Multiple Choice Questions (MCQ)

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Category: Medicine--->Cardiology
Page: 2

Question 6#Print Question

A 55-year-old man presents with gradually increasing shortness of breath and leg swelling that occurred while on a business trip. He has congestive heart failure, which has caused fatigue and shortness of breath if he walks a block or climbs a flight of stairs. Blood pressure is 140/90; there is no jugular venous distension or gallop, and only minimal pedal edema. An echocardiogram shows left ventricular ejection fraction is 45%. Current medications include aspirin and simvastatin. The patient desires to keep medications to a minimum. What additional treatments are indicated at this time?

a. Spironolactone
b. An ACE inhibitor and a beta-blocker
c. Digoxin
d. Furosemide
e. An implantable defibrillator

Question 7#Print Question

A 34-year-old woman is referred by an OB-GYN colleague for the onset of fatigue and dyspnea on exertion 1 month after her second vaginal delivery. Physical examination reveals a laterally displaced PMI, elevated jugular venous pressure, and pitting lower extremity edema. Echocardio-gram shows systolic dysfunction with an ejection fraction of 30%. Which statement most accurately describes her condition? 

a. This disease may occur unexpectedly years after pregnancy and delivery
b. About half of similar patients will recover completely
c. The condition is idiosyncratic; the risk of recurrence with a future pregnancy is no greater than average
d. This condition will require a different therapeutic approach than the typical dilated cardiomyopathy
e. This condition will require endomyocardial biopsy for diagnosis

Question 8#Print Question

Yesterday you admitted a 55-year-old man to the hospital for an episode of chest pain. The patient has past medical history of COPD, peripheral vascular disease with claudication, hypertension and hypercholesterolemia. On admission his BMI is 40, there is bilateral wheezing, and cardiac examination reveals a grade 1/6 early systolic murmur at the upper left sternal border without radiation. Blood pressure readings have consistently been 140/90 to 150/100. Cardiac enzymes are normal. A resting ECG shows left ventricular hypertrophy with secondary ST-T-wave changes (“LVH with strain”). You decide to do a cardiac stress test on this patient. Which cardiac stress test would be most appropriate for this patient? 

a. Exercise EKG stress test
b. Exercise nuclear stress test
c. Pharmacologic nuclear stress test with adenosine
d. Pharmacologic nuclear stress test with dipyridamole
e. Pharmacologic echo stress test with dobutamine

Question 9#Print Question

A 75-year-old patient presents to the ER after a syncopal episode. He is again alert and in retrospect describes occasional substernal chest pressure and shortness of breath on exertion. His blood pressure is 110/80 and lungs have a few bibasilar rales. Which auscultatory finding would best explain his findings?

a. A harsh systolic crescendo-decrescendo murmur heard best at the upper right sternal border
b. A diastolic decrescendo murmur heard at the mid-left sternal border
c. A holosystolic murmur heard best at the apex
d. A mid-systolic click
e. A pericardial rub

Question 10#Print Question

A 72-year-old man presents with shortness of breath that awakens him at night. He is unable to walk more than one city-block before stopping to catch his breath. Physical examination findings include normal blood pressure, bilateral basilar rales, and neck vein distention. The patient has diabetes and a known history of congestive heart failure. His last echocardiogram revealed a left ventricular ejection fraction of 25%. The patient has compliant with his medication regimen that includes an ACE inhibitor, beta-blocker, a loop diuretic, metformin, and glipizide. What is the most likely etiology for the patient’s heart failure? 

a. Metabolic
b. Infiltrative
c. Coronary artery disease
d. Valvular disease
e. Infectious

Category: Medicine--->Cardiology
Page: 2 of 9