Block 1 Flashcards
A 42 year old male with a history of hypertension has been experiencing
dyspnea on exertion. He denies any chest pain. His blood pressure is 140/40,
heart rate 90, and respirations 18. Physical examination reveals elevated
jugular venous pressure and an early systolic ejection sound is heard. A III/IV
early diastolic decrescendo murmur heard best at the right upper sternal
border is present along with a I/IV diastolic rumble at the apex. Also noted is a
II/VI systolic ejection murmur at the right upper sternal border. What other
physical exam finding might you expect?
A. Pulses bispheres
B. Pulsus alternans
C. Pulsus paradoxus
D. Pulses parvus et tardus
C. Pulsus paradoxus
You are called to evaluate a 57-year-old man with pressure-like chest pain that occurred while he was shoveling the
snow. The pain radiates to the jaw and medial aspect of the left arm. The patient denies dizziness, nausea, vomiting,
or palpitations. He has a past medical history of hypertension and he smokes 2 packs of cigarettes per day. He has a
brother who had a myocardial infarction that required balloon angioplasty when he was in his forties. The patient has
recently been told to modify his diet because of a recently discovered high glucose and cholesterol level. On physical
examination the patient appears pale and diaphoretic. Blood pressure is 160/100 mm Hg and pulse is 108/min. His
extremities are cool. Heart examination reveals an S4 gallop. Lungs are normal. Peripheral pulses are palpable and
bilaterally equal. He has no peripheral edema. Which of the following is the most likely diagnosis?
a. Right ventricular infarction
b. Cardiogenic shock
c. Acute myocardial infarction
d. Congestive heart failure (CHF)
e. Prinzmetal’s angina
c. Acute myocardial infarction
The Kussmaul sign is seen in which of the following disorders?
a. Cardiomyopathy
b. Left ventricular infarction
c. Right ventricular infarction
d. Septal wall dysfunction
e. Tricuspid regurgitation
c. Right ventricular infarction
The a wave of the jugular venous pulse represents which of the following?
a. Right ventricular contraction
b. Right atrial contraction
c. Passive atrial filling
d. The open tricuspid valve
e. Filling of the right ventricle
b. Right atrial contraction
- A 55-year-old postal worker presents to the emergency room with chest
pain. On a scale of 1 to 10, he rates the pain a 9. It started 30 minutes ago
and hasn’t gone away. He has never had it before. He denies any injury or
trauma; he has no medical conditions that are being treated. Nothing makes
the pain better or worse. When questioned further, he has noticed nausea and
increased sweating with the pain. Based on this description, which of the
attributes of this symptom have not been addressed?
(A) Remitting or exacerbating factors
(B) Quality
(C) Severity
(D) Timing
(B) Quality
- A 25-year-old graduate student presents to your clinic; she is concerned about
her exposure to a communicable disease that occurred at a party she recently
attended. You, the interviewer, enter the room and greet the patient and then ask
what brought her into your office today. She states that she wants to establish care,
so you start by asking her if she has any specific concerns that she would like you to
address. She states that she is concerned that she may have gotten an STD. You
continue to maintain eye contact and state, “Go on.” Which type of interviewing
technique have you demonstrated?
(A) Echoing
(B) Directed questioning
(C) Facilitation
(D) Reassurance
(C) Facilitation
- A 42-year-old retail manager is sitting in your clinic exam room, waiting for
a routine checkup for hypertension. You enter the room and sit down, making
eye contact, and move your body slightly toward the patient. You nod your
head as the patient begins to bring you up to date on his life since his last
appointment. This interviewing technique is an example of:
(A) Echoing
(B) Adaptive questioning
(C) Nonverbal communication
(D) Empathic responses
(C) Nonverbal communication
- A 55-year-old legal secretary comes into your office to establish care. She
starts the interview by telling you her whole life story, tells you about her
husband, children, and grandchildren, and then pulls out a written list of 20
different items that relate to her health that she wants to address with you in
today’s interview. She is very friendly and relaxed. What specific type of
patient is this?
(A) Anxious patient
(B) Talkative patient
(C) Angry or disruptive patient
(D) Silent patient
(B) Talkative patient
- A 69-year-old woman presents to your office with the complaint of pain. She
was diagnosed with breast cancer that has metastasized to the bone 6 months
ago. At the time, she did not want radiation therapy even for relief of the pain. You
then discussed with her that her prognosis is poor and that her time to live is
limited. She was not interested in hearing about it. You observe that she has lost
more weight and that she is even more anorexic than at her previous visit 1 month
ago. Today, she is frustrated because she hurts when she gets up and tries to walk
around. She has planned a trip to the Bahamas to take place in 4 more months.
What stage of grief is this patient currently in?
(A) Denial
(B) Anger
(C) Bargaining
(D) Depression or sadness
(E) Acceptance
(A) Denial
A 45-year-old
man is evaluated for a 6-month history of progressive dyspnea on
exertion and lower-extremity edema. He can now walk only one block
before needing to rest. He reports orthostatic dizziness in the last 2
weeks. He denies chest pain, palpitations, or syncope. He was
diagnosed 15 years ago with non-Hodgkin lymphoma, which was
treated with chest irradiation and chemotherapy and is now in
remission. He also has type 2 diabetes mellitus. He takes furosemide
(80 mg, 3 times daily), glyburide, and low-dose aspirin. On physical
examination, he is afebrile. Blood pressure is 125/60 mm Hg supine
and 100/50 mm Hg standing; pulse is 90/min supine and 110/min
standing. Respiration rate is 23/min. BMI is 28. There is jugular venous
distention and jugular venous engorgement with inspiration.
central venous pressure is 15 cm H2O. Cardiac examination discloses
diminished heart sounds and a prominent early diastolic sound but
no gallops or murmurs. Pulmonary auscultation discloses normal
breath sounds and no crackles. Abdominal examination shows
shifting dullness, and lower extremities show 3+ pitting edema to the
level of the knees. The remainder of the physical examination is
normal. BUN 40 mg/dL, Cr 2.0 mg/dL, ALT 130 U/L, AST 112 U/L,
Albumin 3.0 g/dL, UA negative for protein,
What’s the most likely diagnosis?
A. Cirrhosis
B. Constrictive pericarditis
C. Nephrotic syndrome
D. Systolic heart failure
B. Constrictive pericarditis
A 55-year-old man is noted to have congestive heart failure and states
that he is comfortable at rest but becomes dyspnoeic even with
walking to bathroom. On echocardiography, he is noted to have an
ejection fraction of 47%. Which of the following is the more accurate
description of this patient’s condition?
(A) Diastolic dysfunction
(B) Systolic dysfunction
(C) Dilated cardiomyopathy
(D) Pericardial disease
(A) Diastolic dysfunction
A 20-year-old female college student is evaluated at the student health center to establish
care. She had no major medical problems prior to college, and there is no family history of
cardiovascular disease. On physical examination, blood pressure is 110/60 mm Hg and
pulse is 70/min. S1
and S2
are normal and there is an S4
present. There is a harsh grade 2/6
midsystolic murmur heard best at the lower left sternal border. The murmur does not radiate
to the carotid arteries. A Valsalva maneuver increases the intensity of the murmur; moving
from a standing position to a squatting position, performing a passive leg lift while
recumbent, and performing isometric handgrip exercises decrease the intensity. Rapid
upstrokes of the carotid pulses are present. Blood pressures in the upper and lower
extremities are equal.
What’s the most likely diagnosis?
A. Aortic coarctation
B. Bicuspid aortic valve
C. Hypertrophic cardiomyopathy
D. Mitral valve prolapse
E. Ventricular septal defect
C. Hypertrophic cardiomyopathy
Which of the following scenarios is most suggestive of limb-threatening ischemia?
A. Forefoot pain when recumbent, monophasic pedal doppler signals, ABI = 0.34.
B. Exertional calf pain, absent pedal pulses, diminished hair growth below the knee.
C. Leg cramps at night, non-palpable popliteal pulse, ABI = 0.68.
D. No symptoms, no palpable pulses at femoral or pedal locations, ABI = 0.45.
A. Forefoot pain when recumbent, monophasic pedal doppler signals, ABI = 0.34.
A 50-year-old man with chronic hypertension presents at the clinic having
run out of his medications, lisinopril and amlodipine, for more than a month.
He is asymptomatic and has a blood pressure of 200/104 mm Hg. Which of the
following is the best management?
A. Admit in the hospital and initiate intravenous nitroprusside.
B. Prescribe clonidine 0.1 mg TID and recheck the blood pressure in 24 to 48 hours.
C. Restart his ACE inhibitor and calcium channel blocker.
D. Refer to a social worker and do not prescribe any antihypertensive agent.
A. Admit in the hospital and initiate intravenous nitroprusside.
An 80-year-old woman without a history of hypertension undergoes surgery for a hip fracture. Her
blood pressure on postoperative day 1 is 178/110 mm Hg. She is asymptomatic except for hip pain.
Which of the following is the best next step?
A. Transfer the patient to the intensive care unit, obtain cardiac enzyme levels, and lower the
blood pressures to the 140/90 mm Hg range.
B. Control the pain and monitor the blood pressure.
C. Start the patient on a beta-blocker and monitor the blood pressure.
D. Restrict visitors and turn down television, alarms, and other noise.
B. Control the pain and monitor the blood pressure.
