18OO MCQ GENERAL SURGERY EOR STUDY GUIDE REVISED AND UPDATED VERSION 9-12-2023

1. A 45-year-old lady has 10 months history of shortness of breath. She is found to have irregularly irregular pulse and loud P2 with fixed splitting and ejection systolic murmur in left 2nd intercostal space. What is the probable diagnosis? A. TOF B. ASD C. VSD D. PDA E. CoA Ans. The key is B. Atrial septal defect. [Most adult patients with a large defect present with (some or all) symptoms including fatigue, exercise intolerance, palpitations, syncope, shortness of breath, peripheral oedema, thromboembolic manifestations, and cyanosis. Arrhythmias are more common after 40 years of age. The common arrhythmias are atrial flutter and atrial fibrillation. Auscultatory findings are: • Loud P2 with fixed splitting of 2nd heart sound. A left-to-right shunt caused increased loading on the right ventricle, leading to delayed emptying and therefore delayed closure of the pulmonary valve which caused this splitting. • Soft systolic ejection murmur in the pulmonary area at the upper left sternal border. • A diastolic rumble over the left lower sternum because of increased flow through the tricuspid valve. Classic auscultatory findings as described above are not present unless the shunt is reasonably large. 2. A 64-year-old man has recently suffered from an MI and is on aspirin, atorvastatin and ramipril. He has been having trouble sleeping and has been losing weight for the past 4 months. He doesn’t feel like doing anything he used to enjoy and has stopped socializing. He says he gets tired easily and can’t concentrate on anything. What is the most appropriate treatment? A. Lofepramine B. Dosulepin C. Citalopram D. Fluoxetine E. Phenelzine