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The patient is exhibiting a productive cough and a low-grade fever. Chest
X-ray on PA view shows a left lower chest area of consolidation adjacent to
the left border of the heart approximately 2 rib spaces above the
costophrenic angle. The lateral x-ray view shows this lesion absent of the
window posterior to the cardiac silhouette. Which is the most likely location
of this area of focal consolidation?
*Left upper lobe apex
*Right middle lobe
*Left upper lobe lingula
*Left lower lobe
Left upper lobe lingula
Ratonale: Lingular consolidation is described in this question precisely. If
the cardiac margin/silhouette is obliterated by the mass, the lesion is either
right middle lobe or left upper lobe lingula.
pg. 1
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The inability to fully relax the myocardium during relaxation is a trademark
of which of the following diagnoses?
Diastolic dysfunction
Rationale: The inability for the heart to relax is a trademark of the diagnosis
of diastolic dysfunction and is common in patients with thickened
hypertrophic myocardium.
An otherwise healthy African American adult male has been diagnosed with
hypertension. He has been restricting his salt intake, eating a DASH
(Dietary Approaches to Stop Hypertension) diet, and exercising more, but
his blood pressure is still elevated. Which is the BEST medication to
prescribe him?
Calcium channel blocker
Rationale: African American patients per JNC8 Hypertension Guidelines
should be managed with a dihydropyridine calcium channel blocker such as
amlodipine (Norvasc) as first line management therapy for hypertension not
at goal with DASH and lifestyle modifications.
pg. 2
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Your patient has been diagnosed with a 4.5cm ascending aortic aneurysm.
Which medical imaging is considered standard of care for serial
surveillance?
CT angiography of the chest
Rationale: CT angiography is considered the standard of care for
measuring vascular luminal dimensions with contrast. CT PE protocol is not
timed properly for the aorta (it's timed for the pulmonary artery). Although a
plain film is able to catch large aneurysms at times, they are not able to
provide multi-axis reconstruction needed to accurately measure the size.
Transesophageal echo is not needed to accurately measure the aorta and
requires the patient to undergo sedation which is unnecessary.
Which of the following medications does not cause beta 1 stimulation?
phenylephrine
Rationale: Phenylephrine only stimulates alpha 1 receptors. The remaining
three all have beta receptor activity.
pg. 3
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A 50-year-old woman with a history of hypertension presents with dyspnea
on exertion and orthopnea. On examination, she has jugular venous
distention and bilateral crackles on lung auscultation. What is the most
likely diagnosis?
Congestive heart failure
Rationale: Of the available options, the most accurate response is
congestive heart failure as it is signifying both a right ventricular back up
with jugular venous extension and crackles on lung assault, which are
suggestive of left ventricular back up. it is possible the patient may have an
acute myocardial infarction that precipitated this, however, a patient has not
described that, rather is only describing dyspnea on exertion and
orthopnea, which both speak to a state of fluid overload. The only
appropriate response of these available is congestive heart failure.
Your patient with a history of HFrEF (heart failure with reduced ejection
fraction) with an ejection fraction of 40% who is also not on optimal medical
therapy has been diagnosed with a myocardial infarction this admission
and received emergent placement of a drug-eluting stent to the left anterior
descending artery. As the medical home who will manage this patient after
discharge, which medication strategy would you expect to be a priority in
the patient's care?
pg. 4
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The patient is exhibiting a productive cough and a low-grade fever. Chest
X-ray on PA view shows a left lower chest area of consolidation adjacent to
the left border of the heart approximately 2 rib spaces above the
costophrenic angle. The lateral x-ray view shows this lesion absent of the
window posterior to the cardiac silhouette. Which is the most likely location
of this area of focal consolidation?
*Left upper lobe apex
*Right middle lobe
*Left upper lobe lingula
*Left lower lobe
Left upper lobe lingula
Ratonale: Lingular consolidation is described in this question precisely. If
the cardiac margin/silhouette is obliterated by the mass, the lesion is either
right middle lobe or left upper lobe lingula.
pg. 1
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The inability to fully relax the myocardium during relaxation is a trademark
of which of the following diagnoses?
Diastolic dysfunction
Rationale: The inability for the heart to relax is a trademark of the diagnosis
of diastolic dysfunction and is common in patients with thickened
hypertrophic myocardium.
An otherwise healthy African American adult male has been diagnosed with
hypertension. He has been restricting his salt intake, eating a DASH
(Dietary Approaches to Stop Hypertension) diet, and exercising more, but
his blood pressure is still elevated. Which is the BEST medication to
prescribe him?
Calcium channel blocker
Rationale: African American patients per JNC8 Hypertension Guidelines
should be managed with a dihydropyridine calcium channel blocker such as
amlodipine (Norvasc) as first line management therapy for hypertension not
at goal with DASH and lifestyle modifications.
pg. 2
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Your patient has been diagnosed with a 4.5cm ascending aortic aneurysm.
Which medical imaging is considered standard of care for serial
surveillance?
CT angiography of the chest
Rationale: CT angiography is considered the standard of care for
measuring vascular luminal dimensions with contrast. CT PE protocol is not
timed properly for the aorta (it's timed for the pulmonary artery). Although a
plain film is able to catch large aneurysms at times, they are not able to
provide multi-axis reconstruction needed to accurately measure the size.
Transesophageal echo is not needed to accurately measure the aorta and
requires the patient to undergo sedation which is unnecessary.
Which of the following medications does not cause beta 1 stimulation?
phenylephrine
Rationale: Phenylephrine only stimulates alpha 1 receptors. The remaining
three all have beta receptor activity.
pg. 3
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A 50-year-old woman with a history of hypertension presents with dyspnea
on exertion and orthopnea. On examination, she has jugular venous
distention and bilateral crackles on lung auscultation. What is the most
likely diagnosis?
Congestive heart failure
Rationale: Of the available options, the most accurate response is
congestive heart failure as it is signifying both a right ventricular back up
with jugular venous extension and crackles on lung assault, which are
suggestive of left ventricular back up. it is possible the patient may have an
acute myocardial infarction that precipitated this, however, a patient has not
described that, rather is only describing dyspnea on exertion and
orthopnea, which both speak to a state of fluid overload. The only
appropriate response of these available is congestive heart failure.
Your patient with a history of HFrEF (heart failure with reduced ejection
fraction) with an ejection fraction of 40% who is also not on optimal medical
therapy has been diagnosed with a myocardial infarction this admission
and received emergent placement of a drug-eluting stent to the left anterior
descending artery. As the medical home who will manage this patient after
discharge, which medication strategy would you expect to be a priority in
the patient's care?
pg. 4
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