A 52-year-old immigrant from Eastern Europe presents to the outpatient clinic complaining of

dyspnea on exertion that has been increasing in severity over the past severat weeks_the also
describes nocturnal dyspnea and a cough that occasionally produces blood-tinged sputum.
When the patient lies in the left lateral decubitus position and exhales fully, you hear a
low-pitched, mid-diastolic murmur at the cardiac apex. Which of the following most likely
underlies her condition and symptoms?
A. Tuberculosis
B. Infective endocarditis
C. Uncontrolled Hypertension
D. Rheumatic fever
E. Atherosclerosis
F. Dilated Cardiomyopathy
A patient with a long history of atrial fibrillation experiences right foot pain. He presents to the emergency
department four hours after the onset of the pain. Physical examination reveals a pale, cold right foot without a
palpable pulse over the dorsalis pedis artery. Which of the following is most likely increased in the extracellular
space of the affected region?
A. Sodium
B. Chloride
C. Potassium
D. Calcium
E. Bicarb
A 3 year old boy whose family immigrated to the United States several months ago is being evaluated for
extreme fatigue and occasional syncope. His mother says that he has experienced episodes of agitation and
tachypnea since birth and that these episodes have progressively worsened to the point that he loses
consciousness. Cardiac exam shows a harsh systolic ejection murmur heard over the left sternal border. Hist
oxygen saturation is 84% while supine and 91% while squatting. Which of the following is the likely diagnosis?
A. Aortic coarctation
B. Atrial septal defect.
C. Mitral stenosis
D. Tetralogy of Fallot
E. Ventricular Septal Defect
A 56 year old male receiving treatment for hypertension experiences periodic dizziness. He presents to the
emergency department after briefly losing consciousness while getting out of bed this morning. On physical
exam, h is blood presuure is 115/75 while sitting and 90/60 mmHg while standing. Understimulationg of which
of the following receptors is most likely responsible for his symptoms?
A. Alpha 1
B. Alpha 2
C. Beta 1
D. Beta 2
E. Dopamine 1
A 34 year odl man comes to the office due to nasal stuffiness and intermittent dizziness for the past several
years. He has not hearing loss or tinnitus. The patient has used several oral antihistamines and glucocorticoid
nasal sprays, but the symptoms persist. He was also evaluated for infertility and found to have a retrograde

ejaculation. Past medical history is notable for failure to thrive in childhood, but the patients subsequent
development was normal. Physical examination shows boggy nasal mucosa. Further evaluation reveals a
congenital deficiency of dopamine beta-hydroxylase. The patient is most likely to develop which of the
following conditions?
A. Aphasia and memory loss
B. Debilitating arthritis
C. Muscle rigidity and tremor
D. Orthostatic hypotension
E. Recurrent infections
A 35 year old woman comes to the emergency department after a syncopal episode. She has persistent chest
pressure, dyspnea, and lightheadedness. The patient has no prior medical issues, and her only regular
medication is an oral contraceptive. She smokes a pack of cigarettes per day and drinks alcohol occasionally.
Physical exam shows altered mental status, cold and clammy skin, and a swollen right lower extremity. Ct
pulmonary angiogram shows a massive saddle pulmonary embolism occluding the majority of both pulmonary
arteries. Which of the following sets of hemodynamic changes will most likely be observed in this patient?
CVP/CO/SVR
A 32-year-old man comes to the office due to a subcutaneous nodule on the dorsum of his right
hand. He says the nodule is painless and has been slowly enlarging over the last several weeks.
The patient's past medical history is insignificant, but his father died of a heart attack at age 38
despite being a nonsmoker. His mother has diabetes mellitus. On examination, he has 2 or 3
small, flat subcutaneous nodules on the dorsum of his right hand, and a larger nodule at the
Achilles tendon area_He also has a few small yellowish papules on his right lower eyelid_Which
of the following is most likely decreased in this patient?
A. HDL particles
B. Homocysteine
C. LDL receptors
D. Lipoprotein lipase
E. Triglycerides

A 65 year old male has a 40 pack year smoking history. He has tried to stop
smoking several times in the past but has never succeeded. He has chronic cough
accompanied by scanty sputum production in the morning. During one of his
morning coughing fits he loses consciousness. Which of the following most likely
contributed to syncope in this patient?
A.
B.
C.
D.
E.

Vagus nerve activation in the external ear

Vestibulocochlear nerve activation in the internal ear
Vetebrobasilar insufficiency
Increased intracranial pressure
Decreased venous return to the heart

A 65 year old man is brought to the ED with severe chest pain. He reports that the
pain began suddenly in the middle of the night. His past medical history is
significant for a recent URI, coronary artery disease, COPD, hypertension, DM2,

obstructive sleep apnea and CKD. He has a history of poor compliance with his
meds. He smokes one pack of cigarettes daily and drinks 1-2 bottles of beer per
day. On physical examination, his blood pressure is 180/120 and his heart rate is
90/min. EKG does not show any acute ST segment or T wave changes. Which of the
following is the most likely diagnosis?
A.
B.
C.
D.
E.
F.

Aspiration pneumonia
Pneumothorax
Pulmonary edema
Aortic dissection
Pleural effusion
Cardiac tamponade

A 54 year old male undergoes invasive cardiovascular testing in response to

exercise. The following effects are observed:
HR: increased
LV ESV: decreased
LV EDV: increased
LV EDP: unchanged.
Which of the following best describes the observed changes?
a.
b.
c.
d.
e.

LV systolic dysfunction
LV ventricular diastolic dysfunction
Global left ventricular ischemia
Pericardial constriction
Normal response to exercise

34 year old homeless male who is a heavy alcohol drinker experiences

progressive exertional dyspnea. He also describes swelling of his ankles.
Sometimes he wakes up in the middle of the night with severe shortness of
breath. The patient dies nine months after the onset of symptoms. Autopsy
shows enlarged cardiac ventricles with some myocardial hypertrophy and
interstial fibrosis. Which of the following is the most likely diagnosis?
a.
b.
c.
d.
e.
f.

Ischemia heart disease

Hypertrophic cardiomyopathy
Dilated cardiomyopathy
Restrictive cardiomyopathy
Rheumatic heart disease
Cor pulmonale
A 53-year-old moderately overweight man complains of intermittent,"squeezing"chest pain. He
reports that brisk walking and stair climbing elicit the pain. He does not smoke or consume
alcohol. His mother suffers from diabetes mellitus, and his father died of a stroke at 62 years of
age_On physical examination, the patient has a blood pressure of 150/95 mm Hg and heart rate

of 80/min. Amlodipine monotherapy is initiated. Which of the following points labeled below best
describes this medication's mechanism of action?
A. A
B. B
C. C
D. D