Smarty PANCE Cardiology(All Accurately solved)
Which of the following conditions would cause a positive Kussmaul's sign on physical
examination?
A. Left ventricular failure
B. Pulmonary edema
C. Coarctation of the aorta
D. Constrictive pericarditis correct answersD. Constrictive pericarditis
Anginal chest pain is most commonly described as which of the following?
A. Pain changing with position or respiration
B. A sensation of discomfort
C. Tearing pain radiating to the back
D. Pain lasting for several hours correct answersB. A sensation of discomfort
Myocardial ischemia is often experienced as a sensation of discomfort lasting 5-15 minutes,
described as dull, aching or pressure.
Eliciting a history from a patient presenting with dyspnea due to early heart failure the severity
of the dyspnea should be quantified by
A. Amount of activity that precipitates it
B. How many pillows they sleep on at night
C. How long it takes the dyspnea to resolve
D. any associated comorbities correct answersA. Amount of activity that precipitates it
A 25 year old female presents with a three day history of chest pain aggravated by coughing and
relieved by sitting. She is febrile and a CBC with differential reveals leukocytosis. Which of the
following physical exam signs is characteristics of her problem?
A. Pulsus paradoxus
B. Localized crackles
C. Pericardial friction rub
D. Wheezing correct answersC. Pericardial friction rub
A 65-year-old white female presents with dilated tortuous veins on the medial aspect of her
lower extremities. Which of the following would be the most common initial complaint?
A. Pain in the calf with ambulation
B. Dull aching heaviness brought on by periods of standing
C. Brownish pigmentation above the ankle
D. Edema on the lower extremities correct answersB. Dull aching heaviness brought on by
periods of standing
,A 22-year-old male received a stab wound in the chest an hour ago. The diagnosis of pericardial
tamponade is strongly supported by the presence of
A. Pulmonary edema
B. Wide pulse pressure
C. Distended neck veins
D. An early diastolic murmur correct answersC. Distended neck veins
A 70-year-old man presents to the emergency department with severe substernal chest pain of
one hour's duration. The patient was taking a morning walk when the onset of pain led him to
seek care. His past medical history includes coronary artery disease, hyperlipidemia, and
hypertension. Medications include aspirin, losartan, and atorvastatin. An electrocardiogram
reveals ST elevations in the inferior leads II, III, and avF as well as in leads V5 and V6. The ST
elevations found in leads V5-V6 are most indicative of pathology in which of the following areas
of the heart?
A. Inferior wall, right coronary artery
B. Interventricular septum, left anterior descending coronary artery
C. Lateral wall of the left ventricle, left circumflex coronary artery
D. Left atrium, left main coronary artery
E. Right ventricle, left main coronary artery correct answersC. Lateral wall of the left ventricle,
left circumflex coronary artery
A 72-year-old male with a new diagnosis of congestive heart failure and atrial fibrillation
develops episodes of hemodynamic compromise secondary to increased ventricular rate. A
decision to perform elective cardioversion is made and the patient is anticoagulated with heparin.
Which test should be ordered to assess for atrial or ventricular mural thrombi?
A. Electrocardiography
B. Chest xray
C. Transesophageal echocardiogram
D. C-reactive protein correct answersC. Transesophageal echocardiogram
A 64-year-old patient with known history of type 1 diabetes mellitus for 50 years has developed
pain radiating from the right buttock to the calf. Patient states that the pain is made worse with
walking and climbing stairs. Based upon this history which of the following would be the most
appropriate test to order?
A. Venogram
B. Arterial duplex scanning
C. X-ray of the right hip and L/S spine
D. Venous Doppler ultrasound correct answersB. Arterial duplex scanning
,A 36-year-old male complains of occasional episodes of "heart fluttering." The patient describes
these episodes as frequent, short-lived and episodic. He denies any associated chest pain. Based
on this information, which one of the following tests would be the most appropriate to order?
A. Holter monitor
B. Cardiac catheterization
C. Stress testing
D. Cardiac nuclear scanning correct answersA. Holter monitor
A patient with a mitral valve replacement was placed post-operatively on warfarin (Coumadin)
for anticoagulation prophylaxis. To monitor this drug for its effectiveness, what test would be
used?
A. PTT
B. PT-INR
C. Platelet aggregation
D. Bleeding time correct answersB. PT-INR
A 64-year-old male, with a long history of COPD, presents with increasing fatigue over the last
three months. The patient has stopped playing golf and also complains of decreased appetite,
chronic cough, and a bloated feeling. Physical examination reveals distant heart sounds,
questionable gallop, lungs with decreased breath sounds at lung bases and the abdomen reveals
RUQ tenderness with the liver two finger-breadths below the costal margin, the extremities show
2+/4+ pitting edema. Labs reveal the serum creatinine level of 1.6 mg/dl, BUN 42 mg/dl, liver
function test's mildly elevated and the CBC to be normal. Which of the following is the most
likely diagnosis?
A. Right ventricular failure
B. Pericarditis
C. Exacerbation of COPD
D. Cirrhosis correct answersA. Right ventricular failure
A 56-year-old male with a known history of polycythemia suddenly complains of pain and
paresthesia in the left leg. Physical examination reveals the left leg is cool to the touch and the
toes are cyanotic. The popliteal pulse is absent by palpation and Doppler. The femoral pulse is
absent by palpation but weak with Doppler. The right leg and upper extremities has 2+/4+ pulses
throughout. Given these findings what is the most likely diagnosis?
A. Venous thrombosis
B. Arterial thrombosis
C. Thromboangitis obliterate
D. Thrombophlebitis correct answersB. Arterial thrombosis
A 48-year-old male with a known history of hypertension is brought to the ED complaining of a
headache, general malaise, nausea, and vomiting. The patient currently takes nifedipine
(Procardia) 90mg XL every day and atenolol (Tenormin) 50 mg every day. Vital signs reveal
, temperature 98.6°F, pulse 72/minute, respiratory rate 20/minute, and the blood pressure is
168/120 mmHg. BP reading taken every 15 minutes from the time of admission reveal the
systolic to run from 176 to 186 mmHg and the diastolic to run from 135 to 150 mmHg. Physical
examination reveals papilledema bilaterally. There are no renal bruits noted. The EKG is normal.
Based on this presentation, what is the most likely diagnosis?
A. Meningitis
B. Secondary hypertension
C. Pseudotumor Cerebri
D. Malignant hypertension correct answersD. Malignant hypertension
A 55-year-old male is seen in follow-up for a complaint of chest pain. Patient states that he has
had this chest pain for about one year now. The patient further states that the pain is retrosternal
with radiation to the jaw. "It feels as though a tightness, or heaviness is on and around my chest".
This pain seems to come on with exertion, however, over the past two weeks he has noticed that
he has episodes while at rest. If the patient remains non-active the pain usually resolves in 15-20
minutes. Patient has a 60-pack-year smoking history and drinks a martini daily at lunch. Patient
appears overweight on inspection. Based on this history what is the most likely diagnosis?
A. Acute myocardial infarction
B. Pain metal variant angina
C. Stable angina
D. Unstable angina correct answersD. Unstable angina
A 60-year-old male is brought to the ED complaining of severe onset of chest pain and
intrascapular pain. The patient states that the pain feels as though "something is ripping and
tearing." The patient appears shocky; the skin is cool and clammy. The patient has an impaired
sensorium. Physical examination reveals a loud diastolic murmur and variation in blood pressure
between the right and left arm. Based on this presentation what is the most likely diagnosis?
A. Aortic dissection
B. Acute myocardial infarction
C. Cardiac tamponade
D. Pulmonary embolism correct answersA. Aortic dissection
A 42-year-old male is brought into the ED with a complaint of chest pain. The pain comes on
suddenly without exertion and lasts anywhere from 10-20 minutes. The patient has experienced
this on three previous occasions. Today the patient complains of lightheadedness with the chest
pain lasting longer. Vital signs T-99.3°F oral, P-106/minute and regular, R-22/minute, BP 146/86
mm Hg. EKG reveals sinus rhythm with a rate of 100. Intervals are PR = 0.06 seconds, QRS =
0.12 seconds. A delta wave is noted in many leads. Based on this information what is the most
likely diagnosis?
A. Sinus tachycardia
B. Paroxysmal supraventricular tachycardia
C. Wolff-Parkinson-White syndrome
Which of the following conditions would cause a positive Kussmaul's sign on physical
examination?
A. Left ventricular failure
B. Pulmonary edema
C. Coarctation of the aorta
D. Constrictive pericarditis correct answersD. Constrictive pericarditis
Anginal chest pain is most commonly described as which of the following?
A. Pain changing with position or respiration
B. A sensation of discomfort
C. Tearing pain radiating to the back
D. Pain lasting for several hours correct answersB. A sensation of discomfort
Myocardial ischemia is often experienced as a sensation of discomfort lasting 5-15 minutes,
described as dull, aching or pressure.
Eliciting a history from a patient presenting with dyspnea due to early heart failure the severity
of the dyspnea should be quantified by
A. Amount of activity that precipitates it
B. How many pillows they sleep on at night
C. How long it takes the dyspnea to resolve
D. any associated comorbities correct answersA. Amount of activity that precipitates it
A 25 year old female presents with a three day history of chest pain aggravated by coughing and
relieved by sitting. She is febrile and a CBC with differential reveals leukocytosis. Which of the
following physical exam signs is characteristics of her problem?
A. Pulsus paradoxus
B. Localized crackles
C. Pericardial friction rub
D. Wheezing correct answersC. Pericardial friction rub
A 65-year-old white female presents with dilated tortuous veins on the medial aspect of her
lower extremities. Which of the following would be the most common initial complaint?
A. Pain in the calf with ambulation
B. Dull aching heaviness brought on by periods of standing
C. Brownish pigmentation above the ankle
D. Edema on the lower extremities correct answersB. Dull aching heaviness brought on by
periods of standing
,A 22-year-old male received a stab wound in the chest an hour ago. The diagnosis of pericardial
tamponade is strongly supported by the presence of
A. Pulmonary edema
B. Wide pulse pressure
C. Distended neck veins
D. An early diastolic murmur correct answersC. Distended neck veins
A 70-year-old man presents to the emergency department with severe substernal chest pain of
one hour's duration. The patient was taking a morning walk when the onset of pain led him to
seek care. His past medical history includes coronary artery disease, hyperlipidemia, and
hypertension. Medications include aspirin, losartan, and atorvastatin. An electrocardiogram
reveals ST elevations in the inferior leads II, III, and avF as well as in leads V5 and V6. The ST
elevations found in leads V5-V6 are most indicative of pathology in which of the following areas
of the heart?
A. Inferior wall, right coronary artery
B. Interventricular septum, left anterior descending coronary artery
C. Lateral wall of the left ventricle, left circumflex coronary artery
D. Left atrium, left main coronary artery
E. Right ventricle, left main coronary artery correct answersC. Lateral wall of the left ventricle,
left circumflex coronary artery
A 72-year-old male with a new diagnosis of congestive heart failure and atrial fibrillation
develops episodes of hemodynamic compromise secondary to increased ventricular rate. A
decision to perform elective cardioversion is made and the patient is anticoagulated with heparin.
Which test should be ordered to assess for atrial or ventricular mural thrombi?
A. Electrocardiography
B. Chest xray
C. Transesophageal echocardiogram
D. C-reactive protein correct answersC. Transesophageal echocardiogram
A 64-year-old patient with known history of type 1 diabetes mellitus for 50 years has developed
pain radiating from the right buttock to the calf. Patient states that the pain is made worse with
walking and climbing stairs. Based upon this history which of the following would be the most
appropriate test to order?
A. Venogram
B. Arterial duplex scanning
C. X-ray of the right hip and L/S spine
D. Venous Doppler ultrasound correct answersB. Arterial duplex scanning
,A 36-year-old male complains of occasional episodes of "heart fluttering." The patient describes
these episodes as frequent, short-lived and episodic. He denies any associated chest pain. Based
on this information, which one of the following tests would be the most appropriate to order?
A. Holter monitor
B. Cardiac catheterization
C. Stress testing
D. Cardiac nuclear scanning correct answersA. Holter monitor
A patient with a mitral valve replacement was placed post-operatively on warfarin (Coumadin)
for anticoagulation prophylaxis. To monitor this drug for its effectiveness, what test would be
used?
A. PTT
B. PT-INR
C. Platelet aggregation
D. Bleeding time correct answersB. PT-INR
A 64-year-old male, with a long history of COPD, presents with increasing fatigue over the last
three months. The patient has stopped playing golf and also complains of decreased appetite,
chronic cough, and a bloated feeling. Physical examination reveals distant heart sounds,
questionable gallop, lungs with decreased breath sounds at lung bases and the abdomen reveals
RUQ tenderness with the liver two finger-breadths below the costal margin, the extremities show
2+/4+ pitting edema. Labs reveal the serum creatinine level of 1.6 mg/dl, BUN 42 mg/dl, liver
function test's mildly elevated and the CBC to be normal. Which of the following is the most
likely diagnosis?
A. Right ventricular failure
B. Pericarditis
C. Exacerbation of COPD
D. Cirrhosis correct answersA. Right ventricular failure
A 56-year-old male with a known history of polycythemia suddenly complains of pain and
paresthesia in the left leg. Physical examination reveals the left leg is cool to the touch and the
toes are cyanotic. The popliteal pulse is absent by palpation and Doppler. The femoral pulse is
absent by palpation but weak with Doppler. The right leg and upper extremities has 2+/4+ pulses
throughout. Given these findings what is the most likely diagnosis?
A. Venous thrombosis
B. Arterial thrombosis
C. Thromboangitis obliterate
D. Thrombophlebitis correct answersB. Arterial thrombosis
A 48-year-old male with a known history of hypertension is brought to the ED complaining of a
headache, general malaise, nausea, and vomiting. The patient currently takes nifedipine
(Procardia) 90mg XL every day and atenolol (Tenormin) 50 mg every day. Vital signs reveal
, temperature 98.6°F, pulse 72/minute, respiratory rate 20/minute, and the blood pressure is
168/120 mmHg. BP reading taken every 15 minutes from the time of admission reveal the
systolic to run from 176 to 186 mmHg and the diastolic to run from 135 to 150 mmHg. Physical
examination reveals papilledema bilaterally. There are no renal bruits noted. The EKG is normal.
Based on this presentation, what is the most likely diagnosis?
A. Meningitis
B. Secondary hypertension
C. Pseudotumor Cerebri
D. Malignant hypertension correct answersD. Malignant hypertension
A 55-year-old male is seen in follow-up for a complaint of chest pain. Patient states that he has
had this chest pain for about one year now. The patient further states that the pain is retrosternal
with radiation to the jaw. "It feels as though a tightness, or heaviness is on and around my chest".
This pain seems to come on with exertion, however, over the past two weeks he has noticed that
he has episodes while at rest. If the patient remains non-active the pain usually resolves in 15-20
minutes. Patient has a 60-pack-year smoking history and drinks a martini daily at lunch. Patient
appears overweight on inspection. Based on this history what is the most likely diagnosis?
A. Acute myocardial infarction
B. Pain metal variant angina
C. Stable angina
D. Unstable angina correct answersD. Unstable angina
A 60-year-old male is brought to the ED complaining of severe onset of chest pain and
intrascapular pain. The patient states that the pain feels as though "something is ripping and
tearing." The patient appears shocky; the skin is cool and clammy. The patient has an impaired
sensorium. Physical examination reveals a loud diastolic murmur and variation in blood pressure
between the right and left arm. Based on this presentation what is the most likely diagnosis?
A. Aortic dissection
B. Acute myocardial infarction
C. Cardiac tamponade
D. Pulmonary embolism correct answersA. Aortic dissection
A 42-year-old male is brought into the ED with a complaint of chest pain. The pain comes on
suddenly without exertion and lasts anywhere from 10-20 minutes. The patient has experienced
this on three previous occasions. Today the patient complains of lightheadedness with the chest
pain lasting longer. Vital signs T-99.3°F oral, P-106/minute and regular, R-22/minute, BP 146/86
mm Hg. EKG reveals sinus rhythm with a rate of 100. Intervals are PR = 0.06 seconds, QRS =
0.12 seconds. A delta wave is noted in many leads. Based on this information what is the most
likely diagnosis?
A. Sinus tachycardia
B. Paroxysmal supraventricular tachycardia
C. Wolff-Parkinson-White syndrome
