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Free notes, MCQs, tables & flowcharts for USMLE Step 1 Physiology
A 62-year-old man is brought to the emergency department because of syncope. He reports sudden onset of palpitations followed by loss of consciousness while carrying his groceries to his car. He is unable to recall any further details and does not have any chest pain or dizziness. He has a history of hypertension, type 2 diabetes mellitus, gastroparesis, and osteoarthritis of the knees. Medications include lisinopril, metformin, and ondansetron as needed for nausea. He also takes methadone daily for chronic pain. Apart from an abrasion on his forehead, he appears well. His temperature is 37.2 °C (98.9 F), heart rate is 104/min and regular, and blood pressure is 135/70 mm Hg. While he is in the emergency department, he loses consciousness again. Telemetry shows polymorphic ventricular tachycardia with cyclic alteration of the QRS axis that spontaneously resolves after 30 seconds. Results of a complete blood count, serum electrolyte concentrations, and serum thyroid studies show no abnormalities. Cardiac enzymes are within normal limits. Which of the following is the most likely underlying cause of this patient's syncope?
APrinzmetal angina
BFast accessory conduction pathway
CBrugada syndrome
DProlonged QT interval
EHypomagnesemia
A 72-year-old man with congestive heart failure is brought to the emergency department because of chest pain, shortness of breath, dizziness, and palpitations for 30 minutes. An ECG shows a wide complex tachycardia with a P-wave rate of 105/min, an R-wave rate of 130/min, and no apparent relation between the two. Intravenous pharmacotherapy is initiated with a drug that prolongs the QRS and QT intervals. The patient was most likely treated with which of the following drugs?
ACarvedilol
BVerapamil
CFlecainide
DQuinidine
ESotalol
A 45-year-old man comes to the physician for a routine health maintenance examination. He feels well. He underwent appendectomy at the age of 25 years. He has a history of hypercholesterolemia that is well controlled with atorvastatin. He is an avid marathon runner and runs 8 miles per day four times a week. His father died of myocardial infarction at the age of 42 years. The patient does not smoke or drink alcohol. His vital signs are within normal limits. Cardiopulmonary examination shows no abnormalities. His abdomen is soft and nontender with a surgical scar in the right lower quadrant. Laboratory studies are within normal limits. An ECG is shown. Which of the following is the most likely diagnosis?
AMobitz type II AV block
BFirst-degree AV block
CMobitz type I AV block
DThird-degree AV block
EAtrial fibrillation
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