ROSH Review- Cardiovascular & Pulmonology UPDATED ACTUAL
Questions and CORRECT Answers
1. A 65-year-old man with a medical history of ather- D) Squatting
osclerosis, hypertension, and stable angina presents
to the clinic for routine follow-up. Current medica-
tions include lisinopril, atorvastatin, aspirin, and pro-
pranolol. Vital signs are HR 76 bpm, RR 17 breaths per
minute, BP 142/88 mm Hg, T 97.6°F, and SpO2 97% on
room air. During cardiac auscultation, a harsh crescen-
do-decrescendo systolic ejection murmur is heard over
the right upper sternal border with radiation to the
carotids bilaterally. Which of the following maneuvers
is most likely to accentuate this murmur?
A) Abrupt standing
B) Handgrip
C) Lying down
D) Squatting
E) Valsalva maneuver
2. Which of the following pathophysiologic changes is A) Decreased elastic recoil
characteristic of chronic obstructive pulmonary dis- pressure
ease?
A) Decreased elastic recoil pressure
B) Decreased number of goblet cells
C) Decreased static hyperinflation
D) Small airway dilation
3. A 65-year-old man presents to the clinic with chest pain C) Pursed-lip breathing
for 2 days. The physical examination reveals signs of
dyspnea. Which of the following physical examination
findings are associated with dyspnea?
, A) Barrel chest
B) Oxygen saturation of 88%
C) Pursed-lip breathing
D) Wheezing
4. A 59-year-old man presents to the clinic to establish A) Change pravastatin to
care. Past medical history includes type 2 diabetes mel- atorvastatin 80 mg daily
litus and prior non-ST elevation myocardial infarction.
Medications are metformin 2 g daily, canagliflozin 100
mg daily, aspirin 81 mg daily, losartan 50 mg daily,
carvedilol 25 mg twice daily, and pravastatin 40 mg
daily. He has never smoked, and his blood pressure is
127/81 mm Hg. Laboratory data is as follows:
Total cholesterol: 191 mg/dL
HDL cholesterol: 43 mg/dL
LDL cholesterol: 138 mg/dL
Sodium: 138 mEq/L
Potassium: 4.2 mEq/L
Chloride: 101 mEq/L
Bicarbonate: 27 mEq/L
Blood urea nitrogen: 22 mg/dL
Creatinine: 1.1 mg/dL
Hemoglobin A1C: 7.4%
Which of the following would be the most appropriate
changes to make to this patient's statin regimen?
A) Change pravastatin to atorvastatin 80 mg daily
B) Change pravastatin to rosuvastatin 10 mg daily
C) Continue pravastatin 40 mg daily
D) Increase pravastatin to 80 mg daily
,5. A 60-year-old man presents with shortness of breath. B) Tricuspid regurgitation
Auscultation of his chest with the patient lying supine
at 45 degrees reveals a systolic murmur at the left
lower sternal border and a jugular venous pressure at
5 cm above the sternal notch. What is the diagnosis?
A) Mitral valve prolapse
B) Tricuspid regurgitation
C) Tricuspid stenosis
D) Ventricular septal defect
6. A 52-year-old man with a history of diabetes mellitus A) Ankle-brachial index
type 2 and cigarette smoking presents to your clinic
with a six-month history of worsening leg pain. The
patient reports his pain is worse when walking and
improved with rest. Physical exam reveals decreased
hair growth over the distal extremities and bilateral
diminished dorsalis pedis pulses. What is the most
appropriate diagnostic test to establish the suspected
diagnosis?
A) Ankle-brachial index
B) CTA of the lower extremities
C) Duplex ultrasonography
D) MRA of the lower extremities
7. A 6-week-old infant presents with decreased activi- A) Cardiac disease
ty and intermittent cyanosis. Multiple studies are ob-
tained. Chest radiography is significant for an enlarged
pulmonary artery shadow and prominent hilar vascu-
larity. A diagnosis of pulmonary hypertension is sus-
pected. What is the most common etiology of pul-
, monary hypertension among children?
A) Cardiac disease
B) Familial pulmonary arterial hypertension
C) Idiopathic pulmonary arterial hypertension
D) Lung disease
8. Which of the following children should be referred for D) A grade 4 holosystolic
cardiac evaluation for a suspected pathological heart murmur that is more in-
murmur? tense with upright posi-
tioning in a 1 year old
A) A grade 1 vibratory murmur with minimal radiation
in a 3 year old
B) A grade 2 musical murmur with no associated click,
gallop, or rub in a 2 year old
C) A grade 2 short systolic murmur that is more intense
when supine rather than sitting in a 4 year old
D) A grade 4 holosystolic murmur that is more intense
with upright positioning in a 1 year old
9. A 62-year-old man with no significant medical history B) Kussmaul sign
presents to his primary care physician with reports
of dyspnea, fatigue, and lower extremity edema. His
BP is 122/79 mm Hg, HR 68 bpm, RR 14 breaths per
minute, and T 37.2°C. He is noted to have jugular
venous distension, and cardiac auscultation reveals a
pericardial knock. His lungs are clear to auscultation,
and his abdomen is tender to palpation of the right up-
per quadrant without distension or rigidity. His lower
extremities show bilateral edema, and he has no calf
Questions and CORRECT Answers
1. A 65-year-old man with a medical history of ather- D) Squatting
osclerosis, hypertension, and stable angina presents
to the clinic for routine follow-up. Current medica-
tions include lisinopril, atorvastatin, aspirin, and pro-
pranolol. Vital signs are HR 76 bpm, RR 17 breaths per
minute, BP 142/88 mm Hg, T 97.6°F, and SpO2 97% on
room air. During cardiac auscultation, a harsh crescen-
do-decrescendo systolic ejection murmur is heard over
the right upper sternal border with radiation to the
carotids bilaterally. Which of the following maneuvers
is most likely to accentuate this murmur?
A) Abrupt standing
B) Handgrip
C) Lying down
D) Squatting
E) Valsalva maneuver
2. Which of the following pathophysiologic changes is A) Decreased elastic recoil
characteristic of chronic obstructive pulmonary dis- pressure
ease?
A) Decreased elastic recoil pressure
B) Decreased number of goblet cells
C) Decreased static hyperinflation
D) Small airway dilation
3. A 65-year-old man presents to the clinic with chest pain C) Pursed-lip breathing
for 2 days. The physical examination reveals signs of
dyspnea. Which of the following physical examination
findings are associated with dyspnea?
, A) Barrel chest
B) Oxygen saturation of 88%
C) Pursed-lip breathing
D) Wheezing
4. A 59-year-old man presents to the clinic to establish A) Change pravastatin to
care. Past medical history includes type 2 diabetes mel- atorvastatin 80 mg daily
litus and prior non-ST elevation myocardial infarction.
Medications are metformin 2 g daily, canagliflozin 100
mg daily, aspirin 81 mg daily, losartan 50 mg daily,
carvedilol 25 mg twice daily, and pravastatin 40 mg
daily. He has never smoked, and his blood pressure is
127/81 mm Hg. Laboratory data is as follows:
Total cholesterol: 191 mg/dL
HDL cholesterol: 43 mg/dL
LDL cholesterol: 138 mg/dL
Sodium: 138 mEq/L
Potassium: 4.2 mEq/L
Chloride: 101 mEq/L
Bicarbonate: 27 mEq/L
Blood urea nitrogen: 22 mg/dL
Creatinine: 1.1 mg/dL
Hemoglobin A1C: 7.4%
Which of the following would be the most appropriate
changes to make to this patient's statin regimen?
A) Change pravastatin to atorvastatin 80 mg daily
B) Change pravastatin to rosuvastatin 10 mg daily
C) Continue pravastatin 40 mg daily
D) Increase pravastatin to 80 mg daily
,5. A 60-year-old man presents with shortness of breath. B) Tricuspid regurgitation
Auscultation of his chest with the patient lying supine
at 45 degrees reveals a systolic murmur at the left
lower sternal border and a jugular venous pressure at
5 cm above the sternal notch. What is the diagnosis?
A) Mitral valve prolapse
B) Tricuspid regurgitation
C) Tricuspid stenosis
D) Ventricular septal defect
6. A 52-year-old man with a history of diabetes mellitus A) Ankle-brachial index
type 2 and cigarette smoking presents to your clinic
with a six-month history of worsening leg pain. The
patient reports his pain is worse when walking and
improved with rest. Physical exam reveals decreased
hair growth over the distal extremities and bilateral
diminished dorsalis pedis pulses. What is the most
appropriate diagnostic test to establish the suspected
diagnosis?
A) Ankle-brachial index
B) CTA of the lower extremities
C) Duplex ultrasonography
D) MRA of the lower extremities
7. A 6-week-old infant presents with decreased activi- A) Cardiac disease
ty and intermittent cyanosis. Multiple studies are ob-
tained. Chest radiography is significant for an enlarged
pulmonary artery shadow and prominent hilar vascu-
larity. A diagnosis of pulmonary hypertension is sus-
pected. What is the most common etiology of pul-
, monary hypertension among children?
A) Cardiac disease
B) Familial pulmonary arterial hypertension
C) Idiopathic pulmonary arterial hypertension
D) Lung disease
8. Which of the following children should be referred for D) A grade 4 holosystolic
cardiac evaluation for a suspected pathological heart murmur that is more in-
murmur? tense with upright posi-
tioning in a 1 year old
A) A grade 1 vibratory murmur with minimal radiation
in a 3 year old
B) A grade 2 musical murmur with no associated click,
gallop, or rub in a 2 year old
C) A grade 2 short systolic murmur that is more intense
when supine rather than sitting in a 4 year old
D) A grade 4 holosystolic murmur that is more intense
with upright positioning in a 1 year old
9. A 62-year-old man with no significant medical history B) Kussmaul sign
presents to his primary care physician with reports
of dyspnea, fatigue, and lower extremity edema. His
BP is 122/79 mm Hg, HR 68 bpm, RR 14 breaths per
minute, and T 37.2°C. He is noted to have jugular
venous distension, and cardiac auscultation reveals a
pericardial knock. His lungs are clear to auscultation,
and his abdomen is tender to palpation of the right up-
per quadrant without distension or rigidity. His lower
extremities show bilateral edema, and he has no calf
