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Arab Board Family Medicine Final Written study materials
Arab Board Family Medicine Final Written study resources

Arab Board Family Medicine Final Written practice questions

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Question 1Family Medicine Principles, History and Professionalism

Which document is the standard international reference that sets out the core ethical principles governing a physician's duty to patients, including confidentiality and respect for autonomy?

  1. The Ottawa Charter for Health Promotion
  2. The WMA International Code of Medical Ethics Correct answer.
  3. The Declaration of Helsinki
  4. The Nuremberg Code

Explanation

The World Medical Association's International Code of Medical Ethics articulates the general duties of physicians toward patients, including confidentiality, respect for autonomy, and non-discrimination. The Declaration of Helsinki addresses research ethics, the Nuremberg Code governs human experimentation, and the Ottawa Charter concerns health promotion.

Question 2Family Medicine Principles, History and Professionalism

A competent adult patient refuses a life-sustaining blood transfusion that their physicians believe is necessary. What is the most appropriate ethical action?

  1. Respect the refusal and document the patient's decision Correct answer.
  2. Proceed with transfusion because preserving life overrides patient preference
  3. Ask the family to consent on the patient's behalf
  4. Seek a court order to authorize the transfusion

Explanation

For a competent adult, the ethical principle of autonomy gives the patient the right to refuse any medical intervention, even life-sustaining treatment. The decision should be documented and supported with ongoing care and communication.

Question 3Family Medicine Principles, History and Professionalism

Which element is essential for valid informed consent before a procedure?

  1. Verbal agreement obtained in the presence of a witness
  2. Disclosure of material risks, benefits, and alternatives Correct answer.
  3. Written documentation by the patient's next of kin
  4. A second clinician's independent approval of the plan

Explanation

Valid informed consent requires the patient to have capacity, receive adequate disclosure of material risks, benefits, and alternatives, understand the information, and voluntarily agree. Documentation format or witness presence is not the defining element.

Question 4Family Medicine Principles, History and Professionalism

A 70-year-old patient with mild cognitive impairment and early dementia wants to drive to the pharmacy alone. Which action best reflects the physician's professional responsibility?

  1. Inform the patient that driving is now prohibited without assessment
  2. Defer the decision entirely to the patient's family
  3. Assess fitness to drive using a structured tool and discuss the findings Correct answer.
  4. Refer the patient directly to the licensing authority without discussion

Explanation

Physicians have a duty to assess and advise on fitness to drive using validated tools and to discuss the implications with the patient, balancing confidentiality with public safety. Direct reporting without assessment or discussion is premature, and the decision is not solely the family's.

Question 5Family Medicine Principles, History and Professionalism

Which historical figure is widely credited with founding modern nursing and establishing standards of hygiene and patient care during the Crimean War?

  1. Clara Barton
  2. Mary Seacole
  3. Elizabeth Blackwell
  4. Florence Nightingale Correct answer.

Explanation

Florence Nightingale is credited with founding modern professional nursing and with using statistical evidence to improve hygiene and reduce mortality during the Crimean War. The other figures made important contributions but are associated with different roles.

Question 6Family Medicine Principles, History and Professionalism

The concept of 'primary health care' as a comprehensive, community-based approach was formally articulated in which 1978 international declaration?

  1. The Helsinki Declaration
  2. The Edinburgh Declaration
  3. The Belmont Report
  4. The Alma-Ata Declaration Correct answer.

Explanation

The 1978 Alma-Ata Declaration, issued by WHO and UNICEF, defined primary health care as essential care based on practical, scientifically sound, and socially acceptable methods, and called for 'Health for All' by 2000.

Question 7Family Medicine Principles, History and Professionalism

Which of the following best describes the principle of 'justice' in biomedical ethics?

  1. Fair distribution of benefits, risks, and resources Correct answer.
  2. Avoiding harm to the patient during treatment
  3. Acting in the patient's best medical interest
  4. Respecting the patient's right to self-determination

Explanation

Justice concerns fairness in the distribution of scarce resources, benefits, and burdens across individuals and groups. Beneficence, non-maleficence, and autonomy describe the other three principles.

Question 8Family Medicine Principles, History and Professionalism

A physician is asked by an employer to disclose an employee's HIV status. The employee has not consented. What is the most appropriate response?

  1. Refer the employer to the employee's family for details
  2. Disclose because the employer has a legitimate occupational interest
  3. Disclose only the viral load to justify any work restrictions
  4. Refuse disclosure and explain confidentiality obligations to the employer Correct answer.

Explanation

Confidentiality is a core professional duty; disclosure of sensitive health information without consent is only justified in specific, legally defined circumstances such as serious risk to identifiable others. The physician should refuse and explain the duty to the employer.

Question 9Family Medicine Principles, History and Professionalism

Which of the following best characterizes the family physician's role as defined by the principles of family medicine?

  1. Delivering continuous, comprehensive, and coordinated care to defined populations Correct answer.
  2. Restricting practice to a single age group or organ system
  3. Focusing exclusively on the treatment of chronic diseases
  4. Providing episodic care limited to acute presentations

Explanation

Family medicine is defined by continuity, comprehensiveness, coordination, and first-contact care for a defined population, integrating biomedical and psychosocial dimensions. Episodic, single-organ, or single-age practice does not reflect these defining features.

Question 10Family Medicine Principles, History and Professionalism

A 30-year-old woman with a newly diagnosed chronic illness asks whether she can discuss her diagnosis with her partner. According to the principle of confidentiality, what should the physician do?

  1. Refuse to discuss disclosure to protect the patient's privacy
  2. Encourage the patient to disclose and offer support for that process Correct answer.
  3. Tell the partner only if the patient signs a general release
  4. Inform the partner directly because partners have a right to know

Explanation

Disclosure of health information to third parties is the patient's decision; the physician supports the patient in deciding whether and how to share information. Direct disclosure without consent breaches confidentiality.

Question 11Family Medicine Principles, History and Professionalism

Which of the following is the most appropriate first step when a physician recognizes a conflict of interest in a clinical decision?

  1. Continue the decision and document the conflict afterward
  2. Ignore minor conflicts because they do not affect care
  3. Disclose the conflict to the patient and relevant parties Correct answer.
  4. Delegate the decision to a colleague without disclosure

Explanation

Transparency through disclosure is the primary professional response to conflicts of interest, allowing patients and institutions to judge the decision fairly. Concealment or delegation without disclosure undermines trust.

Question 12Family Medicine Principles, History and Professionalism

Which of the following best describes the ethical principle of 'non-maleficence'?

  1. The duty to allocate resources fairly
  2. The duty to maximize benefits to the patient
  3. The duty to avoid causing harm Correct answer.
  4. The duty to respect the patient's choices

Explanation

Non-maleficence, often summarized as 'first, do no harm', obliges physicians to avoid interventions that cause unnecessary harm. Beneficence, autonomy, and justice describe the other principles.

Question 13Family Medicine Principles, History and Professionalism

A terminally ill patient with capacity asks about palliative sedation to relieve intractable suffering. Which ethical consideration is most directly relevant?

  1. The principle of distributive justice
  2. The doctrine of double effect Correct answer.
  3. The doctrine of informed refusal
  4. The rule of rescue

Explanation

Palliative sedation raises questions about the doctrine of double effect, which holds that an action with a good intended effect (relief of suffering) may be permissible even if a foreseen but unintended effect (hastened death) occurs. The other doctrines address different ethical situations.

Question 14Family Medicine Principles, History and Professionalism

Which of the following statements about the doctor-patient relationship is most consistent with the concept of 'shared decision-making'?

  1. The patient decides alone after reading information leaflets
  2. The physician decides and informs the patient of the plan
  3. The physician and patient exchange information and agree on a plan Correct answer.
  4. The family decides on behalf of the patient in all cases

Explanation

Shared decision-making involves a two-way exchange in which the physician provides evidence-based information and the patient contributes values and preferences, leading to an agreed plan. It differs from paternalistic or purely consumerist models.

Question 15Family Medicine Principles, History and Professionalism

A physician in a rural clinic has limited resources and must decide how to allocate a single ventilator between two patients. Which ethical framework is most appropriate to guide this decision?

  1. A transparent, evidence-based triage protocol applied consistently Correct answer.
  2. The patients' ability to pay for the treatment
  3. A first-come, first-served rule without any clinical criteria
  4. The attending physician's personal preference for one patient

Explanation

Resource allocation under scarcity should follow transparent, consistent, and evidence-based criteria that reflect both clinical benefit and fairness. Arbitrary or payment-based criteria violate justice and professional standards.

Question 16Family Medicine Principles, History and Professionalism

Which of the following best describes the concept of 'cultural competence' in family medicine?

  1. Applying the same approach to all patients regardless of background
  2. Adapting care to patients' cultural beliefs, values, and language needs Correct answer.
  3. Referring patients of different backgrounds to specialist colleagues
  4. Requiring patients to adopt the clinician's cultural norms

Explanation

Cultural competence involves recognizing and adapting to patients' cultural values, beliefs, and communication needs to improve care quality and equity. It does not mean treating everyone identically or imposing the clinician's norms.

Question 17Health Promotion, Disease Prevention and Screening

A 52-year-old woman with no symptoms asks about colorectal cancer screening. She has no family history and no other risk factors. Which screening strategy is appropriate for average-risk adults of her age?

  1. Colonoscopy every 10 years Correct answer.
  2. Annual colonoscopy
  3. CT colonography every 12 months
  4. No screening until age 60

Explanation

Average-risk adults are offered colorectal screening from around age 50 (or earlier in some regional guidelines), and colonoscopy every 10 years is one accepted strategy alongside annual faecal immunochemical testing. Screening intervals are based on the test's sensitivity and the slow progression of adenoma to carcinoma.

Question 18Health Promotion, Disease Prevention and Screening

A 30-year-old man has a documented anaphylactic reaction to egg white. He needs influenza vaccination during the current season. What is the most appropriate approach?

  1. Refer for desensitisation before any influenza vaccine
  2. Permanently withhold influenza vaccine
  3. Give a half dose and repeat in 4 weeks
  4. Give the vaccine in the usual way with observation for at least 15 minutes Correct answer.

Explanation

Current guidance allows influenza vaccination of people with egg allergy, including those with severe reactions, using the standard age-appropriate vaccine with a period of post-vaccination observation. Egg protein content in modern vaccines is low and serious reactions are rare.

Question 19Health Promotion, Disease Prevention and Screening

A 58-year-old man smokes 20 cigarettes daily and has done so for 30 years. He is asymptomatic and asks about lung cancer screening. Which statement best reflects the evidence-based recommendation?

  1. Annual low-dose CT is offered to high-risk ever-smokers within defined age limits Correct answer.
  2. Sputum cytology every 6 months is recommended
  3. Chest radiography every year is the preferred screening test
  4. Screening is not offered to asymptomatic smokers at any age

Explanation

Low-dose CT screening reduces lung cancer mortality in high-risk ever-smokers and is recommended within defined age and pack-year eligibility criteria. Chest radiography and sputum cytology have not shown mortality benefit as screening tools.

Question 20Health Promotion, Disease Prevention and Screening

A 26-year-old woman attends for preconception advice. She has no chronic illness and takes no regular medication. Which single intervention has the strongest evidence for reducing the risk of neural tube defects?

  1. Folic acid 400 micrograms daily started before conception Correct answer.
  2. Vitamin D 10 micrograms daily in pregnancy
  3. Calcium supplementation before conception
  4. Iron supplementation from the first trimester

Explanation

Periconceptional folic acid supplementation reduces the occurrence and recurrence of neural tube defects, and the protective effect depends on starting before conception and continuing through early gestation. Higher doses are used for women with additional risk factors such as previous affected pregnancy or diabetes.

Question 21Health Promotion, Disease Prevention and Screening

A 45-year-old woman with type 2 diabetes attends for review. Her blood pressure is 138/86 mmHg on repeated readings and she has no albuminuria. Which blood pressure target is generally recommended for most adults with diabetes?

  1. Below 120/70 mmHg
  2. Below 140/90 mmHg Correct answer.
  3. Below 160/100 mmHg
  4. Below 150/95 mmHg

Explanation

Most guidelines recommend a treatment target of below 140/90 mmHg for adults with diabetes, with individualised lower targets in selected patients who tolerate treatment. Excessively tight targets increase adverse effects without consistent benefit in all patients.

Question 22Health Promotion, Disease Prevention and Screening

A 60-year-old woman is found to have a fasting plasma glucose of 6.4 mmol/L on two occasions. She is asymptomatic. What is the correct classification and initial management?

  1. Impaired fasting glucose; offer structured lifestyle intervention and annual review Correct answer.
  2. Type 2 diabetes; start metformin immediately
  3. Impaired fasting glucose; start an SGLT2 inhibitor
  4. Normal glucose; no action needed

Explanation

A fasting glucose between 6.1 and 6.9 mmol/L indicates impaired fasting glucose (prediabetes), which warrants intensive lifestyle intervention and periodic reassessment for progression to diabetes. Pharmacotherapy is not routinely indicated at this stage in an asymptomatic patient.

Question 23Health Promotion, Disease Prevention and Screening

A 35-year-old woman with no symptoms asks about cervical screening. She has been sexually active since age 20 and has never been screened. What is the most appropriate recommendation?

  1. Advise she needs no screening because she is asymptomatic
  2. Reassure her that screening starts at age 50
  3. Offer cervical screening now according to the local programme Correct answer.
  4. Recommend annual colposcopy

Explanation

Cervical screening is offered to sexually active women from around age 25 to 30 depending on the regional programme, and a woman who has never been screened should be offered testing now. Screening is a preventive service for asymptomatic women and does not depend on symptoms.

Question 24Health Promotion, Disease Prevention and Screening

A 68-year-old man with a body mass index of 31 kg/m² and no known diabetes attends for cardiovascular risk assessment. Which additional measurement most improves the accuracy of his risk estimate?

  1. Serum ferritin
  2. Abdominal ultrasound
  3. Fasting lipid profile Correct answer.
  4. Serum uric acid

Explanation

Cardiovascular risk prediction tools incorporate age, sex, smoking, blood pressure, and lipid values, so a fasting lipid profile is essential to calculate risk accurately. Other biomarkers are not part of standard risk equations.

Question 25Health Promotion, Disease Prevention and Screening

A 55-year-old woman has a body mass index of 34 kg/m² and reports no other symptoms. Which screening recommendation is specifically indicated because of her obesity?

  1. Screening for type 2 diabetes with HbA1c or fasting glucose Correct answer.
  2. Routine screening for ovarian cancer
  3. Annual chest radiography
  4. Annual serum calcium measurement

Explanation

Obesity is a major risk factor for type 2 diabetes, and adults with overweight or obesity should be screened with HbA1c or fasting glucose. Screening for ovarian cancer and annual chest radiography have no proven benefit in this context.

Question 26Health Promotion, Disease Prevention and Screening

A 70-year-old man with hypertension and a 40 pack-year smoking history attends for a preventive visit. Which combination of preventive services is most appropriate for him?

  1. Routine screening for hepatitis C in all adults over 65
  2. Blood pressure review, smoking cessation support, and abdominal aortic aneurysm screening Correct answer.
  3. Annual electrocardiography in asymptomatic men
  4. Routine prostate-specific antigen testing without discussion

Explanation

Men aged 65 to 75 with a smoking history should be offered one-time abdominal aortic aneurysm ultrasound screening, alongside blood pressure control and smoking cessation. Screening decisions for prostate cancer require shared decision-making rather than routine testing.

Question 27Health Promotion, Disease Prevention and Screening

A 24-year-old woman is due for routine vaccination review. She has no chronic conditions and is not pregnant. Which vaccine should be avoided during pregnancy but is recommended before conception if she is not immune?

  1. Hepatitis B vaccine
  2. Measles-mumps-rubella vaccine Correct answer.
  3. Inactivated influenza vaccine
  4. Tetanus-diphtheria vaccine

Explanation

Live attenuated vaccines such as MMR are contraindicated in pregnancy, so non-immune women should be vaccinated before conception and advised to avoid pregnancy for a short period afterwards. Inactivated vaccines such as tetanus, influenza, and hepatitis B are safe in pregnancy.

Question 28Health Promotion, Disease Prevention and Screening

A 62-year-old woman has a bone mineral density T-score of -2.0 at the femoral neck. She has no prior fracture and takes no glucocorticoids. How should this result be interpreted?

  1. Severe osteoporosis requiring teriparatide
  2. Normal bone density for age
  3. Osteopenia; advise lifestyle measures and assess fracture risk Correct answer.
  4. Osteoporosis requiring immediate bisphosphonate therapy

Explanation

A T-score between -1.0 and -2.5 defines osteopenia, whereas osteoporosis requires a T-score of -2.5 or below or a fragility fracture. Management in osteopenia is guided by overall fracture risk assessment rather than drug therapy in all cases.

Question 29Health Promotion, Disease Prevention and Screening

A 50-year-old man with a body mass index of 27 kg/m² and no symptoms asks about screening for type 2 diabetes. Which test is acceptable for screening in this context?

  1. Fasting insulin level
  2. Random urine glucose
  3. HbA1c Correct answer.
  4. Oral glucose tolerance test in all adults

Explanation

HbA1c or fasting plasma glucose are the standard screening tests for type 2 diabetes in asymptomatic adults with risk factors. Random urine glucose and fasting insulin are not validated screening tools.

Question 30Health Promotion, Disease Prevention and Screening

A 40-year-old woman reports a 10 pack-year smoking history and asks about the best single measure to reduce her future cancer and cardiovascular risk. What advice should be given?

  1. Vitamin E supplementation
  2. Annual chest radiography
  3. Annual low-dose CT screening
  4. Structured smoking cessation support with pharmacotherapy Correct answer.

Explanation

Stopping smoking is the single most effective intervention for reducing smoking-related cancer and cardiovascular risk, and combining behavioural support with pharmacotherapy improves quit rates. Screening does not replace cessation and does not reduce the underlying risk.

Question 31Health Promotion, Disease Prevention and Screening

A 32-year-old woman is 10 weeks pregnant and has no immunity to rubella. What is the most appropriate action?

  1. Vaccinate immediately in the first trimester
  2. Defer all vaccination indefinitely
  3. Vaccinate after delivery and advise contraception until then Correct answer.
  4. Give immunoglobulin and consider the case closed

Explanation

Live vaccines such as MMR cannot be given during pregnancy, so susceptible women should be vaccinated in the postpartum period, with advice to avoid pregnancy for about one month after vaccination. This protects future pregnancies without exposing the current pregnancy.

Question 32Health Promotion, Disease Prevention and Screening

A 65-year-old man asks about screening for abdominal aortic aneurysm. Which statement best describes the evidence-based recommendation for men of his age with a smoking history?

  1. One-time ultrasound screening is recommended Correct answer.
  2. Annual ultrasound screening is recommended
  3. Screening is recommended only after symptoms develop
  4. Screening with CT angiography is preferred

Explanation

A single ultrasound screen between ages 65 and 75 is recommended for men with a smoking history because it detects aneurysms that can be monitored or repaired electively. Repeated annual imaging and CT angiography are not indicated for primary screening.

Question 33Health Promotion, Disease Prevention and Screening

A 28-year-old woman has a body mass index of 36 kg/m² and PCOS. She is not currently trying to conceive. Which preventive counselling point is most relevant?

  1. Routine screening for cervical cancer every 6 months
  2. Annual mammography from age 30
  3. Screening for impaired glucose tolerance and type 2 diabetes Correct answer.
  4. Routine bone density scanning

Explanation

PCOS with obesity increases the risk of insulin resistance and type 2 diabetes, so periodic screening with HbA1c or an oral glucose tolerance test is recommended. Mammography and bone density screening are not indicated at this age on the basis of PCOS alone.

Question 34Health Promotion, Disease Prevention and Screening

A 70-year-old woman with mild cognitive impairment lives alone. Which preventive intervention has the strongest evidence for reducing her risk of hip fracture?

  1. Annual chest radiography
  2. Long-term bed rest to prevent falls
  3. Weight-bearing and balance exercise with home safety assessment Correct answer.
  4. Routine calcium supplementation alone

Explanation

Exercise programmes combining balance, strength, and gait training, together with home hazard reduction, reduce falls and fall-related fractures in older adults. Calcium alone does not prevent falls, and bed rest increases weakness and fracture risk.

Question 35Health Promotion, Disease Prevention and Screening

A 45-year-old man has a fasting plasma glucose of 5.4 mmol/L and a body mass index of 24 kg/m². He has no family history of diabetes. What is the most appropriate screening recommendation?

  1. Start metformin for diabetes prevention
  2. Perform an oral glucose tolerance test every 3 months
  3. Repeat screening at intervals according to local guidance Correct answer.
  4. No further screening at any point

Explanation

His fasting glucose is within the normal range and his risk profile is low, so periodic rescreening according to local guidance is appropriate. Pharmacotherapy and frequent diagnostic testing are not indicated in this setting.

Question 36Health Promotion, Disease Prevention and Screening

A 60-year-old woman with a 30 pack-year smoking history attends for a preventive visit. Which screening test should be offered in addition to lung cancer screening?

  1. Annual chest radiography
  2. Abdominal aortic aneurysm ultrasound Correct answer.
  3. Routine serum CA-125 measurement
  4. Routine ovarian cancer screening

Explanation

Women aged 65 to 75 with a smoking history should be offered one-time abdominal aortic aneurysm ultrasound screening, alongside lung cancer screening where eligible. Ovarian cancer screening and annual chest radiography have no proven mortality benefit.

Question 37Cardiovascular Disorders

A 58-year-old man with no prior cardiac history presents with central chest pain that began 45 minutes ago. His ECG shows ST elevation in leads II, III and aVF. Which coronary artery is most likely occluded?

  1. Right coronary artery Correct answer.
  2. Left anterior descending artery
  3. Left main coronary artery
  4. Left circumflex artery

Explanation

ST elevation in the inferior leads (II, III, aVF) localises injury to the inferior wall, which is supplied by the right coronary artery in most individuals. The LAD supplies the anterior wall, and the circumflex supplies the lateral wall.

Question 38Cardiovascular Disorders

Which single finding on the resting 12-lead ECG is most specific for left ventricular hypertrophy?

  1. Left ventricular strain pattern with repolarisation changes Correct answer.
  2. Cornell voltage criteria
  3. Sokolow-Lyon voltage criteria
  4. Left axis deviation

Explanation

Voltage criteria such as Sokolow-Lyon and Cornell are sensitive but poorly specific, especially in young thin adults. The strain pattern of downsloping ST depression and T-wave inversion in lateral leads adds specificity for true hypertrophy.

Question 39Cardiovascular Disorders

A 70-year-old woman with permanent atrial fibrillation has a CHA2DS2-VASc score of 4. She has no contraindications to anticoagulation. What is the most appropriate long-term antithrombotic strategy?

  1. No antithrombotic therapy because she has no symptoms
  2. Oral anticoagulation with a direct oral anticoagulant or warfarin Correct answer.
  3. Aspirin 75 mg once daily
  4. Dual antiplatelet therapy with aspirin and clopidogrel

Explanation

A CHA2DS2-VASc score of 2 or more in women (or 1 or more in men) warrants oral anticoagulation to reduce stroke risk. Antiplatelets are markedly inferior to anticoagulation for atrial fibrillation stroke prevention.

Question 40Cardiovascular Disorders

A 24-year-old man has a blood pressure of 168/104 mmHg recorded on three separate visits, with no identifiable secondary cause after screening. Which diagnosis is most appropriate?

  1. Primary (essential) hypertension Correct answer.
  2. White coat hypertension
  3. Masked hypertension
  4. Hypertensive emergency

Explanation

Persistently elevated readings on repeated visits without an identifiable secondary cause define primary hypertension. Secondary causes should be screened for, particularly in young patients, but absence of a cause supports the primary diagnosis.

Question 41Cardiovascular Disorders

A 64-year-old man with heart failure with reduced ejection fraction (ejection fraction 30%) is stable on an ACE inhibitor and beta-blocker. Which additional drug has been shown to reduce both mortality and heart failure hospitalisation in this setting?

  1. Digoxin
  2. Amlodipine
  3. Furosemide
  4. Mineralocorticoid receptor antagonist Correct answer.

Explanation

Mineralocorticoid receptor antagonists such as spironolactone reduce mortality and hospitalisation in HFrEF when added to standard therapy. Loop diuretics relieve congestion but do not improve survival.

Question 42Cardiovascular Disorders

A 55-year-old man presents with sudden-onset tearing chest pain radiating to the back. Blood pressure is 180/100 mmHg in the right arm and 140/85 mmHg in the left arm. Which is the most appropriate initial imaging investigation?

  1. Transthoracic echocardiography
  2. Exercise stress testing
  3. CT angiography of the aorta Correct answer.
  4. Chest radiograph

Explanation

The clinical picture suggests acute aortic dissection, and CT angiography of the aorta is the first-line diagnostic test in stable patients. It rapidly confirms the diagnosis and defines the extent of the dissection.

Question 43Cardiovascular Disorders

Which physical examination finding is most characteristic of severe aortic stenosis?

  1. Wide pulse pressure
  2. Collapsing pulse
  3. Slow-rising low-volume pulse Correct answer.
  4. Bounding peripheral pulses

Explanation

Severe aortic stenosis produces a fixed outflow obstruction, giving a slow-rising, low-volume (plateau) pulse with a narrow pulse pressure. Collapsing or bounding pulses suggest aortic regurgitation.

Question 44Cardiovascular Disorders

A 68-year-old woman with known mitral stenosis develops sudden palpitations and breathlessness. Her ECG shows an irregular narrow-complex tachycardia at 150 beats per minute. Which complication is most likely?

  1. Complete heart block
  2. Ventricular tachycardia
  3. Atrial fibrillation Correct answer.
  4. Sinus tachycardia

Explanation

Left atrial enlargement from mitral stenosis predisposes to atrial fibrillation, which presents as an irregularly irregular narrow-complex tachycardia. This can precipitate acute decompensation because the loss of atrial contribution impairs ventricular filling.

Question 45Cardiovascular Disorders

A 30-year-old woman has a resting heart rate of 120 beats per minute, a diffuse goitre, tremor and weight loss. Her ECG shows a narrow-complex regular tachycardia. Which mechanism best explains the rhythm?

  1. Enhanced automaticity of an ectopic atrial focus
  2. Re-entry within the atrioventricular node
  3. Atrioventricular block with junctional escape
  4. Increased sympathetic drive from thyrotoxicosis Correct answer.

Explanation

Thyrotoxicosis causes sinus tachycardia through increased sympathetic tone and direct thyroid hormone effects on the sinoatrial node. The rhythm is driven by physiologic sinoatrial automaticity, not a re-entrant circuit.

Question 46Cardiovascular Disorders

A 72-year-old man with chronic stable angina is prescribed a beta-blocker. Which effect is the primary mechanism by which beta-blockers relieve anginal symptoms?

  1. Plaque stabilisation
  2. Increased collateral vessel formation
  3. Reduction in myocardial oxygen demand Correct answer.
  4. Coronary vasodilation

Explanation

Beta-blockers reduce heart rate, contractility and blood pressure, lowering myocardial oxygen demand and thereby relieving ischaemia. They do not act primarily as coronary vasodilators.

Question 47Cardiovascular Disorders

A 60-year-old man with acute decompensated heart failure has bibasal crackles, raised jugular venous pressure and peripheral oedema. Which intravenous agent is most appropriate for initial symptom relief?

  1. Intravenous furosemide Correct answer.
  2. Intravenous adenosine
  3. Intravenous amiodarone
  4. Intravenous bisoprolol

Explanation

Intravenous loop diuretics relieve congestion in acute decompensated heart failure by promoting natriuresis and diuresis. Beta-blockade is not initiated intravenously in the acute congested phase.

Question 48Cardiovascular Disorders

A 45-year-old man has a blood pressure of 178/108 mmHg with headache and confusion. Fundoscopy shows papilloedema. Which is the most appropriate management approach?

  1. Gradual reduction of blood pressure over hours with intravenous therapy Correct answer.
  2. Oral captopril and outpatient review
  3. Rapid reduction of blood pressure to normal within one hour
  4. Reassurance and ambulatory monitoring

Explanation

This is a hypertensive emergency with target-organ damage, requiring controlled blood pressure reduction, usually with intravenous agents, over hours to avoid ischaemic complications. Precipitous normalisation can compromise cerebral and coronary perfusion.

Question 49Cardiovascular Disorders

A 58-year-old woman has a deep vein thrombosis and is started on anticoagulation. Which condition must be excluded before diagnosing unprovoked venous thromboembolism?

  1. Hypothyroidism
  2. Iron deficiency anaemia
  3. Osteoarthritis
  4. Undiagnosed malignancy Correct answer.

Explanation

Unprovoked venous thromboembolism warrants screening for occult malignancy, although extensive tumour screening is not universally recommended. Age-appropriate cancer screening should be considered.

Question 50Cardiovascular Disorders

A 66-year-old man with heart failure with preserved ejection fraction (ejection fraction 55%) has exertional breathlessness and ankle swelling. Which treatment approach is most appropriate?

  1. High-dose ACE inhibitor uptitration
  2. Sacubitril-valsartan initiation
  3. Diuretics for congestion plus management of comorbidities Correct answer.
  4. Routine digoxin therapy

Explanation

In HFpEF, diuretics relieve congestion and management focuses on treating comorbidities such as hypertension, diabetes and atrial fibrillation. Neurohormonal agents have not shown the same mortality benefit as in HFrEF.