Cardiology 13

An elevated serum level of which of the following is a predictor of future cardiovascular events?

A 32-year-old woman has cold, pale, numb fingers in both hands when she holds a frozen package taken out of the freezer. After quickly placing the package down, rewarming the hands for 15 minutes causes the hands and fingers to be flushed. Which of the following is the most likely diagnosis?

Marfan syndrome is diagnosed in a 17-year-old woman. Which of the following is the most likely complication of the syndrome?

A 26-year-old man is experiencing a prolonged episode of “palpitations”. In the triage area he get weak after complaining of dizziness, shortness of breath, and chest pain. His vital signs are BP: 138/84 mmHg; pulse: 200 bpm, regular; respirations: 20 breaths/min. Cardiac monitor reveals a regular, narrow QRS complex and a heart rate of 200 beats/min. Which of the following is the most appropriate initial intervention?

Which of the following medications is the treatment of choice for hypotension caused by the administration of Verapamil?

The common causes of pulseless electrical activity (PEA) include all of the following except:

Which of the following is the most common cause of sudden cardiac death in young athletes?

Which of the following valvular problems typically presents with a syncopal attack, angina pectoris, and manifestations of left heart failure?

Which of the following is the basic mechanism of action of nitroglycerin in the treatment of angina pectoris?

A 66-year-old male suffered a myocardial infarction six weeks ago and underwent angiography with stent placement. He now presents to the ED with chest pain, which he has not had since the MI. He describes the pain as a “pressure” sensation in the retrosternal area. The pain has been continuous for the past 24 hours and seems to ease up when he sits up and leans forward. He can’t sleep due to the pain and it hurts when he coughs. An initial EKG is obtained demonstration diffuse ST changes in all leads. What is the most likely diagnosis for this patient’s symptoms?

A 44-year-old male presents via paramedic EMS with a 40-minute history of chest pain unrelieved by nitroglycerin. Onset occurred after several episodes of emesis and he has developed cervical subcutaneous emphysema . His vital signs are significant for a blood pressure of 92/46 mmHg (right arm supine); heart rate of 104 beats/minute (regular) and a respiratory rate of 24 breaths/minute. Which of the following is the most likely diagnosis for his symptoms?

A 90-year-old male presents to the emergency department with anxiety, confusion, and altered mental status. He denies chest pain and dyspnea. Vital signs are BP = 92/50 mmHg, right arm (seated); pulse = 124 beats/min (regularly irregular); resp. = 32 breaths/min (non-labored); temp = 97.8 degrees F (oral). Physical examination reveals postural hypotension, delayed capillary refill, cool/clammy skin, and collapsed neck veins. Cardiac exam reveals normal intensity of S1 and S2 with an irregular rhythm. Lungs are clear bilaterally. What is your most likely preliminary diagnosis?

A 67-year-old man who has known chronic bronchitis and atherosclerotic heart disease has a 1 week history of increasing exertional dyspnea. Which of the following is the preferred diagnostic test to differentiate pulmonary dyspnea from cardiac dyspnea?

A 67-year old man is brought to the emergency room via EMS secondary to a syncopal episode at work. Physical exam reveals a diminished intensity of S2 and a prominent S4. There is a Grade III/VI crescendo-decrescendo systolic murmur best heard at the second intercostal space in the right upper sternal border; it is harsh at the base and radiates to both carotid arteries. Which of the following valvular problems is the most likely cause of his symptoms/findings?

A 60-year-old male suffered a myocardial infarction 6 weeks ago. He now presents to the ED with dyspnea, a low grade fever, and chest pain. He describes the pain as a “sharp” retrosternal discomfort that has been continuous for the past 24 hours and seems to ease up when he sits up and leans forward. He can’t sleep due to the pain and states it hurts when he coughs or takes a deep breath. What is the most likely etiology of his pain?

A 59-year-old male was brought to the emergency department after a motor vehicle. His passenger reports that he suddenly complained of light headedness and then passed out behind the wheel of the car. His ECG shows complete dissociation between the p waves and QRS complexes. Which of the following is the most likely diagnosis?

An unresponsive patient is brought to the emergency room. An initial twelve lead ecg shows the presence of Osborne waves, but the rhythm quickly deteriorates to ventricular fibrillation. She is converted to normal sinus rhythm but remains pulseless. Along with high quality CPR and medication administration, which of the following measures should be taken to correct the underlying cause of the pulseless electrical activity?

A 64-year-old female presents with decreased appetite and nausea. She also reports bilateral swelling in her legs. On examination she has a laterally displaced point of maximal impulse and an S3 gallop. Which of the following examination findings would also be likely to be found on this patient?

A 74-year-old male with a history of chronic obstructive pulmonary disease is complaining of several hours of palpations and a vague “funny feeling” in his chest. His blood pressure is 132/88 and his pulse rate is 150 beats per minute and regular. An ECG shows saw-tooth like p-waves, which are conducting QRS complexes on a 2:1 ratio. Which of the following is the most likely diagnosis of this patient?

A 47-year-old female presents with a complaint of palpitations. She describes them as a forceful pounding beat. She also reports mild dyspnea on exertion. On examination she appears well and has a regular pulse of 82 beats per minute. On auscultation of her heart there is a diastolic murmur that has a blowing quality heard in the 2nd intercostal space at the parasternal region. Which of the following is the most likely diagnosis?

A 25-year-old male presents for a medical screening prior to running in a marathon. He reports that he is usually quite healthy, but recently he has been experiencing dyspnea on exertion and chest pain that is occurring both at rest and during exertion. His family history is significant for having a 22 year old brother with sudden death during a college basketball game. The patient reports that he never got himself checked out. On examination there is a harsh systolic murmur which is heard at the left lower sternal border. It is enhanced by the valsalva maneuver. Which of the following is the most likely diagnosis?

A 48-year-old female with a history of Lyme disease presents with a history of feeling lightheaded. An ECG is performed and shows progressively lengthening PR intervals with eventual dropped QRS complexes. Which of the following is the most likely diagnosis?

A 67-year-old male smoker is found to have a 3.5 cm abdominal aortic aneurysm as an incidental finding on an abdominal CT scan. He is asymptomatic. On examination his blood pressure is 130/88. The abdominal aorta is palpable, but there are no abdominal bruits and the peripheral pulses in the lower extremities are strong bilaterally. Which of the following is the most appropriate management at this time?

A 54-year-old African American male presents with a complaint of increasing dyspnea on exertion and three pillow orthopnea that has progressively getting worse for several weeks. On examination he is tachycardic, has a BP of 120/90. There is jugular venous distension, and a murmur of mitral regurgitation. An echocardiogram shows a dilated left ventricle and an ejection fraction of 35%. Which of the following is the most underlying cause of his condition?

A 48-year-old female with a known history of amyloidosis presents with a history of several months of mild exercise intolerance. Over the past few weeks she has developed lower extremity edema, mild abdominal discomfort, and occasional rapid palpitations. On examination she has an S4 gallop, 3+ pitting edema, and mild ascites. An echocardiogram reveals moderately enlarged atria, and an ejection fraction of 30%. Which of the following is the most likely diagnosis?

An unresponsive 67-year-old man is brought to the emergency room. He is hooked up to the monitor and the ventricular fibrillation is shown. He is defibrillated and immediately converts to normal sinus rhythm, but continues to have no pulse. Chest compressions are immediate started. IV access is established. Which of the following is the most appropriate next action in the management of this patient?

An unresponsive patient is transferred to the emergency room in ventricular tachycardia. Paramedics have administered one shock, followed by 2 minutes of CPR and a dose of epinephrine, and another 2 minutes of CPR followed by a second attempt at defibrillation. He remains in ventricular tachycardia. Following another 2 minute round of high quality CPR, which of the following medications should be administrated to this patient?

A 54-year-old female is brought to the emergency room with a complaint of chest pain. Immediately after she reaches triage she collapses and has no pulse. CPR is started and she is placed on a monitor and her rhythm is ventricular fibrillation. She is defibrillated and returns to normal sinus rhythm with a pulse and spontaneous breathing. Her blood pressure is 82/48 and vasopressors are started and she is given a bolus of IV saline. A 12 lead ECG shows no evidence of ischemia or infarct. She remains unresponsive. Which of the following actions would be most appropriate for this patient?

Which of the following is seen in hypertensive retinopathy but not in diabetic retinopathy?

The main effect of a β2-receptor is: