Cardiology — MCQs

A 31-year-old man presents with a several-month history of foot sensory changes. He has noticed that he has a hard time telling the difference between a hardwood floor and carpet beneath his feet. He's also had a couple of falls lately; these falls were not preceded by any lightheadedness or palpitations. He is adopted, so his family history is unknown. On physical exam, he has leg and foot muscular atrophy and 4/5 strength throughout his bilateral lower extremities. Sensation to light touch and pinprick is decreased up to the mid-calf. Ankle jerk reflex is absent bilaterally. He has a significant pes cavus deformity of both feet. Nerve conduction studies show decreased conduction velocities in his bilateral peroneal nerves. Which of the following is the best treatment for this patient?

A 16-year-old boy comes to the physician because his parents are concerned about his persistently poor performance at school. He has had increased impulsivity and has difficulty making and keeping friends. On questioning, he reports that he is being bullied by his classmates for his high-pitched voice, thin build, and poor grades. He is at the 94th percentile for height and 50th percentile for weight. Physical examination shows bilateral gynecomastia, sparse pubic hair, and long limbs compared with the trunk. Genital examination shows small, firm testes. Serum studies show increased levels of luteinizing hormone and follicle-stimulating hormone and a slightly decreased serum testosterone. This patient is at increased risk of which of the following complications?

A 55-year-old man is brought to the emergency department by ambulance after being found disoriented. He has limited ability to communicate in English but indicates that he has left flank pain and a fever. Chart review reveals that he has diabetes and sleep apnea but both are well controlled. He also has a 30-pack-year smoking history and has lost about 20 pounds since his last presentation. Physical exam reveals a bulge in his left scrotum and ultrasound reveals bilateral kidney stones. Which of the following findings is also associated with the most likely cause of this patient's symptoms?

A 57-year-old female presents to her primary care physician with a chief complaint of feeling tired all the time. She states her symptoms began several months ago, around the time that her husband committed suicide. Since then she has had thoughts of joining her husband. She complains of feeling excessively weak and states that she no longer has enough energy to go to the gym which she attributes to her 15 pound weight gain over the last month. The patient's medical history includes joint pain, a skin rash that recently resolved, obstructive sleep apnea, and metabolic syndrome. The patient takes ibuprofen and omeprazole as needed but otherwise cannot remember any other medications that she takes. On physical exam you note an overweight woman who has an overall depressed affect. The patient's cardiac exam reveals a normal rate and rhythm. The pulmonary exam reveals bilateral clear lung fields with good air movement. The patient's skin is very dry and tight appearing and her hair is coarse. Overall the patient appears somewhat unkempt. Laboratory work is performed and reveals the following: Hemoglobin: 13.0 g/dL Hematocrit: 37% Leukocyte count: 4,500 cells/mm^3 with normal differential Platelets: 250,000/mm^3 Serum: Na+: 140 mEq/L K+: 4.4 mEq/L Cl-: 102 mEq/L BUN: 15 mg/dL Glucose: 122 mg/dL Creatinine: 1.0 mg/dL Thyroid-stimulating hormone: 5.3 µU/mL Ca2+: 10.2 mg/dL AST: 11 U/L ALT: 13 U/L Which of the following laboratory findings is most likely to be abnormal in this patient?

A 45-year-old man presents to the emergency department with crushing substernal chest pain. The patient has a past medical history of obesity, diabetes, and hypertension. He drinks 5 alcoholic drinks every night and has a 40 pack-year smoking history. The patient works as a truck driver and leads a sedentary lifestyle. His initial electrocardiogram (ECG) is notable for ST elevation in V2-V5 with reciprocal changes. The patient is sent for cardiac catheterization, and several stents are placed. The patient is being monitored after the procedure, when he suddenly becomes less responsive. His temperature is 98.5°F (36.9°C), blood pressure is 87/48 mmHg, pulse is 150/min, respirations are 18/min, and oxygen saturation is 97% on room air. Jugular venous distension is absent and pulmonary exam is notable for clear breath sounds bilaterally. The patient states that he is experiencing back and flank pain and is tender to palpation over his lumbar back and flanks. The patient is given 3 liters of Lactated Ringer solution and his blood pressure improves to 110/70 mmHg and his pulse is 95/min. Which of the following is the best next step in management?

In a patient with suspected interstitial lung disease, which of the following is most appropriate to confirm the diagnosis?

A 74-year-old Hispanic man comes to the physician because of a three-week history of dizziness upon standing and a brief loss of consciousness one hour ago. The patient suddenly collapsed on his way to the bathroom after waking up in the morning. He did not sustain any injuries from his collapse. He has a history of gastroesophageal reflux disease, benign prostatic hyperplasia, and gout. The patient's mother died of a grand mal seizure at the age of 53 years. He has smoked one pack of cigarettes daily for 55 years. He drinks three beers and two glasses of whiskey daily. Current medications include ranitidine, dutasteride, tamsulosin, and allopurinol. He is 166 cm (5 ft 5 in) tall and weighs 62 kg (137 lb); BMI is 22.5 kg/m2. He appears pale. Temperature is 36.7°C (98.0°F), pulse is 83/min, and blood pressure is 125/80 mm Hg supine and 100/70 mm Hg one minute after standing with no change in pulse rate. Physical examination shows conjunctival pallor. A plopping sound is heard on auscultation, immediately followed by a low-pitched, rumbling mid-diastolic murmur heard best at the apex. The remainder of the examination shows no abnormalities. An ECG shows regular sinus rhythm. Which of the following is the most likely diagnosis?

A 65-year-old man presents to the emergency department for a loss of vision. He was outside gardening when he suddenly lost vision in his right eye. He then immediately called emergency medical services, but by the time they arrived, the episode had resolved. Currently, he states that he feels fine. The patient has a past medical history of diabetes and hypertension. His current medications include lisinopril, atorvastatin, metformin, and insulin. His temperature is 99.5°F (37.5°C), blood pressure is 140/95 mmHg, pulse is 90/min, respirations are 12/min, and oxygen saturation is 98% on room air. Cardiac exam is notable for a systolic murmur along the right sternal border that radiates to the carotids. Pulmonary exam reveals mild bibasilar crackles. Neurological exam reveals cranial nerves II-XII as grossly intact with 5/5 strength and normal sensation in the upper and lower extremities. The patient has a negative Romberg's maneuver, and his gait is stable. A CT scan of the head demonstrates mild cerebral atrophy but no other findings. Which of the following is the next best step in management?

A 45-year-old male presents to the hospital complaining of frequent headaches and a decreased libido. During the physical exam, the patient also states that he has recently been experiencing vision problems. The patient is suffering from what type of adenoma?

A 62-year-old man presents for evaluation of an adrenal nodule, which was accidentally discovered while performing a computerized tomography (CT) scan of the abdomen for recurrent abdominal pain. The CT was negative except for a 3 cm low-density, well-circumscribed nodule in the left adrenal gland. He reports weight gain of 12 kg (26.4 lb) over the past 3 years. He has type 2 diabetes mellitus and hypertension, which have been difficult to control with medications. Which of the following is the best initial test for this patient?