Cardiology — MCQs

A 14-year-old boy presents with his mother complaining of a swollen, red, painful left knee. His physician aspirates the joint and discovers frank blood. The patient denies a recent history of trauma to the knee. Upon further discussion, the mother describes that her son has had multiple swollen painful joints before, often without evidence of trauma. She also mentions a history of frequent nosebleeds and gum bleeding following visits to the dentist. Which of the following is the most likely underlying diagnosis?

A 50-year-old woman comes to the emergency department because of fever and productive cough with blood in the sputum for 1 day. She also reports a sharp pain under her ribs that is worsened on taking deep breaths. Over the past 2 years, she has had repeated episodes of sinusitis, for which she used over the counter medication. She has recently started a new job at a wire-mesh factory. Her temperature is 38.3°C (100.9 °F), pulse is 72/min, respirations are 16/min, and blood pressure is 120/80 mm Hg. Physical examination shows palpable nonblanching skin lesions over her hands and feet. Examination of the nasal cavity shows ulcerations of the nasopharyngeal mucosa and a small septal perforation. Pulmonary examination shows stridor on inspiration. Laboratory studies show: Hemoglobin 13.2 g/dL Leukocyte count 10,300/mm3 Platelet count 205,000/mm3 Serum Urea nitrogen 24 mg/dL Creatinine 2.4 mg/dL Urine Protein 2+ RBC 70/hpf RBC casts numerous WBC 1–2/hpf A chest x-ray shows multiple cavitating, nodular lesions bilaterally. Which of the following additional findings is most likely to be present in this patient?

A 42-year-old man comes to the physician because of a 2-month history of fatigue and increased urination. The patient reports that he has been drinking more than usual because he is constantly thirsty. He has avoided driving for the past 8 weeks because of intermittent episodes of blurred vision. He had elevated blood pressure at his previous visit but is otherwise healthy. Because of his busy work schedule, his diet consists primarily of fast food. He does not smoke or drink alcohol. He is 178 cm (5 ft 10 in) tall and weighs 109 kg (240 lb); BMI is 34 kg/m2. His pulse is 75/min and his blood pressure is 148/95 mm Hg. Cardiopulmonary examination shows no abnormalities. Laboratory studies show: Hemoglobin A1c 6.8% Serum Glucose 180 mg/dL Creatinine 1.0 mg/dL Total cholesterol 220 mg/dL HDL cholesterol 50 mg/dL Triglycerides 140 mg/dL Urine Blood negative Glucose 2+ Protein 1+ Ketones negative Which of the following is the most appropriate next step in management?

A 35-year-old patient with a history of diabetes presents to the ED with a myriad of systemic complaints. An arterial blood gas shows serum pH = 7.3, HCO3- = 13 mEq/L, PCO2 = 27 mmHg. Which of the following would you LEAST expect to observe in this patient?

A 74-year-old man presents to the emergency department with shortness of breath that started about 30 minutes ago. He is also experiencing chest pain on deep inspiration. He has several significant medical conditions including chronic obstructive pulmonary disease, hypertension, and dyslipidemia. He used to smoke about 3 packs of cigarettes every day until last year when he quit. He was in the emergency room 2 weeks ago for a hemorrhagic stroke which was promptly treated. He currently weighs 97.5 kg (215 lb). His respirations are 20/min, the blood pressure is 110/80 mm Hg, and the pulse is 105/min. On physical examination, Homan's sign is positive. An ECG and chest X-ray are performed. His current oxygen saturation is at 87% and D-dimer results are positive. He is wheeled in for a CT scan. What is the most appropriate initial treatment for this patient?

A 64-year-old woman presents to the physician with fever and sore throat for 2 days. She was diagnosed with rheumatoid arthritis 15 years ago. She has had several flares necessitating admission to the hospital in recent years. She has developed deformity in her joints despite aggressive therapy. She is a candidate for surgical correction. Her temperature is 38.2°C (100.9°F), and the rest of her vital signs are stable. Physical examination of the hands reveals multiple swan-neck, boutonniere, and Z-line deformities. Ulnar deviation is evident in both hands. She has flat feet. There are 3 firm, nontender nodules palpated around the right elbow and one on the left Achilles tendon. The spleen is palpated 5 cm below the costal margin with a percussion span of 15 cm. Lymphadenopathy is absent on exam. The laboratory test results show: Hemoglobin 11 g/dL Mean corpuscular volume 90 μm3 Leukocyte count 3,500/mm3 Segmented neutrophils 20% Lymphocytes 70% Platelet count 240,000/mm3 Erythrocyte sedimentation rate 65 mm/hour Rheumatoid factor 85 IU/mL (Normal: up to 14 IU/mL) Which of the following is the most likely cause of this patient’s current condition?

A 49-year-old man presents to his primary care physician for leg pain. He states that when he goes for walks with his dog, he starts feeling calf pain. He either has to stop or sit down before the pain resolves. He used to be able to walk at least a mile, and now he starts feeling the pain after 8 blocks. His medical history includes hyperlipidemia and hypertension. He takes lisinopril, amlodipine, and atorvastatin, but he admits that he takes them inconsistently. His blood pressure is 161/82 mmHg, pulse is 87/min, and respirations are 16/min. On physical exam, his skin is cool to touch and distal pulses are faint. His bilateral calves are smooth and hairless. There are no open wounds or ulcers. Dorsi- and plantarflexion of bilateral ankles are 5/5 in strength. Ankle-brachial indices are obtained, which are 0.8 on the left and 0.6 on the right. In addition to lifestyle modifications, which of the following is the next best step in management?

A 35-year-old man presents to pulmonary function clinic for preoperative evaluation for a right pneumonectomy. His arterial blood gas at room air is as follows: pH: 7.34 PaCO2: 68 mmHg PaO2: 56 mmHg Base excess: +1 O2 saturation: 89% What underlying condition most likely explains these findings?

A 62-year-old man comes to the physician for the evaluation of lower back pain and tingling and numbness in his legs for the past 6 months. The pain radiates bilaterally to his buttocks and legs gets worse while standing or walking downhill. Two weeks ago, he had an upper respiratory tract infection that resolved spontaneously. He has hypertension and hypercholesterolemia. His son has ankylosing spondylitis. The patient does not smoke. He drinks 2–3 beers on the weekends. Current medications include enalapril and atorvastatin. He is 180 cm (5 ft 11 in) tall and weighs 90 kg (198 lb); BMI is 27.8 kg/m2. His temperature is 37°C (98.6°F), pulse is 70/min, and blood pressure is 135/85 mm Hg. There is no tenderness to palpation over the lumbar spine. Sensation to pinprick and light touch is decreased over the lower extremities. The patient's gait is unsteady and wide based. Muscle strength is normal. Deep tendon reflexes are 1+ bilaterally. Babinski's sign is absent bilaterally. Further evaluation is most likely to reveal which of the following findings?

A 62-year-old woman comes to the physician because of a 2-month history of a rash on her ankles with intermittent itching. After the rash developed, she started applying a new scented lotion to her legs daily. She works as a cashier at a grocery store. She has type 2 diabetes mellitus and hypertension. Current medications include metformin and enalapril. Examination shows enlarged superficial veins of the right lower extremity and red-brown discoloration with indistinct margins over the medial ankles. There is 1+ edema in the lower extremities. Which of the following is the most likely cause of this patient’s skin findings?