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An 82-year-old woman has an acute ST segment elevation anterior wall myocardial infarction (STEMI). Vital signs are normal. Examination shows clear lungs to auscultation. An apical S4 gallop is heard. Cardiac monitoring shows sinus rhythm without ectopy. Which of the following medications should be administered?
An 18-year-old man has a 2 day history of fever, diffuse muscle aches, and mild anterior chest discomfort. Blood pressure 102/74 mm Hg, pulse 116/min with frequent premature beats, oral temperature 101 F., and respirations 23/min. Examination shows clear lung fields to auscultation. Heart size is indeterminate. A 1/6 apical holosystolic murmur is heard along with an apical S3 gallop. White blood count is 4900/microL. Which of the following is the most likely diagnosis?
A 57-year-old man with a history of hypertension has newly-diagnosed gout. Which of the following agents could make his gout worse?
An 81-year-old man has an acute inferior wall myocardial infarction. Blood pressure 140/90 mm Hg, pulse 66/min. Examination shows lungs clear to auscultation. An apical S4 gallop is heard. Electrocardiography shows normal sinus rhythm and PR interval 0.57 sec. Which of the following medications should not be administered?
A 55-year-old woman has a 3 month history of dry skin, forgetfulness, and constipation. Evaluation demonstrates hypothyroidism. Which of the following is the most likely cardiovascular abnormality to be present?
Which of the following medications is best avoided when treating a hypertensive patient who has insulin-dependent diabetes mellitus?
Which of the following classes of medications is most likely to cause angioneurotic edema?
A 12-year-old boy has anterior chest pressure radiating into his left arm while he is running. The discomfort spontaneously ends with 3 to 5 minutes of rest. Blood pressure 94/70 mm Hg, pulse 88/min/regular, and respirations 16/min. Jugular venous pressure is normal. Carotid artery pulsation is normal. Heart size is indeterminate with an apical S3 gallop. No murmur is heard. Which of the following is the most likely diagnosis?
A 14-year-old boy suddenly faints while playing basketball. Upon examination in the emergency department, the patient is awake and oriented. Vital signs are normal. Carotid upstroke is normal. Lungs are clear to auscultation. There is an apical lift, but no murmur or gallop is heard. Which of the following maneuvers should be used to increase suspicion of hypertrophic obstructive cardiomyopathy?
A healthy 24-year-old woman suddenly has severe anterior chest pain that is eased while sitting and bending forward, but increased during recumbency or deep inspiration. A pericardial friction rub is heard. The clinical diagnosis is viral pericarditis. Which of the following is the preferred initial therapy?
A 27-year-old male with a history of Marfan syndrome presents with a history of exertional dyspnea, angina and a pounding sensation in his neck over the past several weeks that seems to be getting worse. On examination, he has the characteristic Marfan appearance, and his apical impulse is hyperdynamic, and displaced downward and laterally. On auscultation of the heart there is a high pitched decrescendo diastolic murmur heard best at the second and third left intercostals spaces. His carotid pulse is rapidly rising and rapid collapsing, and there are visible pulsations in his nail beds. Which of the following is the most likely diagnosis?
An 88-year-old female presents with a complaint of intermittent episodes of palpitations, weakness, confusion and presyncope. On examination she has a BP of 150/74, a pulse rate of 64 that is regular. Her cardiac examination is normal. An event monitor is ordered, and there are alternating symptomatic recordings showing tachycardic and bradycardic rhythms. Which of the following is the most appropriate first line treatment for this patient?
A 17-year-old male presents for his college physical. It is noted that he has a blood pressure of 158/86 in his right arm, 156/82 in his left arm, and 120/82 in his right leg. The femoral pulse is weak and delayed when compared to the radial pulse. Which of the following findings would likely be seen on his chest x-ray?
A 46-year-old female presents to her primary care clinician due to decreased exercise tolerance. She was previously healthy. On examination there is a loud systolic ejection murmur at the 3rd and 4th interspaces and a widely fixed splitting of the S2 heart sound. Which of the following is the most likely diagnosis?
You are evaluating a 4-year-old male for the first time and his previous records are not available. His foster mother reports that when he gets upset and cries, it appears that he is having trouble breathing and he will squat down with his knees drawn up to his chest. She reports that his hands, feet and lips appear bluish when this occurs. On auscultation you hear a systolic ejection murmur at the upper left sternal border and note mild clubbing of the fingers. Which of the following is the most likely diagnosis of this patient?
A 35-year-old female is diagnosed with a heart murmur on a routine physical examination. She is asymptomatic. Echocardiogram reveals a small ventricular septal defect with a left to right shunt. Which of the following is the most appropriate treatment for this patient?
A 39-year-old male has a history of difficult to control hypertension despite treatment with hydrochlorothiazide and lisinopril. On examination he has a blood pressure of 142/106 in his right arm. He complains of weakness, frequent headaches, polydipsia and polyuria. Laboratory results reveal hypokalemia and low plasma renin. Which of the following conditions is most likely responsible for his hypertension?
A 24-year-old male is found to be hypertensive with a blood pressure of 162/94. Repeat readings are consistent with this. He denies any past medical problems. He does not take any medications, does not smoke, drink alcohol or take illicit drugs. On examination you note bilateral renal artery bruits. Which of the following conditions is most likely the cause of his hypertension?
A 52-year-old female is brought to the emergency department with severe headache, irritability and altered mental status. Her blood pressure is 228/134. Which of the following physical exam findings must be present for this to be considered malignant hypertension?
A 56-year-old female presents with jaw pain for 30 minutes. The pain started when she was shoveling snow. An ECG is performed and shows ST elevation in leads I, AVL, V5 and V6. Based on this information where is the most likely area of ischemia in this patient?
A 66-year-old white male presents with dizziness, chest pressure, shortness of breath, and heart palpitations for several weeks. EKG is shown here. Cholesterol is borderline elevated at 210. Troponin levels are normal at 0.2 ng/mL. D-dimer level is normal at 0.37.
Which of the following abnormal heart rhythms is evident in the patient’s electrocardiogram?
A 47-year-old male presents with chest pain on exertion that is relieved by rest. The patient describes his chest pain as chest pressure with the occasional “squeezing.” No chest X-ray abnormalities, CT scan abnormalities, or blood work abnormalities are found. Which is the appropriate diagnosis?
In addition to diuretics, which of the following medications would you add to a treatment regimen when congestive heart failure presents with additional symptoms of chest pain and hypertension?
A healthy 40-year-old male presents for routine, annual check-up. The patient does not complain of any symptoms. Electrocardiogram is normal. Blood pressure is normal. Auscultation of the heart reveals a “swishing” sound. You order an echocardiogram to evaluate the “swishing” sound. Which of the following abnormalities would you expect to find on the echocardiogram?
Quinidine and procainamide are maintenance medications for abnormal heart rhythms such as supraventricular tachycardia and symptomatic premature ventricular contractions. These medications belong to the class of drugs known as:
The condition of resting chest pain, also known as Prinzmetal’s angina, is most effectively treated with which of the following medications?
A 58-year-old female presents with exertional dyspnea, non-productive cough, and fatigue. Auscultation of the chest reveals basilar rales and gallops. Patient’s chest X-ray reveals cardiomegaly, bilateral pleural effusions, and perivascular edema. Based on the patient’s presentation, physical exam, and test results, which of the following is the most accurate diagnosis?
Which of the following cardiac arrhythmias is most effectively treated with intravenous administration of a 6 mg dose of adenosine?
A 46-year-old patient experienced a myocardial infarction two weeks previously, and now presents with fever. Echocardiogram reveals pericarditis. Chest X-ray reveals pleural effusions. Based on the patient’s presentation, physical exam, and test results, which of the following is the most accurate diagnosis?
An 83-year-old woman has exertional dyspnea and angina pectoris caused by severe aortic valve stenosis. In addition to an ejection murmur in the aortic area, which of the following signs is most likely to be noted on examination?