1 >>Aortic regurgitation is accurately characterized by which of the following statements? ?
- (A) Most cases of aortic regurgitation (with or without associated lesions) are due to congenital (including Marfan’s syndrome), syphilitic, or spondylitic causes
- (B) Quincke’s pulse refers to the pistol-shot sound audible over the femoral arteries
- (C) The Graham Steell murmur of pulmonary regurgitation is frequently associated
- (D) The echocardiogram frequently reveals fluttering of the anterior leaflet of the mitral valve
2 >>Which of the following findings probably would be present in a patient who sustained recurrent pulmonary emboli? ?
- (A) No right ventricular uptake on thallium 201 scintigraphy
- (B) Left bundle branch block pattern on electrocardiographic examination
- (C) Tricuspid regurgitant flow on Doppler echocardiography
- (D) Non of the above
3 >>True statements regarding the effect of alcohol on the heart include which of the following? ?
- (A) Chronic ingestion of alcohol will lead to a restrictive cardiomyopathy (B) Once heart failure dev
- (B) Once heart failure develops, discontinuing the consumption of alcohol will not app
- (C) If thiamine deficiency is present in an alcoholic, high output failure is noted
- (D) If a patient with heart failure caused by ethanol continues to drink, he or she is unlikely to be alive in 3 years
4 >>True statements regarding cardiac neoplasms include ?
- (A) lymphoma is the most common malignant neoplasm that primarily involves the heart
- (B) the most common site for a myxoma is the right atrium
- (C) myxomas may arise as part of a familial syndrome that also includes pigmented skin lesions and endocrine abnormalities
- (D) a midsystolic “plop” typically indicates the presence of a cardiac myxoma
5 >>A 65-year-old man with a history of multiple prior myocardial infarctions and episodes of congestive heart failure presents to the emergency room with sustained ventricular tachycardia (VT). His blood pressure is stable and he is mentating well. Administration of which of the following antiarrhythmic agents would be most appropriate? ?
- (A) Epinephrine
- (B) Lidocaine
- (C) Bretylium
- (D) Propafenone
6 >>The rhythm of the patient in VII-93 converts to normal sinus after the administration of the above agent. Unfortunately, in spite of continued administration the patient develops several other episodes of sustained VT. The most recent episode is poorly tolerated with the development of significant hypotension requiring electrical cardioversion. An electrophysiologic study fails to reveal an inducible VT/VF rhythm. Which of the following treatment recommendations would be associated with the highest overall survival? ?
- (A) Sotalol
- (B) Amiodarone
- (C) Propafenone
- (D) Placement of an implanted cardioverter/defibrillator (ICD)
7 >>Which of the following statements regarding exercise and cardiovascular morbidity is true? ?
- (A) Regular exercise does not provide adequate protection against an MI during heavy physical exertion
- (B) Heavy physical exertion can trigger the onset of an acute MI
- (C) The incidence of MI is less frequent during the early morning hours after arising from sleep
- (D) The mechanism of cardiac ischemia involves decreased oxygen delivery due to vasoconstriction of the coronary arteries and not due to atherosclerotic plaque
8 >>A 70-year-old woman presents with blurring of vision in the left eye since waking earlier in the morning. She reports 2 months of fevers, sweats, anorexia, and a 4.5-kg (10-lb) weight loss. She also reports increasingly severe left temporal headaches over the same time period. Her physical examination reveals scalp tenderness over the left temporal region. Her laboratories reveal a normochromic, normocytic anemia, mildly elevated alkaline phosphatase, and an erythrocyte sedimentation rate of 92. Appropriate action includes ?
- (A) obtaining an emergent MRI/MRA of her head
- (B) referring the patient for a biopsy of her temporal artery, but abstaining from initiating therapy until the biopsy results are available
- (C) initiating high-dose glucocorticoid therapy and referring the patient for a temporal artery biopsy
- (D) obtaining a head CT to rule out metastatic disease and scheduling a colonoscopy
9 >>Which of the following statements concerning acute rheumatic fever is true? ?
- (A) Migratory polyarthritis occurs in < 10% of patients
- (B) Sydenham’s chorea typically occurs early in the course of the disease
- (C) Erythema marginatum is a common finding, occurring in > 50% of cases
- (D) Secondary prophylaxis should be initiated in order to decrease recurrent episodes of rheumatic fever
10 >>You are asked to evaluate a 65-year-old man in the emergency room complaining of the acute onset of chest pain. During your evaluation the patient becomes unresponsive and is pulseless. A cardiac monitor reveals ventricular fibrillation. What would be the most appropriate sequence of events? ?
- (A) Immediately begin CPR, followed by intubation, followed by defibrillation starting at 100 J, followed by 200 J and then 360 J
- (B) Immediately begin CPR, followed by intubation then defibrillation starting at 200 J, then 300 J, then 360 J
- (C) Immediately begin CPR, followed by defibrillation at 100 J, then 200 J, then 360 J
- (D) Immediately begin CPR, followed by defibrillation at 200 J, then 300 J, then 360 J
11 >>The patient in Question eventually develops a sinus rhythm with a stable blood pressure. He is transferred to the intensive care unit. It is discovered that the etiology of his ventricular fibrillation is most likely associated with a large anterior wall and myocardial infarction. During his postinfarction recovery phase, the patient undergoes a percutaneous coronary angioplasty with a stent placement; he quickly stabilizes. The patient has no further chest pain and no further arrhythmias during his hospitalization. Which of the following would be the most appropriate management decision with respect to his arrhythmia? ?
- (A) No antiarrhythmia therapy is required
- (B) An implantable cardioverter-defibrillator (ICD)
- (C) Beta blocker
- (D) Epinephrine
12 >>A woman who has rheumatoid arthritis suddenly develops pain and swelling in the right calf. The most likely diagnosis is ?
- (A) ruptured plantaris tendon
- (B) pes anserinus bursitis
- (C) ruptured popliteal cyst
- (D) thrombophlebitis
13 >>A young man is brought to the emergency department after having been submerged for a prolonged period in a nearby pond. Cardiopulmonary resuscitation was performed at the scene. The patient is being ventilated by mask and bag upon arrival in the emergency department. A brief examination reveals that the patient has no obvious sites of trauma and is conscious but not communicative. His blood pressure is 90/60, pulse is 120, temperature is 36C (96.8F), and respiratory rate is 30. Cardiac rhythm reveals sinus tachycardia. Pulse oximetry reveals oxygen saturation of 83%. Which of the following is the best method to reverse the patient’s apparent hypoxemia? ?
- (A) Administration of sodium bicarbonate
- (B) Administration of acetazolamide
- (C) Administration of supplemental oxygen
- (D) Application of continuous positive airway pressure (CPAP) and administration of supplemental oxygen
14 >>A 63-year-old man has pneumococcal pneumonia with extensive air-space consolidation in the left upper and left lower lobes. He complains of extreme shortness of breath when positioned with his left side down. An arterial blood sample drawn in this position shows a PO2 of 6.2 kPa (46 mmHg); 10 min earlier, an arterial blood sample drawn while his right side was dependent had revealed a P of 8.2 kPa (66 mmHg). The most likely explanation for the drop in PO2 when the man was lying on O2 his left side is ?
- (A) increased blood flow to the dependent lung
- (B) reduced ventilation to the dependent lung
- (C) increased airway resistance in the dependent lung
- (D) accumulation of interstitial edema in the dependent lung
15 >>A 65-year-old man presents with progressive shortness of breath. Other than a history of heavy tobacco use, the patient has a benign past medical history. Breath sounds are absent two-thirds of the way up on the left side of the chest. Percussion of the left chest reveals less resonance than normal. While you place your hand on the left side of the chest and have the patient say “ninetynine,” no tingling is appreciated in the hand. The trachea appears to be deviated toward the left. Which of the following diagnoses is most likely ?
- (A) Bacterial pneumonia
- (B) Viral pneumonia
- (C) Bronchial obstruction
- (D) Pleural effusion
16 >>The best way to make a diagnosis of cystic fibrosis in a patient suspected of having this disorder is ?
- (A) sweat chloride test
- (B) stool for fetal fat content
- (C) pulmonary function testing
- (D) None Of These
- (A) Inhaled cromolyn sodium
- (B) Prednisone
- (C) Inhaled beclomethasone
- (D) Discontinuation of visits to the animal facility
18 >>The primary pathophysiologic problem in idiopathic pulmonary fibrosis is believed to be ?
- (A) microorganism-mediated activation of pulmonary neutrophil
- (B) immune complex- mediated activation of alveolar macrophages
- (C) direct immune complex- mediated pulmonary interstitial damage
- (D) primary fibroblast proliferation
19 >>A 59-year-old man with a long-standing smoking history presents with persistent dyspnea. His FEV is 1.0 1 L/min, arterial blood gas reveals P of 60 mmHg, P O CO 2 2 of 40 mmHg, pH 7.45, and O saturation of 90%. He has 2 hyperlucent lungs on chest x-ray and decreased breath sounds on physical examination. The patient’s current medical regimen consists of theophylline (300 mg twice daily) and inhaled isoproterenol. The most important addition to the patient’s therapy would be ?
- (A) trimethoprim-sulfamethoxazole
- (B) substitution of albuterol for isoproterenol
- (C) oxygen therapy
- (D) prednisone
20 >>Although asthma is a heterogeneous disease, a given individual with asthma would be most likely to ?
- (A) relate a personal or family history of allergic diseases
- (B) conform to a characteristic personality type
- (C) display a skin-test reaction to extracts of airborne allergens
- (D) demonstrate nonspecific airway hyperirritability