Cardiology — MCQs

A 65-year-old woman presents to the clinic for a routine checkup. She has unintentionally lost 4.5 kg (9.9 lb) in the past month but denies any other complaints. Her pulse rate is 90/min, respiratory rate is 18/min, temperature is 37.0°C (98.6°F), and blood pressure is 150/70 mm Hg. An irregularly irregular rhythm is heard on auscultation of the heart. Neck examination shows a markedly enlarged thyroid with no lymphadenopathy or bruit. Laboratory tests show low serum thyroid-stimulating hormone level, high T4 level, absent thyroid-stimulating immunoglobulin, and absent anti-thyroid peroxidase antibody. Nuclear scintigraphy shows patchy uptake with multiple hot and cold areas. Which of the following is the most likely diagnosis?

A 66-year old man comes to the physician because of fatigue for 6 months. He says that he wakes up every morning feeling tired. Most days of the week he feels sleepy during the day and often takes an afternoon nap for an hour. His wife says he snores in the middle of the night. He has a history of heart failure and atrial fibrillation. His medications include aspirin, atorvastatin, lisinopril, metoprolol, and warfarin. He drinks 1–2 glasses of wine daily with dinner; he does not smoke. He is 175 cm (5 ft 9 in) tall and weighs 96 kg (212 lb); BMI is 31.3 kg/m2. His blood pressure is 142/88 mm Hg, pulse is 98/min, and respirations are 22/min. Examination of the oral cavity shows a low-lying palate. Cardiac examination shows an irregularly irregular rhythm and no murmurs. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in management?

A 73-year-old male is brought into the ED unconscious with cold, clammy skin. His blood pressure is 65 over palpable. There are no signs of blood loss. You recognize the patient is in acute shock and blood is drawn for investigation as resuscitation is initiated. Which of the following might you expect in your laboratory investigation for this patient?

A 14-year-old boy is brought to the emergency department from school after falling in gym class. He was unable to stand after the accident and has a painful and swollen knee. On presentation he says that he has never had an incident like this before; however, he does suffer from hard to control nosebleeds and prolonged bleeding after minor cuts. Based on his presentation a panel of bleeding tests is obtained with the following results: Bleeding time: Prolonged Prothrombin time: Normal Partial thromboplastin time: Prolonged Which of the following describes the function of the component that is defective in the most likely cause of this patient's symptoms?

A 66-year-old man is brought to the emergency department because of fever, chills, and altered mental status for 3 days. According to his daughter, he has had a productive cough during this period. He has type 2 diabetes, hypertension, hypercholesterolemia, peripheral neuropathic pain, and a history of deep vein thromboses. Current medications include insulin, lisinopril, atorvastatin, warfarin, and carbamazepine. He is oriented only to self. His temperature is 39.3°C (102.7°F), pulse is 110/min, respirations are 26/min, and blood pressure is 86/50 mm Hg. Physical examination shows ecchymoses on both lower extremities. Crackles are heard at the right lung base. Laboratory studies show: Hemoglobin 11.1 g/dL Leukocyte count 18,000/mm3 Platelet count 45,000/mm3 Prothrombin time 45 sec Partial thromboplastin time 75 sec Serum Na+ 135 mEq/L K+ 5.4 mEq/L Cl- 98 mEq/L Urea nitrogen 46 mg/dL Glucose 222 mg/dL Creatinine 3.3 mg/dL Which of the following is the most likely cause of this patient's ecchymoses?

A 27-year-old man is brought to the emergency department with his family because of abdominal pain, excessive urination and drowsiness since the day before. He has had type 1 diabetes mellitus for 2 years. He ran out of insulin 2 days ago. His vital signs at admission include a temperature of 36.8°C (98.24°F), a blood pressure of 102/69 mmHg, and a pulse of 121/min. On physical examination, he is lethargic and his breathing is rapid and deep. There is a mild generalized abdominal tenderness without rebound tenderness or guarding. His serum glucose is 480 mg/dL. The patient is admitted to the intensive care unit and management is started. Which of the following is considered a resolution criterion for this patient's condition?

A 25-year-old man comes to the physician because of a severe headache for 1 hour. Every day of the past week, he has experienced 3–4 episodes of severe pain over his left forehead. Each episode lasts around 30–45 minutes, and he reports pacing around restlessly during these episodes. He has been using acetaminophen for these episodes, but it has provided only minimal relief. He works as a financial analyst and says his job is very stressful. He had experienced similar symptoms 4 months ago but did not seek treatment at that time. He has no history of serious illness and takes no other medications. He has smoked one pack of cigarettes daily for 7 years. He appears anxious. Vital signs are within normal limits. There is conjunctival injection and tearing of the left eye. The remainder of the physical examination is unremarkable. Which of the following measures is most likely to provide acute relief of this patient's headaches?

A 57-year-old man is sent to the emergency department by his primary care physician for hypertension. He was at a general health maintenance appointment when his blood pressure was found to be 180/115 mmHg; thus, prompting his primary doctor to send him to the emergency room. The patient is otherwise currently asymptomatic and states that he feels well. The patient has no other medical problems other than his hypertension and his labs that were drawn last week were within normal limits. His temperature is 98.3°F (36.8°C), blood pressure is 197/105 mmHg, pulse is 88/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam is unremarkable. Laboratory values are redrawn at this visit and shown below. Hemoglobin: 15 g/dL Hematocrit: 46% Leukocyte count: 3,400/mm^3 with normal differential Platelet count: 177,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 102 mEq/L K+: 4.0 mEq/L HCO3-: 24 mEq/L BUN: 29 mg/dL Glucose: 139 mg/dL Creatinine: 2.3 mg/dL Ca2+: 10.2 mg/dL Which of the following is the most likely diagnosis?

A 45-year-old man with type 1 diabetes mellitus comes to the physician for a health maintenance examination. He has a 10-month history of tingling of his feet at night and has had two recent falls. Three years ago, he underwent retinal laser photocoagulation in both eyes. Current medications include insulin and lisinopril, but he admits not adhering to his insulin regimen. He does not smoke or drink alcohol. His blood pressure is 130/85 mm Hg while sitting and 118/70 mm Hg while standing. Examination shows decreased sense of vibration and proprioception in his toes and ankles bilaterally. His serum hemoglobin A1C is 10.1%. Urine dipstick shows 2+ protein. Which of the following additional findings is most likely in this patient?

A 65-year-old man comes to the physician because of shortness of breath, chest pain, and a cough for 2 days. The pain is exacerbated by deep inspiration. He has a history of congestive heart failure, hypertension, type 2 diabetes mellitus, and hyperlipidemia. Current medications include metoprolol, lisinopril, spironolactone, metformin, and simvastatin. He has smoked half a pack of cigarettes daily for the past 25 years. His temperature is 38.5°C (101.3°F), pulse is 95/min, respirations are 18/min, and blood pressure is 120/84 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 93%. Examination shows dullness to percussion and an increased tactile fremitus in the right lower lung field. Auscultation over this area shows bronchial breath sounds and whispered pectoriloquy. The remainder of the examination shows no abnormalities. Which of the following is the most likely cause of these findings?