Your patient is asked to see you in followup for his fasting labs. His total cholesterol = 230 mg/dl, triglycerides = 1200 mg/dl, unable to calculate LDL. Your patient should be advised that due to these findings he is at risk for which of the following?
A: diabetes mellitus
B: pancreatitis
...
your patient is asked to see you in followup for his fasting labs his total cholesterol 230 mgdl
triglycerides 1200 mgdl
unable to calculate ldl your patient should be advised that due to th
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Your patient is asked to see you in follow-up for his fasting labs. His total cholesterol =
230 mg/dl, triglycerides = 1200 mg/dl, unable to calculate LDL. Your patient should be
advised that due to these findings he is at risk for which of the following?
A: diabetes mellitus
B: pancreatitis
C: gout
D: diabetes insipidus
E: hypertension - B
The correct answer is (B). Very elevated triglycerides, especially over 1000 mg/dl,
increase the patient's risk of acute pancreatitis. This patient requires prompt treatment.
Hypertriglyceridemia may be a component of metabolic syndrome but does not directly
cause diabetes mellitus or hypertension. Hypertriglyceridemia does not increase the risk
of gout and diabetes insipidus.
Patients diagnosed with an auricular hematoma are at increased risk of developing
which condition?
A: Cartilage necrosis
B: Cholesteatoma
C: Coagulopathy
D: Exostosis
E: Otomycosis - The Correct Answer is: A
Auricular hematomas occupy the subperichondral space, leading to decreased or
absent diffusion from the perichondrium to the cartilage and resulting in increased risk
of necrosis (A). Coagulopathy (C) may predispose a patient to experiencing a
hematoma. Cholesteatoma (B) may result from TM trauma, but not blunt trauma to the
outer ear.
A 78-year-old Caucasian female has a 3-year history of stiffness and achiness of
bilateral shoulders and hips. She has been tested for rheumatoid arthritis in the past
and has been found negative. Multiple radiographs of her hips and shoulders are
unremarkable. She admits that she was placed on prednisone for an allergic reaction
and noted a temporary resolution of her symptoms. For the past two weeks she
complains of increasing symptoms now involving her neck and pain in her jaw with
,chewing. Today she noticed that her scalp is sore when she brushed her hair on the
right side. What is the most feared complication of this condition that may be prevented
with prompt diagnosis and treatment?
A
blindness
B
costovertebral angle (CVA)
C
aneurysm
D
arm claudication
E
polymyalgia rheumatica (PMR) - A
The correct answer is (A). This patient has long standing symptoms of PMR with current
symptoms suggestive of giant cell (temporal) arteritis. Visual loss is the most feared
complication of temporal arteritis, but it can be prevented by prompt initiation of high-
dose prednisone. PMR often occurs with or prior to development of temporal arteritis
and is not considered a complication. Large vessel involvement--which may result in
choices (B), (C), and (D)--is less common than temporal artery involvement in GCA.
The patient does not have symptoms of large vessel involvement.
A 4-month-old male presents for a well child check. He is healthy, and the mother feels
that the child is eating and growing well. On examination, there is no evidence of
cyanosis. The peripheral pulses are normal and equal. There is a medium-pitched harsh
pansystolic murmur heard best at the left sternal border at the fourth intercostal space.
There is no heave or thrill present. The murmur radiates over the entire precordium and
the S2 is physiologically split. What is the most likely diagnosis?
A
Atrial septal defect
B
Coarctation of the aorta
C
Patent ductus arteriosus
D
Tetralogy of fallot
E
Ventricular septal defect - The Correct Answer is: E
,The patient in this scenario is exhibiting the classic signs of a ventricular septal defect.
An atrial septal defect has a fixed, widely split S2, with a right ventricular heave as well
as a systolic ejection murmur, which is best heard at the left sternal border second
intercostal space. Coarctation of the aorta has absent or diminished femoral pulses and
a blowing systolic murmur. A patent ductus arteriosus murmur is classically described
as a rough machinery systolic murmur, and there are bounding pulses with a widened
pulse pressure. Tetralogy of fallot can have associated cyanosis, with hypoxemic spells
during infancy, easy fatigability, and dyspnea on exertion. Tetralogy of fallot has the
presence of a right ventricular lift and a rough, systolic ejection murmur that is present
along the left sternal border in the third intercostal space that radiates to the back. Aortic
stenosis has a harsh systolic ejection murmur present at the right sternal border, and
associated thrill in the carotid arteries.
A 24-month-old infant presents for his routine physical examination. The parents state
that he has been following all of his developmental milestones. On examination, the
clinician hears a grade II/VI murmur along the left sternal border, which radiates into the
left axilla and the left side of the back. The child also has decreased femoral pulses
bilaterally. The clinician orders a chest X-ray. Which of the following is the expected
finding on X-ray based on the presentation?
A
notching or scalloping of the ribs
B
boot-shaped heart—right ventricular hypertrophy
C
"egg on string"—narrowed mediastinum
D
absence of the main pulmonary artery - The Correct Answer is: A
The patient's presentation is consistent with findings of coarctation of the aorta. The
pathognomonic finding in coarctation is decreased or absent femoral pulses. However,
the majority of children show no signs of coarctation in infancy and develop signs and
symptoms during childhood, most notably unequal pulses and blood pressure between
arms and legs (arms greater than legs). In addition, a grade II/VI ejection murmur is
heard at the aortic area and left sternal border that radiates into the left axilla and left
back. Chest X-ray shows a normal-sized heart, a prominent aorta, indents at the level of
the coarctation, and a dilated poststenotic segment resulting in the "figure 3" sign.
Scalloping or notching of the ribs is due to enlargement of the intercostal arteries.
Echocardiography is used to directly visualize the coarctation and estimate the
obstruction. Asymptomatic infants and children are encouraged to have corrective
surgery prior to age 5, after which they are at increased risk for myocardial dysfunction
and hypertension, and require exercise testing prior to participation in aerobic activities.
The boot-shaped heart is seen in patients with tetralogy of Fallot secondary to right
ventricular hypertrophy; the narrowed mediastinum finding with "egg on a string" is
typically seen in patients with transposition of the great vessels.
, A 68-year-old woman with a history of hypertension and diabetes mellitus type 2 comes
to the emergency department with her son, who noticed that while decorating for
Christmas she seemed more dyspneic than normal, and had to sit down frequently. In
addition, he noticed that she was pale and diaphoretic, and insisted on driving her to the
emergency department. On questioning, she denies chest pain, but admits to being
more fatigued than usual, with frequent jaw discomfort during activity. Activities such as
vacuuming her house cause dyspnea, and she now has to stop several times while
carrying laundry up from the basement. On physical examination, the patient's blood
pressure is 90/50, pulse 99 bpm, respirations 22, and she is afebrile. Auscultation of the
chest demonstrates a new systolic murmur. An EKG demonstrates normal sinus rhythm
with nonspecific ST and T wave changes. Serial troponin elevations above the 99 th
percentile of normal are noted. Which of the following would be the most appropriate
next step in the management of this patient?
A Clopidogrel, heparin, and aspirin, followed by cardiac catheterization
B
Nuclear stress test
C
Treadmill stress test
D
Thiazide diuretics and loop diuretics
E
Dobutamine stress echocardiogram - The Correct Answer is: A
In patients with non-ST-segment myocardial infarction, such as this patient with
ischemic symptoms and serial troponin elevation above the 99 th percentile of normal,
clopidogrel, aspirin, and heparin prior to cardiac catheterization are recommended, with
the intention of percutaneous coronary intervention. In addition, morphine, oxygen,
nitrates, beta blockade, ACE inhibitors, statin therapy, and glycoprotein IIb/IIa inhibitors
should be considered, depending on the patient's blood pressure, heart rate, and
hemodynamic stability. Choice D would be useful in the treatment of patients with
hypertension and lower extremity edema. Choices B, C, and E, are all forms of stress
testing, which should be performed in patients with symptoms of angina pectoris, but
not for patients with acute myocardial infarction
A 2-month-old female presents for a well child check. The mother has no concerns and
feels that the child is doing well. On exam, there is no evidence of cyanosis and the
peripheral pulses are normal and equal. However, there is a fixed and widely split S2, a
right ventricular heave, and a systolic ejection murmur present. The murmur is heard
best at the left sternal border second intercostal space. What is the most common
abnormality present on an ECG?
A
Atrioventricular heart block
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