Cardiology 12

A 14-year-old boy has newly-diagnosed hypertension. The presence of which of the following signs is most suggestive of coarctation of the aorta?

An 83-year-old woman has an acute anterior wall myocardial infarction complicated by pulmonary edema. Blood pressure 126/90 mm Hg, pulse 110/min, and respirations 38/min. Which of the following medications should not be administered to the patient?

An 82-year-old woman who does not drink alcohol has a 1 hour history of severe abdominal and back pain without nausea or vomiting. Blood pressure 74/50 mm Hg, pulse 114/min, respirations 22/min, and axillary temperature 98.6 degrees F. Examination shows mild abdominal distention and tenderness, but no mass. Hemoglobin is 10.2 g/dL and white blood count 6700/microL. Which of the following is the most likely diagnosis?

A 55-year-old woman has scleroderma complicated by pulmonary hypertension. Examination shows a 2/6 holosystolic murmur in the 4th intercostal space. The murmur increases with inspiration. The murmur is related to which of the following?

The presence of which of the following differentiates diastolic left heart failure from right heart failure?

A 15-year-old boy faints while playing basketball. In the emergency department he is alert and non-cyanotic. Blood pressure 140/90 mm Hg, pulse 72/min/regular and respiratory rate 16/min. Examination shows apical lift, 2/6 ejection murmur at the apex and bisferiens carotid pulse. Which of the following is the preferred initial therapy?

A 14-year-old girl has anterior chest pressure when running. The discomfort spontaneously ends with 3 minutes of rest. Vital signs are normal. Examination shows an non-cyanotic patient with normal jugular venous pressure and carotid upstroke. An apical lift is felt. A 2/6 ejection murmur is heard just medial to the apex and an apical S4 gallop is heard. Which of the following is the most likely diagnosis?

An 88-year-old man has exertional dyspnea. Blood pressure 90/70 mm Hg, pulse 86/min, respirations 18/min. Carotid upstroke is slow. A 3/6 ejection murmur is heard loudest in the 2nd intercostal space along the right sternal border. An apical S4 gallop is heard. Which of the following is the most likely etiology of the cardiac disorder?

An 82-year-old woman has chronic weakness. Blood pressure is 90/70 mm Hg, pulse 94/min/irregularly irregular, and respirations 24/min. Lungs are clear to auscultation. The apical impulse is in the 6th intercostal space in the anterior axillary line. A 2/6 apical holosystolic murmur and apical S3 gallop are heard. Which of the following should not be administered?

One week after trauma to her left lower leg, a healthy 44-year-old woman has deep vein thrombosis in the affected area. Which of the following is the most appropriate management?

An infant is born with an atrioventricular septal defect. The infant most likely has which of the following conditions?

A 66-year-old woman has the sudden onset of palpitations. Electrocardiography shows atrial fibrillation. Presence of which of the following signs is most suggestive of hyperthyroidism as the cause of the arrhythmia?

A newborn infant has transposition of the great arteries. The mother most likely has which of the following conditions?

Marfan syndrome is diagnosed in an asymptomatic 18-year-old man. Which of the following is the most appropriate management?

A newborn pre-term infant has tachypnea. Examination shows a continuous murmur in the left supraclavicular area. Which of the following is the preferred initial therapy?

A 45-year-old male presents with recurrent substernal crushing chest pain that often wakes him from sleep. He exercises regularly and does not experience this pain. An ECG done while he was symptomatic shows ST elevations in leads V1-V6. No Q waves are present. His pain is relieved with sublingual nitroglycerine. Coronary catheterization shows no significant stenosis in any of the vessels. Which of the following is the most likely diagnosis?

A 56-year-old male with a history of tuberculosis presents with a complaint of new onset peripheral edema over the past week. On examination there is a positive Kussmaul’s sign, and on auscultation of the heart there is an early, high pitched third heart sound. . There is hepatomegaly and bilateral pitting edema. Which of the following is the most likely diagnosis?

A 45-year-old male presents for a routine physical. He has a history of smoking 1 pack of cigarettes per day for 25 years. He does not have any symptoms but has questions regarding abdominal aneurysms, as his brother died of a ruptured aortic aneurysm at age 57. The patient’s aorta is palpable and is 2 cm in diameter. Which of the following steps should be taken next in this patient?

A 68-year-old male presents with sudden onset of pain and paresthesias in his left leg that occurred while he was playing cards. On examination the limb is cool, pale, and the posterior popliteal, tibialis posterior, and dorsalispedis pulses are not palpable or detectable via doppler. Which of the following physical exam findings signifies the onset of irreversible ischemia?

A 72-year-old male with a history of coronary artery disease presents with a history of substernal chest heaviness which came on while he was watching television. The pain was not relieved with three sprays of sublingual nitroglycerine. His ECG shows Q waves and ST elevations in V1, V2, V3, V4, V5 and V6. Which of the following is the most likely location of his infarction?

A 68-year-old female presents to the clinic for a routine physical examination. She is new to the practice, but denies any chronic medical problems. Her only medications are a daily vitamin and aspirin. Her blood pressure is 160/98. An ECG shows a second degree type I AV block. Her examination is otherwise normal. Which of the following medications is contraindicated in this patient?

A 48-year-old male presents to the ED with 2 hours of crushing substernal chest pain that radiates to his jaw. A 12 lead ECG shows ST segment elevation in leads V1, V2, V3 and V4. Which of the following is the location of the ischemia?

A 67-year-old male presents to the emergency department with a history of vague abdominal pain radiating to his back. On examination of his abdomen there is a 4 cm pulsatile tender mass just inferior to the umbilicus. Which of the following imaging studies should be performed initially to confirm the diagnosis?

An 89-year-old male is brought to the emergency department from his nursing home following a syncopal episode. He normally takes digoxin and warfarin for chronic atrial fibrillation. On examination he is pale appearing and is confused. He has a pulse rate of 168, a blood pressure of 92/64, and marked distention of the internal jugular vein. His ECG shows no P waves, and regular, wide QRS complexes which all have the same morphology. Which of the following is the most likely diagnosis of this patient?

A 36-year-old diabetic female presents with a complaint of dyspnea for one hour. An ECG is performed and there are ST segment elevations in leads II, III, and AVF. Which of the following arteries is most likely occluded?

A 68-year-old male presents with a feeling of palpitations and slight light headedness that came on when he was playing with his grandchildren. The symptoms have been present for approximately 1 hour. He has no chest pain, or shortness of breath. He has a history of hypertension and takes lisinopril. He has no other significant medical problems. On examination his carotid pulse is thread and 168 beats per minute. His blood pressure is 110/84. He is conscious and responding to questions appropriately. An ECG shows a regular, wide complex tachycardia. Which of the following interventions would be the most appropriate next intervention for this patient?

A 58-year-old male with a history of diabetes mellitus, hypertension and hyperlipidemia presents for a preoperative physical examination prior to undergoing a prostatectomy. He has no history of renal insufficiency and has no known coronary artery disease. His current medications are metformin, rosuvastatin, lisinopril, and aspirin. His examination is normal and he has a normal ECG. Which of the following interventions should be done prior to his surgery?

A 57-year-old female is admitted to the hospital for acute renal failure. On the second day of her hospitalization she complains of dyspnea and cough. On auscultation a pericardial friction rub is heard. A chest x-ray shows mild cardiomegaly. ECG shows low voltage QRS complexes. Which of the following is the most likely diagnosis?

A 78-year-old female is brought to the emergency room following a syncopal episode. On examination her blood pressure is 110/68 and her heart rate is 54. Her ECG shows that a PR interval of 0.16 seconds with frequent non-conducted QRS complexes. Which of the following is the most appropriate treatment for this patient?

A 36-year-old nurse presents for a pre-employment physical. She has no physical complaints or significant past medical history. An ECG is performed and shows an RSR pattern in leads V1 and V2 and wide S waves in lead I and V6. What is the most likely cause of this ECG finding?