Internal Medicine Quiz | Practice MCQ #mcq.ImBooz

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1 >>A 20-year-old woman has mild pulmonic stenosis (transvalvular gradient is 20 mmHg). Which of the following statements regarding this situation is true? ?

2 >>Which of the following findings would be expected in a person with coarctation of the aorta? ?

3 >>A 15-year-old boy residing with his parents on a military base presents with a fever of 38.�C (101.5�F) and complains of lower back, knee, and wrist pain. The arthritis is not localized to any one joint. He gives a history of a severe sore throat several weeks earlier. Physical examination of the skin reveals pea-sized swellings over the elbows and wrists. He also has two serpiginous, erythematous pink areas on the anterior trunk, each about 5 cm in diameter. Laboratory investigation includes negative blood cultures, negative throat culture, normal CBC, and an erythrocyte sedimentation rate (ESR) of 100. An antistreptolysin-O (ASO) titer is elevated. At this point, appropriate therapy would consist of ?

4 >>Each patient below is alert and oriented and has a blood pressure of 110/60. In which patient would adenosine constitute appropriate initial therapy? ?

5 >>A 72-year-old man with a long history of tobacco use presents to the emergency room with shortness of breath. He is mildly cyanotic and hypotensive. On exam he has poor air movement bilaterally and has evidence of an elevated jugular venous pressure. A Swan-Ganz is placed revealing right atrial pressures of 15 mmHg (normal range 0- 5), a pulmonary artery pressure of 70/28 (normal range 12- 28/3- 13), and a pulmonary capillary wedge pressure of 10 (normal range 3- 11). Which of the following is most consistent with this clinical picture? ?

6 >>A 23-year-old man presents to the emergency room with palpitations; his heart rate is 180 and he has a normal systolic blood pressure. An attempt to slow his heart rate is made using verapamil. Unfortunately, the patient’s condition rapidly deteriorates. He is now pulseless, and a rhythm strip reveals ventricular fibrillation. Which of the following is most consistent with the patient’s initial cardiac rhythm at presentation? ?

7 >>Which of the following statements best describes long-acting nitrate preparations? ?

8 >>A 70-year-old retired banker with no past medical history presents to the emergency department 4 h after the onset of severe substernal crushing chest pain with radiation to the left arm and neck. Electrocardiography reveals significant ST-segment elevation in leads I, L, V , and 5 V . The patient has no clear-cut medical contraindications 6 to anticoagulation. Which of the following would be the optimal management strategy at this time? ?

9 >>A 14-year-old boy is brought into the emergency room pulseless and undergoing cardiopulmonary resuscitation. He collapsed while playing basketball. There is no history of trauma, and no prior history of cardiovascular disease. Which of the following conditions would most likely be identified at the time of autopsy? ?

10 >>A previously healthy 58-year-old man is admitted to the hospital because of an acute inferior myocardial infarction. Within several hours, he becomes oliguric and hypotensive (blood pressure is 90/60 mmHg). Insertion of a pulmonary artery (Swan-Ganz) catheter reveals the following pressures: pulmonary capillary wedge, 4 mmHg; pulmonary artery, 22/4 mmHg; and mean right atrial, 11 mmHg. This man would best be treated with ?

11 >>A 63-year-old black woman with a long history of hypertension and diabetes is brought to the emergency department by relatives because she has become incoherent over the past 24 h. Physical examination reveals a disoriented woman whose blood pressure is 230/160, respiratory rate is 25, and pulse is 110. The patient is afebrile. The chest reveals bibasilar rales. Cardiac examination is remarkable only for the presence of an S . There is no 4 organomegaly or focal neurologic findings. The patient is oriented to person only. The family revealed that the patient has not been taking her antihypertensive medicines in the past several weeks. The patient is placed on a cardiac monitor, and both intravenous and intraarterial lines are placed. An emergent CT scan reveals no evidence of hemorrhage or mass lesion. The most appropriate next step in management would be to ?

12 >>Which of the following statements regarding physiologic maneuvers used to distinguish one cardiac condition from another is true? ?

13 >>Which of the following patients should undergo operative excision of an abdominal aortic aneurysm and replacement with a vascular graft? ?

14 >>A 68-year-old man who has had a recent syncopal episode is hospitalized with congestive heart failure. His blood pressure is 160/80 mmHg, his pulse rate is 80 beats per minute, and there is a grade III/VI harsh systolic murmur. An echocardiogram shows a disproportionately thickened ventricular septum and systolic anterior motion of the mitral valve. Which of the following findings would most likely be present in this man? ?

15 >>A 73-year-old patient develops acute renal failure secondary to bladder obstruction. His serum creatine is 327 ?mol/L (3.7 mg/dL) with a potassium of 6.5 meq/L. The patient had an electrocardiogram, which revealed peaked T waves as the only abnormality. If the hyperkalemia were not corrected, what would be the expected next electrocardiographic abnormality? ?

16 >>For the last 6 h, a 33-year-old man has had sharp, pleuritic substernal chest pain that is relieved when he sits upright. His electrocardiogram shows diffuse ST-segment elevation. Which of the following observations supports a diagnosis of acute pericarditis? ?

17 >>Which of the following electrocardiographic findings represents a manifestation of digitalis toxicity? ?

18 >>What is the most common cause of pulseless electrical activity (PEA)? ?

19 >>Which of the following congenital cardiac disorders will lead to a left-to-right shunt, generally with cyanosis? ?

20 >>Absolute contraindications to the use of thrombolytic agents in the setting of an acute anterior myocardial infarction include which of the following? ?