35 YO male with a history of IV drug use presents with fever, cough, SOB, and long smoking history. The patient is febrile, tachypneic, tachycardic, and hypotensive. A new systolic murmur is appreciated, as well as diffused bronchial breath sounds bilateral. Laboratory studies reveal elevated white blood cell count and elevated erythrocyte sedimentation rate. What is the diagnosis?

54 YO male known to have DM and CKD, recently admitted for ACS. Presented now to the clinic for follow up. He has high creatinine and slightly high cholesterol, low HDL and high LDH. Which of the following medications you want to add to his treatment?

76 YO male came to the clinic for routine check up. His BP is 152/95 for the first time. What is the best management?

A 68-year-old patient k/c of DM and HT, presented to the hospital with chest pain for 2 hours. The pain is retrosternal, associated with nausea and sweating. BP 112/77, HR 78. ECG showed ST segment elevation in lead II, lead Ill and aVF. What is the most appropriate next step in evaluating this patient?

DM patient with IHD. What is your goal in management?

Patient presents with late systolic murmur heard best at the apex with mid-systolic click best heard at standing position. What is the diagnosis?

Which of the following cardiac murmurs is expected to decrease by Valsalva maneuver and with handgrip?

26 Y.O. male patient presented to the hospital with repeated attacks of syncope during micturition and while coughing. His ECG is normal. What is the most appropriate management for this patient?

Patient had a stab wound in the chest and presented with a weak thread pulses, raised JVP and equal bilateral air entry in both lungs. What is the diagnosis?

61 Y.O. male Patient came for routine check up. His Echo showed concentric LV hypertrophy and severely stenotic aortic valve. His Ejection fraction is normal. ECG is unremarkable, and he is asymptomatic. what is the most appropriate next step?

Patient with neck pain, palpitation and sweating for 1 hour. EKG was normal, troponin was normal. What is the best next step?

56 Y.O. male patient presented to the hospital with fever and early diastolic murmur heard best at the LLSB. His ECG is insignificant. Which of the following is more sensitive to make the diagnosis?

43 YO male presented to ER with syncope and hypotension. ECG showed SVT. What is the best next step?

Which of the following is least frequently associated with infective endocarditis?

36 Y.O. male patient presented to the hospital with palpitation for 6 hours. BP 131/67, HR 122, regular. ECG is shown below. What is your next step to manage this patient?

A 28-year-old healthy pregnant lady presents with a new murmur. She is currently in the second trimester. She is otherwise asymptomatic. Examination reveals low pitched early diastolic murmur heard best at the apex, and bilateral mild lower extremity edema. What is the most likely cause of her symptoms?

65 YO female known to have HTN and CHF controlled on perindopril and Lasix. Which of the following should be added to his treatment?

Which of the following is the most modifiable risk factor for MI?

65 YO male known case of heart failure came with lower limb edema and ascites. He is on ACEI and furosemide. Examination revealed large ascites. Which of the following is the best next step?

68-year-old man with substernal chest pain at rest. He has experienced chest pain with exertion several times over the past 3 months but reports resolution with rest. In the emergency department, he receives treatment with sublingual nitroglycerin. Several minutes later he notes the resolution of his pain. Which of the following contributed to pain relieve in this patient?

54 YO female medically free came to the clinic for routine checkup. Her cardiac examination revealed grade 4 pansystolic murmur heard best at the apex and radiate to the axilla. She is asymptomatic and the rest of her examination is normal. What is the best next step to confirm the diagnosis?

60 YO male patient k/c of DM and HTN presented to ER with neck pain and sweating for one hour. He has a previous history of recurrent chest pain which resolve spontaneously after resting. ECG done and shpwed non-specific ST segment and T wave changes. Troponin is normal. What is your next step?

Which of the following is expected to decrease mortality in a patient with heart failure?

Which of the following cardiac murmurs is expected to decrease by Valsalva maneuver and with handgrip?

43 YO male patient presents with worsening LL edema. Examination shows clear lungs, muffled heart sounds, raised JVP and hypotension. What is the next step in management?

Which of the following is most frequently associated with infective endocarditis?

66 years old male patient presented with progressive SOB. He is k/c of bronchogenic carcinoma. O/E: BP 88/59. JVP is elevated, lungs are clear and the heart sounds are very quiet. What's the most appropriate next step to confirm the diagnosis?

56 Y.O. male patient going for elective hernia surgery. Known to have bicuspid aortic valve and prosthetic heart valve since 4 years. What is the best antibiotic prophylaxis before his surgery?

65 YO male presented to ER with severe right leg pain and absent pedal pulse. Which of the following is the most diagnostic investigation?

Patient came with typical chest pain and sweating. ECG shows sinus tachycardia with LBBB. Started on aspirin, atorvastatin and morphine. Cardiac enzyme is pending. What is the next step?

60 years-old man is admitted to the Coronary Care Unit with acute myocardial Infraction. His hemodynamic parameters 2 hours later are: bp 80/50 mmHg HR 40 / min SpO 95% on room air. Which of the following would be the most appropriate management?

23 years old female with history of ASD, found to have decrescendo early diastolic murmur 2/6 on the left lower sternal border. what is the most likely diagnosis?

77 YO female K/C of asthma on salbutamol and migraine on ibuprofen presented to the hospital with A-fib. What is the best management regarding anticoagulation?

56 years old male patient presented with fatigue, SOB, elevated JVP which increases with inspiration, ascites and positive shifting dullness. BP 102/67. which of the following has the highest diagnostic value for his condition?

40 years old male presented to ER with shortness of breath for two weeks. relieved by rest and increased with exertion. No Chest Pain and No palpitations. No Sweating. Troponin: 0.09 (Normal < 0.04). What is the most likely diagnosis?

56 years old male patient presented with fatigue, SOB, elevated JVP which increases with inspiration, ascites and positive shifting dullness. BP 102/67. which of the following has the highest diagnostic value for his condition?

44 Y.O. male patient post prosthetic aortic valve replacement 7 days ago presented with history of fever for 3 days. He was diagnosed with infective endocarditis. What is the most likely causative organism?

50 YO male known case of DM, HTN and CHF on HTN meds and beta blocker, admitted to cardiac care unit as a case of NSTEMI. What will you add to improve his condition?

67 YO male diagnosed with peripheral artery disease. What is the best way to prevent cardiovascular events in the future?

66 Y.O. male patient k/c of dilated cardiomyopathy came for routine check up, he is asymptomatic. BP 111/87, HR 140 irregular. ECG showed atrial fibrillation. What is your next step to manage this patient?

56 YO male k/c of DM and HTN on hydrochlorothiazide, his BP is still not controlled. What is the best next step?

71 YO. male Patient k/c of CHF, presented to ER with SOB, orthopnea, PND, hepatomegaly and LL edema and basal crackles. what is your next step in managing his condition?

50 YO male presented with history of shortness of breath and fatigue. Admitted for DHF. Upon physical examination you heard an early diastolic murmur and when you auscultate over the femoral artery you heard femoral pistol shot sound. What is the most likely diagnosis?

60 years-old man is admitted to the Coronary Care Unit with acute myocardial Infraction. His hemodynamic parameters 2 hours later are: bp 80/50 mmHg HR 40/min SpO2 95% on room air. Which of the following would be the most appropriate management?

71 Y.O. male patient going for dental extraction. Known to have idiopathic subvalvar hypertrophic aortic stenosis. Which of the following is true?

Patient presents with a mid-diastolic murmur heard best at the apex and an early diastolic decrescendo murmur. What is the most likely diagnosis?

Elderly patient is admitted to ICU with low COP and high pulmonary wedge pressure. What is the type of shock?

Which of the following is a side effect of ACE inhibitors?

60 YO male post cholecystectomy 4 days ago presented to ER with chest pain started 4 hours ago and ECG showed STEMI. He was given Oxygen, morphine, aspirin, heparin and nitrate. What would you do after ER management?

26 Y.O. male patient presented to the hospital with syncope. The attack is preceded by nausea, sweating and fear. His ECG is normal. What is the most appropriate management for this patient?

43 years old male known to have HTN started on ACEl and then his creatinine increased from 1.2 to 1.5. His potassium is high. What is the best next step?

54 years old male K/C of HTN, TIA, A-fib on warfarin. For the last 6 months there is no A-fib attack. ECG: regular sinus rhythm. What is the best management regarding warfarin?

76 YO male patient presented to the hospital with inferior MI and was managed by PCI. His current medications include warfarin for Atrial fibrillation and his cardiac medications. What is the best management regarding his anticoagulation therapy?

65 years old female K/C of DM, HTN, TIA diagnosed with A-Fib. Calculate her CHA2DS2-VASc score?

68 Y.O. patient k/c of DM and HTN, presented to the hospital with chest pain for the past week. The pain is retrosternal and last for 15 min, increasing in intensity. ECG showed ST segment depression in lead V1-V4. The patient received statin, aspirin, b blocker, heparin, nitrate and captopril. What to add?

72 YO male K/C of CHF on ACE inhibitors, spironolactone and furosemide. Presented with hypotension. Admitted and started on IV fluids. Labs shows increased urea and creatinine and FENa 0.6%. What is the best next step?

58 YO male known to have HTN, and DM found to have proteinuria. Which of the following medications should be started?

Which of the following will decrease mortality after inferior-lateral MI?

76 Y.O. male patient presented to the hospital with transient loss of consciousness. BP 109/73, HR 40, regular. What is the best next step?

Young male medically free presents to the clinic complaining of frequent palpitation lasting for 10-15 min in the last 6 months. ECG is normal. What further investigation is needed?

34 YO male presented to ER with hypotension and raised JVP with weak heart sounds after MVA. What is the type of shock?

Patient known case of HTN on captopril presents with dry cough. What is the best next step?

65 YO male admitted to ICU with hypotension requiring inotropes. He has warm extremities and neglected urine output for hours. What is the most likely type of shock?

69 YO male presented to ER with history of recurrent exertional chest pain, progressive SOB and syncope. Echo showed aortic stenosis. What is the most appropriate management?

46 years old male patient presented with SOB for 2 months. He is k/c of TB. O/E: BP 112/77. He has distended JVP which increases with inspiration. No murmurs. What's the most likely diagnosis?

Patient presents with gait instability, right arm weakness and loss of balance for the past two weeks. Mild headaches, fatigue, anorexia, night sweats and chills over the last week. Hx of IV heroin use, and his last injection was a day ago. No head trauma. He is febrile. BP is 142/75. multiple needle tracks on the arms. There is a grade Ill holosystolic murmur heard loudest at the cardiac apex. Neurological examination shows right lower facial droop and 2/5 strength in the right upper limb. He has a wide based gait, difficulty with heel to shin testing. Urinalysis shows red cell casts, proteinuria. What is the most likely cause of this patient presentation?

What is the most important preventable risk factor for Dyslipidemia and CAD in females?

29 Y.O. male patient going for thyroidectomy. Khown to have mitral valve prolapse. What is the best antibiotic prophylaxis before his surgery?

67 YO male admitted with Ml. after two days of discharge he developed severe pain in his left leg. What is the most likely cause?

70 years old male patient, known case of DM, HTN presents with unstable angina which was treated with statin, aspirin, B-Blocker, heparin and nitrate. What do you want to add?

What is the recommended age to start screening for HTN in low-risk population?

46 Y.O. male patient known to have HTN on amlodipine and losartan. His BP is not controlled. What is the best medication to add?

45 YO male known hypertensive (on lisinopril 20 mg and amlodipine 5 mg) and recent Hx of thromboembolism (on warfarin 2mg) presented with productive cough and hemoptysis for 2 months. MTB-PCR is +ve. He was started on first line anti TB medications. Which of the following adjustment should be made to his medications?

Diabetic patient presents with central chest pain after exercise, lasts for 15 mins and relieves by rest. ECG shows depressed ST segment in lead V1-V3. what is the best next step?

Pediatric patient presented with recurrent syncope and palpitation. ECG: narrow complex tachycardia 250 - 290 beats per minute. Which of the following is the most likely diagnosis?

Which of the following is the most important intervention to control HTN?

58 YO male known to have HTN, and DM found to have proteinuria. Which of the following medications should be started?

61 Y.O. male Patient k/c of DM, HTN came for routine check up and was found to have LV enlargement and EF of 40%. His ECG is normal and he is asymptomatic. what is the most appropriate next step?

65 YO male presented to ER with acute left lower limb pain for 3 hours. Associated with numbness and absent pulse. ECG: Atrial fibrillation. What is the best next step?

26 Y.O. male patient presented to the hospital with syncope during a football game. His father had a sudden cardiac death at 37. 0/E he has mid-systolic murmur heard best at the left lower sternal border. ECG is normal. What is the most appropriate next step?

What is the most common type of murmur associated with rheumatic heart disease?

A 38-year-old woman presents with chest pain, her pain began at night while watching television and lasted for 45 minutes, she describes the pain as substernal and radiating to her left shoulder. similar episodes All occurring at rest, on arrival to the emergency department, her chest pain had resolved, while in the emergency department, she experiences a recurrence of chest pain, ECG shows ST-segment elevation in leads V1-V4. What is the diagnosis?

67 years old male patient presented with SOB, orthopnea and PND for one month. O/E he has early dialistic murmur. Echo showed sever aortic regurgitation and EF 40%. Which of the following is the best management for this patient?