Cardiovascular Practice Questions

Question 1

A 58-year-old man comes to the emergency department for complaints of crushing chest pain for 4 hours. He was shoveling snow outside when the pain started. It is rated 7/10 and radiates to his left arm. An electrocardiogram (ECG) demonstrates ST-segment elevation in leads V2-4. He subsequently undergoes percutaneous coronary intervention (PCI) and is discharged with aspirin, clopidogrel, carvedilol, atorvastatin, and lisinopril. Five days later, the patient is brought to the emergency department by his wife with complaints of dizziness. He reports lightheadedness and palpitations for the past 2 hours but otherwise feels fine. His temperature is 99.7°F (37.6°C), blood pressure is 95/55 mmHg, pulse is 105/min, and respirations are 17/min. A pulmonary artery catheter is performed and demonstrates an increase in oxygen concentration at the pulmonary artery. What finding would you expect in this patient?

Accepted Answer

Harsh, loud, holosystolic murmur at the lower left sternal border

Answer

Widespread ST-segment elevations

Answer

Pulseless electrical activity

Answer

Drop of systolic blood pressure by 20 mmHg during inspiration

Answer

Normal findings

Question 2

A 67-year-old man comes to the emergency department because of retrosternal chest pressure and shortness of breath for 4 hours. The symptoms started while he was walking to work and have only minimally improved with rest. He has a history of type 2 diabetes mellitus. He has smoked one pack of cigarettes daily for 35 years. He appears uncomfortable. His pulse is 95/min. Serum studies show a normal troponin concentration. An ECG shows no abnormalities. Which of the following is the most likely underlying cause of this patient's symptoms?

Accepted Answer

Disruption of an atherosclerotic plaque with a non-occlusive coronary artery thrombus

Answer

Atherosclerotic plaque thrombus with complete coronary artery occlusion

Answer

Stable atherosclerotic plaque with 85% coronary artery occlusion

Answer

Aortic valve thickening and calcification

Answer

Coronary artery occlusion due to transient increase in vascular tone

Question 3

A medical research study is evaluating an investigational novel drug (medication 1) as compared with standard therapy (medication 2) in patients presenting to the emergency department with myocardial infarction (MI). The study enrolled a total of 3,000 subjects, 1,500 in each study arm. Follow-up was conducted at 45 days post-MI. The following are the results of the trial:
Endpoints Medication 1 Medication 2 P-Value
Primary: death from cardiac causes 134 210 0.03
Secondary: hyperkalemia 57 70 0.4
What is the relative risk of death from a cardiac cause, expressed as a percentage? (Round to the nearest whole number.)

Accepted Answer

64%

Answer

42%

Answer

72%

Answer

36%

Answer

57%

Question 4

Cardiac muscle serves many necessary functions, leading to a specific structure that serves these functions. The structure highlighted is an important histology component of cardiac muscle. What would be the outcome if this structure diffusely failed to function?

Accepted Answer

Failure of propagation of the action potential from the conduction system

Answer

Failure of potassium channels to appropriately open to repolarize the cell

Answer

Ineffective excitation-contraction coupling due to insufficient calcium ions

Answer

Inappropriate formation of cardiac valve leaflets

Answer

Outflow tract obstruction

Question 5

A 55-year-old man comes to the physician because of a 4-month history of episodic, pressure-like chest pain. The chest pain occurs when he is walking up stairs and improves with rest. He has hypertension and type 2 diabetes mellitus. His father died from a myocardial infarction at the age of 50 years. Current medications include hydrochlorothiazide and metformin. His pulse is 85/min, respirations are 12/min, and blood pressure is 140/90 mm Hg. Cardiac examination shows normal heart sounds without any murmurs, rubs, or gallops. An ECG shows high amplitude of the S wave in lead V3. An exercise stress test is performed but stopped after 4 minutes because the patient experiences chest pain. An ECG obtained during the stress test shows sinus tachycardia and ST-segment depressions in leads V1–V4. Which of the following is the most appropriate long-term pharmacotherapy to reduce the frequency of symptoms in this patient?

Accepted Answer

Metoprolol

Answer

Clopidogrel

Answer

Aspirin

Answer

Nitroglycerin

Answer

Isosorbide mononitrate

Question 6

A 55-year-old woman comes to the physician because of involuntary hand movements that improve with alcohol consumption. Physical examination shows bilateral hand tremors that worsen when the patient is asked to extend her arms out in front of her. The physician prescribes a medication that is associated with an increased risk of bronchospasms. This drug has which of the following immediate effects on the cardiovascular system?

Stroke volume | Heart rate | Peripheral vascular resistance

Accepted Answer

↓ ↓ ↑

Answer

↓ ↓ ↓

Answer

↓ ↑ ↑

Answer

↑ ↑ ↑

Answer

↑ ↑ ↓

Question 7

A 44-year-old man presents for a checkup. The patient says he has to urinate quite frequently but denies any dysuria or pain on urination. Past medical history is significant for diabetes mellitus type 2 and hypertension, both managed medically, as well as a chronic mild cough for the past several years. Current medications are metformin, aspirin, rosuvastatin, captopril, and furosemide. His vital signs are an irregular pulse of 74/min, a respiratory rate of 14/min, a blood pressure of 130/80 mm Hg, and a temperature of 36.7°C (98.0°F). His BMI is 32 kg/m2. On physical examination, there are visible jugular pulsations present in the neck bilaterally. Laboratory findings are significant for the following:
Glycated Hemoglobin (Hb A1c) 7.5%
 Fasting Blood Glucose 120 mg/dL
Serum Electrolytes
Sodium 138 mEq/L
Potassium 3.9 mEq/L
Chloride 101 mEq/L
Serum Creatinine 1.3 mg/dL
Blood Urea Nitrogen 18 mg/dL
Which of the following is the next best step in the management of this patient?

Accepted Answer

Start exenatide.

Answer

Replace captopril with valsartan.

Answer

Stop furosemide.

Answer

Stop metformin.

Answer

Start rosiglitazone.

Question 8

A 67-year-old man presents to the emergency department with a 1-hour history of nausea and upper abdominal and substernal chest pain radiating to his lower jaw. He vomited several times before arriving at the hospital. His last visit to the primary care physician was 6 months ago during which he complained of fatigue, ‘slowing down’ on his morning walks, and abdominal pain that exacerbated by eating spicy food. His current medications include atorvastatin, metformin, insulin, omeprazole, aspirin, enalapril, nitroglycerin, and metoprolol. Today, his blood pressure is 95/72 mm Hg in his right arm and 94/73 in his left arm, heart rate is 110/min, temperature is 37.6°C (99.6°F), and respiratory rate is 30/min. On physical examination, he is diaphoretic and his skin is cool and clammy. His cardiac enzymes were elevated. He is treated appropriately and is admitted to the hospital. On day 5 of his hospital stay, he suddenly develops breathlessness. His blood pressure drops to 80/42 mm Hg. On examination, bibasilar crackles are heard. Cardiac auscultatory reveals a high pitched holosystolic murmur over the apex. Which of the following most likely lead to the deterioration of this patient’s condition?

Accepted Answer

Papillary muscle rupture leading to reflux of blood into left atrium

Answer

Scarring of mitral valve as a complication of childhood illness

Answer

Ballooning of mitral valve into the left atrium

Answer

Age-related fibrosis and calcification of the aortic valve

Answer

Aortic root dilation

Question 9

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?

Accepted Answer

Prolapse of a mitral valve leaflet of ≥2 mm above the level of the annulus in systole

Answer

Left atrial mass arising from the region of the septal fossa ovalis

Answer

Doming of the mitral valve leaflets in diastole

Answer

Retrograde blood flow into the right atrium

Answer

High pressure gradient across the aortic valve

Question 10

A 56-year-old Caucasian male presents to the clinic to establish care. He has never seen a physician and denies any known medical problems. Physical examination is notable for central obesity, but the patient has regular heart and lung sounds. He has a blood pressure of 157/95 mm Hg and heart rate of 92/min. He follows up 2 weeks later, and his blood pressure continues to be elevated. At this time, you diagnose him with essential hypertension and decide to initiate antihypertensive therapy. Per the Joint National Committee 8 guidelines for treatment of high blood pressure, of the following combinations of drugs, which can be considered for first-line treatment of high blood pressure in the Caucasian population?

Accepted Answer

ACE inhibitor, ARB, CCB, or thiazide

Answer

ACE inhibitor, angiotensin receptor blocker (ARB), beta-blocker (BB), or thiazide

Answer

ACE inhibitor, ARB, CCB, or loop diuretic

Answer

ACE inhibitor, ARB, alpha-blocker, or loop diuretic

Answer

ACE inhibitor, ARB, alpha-blocker, or direct vasodilator

Cardiovascular

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Cardiac output determinants

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