Cardiology — MCQs

A 57-year-old man presents to his primary care provider with progressive right foot swelling, redness, and malaise. He reports seeing a blister on his forefoot several months ago after he started using new work boots. He has dressed the affected area daily with bandages; however, healing has not occurred. He has a history of type 2 diabetes mellitus and stage 2 chronic kidney disease. He has smoked 20 to 30 cigarettes daily for the past 25 years. Vital signs are a temperature of 38.1°C (100.58°F), blood pressure of 110/70 mm Hg, and pulse of 102/minute. On physical examination, there is a malodorous right foot ulcer overlying the first metatarsophalangeal joint. Fluctuance and erythema extend 3 cm beyond the ulcer border. Moderate pitting edema is notable over the remaining areas of the foot and ankle. Which of the following is the best initial step for this patient?

A 40-year-old man comes to the physician because of weight gain over the past 3 months. During this period, he has gained 10 kg (22 lb) unintentionally. He also reports decreased sexual desire, oily skin, and sleeping difficulties. There is no personal or family history of serious illness. He has smoked one pack of cigarettes daily for the past 10 years. The patient appears lethargic. His temperature is 37°C (98.6°F), pulse is 80/min, and blood pressure is 150/90 mm Hg. Physical examination shows central obesity, acne, and thin, easily bruisable skin with stretch marks on the abdomen. There is darkening of the mucous membranes and the skin creases. Examination of the muscles shows atrophy and weakness of proximal muscle groups. His serum glucose concentration is 240 mg/dL. Which of the following findings would most likely be present on imaging?

A 26-year-old woman comes to the physician for a pre-employment examination. She has no complaints. She has a history of polycystic ovarian syndrome. She exercises daily and plays soccer recreationally on the weekends. Her mother was diagnosed with hypertension at a young age. She does not smoke and drinks 2 glasses of wine on the weekends. Her current medications include an oral contraceptive pill and a daily multivitamin. Her vital signs are within normal limits. Cardiac examination shows a grade 1/6 decrescendo diastolic murmur heard best at the left sternal border. Her lungs are clear to auscultation bilaterally. Peripheral pulses are normal and there is no lower extremity edema. An electrocardiogram shows sinus rhythm with a normal axis. Which of the following is the most appropriate next step in management?

An obese 37-year-old woman is brought to the emergency department 2 hours after the onset of weakness in her left arm and leg. She fell from the stairs the day prior but did not have any loss of consciousness or nausea after the fall. She travels to Asia regularly on business; her last trip was 4 days ago. She has no history of serious illness. Her only medication is an oral contraceptive. Her temperature is 37.8°C (100°F), pulse is 113/min and regular, and blood pressure is 162/90 mm Hg. Examination shows decreased muscle strength on the left side. Deep tendon reflexes are 4+ on the left. Babinski sign is present on the left. The right lower leg is swollen, erythematous, and tender to palpation. Further evaluation is most likely to show which of the following?

A 35-year-old man is brought to the emergency department because of a 2-week history of abdominal cramps, vomiting, and constipation. He also reports having to urinate frequently and occasional leg pain. He has had similar episodes in the past. He has hypertension and peptic ulcer disease. Current medications include captopril and ranitidine. He appears depressed. Physical examination shows weakness in the extremities. Abdominal examination shows mild epigastric tenderness. There is no rebound or guarding. He has a restricted affect. Laboratory studies show elevated serum parathyroid hormone levels; serum calcium is 14.2 mg/dL. Abdominal ultrasonography shows multiple small calculi in the right kidney. Which of the following is most likely to provide rapid relief in this patient?

A 60-year-old man with a long-standing history of type 2 diabetes and hypertension managed with lisinopril and metformin presents with itchy skin. He also describes moderate nausea, vomiting, muscle weakness, and fatigue. The vital signs include: temperature 36.8°C (98.2°F), heart rate 98/min, respiratory rate 15/min, blood pressure 135/85 mm Hg, oxygen saturation 100% on room air. Physical exam is notable for pale conjunctivae, pitting edema, and ascites. Laboratory findings are shown below: BUN 78 mg/dL pCO2 25 mm Hg Creatinine 7.2 mg/dL Glucose 125 mg/dL Serum chloride 102 mmol/L Serum potassium 6.3 mEq/L Serum sodium 130 mEq/L Total calcium 1.3 mmol/L Magnesium 1.2 mEq/L Phosphate 1.9 mmol/L Hemoglobin 9.5 g/dL MCV 86 μm3 Bicarbonate (HCO3) 10 mmol/L Shrunken kidneys are identified on renal ultrasound. The doctor explains to the patient that he will likely need dialysis due to his significant renal failure until a renal transplant can be performed. The patient is concerned because he is very busy and traveling a lot for work. Given his lifestyle requirements, what is a potential complication of the most appropriate dialysis modality for this patient?

Twelve days after undergoing a cadaveric renal transplant for adult polycystic kidney disease, a 23-year-old man has pain in the right lower abdomen and generalized fatigue. During the past 4 days, he has had decreasing urinary output. Creatinine concentration was 2.3 mg/dL on the second postoperative day. Current medications include prednisone, cyclosporine, azathioprine, and enalapril. His temperature is 38°C (100.4°F), pulse is 103/min, and blood pressure is 168/98 mm Hg. Examination reveals tenderness to palpation on the graft site. Creatinine concentration is 4.3 mg/dL. A biopsy of the transplanted kidney shows tubulitis. C4d staining is negative. Which of the following is the most likely cause of this patient's findings?

A 67-year-old Caucasian female presents to her primary care physician after a screening DEXA scan reveals a T-score of -3.0. Laboratory work-up reveals normal serum calcium, phosphate, vitamin D, and PTH levels. She smokes 1-2 cigarettes per day. Which of the following measures would have reduced this patient's risk of developing osteoporosis?

A 65-year-old man is brought to the emergency department because of a 3-day history of increasing shortness of breath and chest pain. He has had a productive cough with foul-smelling sputum for 1 week. He has gastritis as well as advanced Parkinson disease and currently lives in an assisted-living community. He smoked one pack of cigarettes daily for 40 years but quit 5 years ago. He has a 30-year history of alcohol abuse but has not consumed any alcohol in the past 5 years. His temperature is 39.3°C (102.7°F), he is tachycardic and tachypneic and his oxygen saturation is 77% on room air. Auscultation of the lung shows rales and decreased breath sounds over the right upper lung field. Examination shows a resting tremor. Laboratory studies show: Hematocrit 38% Leukocyte count 17,000/mm3 Platelet count 210,000/mm3 Lactic acid 4.1 mmol/L (N=0.5–1.5) A x-ray of the chest shows infiltrates in the right upper lobe. Which of the following is the most significant predisposing factor for this patient's respiratory symptoms?

A 62-year-old woman with type 2 diabetes mellitus comes to the physician because of a 3-month history of fatigue and weakness. Her hemoglobin A1c concentration was 13.5% 12 weeks ago. Her blood pressure is 152/92 mm Hg. Examination shows lower extremity edema. Serum studies show: K+ 5.1 mEq/L Phosphorus 5.0 mg/dL Ca2+ 7.8 mg/dL Urea nitrogen 60 mg/dL Creatinine 2.2 mg/dL Which of the following is the best parameter for early detection of this patient’s renal condition?