A 65-year-old man with a medical history of atherosclerosis, hypertension, and stable
angina presents to the clinic for routine follow-up. Current medications include lisinopril,
atorvastatin, aspirin, and propranolol. 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 crescendo-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 - D) Squatting
Which of the following pathophysiologic changes is characteristic of chronic obstructive
pulmonary disease?
A) Decreased elastic recoil pressure
B) Decreased number of goblet cells
C) Decreased static hyperinflation
D) Small airway dilation - A) Decreased elastic recoil pressure
A 65-year-old man presents to the clinic with chest pain 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 - C) Pursed-lip breathing
A 59-year-old man presents to the clinic to establish care. Past medical history includes
type 2 diabetes mellitus 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:
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 8 - A) Change pravastatin to atorvastatin 80 mg daily
A 60-year-old man presents with shortness of breath. 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 - B) Tricuspid regurgitation
A 52-year-old man with a history of diabetes mellitus 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 - A) Ankle-brachial index
A 6-week-old infant presents with decreased activity and intermittent cyanosis. Multiple
studies are obtained. Chest radiography is significant for an enlarged pulmonary artery
shadow and prominent hilar vascularity. A diagnosis of pulmonary hypertension is
suspected. What is the most common etiology of pulmonary hypertension among
children?
A) Cardiac disease
B) Familial pulmonary arterial hypertension
, C) Idiopathic pulmonary arterial hypertension
D) Lung disease - A) Cardiac disease
Which of the following children should be referred for cardiac evaluation for a suspected
pathological heart murmur?
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 - D) A grade 4 holosystolic murmur that is more intense with upright positioning
in a 1 year old
A 62-year-old man with no significant medical history 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 upper
quadrant without distension or rigidity. His lower extremities show bilateral edema, and
he has no calf tenderness. What other physical exam finding is most likely in this
condition?
A) Janeway lesion
B) Kussmaul sign
C) Pericardial friction rub
D) S3 gallop
E) S4 gallop - B) Kussmaul sign
A 67-year-old man presents to the clinic for a hospital follow-up after a myocardial
infarction 1 month ago. The hospital records reveal that the patient underwent
percutaneous coronary intervention and received two stents to the left anterior
descending artery. His medical history includes hypertension, type 2 diabetes mellitus,
and hyperlipidemia. Which of the following medications should the clinician expect the
patient to be taking currently?
A) Aspirin alone
B) Aspirin and clopidogrel
C) Aspirin and warfarin
D) Aspirin, enoxaparin, and ticagrelor - B) Aspirin and clopidogrel
Which of the following cardiac auscultation findings is most consistent with mitral valve
regurgitation?
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