination is unremarkable. During her training sessions, which regulatory response meets the oxygen demand for the myocardium?

A 51-year-old man with a history of hypertension and hyperlipidaemia is brought to the emergency department by his wife for difficulty in breathing. He is unconscious and pulseless on arrival. Despite appropriate safe-living measures, he dies. Post-mortem examination of the heart shows a necrotic, pale yellow plaque in the left circumflex coronary artery. Similar lesions are likely to be found in which f the following arteries?

A 13-year-old boy, after two weeks of having a mild upper respiratory tract infection, presents with fever and chest pain. On examination, he has mild fever, his pulse is 90 bpm, respiratory rate 20 breaths/min, blood pressure is 85/45 mmHg. A friction rub is audible on auscultation of the chest. A chest radiograph shows pulmonary oedema. An echocardiogram shows small vegetations at the line of closure of mitral and aortic valve. Which of the following laboratory findings is most characteristic of the disease affecting this patient?

A 62-year -old woman comes to the emergency department 1 hour after her husband saw her faint shortly after getting out of bed from a nap. She regained consciousness within 30 seconds and was fully alert and oriented. She has had 2 similar episodes in the last 5 years, once while standing in line at the grocery store and once when getting out of bed in the morning. Her blood pressure is 114/72 mmHg when supine and 95/60 mmHg while standing. Which physiological change is most likely to be lost in this patient?

A 53-year-old woman visits the emergency department after losing consciousness while working in her garden. She says she recently had episodes of dizziness and fainting. Her ECG looks unremarkable except the QT interval is prolonged. Which is the most likely ionic basis of ECG change in this patient?

A 23-year-old man comes to the physician with a 1-week history of sharp, substernal chest pain that is worse with inspiration and relieved with leaning forward. He has also had nausea and myalgias. His father has coronary artery disease. His temperature is 37.3°C (99.1°F), pulse is 110/min, and blood pressure is 130/84 mm Hg. Cardiac examination shows a high-pitched rubbing sound between S₁ and S₂ that is best heard at the left sternal border. ECG shows depressed PR interval and diffuse ST elevations. Which of the following is the most likely cause of this patient’s symptoms?

A 55-year-old man is brought to the emergency department 12 hours after the sudden onset of shortness of breath and substernal chest pain at rest; the pain is increased by inspiration. He has also had a nonproductive cough, fever, and malaise for the past 5 days. He does not smoke or use illicit drugs. His temperature is 38°C (100.4°F), pulse is 125/min, respirations are 32/min, and blood pressure is 85/45 mm Hg. Physical examination shows distended neck veins. Auscultation of the chest discloses bilateral basilar rales and muffled heart sounds. An ECG shows sinus tachycardia, diffuse ST segment elevation, low voltage QRS complexes, and fluctuating R wave amplitude. Which of the following is the most likely diagnosis?

A 61-year-old man is brought to the emergency department by ambulance because of severe retrosternal chest pain and shortness of breath for 30 minutes. Paramedics report that an ECG recorded en route to the hospital showed ST-segment elevation in I, aVL, and the precordial leads. On arrival, the patient is unresponsive to painful stimuli. Examination shows neither respiration nor pulse. Despite appropriate lifesaving measures, he dies 10 minutes later. Which of the following is the most likely cause of death in this patient?

Seventy-two hours after admission for an acute myocardial infarction, a 48-year-old man develops dyspnea and a productive cough with frothy sputum. Physical examination shows coarse crackles in both lungs and a blowing, holosystolic murmur heard best at the apex. ECG shows Q waves in the anteroseptal leads. Pulmonary capillary wedge pressure is 23 mm Hg. Which of the following is the most likely cause of this patient’s current condition?

A 56-year-old man comes to the emergency department because of nausea and shortness of breath that started while he was at work 1 hour ago. He also reports lightheadedness that started earlier in the day. He has type 2 diabetes mellitus, for which he takes metformin and sitagliptin. He has smoked 1 pack of cigarettes daily for 20 years. He appears pale and diaphoretic. A 12-lead ECG is shown. Which of the following is the most likely underlying cause of this patient's symptoms?

A 67-year-old man comes to the emergency department because of retrosternal chest pressure and shortness of breath for 4 hours. The symptoms started while he was walking to work and have only minimally improved with rest. He has a history of type 2 diabetes mellitus. He has smoked one pack of cigarettes daily for 35 years. He appears uncomfortable. His pulse is 95/min. Serum studies show a normal troponin concentration. An ECG shows no abnormalities. Which of the following is the most likely underlying cause of this patient's symptoms?

What is the structure that represent umbilical vein in a 20 years old male?