Prior to undergoing a total knee arthroplasty, a 62-year-old man with coronary artery disease undergoes diagnostic cardiac catheterization. The catheter is inserted via the femoral artery and then advanced to the ascending aorta. Pressure tracing of the catheter is shown. The peak marked by the arrow is most likely caused by which of the following?
ALeft atrial contraction
BClosure of the aortic valve
COpening of the pulmonic valve
DRight atrial relaxation
ERight ventricular contraction
A 32-year-old woman comes to the office for a regular follow-up. She was diagnosed with type 2 diabetes mellitus 4 years ago. Her last blood test showed a fasting blood glucose level of 6.6 mmol/L (118.9 mg/dL) and HbA1c of 5.1%. No other significant past medical history. Current medications are metformin and a daily multivitamin. No significant family history. The physician wants to take her blood pressure measurements, but the patient states that she measures it every day in the morning and in the evening and even shows him a blood pressure diary with all the measurements being within normal limits. Which of the following statements is correct?
AThe physician has to measure the patient’s blood pressure because it is a standard of care for any person with diabetes mellitus who presents for a check-up.
BAssessment of blood pressure only needs to be done at the initial visit; it is not necessary to measure blood pressure in this patient at any follow-up appointments.
CThe physician should not measure the blood pressure in this patient and should simply make a note in a record showing the results from the patient’s diary.
DThe physician should not measure the blood pressure in this patient because she does not have hypertension or risk factors for hypertension.
EThe physician should not measure the blood pressure in this patient because the local standards of care in the physician's office differ from the national standards of care so measurements of this patient's blood pressure cannot be compared to diabetes care guidelines.
A 27-year-old male arrives in the emergency department with a stab wound over the precordial chest wall. The patient is in distress and is cold, sweaty, and pale. Initial physical examination is significant for muffled heart sounds, distended neck veins, and a 3 cm stab wound near the left sternal border. Breath sounds are present bilaterally without evidence of tracheal deviation. Which of the following additional findings would be expected on further evaluation?
ADecrease in central venous pressure by 5 mmHg with inspiration
B15 mmHg decrease in systolic blood pressure with inspiration
CDecrease in the patient's heart rate by 15 beats per minute with inspiration
DSteadily decreasing heart rate to 60 beats per minute
EElevated blood pressure to 170/110
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