Cardiology 5

A 20-year-old woman who chronically abuses cocaine has a 2 month history of progressive weakness. For the past week swelling of both ankles has been present. Blood pressure 80/54 mm Hg, pulse 118/min/regular, respirations 18. Examination shows normal jugular venous pressure and lungs clear to auscultation. The cardiac 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 most likely diagnosis?

A 56-year-old woman has a 3 week history of progressively worsening edema of her feet, ankles, and legs followed by increasing abdominal swelling over the past 6 days. Blood pressure 90/72 mm Hg, pulse 122/min/regular, and respirations 26/min. Examination shows elevation of jugular venous pressure, lungs clear to auscultation, and distant heart tones. Shifting abdominal dullness is noted. Three plus (3 +/4) bilateral edema of the feet and ankles is noted. Which of the following is the most likely diagnosis?

A 57-year-old man has endocarditis caused by Streptococcus bovis infection. In addition to antibiotic therapy, which of the following is proper management of the patient?

A 74-year-old woman who is receiving multiple medications as therapy for chronic systolic heart failure has a 1 week history of weakness. Presence of which of the following electrocardiographic abnormalities is most suggestive of hypokalemia?

Without any premonitory symptoms, a healthy 17-year-old man has 2 syncopal attacks while standing still. Blood pressure is 114/70 mm Hg, pulse 40/min/irregular, and respirations 16/min. Examination shows a single 6 cm round flat rash in the left axilla. It has an erythematous ring with central clearing and a target appearance. The heart size is normal. No murmur or gallop is heard. Electrocardiography shows normal sinus rhythm with Mobitz type 1 atrioventricular block. Which of the following is the most likely diagnosis?

During physical examination an elderly patient is noted to have a painless, brown-colored ulceration in the area of the medial malleolus. Which of the following is the most likely diagnosis?

A 77-year-old man has a 3 week history of progressively worsening edema of his feet, ankles, and legs. In the past week increasing abdominal swelling is noted. Blood pressure 90/66 mm Hg, pulse 110/min/regular, and respirations 24/min. Constrictive pericarditis is diagnosed. Which of the following signs is most likely to be noted upon examination?

An 80-year-old woman has increasing frequency of angina pectoris now awakening her from sleep. Vital signs are normal. Examination of the lungs and heart is normal except for an apical S4 gallop. Which of the following should be excluded in the treatment regimen?

Daily amiodarone therapy is initiated in prevention of recurrent atrial fibrillation n a 55-year-old man with history of remote myocardial infarction. She should be counseled that which of the following is the most likely adverse effect?

An 81-year-old woman has increasing frequency of angina pectoris now awakening him from sleep. Vital signs are normal. Examination of the lungs and heart is normal except for an apical S4 gallop. In addition to aspirin, metoprolol, and heparin, which of the following should be administered?

Which of the following is the most common clinical characteristic in preeclampsia?

The murmur of aortic regurgitation is often accentuated by which of the following maneuvers?

Which of the following cardiac rhythms is characterized by progressively lengthening PR intervals followed by a dropped QRS complex?

Which of the following is the most appropriate treatment for a patient with temporal arteritis?

A 19-year-old college basketball player has a syncopal episode while playing. A systolic murmur is heard at the left sternal border. Which of the following is the most probable diagnosis in this patient?

A 64-year-old male presents with a complaint of a “funny feeling” in his chest for three days. He denies any other symptoms. On examination he has a heart rate of 84 and a blood pressure of 138/86. ECG reveals atrial fibrillation. How long should this patient be anticoagulated prior to cardioversion?

Which of the following studies is the most helpful in establishing the diagnosis for a patient with infective endocarditis?

Which of the following is a clinical characteristic for patent ductus arteriosus?

Which answer best describes the electrocardiogram shown?

A 44-year-old man with no history of coronary artery disease comes to the office with elevated triglycerides (820 mg/dL), a low high-density lipoprotein cholesterol (30 mg/dL), and normal total cholesterol and low-density lipoprotein cholesterol levels after 6 months of dietary therapy. Which of the following medications is most appropriate for this patient?

An otherwise healthy 22-year-old male presents with episodes of heart palpitations, dizziness, and shortness of breath. The patient’s electrocardiogram is shown below. Based on the findings, this patient suffers from which of the following disorders?

A 66-year-old female who has recently undergone radiation therapy for breast cancer presents with shortness of breath and reduced exercise capacity. Auscultation of the chest reveals right-sided rales. Chest X-ray shows mildly enlarged cardiac silhouette. Echocardiogram reveals mildly reduced left ventricular function. Based on the patient’s presentation, physical examination, and test results, which of the following is the most appropriate diagnosis?

An 86-year-old-female presents with a history of dizziness and loss of consciousness during urination. All lab values are within normal limits; chest X-ray is normal; and CT scans of chest, abdomen, and pelvis are all within normal limits. Which of the following is the best diagnosis?

A 46-year-old, otherwise healthy, male presents with recurrent chest pain that occurs through the night, at rest. Chest X-ray was within normal limits. EKG was within normal limits. Auscultation of the chest reveals no abnormalities. Cardiac stress testing was performed, but was uneventful and the patient remained asymptomatic throughout the exam. Based on the patient’s presentation, physical exam, and test results, which of the following is the most likely diagnosis?

A 53-year-old female presents to the emergency room with numbness and tingling in the extremities and weakness. The patient’s electrocardiogram is shown below. Which of the following electrolyte disorders can be diagnosed from this electrocardiogram?

A 70-year-old male presents with chest pain and shortness of breath. Physical examination and auscultation reveal low-intensity pulse in the carotid arteries. Chest X-ray shows fluid in the lungs. Echocardiogram reveals a calcified, poorly functioning aortic valve. Which of the following is the correct diagnosis?

A 54-year-old African-American female presented with dizziness and nausea when transitioning from a sitting to a standing position. You have diagnosed her with orthostatic hypotension. What course of treatment would you suggest to this patient?

A 68-year-old female presents to the emergency room with chest pain lasting for 30 minutes. Patient does not complain of pain radiating to other parts of the body and blood pressure is slightly elevated at 140/90 mmHg. Electrocardiogram performed in the emergency room is below.

Based on the patient’s symptoms and electrocardiographic findings, which of the following is the most accurate diagnosis?

A 46-year-old white male presents with dizziness, chest pressure, shortness of breath, and heart palpitations that have occurred over several weeks. EKG is normal with no S-T segment abnormalities. Cholesterol is borderline elevated at 210. Troponin levels are normal at 0.2 ng/mL. D-dimer level is normal at 0.37. Which diagnostic test would you suggest and why?

A 60-year-old male presents with episodes of heart palpitations and shortness of breath. Auscultation of the chest reveals a regular heart rhythm. The electrocardiogram reveals a cardiac arrhythmia.

Which cardiac arrhythmia is denoted on the patient’s electrocardiogram?