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An 18-year-old man with known hypertrophic obstructive cardiomyopathy has exertional dyspnea. Which of the following is the pathophysiologic mechanism that causes the dyspnea?
A 78-year-old man has exertional anterior chest pressure radiating to his left arm with associated dyspnea. After sitting down and taking a sublingual nitroglycerin, the discomfort and dyspnea both end. Which of the following is the pathophysiologic mechanism causing the dyspnea?
Which of the following is considered a more powerful risk factor for coronary heart disease in a woman than a man?
A 34-year-old woman with Marfan syndrome has acute, tearing pain in the anterior chest. One hour later blood pressure 64/40 mm Hg, pulse 136/min, and respirations 36/min. Examination shows elevated jugular venous pressure and distant heart tones. Which of the following is the preferred diagnostic test?
Antibiotic prophylaxis against endocarditis is most appropriate for which of the following men?
A 64-year-old woman with chronic hypertension has acute, tearing pain in the anterior chest. One hour later blood pressure 64/40 mm Hg, pulse 136/min, and respirations 36/min. Examination shows elevated jugular venous pressure and distant heart tones. Which of the following abnormalities on echocardiography is most suggestive of pericardial tamponade?
A 78-year-old woman is admitted for treatment of unstable angina pectoris. Which of the following medications should not be administered?
A 57-year-old man has chronic systolic heart failure. Addition of spironolactone to his regimen of metoprolol, furosemide, and lisinopril is most likely to cause which of the following adverse effects?
A 52-year-old man has a 3 week history of weight gain, abdominal distention, and bilateral peripheral edema. Examination shows elevated jugular venous pressure, ascites, and bilateral ankle edema. No heart murmur is heard. Kussmaul sign is present. Which of the following is most likely to be noted in his past medical history?
The presence of which of the following differentiates pericardial tamponade from constrictive pericarditis?
A 58-year-old male complains of a dull ache and swelling in his lower extremities that is usually worse at the end of the day. He reports that it is relieved when he elevates his legs. Based on this history, which of the following findings is most likely to be found on physical examination?
An 88-year-old female presents with a rash on both of her legs. She reports a long standing history of lower extremity edema, but over the past several months she has noticed that there has been a color change in the skin and the skin has become very flaky and pruritic. She denies any new products or creams. On examination there is 2+ pitting edema, and dusky erythema. The skin is lichenfied, and has areas of crusting. Which of the following is the most likely diagnosis?
A 75-year-old nursing home resident complains of severe tearing chest pain, for approximately 30 minutes. He reports it came on very suddenly. The pain radiates to his back and he is also complaining of dyspnea. On examination his neck veins are distended and his voice is hoarse. A chest x-ray shows a widened mediastinum. Which of the following is the most likely diagnosis?
A 92-year-old male is brought in to the clinic by her daughter for evaluation of an ulcer on her foot. He states that he had not noticed it and that it was not painful. His past medical history is significant for diabetes which is poorly controlled. On examination there is a punched out ulcer at the lateral aspect of the metatarsal phalangeal joint of the great toe. The base is necrotic, and there is no granulation tissue. The surrounding skin is pale, hairless, cool to the touch and shiny. Which of the following is the most likely diagnosis?
A 50-year-old male presents with a complaint of chest pain that has started to occur when he is carrying heavy loads at his job as a construction worker. He has a history of poorly controlled hypertension. On examination there is a medium pitched crescendo-decrescendo midsystolic murmur heard at the right second intercostal space radiating to the left sternal border. Which of the following is the most likely diagnosis?
A 30-year-old female presents with a history of dyspnea on exertion and palpitations. Her past medical history is significant for frequent throat infections as a child. On auscultation of her heart an opening snap and a diastolic murmur with a rumbling quality is heard. Which of the following is the most likely diagnosis?
A 69-year-old male has been admitted for an acute myocardial infarction. On examination there is a new murmur that is consistent with mitral insufficiency. What is the most likely cause of this murmur?
A 23-year-old male presents with a complaint of pleuritic chest pain for two days it is worse when he is supine, and relieved by sitting up. His past medical history is significant for a recent viral upper respiratory infection. On examination you hear a normal pericardial friction rub. What findings would you expect to see on this patient’s ECG?
A 63-year-old female with a known history of aortic stenosis presents for a routine follow up appointment. She has no complaints at this time. On examination her carotid pulse has a diminished upstroke and a delayed peak. Which of the following is the correct terminology for this physical examination finding?
A 48-year-old female presents with a complaint of mild dyspnea on exertion over several months. On examination her carotid pulse has a double impulse, and on auscultation of her heart there is a systolic ejection murmur and a decrescendo diastolic murmur. Which of the following is the most likely diagnosis?
A 44-year-old man presents with shortness of breath on exertion and occasional heart palpitations. Auscultation of the chest reveals a soft systolic and diastolic decrescendo murmur with radiation to the right sternal border and arterial pulses that are large and bounding. Chest X-ray reveals left-sided atrial enlargement with ventricular hypertrophy. Based on the presentation and physical examination, which of the following is the proper diagnosis?
A 58-year-old male patient arrives in the emergency room with chest pain and an apparent arrhythmia. His examination reveals runs of ventricular tachycardia with symptomatic ventricular premature beats. He has not yet shown any signs of ventricular fibrillation and you want to prevent any such occurrence. Which of the following treatments would be most appropriate for the patient’s current condition?
A 45-year-old female with a history of rheumatic fever presents with the complaint of exercise intolerance. Physical examination reveals jugular venous distention, peripheral edema, and hepatomegaly. Auscultation of the chest reveals a pancystolic murmur along the left lower sternal border with radiation to the right sternum, and xiphoid and increased jugular venous pressures. Chest X-ray reveals prominent right heart border and dilatation of the superior vena cava. Electrocardiogram reveals right axis deviation. Based on the presentation and physical examination, which of the following is the proper diagnosis?
A 50-year-old male presents with occasional chest pain, fatigue, and intermittent dizzy spells. Auscultation of the chest reveals a murmur in the left intercostal space between the second and third ribs, with a midsystolic crescendo-decrescendo radiating to the left shoulder and neck. An early pulmonic ejection sound is also appreciated during chest auscultation. Based on the presentation and physical examination, which of the following is the proper diagnosis?
A 24-year-old male presents with heart palpitations, dizziness, and shortness of breath. The patient’s electrocardiogram is illustrated below. Which of the following is the proper treatment for the abnormal rhythm shown on the electrocardiogram?
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Altering one’s diet to include higher amounts of water, caffeine, and salt is the indicated treatment for which of the following disorders?
A 36-year-old male presents for routine examination. His blood pressure was noticed to be mildly elevated. He is very compliant with doctors’ advice. Which of the following treatment options would you suggest to manage newly diagnosed, mild hypertension?
A 46-year-old obese African-American male presents with sudden onset of chest tightness radiating to his back and left arm, along with nausea. Chest X-ray was normal, and electrocardiogram is shown here. Troponin level was 0.4. D-dimer level was 0.42. Pulse oximetry was normal at 100% at room air. Blood pressure was 150/70. Patient was administered nitroglycerin with no resolution of chest pain. EKG demonstrated normal sinus rhythm with non specific ST-T changes. Based on the patient’s presentation, which of the following diagnostic procedures would you perform?
A 56-year-old Caucasian male presents for a routine physical exam. This gentleman complains of pain in his legs after walking a short distance, indicating claudication. Which of the following medications would you prescribe for maintenance therapy of this disorder?
Congestive heart failure is most effectively treated by which of the following medications?