Multiple Choice Questions (MCQ)

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Category: Q&A Medicine--->Cardiology
Page: 11

Question 51#Print Question

A 20-year-old woman presents to the clinic with fever and arthritis. She reports that she developed these symptoms over the past few days, and the pain seems to be jumping from one joint to the next. There is no significant medical or family history, and she does not smoke or use illicit drugs. She reports that she had a throat infection 3 weeks ago, but she denies any recent exposure to sick contacts or recent sexual activity. The patient has a temperature of 38.6°C, blood pressure of 124/78 mmHg, heart rate of 88 beats per minute, respiratory rate of 16 breaths per minute, and oxygen saturation of 100% on room air. On examination, she has a 2/6 blowing systolic murmur at the apex. There is erythema and swelling of her knees as well as her left elbow and wrist, and there are no skin or nail findings. Her white blood cell count is 15,000/mm3 and the erythrocyte sedimentation rate is 45 mm/h. Antistreptolysin O titers are positive; blood cultures are drawn and are negative.

Which of the following is the most likely diagnosis?

a. Rheumatoid arthritis
b. Gonococcal arthritis
c. Rheumatic fever
d. Infective endocarditis

Question 52#Print Question

A 38-year-old immigrant woman comes to the Emergency Department with right-sided weakness and slurring of her speech. Initial imaging and studies are obtained, and she is found to have suffered an ischemic stroke and is treated appropriately. When you go to examine her, she has an irregularly irregular pulse, and on cardiac examination she has an early diastolic high-pitched opening snap at the apex followed by a low-pitched diastolic rumbling murmur. Upon further discussion with the family, they indicate that she does not have any chronic medical problems and has not been to the doctor since she was a baby. She had frequent throat infections as a child, but these always resolved without treatment. She takes no medications and does not smoke or drink alcohol.

 The mechanism by which this condition developed is most similar to which of the following other conditions?

a. Infective endocarditis
b. Cystic fibrosis
c. Graves disease
d. Sarcoidosis
e. Guillain–Barré syndrome

Question 53#Print Question

A 42-year-old woman is brought to the hospital after losing consciousness. She was at an outdoor graduation ceremony when her daughter’s name was called and she stood up with excitement. After she stood up, she felt lightheaded, nauseous, and started to develop tunnel vision. She tried to sit down but forgets what happened at this point. She awoke seconds later and was alert. She has a history of diabetes and GERD and takes metformin and omeprazole. There is no family history of heart disease or seizures. She is currently comfortable with no abnormalities on physical examination. Her blood pressure is normal and it does not change after going from a seated to a standing position.

Which of the following is the most likely diagnosis?

a. Arrhythmia
b. Orthostatic hypotension
c. Seizure
d. Vasovagal syncope

Question 54#Print Question

A 52-year-old woman presents with fatigue, peripheral edema, and periorbital purpura. She states that the symptoms of fatigue and peripheral edema have developed gradually over the past few months, but the periorbital skin changes occurred abruptly after sneezing. She also experiences dyspnea after moderate exertion, which is abnormal for her. Her vitals are within normal limits. Her jugular veins are distended, and there are third and fourth heart sounds. Her lungs are clear bilaterally and she has pitting edema around the ankles. A urinalysis reveals significant proteinuria, and an ECG shows low voltages throughout all the leads. The patient is admitted and a cardiac biopsy is performed. The tissue is stained with Congo red and shows apple-red birefringence under polarized light.

Which of the following is the correct diagnosis?

a. Amyloid cardiomyopathy
b. Hypertrophic cardiomyopathy
c. Rheumatoid arthritis
d. Hemochromatosis
e. Temporal (giant cell) arteritis

Question 55#Print Question

A 46-year-old man with a history of familial hypercholesterolemia is admitted to the hospital for chest pain. He is found to have a massive myocardial infarction and undergoes PCI. The following day, the patient becomes hypotensive, and on examination he has distant heart sounds.

Which of the following should be avoided in this patient?

a. IV normal saline
b. Inotropic agents
c. Immediate surgery
d. Immediate pericardiocentesis

Category: Q&A Medicine--->Cardiology
Page: 11 of 12