1.

Unequal upper extremity arterial pulsations are commonly found in each of

the following disorders EXCEPT :
A. Aortic dissection
B. Takayasu disease
C. Subvalvular aortic stenosis
D. Supravalvular aortic stenosis
E. Subclavian artery atherosclerosis

2. When present, each of the following heart sounds occurs shortly after S2,
EXCEPT :
A. Tumor flop
B. Opening snap
C. Ejection click
D. Pericardial knock
E. Third heart sound

3. Each of the following findings during an exercise test is associated with

multivessel (or left main) coronary artery disease EXCEPT :
A. Sustained ventricular tachycardia
B. ST segment elevation in lead aVR
C. Early onset of ST segment depression
D. Persistent of ST segment changes late into the recovery phase
E. Failure to increase systolic blood pressure by at least 10 mmHg

4. Each of the following statements regarding continuous murmur is true

EXCEPT :
A. Patent ductus arteriosus causes a continuous murmur
B. Continuous murmurs and holosystolic murmurs are synonymous
C. A continuous cervical venous hum is commonly found in healthy children
D. Arterial continuous murmurs occur in both constricted and nonconstricted
arteries
E. By definition, a continuous murmur must continue without interruption
through S2

5. All of the following interventions have a blood pressure-lowering effect

EXCEPT :

1
 A. Tobacco cessation
B. Reduction of dietary sodium
C. Daily magnesium supplements
D. A diet that reduces caloric intake by 1000 calories per day
E. Reduction of ethanol consumption to less than 1 oz (30 ml)/d

6. True statements regarding the effect of medications on the lipid profile

include all of the following EXCEPT :
A. Thiazide diuretics increase triglyceride levels
B. Nonselective beta-blockers increase HDL levels
C. Immunosuppressive agents increase triglyceride levels
D. Protease inhibitors raise total cholesterol and triglyceride levels
E. Estrogen replacement therapy raises HDL and triglyceride levels

7. Each of the following is a component of the atherogenic metabolic

syndrome EXCEPT :
A. Abdominal obesity
B. Serum triglyceride ≥150 mg/dl
C. Hypertension (≥130/≥85 mmHg)
D. Serum low-density lipoprotein >140 mg/dl
E. Hyperglycemia (fasting serum glucose ≥110 mg/dl)

8. All of the following are independent adverse risk predictors in patient who
present with unstable angina or non-ST-elevation myocardial infarction
EXCEPT :
A. Diabetes mellitus
B. Lack of prior aspirin use
C. St-segmen deviation ≥0,05 mV
D. Increased cardiac troponin level
E. Increased C-reactive protein level

9. Each of the following statements about the clinical manifestations of aortic

dissection is correct EXCEPT :
A. Men are more frequently affected than women
B. Severe pain is the most common presenting symptom
C. Patients with aortic dissection usually present with hypotension
D. Pulse deficits are more common in proximal than in distal aortic dissection

2
 E. Aortic regurgitation is more common in proximal aortic dissection than in
distal aortic dissection

10. Each of the following steps is appropriate in the management of patient

with acute aortic dissection EXCEPT :
A. Use of narcotics for pain relief
B. Intravenous beta-blocker therapy
C. Intravenous sodium nitroprusside
D. Urgent surgical repair for distal dissection
E. Urgent surgical repair for proximal dissection

11. Each of the following is an appropriate therapy for a patient with acute ST-
elevation myocardial infarction and cardiogenic shock EXCEPT :
A. Bypass surgery
B. Vasopressor drugs
C. Fibrinolytic therapy
D. Intra-aortic balloon pump
E. Urgent percutaneous intervention

12. Each of the following is a major contributor to myocardial oxygen demand

EXCEPT :
A. Heart rate
B. Left ventricular volume
C. Ventricular wall tension
D. Plasma hemoglobin level
E. Myocardial contractile state

13. Each of the following is a beneficial effect of regular exercise EXCEPT :

A. Decreased triglyceride levels
B. Decreased heart rate variability
C. Favorable changes in the fibrinolytic system
D. Increased expression of nitric oxide synthase
E. Improved systolic and diastolic blood pressure

14. True statements about ASDs include all of the following EXCEPT :
A. Atrial arrhythmias are uncommon in children with with ASDs
B. A patent foramen ovale can be found in approximately 25% of healthy adults

3
 C. Children with ASDs typically experience easy fatigability and exertional
dyspnea
D. The sinus venosus type ASD is almost always accompanied by anomalous
pulmonary venous connection
E. The most common presenting symptoms of ASDs in adults are exercise
intolerance and palpitations

15. Each of the following statements regarding pericardial effusion in patients

with HIV infection is true EXCEPT :
A. Pericardial effusion is a marker for increased mortality
B. Symptomatic effusions and cardiac tamponade are rare
C. Many such effusions will resolve without specific therapy
D. Direct HIV infection of the pericardium is almost always the cause
E. Pericardial effusion is the most common cardiac manifestation of HIV infection

16. All of the following physical findings are frequently present in cardiac
tamponade EXCEPT :
A. Kusmaul’s sign
B. Heart rate >100/min
C. Respiratory rate >20/min
D. Elevated jugular venous pressure
E. Inspiratory drop in systolic blood pressure >10 mmHg

17. Each of the following statements regarding the ECG in acute pericarditis is
true EXCEPT :
A. Sinus tachycardia is a common finding
B. PR depression is present in the majority of patients
C. The majority of patients demonstrate ECG abnormalities
D. Global ST segment elevation is seen in early pericarditis
E. T wave inversions develop before ST elevation return to baseline

18. Each of the following is associated with Ebstein’s anomaly of the tricuspid
valve EXCEPT :
A. Atrial flutter
B. Atrial septal defect
C. A widely split of the S1
D. Ventricular preexcitation
E. Paradoxical splitting of the S2

4
19. Characteristics of variant angina include all the following EXCEPT :
A. By definition, it is always associated with transient elevation on the ECG
B. It is commonly characterized by periods of spontaneous remission
C. It is commonly associated with truly normal coronary artery
D. It may, at times, be precipitated by exertion
E. It frequently recurs at the same time of day

20. All the following statements regarding the process of atherogenesis are true
EXCEPT :
A. Fatty streaks consist almost exclusively of macrophages
B. Both thromboxane A2 and prostacycline are formed from arachidonic acid
C. Diets high in eiocosapentaenoic acid result in elevated production of
thromboxane A2
D. Platelet-derived growth factor increases the number of LDL receptors on
smooth muscle cells
E. The majority of atherosclerotic lesions progress through secretion of growth
factors by the macrophages

21. A relatively low risk for infective endocarditis is found in patients with:
A. Ventricular septal defects
B. Coarctation of the aorta
C. Patent ductus arteriosus
D. Prosthetic heart valves
E. Atrial septal defects

22. In patients with aortic regurgitation, a disproportionate elevation in the

femoral artery systolic pressure compared with that in the upper
extremities is called:
A. Hill’s sign
B. Muller’sign
C. Quincke’s sign
D. Corrigan’s pulse
E. Duroziez’s murmur

23. Which of the following therapies improves survival in patients with cor
pulmonale secondary to chronic obstructive pulmonary disease?
A. Digoxin

5
 B. Oxygen
C. Hydralazine
D. Theophylline
E. Beta-adrenergic agonists

24. Which of the following ECG findings is LEAST likely in patient experiencing
an acute anterior ST-elevation myocardial infarction?
A. Shortened QT interval
B. ST elevation in leads V2 to V4
C. New right bundle branch block
D. ST depression in leads III and aVF
E. Hyperacute T waves in the precordial leads

25. Which of the following conditions is associated with increased left

ventricular preload?
A. Sepsis
B. Dehydration
C. Mitral regurgitation
D. Pulmonary embolism
E. Right ventricular infarction

26. A 60-year-old man is admitted to CCU after 14 hours of chest pain, now
resolved. The initial ECG reveals 1-mm ST segment elevations with T wave
inversions and pathologic Q-waves in leads II,III and aVF. The initial
cardiac examination is unremarkable. On the second day, a faint late
systolic murmur is hear at the apex, and by the third day this murmur has
increased to grade 3/6. The patient has mild dyspnea, and a chest radiogram
shows pulmonary vascular redistribution.
Question : The most likely explanation for the murmur is:
A. Ruptured posterior papillary muscle
B. Ruptured anterior papillary muscle
C. Infarcted posterior papillary muscle
D. Infarcted anterior papillary muscle
E. Ruptured chorda tendineae

27. A 65-year-old man developed an acute anterior myocardial infarction

several days ago. His course has been complicated in the last 24 h by
pericardial friction rub and pleuritic chest pain, which has been difficult to

6
 control with narcotics or steroids. He suddenly develops hypotension
accompanied by marked jugular venous distension and electromechanical
dissociation. No murmurs are audible.
Question : The most likely etiology of this patient’s acute difficulty is?
A. Acute mitral regurgitation due to rupture of the papillary muscle
B. Extension of an acute myocardial infarction
C. Right ventricular infarction
D. Ventricular septal rupture
E. External cardiac rupture

28. You are evaluating a patient with a wide-complex tachycardia. The patient
has a history of WPW syndrome.
Question: Which medication is the most effective for treating this patient’s
tachycardia?
A. Digoxin
B. Diltiazem
C. Verapamil
D. Adenosine
E. Procainamide

29. In African American with NYHA class II heart failure, which of the
following drug combinations should be added to an Angiotensin-
Converting Enzyme Inhibitor and beta blocker?
A. Hydralazine/digoxin
B. Isosorbid dinitrate/digoxin
C. Isosorbid dinitrate/hydralazine
D. Hydralazine/angiotensin receptor blockers
E. Isosorbid dinitrate/angiotensin receptor blockers

30. When treating a patient with non-ST segment elevation (NSTEMI), risk
stratification and timely administration of anti-ischemic and anti-
thrombotic therapies are paramount. For a patient with unstable angina
with negative biomarkers, which medication regimen is most appropriate
as initial treatment?
A. Aspirin, beta blocker, spironolactone, HMG-CoA reductase inhibitor (statin)
B. Aspirin, nitroglycerine, beta-blocker, heparin, GP IIB/IIIa inhibitor
C. Aspirin, clopidogrel, nitroglycerine, beta-blocker, heparin
D. Aspirin, morphine, streptokinase, nitroglycerine

7
 E. Aspirin, morphine, oxygen, nitrates

31. A 35-year-old man is evaluated for dyspnea. On examination, he is noted to

be hypoxic with SaO2 of 85% on room air. His cardiac examination reveals a
harsh machinery-like murmur. Palpable thrill throughout systole and
diastole. There is late systolic accentuation of the murmur at the upper left
sterna angle. He is noted to have cyanosis and clubbing of the toes but not
his fingers. What is the most likely cause of the patient’s murmur?
A. Anomalous pulmonary venous return
B. Ventricular septal defect
C. Coarctation of the aorta
D. Patent ductus arteriosus
E. Tetralogy of Fallot

32. A 35-year-old man sustained syncope during exercise and has a systolic
murmur that intensifies on standing upright.
Question : What is the most likely diagnosis?
A. Aortic stenosis
B. Left atrial myxoma
C. Vasovagal syncope
D. Carotid sinus hypersensitivity
E. Hypertrophic cardiomyopathy

33. A 73-year-old woman with recent episodes of dizziness begins to feel

lightheaded whilw seated at church, then within seconds turns pale and
slumps to the floor with a few clonic jerks. She regain consciousness 1
minute later, completely aware of where she is and asks what has
happened. When ambulance arrives, her blood pressure is 110/70 mmHg
and the heart rate is 60/min.
Question : What is the most likely cause of syncope?
A. Hysterical fainting
B. Ventricular tachycardia
C. Neurocardiogenic syncope
D. Wenckebach phenomenon
E. High-degree atrioventricular block

34. Which of the following statements regarding diabetes mellitus as a

cardiovascular risk factor is correct?

8
 A. The prevalence of diabetes is decreasing in the developed world
B. The recommended screening test for type-2 diabetes is measurement of A1C
C. Statin therapy reduces coronary events only in diabetics with abnormal
cholesterol levels
D. Lifestyle modifications significantly reduce the rate of diabetes development in
at-risk individuals
E. Fibric acid derivatives are the lipid lowering agents of choice for the prevention
of coronary events in diabetics

35. A 55-year-old previously healthy man is brought to the emergency

department because of left-sided chest pain over the past 3 hours. He
denies shortness of breath or cough. The discomfort seems less intense
whwn he sits forward. The chest radiograph is unremarkable. The ECG
showed ST segment elevation in leads I,II,III,avF, V1-V6.
Question : Which of the following statements regarding this patient’s
condition is TRUE?
A. Measurement of cardiac biomarkers can quickly differentiate the cause of chest
pain
B. Thrombolytic therapy is indicated if cardiac catheterization is not available
C. Nitrates will substantially help relieve the chest pain
D. Glucocorticoids are an appropriate initial therapy
E. Aspirin should be administered

36. A 60-year-old man comes to the hospital with chest pain and shortness of
breath 8 hours ago. ECG reveals an acute myocardial infarction. Physical
examination, a new systolic murmur heard at mitral area and by
echocardiography it is found acute mitral regurgitation.
Question: What is the other finding most likely in this patient?
A. Diminished forward stroke volume
B. High-pitched holosystolic murmur
C. Diminished first heart sound
D. Late systolic murmur
E. Pericardial knock

37. A 22-year-old woman complains of palpitation, chest pain and a little bit
fatigue on exertion. On examination her blood pressure is 130/85 mm Hg.
The echocardiogram reveals mitral valve prolapse.

9
 Question: Which of the following is the most common physical finding in
this condition?
A. Diastolic click
B. Diastolic rumble
C. Aortic regurgitation
D. Late systolic murmur
E. Absent first heart sound

38. A 60 year-old man comes to the emergency room with new-onset syncope.
On examination, his BP of 110/95 mmHg and a harsh systolic ejection
murmur at the right ICS-2, radiating to both carotids.
Question: Auscultation of the S-2 at the base might reveal which of the
following?
A. It is diminished
B. It is widely split
C. It is accentuated
D. It shows fixed splitting
E. It is normal in character

39. A 25 year-old woman has been told she has rheumatic heart disease. She
admitted to the hospital because of shortness of breath and of palpitations.
Her echocardiogram reveals enlargement of the left atrial chamber. You
suspect that this patient has a rheumatic valvular heart disease.
Question: Which of the following murmur is most likely present in this
patient?
A. Holosystolic murmur at apex cordis
B. Diastolic rumble at apex of the heart
C. Harsh systolic murmur at left upper sternal border
D. Early diastolic decrescendo at right upper sternal border
E. Late-peaking systolic murmur at right upper sternal border

40. A 48 year-old man is admitted to the hospital for chest pain since for the
past two days. On examination, Bp 110/80 mmHg, HR 110 bpm, RR 26/min, T
38.50 C. EKG reveals ST segment elevation in limbs leads as well as V2-V6. He
has end stage renal disease as a consequence of diabetes.
Question: Which of the following is usually find on physical examination?
A. Pericardial friction rub
B. Pericardial knock

10
 C. Paradoxal pulse
D. Kusmaull’s sign
E. Gallop rhythm

41. Seorang laki-laki 20 tahun masuk rumah sakit dengan keluhan sesak napas,
batuk produktif dan merasa sangat lemah. Pada pemeriksaan fisis: tekanan
darah 120/75 mmHg, denyut jantung 90/menit, pernapasan 28/menit.
Terdengar bising sistolik III/VI di ruang interkostal-2 kiri. CXR: arteri
pulmonalis dan cabangnya menonjol.
Pertanyaan: Bagaimana sifat bunyi jantung ke-2 pada pemeriksaan
auskultasi?
A. A2 dan P2 pecah terfiksasi
B. Intensitas menurun
C. Pecah dan melebar
D. A2 mengeras
E. Normal

42. Seorang laki-laki 65 tahun mendatangi rumah sakit dengan keluhan capek
dan sesak napas bila melakukan aktivitas fisik. Pada pemeriksaan fisis:
Tekanan darah 165/60 mmHg, denyut jantung 75/menit. Auskultasi: bunyi
jantung ke-2 melemah dan terdengar bising diastolic dekresendo d iruang
interkostal ke-3 kanan yang terdengar sampai di apeks kordis.
Pertanyaan: Palpasi nadi: jenis pulsus apa ditemukan pada penderita ini?
A. Pulsus dikrotik
B. Pulsus alternans
C. Pulsus bigeminus
D. Pulsus paradoksus
E. Pulsus hiperkinetik

43. Seorang penderita perempuan 25 tahun mempunyai riwayat penyakit

jantung reumatik, masuk rumah sakit dengan keluhan sesak napas dan
berdebar-debar. Hasil pemeriksaan ekokardiogram menunjukkan
pembesaran atrium kiri. Ditambah dengan hasil pemeriksaan fisis anda
merasa pasti perempuan ini menderita penyakit jantung katup tertentu
akibat reuma.
Pertanyaan: Bising jantung apa yang anda temukan sehingga anda
memastikan diagnosis anda diatas?
A. Bising holosistolik di apeks kordis

11
 B. Bising sistolik kasar di ruang interkostal-2 kiri
C. Bising diastolik di iktus kordis menjalar ke medial
D. Bising sistolik kasar di sela iga-2 kanan menjalar ke leher
E. Bising diastolik dini dekresendo di ruang interkostal-2 kanan

44. Seorang penderita perempuan, 38 tahun tanpa riwayat penyakit

sebelumnya mengeluh sesak napas ringan dan rasa lelah bila beraktivitas
sejak satu bulan terakhir. Pada pemeriksaan fisis: TD 90/60 mmHg. DJ
95/menit dengan irama tidak beraturan, Bunyi S1 mengeras tapi tidak
terdengar bunyi opening snap. Hasil kateterisasi jantung memastikan
adanya stenosis mitralis kritis.
Pertanyaan : Mengapa pada penderita ini tidak terdengar opening snap?
A. Pengisian ventrikel pada fase awal diastole berkurang
B. Adanya kalsifikasi pada daun katup mitral
C. Irama jantung sangat tidak teratur
D. Kontraksi atrium kiri melemah
E. Adanya prolaps katup mitral

45. Seorang wanita 60 tahun mengeluh sesak napas. Hal ini sudah lama dialami
dan sudah berobat jantung lama tapi tidak teratur. Pemeriksaan fisis:
Tekanan darah 180/100 mmHg, Nadi 120/mnt, ronki basal paru bilateral,
udem tungkai bilateral. Foto toraks: kardiomegali.
Pertanyaan:Gejala akut mana yang timbul akibat mekanisme kompensasi
jantung?
A. Kardiomegali
B. Nadi 120 x/mnt
C. Ronki paru bilateral
D. Udema tungkai bilateral
E. Tekanan darah 180/100 mmHg

46. Dua minggu yang lalu anda meningkatkan dosis furosemide 2 kali lipat
pada penderita wanita umur 67 tahun yang telah mendapat terapi standard
untuk gagal jantung sistolik yang dideritanya. Tiga hari kemudian dia
masuk ke CVCU dengan agak delier disertai mual dan muntah. Pada EKG
terlihat blok AV derajat III.
Pertanyaan: Pemeriksaan apa yang paling penting dimintakan pada
penderita ini?
A. Konsentrasi PaCO2

12
 B. Kadar serum digoxin
C. Kadar klorida dalam darah
D. Kadar magnesium dalam darah
E. Kadar natrium bikarbonas darah

47. Seorang penderita masuk RS dengan keluhan berdebar-debar dan ada

riwayat batuk darah beberapa jam yang lalu. Pada pemeriksaan fisis
tekanan darah 115/70 mmHg. Terdengar bising presistolik di apeks kordis
grade 2/4. CXR : pinggang jantung menghilang.
Pertanyaan : Apa yang menjadi penyebab batuk darah pada penderita ini?
A. Edema interstitial
B. Pecahnya cabang vena pulmonalis
C. Pecahnya cabang arteri bronkhialis
D. Jumlah trombosit sangat berkurang
E. Laserasi mukosa bronkhus akibat batuk

48. Seorang pria sementara bermain tennis, tiba-tiba dada terasa berat, disertai
keringat dingin. Beberapa menit kemudian penderita merasa lemah badan.
Penderita segera dibawa ke UGD. Hasil pemeriksaan EKG menunjukkan
adanya depresi segmen ST di sandapan II,III dan aVF.
Pertanyaan : Apa yang menjadi dasar patomekanisme utama pada
penderita ini ?
A. Inflamasi akut sel endotel
B. Terjadi gangguan konduksi
C. Terjadi ruptur plak ateroma
D. Tekanan darah tiba-tiba turun
E. Proses aterokslerosis bertambah

49. Seorang penderita perempuan 62 tahun dengan gambaran LBBB kronis

pada EKG dimasukkan ke CVCU dengan keluhan nyeri dada substernal
sejak 4 jam yang lalu disertai sesak napas. Laboratorium: serum troponin-T
meningkat. Keputusan ahli jantung untuk segera melakukan angiografi
koroner dan selanjutnya dilakukan tindakan PTCA dengan implantasi stent
di left anterior descending artery. Tiga hari kemudian kembali penderita
mengeluh nyeri dada.
Pertanyaan: Pemeriksaan mana dibawah ini yang paling bermanfaat untuk
memastikan kemungkinan adanya kerusakan miokard yang baru?
A. Ekokardiografi

13
 B. Serum troponin-I
C. Serum troponin-T
D. Serum myoglobin
E. Elektrokardiografi

50. Seorang wanita dengan riwayat kanker payudara kiri sekitar 10 tahun lalu,
telah dilakukan mastektomi dan terapi radiasi. Selama itu tidak ada
keluhan. Sejak seminggu terakhir timbul keluhan sesak napas yang makin
hari makin bertambah berat. Tidak ada sakit dada. Badan terasa lemas.
Fisis: BJ I dan II normal agak melemah, tekanan darah 90/50 mmHg, denyut
jantung 120/menit, pernapasan 24/menit, afebris. EKG menunjukkan “low
voltage” dan kompleks QRS menunjukkan pulsus alternans. Foto tórax
kardiomegali. Dianjurkan pemeriksaan ekokardiografi.
Pertanyaan: Maksud pemeriksaan ekokardiografi adalah untuk mendeteksi
adanya?
A. Vegetasi
B. Efusi perikard
C. Kardiomiopati
D. Radang perikard
E. Myxoma atrium kiri

51. Wanita 62 tahun dengan riwayat Atrial Fibrillasi sudah 1 tahun, berobat
tidak teratur. Tiba-tiba mengeluh nyeri pada kaki kiri, terasa panas, dan
bertambah bila berjalan. Saat diperiksa kaki kiri tampak pucat, perabaan
masih ada, jari-jari bisa digerakkan. Perabaan artery poplitea kiri pulasi
tidak ada. Dokter menganjurkan melakukan pemeriksaan
ekokardiography.
Pertanyaan :Tujuan pemeriksaan ekokardiografi adalah untuk melihat
kemungkinan adanya :
A. Aorta stenosis
B. Pericard effusion
C. Dilatasi atrium kanan
D. Thrombus atrium kiri
E. Ruptur kordae tendinea

52. Seorang wanita, 48 tahun datang ke poliklinik dengan keluhan nyeri dada
sewaktu naik tangga dan berkurang saat istrahat. Keadaan ini dirasakan
sejak 3 bulan yang lalu. Ada riwayat hipertensi sejak 10 tahun lalu dengan

14
 terapi kaptopril 2x25 mg/hari secara teratur. Lima bulan lalu sudah
dilakukan pemeriksaan ekokardiografi dan ditemukan adanya disfungsi
diastolik. Hasil rekaman EKG seminggu lalu dalam batas normal.
Pertanyaan: Pemeriksaan yang ideal dan tepat untuk mengevaluasi keluhan
nyeri dada pada penderita ini adalah?
A. Uji latih jantung dengan beban
B. Ekokardiografi transesofageal
C. Elektrokardigrafi serial
D. Angiografi koroner
E. Monitoring Holter

53. Seorang laki-laki 55 tahun datang ke rumah sakit dengan nyeri dada
substernal hebat sejak satu jam yang lalu. Nyeri dadanya mulai terasa saat
istrahat disertai sesak napas dan mual-mual. Rekaman EKG menunjukkan
DJ 42/menit dengan blok AV derajat II Mobitz tipe II. Foto polos dada
normal.
Pertanyaan: Gambaran elektrokardiogram lainnya yang mungkin
ditemukan pada penderita ini adalah?
A. Elevasi segmen ST di V1-V3
B. Bentuk gelombang tidak sama
C. Depresi segmen ST di I and aVL
D. Elevasi segmen ST di II, III, and aVF
E. Gelombang T yang tinggi di sandapan prekordial

54. Pada saat mendaki gunung, tiba-tiba seorang pendaki jatuh dan mengalami
patah tulang panggul kanan. Beberapa jam kemudian penderita mengeluh
kaki kanan sakit sekali, dan jari-jari kaki sulit digerakkan. Kulit kaki kanan
berubah warna dari kemerahan menjadi biru kehitaman.
Pertanyaan . Apa diagnosis yang paling mungkin?
A. Iskialgia
B. Iskemia tungkai akut
C. Trombosis vena dalam
D. Fistel AV tungkai bawah
E. Iskemia tungkai kronis kritis

55. Lima hari setelah tindakan operasi tulang panggul, seorang pasien laki-laki
40 tahun mengalami pembengkakan pada tungkai kanan pada daerah betis
dan kaki, nyeri pada betis dan kulit kaki kanan agak memerah. Penderita

15
 mempunyai riwayat merokok 2 bungkus perhari selama 15 tahun. Hasil foto
tungkai tulang-tulang tidak ditemukan kelainan, massa tumor tidak ada.
Tanda vital: TD:120/80 mmHg, nadi: 90/mnt, pernapasan: 16 /mnt, suhu
badan: 36.4 C
Pertanyaan: Apa diagnosis yang paling mungkin ?
A. Vaskulitis
B. Ulkus tungkai
C. Iskemia tungkai akut
D. Trombosis vena dalam
E. Iskemia tungkai kronik kritis

56. Penderita perempuan 55 denga riwayat DM 20 tahun, mengeluh luka pada

tumit kanan sejak 2 minggu terakhir, tidak mau sembuh, nyeri dan berbau
busuk. Pemeriksaan fisik: perabaan arteri tibialis posterior lemah. Hasil
laboratorium : GDS 360 mg/dl, Lekosit 13.000/mm3. Hasil pemeriksaan USG
Doppler: arteri tibialis anterior dan posterior kalsifikasi berat, aliran darah
lambat, kollateral banyak.
Pertanyaan : Apa diagnosis yang paling mungkin ?
A. Vaskulitis
B. Ulkus Venous
C. Iskemia Tungkai Akut
D. Thrombosis Vena Dalam
E. Iskemia Tungkai Kronik Kritis

57. Seorang wanita 16 tahun datang ke poliklinik jantung dengan keluhan nyeri
sendi sendi kaki disertai demam sejak 2 minggu yang lalu. Beberapa hari
terakhir penderita tidak bisa berdiri sendiri. Pemeriksaan fisis : TD 120/80
mmHg, Nadi 78/menit, pernapasan 24/menit, suhu badan 380 C .
Laboratorium: lekosit 15.000/mm3 serta ASTO dan CRP meningkat.
Pertanyaan : Apa diagnosis sementara pada kasus ini ?
A. Karditis
B. Poliartritis
C. Demam rematik
D. Endokarditis infektif
E. Penyakit jantung Rematik

58. Seorang laki-laki 50 tahun masuk ke UGD dengan keluhan nyeri dada
substernal. Nyeri dada ini sudah sering terjadi setiap melakukan kegiatan

16
 fisik. Hasil EKG istrahat tidak memperlihatkan tanda-tanda iskemia
miokard. Pada pemeriksaan uji latih jantung dengan beban memunjukkan
hasil respons iskemik positif, namun hasil pemeriksaan angiografi koroner
tidak terlihat adanya lesi aterosklerosis.
Pertanyaan : Apa diagnosis anda?
A. Sindroma X
B. Iskemia tenang
C. Sindroma Barlow
D. Angina dekubitus
E. Iskemia subendokard

59. Anda diminta untuk mengevaluasi penderita perempuan 65 tahun yang

memeriksakan diri untuk evaluasi rutin terhadap gagal jantung yang
diidapnya sejak beberapa waktu yang lalu. Pada pemeriksaan fisis
ditemukan adanya krepitasi halus dikedua basal paru. Selama ini penderita
telah memperoleh terapi penyekat EKA, digoxin, furosemide. Tekanan
darah 90/70, Nadi 80/menit, napas 16/menit. Paru-paru terdengar adanya
krepitasi halus, tidak ada bising jantung maupun edema tungkai. Jumlah
urine 45 cc/jam.
Pertanyaan: Apa saran anda terhadap penderita pada saat ini?
A. Stop penyekat EKA
B. Stop terapi furosemide
C. Beri dobutamine intravena
D. Terapi sebelumnya dilanjutkan
E. Ganti penyekat EKA dengan penyekat reseptor angiotensin

60. Seorang penderita laki-laki 73 tahun di deteksi adanya gangguan irama

berupa pulsus irregular di poliklinik. Tidak ada keluhan baik waktu
istrahat maupun waktu bergiat. Pada pemeriksaan EKG: Gelombang P tidak
terlihat, interval RR tidak teratur dengan laju 74/min. Gambaran EKG 3
tahun lalu masih irama sinus.
Pertanyaan: Obat apa yang anda sarankan untuk dikonsumsi secara rutin
pada penderita ini untuk mencegah timbulnya komplikasi tromboemboli?
A. Digoxin + aspirin
B. Klopidogrel+ aspirin
C. Amiodarone + digoxin
D. Aspirin + antikoagulan
E. Antikoagulan+ klopidogrel

17
61. Seorang penderita laki-laki dengan riwayat hipertensi, DM, dan
hiperlipidemia datang ke poliklinik dengan keluhan nyeri pada tungkai
bawah kalau dia berjalan 200-300 meter. Pemeriksaan fisis TD : 160/90
mmHg Nadi : 90/menit. Penderita belum mau diperiksakan secara lengkap.
Pertanyaan: Apa saran sementara kepada penderita ini yang sangat berguna
untuk mengurangi gejala dan sekaligus dapat menurunkan mortalitas
jangka panjang?
A. Stop merokok sigaret
B. Beri obat hipolipidemia
C. Beri obat kortikosteroid
D. Minum aspirin setiap hari
E. Beri obat silostasol setiap hari

62. Seorang laki-laki 55 tahun masuk rumah sakit dengan keluhan sesak napas.
Pada pemeriksaan fisis: Tekanan darah 100/70 mmHg, nadi 110/menit, napas
28/menit. Terdengar bunyi krepitasi saat inspirasi di kedua basal paru.
Pemeriksaan ekokardiografi: fraksi ejeksi 35% dan gerakan dinding
jantung hipokinetik global.
Pertanyaan: Obat mana dibawah ini yang paling bermanfaat untuk
mengurangi risiko kematian?
A. Antagonis kalsium
B. Penyekat EKA
C. Furosemide
D. Digitoxin
E. Aspirin

63. Seorang penderita perempuan berumur 45 tahun didiagnosis menderita

fibrilasi atrium dengan laju ventrikel 140/menit. Dia mengeluh sedikit
pusing dengan tekanan darah 75/50 mmHg. Pada pemeriksaan fisis:
terdengar bunyi jantung pertama yang keras disertai bising presistolik di
apeks kordis.
Pertanyaan: Yang mana tindakan paling tepat yang anda rekomendasikan?
A. Kardioversi listrik
B. Digoxin intravena
C. Diltiazem intravena
D. Amiodarone intravena
E. Diawali manuver vagal

18
64. Seorang penderita laki-laki 63 tahun masuk CVCU akibat sesak napas dan
didiagnosis sebagai SKA. Beberapa jam perawatan hemodinamik menjadi
stabil. Hasil pemeriksaan ekokardiografi hipokinetik dinding anterior dan
inferior. Dilakukan angiografi koroner dan ditemukan stenosis multipel di
arteri koronaria kanan 70-90%. Juga terdapat lesi subtotal di LAD panjang.
Riwayat faktor risiko : hipertensi, merokok dan diabetes mellitus.
Pertanyaan : Apa usulan tindakan yang terbaik pada penderita ini?
A. ”PTCA + stenting”
B. Bedah pintas koroner
C. Transplantasi jantung
D. ”Enhanced external counterpulsation”
E. Terapi konservatif dengan obat-obat optimal

65. Seorang laki-laki 67 tahun yang sering mengalami episode rasa pusing yang
berulang selang beberapa bulan terakhir dimasukkan ke rumah sakit
karena pingsan. Dari gambaran EKG irama sinus, namun pada pemantauan
EKG-strip saat dia dirawat menunjukkan adanya komplek QRS yang hilang
setiap 3 denyut. Interval gelombang P dengan gelombang P berikutnya
teratur.
Pertanyaan: Mana tindakan/obat yang paling tepat untuk keadaan ini?
A. Pemberian atropine 2 mg IV
B. Pemasangan pacu jantung tetap
C. Pemberian dopamine 5 mg/menit IV
D. Pemberian isoproterenol 2 mg/menit IV
E. Tidak ada terapi spesifik untuk aritmia jinak ini

66. Seorang penderita laki-laki, 65 tahun masuk UGD, rujukan dari RS daerah
dengan diagnosis infark miokard akut. Telah diberikan aspilet dan oksigen.
Pada saat di UGD tekanan darah 70/40 mmHg, denyut jantung 125/menit
dan lemah. Lima menit kemudian tiba-tiba penderita tidak sadar,
pernapasan melemah, badan teraba dingin dan akhirnya nadi tak teraba.
Pertanyaan: Hasil rekaman EKG penderita pada keadaan terakhir
menunjukkan?
A. Takikardia supraventrikuler
B. Bradikardia sinus
C. Fibrilasi ventrikel
D. Fibrilasi atrium

19
 E. Blok AV total

67. Seorang wanita kulit putih, 62 tahun masuk ke rumah sakit akibat baru saja
mengalami pingsan yang berulang disertai kejang-kejang. Tidak ada
riwayat sakit dada, sesak napas, sianosis maupun edema tungkai. Pada
pemeriksaan fisis, TD 180/80 mmHg dan nadi 40/menit teratur. Intensitas S1
pada apeks jantung sangat bervariasi. Terdengar bising sistolik ejeksi
der.II/VI pada basis jantung.
Pertanyaan: Diagnosis yang paling mungkin adalah?
A. Blok AV komplit dengan sindroma Adam-Stokes
B. Bradikardia sinus dengan episode henti ventrikel
C. Fibrilasi atrium dengan blok AV parsial
D. Tumor otak dengan epilepsi sekunder
E. Blok AV 2:1 derajat II

68. Seorang laki-laki, 48 tahun mengeluh sesak waktu beraktivitas disertai

nyeri dada. Pemeriksaan fisis: TD 110/90 mmHg. Nadi 88/menit. Hasil
pemeriksaan ekokardiografi menunjukkan area orificium katup aorta <0,70
cm2.
Pertanyaan: Apa tindakan awal yang harus dilakukan pada penderita ini?
A. Angiografi koroner
B. Konsul ahli bedah thorax
C. Uji latih jantung dengan beban
D. Evaluasi ekokardiografi 6 bulan kemudian
E. Evaluasi ekokardiografi 2 tahun kemudian

69. Seorang laki-laki, 50 tahun memeriksakan diri ke dokter dengan keluhan

sesak napas waktu bergiat yang makin memberat bila berbaring. Pada
pemeriksaan fisis TD 110/70 mmHg. DJ 120/menit dan terdengar ronki basah
halus dikedua basal paru. Pemeriksaan CXR: kardiomegali disertai tanda-
tanda edema intersitial.
Pertanyaan: Hal apa /aktivitas yang mana dibawah ini yang tidak aman buat
penderita?
A. Jalan kaki santai
B. Vaksinasi influenza
C. Batasi asupan garam
D. Batasi minum alkohol
E. Melakukan olah raga isometrik

20
70. Seorang laki-laki, 36 tahun masuk UGD dengan keluhan sesak napas. Tak
ada riwayat merokok, hipertensi maupun DM. Pada pemeriksaan fisis: sakit
sedang, tekanan darah Tekanan nadi 70 mmHg, nadi 100/menit, pada
auskultasi jantung terdengar bising diastolik derajat III/IV pada basis
jantung. Rontgen: kardiomegali.
Pertanyaan: Diagnosis yang paling mungkin kasus diatas adalah?
A. Regurgitasi aorta
B. Regurgitasi pulmonal
C. Regurgitasi trikuspidal
D. Stenosis + regurgitasi aorta
E. Stenosis + regurgitasi pulmonal
71. Seorang Polwan 38 tahun masuk RS dengan keluhan palpitasi dan sesak napas. Keluhan
ini dialami pertama kali secara tiba-tiba setelah minum segelas kopi. Sebelumnya pasien
sehat. Pada pemeriksan TD 100/55 mmHg. EKG tampak gambaran supraventricular
tachycardi dengan laju jantung 195 x/min.
Pertanyaan:

A. Mekanisme yang paling sering menyebabkan terjadinya supraventricular tachycardi

adalah enhanced automaticity.
B. Penyebab utama penyakit ini adalah adanya accesorry pathway.
C. Digoksin (I.V.)merupakan drug of choice. Apabila tidak berhasil dilakukan
Kardioversi.
D. Prognosis SVT pada pasien wanita muda biasanya baik.
E. Setelah gejala teratasi, pasien dianjurkan dilakukan studi elektrofisiologi untuk
menentukan tipe takikardi.

72. One of the clinical assessment in the diagnosis of pulmonary embolism is thorax X-ray. An
enlarged right decending pulmonary artery showed in thorax X-ray is called:
A. Westermark sign.
B. Hampton’s hump
C. De’Muzet sign
D. Palla’s sign
E. Quincle sign.

73. Risk and benefits of oral anticoagulants for stroke prevention in atrial fibrillation is
stratified by:
A. Well’s score.
B. Apgar score.
C. Chads score.
D. TIMI score.
E. Lichtenstein score.

21
74. Gejala infark miokard adalah pasien dengan nyeri dada hebat dan berkeringat hebat, nyeri
ini hilang dengan pemberian morfin. Kejadian tersebut diakibatkan oleh rupture plak
atherosclerosis yang memiliki karakteristik :
A. Bahu plak atherosklerotik yang banyak mengandung jaringan fibrosa.
B. Bahu plak atherosklerotik yang banyak mengandung makrofag.
C. Bahu plak atherosklerotik yang banyak mengandung platelets.
D. Bahu plak atherosklerotik yang banyak sikatriks.
E. Bahu plak atherosklerotik yang banyak mengandung kolagen.

75. Pada awal kejadian plak atherosclerosis terutama melibatkan sitokin yang berfungsi untuk
merekrut sel monosit yang beredar yaitu:
A. AGE
B. TNF-alfa
C. TGF-beta
D. IL-1
E. PAI-1

76. Nitrat efektif meredakan angina karena :

A. Melebarkan a, koroner
B. Menurunkan afterload
C. Menurunkan preload
D. Memiliki efek analgesik
E. Semua benar

77. Test ASTO bagi penderita reumatik bermakna untuk :

A. memantau perlangsungan penyakit
B. membuktikan adanya proses inflamasi
C. memantau hasil pengobatan
D. membuktikan bhw infeksi sedang berlangsung
E. menentukan

78. Digoksin:
A. Half-life 12 jam
B. Membuka calcium channel
C. Kronotropik negatif
D. Efektif pada SVT
E. Semua benar

79. Didalam mitokondria sel otot jantung tidak mengandung enzim:

A. NADH dehidrogenase
B. Asetil Ko-A karboksilase
C. Beta-ketoacil KoA tiolase
D. Sitrat sintase

22
 E. Sitokrom oksidase

80. Tahapan kejadian gangguan sel endotel adalah:

A. Disfungsi endotel-stimulasi endotel-aktifasi endotel-jejas endotel
B. Stimulasi endotel-aktifasi endotel-disfungsi endotel-jejas endotel
C. Jejas endotel-disfungsi endotel-aktifasi endotel-stimulasi endotel
D. Stimulasi endotel-jejas endotel-aktifasi endotel-disfungsi endotel
E. Jejas endotel-aktifasi endotel-stimulasi endotel-disfungsi endotel

81. Mitral valve prolapse :

A. Tend to be more common in patients with shallow chest wall
B. The ejection click is best heard at the left sternal border
C. The duration of the murmur corresponds with the severity of mitral regurgitation.
D. Paroxysmal SVT is the most frequent arrhythmia noted.
E. All correct.

82. Peripheral Vascular Disease:

A. Predilection to female than male (F:M=4:1).
B. Skin discoloration of the extremities.
C. Up to 50% have exertional symptoms.
D. Anticoagulat is the first line therapy.
E. All correct.

83. Antiphospholipid antibody syndrome

A. May occur at any age, but usually in old individuals.
B. Diabetes Mellitus is one of the risk factor.
C. Patients may present with myocarditis with pain mimicking angina
D. 50% of patients have thrombocytopenia.
E. All correct.

84. Fabry’s disease

A. X-linked with full expression in males & only patial expression in female.
B. Usualy presented with hypertension, angina chest pain and mitral regurgitation.
C. Echocardiography shows massive LVH and LV dilatation.
D. Endomyocardial biopsy can make the diagnosis.
E. All correct.

85. Which of the following test could be performed in the cardiac work-up for syncope
patients :
A. Tilt table test.
B. Signal averaged ECG.
C. Holter monitoring.

23
 D. Electrophysiological study.
E. All correct.

86. A 15 yo male presented with cyanosis, sign of congestive heart failure and hemoptysis.
There is no heart murmur found on examination. Echocardiography shows : ASD II,
inferior displacement of tricuspid valve annulus and tricuspid regurgitation. The diagnosis
is :
A. Ehler Danlos syndrome.
B. Abstein anomaly.
C. Eisemenger’s syndrome.
D. Endocardial cushion defects.
E. Reiter’s syndrome.

87. Transposition of the great arteries :

A. Is the form of acyanotic congenital heart disease.
B. Associated with genetic syndrome.
C. Female > male (3 : 1).
D. Rastelli operation is one of the alternative surgical procedure.
E. All correct.

88. A 70 yo female admitted to the hospital with confusion, nausea and vomiting. She has
long been regulary taken digoxine tablet for her chronic congestive heart failure. ECG
shows: SA block and Ventricular extrasystole. Blood examination shows the digoxine level
is 1,8 ng/dL, which indicated digoxine intoxication.
A. Pharmacokinetic interaction is the most common cause of digoxine intoxication.
B. One of the risk factor is hypochlorhydria.
C. Quinidine I.V. has been reported beneficial.
D. In situation no anti-arrhythmic agents available, hemodialysis is effective in the
treatment of digoxine intoxication.
E. All correct.

89. In patients with asymptomatic systolic left ventricular dysfunction, the SOLVD prevention
trial showed that ACE-inhibitors :
A. Improve symptom
B. Reduced LV dilatation.
C. Have no effect on overall mortality.
D. Reduce mortality due to heart failure.
E. Reduce time to hospitalization for heart failure.

90. The following disorder is known to be associated with an increased risk for pulmonary
hypertension :
A. HIV infection.
B. Cirrhosis hepatic.?

24
 C. Hyperthyroidism.
D. Osler-Weber-Rendu disease.
E. Vit B1 deficiency.

91. The effect of concurrent medication on hyperlipidemia include :

A. ACE-inhibitors leads to alterations in lipid profile.?
B. Estrogen therapy leads to increase triglyceride level.?
C. Alpha-adrenergic blockers adversely affect lipid.
D. Calcium antagonist tend to have a neutral effect on lipid.?
E. Cardioselective beta-blockers may lead to an increase in VLDL levels.

92. Each of the following statements about coartation aorta is true, EXCEPT :
A. Coartation of the aorta usually occurs just proximal to the left subclavian artery.
B. Coartation of the aorta is frequently associated with a bicuspid aortic valve.

C. Simultaneous palpation of the upper and lower extremity pulses may reveal diagnosis.

D. A suprasternal thrill is common in this condition.

E. The most common symptoms of Coartation of the aorta are headaches, intermittent
claudication, and leg fatigue.

93. A 32 yo woman with new Atrial fibrillation (AF) starting last week present to your clinic. She
has a history of TOF repaired at 18 months old. Her exam shows a BP of 120/80 mmHg, a 2/6
holosystolic murmur is heard along the lower left sternal border, and a 2/4 early decrescendo
diastolic murmur is heard in the second left intercostals space. An ECG shows AF with RBBB.
Which of the following is the most likely reason that this patient developed AF ?

A. Aortic & mitral valve regurgitation.

B. Residual VSD & tricuspid regurgitation.

C. Pulmonary & tricuspid regurgitation.

D. RV outflow obstruction with significant gradient.

E. Residual VSD.

25
94. All of the following statement are true regarding sporadic cardiac myxomas EXCEPT :

A. they are more common in female.

B. They comprise up to 50% of cardiac tumor.

C. Location of the tumor on the right side of the heart is more often associated with
malignant type of myxomas.

D. They are the commonest cause tumor-related emboli.

E. Following resection of the initial myxomas, a recurrence af a second myxomas is

expected in about 10% of cases.

95. A 32 yo woman complains of dizzy spells and one syncope episode. She has been well
until the previous summer when she developed mild arthritis and a knee effusion. On
examination, there is no evidence of infection. Resting pulse of 48 x/min. ECG showed second
degree AV block. Though her erythrocyte sedimentation rate was elevated to 77 mm/hr, her
antinuclear antibody titer was nagative. The most likely diagnosis is :

A. Subacute rheumatic fever.

B. Lyme disease.

C. Systemic Lupus Erythematosus.

D. Hemochromatosis.

E. Trichinella spiralis infection.

96. The M-mode Echocardiogram illustrated would most likely be observed in a patient wth
which disease?

A. HOCM

B. Marfan syndrome

C. MS

D. Ruptur papilla muscle

26
E. Aortic Insufficiency

97. Each of the following statements about Congenital Aortic stenosis is true, EXCEPT :

A. This anomaly occurs more frequently in males than females.

B. Most children with congenital AS develop and grow normally and are asymptomatic.

C. The presence of left ventricular hypertrophy with strain on the ECG in childfood usually
indicates severe AS.

D. Any child with clinically evidence of AS should undergo cardiac catheterization.

E. Antibiotic prophylaxis for endocarditis is indicated in all patients with this disorder,
regardless of the severity of obstruction.

98. All of the following statements regarding streptococcal and enterococcal endocarditis are
correct EXCEPT :

A. In case of pneumococcal endocarditis, concurrent pneumonia or meningitis is common.

B. The majority of cases of enterococcal endocarditis occur in elderly males.

C. Group B streptococcal endocarditis is characterized by large vegetations and a high

incidence of systemic embolism.

D. Patients with uncomplicated streptococcal viridans or bovin endocarditis can be

adequatelytreated with a 2-weeks course of penicillin and plus gentamicin

E Endocarditis cause by penicillin-resistant enterococci can be adequately treated with high

dose of vancomycin I.V. for 4-6 weeks.

99. In addition to the “ major manifestation” of acute rheumatic fever including carditis,
polyarthritis, chorea, erythema marginatum and subcutaneous nodules, other supporting
evidence for this condition includes :

A. Prolong QT-interval.

B. Fever.

C. Elevated C-reactive protein.

D. Rising streptococcal antibody.

27
E. Normochromic normocytic anemia.

100. The following statements concern hypertension in pregnancy :

A. Hypertension implicates about 10% of pregnancy.

B. Elevated BP during pregnancy or in post partum period without a history of

hypertension/eclampsia is associated with hypertension later life.

C. Hydrelazine is one of the alternative drug used in the treatment of pregnant hypertensive
patients.

D. Preeclampsia usually occur at the end of the second trimester in multiparous women.

E. Severe hypertension near term or during delivery should be treated with MgSO4 alone.

31. True statements with regard to cardiac involvement in systemic lupus erythematosus (SLE)
include :

A. Pericarditis is the most common cardiac finding.

B. Libman-Sacks lesions are caused by active myocarditis.

C. Libman-Sacks lesions rarely produce serious valvular regurgitation during acute phase of
the disease.

D. In pregnant women with active SLE, fetal tachycardia are caused by transplacental transfer
of abnormal antibodies.

32. True statements about peripartum cardiomyopathy (PPCM) include all of the following,
EXCEPT :

A. Symptoms of PPCM most commonly occur in the immediate post partum period.

B. Clinical an hemodynamic findings in PPCM are indistinguishable from those other forms of
dilated cardiomyopathy.

C. The incidence of PPCM is greatest in primiparous white women of European extraction

D. Approximately 50% of PPCM patients show complete or near-complete recovery within the
first 6 month after delivery.

E. Subsequent pregnancies in women with PPCM carry an increase risk for relapsw.

28
 33. True statements about the diagnosis of pulmonary emboli include all of the following,
EXCEPT :

A. Arterial blood gas measurement may be misleading in the diagnosis of acute pulmonary
emboli.

B. The ECG finding consistent with pulmonary emboli include righ heart strain and
tachycardia.

C. Pulmonary infarction due to pulmonary emboli may be visualized on the chest X-ray.

D. A narrow splitting of the second heart sound is often heard in cases of large pulmonary
emboli.

E. Fibrin degradation products have been found to be elevated in some patients with
pulmonary embolism.

34. Mitral valve prolaps:

A. Most common occur in thin females

B. Half of the case is caused by endocarditis.

C. Low pitched murmur at the apex

D. patients usually complain with exersional dyspnea.

E. All correct.

35. Therapeutic principles in preventing renal disease progression in hypertensive patients with
chronic kidney disease :

A. Restrict dietary sodium to < 5gr/day.

B. Agrassive use of diuretics

C. RAS blockade is effective and well tolerated.

D. Dydydropyridine CCBs is recommended.

E. All correct.

36. Combination between two antihypertensive agents highly recdommended is :

29
 A. Beta-blockers – ACE-inhibitors. B. Beta-blockers – diuretics.

C. ACE-inhibitors – ARB. D. ARB – beta-blockers.

E. ACE-inhibitors – alfa-blockers.

37. Screening & diagnosis of hyperaldosteronism is :

A. Hypertensive patients with spontaneous hyperkalemia.

B. Hypertensive patients with marked diuretic-induced hypokalemia.

C. Hypertensive patients refractory to usual antihypertensive therapy.

D. Hypertension trigger by micturition.

E. All correct.

38. Hypertensive patients in whom treatment was accompanied by regression of left-ventricular

hypertrophy leads to an improvement in prognosis is based on :

A. Valsartan Heart Failure Trial (Val-HeFT).

B. Valsartan Antihypertensive Long-trem Use Evaluation (VALUE).

C. Lorsartan Intervention For Endpoint reduction in hypertension (LIFE).

D. Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT).

E. Systolic Hypertension in the Elderly Program (SHEP).

39. ASD :

A. Wide splitting for the second heart sound.

B. ECG may show right ventricular conduction delayed.

C. Echo may show enlargement of the right atrium.

D. In small ASD spontaneous closure may occur.

E. All correct.

93.

30
31