Cardiovascular Practice Questions

Question 1

A 48-year-old male accountant presents to the family practice clinic for his first health check-up in years. He has no complaints, and as far as he is concerned, he is well. He does not have any known medical conditions. His blood pressure is 140/89 mm Hg and his heart rate is 89/min. Physical examination is otherwise unremarkable. What is the single best initial management for this patient?

Accepted Answer

Return to the clinic for a repeat blood pressure reading and counseling on the importance of aerobic exercise.

Answer

Treat the patient with beta-blockers.

Answer

Try angiotensin-converting enzyme inhibitor.

Answer

Start trial of calcium channel blockers.

Answer

The patient does not require any treatment.

Question 2

An 83-year-old male presents with dyspnea, orthopnea, and a chest radiograph demonstrating pulmonary edema. A diagnosis of congestive heart failure is considered. The following clinical measurements are obtained: 100 bpm heart rate, 0.2 mL O2/mL systemic blood arterial oxygen content, 0.1 mL O2/mL pulmonary arterial oxygen content, and 400 mL O2/min oxygen consumption. Using the above information, which of the following values represents this patient's cardiac stroke volume?

Accepted Answer

40 mL/beat

Answer

30 mL/beat

Answer

70 mL/beat

Answer

60 mL/beat

Answer

50 mL/beat

Question 3

A 71-year-old man develops worsening chest pressure while shoveling snow in the morning. He tells his wife that he has a squeezing pain that is radiating to his jaw and left arm. His wife calls for an ambulance. On the way, he received chewable aspirin and 3 doses of sublingual nitroglycerin with little relief of pain. He has borderline diabetes and essential hypertension. He has smoked 15–20 cigarettes daily for the past 37 years. His blood pressure is 172/91 mm Hg, the heart rate is 111/min and the temperature is 36.7°C (98.0°F). On physical examination in the emergency department, he looks pale, very anxious and diaphoretic. His ECG is shown in the image. Troponin levels are elevated. Which of the following is the best next step in the management of this patient condition?

Accepted Answer

Clopidogrel, atenolol, anticoagulation and monitoring

Answer

CT scan of the chest with contrast

Answer

Echocardiography

Answer

Fibrinolysis

Answer

Oral nifedipine

Question 4

A 70-year-old male presents for an annual exam. His past medical history is notable for shortness of breath when he sleeps, and upon exertion. Recently he has experienced dyspnea and lower extremity edema that seems to be worsening. Both of these symptoms have resolved since he was started on several medications and instructed to weigh himself daily. Which of the following is most likely a component of his medical management?

Accepted Answer

Carvedilol

Answer

Lidocaine

Answer

Verapamil

Answer

Aspirin

Answer

Ibutilide

Question 5

A 14-year-old boy who has been otherwise healthy presents to his doctor complaining of feeling easily winded and light-headed at basketball practice. He has never felt this way before and is frustrated because he is good enough to make varsity this year. He denies smoking, alcohol, or recreational drug use. His mother is very worried because her oldest son and brother had both died suddenly while playing sports despite being otherwise healthy. The transthoracic echocardiogram confirms the suspected diagnosis, which demonstrates a preserved ejection fraction and systolic anterior motion of the mitral valve. The patient is advised that he will need to stay hydrated and avoid intense exercise, and he will likely need an ICD due to his family history. Which of the following physical exam findings is consistent with this patient’s most likely diagnosis?

Accepted Answer

Systolic ejection murmur that worsens with the Valsalva maneuver

Answer

Tricuspid regurgitation

Answer

Systolic ejection murmur that radiates to the carotids

Answer

S3 heart sound

Answer

Mitral regurgitation

Question 6

A 71-year-old man presents to the emergency department for shortness of breath. The patient was returning from a business trip to China, when he suddenly felt short of breath during the taxi ride home from the airport. The patient has a past medical history of poorly controlled diabetes mellitus and a 50 pack-year smoking history. The patient is non-compliant with his medications and is currently only taking ibuprofen. An initial ECG demonstrates sinus tachycardia. A chest radiograph is within normal limits. Laboratory values are notable for a creatinine of 2.4 mg/dL and a BUN of 32 mg/dL as compared to his baseline creatinine of 0.9 mg/dL. His temperature is 98.8°F (37.1°C), pulse is 122/min, blood pressure is 145/90 mmHg, respirations are 19/min, and oxygen saturation is 93% on room air. On physical exam, you note an older gentleman in distress. Cardiac exam is notable only for tachycardia. Pulmonary exam is notable for expiratory wheezes. Which of the following is the best confirmatory test for this patient?

Accepted Answer

CT angiogram

Answer

Ventilation perfusion scan

Answer

Lower extremity ultrasound with Doppler

Answer

Arterial blood gas

Answer

D-dimer

Question 7

A 74-year-old man comes to the physician for a 6-month history of progressively worsening fatigue and shortness of breath on exertion. He immigrated to the United States 35 years ago from India. His pulse is 89/min and blood pressure is 145/60 mm Hg. Crackles are heard at the lung bases. Cardiac examination shows a grade 3/6 early diastolic murmur loudest at the third left intercostal space. Further evaluation of this patient is most likely to show which of the following?

Accepted Answer

Water hammer pulse

Answer

Paradoxical splitting of S2

Answer

Pulsus paradoxus

Answer

Pulsus parvus et tardus

Answer

Fixed splitting of S2

Question 8

A 51-year-old African American man presents to his primary care physician’s office for an annual visit. He has no major concerns and says that he has been healthy for the last year. His past medical history is significant for diabetes as well as long standing hypertension that has developed gradually since his 30's; however, he has refused to take any medications. Physical exam shows no abnormal findings. Routine laboratory testing reveals the following:

Serum creatinine concentration: 1.5 mg/dL
Blood urea nitrogen: 31 mg/dL

Based on these results, urine studies are conducted that reveal mild proteinuria of less than 1 g/day and no casts.

Which of the following is most likely associated with the cause of this patient's elevated creatinine?

Accepted Answer

Kimmelstiel-Wilson lesions

Answer

String of beads on angiography

Answer

Apple-green birefringent lesions

Answer

Renal cortex necrosis

Answer

Flea-bitten kidney

Question 9

A 58-year-old woman who underwent urgent coronary artery bypass grafting develops sudden-onset of difficulty breathing shortly after postoperative transfusion of 1 unit of packed red blood cells because of moderate blood loss. She has alcohol use disorder, and has smoked one pack of cigarettes daily for 22 years. Her temperature is 38.3ºC (100.8ºF), respirations are 35/min, and blood pressure is 88/57 mmHg. Pulse oximetry on room air shows an oxygen saturation of 72%. Physical examination shows profuse sweating and cyanosis. There is no jugular venous distension and no peripheral edema. A chest x-ray shows bilateral alveolar and interstitial infiltrates and a normal cardiac silhouette. Which of the following is the most likely underlying mechanism of this patient's transfusion reaction?

Accepted Answer

Activation of primed neutrophils

Answer

Type I hypersensitivity reaction

Answer

Excessive circulating blood volume

Answer

ABO incompatibility

Answer

Cytokine accumulation during blood storage

Question 10

A 47-year-old man presents as a new patient at an outpatient clinic. He has never seen a physician before, but was motivated by his 40-year-old brother's recent heart attack and seeks to optimize his health. In particular, he read that uncontrolled atherosclerosis can lead to a heart attack. Which molecule is downregulated in response to the advent of atherosclerosis?

Accepted Answer

Nitric oxide

Answer

Tumor necrosis factor

Answer

Serotonin

Answer

Interleukin 1

Answer

Thromboxane A2

Cardiovascular

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