Aquifer Internal Medicine End of Case Questions & Answers (100% correct 2023)

A 52-year-old female presents with one month of progressive dyspnea on exertion, a productive cough of clear sputum, bilateral leg swelling, and orthopnea. She has had no chest pain or fevers. She has a history of poorly controlled hypertension and 30-pack-years of smoking. Before beginning her physical exam, you determine that her pre-exam probability of heart failure is moderate. On exam, you find a jugular venous pulse and pressure (JVP) of 12 cm with positive hepatojugular reflux, regular heart rate, normal S1 and S2 with S3 gallop, 3/6 systolic crescendo-decrescendo murmur at the right upper sternal border, crackles at both lung bases. Which of the following physical examination findings most increases your post-exam probability of congestive heart failure? A. Bibasilar crackles B. Hepatojugular reflux C. Increased jugular venous pressure D. Systolic murmur in the aortic area E. Third heart sound correct answersThe answer is E. From IM 04. A 68-year-old male with hypertension and non-ischemic cardiomyopathy is admitted to the hospital with an acute exacerbation of his congestive heart failure (CHF). An echocardiogram (ECG) one month ago showed left-ventricular hypertrophy and a left-ventricular ejection fracture (LVEF) of 60%. He takes ramipril and chlorthalidone at home, and these are continued. His pulse is 85 beats/minutes, blood pressure is 134/88 mmHg, and oxygen saturation is 95% on two liters of oxygen by nasal cannula. His exam is notable for jugular venous pulse and pressure (JVP) of 12, bilateral leg edema, and crackles at his lung bases. What will be the next step in management of this man? A. Add furosemide intravenously B. Add metoprolol orally C. Add valsartan D. Increase dose of chlorthalidone E. Increase dose of ramipril correct answersThe answer is A. From IM 04.