1 >>Which of the following statements regarding the vascular biology of the atherosclerotic process is true? ?
- (A) The atheroma is the initial lesion of atherosclerosis
- (B) Unlike LDL, lipoprotein (a) [Lp(a)] is not particularly atherogenic
- (C) Atherosclerosis is a diffuse proce
- (D) Adhesion molecules such as VCAM-1 are expressed by endothelial cells and act as receptors for circulating lymphocytes and monocytes
2 >>A 54-year-old woman presents to the office asking for a second opinion regarding her shortness of breath. She has a history of cigarette smoking for many years but stopped 2 years ago, when she was found to have breast cancer. She underwent a modified radical mastectomy but received no additional therapy. She also has a history of hypertension previously controlled with hydrochlorothiazide (HCTZ). Approximately 6 months ago, she saw her internist because of mild shortness of breath unresponsive to an increase in the HCTZ dose or a subsequent change to furosemide. She developed ankle swelling, worsened shortness of breath, and orthopnea. Blood pressure is 130/ 100 without pulsus paradoxus, and pulse is 110. She appears to be in moderate respiratory distress. Chest examination reveals faint bibasilar crackles. Heart sounds are decreased but unremarkable. The abdomen is benign. There is 2+ pitting edema. Chest x-ray reveals moderate cardiomegaly and bilateral pleural effusions. ECG demonstrates low voltage but no evidence of right ventricular strain. Which of the following statements is true? ?
- (A) The increasing doses of diuretics have helped her remain at home and free of worsening dyspnea
- (B) The patient probably has direct myocardial invasion by a tumor
- (C) An echocardiogram would offer absolute proof of the diagnosis
- (D) The lack of pulsus paradoxus could suggest the presence of an atrial septal defect
3 >>Which of the following has been demonstrated to reduce perioperative mortality in patients undergoing noncardiac surgery? ?
- (A) Nitrates
- (B) Beta blocker
- (C) Calcium channel blocke
- (D) Diuretic therapy
4 >>Acute hyperkalemia is associated with which of the following electrocardiographic changes? ?
- (A) QRS widening
- (B) Prolongation of the ST segment
- (C) A decrease in the PRinterval
- (D) Prominent U waves
5 >>Which of the following statements regarding exercise tolerance tests is true? ?
- (A) A marked increase in blood pressure during the test suggests poor conditioning and probably will cause the test to be nondiagnostic
- (B) Given a specificity of 90% and a sensitivity of 80%, a positive test in a patient whose prior probaVII-72. (Continued) bility of having coronary artery disease (based on clinical factors) is 10% suggests a 80% likelihood that the patient actually has coronary artery disease
- (C) Thallium 201 exercise scanning increases both the sensitivity and the specificity for detecting ischemic heart disease
- (D) A thallium 201 scan done at peak exercise that reveals a nonperfused area of myocardium indicates that the patient has suffered a prior myocardial infarction
6 >>Mild heart failure resulting from left ventricular dysfunction is accurately described by which of the following statements? ?
- (A) Cardiac output would be depressed at rest
- (B) Plasma norepinephrine levels would be lower than those in normal controls during exercise
- (C) Myocardial norepinephrine content would be high
- (D) Cardiac output would fail to rise appropriately when oxygen consumption was increased during exercise
7 >>Drugs that would antagonize the interaction of catecholamines with adrenergic receptors include ?
- (A) methyldopa
- (B) clonidine
- (C) phenylephrine
- (D) yohimbine
8 >>A 37-year-old man with Wolff-Parkinson-White syndrome develops a broad-complex irregular tachycardia at a rate of 200 beats per minute. He appears comfortable and has little hemodynamic impairment. Useful treatment at this point might include ?
- (A) digoxin
- (B) amiodarone
- (C) propranolol
- (D) direct-current cardioversion
9 >>Sudden cardiac death is accurately described by which of the following statements? ?
- (A) Ventricular tachycardia or ventricular fibrillation during the convalescent phase (3 days to 8 weeks) after a myocardial infarction is not a risk factor for subsequent sudden cardiac death
- (B) The presence of VPCs in a patient convalescing from a myocardial infarction increases the risk of sudden cardiac d
- (C) If only one person is present to provide basic life support, chest compressions should be performed at a rate of 80 per minute, and breaths twice in succession every 15 s
- (D) Assuming there is no spontaneous pulse, a 400-J shock should be delivered immediately upon recognition of ventricular tachycardia or ventricular fibrillation
10 >>A 17-year-old girl has an atrial septal defect of the sinus venosus type, with a 3:1 pulmonary-to-systemic blood flow ratio. True statements concerning her condition include which of the following? ?
- (A) The patient is likely to complain of chest pain, dyspnea on exertion, and recurrent palpitations
- (B) She probably has partial anomalous connection of the pulmonary veins
- (C) The magnitude of the shunt is a function of the amount of total blood flow
- (D) A systolic murmur probably would be due to flow across the defect
11 >>The initial positive deflection in the jugular venous pulse (a wave) can be accentuated in which of the following conditions? ?
- (A) Reentrant paroxysmal supraventricular tachycardia (PSVT)
- (B) Tricuspid regurgitation
- (C) Atrial fibrillation
- (D) Multiple pulmonary emboli
12 >>For which of the following patients would cardiac surgery be appropriately recommended? ?
- (A) An asymptomatic 20-year-old man with a loud midsystolic murmur due to a congenital bicuspid aortic valve
- (B) A 54-year-old man who has aortic stenosis and has chest pain on moderate to strenuous exertion
- (C) A 33-year-old man who has chest pain, fatigue, cyanosis, a large ventricular septal defect, a 2:1 rightto-left shunt, and a normal pulmonary outflow tract and pulmonic valve
- (D) A 52-year-old man who has chronic mitral regurgitation and has recently developed pulmonary edema associated with the onset of rapid atrial fibrillation
13 >>True statements regarding balloon valvuloplasty include ?
- (A) balloon dilatation of a stenotic pulmonary valve is not feasible because of the danger of rupture of the thin-walled pulmonary artery
- (B) mitral valvuloplasty increases the effective diastolic valve area to normal size
- (C) balloon aortic valvuloplasty is contraindicated in calcific aortic stenosis because the fracture of calcium deposits on the leaflets leads to cerebral emboli
- (D) restenosis after aortic valvuloplasty is a significant problem
14 >>True statements regarding hemodynamic changes occurring during exercise include which of the following? ?
- (A) Venous return is impeded by the pumping action of skeletal muscles
- (B) The increased adrenergic nerve impulses to the heart as well as an increased concentration of circulating catecholamines help augment the contractile state of the myocardium
- (C) Venoconstriction in exercising muscles as well as increased cardiac output leads to marked increases in systemic blood pressure
- (D) End-diastolic volume decreases in a failing heart during exercise
15 >>A 34-year-old woman is bothered by palpitations and chest pain. On auscultation, the first heart sound is normal, but there is a midsystolic click and a late systolic murmur. Her electrocardiogram shows T-wave inversions in leads II, III, and aVF. True statements concerning her condition include which of the following? ?
- (A) An exercise stress test would most likely be positive
- (B) An echocardiogram may show abrupt posterior displacement of both mitral leaflets
- (C) The woman’s chest pain could be due to partial obstruction of her coronary ostia
- (D) The click and murmur would be expected to occur later in systole when the woman stands
16 >>A permanent atrioventricular sequential pacemaker (DDD) would be preferred to a standard ventricular pacemaker (VVI) in which of the following patients? ?
- (A) A 64-year-old woman with atrial fibrillation and a ventricular rate of 40 beats per minute
- (B) A 56-year-old man with a prolonged PRinterval
- (C) An active 46-year-old man with a sinus rhythm at a rate of 48
- (D) A 50-year-old man with hypertrophic cardiomyopathy and infranodal second-degree atrioventricular block
17 >>In which of the following patients would you recommend a preoperative noninvasive functional assessment? ?
- (A) An emergent repair of a ruptured appendix
- (B) A 65-year-old man prior to undergoing a carotid endarterectomy, who underwent a coronary artery bypass graft (CABG) 2 years earlier and has had no prior symptoms
- (C) A 62-year-old man with hypertension, hypercholesteremia, and diabetes mellitus who is having recurrent chest pain with only minimal exertion prior to his radical prostatectomy
- (D) A 65-year-old man with a prior history of angina but no history of myocardial infarction planning to undergo an elective hip replacement
18 >>A 65-year-old obese man complains of progressive pain in both knees, exacerbated by walking. Past medical history is unremarkable. Physical examination discloses normal pulses and circulation and no joint effusions. Bony crepitus is evident upon movement of either knee joint. Routine laboratory studies, including an ESR, are normal. Radiographs of the knees reveal joint space narrowing. What is the most important pathophysiologic feature in this situation? ?
- (A) Deposition of calcium pyrophosphate crystals
- (B) Deposition of urate crystals
- (C) Lymphocytic infiltration of synovium
- (D) Loss of articular cartilage
19 >>A 50-year-old woman with a history of hypertension (but taking no medication currently) presents to the emergency ward with a complaint of sudden palpitations and faintness. Her pulse is 120, and the 12-lead ECG discloses a wide-complex tachycardia. Which of the following characteristics would suggest a ventricular origin for her tachycardia rather than supraventricular tachycardia with aberrant conduction? ?
- (A) A QRS complex of 0.12 s
- (B) A QRS complex of 0.22 s
- (C) Very irregular rhythm
- (D) Atrioventricular dissociation
20 >>A 23-year-old man has had recent onset of exertional dyspnea. A grade III/VI systolic murmur is heard at the left sternal border. Electrocardiography shows apical and lateral Q waves and left ventricular hypertrophy. Echocardiography reveals asymmetric septal hypertrophy without evidence of obstruction. Correct statements regarding this clinical situation include which of the following? ?
- (A) The man’s dyspnea is best explained by lateral wall infarction
- (B) No familial predisposition is seen
- (C) The risk of sudden death is low
- (D) Calcium channel blockers may relieve the symptoms