Extra credit questions Flashcards
A 53 yo Caucasian male arrives at your naturopathic medicine clinic seeking alternatives to statin drugs. He has read about harmful side effects on the internet and is concerned. His cardiologist prescribed atorvastatin (Lipitor) 80 mg po QD after the patient underwent catheterization and stent placement for a coronary artery blockage. You provide health teaching about the pleiotropic effects of Statins which includes all EXCEPT:
a. Plaque stabilization
b. Lowering of cholesterol
c. Vasodilation
d. Association with decreased cardiovascular events
c. Vasodilation (correct answer)
SB, a 60 yo Asian female, has average ambulatory home monitoring BPs in the 140’s/90’s mm Hg. PE is negative for signs of end organ damage. Her ASCVD score is 4.8%. Your diagnosis is Stage 1 HTN. An initial trial of diet and lifestyle intervention may include:
a. DASH diet + low sodium <1500 mg/d
b. Hibiscus tea 1 cup po TID
c. Weight management to decrease waist circumference and BMI
d. All of the above
d. All of the above (correct answer)
An 80 yo African American female presents for her annual exam. She appears frail, with slow gait and appears out of breath as she reaches the exam room. Vital signs are T98.8, P110, R22, BP 160/94, O2 Sats 89%. She states she feels tired all the time and anxious but thinks it’s because her husband passed last winter. Your next step includes:
a. 02 via NC at 2L/min
b. one nitroglycerin tab sublingual
c. ECG
d. A and C
d. A and C (correct answer)
A 46 yo Hispanic male presents with blurred vision and severe headache (pain 8/10; 10 worst) not relieved by acetaminophen (Tylenol). Vital signs are T98.4, P90, R20, BP 210/120, O2 Sats 98%. Fundoscopic exam reveals papilledema and cotton wool spots. SHx includes recreational cocaine and methamphetamine use. Abdominal exam is positive for mild TTP, negative hepatosplenomegaly. UA is positive for blood and protein. You suspect ___ and your plan includes ____.
a. HTN stage 2; increase anti-hypertensive medication dose
b. White coat HTN; prescribe ambulatory home BP monitoring
c. Hypertensive Emergency; refer to ER
d. Hypertensive Urgency; refer to cardiology
c. Hypertensive Emergency; refer to ER
A 19 yo male was resuscitated on the field during a college soccer match. He was diagnosed with hypertrophic cardiomyopathy (aka Idiopathic Hypertrophic Subaortic Stenosis or IHSS). He comes to you after hospital discharge because he doesn’t want to take “heart drugs” for the rest of his life and would prefer diet and lifestyle management so he can play soccer professionally. He reports feelings of depression. Your recommendations include:
a. Ongoing cardiology co-management and beta-blockers
b. PHQ-9 screen and counseling referral
c. Avoiding strenuous sports
d. All of the above
d. All of the above
XX is a 72 year old African American female coming to you looking for natural ways to treat her atrial fibrillation. Her onset occurred after a MI 6 years ago and required a pacemaker implant. She has been recently placed on Warfarin. She is seeking your help because she feels lightheaded, tired, weak, and shaky. She is currently taking carvediol and amiodarone. Her cardiologist has suggested CoQ10 supplementation. Her PE is remarkable for a soft S1 with an irregular rythym, increased JVP, hepatomegaly and pulmonary rales, bilaterally. She keeps saying, “I just feel so tired, can you make me feel not tired anymore?” Your suggestion for her would be:
a. A tincture including garlic, ginger, hawthorne, and Siberian ginseng
b. A ketogenic diet
c. 400 mg of Magnesium chelate, daily
d. Turmeric 300 mg daily
c. 400 mg of Magnesium chelate, daily
TG is a 48 year old male seeing you because he just doesn’t feel right lately. He can’t pinpoint what doesn’t feel right and says he would feel better if the doc would give him a clean bill of health so his mind can rest. He currently smokes cigarettes occasionally, drinks 2 beers every night and eats “his good ole meat and potatoes diet”. ROS was pertinent for intermittent heartburn, frequent urination with burning, and “needs to go to the eye doc because his eyes are getting old”. PE: BP: 190/120, funduscopic exam, cardiovascular, respiratory, abdominal exam is WNL. UA shows glucose, WBC and nitrites. You decide that this is a hypertensive emergency and instruct the patient to go the ER. What should happen next?
a. Receive 1000 mg of IV Mg medication to treat hypertension.
b. He is in renal failure and will be sent to ICU.
c. He will be sent home and asked to follow up with his doctor, as this wasn’t a hypertensive emergency.
d. Prescribe amiodarone.
c. He will be sent home and asked to follow up with his doctor, as this wasn’t a hypertensive emergency.
KL is a 39 year old Caucasian male who is seeking help for natural ways to deal with his cholesterol. His recent labs showed the following: TGL: 200 mg/dl, LDL- 220 mg/dl, HDL: 31 mg/dl. He has no history of diabetes. His vitals in office were: HR 68, weight: 202 lbs, ht: 6’4”, BP: 138/78. His family history includes: father passed away from MI at 53, grandfather had a stroke at 58. With all of this information you have, you decide you are going to determine his ASCVD risk percentage. Which of these values is not needed to calculate his risk for his case?
a. Systolic blood pressure
b. LDL
c. Family history
d. None, as he doesn’t meet the parameters to calculate his ASCVD risk.
d. None, as he doesn’t meet the parameters to calculate his ASCVD risk.
ABC is a 86 year old female coming in for a ROC for weight gain concerns. Her weight gain started about 3 months ago. She reports being cold, tired, nauseated, constipated, having a nasty dry cough, and feels the need to use two pillows instead of one at night for her head as it helps her sleep better. PE shows a respiratory rate of 24, skin pallor as well as cool to touch, pitting edema of her feet. Her cardiac exam reveals S3 sounds. Which of these labs are the most appropriate to order:
a. TSH
b. BNP
c. CMP
d. Wellness panel and BNP
d. Wellness panel and BNP
DT is a 5 year old male who is in your office with his mother for his well child exam. He was playing soccer with his pee wee team and fell pretty hard to the ground, yesterday. Since then, he has been holding his chest and told his dad his heart hurts really bad. His mother tells you he has been turning “blue” because he is holding his breath due to the pain. In office the child is alert, holding on to his mother’s waist. His blood pressure is in the 89th percentile for his age and height. His cardiac exam revealed a systolic, diamond shaped, blowing murmur in the 2nd left intercostal space. Skin, respiratory exams are WNL. Your most likely diagnosis from your differential diagnosis is:
a. Cardiomyopathy
b. Pathologic murmur, most likely due to ASD
c. Muscle strain of the intercostal muscles
d. Hypertension stage 1 and he should refrain from team sports.
c. Muscle strain of the intercostal muscles
A 67 year old African American male presents to office complaining of a “fluttering feeling” in his chest for the last several hours. He is slightly anxious in office. He denies feeling dizzy or faint. He has experienced 4-5 of these episodes over the last several months. He was diagnosed with hypertension 6 years ago, but has not taken the medications prescribed. He has never smoked and drinks 2-3 drinks on the weekends with friends.
On physical exam you find that he is afebrile, with a pulse of 110 bpm with an irregularly irregular rhythm and a blood pressure of 168/98. He is alert and oriented. You note that he is wearing shorts and flip-flops despite it being quite cold out.
What are your next step(s) with this patient?
A. You assure the patient his palpitations are due to anxiety and refer him for biofeedback
B. This patient should immediately be transported to the ER for catheter ablation
C. Run an ECG, CMP, thyroid panel and CBC
D. The diagnosis can be made on his presentation, you use the CA2DS-VASC to asses risk and begin treatment with 81mg aspirin, CoQ10 and decreased caffeine intake
C. Run an ECG, CMP, thyroid panel and CBC
A 67 year old African American male presents to office complaining of a “fluttering feeling” in his chest for the last several hours. He is slightly anxious in office. He denies feeling dizzy or faint. He has experienced 4-5 of these episodes over the last several months. He was diagnosed with hypertension 6 years ago, but has not taken the medications prescribed. He has never smoked and drinks 2-3 drinks on the weekends with friends.
On physical exam you find that he is afebrile, with a pulse of 110 bpm with an irregularly irregular rhythm and a blood pressure of 168/98. He is alert and oriented. You note that he is wearing shorts and flip-flops despite it being quite cold out.
What is the best explanation for this patient’s symptoms?
A. Atrial fibrillation exacerbated by hyperthyroidism
B. Panic attack
C. Premature ventricular contractions
D. Wolfe-Parkinson White Syndrome
A. Atrial fibrillation exacerbated by hyperthyroidism
A 67 year old African American male presents to office complaining of a “fluttering feeling” in his chest for the last several hours. He is slightly anxious in office. He denies feeling dizzy or faint. He has experienced 4-5 of these episodes over the last several months. He was diagnosed with hypertension 6 years ago, but has not taken the medications prescribed. He has never smoked and drinks 2-3 drinks on the weekends with friends.
On physical exam you find that he is afebrile, with a pulse of 110 bpm with an irregularly irregular rhythm and a blood pressure of 168/98. He is alert and oriented. You note that he is wearing shorts and flip-flops despite it being quite cold out.
The patient returns to office 2 weeks later and wants your help to get his blood pressure under control. He does not have CDK or diabetes. What is his target blood pressure and what medications are recommended for this patient according to the JNC-8?
A. < 150/90 mmHg; Furosamide
B. < 150/90 mmHg; Lisinopril
C. < 150/90 mmHg; Amlodipine
D. All of these are recommended treatments either alone or in combination
C. < 150/90 mmHg; Amlodipine
A 63 year old female presents to office with nausea and some SOB that began last night (8 hours ago). She tells you she just wanted to come see you because she “feels like something is really off”. She is anxious and diaphoretic in office. You decide to send her to the ER to rule out MI.
In the ER they run an ECG. Which of the following ECG findings is NOT suggestive of an MI?
A. ST segment elevation of > 1mm in more than 2 leads
B. Reciprocal ST depression in a lead “opposite” to where the MI is occurring
C. T wave inversion or “peaking”
D. Delta waves
D. Delta waves
Wolff–Parkinson–White syndrome) (WPW
The ECG is ran 9 hours after the onset of symptoms and is found to be normal. At this time they also decide to run cardiac enzymes. At this time, which of the following findings would rule out an MI?
A. Negative CK-MB
B. A normal ECG
C. Negative Myoglobin
D. All of these would rule out an MI
A. Negative CK-MB
A 62yo woman with a history of angina experiences crushing chest pains, sweating, and tachycardia while driving to the airport. She pulls over, takes a sublingual nitroglycerine (NG), and then continues to drive. The pain is not improved so she pulls over twice more and takes more NG. Still feeling chest pain, she boards her 5 hour flight and chews four aspirin. After she gets to her destination she goes to the ER and she is diagnosed with an MI. The doctor tells her the aspirin probably saved her life. Which of the following cardiac enzymes is least likely to be elevated in the ER (>8 hrs after event)?
a. CK
b. CK-MB
c. Myoglobin
d. Troponin I and T
c. Myoglobin
Increase 2-3 hrs after MI
A 34-year-old African American female presents with recent-onset headaches, blurred vision, and dyspnea. On physical examination, she appears very ill and has difficulty concentrating and answering questions. Her blood pressure reading in office is 190/130. What is the appropriate management for this patient?
a. This is hypertensive urgency. You perform an ophthalmoscope exam, full cardiac and respiratory PE, then perform an in-office UA and order a CMP to help you determine the most appropriate treatment.
b. This is hypertensive urgency. You call 911; she needs IV sodium nitroprusside treatment.
c. This is a hypertensive crisis. You perform an ophthalmoscope exam, full cardiac and respiratory PE, then perform an in-office UA and order a CMP to help you determine the most appropriate treatment.
d. This is a hypertensive emergency. You call 911; she needs IV sodium nitroprusside treatment.
d. This is a hypertensive emergency. You call 911; she needs IV sodium nitroprusside treatment.
Ranjit is a 54yo Indian male who comes to see you for fatigue, SOB, peripheral edema, bloating, low appetite and a history of hemochromatosis. You strongly suspect Restrictive Cardiomyopathy (RCM). Which test is diagnostic for RCM?
a. ECG
b. Echocardiogram
c. Cardiac catheterization with biopsy
d. Angiogram
c. Cardiac catheterization with biopsy
Hemochromatosis:
Excess iron can poison organs, which can lead to conditions such as cancer, irregular heartbeat, and cirrhosis of the liver.
Symptoms are related to conditions that arise from iron overload such as diabetes, darkening of the skin, abnormal heart rhythm, or arthritis.
Joan brings in her 4yo daughter, Ella, concerned because she keeps saying her “heart hurts”. Which of the following is lowest on your ddx?
a. Myocardial ischemia
b. Esophagitis
c. Costochondritis
d. Psychogenic
a. Myocardial ischemia
Roberta is a 55yo Caucasian female presenting for annual physical. Aside from occasional DOE (dyspnea on exertion) and a history of rheumatic fever, there are no pertinent subjective findings. On PE, you palpate a small volume pulse, S1 and S2. On auscultation, you note the first heart sound (S1) is accentuated and you think you hear a low pitch diastolic rumble. As you set up the ECG, which of the following is highest on your ddx?
a. Aortic stenosis
b. Mitral stenosis
c. Mitral valve prolapse
d. Mitral Regurgitation
b. Mitral stenosis
A 64 year-old male, with a long history of COPD, presents with increasing fatigue over the last three months. The patient has stopped playing golf and also complains of decreased appetite, chronic cough and a bloated feeling.
Physical examination reveals distant heart sounds, questionable gallop, lungs with decreased breath sounds at lung bases and the abdomen reveals RUQ tenderness with the liver two finger-breadths below the costal margin, the extremities show 2+/4+ pitting edema.
Labs reveal the serum creatinine level 1.6 mg/dl, BUN 42 mg/dl, liver function test’s mildly elevated and the CBC to be normal. Which of the following is the most likely diagnosis?
A. Right ventricular failure
B. Pericarditis
C. Exacerbation of COPD
D. Cirrhosis
A. Right ventricular failure
Signs of right ventricular failure are fluid retention i.e. edema, hepatic congestion and possibly ascites.
A 55 year-old male is seen in follow-up for a complaint of chest pain. Patient states that he has had this chest pain for about one year now. The patient further states that the pain is retrosternal with radiation to the jaw.
“It feels as though a tightness, or heaviness is on and around my chest”.
This pain seems to come on with exertion however, over the past two weeks he has noticed that he has episodes while at rest. If the patient remains non-active the pain usually resolves in 15-20 minutes. Patient has a 60-pack year smoking history and drinks a martini daily at lunch. Patient appears overweight on inspection.
Based upon this history what is the most likely diagnosis?
A. Acute myocardial infarction
B. Prinzmetal variant angina
C. Stable angina
D. Unstable angina
D. Unstable angina
Pain in unstable angina is precipitated by less effort than before or occurs at rest.
Which of the following ECG findings is consistent with hyperkalemia?
A. Prolonged QT interval
B. Delta wave
C. Peaked T waves
D. Prominent U waves
C. Peaked T waves
Narrowing and peaking of T waves are the beginning EKG changes associated with hyperkalemia.
You’re evaluating a 35-year-old man who presents to your office with a headache. On physical examination, his blood pressure is 240/120 mmHg. On fundoscopic examination, you note the presence of papilledema. What’s this person’s underlying diagnosis?
A. Hypertensive emergency B. Hypertensive urgency C. Stage I hypertension D. Stage III hypertension E. Prehypertension
A. Hypertensive emergency
(This person has a headache and papilledema, which is a sign of damage due to hypertension. This is called hypertensive emergency.
A blood pressure >= 180 mmHg systolic with no symptoms is an example of a hypertensive urgency (B).
Stage I hypertension, Choice (C), is a systolic blood pressure of 140–159 mmHg and/or a diastolic blood pressure of 90–99 mmHg.
There’s no Stage III hypertension, Choice (D), only Stages I and II.
You’re evaluating a 25-year-old woman who presents with palpitations. On examination, you hear a midsystolic click. Which one of the following would you recommend concerning evaluation of her heart condition?
A. She should be screened for major depressive disorder.
B. She should be screened for a bleeding diathesis.
C. She should be screened for rheumatic fever.
D. Her murmur would decrease with a Valsalva maneuver.
E. She may need a beta blocker if the palpitations continue.
E. She may need a beta blocker if the palpitations continue.
(This person has mitral valve prolapse, as seen with a midsystolic click. It’s associated with panic disorder. If palpitations occur with mitral valve prolapse, a beta blocker is first-line medication.)
For choice (C), you can see mitral stenosis and tricuspid stenosis with rheumatic fever.
Mitral valve prolapse would increase in the setting of a Valsalva maneuver, Choice (D). –>(Decreases w/ Wolff–Parkinson–White syndrome)
Mrs. Jones is a 68 y/o female that presents to office today for an annual wellness exam. Past medical history is positive for gallbladder surgery when she was 38, diabetes (12 year history, well controlled) and cataracts. Her blood pressure at this visit is 170/100mmHg. She was seen on a homeopathy visit one week ago and her blood pressure was 165/98mmHg at that visit.
Which of the following is NOT true about the management of her care?
A. Because her blood pressure is 20/10 higher than target blood pressure, it is most appropriate to start her on two medications for the management of her care.
B. The first standard medications choices for her care are an ACEi or ARB as well as a CCB.
C. We want to follow up and re-assess her medication every 2-4 weeks to add or change the medications until her blood pressure is well managed.
D. We should recommend a DASH diet for her, which emphasizes whole fruits and vegetables and low sodium as a cornerstone of the diet.
D. We should recommend a DASH diet for her, which emphasizes whole fruits and vegetables and low sodium as a cornerstone of the diet.
(The DASH diet works well when combined with a low sodium diet but it does not emphasize low sodium specifically.)
A six year old boy presents to the office today with a chief complaint of chest pain. When he is asked where the pain is, he points very specifically to his left sternal border, around the level of T5. Which of the following is NOT an appropriate next step?
A. Because the specific location, ask more questions to rule out muscle strain or chostochondritis (recent injuries, recent vomiting, sports activities).
B. The fact that the child can point to the specific spot indicates that this is musculoskeletal in origin and no additional diagnostic workup is indicated.
C. Perform a cardiovascular exam and listen to his heart and lungs. While it is unlikely to be cardiac in origin, a cardiovascular exam is still merited.
D. Perform a tuning fork test over the area to see if it recreates the pain. This will increase the likelihood that the problem is musculoskeletal in origin if positive.
B is incorrect. A complete workup to rule out other conditions is still merited.
B. The fact that the child can point to the specific spot indicates that this is musculoskeletal in origin and no additional diagnostic workup is indicated.
Your 35 year old patient presents to the office after experiencing a pulmonary embolism after developing a DVT on an international flight. At the ER, they diagnosed her with factor V leiden mutation. She now presents to your office and wants you to manage her care. Which of the following is NOT an appropriate next step?
A. Have your patient avoid leafy green vegetables and vitamin K supplements, put her on daily low dose aspirin and inform her that you are happy to manage her condition.
B. Encourage your patient to avoid OCPs.
C. Encourage your patient to stop smoking.
D. Require that your patient also work with a hematologist in conjunction with your care.
A is incorrect. We should not solely manage these on our own.
A 10 year old boy presents to the office for his annual wellness exam. At today’s visit, his BMI is over the 95% for his height and age. Which of the following is NOT the best next step?
A. Encourage his family to go on a diet and to compete with weekly weigh ins. Give rewards and incentives when he successfully loses weight each week.
B. Refer the family to a local cooking class and encourage more fruits and vegetables in their diet. Recommend that they spend fewer hours each day on screens.
C. Explore movement that he enjoys, whether that is walking, biking, sports, etc. Try to help him integrate those into his weekly activities.
E. Discuss health risks with the family and encourage the entire family to participate to improve everyone’s health. De-emphasize physical appearance as a motivator.
A is incorrect. Weight centered focus can be harmful.
Your 67 year old male patient presents today after being released from the ER after an acute MI. He wants your recommendations for naturopathic recovery. All of the suggestions below can help recovery except one. Which treatment should be avoided?
A. CoQ10
B. L-carnitine
C. Fish Oil
D. Hawthorne
C- Fish oil should be avoided.
A 55 year old female presents to your office by herself. She is has had worsening shortness of breath for the last 2 hours. She is not experiencing chest pain or back pain, headache, nausea or visual disturbances. This is her first such episode. Four years ago, she was diagnosed with essential hypertension, but she has not been managing her medications well, neither has she had any follow up visits. No other co-morbidities are present.
On Physical Exam: Vitals: Pulse: 120bpm RR: 28/min BP: 230/145 mm Hg Temp: 98.6°F
Cardiovascular: 3rd heart sound, gallop rhythm, cardiomegaly, peripheral pulses normal; JVP is 7 cm above the sternal angle.
Fundi: Grade II hypertensive retinopathy. No papilledema noted.
Respiratory: bilateral fine crackles up to mid zones
ECG: Normal RR with left ventricular hypertrophy
Troponin T-assay: negative
What is the most likely diagnosis and the most appropriate next step?
a. She is experiencing an acute myocardial infarction. Refer her for emergency medical services.
b. Unable to diagnose at this time. Run an ECG.
c. She is experiencing a hypertensive emergency. Refer her for emergency medical services.
d. She has signs and symptoms of anxiety. Manage in office with mindfulness-based stress reduction.
c. She is experiencing a hypertensive emergency. Refer her for emergency medical services.
A 55 year old female presents to your office by herself. She is has had worsening shortness of breath for the last 2 hours. She is not experiencing chest pain or back pain, headache, nausea or visual disturbances. This is her first such episode. Four years ago, she was diagnosed with essential hypertension, but she has not been managing her medications well, neither has she had any follow up visits. No other co-morbidities are present.
On Physical Exam: Vitals: Pulse: 120bpm RR: 28/min BP: 230/145 mm Hg Temp: 98.6°F
Cardiovascular: 3rd heart sound, gallop rhythm, cardiomegaly, peripheral pulses normal; JVP is 7 cm above the sternal angle.
Fundi: Grade II hypertensive retinopathy. No papilledema noted.
Respiratory: bilateral fine crackles up to mid zones
ECG: Normal RR with left ventricular hypertrophy
Troponin T-assay: negative
After initial management of patient’s condition, which of the following is the most appropriate?
a. Avoid carvedilol, as beta blocker will further depress cardiac function and worsen the heart failure.
b. Prescribe hydrochlorothiazide, a potassium sparing diuretic, to manage the patient’s hypertension.
c. Prescribe furosemide, a loop diuretic, to manage the patient’s hypertension.
d. Both A and C are correct.
d. Both A and C are correct.
A 55 year old female presents to your office by herself. She is has had worsening shortness of breath for the last 2 hours. She is not experiencing chest pain or back pain, headache, nausea or visual disturbances. This is her first such episode. Four years ago, she was diagnosed with essential hypertension, but she has not been managing her medications well, neither has she had any follow up visits. No other co-morbidities are present.
On Physical Exam: Vitals: Pulse: 120bpm RR: 28/min BP: 230/145 mm Hg Temp: 98.6°F
Cardiovascular: 3rd heart sound, gallop rhythm, cardiomegaly, peripheral pulses normal; JVP is 7 cm above the sternal angle.
Fundi: Grade II hypertensive retinopathy. No papilledema noted.
Respiratory: bilateral fine crackles up to mid zones
ECG: Normal RR with left ventricular hypertrophy
Troponin T-assay: negative
After your patient’s condition has been stabilized, you want to recommend a naturopathic therapy. Which of the following has been shown to decrease systolic blood pressure up to 17 mmHg (you can expect a drop of 5-10 mmHg)?
a. magnesium
b. niacin
c. beta carotene
d. CoQ10
d. CoQ10
Your new patient is a 40 year old male who is in office for an annual wellness exam. His past medical history is non-remarkable for cardiovascular conditions. He notes that he was often sick as a child, but has been very healthy in adulthood. Recently, however, he has noticed occasional dyspnea with exercise.
Physical Exam reveals an accentuated and snapping S1, an opening snap, low-pitch diastolic rumble at the apex, and a pre-systolic accentuation. The rest of his cardiovascular exam was non-remarkable, as were his respiratory, abdominal, and HEENT exams.
Based on PE and history, what is the most likely valve pathology in this patient?
a. mitral stenosis
b. pulmonic stenosis
c. aortic stenosis
d. aortic regurgitation
a. mitral stenosis
Your new patient is a 40 year old male who is in office for an annual wellness exam. His past medical history is non-remarkable for cardiovascular conditions. He notes that he was often sick as a child, but has been very healthy in adulthood. Recently, however, he has noticed occasional dyspnea with exercise.
Physical Exam reveals an accentuated and snapping S1, an opening snap, low-pitch diastolic rumble at the apex, and a pre-systolic accentuation. The rest of his cardiovascular exam was non-remarkable, as were his respiratory, abdominal, and HEENT exams.
Which is NOT a complication of this patient’s valve condition?
a. congestive heart failure
b. coarctation of the aorta
c. atrial fibrillation
d. systemic emobilization
b. coarctation of the aorta
A 74 year old man presents to your office with dyspnea on exertion. He was previously well, but now has to stop to catch his breath with even a short walk around the block. He denies chest pain. He reports that he must be propped up with 3-4 pillows in order to sleep at night.
Physical Exam reveals:
P = 82, BP = 120/74, JVP = 8 cm.
Lungs: bilateral fine crackles up mid way up the lungs
Cardiac exam: Normal S1, soft S2, audible S3 with summation gallop, 4/6 late peaking systolic murmur at the right upper sternal border. No thrills on palpation.
Physical Exam findings and this patient’s history indicate which valve pathology?
a. triscuspid regurgitation
b. rheumatic mitral stenosis
c. aortic stenosis
d. aortic regurgitation
c. aortic stenosis
A 74 year old man presents to your office with dyspnea on exertion. He was previously well, but now has to stop to catch his breath with even a short walk around the block. He denies chest pain. He reports that he must be propped up with 3-4 pillows in order to sleep at night.
Physical Exam reveals:
P = 82, BP = 120/74, JVP = 8 cm.
Lungs: bilateral fine crackles up mid way up the lungs
Cardiac exam: Normal S1, soft S2, audible S3 with summation gallop, 4/6 late peaking systolic murmur at the right upper sternal border. No thrills on palpation.
Given this patient’s signs of heart failure and the above valvular condition, what is his current life expectancy?
a. His survival expectancy is not affected
b. 5 years
c. 2-3 years
d. 1-2 years
d. 1-2 years
Jack is a 62-year-old male who comes to you with symptoms of shortness of breath, left sided shoulder pain. He has a 10-year history of high blood pressure and ascites is present on physical exam. He had an episode of chest pain earlier in the day, but is currently pain free, sat up looking undistressed with a blood pressure of 150/90 and LDL of 200. When you use this information to calculate a 10-year risk with the ASCVD calculator, you find his risk is 7.9. Which is the most appropriate statement about Jack’s case?
a) The ASCVD calculator isn’t reliable with an LDL >190
b) Assess for familial hypercholesterolemia because of LDL level
c) Prescribe Furosemide, a loop diuretic to help
d) A and B are correct
d) A and B are correct
Maxwell is 48 years old and arrives in office on 3 hypertension medications with a blood pressure that is still uncontrolled at 155/100. You ordered a test for Renin/Aldosterone ratio to see if he could possibly have primary aldosteronism. Suddenly you realize, the only way to get accurate reading is for Maxwell to not be on BP medications (for 3-5 days), and you don’t feel comfortable taking him off his medication for the test. Instead, what is the best drug to be administered to help rule out primary aldosteronism?
a) ACEi
b) spironolactone
c) oral corticosteroids
d) propanolol
b) spironolactone
