19) 35 year old lady known case of

hypertrophic obstructive cardiomyopathy

presented with grade III NYHA

classification dyspnea .she is on

Metoprolol 50 mg once daily . her last echo

shows LVOT mean gradient of 60mmHg

with valsalva maneuver. which of the

following medications should be added and

have inhibitory effect on myosin

a. Dipyridamole

b. Amiodarone

Mavacamtin.

Ivabradine.

e. Procainamide

20) A middle-aged obese male presents with

sudden onset of excruciating chest pain that

is now radiating into his back. He has woken

up from his sleep 3 hours ago. he is

diaphoretic & anxious, He is administered

nitroglycerin by the triage nurse but this

does not provide any relief. BP on the right

arm is 190/90 mmHg and on the left arm, it

is 145/75 mmHg. RRis 28/minute and he is

afebrile, His initial set of cardiac enzymes is

negative and the ECG reveals non-specific

ST changes, In this patient what will most

likely be neard during auscultation?

a. Crescendo-decrescendo systolic murmur

b oud P2$XRP

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c. Systolic ejection click

d. High pitched early diastolic murmur