Cardiology — MCQs

A 66-year-old man is brought to the emergency department because of weakness of his left leg for the past hour. He was unable to get out of bed that morning. His pants are soaked with urine. He has hypertension and coronary artery disease. Current medications include enalapril, carvedilol, aspirin, and simvastatin. His temperature is 37°C (98.6F), pulse is 98/min, and blood pressure is 160/90 mm Hg. Examination shows equal pupils that are reactive to light. Muscle strength is 2/5 in the left lower extremity. Plantar reflex shows an extensor response on the left. Sensation is decreased in the left lower extremity. On mental status examination, he is oriented to time, place, and person and has a flat affect. When asked to count backwards from 20, he stops after counting to 17. When asked to name 10 words beginning with the letter “d,” he stops after naming two words. Fundoscopy shows no abnormalities. Which of the following is the most likely cause of this patient's symptoms?

A 48-year-old Caucasian man presents to your office for initial evaluation as he has recently moved to your community and has become your patient. He has no significant past medical history and has not seen a physician in over 10 years. He takes no medications and denies having any allergies. He has been a smoker for the past 20 years and smokes approximately half a pack daily. His brother and father have diabetes; his brother is treated with metformin, whereas, his father requires insulin. His father has experienced two strokes. On presentation, he is a pleasant obese man with a body mass index of 34 kg/m2. On physical examination, his blood pressure is 170/90 mm Hg in the left arm and 168/89 mm Hg in the right arm. The patient is instructed to follow a low-salt diet, quit smoking, perform daily exercise, and diet to lose weight. He returns several weeks later for a follow-up appointment. The patient reports a 1.8 kg (4 lb) weight loss. His blood pressure on presentation is 155/94 mm Hg in both arms. What is the most appropriate next step in management?

A 60-year-old man presents to the emergency room with a chief complaint of constipation. His history is also significant for weakness, a dry cough, weight loss, recurrent kidney stones, and changes in his mood. He has a 30 pack-year history of smoking. A chest x-ray reveals a lung mass. Labs reveal a calcium of 14. What is the first step in management?

A 61-year-old male presents to an urgent care clinic with the complaints of pain in his joints and recurrent headaches for a month. He is also currently concerned about sweating excessively even at room temperature. His wife, who is accompanying him, adds that his facial appearance has changed over the past few years as he now has a protruding jaw and a prominent forehead and brow ridge. His wedding ring no longer fits his finger despite a lack of weight gain over the last decade. His temperature is 98.6° F (37° C), respirations are 15/min, pulse is 67/min and blood pressure is 122/88 mm Hg. A general physical exam does not show any abnormality. What lab findings are most likely to be seen in this patient?

A 44-year-old man presents for a routine check-up. He has a past medical history of rheumatic fever. The patient is afebrile, and the vital signs are within normal limits. Cardiac examination reveals a late systolic crescendo murmur with a mid-systolic click, best heard over the apex and loudest just before S2. Which of the following physical examination maneuvers would most likely cause an earlier onset of the click/murmur?

A 74-year-old woman with no significant past medical history presents with 1 week of fever, unremitting headache and hip and shoulder stiffness. She denies any vision changes. Physical examination is remarkable for right scalp tenderness and range of motion is limited due to pain and stiffness. Neurological testing is normal. Laboratory studies are significant for an erythrocyte sedimentation rate (ESR) at 75 mm/h (normal range 0-22 mm/h for women). Which of the following is the most appropriate next step in management?

A 36-year-old woman comes to the physician because of a 4-day history of fever, malaise, chills, and a cough productive of moderate amounts of yellow-colored sputum. Over the past 2 days, she has also had right-sided chest pain that is exacerbated by deep inspiration. Four months ago, she was diagnosed with a urinary tract infection and was treated with trimethoprim/sulfamethoxazole. She appears pale. Her temperature is 38.8°C (101.8°F), pulse is 92/min, respirations are 20/min, and blood pressure is 128/74 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 99%. Examination shows pale conjunctivae. Crackles are heard at the right lung base. Cardiac examination shows no abnormalities. Laboratory studies show: Hemoglobin 12.6 g/dL Leukocyte count 13,300/mm3 Platelet count 230,000/mm3 Serum Na+ 137 mEq/L Cl- 104 mEq/L K+ 3.9 mEq/L Urea nitrogen 16 mg/dL Glucose 89 mg/dL Creatinine 0.8 mg/dL An x-ray of the chest shows an infiltrate at the right lung base. Which of the following is the most appropriate next step in management?

A 37-year-old woman comes to the physician because of a 2-week history of palpitations and loose stools. She has had a 2.3-kg (5-lb) weight loss over the past month. She has had no change in appetite. She has no history of serious illness. She works in accounting and has been under more stress than usual lately. She takes no medications. She appears pale. Her temperature is 37.8°C (100.1°F), pulse is 110/min, respirations are 20/min, and blood pressure is 126/78 mm Hg. Cardiopulmonary examination shows no abnormalities. The abdomen is soft and nontender. There is a bilateral hand tremor with outstretched arms and a palpable thyroid nodule in the left lobe. Serum laboratory studies show a thyroid stimulating hormone level of 0.03 μU/mL and a thyroxine level of 28 μg/dL. A radioactive iodine uptake scan shows enhancement in a 3-cm encapsulated nodule in the lower left lobe with decreased uptake in the remaining gland. Which of the following is the most likely diagnosis?

A 58-year-old woman comes to the physician because of a 3-month history of itching of both legs. She also has swelling and dull pain that are worse at the end of the day and are more severe in her right leg. She has hyperthyroidism, asthma, and type 2 diabetes mellitus. Four years ago, she had basal cell carcinoma of the face that was treated with Mohs surgery. Current medications include methimazole, albuterol, and insulin. She has smoked 3–4 cigarettes a day for the past 29 years. She goes to a local sauna twice a week. Her temperature is 37°C (98.6°F), pulse is 75/min, respirations are 16/min, and blood pressure is 124/76 mm Hg. Physical examination shows fair skin with diffuse freckles. There is 2+ pitting edema of the right leg and 1+ pitting edema of the left leg. There is diffuse reddish-brown discoloration and significant scaling extending from the ankle to the mid-thigh bilaterally. Pedal pulses and sensation are intact bilaterally. Which of the following is the most likely underlying mechanism of this patient's symptoms?

A 22-year-old woman with a history of type I diabetes mellitus presents to the emergency department with nausea, vomiting, and drowsiness for the past day. Her temperature is 98.3°F (36.8°C), blood pressure is 114/74 mmHg, pulse is 120/min, respirations are 27/min, and oxygen saturation is 100% on room air. Physical exam is notable for a confused and lethargic young woman. Initial laboratory values are notable for the findings below. Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 2.9 mEq/L HCO3-: 9 mEq/L BUN: 20 mg/dL Glucose: 599 mg/dL Creatinine: 1.1 mg/dL Ca2+: 10.2 mg/dL AST: 12 U/L ALT: 10 U/L An initial ECG is notable for sinus tachycardia. Which of the following is the best initial step in management for this patient?