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3,531 questions
A 29-year-old white woman presents to the emergency department with the complaint that her heart is ''racing away.'' The patient reports that this symptom began 1 hour ago and that it is associated with mild shortness of breath. She also reports having had similar episodes in her life, but she says they never lasted this long and that they usually abated with a simple cough. On examination, the patient's pulse is regular at 175 beats/min. Her lungs are clear, and she is in mild distress. Electrocardiography reveals atrioventricular nodal reentry tachycardia (AVNRT). Which of the following statements regarding AVNRT is false?
A 21-year-old woman presents to the clinic with symptoms of increased shortness of breath and decreased exercise tolerance. She used to be a keen hockey player when at school but is now virtually unable to even walk to the bus stop without becoming short of breath. On examination she looks tired and slightly short of breath at rest. Her BP is elevated at 145/92 mmHg. Investigations; Echocardiogram -increased right atrial size, elevated right arterial pressure by Doppler Cardiac catheterization; 02 saturation SVC 74o/o, 02 saturation RA 82o/o, 02 saturation RV 82o/o , 02<w:t>saturation LA 91o/o , 02<w:t>saturation LV 91% . Which of the following is the most likely diagnosis?
A 72-year-old man was admitted with an acute anterior myocardial infarction. He bas chronic renal impairment, with a recent creatininerecorded at 148 µmol/1. Medication included ramipril, atorvastatin and indapamide for the treatment of hypertension. He was taken straight to the angiography suite where he received stenting of a left main stem stenosis. You are asked to see him about 30hrs after as the nurses feel he is deteriorating. On examination his BP is 149/84 mmHg, his pulse is 75/min and regular. His legs look dusky in colour, particularly his right big toe which looks blue in colour. He has splinter haemorrhages affecting toenails on both feet. There is a loud left femoral bruit. Investigations; Hb 13.2 g/dl, WCC 5.0 x109/l, PLT 190 x109/l, Na+ 141 mmol/1, K+ 5.9 mmol/1, Creatinine 630 µmol/1, Urine blood++, protein+. Which of the following is the most likely diagnosis?
A 70-year-old man presents with severe tearing back and chest pain which came on very suddenly. He has a past medical history of hypertension for which he takes ramipril 10mg daily, amlodipine 5mg, and he smokes 30 cigarettes per day. On examination he is in severe pain, his BP is 155/85 mmHg, he has bilateral upgoing plantars and 4/5 weakness affecting left ankle dorsiflexion. He appears to have a pericardia! rub. Which of the following features is most suggestive of dissecting aortic aneurysm?
A 75-year-old woman with a history of symptomatic, recurrent, persistent nonvalvular AF comes to your office. She has been told that there are several options for the treatment of her AF. Which of the following is true regarding establishment and maintenance of normal sinus rhythm, as compared with pharmacologic rate control?
A 67-year-old man attends the cardiology clinic. He bas been suffering some angina-type chest pain on going out in the cold air and is worried that he might have coronary artery disease. There is a past medical history of smoking 20 cigarettes per day, and hypertension which is managed with ramipril 10mg daily. His GP has sent an ECG which appears to show that he is in left bundle branch block. What would you expect to hear on auscultation?
A 42-year-old man with the features of congenital myotonic dystrophy comes to see you for review. He has suffered from mild intellectual impairment, frontal balding typical of the disease and increasing muscle weakness with increased muscle tone over the past few years. Most recently he has suffered from a number of episodes of syncope. On examination his BP is 129/70 mmHg, his pulse 55 BPM, there are no other significant findings on cardiovascular examination. What ECG findings might you most commonly expect to see in this case?
A 65-year-old female patient with severe heart failure presents with increasing shortness of breath. Her current pharmacological treatment consists of an angiotensin-converting enzyme (ACE) inhibitor, loop diuretic and b-blocker. What is the most appropriate management?
A 78-year-old woman presents to AE with three episodes of syncope in the last 24 hours. There is no history of chest pain. She is taking frusemide 80 mg od and ramipril 10 mg od for known hypertension. She is conscious with a blood pressure of 100/40 mmHg. Potassium is 5.3 mmol/l. Her ECG shows complete heart block with rate of 40 bpm. QRS duration is 150 ms with a right bundle-branch block configuration. What is the optimum initial management?
K+ 5.0 mmol/1, Creatinine 100 µmol/1. ECG LVH and widespread Q waves. Which of the following is most directly correlated with increased risk of sudden death?
A 30-year-old man is being investigated for hypertension. A combination of BPs estimated by colour flow Doppler and measured values are listed below. Observed BPs: LV 200/10 mmHg, Ascending aorta 200/70 mm.Hg, Right arm 190/70 mmHg, Right femoral artery 110/70 mmHg. Which of the following is the most likely diagnosis?
A 21-year-old man presents with lethargy over the last week, he has periorbital oedema and proteinuria. The patient mentions he has been to hospital a number of times in the past due to the same symptoms as well as mild eczema. Light microscopy of a renal biopsy showed normal morphology. Electron microscopy of the renal biopsy reveals the diffuse effacement of the epithelial podocytes. The most appropriate treatment is:
A 56-year-old man, diagnosed with psoriasis three years ago, presents to your clinic with pruritus. His symptoms are not improving despite being prescribed conventional therapy. On examination, you note the presence of erythematous scaly plaques on the extensor surfaces of the knee and elbows. There is no evidence of flexural involvement. The most appropriate treatment 1• s:
A 30-year-old woman presents with pleuritic chest pain and haemoptysis. Her blood pressure is stable at 130/80 mmHg. A ventilation/perfusion scan shows minor mismatch at the lung bases. There is no evidence of RV dysfunction, clinically and on echocardiography. In addition to oxygen, which of the following is the appropriate management for this patient?
The patient in Question 18 adhered to your recommendations, but his blood pressure remains elevated to the same degree. He is interested in controlling his blood pressure but is worried about the cost of medications. What should be the first-line pharmacologic therapy for this patient?
A 23-year-old woman presents to the GP complaining of palpitations. She says these are rapid and when she gets them she feels light headed and sick. They tend to come on without warning, but have occurred when she bas been out dancing with friends, and after a game of squash. On examination she looks well; her BMI is 21, pulse 70/min regular, BP 122/70 mmHg. Bloods; Hb 13.1 g/dl, wee5.4 x109/l, PLT 251 x109/l, Na+ 139 mmol/1, K+ 4.0 mmol/1, ereatinine 75 µmol/1. Which of the following investigations is most likely to help with the diagnosis?
A 65-year-old woman complains of panic attacks. She has recently retired as a school teacher, but 2-3 times a week she suffers extreme anxiety, becomes short of breath and sweats excessively. Elevated catecholamines are detected in the urine. The most appropriate medical treatment is:
A 78-year-old lady is admitted from home by ambulance. She was found lying on the floor by her home help after suffering a fall. She has a history of hypertension managed with ramipril 10mg PO daily. On examination her temperature is 30.0oC, her BP is 100/50 mm.Hg, with a pulse of 52/min. She has a fractured left neck of femur. Bloods; Hb 14.5 g/dl, WCC 4.5 x109/l, PLT 192 x109/l, Na+ 143 mmol/1, K+ 5.3 mmol/l, ereatinine 195 µmol/1. Which of the following ECG features is most characteristic of moderate to severe hypothermia?
A 45-year-old man attends for review. He has been suffering increasing shortness of breath over the past few years. He is a non-smoker who drinks 20 units per week of alcohol and has no significant past cardiovascular history. Now he presents with what seems to have been a transient ischaemic attack (TIA), with weakness and co-ordination problems affecting his left side, which have resolved over the past 24 hours. On examination blood pressure is 142/95 mmHg and he is in sinus rhythm. There is no opening snap, but a diastolic murmur is heard which changes in character according to posture. Bloods are unremarkable, including C-reactive protein (CRP), which is in the normal range. Which of the foilowing diagnoses fit best with this clinical picture?
You are asked to review a 19-year-old woman who presents with increasing shortness of breath on exercise. She is from a travelling family and has rarely encountered medical care. On examination she appears of short stature with extra skin folds around her neck, and appears to have failure of secondary sexual development. Her blood pressure is raised at 165/100 mmHg. She reports that her legs feel tired all the time and she has occasional chest pain on exercising. Which of the following cardiac diagnoses fits best with her clinical condition?