Clinical Cardiology Multiple Choice Questions

A 45 year old male patient presents with abrupt severe chest pain, flank pain, and syncope. Physical exam reveals asymmetric extremity blood pressure. Percussion of the lungs is dull and there is decreased tactile fremitus. On ausculatation you hear a decrescendo diastolic murmur best heard at the lower left sternal border. It has a blowing quality and is heard best when patient is leaning forward. CT with contrast shows a displaced trachea and pleural effusion. Which diagnosis is most likely?

An 80 year old female presented to the emergency room with an MI. Prior medical history includes hypertension, and no prior history of angina. On the 3rd day EKG and physical exam showed abrupt pulseless electrical activity. Shortly after she died. What is the likely complication?

What is the most common peripheral aneurysm?

What is the most common cause of abdominal aortic aneurysm?

A 35 year old female presents to the ED with dyspnea, hoarseness, hemoptysis, and lower leg edema. Clinical examination shows a loud S1 with an opening snap and rumbling mid-diastolic murmur. EKG shows left atrial enlargement and right ventricular hypertrophy. Chest x ray confirms this and shows interstitial edema. What is the likely diagnosis?

What can cause a decreased amplitude of P-waves, increase in PR interval, bradycardia in the form of AV block, and even an absence of P waves eventually leading to a "sine wave."

Which of the following is the most common cause of multifocal atrial tachycardia?

Which of the following ventricular septal defects can you expect to close spontaneously more so than the others?

An EKG shows a U wave which occurs just after the T-wave and is of smaller amplitude than the T-wave. Further, there is flattening of the T-wave and ST-depression. What does this indicate?

High uric acid and glucose intolerance are typical of which type of lipid disorder according to Fredrickson classification?

Electrical altercans is a finding on EKG of alternating amplitude of QRS complexes. Which of these diseases is most associated with this finding?

Which of the following is NOT a component of long term medical management of MI?

What is the greatest source of the biomarker CPK?

What pathology causes the greatest absolute number of ascending (thoracic) aortic dissections?

A 70 year old female presents with ascites, edema, and jaundice. Physical exam shows JVD and hepatomegaly. Auscultation reveals a decrescendo diastolic rumble at the lower left sternal border that is louder with inspiration. What is the likely diagnosis?

A shortened QT interval, shortened ST segment, and Osborn waves (J waves) can be caused by?

Which of the following is the most common ventricular septal defect?

Which is the most common form of lipid disorder according to the Fredrickson Lipid Classification?

Peaked T waves best seen in the precordial leads, widening of QRS complexes, and sometimes ST depression may indicate.

A 60 year old male with a prior medical history of pulmonary hypertension presents with ascites and lower extremity edema. Physical exam reveals an elevated JVP and a large pulsatile liver. Auscultation shows a holosystolic murmur at lower left sternal border that is louder with inspiration. Which of the following is most likely

A posterior wall MI involves which artery?

What is the most common etiology of mitral stenosis?

Which of the following would be first line treatment for acute AV node Reentry Tachycardia?

A 60 year old male complains of a cramping sensation in his calf after walking 50 feet or so. When he stops, the pain goes away. The pain returns upon walking. What term best describes these symptoms?

What is the most common visceral aneurysm?

What is the standard antimicrobial therapy for bacterial endocarditis prophylaxis?

A 35 year old patient recovering from a cold presents with dyspnea, orthopnea and edema. Physical exam shows elevated JVP, peripheral edema, and crackles. Auscultation reveals a displaced PMI and an S3 sound. EKG shows ST elevation. Chest x ray shows cardiomegaly, pulmonary congestion and thickened sub-plueral interlobular septa (Kerley B lines). Which of these diagnoses is most reasonable?

Peripheral neuropathy is most often associated with which type of lipid disorder?

A patient with a history of TB presents with peripheral edema, and ascites. Physical exam reveals hepatomegaly, elevated JVP. Kussmaul's sign (Increased JVP on inspiration) is positive but no pulsus paradoxus is noted. On auscultation a high pitched heart sound is noted during diastole. Which of the following can most reasonably explain these findings

A patient presents with weakness, dyspnea and pulmonary edema. Auscultation reveals a blowing holosystolic murmur, immediately after S1 that radiates to the axilla. Based off this information alone, which of the following is most likely

Which of the following presentations of cardiomyopathy is most common?

Which of the following Fredrickson Lipid Classification categories involved familial lipoprotein lipase (LPL) deficiency resulting in high triglycerides and chylomicrons. Signs include pancreatitis, lipemia retinalis, hepatosplenomegaly and eruptive xanthomas.

A lateral wall MI involves which artery?

Which of the following tests is the gold standard for diagnosing mitral regurgitation?

A prominent S4 and a crescendo-decrescendo murmur at LLSB (similar to AS but not as RUSB)( that does not radiate to the carotids and increases on expiration (more blood fills LV) would make you most concerned for?

A patient presents with fatigue, dyspnea and chest pain. EKG shows diffuse ST elevation. He is hypotensive with pressure varying from inspiration to expiration. In addition, physical exam reveals muffled heart sounds and elevated JVP that increases on inspiration. Chest x ray shows cardiomegaly resembling a water-bottle. Which of the following is the most likely diagnosis?

In western countries, what is the most common valvular heart disease?

Premature atherosclerosis, corneal arcus and tendon xanthomas are signs of which type of lipid disorder?

What is the most common cause of valvular heart disease in developing countries

Which class of drugs is most commonly indicated for treatment of hypertrophic cardiomyopathy?

A mid-systolic click followed by a late systolic murmur is virtually diagnostic for which of the following diseases?

Which of the following is the most common etiology of tricuspid regurgitation?

A 60 year old male smoker with COPD and hypertension presents with abdominal pain and lower back pain. Physical exam reveals a pulsatile abdomen and "blue toes." Which of the following tests is the gold standard for evaluating and diagnosing this pathology?

Which of the following complications from acute MI is the most common cause of mortality

Which of the following is the most common congenital heart defect?

A 58 year old female presents with dyspnea, angina and multiple cases of syncope. Auscultation reveals a systolic, high pitched, crescendo-decrescendo murmur that radiates to the carotids. Further, pulusus parvus and tardus is noted. What is the most likely diagnosis?

In an aneurysm below the inguinal ligament, what is the most common complication?

Which of the following would NOT be an indication for bacterial endocarditis prophylaxis?

If you suspect a patient with HIV has non-ischemic dilated cardiomyopathy myocarditis, what test would best confirm your diagnosis?

Operating on an AAA is indicated in an otherwise healthy individual when it gets larger than _______?

What is standard risk factor reduction therapy for asymptomatic carotid disease?

Which of the following arrhythmias would NOT present with a narrow QRS and irregular rhythm?

Carotid endarterectomy surgery is indicated at what level of stenosis?

A patient with CHF presents for further work up. Chest x ray shows cardiomegaly, pulmonary edema and rib notching. Which of the following would be a reasonable cause of his CHF?

A 39 year old male presents with claudication, Raynaud's phenomenon and digital ulceration. Which of the following would be most reasonable?

An inferior wall MI involves which artery?

A patient comes to the clinic on follow up from an acute ST segment elevation myocardial infarction (STEMI). Examination reveals a new systolic heart murmur. Which of the following is the best explanation for this finding?

A 53 yo healthy male undergoes an exercise stress test, running on a treadmill until a maximum exertion is obtained. Which of the following statements correctly describes the effects of autonomic nerve activity on the cardiovascular system in this healthy individual?

A three year old female presents for a well-child visit and was found to have rough, continuous murmur hear over the left pulmonary area. What is this murmur?

A 21 year old woman presents to the clinic with complaints of palpitations and a headache. On physical exam, the patient is anxious and diaphoretic with a blood pressure of 175/105 mm Hg and a heart rate of 122 b[m. ECG demonstrates sinus tachycardia. Based on this presentation, what is a likely diagnosis.

Which of the following radiographic findings is associated with tetralogy of Fallot?

What is the cardiac ausculatory hallmark of an atrial septal defect?

A 53 year old man with history of tobacco presents to the emergency department complaining of severe, ripping, substernal chest pain that radiates to his back. His blood pressure is 175/92 mm Hg. Chest X-ray reveals a widened mediastinum, What is his most likely diagnosis.

An 81 year old woman with a 10 year history of well-controlled atrial fibrillation complains of a 6-day history of fatigue, dyspnea, and a 10 pound weight gain. She denies angina or diaphoresis. Based on this history what is the most likely diagnosis?

A 67 year old male with history of coronary artery disease with prior myocardial infarction and stable, chronic heart failure returns tot he clinic for follow up. Which of the following medication regimens is most appropriate for him?

A 37 year old diabetic patient with history of paroxysmal atrial fibrillation and hypertension presents with sudden onset of severe pain in his left arm. On physical examination, the left arm is cool and pale with nonpalpable radial and ulnar pulses. What is the most likely cause for his pain?

Which of the following is the most likely cause of paradoxical splitting of S2?

Orthostatic hypotension is defined as a drop in systolic blood pressure of at least ____________ or a drop of diastolic blood pressure of at least _________________ within 3 minutes of standing from the sitting position.

A 47 year old male presents with shortness of breath. On physical examination, the patient is sitting upright with moderately labored breathing, marked jugular venous distention (JVD), bilateral pulmonary rales, and a S3 gallop. Blood pressure is 120/90 and heart rate is 110 bpm. Chest x-ray shows pulmonary congestion. ECG demonstrates sinus tachycardia with low voltage QRS. Which class of medication should be given to this patient immediately to improve symptoms.

Which of the following medications is used to control the ventricular rate during an acute event of rapid atrial fibrillation?

Which of the following is a contraindication for an exercise treadmill stress test.

Which of the following antiarrhythmic drugs most potently blocks sodium channel current in the myocardium?

According to the American Diabetes Association, risk reduction for cardiovascular events in patients with diabetes can be achieved by the use of:

A 58 year old female with history of Type 2 diabetes mellitus presents for routine follow up. Which of the following would have the LEAST impact on prevention of her risk of developing macrovascular complications from diabetes?

Secondary [prevention of an St-elevation myocardial infarction should include which of the following measures?

An increase in which of the following factors is most likely to increase the preload?

Which is the mechanism by which cardiac tamponade impedes cardiac output?

Which of the following is used to describe diastolic dysfunction?

You have started your patient who has giant cell arteritis on her glucocorticoid therapy. Which of the following laboratory studies would be used to monitor her response to this therapy?

A 50 year old woman presents to the office with a 1 week history of substernal chest pain. The symptoms occur with climbing the stairs in her home and with moderate-paced walking. The pain is relieved with rest, She denies any current chest pain. Her physical examination and ECG are normal. What I the nest test you would order?