MCCQE1 Questions and Answers(A+ Solution guide)

An 80-year-old woman comes to the urgent care clinic with dyspnoea on exertion. On physical examination, her blood pressure is 100/70, and her pulse is 75. She has no pulsus paradoxus. Her jugular veins are distended, and she has distant heart sounds. In addition, she has extra third and fourth heart sounds. Her liver is enlarged, and she has pedal oedema. She has occasional premature ventricular contractions on her electrocardiogram. A chest x-ray reveals clear lung fields with a dilated cardiac silhouette. Her echocardiogram reveals ventricular walls with a "speckled pattern". Which of the following is the most likely diagnosis? - Alcoholic cardiomyopathy - Amyloidosis - Haemochromatosis - Tuberculosis - Viral myocarditis - Answer-Amyloidosis Restrictive cardiomyopathy with 'speckled' left ventricular wall Primary cardiac amyloidosis usually develops into diastolic dysfunction Alcoholic cardiomyopathy: biventricular dilated cardiomyopathy A 92-year-old man with a 45-year history of chronic obstructive pulmonary disease is intubated in the ICU because of a bout of viral pneumonia that fails to improve after 72 hours of antibiotics. Although the inspired fraction of oxygen is 100%, the patient's pO2 remains at 57 mmHg. Positiveend expiratory pressure (PEEP) is added to allow the inspired fraction of oxygen. Twelve hours after the introduction of PEEP the patient suddenly become hypotensive. At the same time, his oxygen saturation drops from 92% to 61%. On physical examination, his BP is 80/50 mmHg and his pulse is 124/min. He has distended neck veins and distant heart sounds. Which of the following would also most likely be seen on this patient's physical examination? - Absence of breath sounds in the right hemithorax - High amplitude carotid artery upstroke - A pleural friction rub - Pulsus alternans - Splenomegaly - Answer-Absence of breath sounds in the right hemithorax Patient has developed a tension pneumothorax, characterised by PEEP followed by sudden hypotension and decreased oxygenation Jugular venous distention occurs because venous return to the right side of the heart is being compressed Rx: immediate needle/tube thoracostomyA 46-year-old man with a history of hypertension and hypercholesterolemia visits the physician for a routine followup. The patient's job involves a lot of travelling, and he admits to occasionally forgetting to take his medications with him when he travels. He complains of several episodes of chest pain in the past few months. The pain is sharp in nature, mainly over his lower chest and epigastrium, and tends to come on when walking. He believes these episodes are due to indigestion and has been taking antacids. There is a family history of heart disease, and his father died of a heart attack at age 48. On physical examination, his blood pressure is 150/80 mmHg and heart rate is 86/min. His lungs are clear to auscultation. Cardiac auscultation reveals normal rate and rhythm, without rubs, gallops, or murmurs. There is no pedal oedema. He is sent for an exercise stress test. Five minutes into the test, he develops ST - Answer-Coronary angiography Multiple risk factors for atherosclerotic coronary artery disease A stress test is considered positive when there are ST depression of >1mm for longer than 0.08 seconds Positive stress test = coronary angiography A 74-year-old woman, who has been followed for the past 25 years for chronic obstructive pulmonary disease comes to the ED complaining of 48 hours of temperature to 38.6 C and worsening shortness of breath. She has a chronic productive cough, which has become more copious. On physical examination, she has rhonchi and increased fremitus in the posterior mid-lung field. A Gram's stain reveals many epithelial cells and multiple gram-positive and gram-negative organisms; no neutrophils are seen. Which of the following is the most likely organism causing the symptoms? - Escherichia coli - Haemophilus influenzae - Klebsiella pneumoniae - Mycobacterium tuberculosis - Mycoplasma pneumoniae - Answer-Haemophilus influenzae