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1) A 75-year-old African-American man presents with a 5-month history of
gradually progressive dyspnea that is especially pronounced when climbing
stairs. He also has been noticing that his ankles and lower legs have
"gotten larger" over roughly the same time period, which no longer allows
him to fit into his sneakers. He denies fever, chills, chest pain, palpitations,
cough, pleurisy, calf pain, abdominal complaints, sick contacts, or travel.
His psychosocial history is noteworthy for chronic alcohol use. His physical
exam reveals bibasilar rales, JVD of 5cm, an S3 gallop, a holosystolic
murmur at the apex that radiates to the left axilla, and 2+ pitting edema to
the level of the mid-calves bilaterally. A bedside echocardiogram was
remarkable for biventricular enlargement.
A Tachycardia
B Fever
C Asymmetric upper extremity blood pressures
D Warm, moist skin
E Acanthosis nigricans - ✔✔A
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©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
,The patient is a 20-year-old man who presents to a medical clinic for a
routine physical required before he enlists in the army. His family history is
significant for 2 relatives who had sudden cardiac arrest in their late 20's or
early 30's. He does not know any more details about these relatives or their
medical history. His review of systems is negative with the exception of rare
episodes of heart palpitations.
What is the most likely finding on the patient's cardiac examination if he
has hypertrophic cardiomyopathy?
A soft heart sounds and an S3 gallop
B brisk heart sounds and an S4 gallop
C early diastolic pericardial knock
D S4 gallop and no murmur
E 3 component friction rub - ✔✔B
What is expected to be true regarding the murmur in this patient?
A It decreases while in an upright posture.
B It becomes less intense with the Valsalva maneuver.
C It decreases with squatting.
D It increases with sustained handgrip.
E It increases with lying down. - ✔✔C
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©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
,A 40-year-old man presents with atrial flutter with 2:1 atrioventricular (AV)
conduction, giving him a pulse of 150 per minute, which is perfectly regular.
His blood pressure is 70/40 mmHg. He takes no medications regularly. You
plan to provide him with urgent direct current cardioversion with conscious
sedation. What would be an appropriate level of energy for cardioversion in
order to restore sinus rhythm in this patient?
A 10 Joules
B 15 Joules
C 50 Joules
D 200 Joules
E 300 Joules
F 360 Joules - ✔✔C
Which of the following complications is commonly associated with
subarterial VSD?
A Infective endocarditis
B Pulmonary hypertension
C Congestive cardiac failure
D Cor pulmonale
E Aortic insufficiency (AI) - ✔✔E
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©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
, A 3-month-old term infant presents for a wellness exam, and his parents
report worsening in his feeding habits and rapid breathing. On exam, there
is a grade III/VI harsh heart murmur heard over the left subclavicular region
that starts in early systole, peaks at S2, and decrescendos until the next
S1. The infant is tachypneic and has bounding pulses of his upper and
lower extremities. All other findings are within normal limits. A chest x-ray
shows an enlarged left ventricle and atrium and increased pulmonary
vasculature markings.
Based on the above findings, what is the most likely diagnosis?
Answer Choices:
A Atrial Septal Defect
B Congenital Pulmonic Valve Stenosis
C Ventricular Septal Defect
D Patent Ductus Arteriosus
E Congenital Aortic Valve Stenosis - ✔✔D
A 12-year-old presents with an injury of his left arm and leg. He states that
he felt dizziness during the 2nd mile of the long distance run organized by
the school. He fell and lost the consciousness for several seconds, but after
that he felt "normal". His father has been diagnosed with Emery-Dreifuss
muscular dystrophy type 1. On examination, you find a few superficial
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©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.