Cardiology — MCQs

A 58-year-old man presents to the emergency department for evaluation of intermittent chest pain over the past 6 months. His history reveals that he has had moderate exertional dyspnea and 2 episodes of syncope while working at his factory job. These episodes of syncope were witnessed by others and lasted roughly 30 seconds. The patient states that he did not have any seizure activity. His vital signs include: blood pressure 121/89 mm Hg, heart rate 89/min, temperature 37.0°C (98.6°F), and respiratory rate 16/min. Physical examination reveals a crescendo-decrescendo systolic murmur in the right second intercostal area. An electrocardiogram is performed, which shows left ventricular hypertrophy. Which of the following is the best next step for this patient?

An 82-year-old comes to the physician for a routine checkup. He feels well. He has a history of hypertension, peripheral vascular disease, carotid stenosis, and mild dementia. His father had Parkinson's disease and died of a stroke at the age of 74 years. He has smoked one-half pack of cigarettes daily for 30 years but quit at the age of 50 years. He drinks alcohol in moderation. Current medications include aspirin and lisinopril. He appears healthy. His temperature is 36.9°C (98.4°F), pulse is 73/min, respirations are 12/min, and blood pressure is 142/92 mmHg. Examination shows decreased pedal pulses bilaterally. Ankle jerk and patellar reflexes are absent bilaterally. Sensation to light touch, pinprick, and proprioception is intact bilaterally. Muscle strength is 5/5 bilaterally. He describes the town he grew up in with detail but only recalls one of three words after 5 minutes. Which of the following is the most appropriate next step in management for these findings?

A 48-year-old female complains of tingling sensation in her fingertips as well as the skin around her mouth which woke her up from sleep. She is in the postoperative floor as she just underwent a complete thyroidectomy for papillary thyroid cancer. Her temperature is 37° C (98.6° F), respirations are 15/min, pulse is 67/min, and blood pressure is 122/88 mm Hg. While recording the blood pressure, spasm of the muscles of the hand and forearm is seen. What is the next best step in the management of this patient?

A 65-year-old man presents to his primary care physician for a pre-operative evaluation. He is scheduled for cataract surgery in 3 weeks. His past medical history is notable for diabetes, hypertension, and severe osteoarthritis of the right knee. His medications include metformin, hydrochlorothiazide, lisinopril, and aspirin. His surgeon ordered blood work 1 month ago, which showed a hemoglobin of 14.2 g/dL, INR of 1.2, and a hemoglobin A1c of 6.9%. His vital signs at the time of the visit show BP: 130/70 mmHg, Pulse: 80, RR: 12, and T: 37.2 C. He has no current complaints and is eager for his surgery. Which of the following is the most appropriate course of action for this patient at this time?

A 34-year-old Caucasian female presents at the ER with fever and sharp pain in her chest upon coughing and inhalation. Three weeks earlier she presented to her rheumatologist with a butterfly rash, joint pain and fatigue and was given a diagnosis of systemic lupus erythematosus. A friction rub is present upon physical exam. Which of the following do you most suspect in this patient?

A 52-year-old man presents to the emergency department because of pain and swelling in his left leg over the past few hours. He traveled from Sydney to Los Angeles 2 days ago. He has had type 2 diabetes mellitus for 10 years and takes metformin for it. He has smoked a pack of cigarettes daily for 25 years. His temperature is 36.9°C (98.4°F), the blood pressure is 140/90 mm Hg, and the pulse is 90/min. On examination, the left calf is 5 cm greater in circumference than the right. The left leg appears more erythematous than the right with dilated superficial veins. Venous duplex ultrasound shows non-compressibility. Which of the following best represents the mechanism of this patient’s illness?

A 53-year-old man is brought to the emergency department following an episode of loss of consciousness 1 hour ago. He had just finished micturating, when he fell down. His wife heard the noise and found him unconscious on the floor. He regained consciousness after 30 seconds and was able to talk normally with his wife immediately. There was no urinary incontinence. On arrival, he is alert and oriented. Cardiopulmonary examination shows no abnormalities. Neurologic examination shows no focal findings. Serum concentrations of glucose, creatinine, and electrolytes are within the reference range. An electrocardiogram shows no abnormalities. Which of the following is the most likely diagnosis?

A 35-year-old woman with type 1 diabetes mellitus comes to the emergency department for evaluation of a 1-month history of fever, fatigue, loss of appetite, and a 3.6-kg (8-lb) weight loss. She has also had a cough for the last 2 months. She reports recent loss of pubic hair. The patient immigrated from the Philippines 7 weeks ago. Her mother has systemic lupus erythematosus. She has never smoked and does not drink alcohol. Her only medication is insulin, but she sometimes misses doses. She is 165 cm (5 ft 5 in) tall and weighs 49 kg (108 lb); BMI is 18 kg/m2. She appears lethargic. Her temperature is 38.9°C (102°F), pulse is 58/min, and blood pressure is 90/60 mm Hg. Examination shows decreased sensation to touch and vibration over both feet. The remainder of the examination shows no abnormalities. Serum studies show: Na+ 122 mEq/L Cl- 100 mEq/L K+ 5.8 mEq/L Glucose 172 mg/dL Albumin 2.8 g/dL Cortisol 2.5 μg/dL ACTH 531.2 pg/mL (N=5–27 pg/mL) CT scan of the abdomen with contrast shows bilateral adrenal enlargement. Which of the following is the most likely underlying mechanism of this patient's symptoms?

A 47-year-old female with a history of hypertension presents to your outpatient clinic for numbness, tingling in her right hand that has been slowly worsening over the last several months. She has tried using a splint but receives minimal relief. She is an analyst for a large consulting firm and spends most of her workday in front of a computer. Upon examination, you noticed that the patient has a prominent jaw and her hands appear disproportionately large. Her temperature is 99 deg F (37.2 deg C), blood pressure is 154/72 mmHg, pulse is 87/min, respirations are 12/min. A fasting basic metabolic panel shows: Na: 138 mEq/L, K: 4.1 mEq/L, Cl: 103 mEq/L, CO2: 24 mEq/L, BUN: 12 mg/dL, Cr: 0.8 mg/dL, Glucose: 163 mg/dL. Which of the following tests would be most helpful in identifying the underlying diagnosis?

A 71-year-old man comes to the emergency department because of a 2-month history of severe muscle cramps and back pain. He says that he is homeless and has not visited a physician in the past 20 years. He is 183 cm (6 ft 0 in) tall and weighs 62 kg (137 lb); BMI is 18.5 kg/m2. His blood pressure is 154/88 mm Hg. Physical examination shows pallor, multiple cutaneous excoriations, and decreased sensation over the lower extremities. Serum studies show: Calcium 7.2 mg/dL Phosphorus 5.1 mg/dL Glucose 221 mg/dL Creatinine 4.5 mg/dL An x-ray of the spine shows alternating sclerotic and radiolucent bands in the lumbar and thoracic vertebral bodies. Which of the following is the most likely explanation for these findings?