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An 82-year-old man who has been in excellent health has an acute ST segment elevation myocardial infarction complicated by pulmonary edema. Four hours after administration of furosemide 80 mg intravenously the patient is hypotensive and oliguric. Which of the following is the primary pathophysiologic mechanism causing the hypotension?
A 32-year-old man has ankylosing spondylitis. Which of the following is most likely sign to be noted on physical examination?
Daily amiodarone therapy is initiated in prevention of recurrent atrial fibrillation in a 65-year-old woman with history of remote myocardial infarction. She should be counseled that which of the following is the most likely adverse effect?
An 84-year-old man has an acute ST segment elevation myocardial infarction complicated by cardiogenic shock. Blood pressure 76/40 mm Hg, pulse 110/min/regular. Bibasilar crackles and an apical S4 gallop are heard. Which of the following is the preferred medication to be administered?
An 84-year-old man with known severe atherosclerotic coronary heart disease is in systolic heart failure. Intravenous administration of which of the following is the best predictor of improved systolic left ventricular function after a revascularization procedure?
A 31-year-old woman has the acute onset of severe chest pain. Systemic lupus erythematosus with acute pericarditis are diagnosed. Which of the following is the preferred initial medication for the pericarditis?
When instituting diuretic therapy for patients with heart failure, which of the following is considered the treatment of choice as first-line therapy in a failing kidney due to its improved sodium clearance?
A 26-year-old woman with known Marfan syndrome wishes to become pregnant. The patient should be counseled that she is at increased risk for which of the following?
A 75-year-old man has a large aneurysm of his ascending aorta. Which of the following is the most likely symptom to be noted by the patient?
Which of the following risk factors is negatively correlated with the development of a thoracic aortic aneurysm?
Which answer best describes the electrocardiogram?
Which answer best describes the electrocardiogram?
Which of the following would you expect to find in a patient with chronic occlusive arterial disease of the lower extremities?
Which of the following are commonly seen in the electrocardiogram of a patient with Wolf-Parkinson-White?
Which of the following is the most common serious consequence of untreated giant cell arteritis?
A 2-year-old boy presents with apparent dyspnea on exertion and recurrent respiratory infections. On physical examination, a continuous “machinery” murmur and thrill are identified. There is no obvious cyanosis. Which of the following is the most likely diagnosis?
A 64-year-old male presents to his primary care physician for a routine physical. He brings up the fact that lately he has been having brief episodes of “pressure-like” retrosternal chest pain that occurs when he is doing heavy yard work. The pain builds up gradually and will resolve if he sits down and rests after a few minutes. He does feel somewhat short of breath when the pain occurs. The last episode of pain he had was over one week ago. His past medical history is significant for hyperlipidemia and hypertension, both of which are well controlled. On examination his blood pressure is 132/84, and his pulse rate is 88. On auscultation of the heart there is a normal S1 and S2 with no additional sounds. An ECG shows non-specific ST changes that are a new finding from an ECG performed 2 years ago. Which of the following would be the most appropriate next step in the evaluation of this patient?
A 55-year-old woman arrives at the office complaining of palpitations, recent weight loss, and a generalized feeling of anxiety. Physical examination discloses an irregularly irregular pulse with a rate of approximately 130 beats per minute. EKG confirms the Atrial fibrillation. Which of the following is not a risk factor in determining her stroke risk?
Which of the following medications is used to prevent further eclamptic seizures?
Which of the following is a maternal risk factor of preeclampsia?
Which of the following diagnostic studies is the most useful in evaluating pulmonary arterial pressure in patients with pulmonary hypertension?
A healthy 40-year-old male presents for routine, annual checkup. The patient does not complain of any symptoms. Electrocardiogram and blood pressure are normal. Auscultation of the heart reveals a “swishing” sound. Which diagnostic procedure would you order to evaluate the “swishing” sound?
A 50-year-old active African-American male presents with chest discomfort that only occurs under resting conditions. Electrocardiogram and subsequent cardiac stress testing are both within normal limits. You diagnose this patient with Prinzmetal’s angina. Which of the following would be the proper course of therapy for this patient?
A 24-year-old female presents with sudden-onset shortness of breath and dizziness. An electrocardiogram reveals the following rhythm.
Which of the following describes this cardiac arrhythmia?
A 52-year-old obese Caucasian female presents with uncontrolled hypertension and intermittent chest pain. You suggest a cardiac stress test to evaluate her symptoms. The electrocardiogram prior to stress testing was within normal limits. During the stress test, the patient develops chest pain and S-T segment depression (see EKG below).
INSERT IMAGE
Based on the patient’s symptoms and electrocardiographic findings, which of the following is the most accurate diagnosis?
A healthy 38-year-old male presents for his yearly physical examination. Auscultation of the chest reveals a pancystolic murmur, decreased S2 sound, and prolonged apical impulse with radiation to the left axilla. Chest X-ray reveals atrial enlargement. Based on the presentation and physical examination, which of the following is the proper diagnosis?
Which of the leads of an electrocardiogram represent the inferior wall of the heart muscle?
Which of the following describes the clinical condition of severe cardiovascular failure caused by poor blood flow, inadequate distribution of blood flow, and inadequate oxygen delivery to the tissues?
A 58-year-old female presents with exertional dyspnea, non-productive cough, and fatigue. Auscultation of the chest reveals basilar rales and gallops. 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 likely diagnosis?
A 58-year-old obese male with a history of deep venous thrombosis presents with edema in the lower extremities and an ulcer on right ankle. The skin in the lower extremities appears shiny, thin, and discolored. The patient complains of lower leg itching and pain upon standing. Based on the patient’s presentation and physical examination, which of the following is the most appropriate diagnosis?