Valvular heart disease — MCQs

A 62-year-old man comes to the physician for decreased exercise tolerance. Over the past four months, he has noticed progressively worsening shortness of breath while walking his dog. He also becomes short of breath when lying in bed at night. His temperature is 36.4°C (97.5°F), pulse is 82/min, respirations are 19/min, and blood pressure is 155/53 mm Hg. Cardiac examination shows a high-pitch, decrescendo murmur that occurs immediately after S2 and is heard best along the left sternal border. There is an S3 gallop. Carotid pulses are strong. Which of the following is the most likely diagnosis?

A 47-year-old man presents for a routine physical examination as part of an insurance medical assessment. He has no complaints and has no family history of cardiac disease or sudden cardiac death. His blood pressure is 120/80 mm Hg, temperature is 36.7°C (98.1°F), and pulse is 75/min and is regular. On physical examination, he appears slim and his cardiac apex beat is of normal character and non-displaced. On auscultation, he has a midsystolic click followed by a late-systolic high-pitched murmur over the cardiac apex. On standing, the click and murmur occur earlier in systole, and the murmur is of increased intensity. While squatting, the click and murmur occur later in systole, and the murmur is softer in intensity. Echocardiography of this patient will most likely show which of the following findings?

A 32-year-old male presents for a new patient visit. He states that he is in good health but has had decreasing exercise tolerance and increased levels of shortness of breath over the past 5 years. He believed that it was due to aging; he has not seen a doctor in 10 years. On auscultation, you note an early diastolic decrescendo blowing murmur that radiates along the left sternal border. In the United States, what is the most likely cause of this patient's condition?

A 43-year-old man presents to his primary care physician for his yearly check-up exam. He has no new concerns but wants to make sure that his hypertension and diabetes are properly controlled. His past medical history is otherwise unremarkable and his only medications are metformin and lisinopril. He has smoked a pack of cigarettes per day since he was 16 years of age and drinks 3 beers per night. Physical exam is remarkable for a murmur best heard in the 5th intercostal space at the left mid-clavicular line. The murmur is high-pitched and blowing in character and can be heard throughout systole. Which of the following properties is characteristic of this patient's most likely disorder?

A 7-year-old boy is brought to the pediatrician by his parents for a routine checkup. The parents note that the patient recently joined a baseball team and has had trouble keeping up with his teammates and gets short of breath with exertion. The patient has otherwise been healthy and has no known history of asthma or allergic reaction. Today, the patient’s temperature is 98.2°F (36.8°C), blood pressure is 112/72 mmHg, pulse is 70/min, and respirations are 12/min. The physical exam is notable for a heart murmur that decreases when the patient bears down. Additionally, the hand grip and rapid squatting maneuvers increase the severity of the murmur. Which of the following is likely heard on auscultation?

A 55-year-old woman presents with fatigue, shortness of breath during ordinary activities, and occasional fluttering in her chest. She denies chest pain or lower extremity edema. She has no prior medical history. She does not smoke but drinks alcohol socially. Her blood pressure is 110/70 mm Hg, her temperature is 36.9°C (98.4°F), and her radial pulse is 95/min and regular. On physical examination, lungs are clear to auscultation, the apical impulse is slightly displaced, and a III/VI holosystolic murmur is audible at the apex and radiates to the axilla. Transthoracic echocardiography shows the presence of mitral regurgitation and an ejection fraction of 60 %. Which of the following is the optimal therapy for this patient?

A 26-year-old woman comes to the physician for a pre-employment examination. She has no complaints. She has a history of polycystic ovarian syndrome. She exercises daily and plays soccer recreationally on the weekends. Her mother was diagnosed with hypertension at a young age. She does not smoke and drinks 2 glasses of wine on the weekends. Her current medications include an oral contraceptive pill and a daily multivitamin. Her vital signs are within normal limits. Cardiac examination shows a grade 1/6 decrescendo diastolic murmur heard best at the left sternal border. Her lungs are clear to auscultation bilaterally. Peripheral pulses are normal and there is no lower extremity edema. An electrocardiogram shows sinus rhythm with a normal axis. Which of the following is the most appropriate next step in management?

A 36-year-old healthy man presents to his physician to discuss his concerns about developing heart disease. His father, grandfather, and older brother had heart problems, and he has become increasingly worried he might be at risk. He takes no medications and his past medical history is only significant for an appendectomy at 20 years ago. He is married happily with 2 young children and works as a hotel manager and exercises occasionally in the hotel gym. He drinks 3–5 alcoholic beverages per week but denies smoking and illicit drug use. Today his blood pressure is 146/96 mm Hg, pulse rate is 80/min, and respiratory rate is 16/min. He has a body mass index of 26.8 kg/m2. His physical examination is otherwise unremarkable. Laboratory tests show: Laboratory test Serum glucose (fasting) 88 mg/dL Serum electrolytes Sodium 142 mEq/L Potassium 3.9 mEq/L Chloride 101 mEq/L Serum creatinine 0.8 mg/dl Blood urea nitrogen 10 mg/dl Cholesterol, total 350 mg/dL HDL-cholesterol 40 mg/dL LDL-cholesterol 280 mg/dL Triglycerides 130 mg/dL Besides appropriate medications for his cholesterol and a follow-up for his hypertension, which of the following supplements is thought to provide a protective cardiovascular effect?

A 43-year-old woman presents to the emergency department complaining of palpitations, dry cough, and shortness of breath for 1 week. She immigrated to the United States from Korea at the age of 20. She says that her heart is racing and she has never felt these symptoms before. Her cough is dry and is associated with shortness of breath that occurs with minimal exertion. Her past medical history is otherwise unremarkable. She has no allergies and is not currently taking any medications. She is a nonsmoker and an occasional drinker. She denies illicit drug use. Her blood pressure is 100/65 mm Hg, pulse is 76/min, respiratory rate is 23/min, and temperature is 36.8°C (98.2°F). Her physical examination is significant for bibasilar lung crackles and a non-radiating, low-pitched, mid-diastolic rumbling murmur best heard at the apical region. In addition, she has jugular vein distention and bilateral pitting edema in her lower extremities. Which of the following best describes the infectious agent that led to this patient’s condition?

A patient with a history of Tetralogy of Fallot is being evaluated for long-term complications. This patient is at greatest risk of damage to which of the following cardiovascular structures?