Cardiology 2

A 70-year-old woman with severe rheumatoid arthritis has exertional anterior chest pressure. Which of the following is the most appropriate initial diagnostic cardiac test to document myocardial ischemia?

Lisinopril therapy is initiated in an 80-year-old woman in treatment of systolic heart failure. In addition to decreasing preload, which of the following is the primary action of the angiotensin converting enzyme inhibitor?

A 21-year-old intravenous drug abuser has tricuspid valve endocarditis. Which of the following is the most likely infecting organism?

A 71-year-old man has marked weakness due to chronic systolic heart failure. Blood pressure 94/70 mm Hg, pulse 92/min/regular. Electrocardiography demonstrates sinus rhythm. In addition to furosemide and captopril, which of the following is the preferred additional medicine to be taken by the patient?

A 71-year-old man takes dabigatran in therapy of non-valvular atrial fibrillation. Which of the following is the mechanism of action of this drug?

A 77-year-old man with known dyslipidemia has a 3 week history of recurrent episodes of dyspnea on exertion without associated wheezing or cough. The dyspnea ends after 4 to 5 minutes of rest. The patient has never smoked. Vital signs are normal. Examination of the lungs and heart is normal. Which of the following is the preferred initial diagnostic test?

A 26-year-old man has weakness caused by dilated cardiomyopathy. Blood pressure 90/70 mm Hg, pulse 102/min/regular, and respirations 16/min. Examination shows the lungs to be clear to auscultation. The apical impulse is in the 6th intercostal space in the anterior axillary line. An apical S3 gallop is heard. Which of the following is the primary pathophysiologic cardiac abnormality?

A 55-year-old man has aortic valve stenosis. Which of the following is the primary pathophysiologic abnormality in this valvular disorder?

A 10-year-old boy has a congenital bicuspid aortic valve with a normal aortic root. Which of the following is appropriate counseling to his parents?

Dabigatran therapy is initiated in a 66-year-old woman in treatment of non-valvular atrial fibrillation. Which of the following is proper counseling?

Which of the following is the most common organism causing subacute bacterial endocarditis (SBE) in a patient with a native valve and no drug abuse history?

Which study is used to monitor patients with deep vein thrombophlebitis on unfractionated heparin therapy?

Which of the following electrolyte abnormalities can prolong the QT syndrome and result in sudden cardiac death?

What is the optimal level of LDL in a patient with hyperlipidemia and diabetes mellitus?

A 44-year-old man with type 2 diabetes mellitus comes to the office for his blood test results. His lipid panel shows total cholesterol of 160 mg/dL, LDL of 110 mg/dL, HDL of 32 mg/dL, and triglycerides of 856 mg/dL. Which of the following medications best addresses his lipid abnormality?

An 18-year-old college hockey player is brought to the emergency department after a syncopal episode during a game. Systolic murmur is noted at the left sternal border and increases in intensity with Valsalva maneuver. Which of the following is the most likely diagnosis?

An infant is evaluated for failure to thrive. A continuous machine murmur is noted. Which of the following is the most likely diagnosis?

Which of the following is the best treatment for torsade de pointes?

Which of the following is present in a patient with anaphylactoid purpura (Henoch-Schönlein purpura)?

A 4-year-old girl is brought to the primary care office for a routine physical examination. Physical examination discloses a grade I/VI systolic heart murmur heard maximally along the left sternal edge. No radiation of the murmur is present. Which of the following is the most likely diagnosis?

A 42-year-old woman comes to the office with pain, slight redness, and edema in the right calf. She had been placed on oral contraceptives for the first time 5 weeks previously by her gynecologist in order to provide contraception and to help regulate her menstrual cycle. The only other medication she is taking is 20 mg atorvastatin (Lipitor) daily for hypercholesterolemia. The patient said she noticed the calf pain three days previously, and thought she had pulled a muscle. The pain intensified, and by the third day, she noticed her lower leg appeared swollen and red. She also reported throbbing pain in her leg when standing. What do you suspect is causing the symptoms in her leg?

A 58-year-old man and his wife come to the clinic. He complains of skin flushing, dizziness, itching, nausea, and vomiting. He is tachycardic (120 bpm). His blood pressure is 150/102. An EKG shows regular heart rhythm with no missing QRS complexes. He has been prescribed niacin (vitamin B3) for hypercholesterolemia and hypertriglyceridemia. The patient is unsure of his dose, but he takes 4 tablets twice daily. The patient recently changed the type of over-the-counter niacin he was using from tablets to capsules, because the capsules are less expensive. His wife thinks the patient has been taking 1,000-mg tablets. This would make his current dose 8,000 mg daily, or 8 grams. Niacin capsules are available in 250–500 mg doses. If the patient was previously taking four 250-mg capsules twice daily, he was taking 2,000 mg, or 2 grams daily. If the capsules he previously took were 500 mg, he was taking 4,000 mg daily, or 4 grams. What do you suspect is this patient’s diagnosis?

A 78-year-old woman is brought to the clinic by her daughter with shortness of breath, fatigue, edema of the lower extremities, irregular heartbeat, and productive cough. The patient appears sleepy and has difficulty staying awake. The daughter states her mother’s symptoms started about two weeks ago and have worsened over time. She also says that her mother has not been to a clinician in two years because “she hates hospitals.” The patient is on no medications and states that she has no known history of heart disease. However, she sometimes has chest pain that radiates down her left arm, which lasts for several minutes. Her blood pressure is 160/90, and her pulse is 100 and irregular. Her respirations are 28 and labored. She is producing white sputum when coughing. Rales are heard bilaterally in both lung bases. What is the most likely diagnosis?

A 55-year-old male comes to the clinic with chest pain, dyspnea, and diaphoresis. He is a smoker, has hypertension, hypercholesterolemia, and a strong family history for cardiac disease. What is the first test you would order to detect possible acute myocardial infarction (MI)?

A 46-year-old woman comes to the office complaining of syncope, especially when standing up from a sitting position. The previous week, she was placed on 2 mg of the alpha blocker prazosin twice daily for Raynaud’s disease by her physician. Her other medications are 20 mg of atorvastatin daily and 60 mg of raloxiphene daily. What is likely to be causing the patient’s syncope?

A 51-year-old man comes to the office for his annual physical. The patient’s only complaint is arthritic-type pain in his left knee. What routine procedure would you order to test for possible cardiovascular disease?

A 53-year-old male comes to the clinic with chest pain, diaphoresis, nausea, lightheadedness, and shortness of breath.An electrocardiogram confirms the patient is having an acute myocardial infarction (MI). What medication should you administer to the patient immediately?

A 67-year-old woman comes to the clinic with a slight nosebleed, which ceases with the application of pressure and an ice pack. Her vital signs are normal, and her blood pressure is 120/84. She is taking warfarin based on International Normalizing Ratio (INR) results for treatment of atrial fibrillation. (Her usual dose is 5 mg daily.) When asked about her other medications, the patient states that she takes omeprazole, 20 mg daily, for gastroestophageal reflux disease (GERD), and amiodarone for atrial fibrillation. She also states she just started taking ginkgo biloba about two weeks ago to improve her memory. The patient’s INR is 3.8. Just prior to taking ginkgo, it was 2.4, according to her medical records, and it had stayed between 2 and 3 for more than a year. The patient does not know the dose of ginkgo she is taking, but she said she followed the label’s instructions. She is taking one tablet in the morning and one at night. What would you tell this patient regarding taking the gingko supplement?

A 9-month-old infant accidentally ingests an unknown quantity of digitalis. The infant has congenital heart disease, characterized by ventricular septal defect, patent foramen ovale, and patent ductus arteriosus. Cardiac evaluation shows tachycardia (152 beats/minute) and a pansystolic murmur. The abdomen is distended but nontender. The remainder of the examination is unremarkable. Serum electrolytes reveal a potassium level of 5.7 mEq/L.An electrocardiogram (EKG) demonstrates a complete atrioventricular dissociation, with a good ventricular rhythm. The most important non- cardiac manifestation of toxicity in this infant is:

A 10-year-old boy, the star goalie for the Salt Lake City Little League soccer team, had a sore throat about two weeks ago but did not tell anyone because he was afraid he would miss the play-offs. Since several children have been diagnosed with rheumatic fever in the area, his mother is worried that he may be at risk as well. You tell her that several criteria must be met to make the diagnosis but that the most common finding is: