Cardiology — MCQs

A 42-year-old man comes to the physician for the evaluation of episodic headaches involving both temples for 5 months. The patient has been taking acetaminophen, but it has not provided relief. He has also had double vision. Ophthalmic examination shows impaired peripheral vision bilaterally. Contrast MRI of the head shows a 14 x 10 x 8-mm intrasellar mass. Further evaluation is most likely to show which of the following findings?

A 65-year-old man presents to the physician for the evaluation of increasing dyspnea and swelling of the lower extremities over the past year. He has no cough. He also complains of frequent awakenings at night and excessive daytime sleepiness. He has no history of a serious illness. He takes no medications other than zolpidem before sleep. He is a 35-pack-year smoker. His blood pressure is 155/95 mm Hg. His BMI is 37 kg/m2. Oropharyngeal examination shows a small orifice and an enlarged tongue and uvula. The soft palate is low-lying. The examination of the nasal cavity shows no septal deviation or polyps. Symmetric pitting edema is seen below the knee, bilaterally. The lungs are clear to auscultation. Echocardiography shows a mildly dilated right ventricle and an elevated systolic pulmonary artery pressure with no abnormalities of the left heart. A ventilation-perfusion scan shows no abnormalities. Which of the following is the most likely cause of this patient’s symptoms?

A 30-year-old man presents to his primary care physician complaining of headaches. He states that over the past month he has been trying to study for an accounting exam, but he finds it increasingly more difficult to focus due to his headaches. He also complains of lower extremity muscle cramping. He has no significant past medical history and takes ibuprofen and acetaminophen as needed. The patient’s temperature is 98°F (36.7°C), blood pressure is 168/108 mmHg, and pulse is 75/min. Labs are obtained, as shown below: Serum: pH (VBG): 7.50 Na: 146 mEq/L K+: 3.2 mEq/L Cl-: 104 mEq/L HCO3-: 32 mEq/L Urea nitrogen: 20 mg/dL Creatinine: 1.1 mg/dL Glucose: 85 mg/dL An ultrasound reveals a hypoechoic lesion within the right adrenal gland. A 2 cm right-sided homogeneous adrenal mass is confirmed with computed tomography. Which of the following findings is associated with the patient’s most likely diagnosis?

A 53-year-old female presents with worsening shortness of breath with activity. Physical exam reveals a diastolic murmur with an opening snap. The patient’s medical history is significant for a left hip replacement 10 years ago, and she vaguely recalls an extended period of illness as a child described as several severe episodes of sore throat followed by rash, fever, and joint pains. Administration of which of the following treatments at that time would have been most effective in reducing her risk of developing cardiac disease?

A 63-year-old man presents to the emergency department because of progressive difficulty with breathing. He has a history of diabetes, hypertension, and chronic bronchitis. He has been receiving medications to moderate his conditions and reports being compliant with his schedule. He reports a recent difficulty with tackling simple chores in the house. He has not been able to walk for more than 1 block over the past few days. His persistent cough has also been worsening with more formation of sputum. During his diagnosis of bronchitis, about a year ago, he had a 40-pack-year smoking history. The patient is in evident distress and uses his accessory muscles to breathe. The vital signs include: temperature 38.6°C (101.5°F), blood pressure 120/85 mm Hg, pulse 100/min, respiratory rate 26/min, and oxygen (O2) saturation 87%. A decrease in breathing sounds with expiratory wheezes is heard on auscultation of the lungs. The arterial blood gas (ABG) analysis shows: PCO2 60 mm Hg PO2 45 mm Hg pH 7.3 HCO3– 25 mEq/L Which of the following is the most appropriate next step in the treatment?

A 66-year-old woman with hypertension comes to the physician because of crampy, dull abdominal pain and weight loss for 1 month. The pain is located in the epigastric region and typically occurs within the first hour after eating. She has had a 7-kg (15.4-lb) weight loss in the past month. She has smoked 1 pack of cigarettes daily for 20 years. Physical examination shows a scaphoid abdomen and diffuse tenderness to palpation. Laboratory studies including carbohydrate antigen 19-9 (CA 19-9), carcinoembryonic antigen (CEA), and lipase concentrations are within the reference range. Which of the following is the most likely cause of this patient's symptoms?

A 72-year-old man presents to his primary care physician for a wellness visit. He says that he has been experiencing episodes of chest pain and lightheadedness. Approximately 1 week ago he fell to the ground after abruptly getting up from the bed. Prior to the fall, he felt lightheaded and his vision began to get blurry. According to his wife, he was unconscious for about 5 seconds and then spontaneously recovered fully. He experiences a pressure-like discomfort in his chest and lightheadedness with exertion. At times, he also experiences shortness of breath when climbing the stairs. Medical history is significant for hypertension and hypercholesterolemia. He does not smoke cigarettes or drink alcohol. Cardiac auscultation demonstrates a systolic ejection murmur at the right upper border and a normal S1 and soft S2. Which of the following is most likely found in this patient?

A 57-year-old man presents to his family physician for a routine exam. He feels well and reports no new complaints since his visit last year. Last year, he had a colonoscopy which showed no polyps, a low dose chest computerized tomography (CT) scan that showed no masses, and routine labs which showed a fasting glucose of 93 mg/dL. He is relatively sedentary and has a body mass index (BMI) of 24 kg/m^2. He has a history of using methamphetamines, alcohol (4-5 drinks per day since age 30), and tobacco (1 pack per day since age 18), but he joined Alcoholics Anonymous and has been in recovery, not using any of these for the past 7 years. Which of the following is indicated at this time?

A 59-year-old man presents to his primary care physician with a 5-month history of breathing difficulties. He says that he has been experiencing exertional dyspnea that is accompanied by a nonproductive cough. His past medical history is significant for a solitary lung nodule that was removed surgically 10 years ago and found to be benign. He works as a coal miner, does not smoke, and drinks socially with friends. His family history is significant for autoimmune diseases. Physical exam reveals fine bibasilar inspiratory crackles in both lungs, and laboratory testing is negative for antinuclear antibody and rheumatoid factor. Which of the following is associated with the most likely cause of this patient's symptoms?

A 75-year-old woman comes to the physician because of generalized weakness for 6 months. During this period, she has also had a 4-kg (8.8-lb) weight loss and frequent headaches. She has been avoiding eating solids because of severe jaw pain. She has hypertension and osteoporosis. She underwent a total left-sided knee arthroplasty 2 years ago because of osteoarthritis. The patient does not smoke or drink alcohol. Her current medications include enalapril, metoprolol, low-dose aspirin, and a multivitamin. She appears pale. Her temperature is 37.5°C (99.5°F), pulse is 82/min, and blood pressure is 135/80 mm Hg. Physical examination shows no abnormalities. Laboratory studies show: Hemoglobin 10 g/dL Mean corpuscular volume 87 μm3 Leukocyte count 8,500/mm3 Platelet count 450,000/mm3 Erythrocyte sedimentation rate 90 mm/h Which of the following is the most appropriate next step in management?