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A 71-year-old woman returns to your clinic after a three-year stay with her family in Italy. She has a history of NIDDM, hypertension, and hyperlipidemia. She will now be living with family in the area. Three years ago you prescribed HCTZ (25mg daily) for her hypertension which she stopped taking when she ran out of medication. Today, her blood pressure (verified on repeat measurement) is 172/106mmHg. Which of the following is the recommended treatment for this patient?
Beta blockers would be advisable as antihypertensive therapy for a patient with which of the following co-existing conditions?
Which of the following is the most sensitive serologic test used to indicate myocardial necrosis?
A 15-year-old male presents acutely to the office. His legs are cool to the touch. Examination reveals that his pulses and blood pressure are higher in the upper extremities than the lower extremities. Femoral pulses are delayed and weakened. Which of the following is the most likely underlying diagnosis?
An 18-year-old asymptomatic man has an apical ejection murmur. Bicuspid aortic valve is diagnosed. Which of the following is the most likely complication?
An 82-year-old woman has systolic heart failure for which she receives metoprolol, furosemide, lisinopril, and digoxin. Electrocardiography shows bursts of ventricular tachycardia, indicating digoxin toxicity. Which of the following is the most likely factors precipitating the toxicity?
Thirty minutes after using cocaine, an 18-year-old man has agitation, sweating, and restlessness. Blood pressure 220/116 mm Hg, pulse 138/min. Which of the following effects is most likely to be noted if intravenous propranolol is administered?
A 12-year-old boy has known long QT interval syndrome. Which of the following activities is most likely to precipitate torsade des pointes (ventricular tachycardia)?
A 33-year-old woman has systolic heart failure related to dilated cardiomyopathy. Which of the following is the least likely cause of the cardiomyopathy?
Which of the following is the mechanism of action of a thrombolytic medication?
A 35-year-old female with a history of a bicuspid aortic valve presents to the emergency room with three weeks of feeling “very sick” She reports that she has had fatigue, fevers, chills, night sweats, anorexia and arthralgias. On examination she appears unwell; there is an early systolic ejection click and a grade 3/6 diastolic decrescendo murmur. The spleen is palplable 3 cm below the costal margin. There are small linear hemorrhages seen on her nail beds, and raised painful lesions on her finger pads. There are painless erythematous lesions on the soles of her feet. On funduscopic examination there are white oval retinal lesions with surrounding areas of hemorrhage. What is the correct medical terminology for these retinal lesions?
A 28-year-old female presents for a routine physical. She has a complaint of easy bruising, but has no significant past medical history. On examination her blood pressure is 152/96. She has truncal obesity with purple abdominal striae and a “buffalo hump” on her back. Which of the following best describes the cause of her elevated blood pressure?
A 15-year-old male who is being treated for acute lymphoblastic leukemia complains of pleuritic chest pain and shortness of breath. On examination his blood pressure is 82/54, he has distended neck veins and muffled heart sounds. His EKG shows low voltage QRS complexes. Which of the following is the most appropriate treatment for this patient?
A 38-year-old female presents with a history of recurrent episodes of syncope. Her physical examination is normal with the exception of a drop in systolic blood pressure of 24 mm Hg when changing form supine to standing position. Tilt testing confirms postural hypotension. Which of the following medications is indicated in the treatment of this patient?
A 28-year-old female presents with a complaint of fatigue, dyspnea, and orthopnea. She is 4 days postpartum, following an uncomplicated pregnancy and spontaneous vaginal delivery at 40 weeks. On examination she has a BP of 118/64, and a pulse rate of 108. There are bibasilar rales and dullness to percussion at the bases. On auscultation of the heart there is a loud S3 and S4 heard. Chest x-ray shows pulmonary congestion and cardiomegaly. Which of the following is the most likely diagnoisis?
A 15-year-old male presents for evaluation of a syncopal episode which occurred while he was running at football practice. He reports he felt fine up until the event. He denies any significant past medical history, but has been experiencing palpitations and lightheadedness lately. His family history is significant for a cousin who died of sudden cardiac death at age 23. On examination he appears well, has normal pulse and blood pressure. There is a hyperdynamic precordial impulse and a loud S4 sound is heard. There is also a crescendo-decrescendo murmur heard along the left sternal border, which increases during the strain phase of the valsalva maneuver. The murmur does not radiate. Which of the following findings would most likely be seen on his ECG?
A 19-year-old male presents to the emergency room with a history of fevers for one week. He reports “feeling awful” with fatigue and fever. He denies any significant past medical history, but does admit to IV drug abuse. His temperature in the emergency room is 101.5o. On examination you observe multiple tender raised nodules on his hands and feet, as well as nontender macular lesions on the soles of his feet. There are also splinter hemorrhages noted on his fingernails. On auscultation there is a systolic murmur heard at the apex. Which of the following organisms is most likely the cause of this patient’s condition?
A 26-year-old female presents to the emergency room for evaluation of left sided calf pain. On examination her left lower extremity is edematous and there is dusky erythema of the posterior calf. Homan’s sign is positive. Which of the following conditions would cause her to have an elevated D-dimer—rendering the test less helpful in this scenario?
A 16-year-old female presents with a complaint of recurrent palpitations and lightheadedness. She reports that they last for several minutes and resolve spontaneously. On examination her blood pressure is 108/64 and her pulse rate is 72. Her thyroid is normal and auscultation of her heart reveals a normal S1 and S2 without any additional heart sounds. A resting ECG shows sinus rhythm with a slurred upstroke of the QRS complex and a short PR interval. Which of the following is the most cause of her palpitations?
A 38-year-old female presents to the emergency department with a complaint of dyspnea, pleuritic chest pain, and hemoptysis. She has no significant past medical history, but is taking a combination oral contraceptive pill. She smokes one-half pack of cigarettes per day. On examination she appears to be in moderate distress, and is tachycardic with a heart rate of 116 beats per minute, and tachypneic with a respiratory rate of 26 breaths per minute. Her SaO2 is 91% on room air. Her exam is otherwise unremarkable. An ECG shows sinus tachycardia. Which of the following tests would be the most appropriate to order at this time?
A 16-year-old Asian male presents with chest pain and shortness of breath. Auscultation of the chest reveals loud S4 gallop, variable systolic murmur, and jugular venous pulsations with a prominent “a” wave. Chest X-ray is essentially normal. Echocardiogram reveals left ventricular hyper-trophy, asymmetric septal hypertrophy, and a small left ventricle. Based on the patient’s presentation, physical examination, and test results, which of the following is the most appropriate diagnosis?
A 70-year-old female, currently being treated for congestive heart failure, presents with nausea and leg swelling. Physical examination reveals distended neck veins, tender hepatomegaly, and pitting edema. Chest X-ray reveals cardiomegaly. Based on the patient’s presentation, physical exam, and test results, which of the following is the most accurate diagnosis?
A newborn female infant presents with severe cyanosis and tachypnea at birth. Auscultation of the chest reveals a hyperdynamic apical impulse and a single S1 and S2 sound. Based on the presentation and physical examination, which of the following is the proper diagnosis?
A 55-year-old active white female presents with lower leg pain with exercise. Pain is relieved with rest. Auscultation of the legs reveal a weak femoral and distal pulse and a femoral bruit. Doppler study reveals an ankle-brachial index of 0.8. Based on the patient’s presentation, physical examination, and test results, which of the following is the most appropriate diagnosis?
A 66-year-old male, currently being treated with diuretics for hypertension, presents for a follow-up visit. His BP has remained elevated despite his current therapy along with lifestyle modifications. Which of the following medications would you prescribe in addition to diuretics to treat his associated symptoms?
A 59-year-old female presents with progressive shortness of breath and non-productive cough. Chest X-ray reveals cardiomegaly and right-sided pleural effusion. Auscultation of the lungs reveals right-sided rales. You diagnose this patient with congestive heart failure. Which of the following is included in the proper initial course of treatment for this disorder?
Which of the following radiological procedures is the most definitive for diagnosing coronary artery disease?
A 92-year-old female with a history of diabetes presents to the Intensive Care Unit following total hip arthroplasty. Vital signs are normal with a blood pressure of 120/80 mmHg and a heart rate of 78. The day following the procedure, the patient’s blood pressure drops to 80/50 mmHg, heart rate increases to 115 beats per minute, and she is unresponsive with fever to 103F. Based on the presentation and patient’s condition, which of the following is the accurate diagnosis?
A 52-year-old female presents with fatigue and occasional heart palpitations. Auscultation of the chest reveals mid-diastolic murmur, accentuated S1, and an opening snap following S2 without radiation. Chest X-ray reveals atrial enlargement. Based on the presentation and physical examination, which of the following is the proper diagnosis?
A 45-year-old obese sedentary female presents with tired, aching legs. Physical exam reveals superficial dilated, tortuous veins in the distribution of the long saphenous vein. Based on the patient’s presentation and physical examination, which of the following is the most appropriate diagnosis?