Exam Master Cardiology(All Accurately solved)
A 62-year-old man with a 15-year history of hypertension presents with severe tearing chest pain
radiating through to the back. Blood pressure is 180/110 mm Hg, heart rate is 120 bpm, and
respiratory rate is 34/min. Physical examination findings include neck negative for bruits/JVD,
lungs clear to auscultation, regular heart rhythm, normal S1/S2 with an S4 present, and a grade
III/IV diastolic rumbling murmur noted with the patient leaning forward. Radial pulses are 1+ on
right and 3+ on left. EKG reveals a sinus tachycardia and evidence of left ventricular
hypertrophy. A STAT chest X-ray is obtained.
Question
What finding is most consistent with the presumptive diagnosis?
1 Prominent pulmonary hila
2 Widening of the superior mediastinum
3 Kerley B lines
4 Right-sided pulmonary effusion
5 Prominent right cardiac shadowing correct answers2. Widening of the superior mediastinum
A 78-year-old woman is an inpatient status post-colectomy for colon cancer. On postoperative
day 3, her oral temperature is noted to be elevated to 100.6°F. Chest X-ray and urinalysis are
both negative for signs of infection. An infectious disease consult is placed in order to better
define the patient's new fever. You suspect superficial thrombophlebitis.
Question
What physical examination findings would support your suspicion?
1 Abdominal tenderness in the right upper quadrant
2 Positive Homans sign in left calf
3 Abdominal tenderness in the left lower quadrant
4 Erythema and tenderness along the vein with IV insertion
5 Erythema and tenderness along her incision site correct answers4. Erythema and tenderness
along the vein with IV insertion
,A 65-year-old man presents to the office due to 6 months of bilateral buttock and thigh cramping
pain. It occurs after walking 20 feet and is completely and quickly relieved with resting. His past
medical history includes hypertension treated with atenolol, and he had a stroke 3 years ago. He
also reports impotence for approximately the same duration of time.
Question
What is the patient's physical exam likely to include?
1 Absent femoral, popliteal, pedal pulses
2 Absent popliteal and pedal pulses; normal femoral pulses
3 Absent pedal pulses; normal femoral and popliteal pulses
4 Normal femoral, popliteal, pedal pulses
5 Normal femoral and popliteal pulses; diminished pedal pulses correct answers1. Absent
femoral, popliteal, pedal pulses
A 51-year-old man with a history of Marfan syndrome presents to the emergency department
with tearing chest pain that radiates to the back and neck. On examination, the patient is
hypertensive; a high-pitched decrescendo diastolic murmur at the left sternal border and
diminished peripheral pulses are noted.
Question
Based on the patient's most likely diagnosis, what is the immediate diagnostic imaging modality
of choice?
1 Posterior-anterior chest X-ray (PA CXR)
2 Computed tomography scan of the chest and abdomen (CT scan)
3 Magnetic resonance imaging of the chest (MRI)
4 12-lead electrocardiogram (ECG)
5 Transesophageal echocardiography (TEE) correct answers2. Computed tomography scan of the
chest and abdomen (CT scan)
A 72-year-old woman presents with a severe unilateral headache, jaw pain, and scalp tenderness.
The patient states the headache is of a piercing quality; her jaw hurts only when she chews, and
feels better a few minutes after she stops chewing. A pulsation of the temporal artery on the same
,side as her headache cannot be appreciated, and prednisone is prescribed until the patient can see
a specialist.
Question
What is the reason prednisone is prescribed in this case?
1 Risk for blindness
2 Stenosis of the contralateral temporal artery
3 As treatment for pseudotumor cerebri
4 Edema reduction of berry aneurysm
5 Angioedema in the oropharynx correct answers1. Risk for blindness
A 45-year-old man is admitted to the hospital with fever, weakness, weight loss, extremity pain,
and a rash on his legs. He states that his symptoms began about 1 week ago. He denies recent
illness or injury and states that he has been in good health for as long as he can remember. On
physical exam, the patient was well-developed, well-nourished, and in mild physical distress. His
lower extremities have ulceration near his medial malleoli and a diffuse lace-like purplish
discoloration on his bilateral lower extremities. His blood pressure was elevated at 152/94 mm
Hg, and a chest radiograph was negative. Laboratory analysis revealed an elevated sedimentation
rate and C-reactive protein, elevated BUN, and creatinine. His red blood cell count was
decreased, and his ANCA was negative. Hepatitis B tests were also negative. Biopsy of the leg
ulceration reveals a fibrinoid necrosis of an arterial wall with a leukocytic inf correct answers2.
Polyarteritis nodosa
A 62-year-old man with a 15-year history of hypertension presents with severe tearing chest pain
radiating through to the back. His blood pressure is 180/110 mm Hg, heart rate is 120 BPM, and
respiratory rate is 34/min. Physical exam findings include lungs clear to auscultation, heart
regular rhythm, normal S1/S2 with an S4 present, and a grade III/IV diastolic rumbling murmur
noted with the patient leaning forward. Radial pulses are 1+ on right and 3+ on left. No evidence
of JVD and carotids are negative for bruits. EKG reveals a sinus tachycardia and evidence of left
ventricular hypertrophy.
Question
What is the most likely diagnosis?
1 Spontaneous pneumothorax
2 Pulmonary saddle embolus
, 3 Thoracic aortic dissection
4 Coarctation of the aorta
5 Acute viral pericarditis correct answers3. Thoracic aortic dissection
A 67-year-old man is recovering following an uncomplicated total hip arthroplasty. His past
medical history is significant for hypertension and mild asthma. On postoperative day 2, he
begins to note stiffness in his right leg. On exam, his right calf is noted to be swollen and slightly
warmer than the left leg. The remainder of the exam is unremarkable. He is afebrile, and his vital
signs are stable.
Question
What diagnostic evaluation is most appropriate in this situation?
1 Compression ultrasonography
2 Contrast venography
3 Contrast-enhanced MRI
4 Lower extremity X-ray
5 Serum B-type natriuretic peptide (BNP) measurement correct answers1. Compression
yltrasonography
A 55-year-old man presents with severe central chest pain. Pain started suddenly and it radiates
to the back and neck. He is unable to lie flat. He feels sick but has not vomited. He has no major
illnesses and knows of none that run in his family. He does not use alcohol, tobacco, or illicit
substances. He is allergic to sulfa drugs.
On physical exam, he appears in extreme pain and is lying on his side. Temperature is 98.6°F,
heart rate is 110, blood pressure is 180/105 mm Hg, and respiratory rate is 20. Cardiac exam
reveals normal S1 and S2 without rubs or gallop. The top of his internal jugular venous column
is present at 2-3 cm above the sternal notch. Chest auscultation shows normal vesicular
breathing. He has normal active bowel sounds tympanic to percussion. Extremity exam is
normal, and the lower motor and sensory function are intact.
ECG shows left ventricular hypertrophy. Chest X-ray shows widened mediasti correct answers2.
Intravenous labetalol
A 45-year-old woman presents with vision loss. The patient states that she was watching TV the
other day and experienced vision loss in her right eye for a few minutes. She describes the loss as
A 62-year-old man with a 15-year history of hypertension presents with severe tearing chest pain
radiating through to the back. Blood pressure is 180/110 mm Hg, heart rate is 120 bpm, and
respiratory rate is 34/min. Physical examination findings include neck negative for bruits/JVD,
lungs clear to auscultation, regular heart rhythm, normal S1/S2 with an S4 present, and a grade
III/IV diastolic rumbling murmur noted with the patient leaning forward. Radial pulses are 1+ on
right and 3+ on left. EKG reveals a sinus tachycardia and evidence of left ventricular
hypertrophy. A STAT chest X-ray is obtained.
Question
What finding is most consistent with the presumptive diagnosis?
1 Prominent pulmonary hila
2 Widening of the superior mediastinum
3 Kerley B lines
4 Right-sided pulmonary effusion
5 Prominent right cardiac shadowing correct answers2. Widening of the superior mediastinum
A 78-year-old woman is an inpatient status post-colectomy for colon cancer. On postoperative
day 3, her oral temperature is noted to be elevated to 100.6°F. Chest X-ray and urinalysis are
both negative for signs of infection. An infectious disease consult is placed in order to better
define the patient's new fever. You suspect superficial thrombophlebitis.
Question
What physical examination findings would support your suspicion?
1 Abdominal tenderness in the right upper quadrant
2 Positive Homans sign in left calf
3 Abdominal tenderness in the left lower quadrant
4 Erythema and tenderness along the vein with IV insertion
5 Erythema and tenderness along her incision site correct answers4. Erythema and tenderness
along the vein with IV insertion
,A 65-year-old man presents to the office due to 6 months of bilateral buttock and thigh cramping
pain. It occurs after walking 20 feet and is completely and quickly relieved with resting. His past
medical history includes hypertension treated with atenolol, and he had a stroke 3 years ago. He
also reports impotence for approximately the same duration of time.
Question
What is the patient's physical exam likely to include?
1 Absent femoral, popliteal, pedal pulses
2 Absent popliteal and pedal pulses; normal femoral pulses
3 Absent pedal pulses; normal femoral and popliteal pulses
4 Normal femoral, popliteal, pedal pulses
5 Normal femoral and popliteal pulses; diminished pedal pulses correct answers1. Absent
femoral, popliteal, pedal pulses
A 51-year-old man with a history of Marfan syndrome presents to the emergency department
with tearing chest pain that radiates to the back and neck. On examination, the patient is
hypertensive; a high-pitched decrescendo diastolic murmur at the left sternal border and
diminished peripheral pulses are noted.
Question
Based on the patient's most likely diagnosis, what is the immediate diagnostic imaging modality
of choice?
1 Posterior-anterior chest X-ray (PA CXR)
2 Computed tomography scan of the chest and abdomen (CT scan)
3 Magnetic resonance imaging of the chest (MRI)
4 12-lead electrocardiogram (ECG)
5 Transesophageal echocardiography (TEE) correct answers2. Computed tomography scan of the
chest and abdomen (CT scan)
A 72-year-old woman presents with a severe unilateral headache, jaw pain, and scalp tenderness.
The patient states the headache is of a piercing quality; her jaw hurts only when she chews, and
feels better a few minutes after she stops chewing. A pulsation of the temporal artery on the same
,side as her headache cannot be appreciated, and prednisone is prescribed until the patient can see
a specialist.
Question
What is the reason prednisone is prescribed in this case?
1 Risk for blindness
2 Stenosis of the contralateral temporal artery
3 As treatment for pseudotumor cerebri
4 Edema reduction of berry aneurysm
5 Angioedema in the oropharynx correct answers1. Risk for blindness
A 45-year-old man is admitted to the hospital with fever, weakness, weight loss, extremity pain,
and a rash on his legs. He states that his symptoms began about 1 week ago. He denies recent
illness or injury and states that he has been in good health for as long as he can remember. On
physical exam, the patient was well-developed, well-nourished, and in mild physical distress. His
lower extremities have ulceration near his medial malleoli and a diffuse lace-like purplish
discoloration on his bilateral lower extremities. His blood pressure was elevated at 152/94 mm
Hg, and a chest radiograph was negative. Laboratory analysis revealed an elevated sedimentation
rate and C-reactive protein, elevated BUN, and creatinine. His red blood cell count was
decreased, and his ANCA was negative. Hepatitis B tests were also negative. Biopsy of the leg
ulceration reveals a fibrinoid necrosis of an arterial wall with a leukocytic inf correct answers2.
Polyarteritis nodosa
A 62-year-old man with a 15-year history of hypertension presents with severe tearing chest pain
radiating through to the back. His blood pressure is 180/110 mm Hg, heart rate is 120 BPM, and
respiratory rate is 34/min. Physical exam findings include lungs clear to auscultation, heart
regular rhythm, normal S1/S2 with an S4 present, and a grade III/IV diastolic rumbling murmur
noted with the patient leaning forward. Radial pulses are 1+ on right and 3+ on left. No evidence
of JVD and carotids are negative for bruits. EKG reveals a sinus tachycardia and evidence of left
ventricular hypertrophy.
Question
What is the most likely diagnosis?
1 Spontaneous pneumothorax
2 Pulmonary saddle embolus
, 3 Thoracic aortic dissection
4 Coarctation of the aorta
5 Acute viral pericarditis correct answers3. Thoracic aortic dissection
A 67-year-old man is recovering following an uncomplicated total hip arthroplasty. His past
medical history is significant for hypertension and mild asthma. On postoperative day 2, he
begins to note stiffness in his right leg. On exam, his right calf is noted to be swollen and slightly
warmer than the left leg. The remainder of the exam is unremarkable. He is afebrile, and his vital
signs are stable.
Question
What diagnostic evaluation is most appropriate in this situation?
1 Compression ultrasonography
2 Contrast venography
3 Contrast-enhanced MRI
4 Lower extremity X-ray
5 Serum B-type natriuretic peptide (BNP) measurement correct answers1. Compression
yltrasonography
A 55-year-old man presents with severe central chest pain. Pain started suddenly and it radiates
to the back and neck. He is unable to lie flat. He feels sick but has not vomited. He has no major
illnesses and knows of none that run in his family. He does not use alcohol, tobacco, or illicit
substances. He is allergic to sulfa drugs.
On physical exam, he appears in extreme pain and is lying on his side. Temperature is 98.6°F,
heart rate is 110, blood pressure is 180/105 mm Hg, and respiratory rate is 20. Cardiac exam
reveals normal S1 and S2 without rubs or gallop. The top of his internal jugular venous column
is present at 2-3 cm above the sternal notch. Chest auscultation shows normal vesicular
breathing. He has normal active bowel sounds tympanic to percussion. Extremity exam is
normal, and the lower motor and sensory function are intact.
ECG shows left ventricular hypertrophy. Chest X-ray shows widened mediasti correct answers2.
Intravenous labetalol
A 45-year-old woman presents with vision loss. The patient states that she was watching TV the
other day and experienced vision loss in her right eye for a few minutes. She describes the loss as
