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A 55-year-old man presents with intermittent claudication in the calves on walking 200 metres, relieved by rest. He smokes and has palpable but reduced foot pulses. Besides smoking cessation and exercise, which medication is most appropriate to reduce his cardiovascular risk?
A
B
C
D
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Sample MOHAP Doctor Exam Practice Questions
Try these sample questions to test your MOHAP Doctor Exam exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.
1A 58-year-old man with type 2 diabetes presents with sudden central crushing chest pain radiating to the left arm, diaphoresis, and nausea for 40 minutes. ECG shows ST-elevation in leads II, III, and aVF. After aspirin and oxygen, what is the single most important immediate management priority?
A.Arrange urgent reperfusion with primary PCI
B.Start a beta-blocker infusion to control heart rate
C.Order an exercise treadmill stress test
D.Give intravenous fluids and observe for 24 hours
Explanation: ST-elevation in II, III, aVF indicates an inferior STEMI. The priority after aspirin/oxygen is immediate reperfusion, with primary percutaneous coronary intervention (PCI) preferred within 90-120 minutes; fibrinolysis is used if PCI is not available in time.
2A 65-year-old woman has a blood pressure of 168/98 mmHg confirmed on three separate occasions. She has no diabetes or chronic kidney disease. According to standard first-line antihypertensive guidance for a patient of this age, which agent is most appropriate to start?
A.An ACE inhibitor such as ramipril as monotherapy
B.A calcium channel blocker such as amlodipine
C.A beta-blocker such as atenolol
D.An alpha-blocker such as doxazosin
Explanation: For patients aged 55 or older (and those of Black African or Caribbean ancestry) without diabetes, a calcium channel blocker such as amlodipine is the recommended first-line antihypertensive. ACE inhibitors are first-line in younger patients.
3A 72-year-old man presents with palpitations and shortness of breath. ECG shows an irregularly irregular rhythm with absent P waves and a ventricular rate of 130 bpm. He is haemodynamically stable. Which scoring tool should guide the decision to start oral anticoagulation?
A.Wells score
B.CURB-65 score
C.CHA2DS2-VASc score
D.GRACE score
Explanation: The rhythm is atrial fibrillation. The CHA2DS2-VASc score estimates annual stroke risk and guides anticoagulation: a score of 2 or more in men (or 3 or more in women) warrants oral anticoagulation.
4A 60-year-old man with known heart failure with reduced ejection fraction is already on an ACE inhibitor and a beta-blocker but remains symptomatic with NYHA class III dyspnoea. His potassium is 4.2 mmol/L and renal function is normal. Which agent is most appropriate to add next to improve survival?
A.Amlodipine
B.Digoxin as first add-on
C.Long-term oral furosemide increase only
D.Spironolactone (a mineralocorticoid receptor antagonist)
Explanation: In HFrEF that remains symptomatic on an ACE inhibitor and beta-blocker, adding a mineralocorticoid receptor antagonist such as spironolactone reduces mortality and hospitalisation. Potassium and renal function must be monitored.
5A 45-year-old man is found to have a total cholesterol of 7.2 mmol/L and an LDL of 5.0 mmol/L on screening. He has no cardiovascular disease, and his 10-year cardiovascular risk is calculated at 18%. What is the most appropriate first-line lipid-lowering therapy?
A.High-intensity statin such as atorvastatin 20 mg
B.Ezetimibe monotherapy
C.Fibrate such as fenofibrate
D.Bile acid sequestrant such as colestyramine
Explanation: A 10-year cardiovascular risk of 10% or more warrants statin therapy for primary prevention; atorvastatin 20 mg is the standard first-line high-intensity statin. Statins are the most evidence-based agents for reducing cardiovascular events.
6A 70-year-old woman presents with progressive exertional dyspnoea and an ejection systolic murmur heard loudest at the right second intercostal space, radiating to the carotids, with a slow-rising pulse. Which valvular lesion is most likely?
A.Mitral regurgitation
B.Aortic stenosis
C.Aortic regurgitation
D.Tricuspid stenosis
Explanation: An ejection systolic murmur at the aortic area radiating to the carotids with a slow-rising (pulsus parvus et tardus) pulse is classic for aortic stenosis. In the elderly it is usually due to calcific degeneration.
7A 55-year-old man presents with intermittent claudication in the calves on walking 200 metres, relieved by rest. He smokes and has palpable but reduced foot pulses. Besides smoking cessation and exercise, which medication is most appropriate to reduce his cardiovascular risk?
A.Warfarin lifelong
B.Pentoxifylline as the primary therapy
C.Clopidogrel (antiplatelet) plus a statin
D.A vasodilator nifedipine alone
Explanation: Peripheral arterial disease is a coronary risk equivalent. Antiplatelet therapy (clopidogrel) plus a statin reduces cardiovascular events and mortality; smoking cessation and supervised exercise are core management.
8A 30-year-old woman presents with episodic palpitations with sudden onset and offset. During an episode the ECG shows a regular narrow-complex tachycardia at 180 bpm with no visible P waves. She is haemodynamically stable. What is the most appropriate first-line manoeuvre?
A.Immediate synchronised DC cardioversion
B.Intravenous amiodarone
C.Intravenous digoxin loading
D.Vagal manoeuvres such as the modified Valsalva
Explanation: This is supraventricular tachycardia. In a stable patient, vagal manoeuvres (e.g. modified Valsalva) are first-line; if unsuccessful, intravenous adenosine is the next step. Cardioversion is reserved for haemodynamic instability.
9A patient on warfarin for atrial fibrillation has an INR of 8.5 with no bleeding. What is the most appropriate management?
A.Withhold warfarin and give oral vitamin K (phytomenadione)
B.Continue the same warfarin dose and recheck in one week
C.Give intravenous protamine sulfate
D.Transfuse fresh frozen plasma urgently
Explanation: An INR above 8 without bleeding is managed by stopping warfarin and giving a small dose of oral vitamin K, then restarting warfarin once the INR is below 5. Vitamin K reverses the anticoagulant effect over hours.
10A 50-year-old man with stable angina is started on a beta-blocker but continues to have symptoms. He has well-controlled asthma history. Which is the most appropriate additional anti-anginal agent?
A.Verapamil added to the beta-blocker
B.A long-acting dihydropyridine calcium channel blocker such as amlodipine
C.An additional beta-blocker at higher dose only
D.A short-acting calcium channel blocker such as immediate-release nifedipine
Explanation: When a beta-blocker alone does not control angina, adding a long-acting dihydropyridine calcium channel blocker such as amlodipine is appropriate. Dihydropyridines do not depress conduction the way verapamil does.
About the MOHAP Doctor Exam Practice Questions
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