BPT CLINICAL INTERNAL MEDICINE EXAM 2026
QUESTIONS AND 100% CORRECT AND VERIFIED
ANSWERS
GRADED A+
• 1
INT - 1.1
These can be heard in mitral stenosis, except for:
A) apical holosystolic murmur radiating towards the axilla
B) low-frequency apical diastolic murmur
C) opening snap
D) loud first heart sound
A) apical holosystolic murmur radiating towards the axilla
Holosystolic heart murmurs that radiate towards the axilla and
are best heard at the apex are characteristic of mitral
regurgitation, therefore they cannot be heard in mitral stenosis.
Severe mitral stenosis might be accompanied by tricuspidal
insufficiency that can cause a holosystolic, apical murmur, but it
never radiates towards the axilla. The pathomechanism behind
the low-frequency, diastolic murmur is the fast, turbulent flow
through the stenotic mitral valve. The opening snap (o.s.) is
heard as the mitral leaflets buckle in their attempt to open and it
,cannot be heard when the valve is severely calcified. The loud,
tapping first heard sound is especially easy to notice when the
heart is in sinus rhythm and when it is introduced by a
presystolic murmur.
• 2
INT - 1.2
Part of the therapy of decompensated heart failure, except
for:
A) mineralocorticoid-antagonists
B) diuretics
C) digoxin
D) parenteral volume expansion
E) ACE-inhibitors
D) parenteral volume expansion
In chronic decompensated heart failure the body is in a state of
fluid overload. Treatment with diuretics and mineralocorticoid-
antagonists is essential. Digoxin should be given because of its
positive inotropic and negative chronotropic effects, while ACE-
inhibitors improve long-term survival. Parenteral administration
of fluids (infusions) is contraindicated as it increases the preload
on the left atrium and the left ventricle and worsens the
symptoms. Acute left ventricle failure might be caused by acute
myocardial infarction, hypertensive crisis or severe aortic
,stenosis as well since these all strain the left ventricle while
bronchial asthma exerts the right ventricle.
• 3
INT - 1.3
Causes of acute left ventricle failure, except for:
A) asthma bronchiale
B) acute myocardial infarction
C) hypertensive crisis
D) severe aortic stenosis
A) asthma bronchiale
Acute left ventricle failure might be caused by acute myocardial
infarction, hypertensive crisis or severe aortic stenosis as well
since these all strain the left ventricle while bronchial asthma
exerts the right ventricle.
• 4
INT - 1.4
Characteristics of hypertrophic obstructive
cardiomyopathy, except for:
A) might be combined with mitral insufficiency
B) digoxin is important in the early stage
C) it often shows a familial distribution
, D) diastolic dysfunction is common
E) syncope is a common symptom
B) digoxin is important in the early stage
Hypertrophic cardiomyopathy has a genetic background in most
of the cases, so it is usually familial. Characteristic symptoms
include syncope and it is often accompanied by mitral
insufficiency because the mitral valve is primarily damaged. The
valve has functional damage, too: because of the Venturi effect
its anterior leaflet moves toward or contacts the interventricular
septum (it is called systolic anterior motion: SAM) and the valve
doesn’t close completely during systole which can result in
severe mitral insufficiency (these changes can be diagnosed
with echocardiography). As the hypertrophic myocardium’s
ability to relaxe is damaged, the diastolic filling decreases which
leads to diastolic dysfunction. Digitalis (Digoxin) is not
recommended either in early or in late stages unless the
disease reaches its „burn-out”, dilated phase.
• 5
INT - 1.5
Features of atrial myxoma, except for:
A) the most common form of primary cardiac tumors
B) it can be diagnosed with echocardiography
QUESTIONS AND 100% CORRECT AND VERIFIED
ANSWERS
GRADED A+
• 1
INT - 1.1
These can be heard in mitral stenosis, except for:
A) apical holosystolic murmur radiating towards the axilla
B) low-frequency apical diastolic murmur
C) opening snap
D) loud first heart sound
A) apical holosystolic murmur radiating towards the axilla
Holosystolic heart murmurs that radiate towards the axilla and
are best heard at the apex are characteristic of mitral
regurgitation, therefore they cannot be heard in mitral stenosis.
Severe mitral stenosis might be accompanied by tricuspidal
insufficiency that can cause a holosystolic, apical murmur, but it
never radiates towards the axilla. The pathomechanism behind
the low-frequency, diastolic murmur is the fast, turbulent flow
through the stenotic mitral valve. The opening snap (o.s.) is
heard as the mitral leaflets buckle in their attempt to open and it
,cannot be heard when the valve is severely calcified. The loud,
tapping first heard sound is especially easy to notice when the
heart is in sinus rhythm and when it is introduced by a
presystolic murmur.
• 2
INT - 1.2
Part of the therapy of decompensated heart failure, except
for:
A) mineralocorticoid-antagonists
B) diuretics
C) digoxin
D) parenteral volume expansion
E) ACE-inhibitors
D) parenteral volume expansion
In chronic decompensated heart failure the body is in a state of
fluid overload. Treatment with diuretics and mineralocorticoid-
antagonists is essential. Digoxin should be given because of its
positive inotropic and negative chronotropic effects, while ACE-
inhibitors improve long-term survival. Parenteral administration
of fluids (infusions) is contraindicated as it increases the preload
on the left atrium and the left ventricle and worsens the
symptoms. Acute left ventricle failure might be caused by acute
myocardial infarction, hypertensive crisis or severe aortic
,stenosis as well since these all strain the left ventricle while
bronchial asthma exerts the right ventricle.
• 3
INT - 1.3
Causes of acute left ventricle failure, except for:
A) asthma bronchiale
B) acute myocardial infarction
C) hypertensive crisis
D) severe aortic stenosis
A) asthma bronchiale
Acute left ventricle failure might be caused by acute myocardial
infarction, hypertensive crisis or severe aortic stenosis as well
since these all strain the left ventricle while bronchial asthma
exerts the right ventricle.
• 4
INT - 1.4
Characteristics of hypertrophic obstructive
cardiomyopathy, except for:
A) might be combined with mitral insufficiency
B) digoxin is important in the early stage
C) it often shows a familial distribution
, D) diastolic dysfunction is common
E) syncope is a common symptom
B) digoxin is important in the early stage
Hypertrophic cardiomyopathy has a genetic background in most
of the cases, so it is usually familial. Characteristic symptoms
include syncope and it is often accompanied by mitral
insufficiency because the mitral valve is primarily damaged. The
valve has functional damage, too: because of the Venturi effect
its anterior leaflet moves toward or contacts the interventricular
septum (it is called systolic anterior motion: SAM) and the valve
doesn’t close completely during systole which can result in
severe mitral insufficiency (these changes can be diagnosed
with echocardiography). As the hypertrophic myocardium’s
ability to relaxe is damaged, the diastolic filling decreases which
leads to diastolic dysfunction. Digitalis (Digoxin) is not
recommended either in early or in late stages unless the
disease reaches its „burn-out”, dilated phase.
• 5
INT - 1.5
Features of atrial myxoma, except for:
A) the most common form of primary cardiac tumors
B) it can be diagnosed with echocardiography
