Cardiology — MCQs

A previously healthy 21-year-old man is brought to the emergency department 4 hours after the sudden onset of shortness of breath and pleuritic chest pain. He has smoked 1 pack of cigarettes daily for the past 3 years. He is 188 cm (6.2 ft) tall and weighs 70 kg (154 lb); BMI is 19.8 kg/m2. Physical examination shows decreased tactile fremitus and diminished breath sounds over the left lung. Which of the following is the most likely cause of this patient's symptoms?

A 32-year-old woman comes to the physician because of a 2-month history of fatigue, muscle weakness, paresthesias, headache, and palpitations. Her pulse is 75/min and blood pressure is 152/94 mm Hg. Physical examination shows no abnormalities. Serum studies show: Sodium 144 mEq/L Potassium 2.9 mEq/L Bicarbonate 31 mEq/L Creatinine 0.7 mg/dL Further evaluation shows low serum renin activity. Which of the following is the most likely diagnosis?

A 12-year-old boy presents to the emergency department with a swollen and painful knee. He says that he was exploring with his friends when he tripped and hit his knee against the ground. He didn't feel like he hit it very hard but it started swelling and becoming very painful. His mom reports that he has always been prone to bleeding from very minor trauma and that others in the family have had similar problems. Based on clinical suspicion a coagulation panel was obtained showing a prothrombin time (PT) of 10 seconds (normal range 9-11 seconds), a partial thromboplastin time (PTT) of 45 seconds (normal 20-35 seconds), and a normal ristocetin cofactor assay (equivalent to bleeding time). Mixing tests with factor IX and XI do not show complementation, but mixing with factor VIII reverses the coagulation abnormality. Which of the following is the most likely diagnosis for this patient?

A 54-year-old woman presents to the emergency ward with a chief complaint of chest pain. The pain is sharp and present in the anterior part of the chest. There is no radiation of the pain; however, the intensity is decreased while sitting and leaning forward. There is no associated shortness of breath. Vital signs are the following: blood pressure is 132/84 mm Hg; pulse rate is 82/min, rhythmic, and regular. Lungs are clear on auscultation and cardiovascular examination demonstrates scratchy and squeaking sounds at the left sternal border. Kussmaul sign is positive and ECG shows new widespread ST segment elevation and PR depression. The most likely cause for these findings in this patient is?

A previously healthy 33-year-old woman comes to the emergency department 1 hour after falling from a ladder. She is conscious. She does not smoke, drink alcohol, or use illicit drugs. There is no family history of serious illness. Her pulse is 72/min, respirations are 17/min, and blood pressure is 110/72 mm Hg. Physical examination shows ecchymosis and point tenderness over the right clavicle. An x-ray of the chest shows a nondisplaced fracture of the midshaft of the right clavicle and a 3.5-mm pulmonary nodule in the central portion of the left upper lung field. No previous x-rays of the patient are available. The fracture is treated with pain management and immobilization with a sling. A CT scan of the chest shows that the pulmonary nodule is solid and has well-defined, smooth borders. Which of the following is the most appropriate next step in management of this patient's pulmonary nodule?

A 72-year-old man with longstanding history of diabetes mellitus and hypertension presents to the emergency department with sudden-onset numbness. On your neurological exam, you note that he has loss of sensation on the left side of his face, arm, and leg. His motor strength exam is normal, as are his cranial nerves. Which of the following is the most likely explanation for his presentation?

A 72-year-old man presents to the physician with blood in his sputum for 3 days. He also mentions that he has had a cough for the last 3 months but thought that it was because of the winter season. He also has often experienced fatigue recently. His temperature is 37.0°C (98.6°F), the respiratory rate is 15/min, the pulse is 67/min, and the blood pressure is 122/98 mm Hg. Auscultation of his chest reveals normal heart sounds but localized rhonchi over the right infrascapular region. A detailed diagnostic evaluation including a complete blood count and other serum biochemistry, chest radiogram, computed tomography of chest and abdomen, magnetic resonance imaging of the brain, bone scan, and pulmonary function tests are ordered, which confirm a diagnosis of limited-disease small cell lung cancer of 2.5 cm (1 in) in diameter, located in the lower lobe of the right lung, with the involvement of ipsilateral hilar lymph nodes and intrapulmonary lymph nodes. The mediastinal, subcarinal, scalene or supraclavicular lymph nodes are not involved, and there is no distant metastasis. There is no additional comorbidity and his performance status is good. The patient does not have any contraindication to any chemotherapeutic agents or radiotherapy. Which of the following is the best treatment option for this patient?

A 29-year-old woman comes to the physician for the evaluation of progressive loss of vision in her left eye and gradual blurring of vision in her right eye over the past 2 months. She also says that she has had occasional headaches and has noticed a decrease in her sense of smell lately. The patient's only medication is fexofenadine for seasonal allergies. She is 158 cm (5 ft 2 in) tall and weighs 61 kg (135 lbs); BMI is 24.7 kg/m2. Vital signs are within normal limits. Visual acuity is 20/40 in the right eye and there is minimal light perception in the left eye. In the swinging flashlight test, both of her eyes dilate as the light moves from the right to left eye. Fundoscopy shows papilledema in the right optic disc and a pale left optic disc. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?

A 55-year-old woman who is an established patient presents to your office. She is complaining of increased urination and increased thirst. She has recently began taking several over-the-counter vitamins and supplements. On further review, she reports she has also been having abdominal pain and constipation. She denies significant weight changes. Her fingerstick blood glucose in your office is 96 mg/dL. Which of the following test is most likely to provide the diagnosis?

A 15-year-old girl comes to the physician for a well-child examination. She feels well. Her father has coronary artery disease and hypertension. Her mother has type 2 diabetes mellitus, hypercholesterolemia, and had a myocardial infarction at the age of 52 years. She is at the 25th percentile for height and above the 95th percentile for weight. Her BMI is 32 kg/m2. Her temperature is 37°C (98.6°F), pulse is 99/min, and blood pressure is 140/88 mm Hg. Physical examination shows no abnormalities. Random serum studies show: Glucose 160 mg/dL Creatinine 0.8 mg/dL Total cholesterol 212 mg/dL HDL-cholesterol 32 mg/dL LDL-cholesterol 134 mg/dL Triglycerides 230 mg/dL In addition to regular aerobic physical activity, which of the following is the most appropriate next step in management?