Internal Medicine Quiz | Practice MCQ #mcq.ImBooz

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1 >>The patient described in Question VII-45 becomes refractory to the above agents and develops chronic atrial fibrillation. In addition to pharmacologic control of his ventricular rate, which of the following interventions would you suggest? ?

2 >>A 65-year old man with long-standing hypertension presents to the emergency room complaining of palpitations. The patient is found to be in atrial fibrillation, and verapamil is administered to slow his ventricular rate. The patient spontaneously converts to normal sinus rhythm. A workup for cardiac ischemia and hyperthyroidism is negative. Over the next 48 h the patient has multiple episodes of paroxysmal atrial fibrillation. Which of the following antiarrhythmic agents would be most successful in treating his paroxysmal atrial fibrillation (PAFib)? ?

3 >>A 22-year-old Michigan woman presents to her local emergency room complaining of dizziness over the past several days, including two syncope episodes followed in each case by unresponsiveness for several minutes. She has always been in excellent health, having played varsity soccer in college. Her last illness occurred 4 months ago, when she developed fever, chills, and generalized weakness; those symptoms cut short a 2-week camping trip to the Cape Cod National Seashore. She uses oral contraceptives but no other prescription medications. She admits to inhaling cocaine over the last 4 months. Physical examination reveals blood pressure of 100/62 and pulse of 30 but is otherwise unremarkable. Chest xray and serum chemistries are unremarkable. ECG demonstrates complete heart block with nonspecific ST- and T-wave changes. There is no evidence of prior myocardial infarction. The most likely cause of her complete heart block is ?

4 >>A 70-year-old man is admitted to the hospital with chest pain of 8 h duration. ECG demonstrates anterior ST elevation, for which he is given tissue plasminogen activator, heparin, and intravenous nitroglycerin. His symptoms resolve, and serum chemistries reveal a peak CPK of 1400 and a CK-MB fraction of 80. He is eventually started on oral medications and transferred out of the cardiac intensive care unit. His subsequent hospital course is uneventful until day 4, when he develops severe shortness of breath. Blood pressure is 110/70, and pulse is 120. Examination reveals a new systolic murmur. The most appropriate therapeutic intervention would be ?

5 >>Which of the following would be the most appropriate drug of choice in the management of torsades de pointes? ?

6 >>Which of the following is appropriate initial therapy in the clinical scenario described in question XI-25? ?

7 >>A 60-year-old man without a significant medical history presents for his annual physical. An electrocardiogram demonstrates two ventricular premature complexes (VPCs) within the 12-lead tracing. Which of the following statements is true? ?

8 >>A female infant is born to a consanguineous marriage of second cousins without complications. In utero, the fetal heart rate was between 80 and 90 beats per minute. The bradycardic heart rate persisted after birth. Approximately 2 weeks after birth the child underwent audiography, which demonstrated bilateral sensory neural deafness. These tests were repeated 2 weeks later with similar results. Unfortunately the mother suffered a cardiac arrest 7 months later and died. She had normal hearing. Which of the following statements concerning this patient’s disorder is true? ?

9 >>Which of the following statements regarding the activation of cardiac myocytes is true? ?

10 >>A 72-year-old woman with a prior history of hypertension is receiving low-dose atenolol, an unknown diuretic, and long-acting diltiazem. She has no other significant cardiac history. The patient is brought to the emergency room after having passed out while getting up to go to the bathroom at 6 A.M. this morning. She is seen by the surgical service, which finds her to have an orbital fracture from when she struck the sink. Internal medicine consultation is requested when an ECG reveals sinus bradycardia at 40 with occasional sinus arrest with pauses of 2 to 3 s but no other abnormalities. She remains somewhat light-headed. Blood pressure is 90/50. Physical examination is otherwise benign. She has been without oral intake since the previous evening. The next steps in treating this patient’s arrhythmia would consist of ?

11 >>Tetralogy of Fallot consists of which of the following abnormalities? ?

12 >>A 64-year-old man with known allergies to penicillin and lobster undergoes a left hip replacement. Recovery is uneventful until the day before discharge, when he begins experiencing palpitations. ECG reveals his baseline right bundle branch block and new atrial flutter at a rate of 110 to 120. He is otherwise asymptomatic. Heparin is started. He remains in atrial fibrillation over the next 2 days while a workup demonstrates normal potassium, magnesium, thyroid-stimulating hormone, and chest x-ray. The decision is made to proceed with chemical cardioversion. He is given intravenous procainamide. Halfway though the infusion, the telemetry suddenly reveals a rate of 240 with narrow QRS complexes. He is found to be pulseless, CPRis begun, and he is defibrillated with 100 J, which restores sinus rhythm that degenerates into atrial fibrillation. This reaction could have been prevented if ?

13 >>Which of the following statements concerning Eisenmenger’s syndrome is true? ?

14 >>Which of the following statements regarding cardiac imaging is correct? ?

15 >>Which of the following statements concerning ventricular free-wall rupture after a myocardial infarction is true? ?

16 >>Cystic medial necrosis is prevalent in which of the following disorders? ?

17 >>A 16-year-old boy is referred by his high school VII-66. (Continued) coach for a physical examination before joining the football team. His older brother died suddenly during football practice; no autopsy was obtained. The patient has a loud systolic murmur. Which of the following would be consistent with hypertrophic cardiomyopathy? ?

18 >>Which of the following disorders can lead to both cardiogenic and noncardiogenic pulmonary edema? ?

19 >>In patients with established coronary artery disease and elevated LDL levels, which of the following statements regarding HMG-CoA reductase inhibitors is true? ?

20 >>You are asked to give medical clearance for a 75- year-old man prior to an elective carotid endarterectomy. His past medical history is significant for hypercholesteremia and hypertension. He also has diet-control diabetes mellitus. His current medications include simvastatin and hydrochlorothiazide. He denies any current or prior cardiac symptoms and has never had a myocardial infarction. His physical examination is unrevealing with the exception of a right carotid bruit. His electrocardiogram is unremarkable with the exception of VPCs at a rate of 2 to 3 per minute. Laboratory analysis is unremarkable including normal renal function and liver function tests. His oxygen saturations are also normal. What would be the expected serious complication rate (perioperative MI, pulmonary edema, or ventricular tachycardia) in this patient? ?