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3,531 questions
A 58-year-old male patient has suffered from a recent acute myocardial infarction 3 days ago. He becomes acutely unwell with a hypotensive episode. There is a pansystolic murmur which is accentuated by inspiration, along the lower left sternal border. A Swan-Ganz catheter was inserted and the following was noted: right atrial pressure was 12 (very high); calculated left atrial pressure was 2 (low normal). What is the likely cause?
A 53-year-old patient who has had chemotherapy for metastatic breast cancer 6 months earlier comes to tl1e clinic complaining of shortness of breath on exertion. Her BP is 125/78 mmHg, her pulse is 94/min and her apex beat is displaced to the anterior axillary line. Investigations: Hb 11.9 g/dl, WCC 5.0 x109/l, PLT 190 x109/l, Na+ 140 mmol/1, K+ 4.5 mmol/1, Creatinine 160 µ.mol/1. CXR - Cardiomegaly, increased shadowing consistent with mild pulmonary oedema at both bases. Which chemotherapeutic agent is most likely to be responsible for this patient's symptoms?
An 18-year-old student is admitted to the Emergency room after a collapse in a night club. He has no recollection of the incident, was assisted by his friends and had begun to regain consciousness by the time the ambulance had arrived. On direct questioning in the Emergency room he admits to 2 previous syncopal episodes. He denies elicit drug use. On examination his BP is 123/72 mmHg, his pulse is 72 regular. Investigations; Hb 13.2 g/dl, WCC 5.3 x109/l, PLT 199 x109/l, Na 142 mmol/1, K 4.6 mmol/1, Creatinine 90 µmol/1, ECG Sinus rhythm, QT interval 0.52s. A defect in which ion channel is the most likely cause of his symptoms?
You are working in the chemical pathology lab and receive a sample request for analysis of B-type natriuretic peptide (BNP). You don't have any clinical details on the form apart from ''chest pain''. You plan to ring the SHO who requested the test for further details. In which of the following situations is BNP most likely to be normal?
A 62-year-old woman suddenly deteriorates 2 days after receiving TPA for an acute myocardial infarction. She complained of severe shortness of breath during the course of the afternoon and when the nurses examined her, her 02 saturation was only 91% on oxygen delivered via re-breather. On examination her BP is 105/70 mmHg, with a pulse of 105/min regular. She has an apical systolic murmur and marked left ventricular failure. Which of the foUowing is the most likely cause?
A 52-year-old man is admitted to the intensive therapy unit with left ventricular failure post-myocardial infarction. Despite prompt activity including angioplasty within a few minutes of the onset of chest pain, his systolic BP on admission to the unit was only 80 mmHg, with a pulse of 105/min. Auscultation of the chest revealed crackles up to the mid zones on both sides consistent with cardiac failure. The team decide to insert an intra-aortic balloon pump timed to coincide with the dicrotic notch. What does the dicrotic notch refer to?
A 70-year-old woman presents to the emergency department with acute pulmonary edema with evidence of myocardial ischemia on ECG. In spite of maximal medical management, she develops cardiogenic shock. A second ECG shows ST segment elevation of 3 mm in the precordial leads. She has no contraindications to thrombolytic therapy. Which of the following statements regarding thrombolytic therapy is true?
A 42-year-old white man presents to your office as a new patient. He has been in good health and has not seen a physician in many years. While attending a local health fair recently, the patient was told that be bad high blood pressure, and he was advised to seek medical help. He seeks your advice about hypertension. His blood pressure is 145/95 mm Hg. Which of the following general statements about hypertension is false?
A 25-year-old black man presents to your office seeking to establish primary care. The patient has no complaints and denies any known medical history. His blood pressure is noted to be 185/115; otherwise, his physical examination is normal. After measuring the patient's blood pressure a total of four times during two office visits, you diagnose hypertension. Which of the following statements regarding the initial evaluation of hypertension in this patient is true?
A 40-year-old white woman whom you have been treating for resistant hypertension presents for routine follow-up. Laboratory results of screening tests were normal. There is electrocardiographic evidence of LVH. The patient's lipid proftle is normal. Tl1e patient has been receiving a thiazide diuretic, a calcium channel blocker, and an ACE inhibitor at near maximal doses for several weeks. Her blood pressure today remains very elevated, at 175/100 mm Hg. She experienced a minimal response to titration of her antihypertensive medicines. With the exception of elevated blood pressure and a fourth heart sound, the patient's physical examinations have been consistently normal. Today, the physical examination is unchanged, except that you notice a soft bruit in the left upper quadrant. Which of the following statements regarding reno-vascular hypertension is true?
A previously healthy 47-year-old woman presents with a complaint of palpitations of sudden onset. Her symptoms have been present for 12 hours. Her evaluation includes an electrocardiogram, which reveals atrial fibrillation (AF) with a ventricular response of 135 beats/min. Her cardiac examination is unre1narkable except for an irregularly irregular pulse. She has no other medical problems and takes no medications. A transthoracic echocardiogram (TTE) is normal. Which of the following is the most likely classification of this patient's AF according to guidelines from the American College of Cardiology (ACC), the American Heart Association (AHA), and the European Society of Cardiology (ESC)?
An 81-year-old man with a history of symptomatic permanent AF presents to your office to discuss options for reestablishing sinus rhythm. He hopes to decrease his symptoms of dyspnea. In addition to AF, the patient has congestive heart failure and echocardiographically doc11mented significant mitral regurgitation. Which of the following is NOT a risk factor for cardioversion failure in this patient?
A 19-year-old man presents to the emergency department complaining of dyspnea and palpitations of acute onset. He has been short of breath for 2 hours now but denies having any chest pain. He has never had these symptoms before, and he denies having any cardiac disorders in the past. He is taking no medicines and has no significant family history of sudden cardiac death or arrhythmias. On examination, the patient is tachycardic but the heartbeat is regular. The patient's lungs are clear. His blood pressure is 110/72 mm Hg, and he is afebrile. ECG reveals a narrow complex tachycardia with a retrogra.de P wave noted in the ST segment. You diagnose the patient as having atrioventricular reentry tachycardia (AVRT). Which of the following statements regarding AVRT is true?
A 60-year-old man presents to his primary care physician for evaluation of dizziness and increased fatigue. An electrocardiogram is performed as part of his evaluation. The ECG demonstrates complete heart block, with a ventricular rate of 44 beats/min. The patient is USMLE IM2e/Basic referred for implantation of a pacemaker. Which of the following is NOT an indication for implantation of a cardiac pacemaker?
A 67-year-old female patient of yours is admitted to the hospital. She has a permanent pacemaker and sees a cardiologist. In reviewing her chart, you note that her pacemaker program code is VVI, with a lower rate of 60 beats/min. Which of the following statements regarding this patient's pacemaker program code is false?
A 76-year-old man with a permanent pacemaker is admitted to the hospital with a diagnosis of pneumonia. The patient unfortunately develops respiratory failure and is intubated. A central venous line is placed for administration of antibiotics and pressors. He improves clinically but develops fever. Blood cultures are positive for Staphylococcus aureus. Appropriate antimicrobial therapy is instituted, and the central line is removed. The patient remains febrile with persistently positive cultures. Which of the following statements regarding pacemaker infection is true?
A 53-year-old black man presents to the emergency department with a complaint of chest pain of 2 hours' duration. The pain woke him from sleep. It is substernal and radiates to his left shoulder. The patient has vomited twice and is diaphoretic. He has no history of coronary artery disease but has hypertension and hypercholesterolemia. Which of the following statements regarding acute myocardial infarction (Ml) is false?
A 49-year-old white man who presented to the emergency department with an ST segment elevation MI was given thrombolytics, oxygen, and aspirin. He is now free of chest pain and will be admitted to the coronary care unit for further monitoring. Which of the foilowing statements regarding adjuvant medical therapy for acute MI is false?
A 69-year-old woman presents to the emergency department for evaluation of dyspnea and nausea. An ECG reveals ST segment depression of 1 mm in leads II, ill, and aVF. The patient is given an aspirin, a beta blocker, and nitroglycerin sublingually, and the ST segment depression resolves. A diagnosis ofunstable angina is made. For this patient, which of the following statements regarding antiplatelet therapy with a thienopyridine is false?
A 62-year-old man with long-standing hypertension presents to your office for evaluation of a nonproductive cough. He has had the cough for 2 or 3 months, and it is getting progressively worse. He is without other complaint. The patient's blood pressure is 168/94 mm Hg; otl1er vital signs are unremarkable. A chest x-ray reveals a widening of the mediastinum. Spiral CT reveals a thoracic aortic aneurysm with impingement upon the trachea. Which of the following statements regarding thoracic aortic aneurysms is true?