Cardiology — MCQs

A 45-year-old male presents to his primary care physician for complaints of dizziness. The patient reports he experiences room-spinning dizziness lasting several hours at a time, approximately 2-3 times a month, starting 3 months ago. Upon questioning, the patient also reports right sided diminished hearing, tinnitus, and a sensation of ear fullness. His temperature is 99 deg F (37.2 deg C), pulse 70/min, respirations 12, blood pressure 130 mmHg/85 mmHg, SpO2 99%. You decide to order an audiometric evaluation. What is the most likely finding of the audiogram?

A 32-year-old man comes to the physician for a follow-up examination 1 week after being admitted to the hospital for oral candidiasis and esophagitis. His CD4+ T lymphocyte count is 180 cells/μL. An HIV antibody test is positive. Genotypic resistance assay shows the virus to be susceptible to all antiretroviral therapy regimens and therapy with dolutegravir, tenofovir, and emtricitabine is initiated. Which of the following sets of laboratory findings would be most likely on follow-up evaluation 3 months later? $$$ CD4 +/CD8 ratio %%% HIV RNA %%% HIV antibody test $$$

A 62-year-old woman comes to the physician because of involuntary, rhythmic movements of her hands for the past 5 months. Her symptoms initially affected her left hand only, but now both hands are affected. She also reports that her symptoms are worse at rest and that performing tasks such as tying her shoelaces and writing have become more difficult. Her husband thinks that she has been more withdrawn lately. She used to drink a half a bottle of sherry every day for the past 18 years but has not consumed alcohol in the past year. She has chronic liver disease, hypertension, and peripheral artery disease. Current medications include aspirin and propanolol. She appears anxious. She is oriented to time, place, and person. Her temperature is 37°C (98.6°F), pulse is 98/min, and blood pressure is 144/82 mm Hg. Examination shows a rhythmic, low-frequency tremor that is more prominent in the left hand. Range of motion in the arms and legs is normal. Increased resistance to passive flexion and extension is present in the left upper limb. Muscle strength is 4/5 in all limbs. Sensations to pinprick and light touch are preserved. The finger-to-nose test is normal bilaterally. Which of the following is the most likely underlying cause of this patient's symptoms?

A 68-year-old Caucasian male complains of severe headache and pain while chewing. Upon examination, he is found to have a left visual field deficit. Laboratory results show elevated erythrocyte sedimentation rate. Which of the following drugs would be the best choice for treatment of this patient?

A 76-year-old male with a history of chronic uncontrolled hypertension presents to the emergency room following an episode of syncope. He reports that he felt lightheaded and experienced chest pain while walking his dog earlier in the morning. He notes that he has experienced multiple similar episodes over the past year. A trans-esophageal echocardiogram demonstrates a thickened, calcified aortic valve with left ventricular hypertrophy. Which of the following heart sounds would likely be heard on auscultation of this patient?

A 21-year-old Cambodian patient with a history of rheumatic heart disease presents to his primary care physician for a routine check-up. He reports being compliant with monthly penicillin G injections since being diagnosed with rheumatic fever at age 15. He denies any major side effects from the treatment, except for the inconvenience of organizing transportation to a physician's office every month. On exam, the patient is found to have a loud first heart sound and a mid-diastolic rumble that is best heard at the apex. Which of the following is the next best step?

A 30-year-old patient comes to the emergency room with a chief complaint of left chest pain and a productive cough with purulent sputum for 1 week. He also complains of shortness of breath. He said he had been previously diagnosed with influenza but did not follow the doctor’s instructions. His vitals include: heart rate 70/min, respiratory rate 22/min, temperature 38.7°C (101.7°F), blood pressure 120/60 mm Hg, and SO2 80%. His hemogram and chest X-ray findings are as follows: Hemoglobin 14 mg/dL Hematocrit 45% Leukocyte count 12,000/mm3 Neutrophils 82% Lymphocytes 15% Monocytes 3% Platelet count 270,000/mm3 Chest X-ray alveolar infiltrates in the left base with air bronchograms What is the most likely diagnosis?

A 32-year-old woman comes to the physician because of worsening fatigue and shortness of breath. Her symptoms began 8 months ago and have progressively worsened since then. She had recurrent episodes of joint pain and fever during childhood. She does not smoke or drink alcohol. She emigrated from the Congo with her parents when she was 12 years old. Her temperature is 37.4°C (99.3°F), pulse is 90/min and regular, respirations are 18/min, and blood pressure is 140/90 mm Hg. There is an opening snap followed by a diastolic murmur at the fifth left intercostal space in the midclavicular line. If left untreated, this patient is at greatest risk for which of the following complications?

A 62-year-old man presents to the emergency department with confusion. The patient’s wife states that her husband has become more somnolent over the past several days and now is very confused. The patient has no complaints himself, but is answering questions inappropriately. The patient has a past medical history of diabetes and hypertension. His temperature is 98.3°F (36.8°C), blood pressure is 127/85 mmHg, pulse is 138/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam is notable for a confused man with dry mucous membranes. Initial laboratory studies are ordered as seen below. Serum: Na+: 135 mEq/L Cl-: 100 mEq/L K+: 3.0 mEq/L HCO3-: 23 mEq/L BUN: 30 mg/dL Glucose: 1,299 mg/dL Creatinine: 1.5 mg/dL Ca2+: 10.2 mg/dL Which of the following is the most appropriate initial treatment for this patient?

A 55-year-old man presents for physical and preventive health screening, specifically for prostate cancer. He has not been to the doctor in a long time. Past medical history is significant for hypertension that is well-managed. Current medication is hydrochlorothiazide. He has one uncle who died of prostate cancer. He drinks one or two alcoholic drinks on the weekends and does not smoke. Today his temperature is 37.0°C (98.6°F), blood pressure is 125/75 mm Hg, pulse is 82/min, respiratory rate is 15/min, and oxygen saturation is 99% on room air. There are no significant findings on physical examination. Which of the following would be the most appropriate recommendation for prostate cancer screening in this patient?