Cardiology — MCQs

A 47-year-old man presents to the physician’s office with an inability to maintain an erection. He can achieve an erection, but it is brief and decreases soon after the penetration. His erectile dysfunction developed gradually over the past 2 years. He denies decreased libido, depressed mood, or anhedonia. He does not report any chronic conditions. He has a 20-pack-year history of smoking and drinks alcohol occasionally. He weighs 120 kg (264.5 lb), his height is 181 cm (5 ft 11 in), and his waist circumference is 110 cm (43 in). The blood pressure is 145/90 mm Hg and the heart rate is 86/min. Physical examination is performed including a genitourinary and rectal examination. It reveals no abnormalities besides central obesity. Which of the following laboratory tests is indicated to investigate for the cause of the patient’s condition?

A 39-year-old woman with type 1 diabetes mellitus comes to the physician because of a 2-month history of fatigue and hair loss. She has smoked one pack of cigarettes daily for the past 15 years. Her only medication is insulin. Her pulse is 59/min and blood pressure is 102/76 mm Hg. Physical examination shows dry skin, coarse hair, and a nontender, diffuse neck swelling in the anterior midline. Further evaluation of this patient is most likely to show which of the following findings?

A 10-year-old boy presents to the emergency department accompanied by his parents with a swollen and painful right knee after he fell from his bicycle a few hours ago. The patient’s mother says he fell off the bike and struck the ground with his whole weight on his right knee. Immediately, his right knee swelled significantly, and he experienced severe pain. The patient’s past medical history is significant for previous episodes of easy bruising that manifest as small bluish spots, but not nearly as severe. The family history is significant for an uncle who had similar symptoms, and who was diagnosed at the age of 13 years old. The patient is afebrile, and the vital signs are within normal limits. On physical examination, a large bruise is present over the right knee that is extending several inches down the leg. The right tibiofemoral joint is warm to the touch and severely tender to palpation. Which of the following is the most likely diagnosis in this patient?

A 32-year-old man comes to the physician because of a 2-week history of a cough and shortness of breath. He also noted several episodes of blood-tinged sputum over the last 4 days. He has a 3-month history of progressive fatigue. His temperature is 37.5°C (98.6°F), pulse is 86/min, respirations are 17/min, and blood pressure is 150/93 mm Hg. Examination shows pale conjunctivae. Crackles are heard on auscultation of the chest. Laboratory studies show: Hemoglobin 10.2 g/dL Leukocyte count 9200/mm3 Platelet count 305,000/mm3 Serum Na+ 136 mEq/L Cl- 101 mEq/L K+ 4.5 mEq/L HCO3- 25 mEq/L Urea nitrogen 28 mg/dL Creatinine 2.3 mg/dL Anti-GBM antibodies positive Antinuclear antibodies negative Urine Blood 2+ Protein 2+ RBC 11–13/hbf RBC casts rare He is started on prednisone and cyclophosphamide. Which of the following is the most appropriate next step in management?

A 40-year-old man presents to the physician for a pre-employment medical check-up. He has no symptoms and his past medical history is insignificant. He is a non-smoker. His temperature is 36.9°C (98.4°F), the heart rate is 76/min, the blood pressure is 124/82 mm Hg, and the respiratory rate is 16/min. His general and systemic examination does not reveal any abnormality. Laboratory evaluation is completely normal; however, his chest radiogram shows a single irregularly shaped nodule in the upper lobe of his right lung. The nodule has circumscribed margins and appears to be surrounded by normally aerated lung parenchyma. The nodule is approx. 7 mm (0.28 in) in diameter. The pattern of calcification is nonspecific and there are no signs of atelectasis or pneumonitis. The physician compares the radiogram with another radiogram which was obtained 5 years back. However, there was no pulmonary nodule in the previous radiogram. No other radiograms are available for comparison. Which of the following is the next best step in the diagnostic evaluation of this patient?

A 70-year-old male is brought to the emergency department from a nursing home due to worsening mental status. His nurse reports that the patient has been very lethargic and sleeping more than usual for the past week. She found him confused and difficult to arouse this morning and decided to bring him to the ER. His past medical history is significant for small cell carcinoma of the lung for which he is receiving chemotherapy. He is also on lithium and bupropion for bipolar disorder. Other medications include metoprolol, valsartan, metformin, and insulin. On admission, blood pressure is 130/70 mm Hg, pulse rate is 100/min, respiratory rate is 17/min, and temperature is 36.5°C (97.7°F). He is drowsy and disoriented. Physical examination is normal. Finger-stick glucose level is 110 mg/dL. Other laboratory studies show: Na+ 120 mEq/L (136—145 mEq/L) K+ 3.5 mEq/L (3.5—5.0 mEq/L) Cl- 107 mEq/L (95—105 mEq/L) Creatinine 0.8 mg/dL (0.6—1.2 mg/dL) Serum osmolality 250 mOsm/kg (275—295 mOsm/kg) Urine Na+ 70 mEq/L Urine osmolality 340 mOsm/kg He is admitted to the hospital for further management. Which of the following is the most likely cause of this patient's condition?

A 32-year-old Caucasian woman presents with a three-month history of weight loss, anxiety, and tremors. She recalls frequent heart palpitations and new discomfort while being outside in the heat. Her labs include a TSH level of 0.1 mIU/L. Additionally, the patient’s serum is positive for antibodies that stimulate the TSH receptor. What process is unique to this patient’s diagnosis?

A 41-year-old woman comes to the physician because of a 1-year history of fatigue, irregular menstrual cycles, and recurrent sinus infections. Examination shows hirsutism and hypopigmented linear striations on the abdomen. Serum studies show hypernatremia, hypokalemia, and metabolic alkalosis. A 24-hour urinary cortisol level is elevated. Serum ACTH is also elevated. High-dose dexamethasone does not suppress serum cortisol levels. Which of the following is the most likely underlying cause of this patient's condition?

A 35-year-old Caucasian female with a history of rheumatoid arthritis presents to your clinic with pleuritic chest pain that improves while leaning forward. Which of the following additional findings would you expect to observe in this patient?

A 32-year-old man comes to the physician because of a 3-month history of progressively worsening shortness of breath on exertion. He is concerned that he has asthma and would like to be started on albuterol. Which of the following findings is most likely to indicate a different diagnosis in this patient?