Cardiology — MCQs

A 40-year-old man with persistent moderate asthma presents for a pulmonary function test. His ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) is 0.69, and his FEV1 is 65% of his predicted values. What other findings can be expected in the remainder of his pulmonary function test?

A 56-year-old man presents to his general practitioner with frequent episodes of facial flushing for the past 2 weeks. He says the episodes are associated with mild headaches and a sensation of fullness in his head and neck. Additionally, he has developed recurrent, often severe, itching after taking a hot shower. The patient denies any smoking history but says he drinks alcohol socially. His blood pressure is 160/90 mm Hg, and his temperature is 37.0°C (98.6°F). On physical examination, his face and neck appear red. Cardiac examination reveals a regular rate and rhythm. Lungs are clear to auscultation bilaterally. The spleen is noted to be palpable just below the costal margin. A complete blood count shows a hemoglobin level of 19.5 g/dL, a total leukocyte count of 12,000/mm3, and a platelet count of 450,000/mm3. Which of the following sets of abnormalities is most likely present in this patient?

A 52-year-old postmenopausal woman seeks evaluation at a medical clinic with complaints of back pain and increased fatigue for 6 months. For the past week, the back pain has radiated to her legs and is stabbing in nature (7/10 in intensity). There are no associated paresthesias. She unintentionally lost 4.5 kg (10.0 lb) in the past 6 months. There is no history of trauma to the back. The past medical history is insignificant and she does not take any medications. The physical examination is normal. The laboratory results are as follows: Hemoglobin 10 g/dL Hematocrit 30% Mean corpuscular volume 80 fL Serum creatinine 1.5 mg/dL Serum total protein 9 g/dL Serum albumin 4.2 g/dL Serum calcium 11.2 mg/dL A peripheral blood smear shows normocytic normochromic cells. An X-ray reveals multiple osteolytic lesions in the vertebrae and long bones. Serum protein electrophoresis shows a monoclonal spike. A bone marrow biopsy shows increased plasma cells making up greater than 50% of the total cell population. Which of the following is the most likely diagnosis in this patient?

A 72-year-old male with history of hypertension, diabetes mellitus, cluster headaches, and basal cell carcinoma presents with complaints of progressive dyspnea. He has had increasing shortness of breath, especially when going on walks or mowing the lawn. In addition, he had two episodes of extreme lightheadedness while moving some of his furniture. His temperature is 98.2°F (36.8°C), blood pressure is 135/92 mmHg, pulse is 70/min, respirations are 14/min, and oxygen saturation is 94% on room air. Physical exam is notable for clear lung fields and a 3/6 systolic ejection murmur best heard at the right 2nd intercostal space. In addition, the carotid pulses are delayed and diminished in intensity bilaterally. Which of the following would most likely be seen in association with this patient’s condition?

A 65-year-old woman comes to the physician for a 18-month history of gradual enlargement of her fingertips and a 2-month history of a hoarse voice. She has had decreased appetite after a respiratory tract infection 3 months ago and a 8-kg (17.6-lb) weight loss during this period. The patient has never smoked. She was diagnosed with obstructive sleep apnea 10 years ago and uses a CPAP mask at night. She retired from her job as an administrative assistant at a local college 5 years ago. She appears tired. Her vital signs are within normal limits. Physical examination shows increased convexity of the nail fold and painful swelling of the soft tissue of her fingers and ankles. There is no discoloration of her lips and oral mucosa. There is faint wheezing in the right upper lung field. This patient's condition is most likely associated with which of the following findings?

A previously healthy 24-year-old man is brought to the emergency department 30 minutes after an episode of loss of consciousness. He was standing in line at a bus stop when he suddenly became tense, fell down, and lost consciousness; this was followed by 4 minutes of violent jerky movements of his arms and legs. He was confused after the episode. He has no recollection of the event or its immediate aftermath. On arrival, he is alert and oriented to time, place, and person. His temperature is 37.7°C (99.4°F), pulse is 98/min, and blood pressure is 130/70 mm Hg. Physical examination shows blood in the mouth. Neurologic examination shows no focal findings. A CT scan of the head shows no abnormalities. Further evaluation of this patient is most likely to show which of the following laboratory findings?

A 69-year-old woman is brought to the physician by her husband because of multiple falls and difficulty maintaining balance while standing or walking over the past year. During this period, she has had blurred vision and diplopia. Her husband has had difficulty understanding her speech for the past 3 months. She has become withdrawn and now refuses to go to social gatherings. Examination shows a broad-based gait and dysarthria. The visual acuity is 20/20 in each eye. There is conjugate limitation of both eyes while looking down. Muscle tone is increased in bilateral upper extremities. Bradykinesia is present. Mental status examination shows apathy. She responds to questions with 1–2 words after a delay of several seconds. Grasp reflex is present. An MRI of the brain is most likely to show which of the following?

A 66-year old man with a 45-pack-year smoking history presents with abdominal pain and constipation. He reports that he has had a worsening cough for several months and has lost 20 pounds over this time period. You order a complete metabolic profile, which demonstrates hypercalcemia. A chest radiograph shows a centrally located mass suspicious for malignancy. Which of the following is the most likely explanation?

A 42-year-old woman presents to the urgent care clinic with recurrent chest pain and pressure radiating to her jaw. ECG is obtained and shows ST-segment elevation, but her cardiac enzymes are repeatedly found to be within normal ranges. She has a heart rate of 82/min and a blood pressure of 128/76 mm Hg. Physical examination reveals regular heart sounds with no friction rub. Which of the following options is an acceptable treatment regimen for this patient’s suspected condition?

A 62-year-old man is brought to the emergency department by his wife because she thinks he has had a stroke. He has hypertension and type 2 diabetes mellitus. Current medications include enalapril and metformin. He has smoked 1 pack of cigarettes per day for the past 35 years. His blood pressure is 162/95 mm Hg. A CT scan of the brain shows a lacunar stroke involving the left subthalamic nucleus. The patient most likely presented with which of the following findings on physical examination?