Cardiology 8

Which of the following is the most common cause of cardiogenic shock?

A 72-year-old Caucasian male, with a history of mild, untreated HTN presents to your office because he has noticed some mild swelling in his ankles for the past month. He reports that his ankles are normal in the morning, when he first gets out of bed, but as the day goes on the swelling worsens and by evening his shoes are very tight. His physical exam is remarkable for blood pressure of 152/98mmHg in the right arm seated and he has 1+ pitting edema in his ankles B/L. His chest X-ray does not show signs of cardiac or pulmonary abnormalities. Which of the following medications should not be part of your initial treatment?

A 42-year-old construction worker with previously diagnosed stage 1 hypertension and type II diabetes is prescribed a thiazide diuretic but his BP remains poorly controlled. Which of the following treatment options would be the most appropriate to consider for this patient?

A 66-year-old male with a history of untreated hypertension (HTN) presents with a four months history of bilateral edema in his ankles that is worse at night. Past medical history is otherwise unremarkable. Family history is significant for HTN and diabetes. He admits to a 1 pack/day tobacco habit and occasional alcohol consumption. Vital signs reveal a blood pressure of 164/94mmHg in the left arm seated. Physical exam is significant for 1+ pitting edema in his ankles. Chest X-ray reveals mild cardiomegaly. Which of the following medications would be most appropriate for initial treatment of this patient?

A 45-year-old retired postal worker, has an average blood pressure of 168/110mmHg which you have confirmed with serial readings over one week. Which of the following treatment options would be most appropriate for this patient?

A 66-year-old African male with untreated HTN, presents to your office for follow up. He is noticing that he gets fatigued easily and that he cannot walk around the block without feeling tired and short of breath. His physical exam is remarkable for blood pressure of 172/98 in the right arm seated and 180/100 in the left arm seated. Of the following medications, which combination should be your initial treatment?

The target LDL levels for a 59-year-old male who is a 40-pack year smoker with HTN, diabetes mellitus, and a family history which includes the death of his father from MI at 54 years of age should be which of the following?

A 35-year-old male presents to your clinic for an initial visit. He has no current complaints and has no significant past medical history. He drinks alcohol occasionally, smokes 1-2 cigars each week, and denies recreational drug use. He does not take any medications on a regular basis but admits to a daily multivitamin. Family history is significant for a father with hypertension and insulin dependent diabetes. Physical examination reveals a well appearing male with blood pressure of 132/84mmHg verified on repeated measurement. The remainder of his exam is unremarkable. Which of the following should you recommend to your patient?

A patient is having a routine physical examination. Funduscopic examination reveals AV narrowing and venous nicking. The nasal border of the optic disc appears blurred. Which of the following is the most likely underlying cause?

A 55-year-old gentleman presents to your clinic for a follow-up visit. He has a history of anxiety, hypercholesterolemia, and GERD. His blood pressure when he entered the room was 146/98mmHg. On your repeat measurement it is 142/90mmHg. At his last two visits his blood pressure was 150/92mmHg and 148/88mmHg. His current medications are buspirone, atorvastatin, and omeprazole. Which of the following is the recommended initial management for this patient?

A 56-year-old male is found unresponsive at his desk. He has no pulse and CPR is initiated. The paramedics arrive and perform an ECG. His rhythm strip is pictured below. Which of the following is the most appropriate next step in the management of this patient?

A 64-year-old female is found unresponsive in her hospital bed. Her cardiac monitor shows the following rhythm:

Which of the following is the most appropriate initial MEDICAL treatment of this patient?

A 43-year-old male presents with a complaint of intermittent palpitations which he describes as a very quick “fluttering sensation in his chest.” They only last a few seconds. He has a history of hypertension but no other medical problems. He is a smoker and admits to high caffeine consumption and increased stress at home. An ECG is performed and is shown below. Which of the following is the most likely diagnosis?

A 42-year-old male presents for a routine physical and is found to have elevated blood pressure. His primary care clinician orders an ECG which is shown below:

A 58-year-old male with a history of prolonged QT syndrome presents post-herpetic neuralgia following an episode of shingles. When making a decision to treat the neuralgia, which of the following medications should be avoided in this patient?

A 58-year-male with a history of chronic stable angina presents to the cardiologist reporting that he is now starting to have angina symptoms at rest. How much stenosis of the coronary arteries is required to result in symptoms that are occurring at rest?

A 28-year-old male presents to the emergency room with a complaint of substernal chest pain for three days. The pain has been associated with dyspnea on exertion and fatigue. He has no chronic medical problems, but does recall having an upper respiratory infection approximately one week ago. On examination his heart rate is 124, and he is mildly dyspneic. On auscultation of his heart there is a normal S1 and S2 without any additional sounds. Laboratory studies show an elevated ESR, CK-MB and troponin. The ECG shows nonspecific ST segment elevations, and diffuse T wave inversions. Which of the following is the most likely diagnosis?

A 54-year-old male presents to the ED complaining of lightheadedness, chest pain and nausea, which started when he was walking his dog this morning. On exam he is cool and clammy, and his blood pressure is 84/52. He is started on oxygen and placed on a monitor which shows sinusbradycardia of 42 beats per minute. IV access is obtained. Which of the following is the most appropriate management of this patient?

A 69-year-old with a history of acute renal failure starts to complain of shortness of breath and chest pain. Shortly after this he starts to become very confused. On examination his blood pressure is 80/54, and his respirations are 26/minute. There is a marked decrease in the strength of his pulse with inspiration. He has markedly elevated jugular venous pressure and his heart sounds are very quiet. Which of the following is the most likely diagnosis?

A 49-year-old female with a history of scleroderma presents with a complaint of abdominal fullness, nausea and right upper quadrant pain. On examination there is marked jugular venous distention, right upper quadrant tenderness and hepatomegaly, moderate ascites and peripheral edema. Cardiac auscultation reveals an early high pitched S3. Chest x-ray is normal, and echocardiogram shows a thickened myocardium and right ventricular dysfunction. Which of the following is the most likely diagnosis?

A 50-year-old obese white male presents with chest pain, shortness of breath, and non-specific headache. Physical examination reveals his blood pressure to be 240/140 mmHg. Which of the following refers to the disorder that is characterized by blood pressure readings of this range?

A 42-year-old male presents for routine examination. His blood pressure was mildly elevated at his last examination and he was advised to adjust his diet to reduce sodium. Although he was very compliant with his dietary adjustments, his blood pressure is still elevated. Which of the following is the class of medication you would initially prescribe to control blood pressure?

A 65-year-old female presents with intermittent heart palpitations, fatigue, and dizziness. Auscultation of the chest reveals an irregular heart rhythm. Electrocardiogram confirmed the presence of an irregular heart rhythm.

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

A newborn male infant presents with extreme cyanosis, hyperpnea, and agitation. Physical examination reveals clubbing of the fingers. Auscultation of the chest reveals increased right ventricle impulse at lower left sternal border and a loud S2. Based on the presentation and physical examination, which of the following is the proper diagnosis?

A newborn male infant presents with cyanosis, shock, heart failure, and respiratory distress. Auscultation of the chest reveals a single S2 sound. Based on the presentation and physical examination, which of the following is the proper diagnosis?

A chronically ill, 85-year-old female presents to the emergency room unresponsive and without a pulse. The patient’s electrocardiogram is shown below. Based on the EKG findings, which is the most appropriate course of treatment?

A 72-year-old African-American male with a history of alcoholism presents with progressive shortness of breath. Auscultation of the chest reveals S3 gallop, rales, and increased jugular venous pressure. Chest X-ray reveals cardiomegaly with vascular congestion. Echocardiogram reveals dilated left ventricle, low cardiac output, and high diastolic pressure. Based on the patient’s presentation, physical examination, and test results, which of the following is the most appropriate diagnosis?

A 19-year-old athletic female presents for annual physical exam. Blood pressure is normal at 120/80 mmHg. Auscultation of the chest is unremarkable. Electrocardiogram reveals the following rhythm. Which cardiac rhythm is denoted on the electrocardiogram?

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A 72-year-old African-American male with a history of alcoholism presents with progressive shortness of breath. Auscultation of the chest reveals S3 gallop, rales, and increased jugular venous pressure. Chest X-ray reveals cardiomegaly with vascular congestion. Echocardiogram reveals dilated left ventricle, low cardiac output, and high diastolic pressure. Based on the patient’s presentation, physical examination, and test results, which of the following is the most appropriate diagnosis?

A 74-year-old male presents with shortness of breath, persistent non-productive cough, orthopnea and exercise intolerance. Auscultation of the chest reveals basilar rales and gallops. Chest X-ray reveals bilateral pleural effusions, venous dilatation, and alveolar fluid. Based on the patient’s presentation, physical exam, and test results, which of the following is the most accurate diagnosis?