پرسش [ سوالات تستي براي دانشجويان پزشكي ]

[Himmler 22171]

در این تاپیک سوالاتی برای دانشجویان پزشکی در همه دوره های کاروزی و بالینی قرار داده میشه . مرجع سوالات کتاب هاریسون است .

 

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بخش اول سوالات: فلب و عروق

cardiovascular

 

........................................................................................................................

 

 

 

1

 

 

A 60-year-old male patient on aspirin, nitrates, and a beta blocker, being followed for chronic stable angina, presents to the ER with a history of two to three episodes of more severe and long-lasting anginal chest pain each day over the past 3 days. His ECG and cardiac enzymes are normal. The best course of action of the following is to

 

A)

Admit the patient and begin intravenous digoxin

B)Admit the patient and begin intravenous heparin

C)Admit the patient and give prophylactic thrombolytic therapy

D)Admit the patient for observation with no change in medication

E)Discharge the patient from the ER with increases in nitrates and beta blockers

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2

 

 

A 60-year-old white female presents with epigastric pain, nausea and vomiting, heart rate of 50, and pronounced first-degree AV block on ER cardiac monitor. Blood pressure is 130/80. The coronary artery most likely to be involved in this process is the

 

A)Right coronary

B)Left main

C)Left anterior descending

D)Circumflex

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3

 

 

You are seeing in your office a patient with the chief complaint of relatively sudden onset of shortness of breath and weakness but no chest pain. ECG shows nonspecific ST-T changes. You would be particularly attuned to the possibility of painless, or silent, myocardial infarction in the

 

A)

Advanced coronary artery disease patient with unstable angina on multiple medications

B)

Elderly diabetic

C)

Premenopausal female

D)

Inferior MI patient

E)

MI patient with PVCs

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4

A 75-year-old African American female is admitted with acute myocardial infarction and congestive heart failure, then has an episode of ventricular tachycardia. She is prescribed multiple medications and soon develops confusion and slurred speech. The most likely cause of this confusion is

A)Captopril

B)Digoxin

C)Furosemide

D)Lidocaine

E)Nitroglycerin

[Himmler 22171]

5

 

Two weeks after hospital discharge for documented myocardial infarction, a 65-year-old returns to your office very concerned about low-grade fever and pleuritic chest pain. There is no associated shortness of breath. Lungs are clear to auscultation and heart exam is free of significant murmurs, gallops, or rubs. ECG is unchanged from the last one in the hospital. The most effective therapy is likely

 

A)

Antibiotics

B)

Anticoagulation with warfarin (Coumadin)

C)

An anti-inflammatory agent

D)

An increase in antianginal medication

E)

An antianxiety agent

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6

 

 

 

 

 

A 72-year-old male presents to the ER with the chief complaint of shortness of breath that awakens him at night and also night cough. Further questioning confirms recent dyspnea on exertion. As you pursue the diagnosis of congestive heart failure using the Framingham criteria, you note the physical exam findings below. Which of the findings is considered among the less specific minor criteria

 

 

؟؟

 

A)

 

Neck vein distention

B)

Rales

C)

S3 gallop

D)

Positive hepatojugular reflux

E)

Extremity edema

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7

 

A 55-year-old patient presents to you with a history of having recently had a myocardial infarction with a 5-day hospital stay while away on a business trip. He reports being told he had mild congestive heart failure then, but is asymptomatic now with normal physical exam. You recommend which of the following medications

؟؟

 

A)

An ACE inhibitor

B)

Digoxin

C)

Diltiazem

D)

Furosemide (Lasix)

E)

Hydralazine plus nitrates

[Himmler 22171]

8

 

A 26-year-old female is referred to you from an OB-GYN colleague due to

the onset of extreme fatigue and dyspnea on exertion 3 months after her second vaginal delivery. By history, physical, and echocardiogram, which shows systolic dysfunction, you make the diagnosis of postpartum cardiomyopathy. Which of the following is correct

؟؟

 

A)Postpartum cardiomyopathy may occur unexpectedly years after pregnancy and delivery

B)About half of all patients will recover completely

C)Since the condition is idiosyncratic, future pregnancy may be entered into with no greater than average risk

D)The postpartum state will require a different therapeutic approach than typical dilated cardiomyopathies

[Himmler 22171]

9

 

Yesterday you admitted a 55-year-old white male to the hospital due to chest pain and ruled out MI. The patient tends to be anxious about his health. On admission, his lungs were clear, and his heart revealed a grade II/VI systolic crescendo-decrescendo murmur at the upper right sternal border; cardiac enzymes were normal, and resting ECG showed right bundle branch block with less than 1 mm ST segment depression. The idea of performing a routine Bruce protocol treadmill exercise test (stress test) to further assess coronary artery disease was considered, but rejected primarily due to which of the following

؟؟

 

A)Anticipated difficulty with the patient’s anxiety (i.e., he might falsely claim chest pain during the test)

B)Pulmonary embolus suspected as the primary diagnosis

C)Concern about the presence of aortic stenosis, a contraindication to stress testing

D)The presence of RBBB, with this baseline ECG change obscuring typical diagnostic ST-T changes

E)Concern that this represents the onset of unstable angina with unacceptable risk of MI with stress testing

[Himmler 22171]

10

 

A 75-year-old patient presents to the ER after a sudden syncopal episode. He is again alert and in retrospect describes occasional substernal chest pressure and shortness of breath on exertion. His lungs have a few bibasilar rales, and his blood pressure is 110/80 On cardiac auscultation, the classic finding you expect to hear is

:

 

A)A harsh systolic crescendo-decrescendo murmur heard best at the upper right sternal border

B)A diastolic decrescendo murmur heard at the mid-left sternal border

C)A holosystolic murmur heard best at the apex

D)A midsystolic click

[Himmler 22171]

11

A 72-year-old male comes to the office with intermittent symptoms of dyspnea on exertion, palpitations, and cough occasionally productive of blood. On cardiac auscultation, a low-pitched diastolic rumbling murmur is faintly heard toward the apex. The origin of the patient’s problem probably relates to

 

A)

Rheumatic fever as a youth

B)

Long-standing hypertension

C)

Silent MI within the past year

D)

Congenital origin

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12

 

You are helping with school sports physicals and see a 13-year-old boy who has had some trouble keeping up with his peers. He has a cardiac murmur, which you correctly diagnose as a ventricular septal defect based on which of the following auscultatory findings

??

A)

A systolic crescendo-decrescendo murmur heard best at the upper right sternal border with radiation to the carotids; the murmur is augmented with transient exercise

B)

A systolic murmur at the pulmonic area and a diastolic rumble along the left sternal border

C)

A holosystolic murmur at the mid-left sternal border

D)

A diastolic decrescendo murmur at the mid-left sternal border

E)

A continuous murmur through systole and diastole at the upper left sternal border

[Himmler 22171]

13

A 40-year-old male presents to the office with a history of palpitations that last for a few seconds and occur two or three times a week. There are no other symptoms. ECG shows a rare single unifocal premature ventricular contraction (PVC). The most likely cause of this finding is

 

A)Underlying coronary artery disease

B)Valvular heart disease

C)Hypertension

D)Apathetic hyperthyroidism

E)Idiopathic or unknown

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14

Subsequent 24-h Holter monitoring in the preceding patient confirms occasional single unifocal PVCs plus occasional premature atrial contractions (PACs). The best antiarrhythmic management in this case is

 

A)Anxiolytics

B)Beta blocker therapy

C)Digoxin

D)Quinidine

E)Observation, no medication

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15

An active 78-year-old female has been followed for hypertension but presents with new onset of mild left hemiparesis and the finding of atrial fibrillation on ECG, which persists throughout the hospital stay. She had been in sinus rhythm 6 months earlier. Optimal treatment by the time of hospital discharge includes antihypertensives plus

 

A)Close observation

B)Permanent pacemaker

C)Aspirin

D)Warfarin (Coumadin

E)Subcutaneous heparin

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16

A 36-year-old white female nurse comes to the ER due to a sensation of fast heart rate, slight dizziness, and vague chest fullness. Blood pressure is 110/70. The following rhythm strip is obtained, which shows

 

A)Atrial fibrillation

B)Atrial flutter

C)Supraventricular tachycardia

D)Ventricular tachycardia

[Himmler 22171]

17

The initial pharmacologic therapy of choice in this stable patient is

 

A)Adenosine 6 mg rapid IV bolus

B)Verapamil 2.5 to 5 mg IV over 1 to 2 min

C)Diltiazem 0.25 mg/kg IV over 2 min

D)Digoxin 0.5 mg IV slowly

E)Lidocaine 1.5 mg/kg IV bolus

F)Electrical cardioversion at 50 joules

[Himmler 22171]

18

A 65-year-old man with diabetes, on an oral hypoglycemic, presents to the ER with a sports-related right shoulder injury. His heart rate was noted to be irregular and the following ECG was obtained. The best immediate therapy is

 

A)

Atropine

B)

Isoproterenol

C)

Pacemaker

D)

Electrical cardioversion

E)

Digoxin

F)

Diltiazem

G)

Observation

[Himmler 22171]

19

While at the grocery store, you see an elderly lady slump to the floor. Going to her aid,

your first step in Adult Basic Life Support (CPR) should be the following

 

A)Check for a carotid pulse

B)Assess breathing

C)Establish an airway

D)Determine responsiveness

E)Institute chest compression

[Himmler 22171]

20

In the ICU, a patient suddenly becomes unresponsive, pulseless, and hypotensive, with cardiac monitor indicating ventricular tachycardia. The crash cart is immediately available. The first therapeutic step among the following should be

 

A)Amiodarone 300 mg IV push

B)Lidocaine 1.5 mg/kg IV push

C)Epinephrine 1 mg IV push

D)Defibrillation at 200 joules

E)Defibrillation at 360 joules