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Patient centered questions MCQs for assessment of "Clinical problem solving and Medical decision

A 35-year-old male, caterer by profession, has presented to the outpatient department with complaints of progressive shortness of breath and leg swelling for 4 weeks. He reports having these started with anorexia. He also reports having been treated with antimalarial drugs for suspected malaria 2 months back. He is a known alcoholic, drinking 250-300 ml thrice a week.

The general examination noted normal vitals. Additionally, he has large central obesity with elevated jugular venous pressure and moderate to severe bilateral ankle edema. Cardiovascular examination reveals an apical beat felt at the seventh intercostal space near the anterior axillary line with a doubtful S4 gallop. His respiratory system examination is noncontributory.

His laboratory investigations are notable for raised alkaline phosphatase, mildly elevated SGPT, borderline decrease in albumin, and increased glycated hemoglobin. His lipid profile, complete blood count, thyroid and renal function tests are normal. His echocardiogram is notable for low ejection fraction (27%) with global hypokinesia, severe mitral regurgitation and dilated cardiac chambers. Endomyocardial biopsy (EMB) is thought to be diagnostic in this patient

Which of the following is likely to be found in the EMB of this patient?

A. Histiocytic and mononuclear infiltrates.
B. interstitial infiltrate with prominent eosinophils
C. Extracellular amyloid deposits
D. Noncaseating granuloma


A 35-year-old male, caterer by profession, has presented to the outpatient department with the complaints of progressive shortness of breath and leg swelling since 4 weeks. He reports to have these started with anorexia. He also reports to have been treated with antimalarial drugs for suspected malaria 2 months back. He is a known alcoholic, drinking 250-300 ml thrice a week.

The general examination noted normal vitals. Additionally, he has a large central obesity with elevated jugular venous pressure and moderate to severe bilateral ankle edema. Cardiovascular examination reveals an apical beat felt at the seventh intercostal space near the anterior axillary line with a doubtful S4 gallop. His respiratory system examination is noncontributory.

His laboratory investigations are notable for raised alkaline phosphatase, mildly elevated SGPT, borderline decrease in albumin, and increased glycated hemoglobin. His electrocardiogram shows right bundle branch block. His echocardiogram is notable for low ejection fraction (27%) with global hypokinesia, severe mitral regurgitation and dilated cardiac chambers. Endomyocardial biopsy (EMB) is thought to be diagnostic in this patient

In which of the following situation EMB is likely recommended for this patient?

A. New-onset and unexplained HF with hemodynamic compromise.
B. Low ejection fraction
C. History of alcohol intake
D. Right bundle branch block
E. History of malaria



A 35-year-old male, caterer by profession, has presented to the outpatient department with the complaints of progressive shortness of breath and leg swelling since 4 weeks. He reports to have these started with anorexia. He also reports to have been treated with antimalarial drugs for suspected malaria 2 months back. He is a known alcoholic, drinking 250-300 ml thrice a week.

The general examination noted normal vitals. Additionally, he has a large central obesity with elevated jugular venous pressure and moderate to severe bilateral ankle edema. Cardiovascular examination reveals an apical beat felt at the seventh intercostal space near the anterior axillary line with a doubtful S4 gallop. His respiratory system examination is noncontributory.

His laboratory investigations are notable for raised alkaline phosphatase, mildly elevated SGPT, borderline decrease in albumin, and increased glycated hemoglobin. His electrocardiogram shows right bundle branch block. His echocardiogram is notable for low ejection fraction (27%) with global hypokinesia, severe mitral regurgitation and dilated cardiac chambers.

Which of the following must be ruled out in view of his existing risk factors?

A. Cardiac amyloidosis
B. Hypertrophic obstructive cardiomyopathy
C. Mitral stenosis
D. Rheumatic heart disease
E. Coronary artery disease


A 35-year-old male, caterer by profession, has presented to the outpatient department with the complaints of progressive shortness of breath and leg swelling since 4 weeks. He reports to have these started with anorexia. He also reports to have been treated with antimalarial drugs for suspected malaria 2 months back. He is a known alcoholic, drinking 250-300 ml thrice a week.

The general examination noted normal vitals. Additionally, he has a large central obesity with elevated jugular venous pressure and moderate to severe bilateral ankle edema. Cardiovascular examination reveals an apical beat felt at the seventh intercostal space near the anterior axillary line with a doubtful S4 gallop. His respiratory system examination is noncontributory.

His laboratory investigations are notable for raised alkaline phosphatase, mildly elevated SGPT, borderline decrease in albumin, and increased glycated hemoglobin. His electrocardiogram shows right bundle branch block. His echocardiogram is notable for low ejection fraction (27%) with global hypokinesia, severe mitral regurgitation and dilated cardiac chambers.

Which of the following is the best next diagnostic modality in this patient?
A. Coronary angiogram
B. Endomyocardial biopsy
C. Stress ECHO
D. Cardiac MRI
E. Troponin I


A 35-year-old male, caterer by profession, has presented to the outpatient department with the complaints of progressive shortness of breath and leg swelling since 4 weeks. He reports to have these started with anorexia. He also reports to have been treated with antimalarial drugs for suspected malaria 2 months back. He is a known alcoholic, drinking 250-300 ml thrice a week.

The general examination noted normal vitals. Additionally, he has a large central obesity with elevated jugular venous pressure and moderate to severe bilateral ankle edema. Cardiovascular examination reveals an apical beat felt at the seventh intercostal space near the anterior axillary line with a doubtful S4 gallop. His respiratory system examination is noncontributory.

His electrocardiogram shows right bundle branch block. His echocardiogram is notable for low ejection fraction (27%) with global hypokinesia, severe mitral regurgitation and dilated cardiac chambers.

Which of the following is the best next treatment option in this patient?
A. Cardiac transplantation
B. Mechanical circulatory support
C. Anti heart failure therapy
D. Mitral valve replacement
E. Cardiac resynchronization therapy.


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