Multiple Choice Questions (MCQ)

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Category: Q&A Medicine--->Cardiology
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Question 1# Print Question

A 68-year-old man presents to the hospital with a 3-hour history of crushing substernal chest pain. He reports that the symptoms developed suddenly and were accompanied by sweating and nausea. The chest pain has been getting worse, is not exacerbated by deep inspiration, and does not radiate to his jaw or either arm. He endorses mild shortness of breath but denies subjective fevers, chills, headache, cough, abdominal pain, and diarrhea. He has a history of coronary artery disease, hypertension, diabetes, and gastroesophageal reflux disease (GERD). He takes aspirin, lisinopril, metformin, and omeprazole. His family history is significant for hypertension in both parents, and his father died of a heart attack at the age of 60. He has a 40 pack-year history of smoking, and denies any alcohol or illicit drug use. On examination, the patient is afebrile with a blood pressure of 150/96 mmHg, heart rate of 89 beats per minute, respiratory rate of 18 breaths per minute, and oxygen saturation of 97% on room air. He appears diaphoretic. There is an S3 on cardiac auscultation, with mildly elevated jugular venous pulsations and bibasilar rales on pulmonary examination. His dorsalis pedis and posterior tibial pulses are diminished bilaterally, with mild swelling around his ankles. His initial laboratory values and ECG (Figure below) are shown below.

  • Hemoglobin 14.2 g/dL
  • Leukocyte count 9,000/mm3
  • Platelets 275,000/mm3
  • Sodium 136 mEq/L
  • Potassium 4.2 mEq/L
  • Chloride 105 mEq/L
  • Bicarbonate 22 mEq/L
  • Blood urea nitrogen 16 mg/dL
  • Creatinine 1.2 mg/dL
  • Glucose 145 mg/dL
  • Calcium 9.6 mg/dL
  • Troponin I Elevated

Which of the following best represents the underlying pathology in this patient?

A. Rupture of a plaque with thrombosis leading to partial occlusion of a coronary artery
B. Vasospasm of a coronary artery
C. Gradual occlusion of a coronary artery by plaque
D. Rupture of a plaque with thrombosis leading to complete occlusion of a coronary artery
E. Superficial erosion of a plaque with thrombosis

Question 2# Print Question

A 62-year-old woman with a history of hypertension and hyperlipidemia presents to the hospital with diffuse muscle pain, weakness, and dark urine. She has no history of autoimmune or renal disease. Over the past month, she has had symptoms of cold intolerance, weight gain, and constipation. Her medications include hydrochlorothiazide, simvastatin, and gemfibrozil. Urine dipstick reveals 3+ blood; however, there are no red blood cells on microscopic analysis. Some of the other laboratory values are shown below:

  • Creatinine 2.3 mg/dL
  • Creatine kinase 34,000 U/L
  • TSH 8.0 μU/mL

Which of the following is the most likely cause of her presentation?

A. Hashimoto thyroiditis
B. Pyelonephritis
C. Polymyositis
D. Medication effect

Question 3# Print Question

A 47-year-old woman presents at night to the Emergency Department with chest pain. She states that the pain started that evening and has progressively been getting worse. She is concerned that she is having a heart attack. The pain is described as a burning sensation associated with a sour taste in her mouth, and it started shortly after she ate dinner; it has occurred on previous occasions, but never as bad as it is now. Previously, she used calcium carbonate tablets that were effective for the pain. She has no history of heart disease or other medical problems, and she takes no regular medications. She does not smoke cigarettes or use cocaine. Her vitals are normal, and her physical examination is unremarkable. Initial laboratory tests and an ECG are normal.

Which of the following is the most likely cause of this patient’s chest pain?

A. Unstable angina
B. Myocarditis
C. Pulmonary embolism
D. Gastroesophageal reflux disease
E. Costochondritis

Question 4# Print Question

A 28-year-old woman frantically presents to the Emergency Department in the middle of the night with chest discomfort that awoke her from sleep. She has experienced similar episodes a few times before, always at night, but never as bad as this. She reports a history of migraines but denies any other medical history, including heart disease. Her medications include NSAIDs as needed and OCPs. She smokes a half pack of cigarettes a day but denies any alcohol or drug use. She admits that she gets “stressed out” a lot but believes that overall she lives a healthy lifestyle. Laboratory values show normal CK and troponin. An ECG shows ST elevations and she is taken for coronary angiography that does not show any significant coronary occlusions.

What is the most appropriate treatment for this patient?

A. Alprazolam
B. Diltiazem
C. Alteplase
E. Reassurance

Question 5# Print Question

A 73-year-old woman is brought in by paramedics after fainting in the mall and hitting her face. She does not remember any preceding symptoms, and she did not lose control of her bowel or bladder. Witnesses at the scene say that she was down for less than a minute, then woke up and was fairly alert. She was bleeding from a laceration on her chin and paramedics were called. When she arrived at the hospital, her initial laboratory values were normal and an EEG did not show epileptiform activity. She is placed on a cardiac monitor. The following day, she becomes lightheaded and loses consciousness while lying in bed, and her monitor shows tachycardia with the QRS complexes being uniformly longer than 120 ms.

What is the most common cause of this rhythm disturbance?

A. Uncontrolled hypertension
B. Distention of the pulmonary veins
C. Accessory pathway
D. Ischemic heart disease

Category: Q&A Medicine--->Cardiology
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