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    21 views2,704 pages

    Internal Medicine Q&A Part 1

    Uploaded by

    Mei Bejerano - Roldan

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 2704
    ‘A 2yeacold Caucasian femaleis beng evaluated ser she ha an episade of syncope. She complains of hang progressive eorional yspnea aver te st wo mons va an occasional dry cough. Cardac fauscutaton ngs overthe ape are gen tlon’ Which fhe felwng bes cpa he physical ndras ints (© A Ascending aris aneuyer © B.Consbctvepencarte © Mra regurgttion © 0 Theuspidvate stenosis oe | TH.yearold man presents tour acer aoutne checkup. He hema prasart complet, His masa etre cigiteartfor rah nee ostoarrts. He tates naproxen aecasinaly to oles kee pan He Goes rot smoke or consume aafol His GP is TOTS mm Hg and is TON. The pyscal xamnaton Showed‘ mil aja eeton ype marr ate tabs or lenea athe rahe ane revealed ‘ermeulrnpertophy and secondary ST segment and T wave changes. Mosert lst ermicuar hypenrapy, aha ay fom stnarmalbes ne damonetsted on schocardography. Ths secon actin tos 00% What he mest potable cause othpertensan ite pen” (© A Rig one aneral vat (© 8 Elevates pisma erin acy © © at insficeney (© 0 ereasea cara ouput © E Increased rirovasculr vue Poot Block 2 92.yer Caucasian fra comes to the physician because fa oneswes sty ffi progscie worecrng of shorness af breath, ana sweling of feet Sha dares ary chest pa. She has na ‘her mee preslems evcept recent cold wo wecks ago. Shee nettaung any med-abons Her {emperanre 226, (99) load prossure ia 11068 rma puse le Some, and vespratans ae Sim ftere oxen race, elevate guar venous peseure an 2 hsteral tng ede one Snine senate. Compt io} courts umeratiabs.Tanehoraic echocardiogram of ex hea il ‘ost ey enon? {© A Cancenichyperophy ate bear © & oven npetvopry or he neat © C mia stenosis © D Hipaknesa othe inion wal © E Vegetatons on are ve (© F Asymmetic septal hypertrophy (© © Dine venice wih fe hypokinesia © Primary pulmonary typatension eto |AdT-yeacold woman ses conciousness far? minutes while shopping in asupemia, Inthe emergency ‘om, she recounts felng nausea and warn spresig oe hr bos medial before passing oe ‘Shefas reverhad a simfarepsode before She hasnt seen a coca for several years an doesnot ake ly mascatora nor dovs she use tease, aanolor use Haram nstryunvemarate. Vic ot the folawng most ike eaused ts ensode? (© A.Cardae amermia © B Seve © C Newocardogenic syncope © D.Heatvate disease © E Ovthostatic ypstensin (© F Tansiertischemic tack Poot 25 yea oi woman eipeienos suden onset papatons an generaizednestness. Dung bis pss hor lad pressures 0080 men ander heat asic Tedmin ana Yep. She has no ‘Sicar past medica Wstery ard does net tke ary medcatons, She repos hag jaf sear pocdes he past wich she as soteated by mmetsng het acein cad water General she S273, Cait aterimmarioneleves her syrgtms win several mus. Tis cl water therapy Werks by afenguhich of he foloning? © A Vascular tone © B Sioatia nae atematem © C sAttaventicuar node conductity © D Purkinje ther conducton © E Venticula myocardium cortractity e FM retum tothe hear Poot 2 ar.yeacoid man s evaluated for hyptension He complans of accasianal maming headaches. Hs past rmedcalhstay/ ia sgnficartfr ype 2 cables molt, coronary arty disease, ard 3 sake wih ‘esidalleesied weakress. He underwent coraary artery bypass Surgery seven years ag and cache Csareveetomy fe yews ago. ta current madeaton ee ncadesahgpnthydrnoranaaise oan, ‘opr aspnn, mean an gytunde. Hs lod pessure 190/120 meng onthe ng arm an TOT 10 mm on te lt rm Hisar rats Shin Pysical examination reveal aperumetcs systole dastote ut_Thelater thang is best exes by wien ofthe flowing? ‘© A Abdominal sae aneuryam © 8 Aare dssectn © C Aart coarctation (© 0 Rena any stenosis © & Aaroerteri sta Poot ‘ar yeacold male's brought the emereeny department ater a syncopal eps. He lst Consciousness wis shopsngin he mal. Hs danas ary nausea, daphores, chestpan,o shares of GreanHe hashad wen epsades of iphtheadeness earth ost mann buthas nt seen 9 cota His past meal star is exeat or long standnghygeransin nich tea estes eraser. food pressures 138/60 mig wh supre, and ISUEE mig whe standng. shear rates 54min, ECG shans 2 srus hy win high valtage prolonged PR wren, prolonged ORS inva normal OT Inna and ossasona premature vec eotiactons (PVC). Echocaraogreny reveal et verticur Iypertopy aa an secon ation (EF) of 88, Wich fhe olla the most ely eause fs pateres syncope? © A Biadyanhhmia (© B Decreased myacardal cortractty (© ©. Tareadee deportes © 0 Autonomic aystuncon © E Venti pemeure beats © F Sezwes Poot A yer oi male's 2 days status post, primary percutaneous corona nerventon (PC) ah stent placement He od grevousyserram av antraiseral myocsrsa infaceen. Hn sara enaymes Fine boon resing sarm ence asrissan. Hehos recovered wel readyfr dschoge. He's cent ‘symptomab He temperature e378 (996 F) load pressures 12070 men Hy, pubes Semin and ‘spratans ate amin He is dachaged wth iniuctans to take re folowing medians epi Sirvastatn, snp, metapotl, ard sublngualnirahcarine. In adson tthe medications ted stow, hich of he foloning medetons shuld ts pant aos tang afer dschge? ‘© A Baseride monantte © 8 Low maecularweghenepsnn © C.Watarn © 0 Clopdogrs © © Amiaspine Poot Block ‘AAT year al presets to youreffce wth awa month hit oflehargy and screseeditia Hs redcalrecrds ved tar hohas ban Usted or Jan pan an selng ove ta iast sans ae was Gipgrosed with dateles metus one year ago. Physiea examina reveals hepatomegaly and tesicuar ‘trary. When of te foning cardae stncmalce a most hat ao be preset nhs pater? (© A Aba sepa defect © B Aati stenosis © © Hpetophic eaiomyopaty © 0 Cardiac candutin lock (© E Endocadal rcelastais eto | 95 year oi Caucasian seis beng evalu for poor wei flvance and muscle veaness. He has ‘no pastmedcal history. Hs blond pressure range rom 176-186 nmi ystale and 105-115 mma Sfostaic an repeat measurements. Hs heart rte 7-8Gimn His serum chemssby is sane or ood fucose oSmgL_ serum ceatnbe 0 Ymglt, sium Na wide Teahy, anaemia 2.4 MEG CT Sean ofthe abcamenreveas a emmass ine lek stena gana. Which of he falowng adétena ndings wold you pectin Bis patent? Plasma renin sotity Serum aldosterone Senn carbonate OAR High Hh law © BS Hah Hon igh cc tw an Hin 00. lw Hah Low OEE Hah Low Hh Poot than ater wal myocar faction. Theres ma istry of prevus chest pan, dyspnea, PAptaons, Syncope orl seng. Heth no yperenson or dabetes ells He does ackyonleage 24 packyeor insta iy pa abr heen slows rain ae a -ame 0 Srtnor wal ype and an jeton acban Tr years leer the patent found dea the =< ‘iret. Autopsy reveals alte it veril wt 3 obuat shape and tinned wal lor mi 3 scr on he nei wa Wich oe along woud nave most ihe prevented his patent's stoi hangs? © AsepHn © & Erato © C.Amoapine © D toosorie dinate © E Dgoon © F Coumadin ‘ ‘at yearols homeless male peserte 24 hous ar the onset of substemal chest pan andie agroses 5 Poot 2 s.year os woman resets to your oe complaining flower exten adem tht trad several ‘weeks ago ad only progressed terete Herpasimsdcal hse sifiertfrFyperensen,wosted th metogrtalfr? years Ariodpine nas aoeed rary because of denuate control of BP with ‘atari lane Sha aes nt smal consume sieanal Shehas no monn aug ates He nos freesure ie Ishii Hg ans er near rae imin The pryscl sxeminan evel steal symm 5s ping dara oft loner sarees, without any sn chaiges ot vacosies Hor neh won pulsation |Srrmal Omer prysical ngs are tn nama ies Her aboratary Suse reveal Me floaing ‘Serum aburnin 450m, Teslcermblnutin D8 mad Seren sod aomeg. ‘Serum passim sOmegt ‘Senn ceainne osm Lint within normal is. Whats the mest hay cause othe edema this att? © A Heart faire © B tnerdsease © C Renal scape © 0 Veneusinsufcieney © E Sie eet other meseatens Poot 2 Bt-yeacoid mal wha has nat sen 2 doctr far th past 20 years presen tothe emergancy room with ‘acuity chest pan that stared sutderiy about vos haus ap. Me describes he pan a =anr9ih {jy and says that ade tons hace ‘On physical exrngton youhear an ery ditte Gecrescendo murmur atte stinal tarde Chests fay shave ndenng of te supe macasteum. EKG ‘snormal_Winsn atte tllning mess conseane most accours forth pants presematon? © A Systemic perenson © B Nartars smrome © © Enler-Danes syndrome © D Bicuspi ari ve © E Giatcal ateris © F. Diabetes metus © 6 .Aerorcerss © H Pulmanaryhypenension Poot A da.yeacoi feral presets othe emergency om ith galptatons and ihtheadedness af acute neat Asa, she nas expenenced insomnia fsngabiy and waht os a She dovs fe sake at Consume scab! She maton any medications rer San pressures 1/80 mip an heatate = {Bm equ Pysical xamnaton reve tag and emaro ie ousted Mande ECS shows aval forlatanwehrapavermeurrespanse Wats the ned best step nthe managemert of his pater? © Deon © 8 Propraae © C.Ldecsne © .Ounidre © E immediate cardoversion Poot '.4.yeacold Caucasian man wih atwoyear istry of abst meltusprserts to yur fc for arutine checkup. Hohas no camplans. Hs medcatone ate mevrrin aid asprin. He Werks 25 3 compat progarmerandhas a sedentary WeslveHe ins on foto cans of beer on weekends ana sakes one ator Sgorates per €ay.On pric examination, Hobe prezaure TEAaL mm hg an haar ae 'sG2mn Hie Bia 225 gir? The remains ctne physical examnaban unremariate, Laborato Suds reveal anHbAic off 8%. Ais checkup one mort) ag, is blond pressure was [49132 mm Ha. Ynch of te folorngrevercans would be most eztv for conaling his Dood pressure? © A Aerobie eres © B warrtoss © © Smoking cessaton © D Bete itetes conto © E Outing lect © F Dita sat resicton eto 2 38. yeacolt woman presets athe emaraencyaom complaring of chest pai forthe past sever hous. sho describes tas sha, rental ora, ar rorraaaung. The pan worsene somawat wth Inspraton and movernent. The pater denies having fevers chil, dyspiea,swelng or fey teairg [dant She soya ae et nofced he pan ona nercaing tee wast ago ul Medexperancea est {5 wel She sys mat she has teen exercising heaviyin an atemp ole weit. Her Mis cure Sthgin?. Her ater hada myocardalifarcton at age 80, Hermedcalistxy is significant fro norma ‘agna geiveies She somes ena pac of Ciatetes daly. On physical exams het Dood ressure [2 Tap nm Hy andherheat ates 7m, Cates evan raveas agua $1 and 20 who stra Sounds or murmurs. That is tendemoss palpation overt strum. What fe most lly cause het Chest pan? © A Gastoesopnaneal eux dsease © 8 Pulnonaryemealsm (© © Unstae angna © 0 Percares © E Costochonins (© F. Stable angi © 8 Peyhiaiedsrder Poot ‘6s yeacoid man presents tthe ER wih substeal chest pin and apheresis. The pain stared one haur ‘go.nd didnotremt wt asc. Horas a past medical Nstary fasta for ich he usesinhaed FAearone and peptic ueer cose for whch he fakes emeprazse_ His fami sary i sgnficant or Postteconcerinris taba ans reas cancer nhs moter, Pryscal examenzion reveals alood presse Uf su/idd mig and snes mn. ruts hess ovr ine npr cars ney ana 3 mis seteh= Turmur ispresent athe care apex. Subingualniogycern and asprin ave amriseredin fe ER. Whe mes the pant repos decreased pan’ Whch fe oar most Wel acount or bis lmgrovemere nh symtoms? (© A stescedet vereula eamplanee © 8 Decreased verter lume © C Decreased et vertical cotacty © 0 trereased systemic stood (© Increases cara pelos (© F eraton near te Poot 2 38 yeacoi female comes to your offce complaining cf accasorlpaptatns. She describes feslig a fast and regurnearbea. Over the pastbwe rah, shea had vee such epsodes, each lasing abt ‘brahours She denes any assocte chest pan, shonness of breath, cough oranie sling "She os cana on sodaloccasans and ies nat smoke Sgafetes she hash te mada proms ar sn ‘ing ny meaeatons Ch mys examination nertemperen 7 HC [0b SF), puseve alm, aos pressure te T3070 mmbg. and resprabone so Iaimin. Onavseason of harhea the sical rps Saesaced andere ean $=. You aso nearaparsstoc murmur, whan nudes tthe apa and radates tone aula Whh af teflaning [she mosey cause of er symptoms? © A itavave prospse (© 8 Myocarl schema © C Rheumaticheart disease (© 0 Mra anna easticaton © E ttectveensocarsis Poot |42.yearold woman values or dapression, mood swnge ant poor slp. She se complans of aid headaches and muscle weakness. Se nae had bua ER vate for hay stones oer the oat year She Genes aryl uguse Her Hood presse 00/05 mre and her heart Simm. Per bortoy ings ne shoan ste Secu Mo meg Ponssum meq. ‘chonse orreat, Bieatonste meg eu iemaa Creatine osmgid, Gucese Somat. Cau nImpa Wich othe alongs the most ey cause of his sates hypertension? (© A Rena parenenya dsease © 8 Reralvascuarstenois © © Aare alssecton © D.Hpatiriism © E Patanjow dans disease © F Adrenal conic disease © G sateral medlay disease Poot 2 1.yeacold ican American mali rtered ta your fice aris alder tater experienced sudden Cardae aes urng king up. He has ne currant complans. He anes aril rg use. Hs Deed Dressrets Tie mmtigan shear rate 75mm Neck spp, no jor sono iterton Upyreciaes. Caves puse seems to rave dvalupatiave. Lungs ae cca There sang apa pulse anda systole elecion-ype murmur along ele sta tarde Wh ofthe fallowng mast ik to increase the murmuritanstyin tis pabere? © A Squating © B.Valsova manewer © C.Sustanedhandore (© 0 Recumbzncy © E Lesraing Poot 2 ab.year old mals brovtt a ER by his son because he had an spiscd af syncope, He was watching TV inanarmnar nan sudden et ig conesavenetenithak any wang sgn. Pe nad ever one ke Wile uncansceus. He neer had such av epsoie beore Hs past medical sis siicrt fr acu Imyacardalnewston si mantra age ant wel-crdalid mpenaion, Ha cuen medeators lle Caytopn meter, yatacheahiande, clopdogrl and asp. His tload pressures 1305 mmig and oat ats is Din with Requent ectopic beats. Physical amination reveled mild hosysofe apa ‘murmur radatngtothe aaa, Which othe oloangis be most rotate parochysicloge mectnism tor his syncope epsose? © A Vasovagareacton © 8 Autythmia © © sutonoric dysfunction © 0 Seaue (© © Pasta rypatension Poot Block ‘4S year ol racanty immigrated Mexican farmer comes to your office complaing ct dyepnes atgue and dominal stron‘or tha pasibva manne. On physical exam, hs toperaure ie 70°C (96.07), lost pressures 12060 mm Ha pusets Eran andrespratonsareioiminYounete peel edema, elevates ular venous pressure wih poste Kassin’ un erincfeases adorn gr ith oes. Chest luseutaten reves decreased nea saund rensty she apex an an eat heat sauna allvang S2. The |ugular venous presturs vaing shows proinert and V'Gescerts. Which efthe folowing the mast Ihe eouse of ns patents symtoms? (© &.Corguimanai © 8 Tibercuass © ©. Trypanasoma cuziinectin © 0 Peas © E Preumcesrass eto ‘ 25 yeaold 02, P1228 ees estos brighton emergency departertyherbofindwho 7 fender yaar bod sta pete boot Su evry ey. der ay parva ‘ Crtaciorn Her torpete's aC (D0F]and eae we fSnen yaa crraons : gece aravanoeeete:hopecan ene seine evening ose av aie Seas pt t ‘tua inthe te loug sea prams anal moat nape tens pet? s co vow SR BP ie seta Bevrosses futased eases Brcesea—teoea SS Becsted Becresees Invented Besos Onreaes Sec Devwonss DecrosedImteessDroemedreresne Set9 Deones Decenaed GrveasetDeoenederesnd SHE frcwsces” Bacresses—Inwseed”Brcemederemod ‘ eASeA = © 8 sa8 a ocsac = ‘omen 78 er SHE =o eros 00:30 1 St-yeacold male comes tothe physician because of abdominal dstenton. He thnks hs ba bly making itharfor he wo breathe. He raceved raion therapy fr Hoagn ymphama several ears apo ar was tea thate cured He dirs aleohl on areqlar basis. His temperature 30 Tc (BEF), lod pressure {aoe rm Hg. puseis mn 2 raspratans ae urn Examnaion shows aja! Yenc pessute? cmatove he sera ange Dulnesst percussion ana decreased ereah sours are neta inthe Mt ing tes. The sbdoran'e gute detondedsath an cows isan. Mid hepstorepay 2 present. Exremes nave 2+ ler entemity adem, ntidabortry sides ate shan belo ‘Senm creatinine O8 maid. ‘bun soma Toalbinubin Oma Pretonbintme TI see Lnnasi i wenn nora mis. Which fe flan she most ey cause of is conor? © A. Umary eatin oss © & Fatal veintromtosie © © Poralvaincampressicn © D tras pericardium (© E Tharace dict cbstucton © F Venaus ae incompetence Poot | a2. yearold woman resets ith progressively otsaning dyspnea on aarban ane minh ater etuning froma vacstonin Toss. She ays ther symptoms have progressed ithe pare that she nay wakes Gang the night wath achokirgsensatn hat mpraves ony vth sting wp. Recent her shortness breath ras requrea nero sipitcary ithe physteal actury ‘She Genes Raving assacatesanestpan, sin as0 arjorepan. She has na signfcart pastmescal istry Famty str is agnfcanforhyrad cancer mhet ure and lng cancer inher father, aheaey ler On physical examination her temperature is S72°C (3 FF pulse is sin, lod pressures 1170 mg and respratons are Iman. Bea ping anhle ‘ama resent Hr berm enlarge 2 cmbel the rghtcosta margn. Lung auecutaon reves Gearaaced treat coun at btaral barae. Caiae oa reveal e presence oa ird heat Sound. Chest way shos an erlrge cardi: stheuste ond sal bier lata efusons. EKG is Unvemarbabis Which oloang be os! We cause a Per Syms? © A Abersclesis (© 8 Veainfecton © C tyme asease © 0 .coceitasomyeosis © E Autommune disease © F sypatnyrotism Poot 45 yea ly avernsight make ecavern ram an attr wall myocardial ifacton devas sudien sat of sharp pan inthe it ice fis chest. Ha practi ds eae ith subst chest pan and Ginphoresis. He has tadro dyspnea, eremtysneng or paptabons since admission. Hspastmedca) ois siyieae tar davetze malls ype 2 He seams my testes especialy nthe suane postan. The pan mproves wnen stngup adleanng farward, Hs breshngis fast and sain duets the pan. His lungs ae clear on auscutaton His lod pressures 120/73 mm ands hata fmin_Thereisna change mood presse upon deep Mepsin. ECG shows Brus hy wit nee (uae ST segmereslevatan” ich of teflon he most ey dagnests? © A ptenentncularnal ne © B Ventnor ee wal tire © Pulmonary fection © 0 Recurent enema © E Ragnvenmcularifrcton © F xiary muse tue © 6 atc dissacion © H deat pancacus (© Lenticular aneuryem Poot an 6. yea. feral nursing home resin tray ta the hospal ith aon meskhistoryof mang, ocreaed ral nak and decreased ambulation. Prysicl earnnaton reveals avery thn fale was ‘owing and appeersiobe mpan_ She opens her eyes sportaeausy bu does rat espendio (uestane Her aca pressurete TSU rendg pulce'sLOsran temperatures 55°C [oe] ond Fspratane ae Zim Cxygensetursion (pulse oxen) U7 anroom a Her sk and ral mucosa Se dy ad her neckveins ate ft. There sa lmphaenepay_On chest auscutaton, thes are races imiverattuope ing lobe AGoomen s sok and nov dstendeo. Theres 2 pit presacral cloner ‘Stern edema, ands deep pasture ulcer nthe sacral area Laboratory analyse teveale he along: ‘Segum eS reat. Potnssum Sameqt Gucese Bema. Biestonste —i4megt un strat, Creatoine simat inch cFne along is te mast ihe csuse of her Inver enremty edema? (© A creased plasma ydostatc pressure (© B Decreased plasma oncotc pressure (© C Renal water ad sodum tenon (© D trcrensed erst orca presse © Decreasesjnphaic range Poot 2 Btyeacold man complains of pabtatons and progressive shatnass of treath over the past several hous. He says that he aso daveope a choking seneaton avery tee testo le down. Hs medeal stows siicart fr hypertersio far he pas 20 years and medcatan non-compliance. He asa 335 {Jaramaing nisi He fepare tats ater ded ata hea wack a ge 70 nae rater sued tam {sina On physica examination hs land pressures 170100 nig and he heart ates T3Dmin ane replay repr Ling seam revesibikaciscraciee. Theres 2+ ping rooms oe ur ‘2tiomtes. Sedsce echocardagranty shows et vertu eecton racton ot %, Which o he faloning ost hy responsi forbs syreturs? ‘© A Cardogene shock © B Diss dstnction © C.Higrouputhestfalure © D. Smal aimay tronchacorsicton © E increased ung comple Poot 2 22-year Caucasian males evaated or an episode of syncope that occured whiz laying soccer. I laced ony 2 minutiae wtnod ony sect yncopal contusion, sespeeeorwssknee®. Heed oor epeade = of dzzress whl plying acive spats as wel as vague chest cscomt He uniededsuddeiy aa “aun age, Auscutaton ois precoraum reveals av sya muy ong ee ssa eae The Peels mos: ike tabeneft fom which ae foloang medians? © ANeaes © B Betableclers © C.Disopyamise © 0 Amine © E Dias Poot Block 1 5S.yeacoi Caucasian male present to your effce wth muscle pai of recent nset Hs past medical storissigticareforhypertensan and an acute myacardal wfrcion experienced 2 mors a9, Hs Curent medeatensincluge mega captor spin and simvast Hs Bod pressure fs 13080 ‘reg anger rat 6 oan Liver runcon tes are sgyatrormal Sewum eewne ras evel vated You suspect a dug nduced eachon Which the felon she most passe mechan of up induced reaction ine pater? (© A mrmune-medated reaction © 8 Cet suace receptor ockage © C.Beracetlareraymeboclage © D-Symetceacton nition (© © Damage ot memtrane taunt igiss eto Block ‘A da.yeacold male presets wi sicmonths of worsening dysonea. Hs symptoms have progiessed the pont tatwabing even one block causes mo tacors short beat. He Matshita of gates Smoking tut qt 1Dyears aga. He irks approximately are alcohol dink day His medical storys [Sansa ar pope cer aaeoas foramen a tes srtacda On pyseal eraminsion Mele seenie, Hs fuseis Sein, blood pessureis MOISE meig, respratay re Miran. Wie xaminng his heart ‘Jounats righ pene, Seng wat aca, decroseado mums nti ear bet inthe ek ire Inerost space and intensedtynanogrp| Theres prurient cadommegay on chesberay. Which ot thefoloving made ons wauldimprove bath his pants sympinns and eardarnega? (© A Quinine © B Metapoa © C ttedpine © 0 Ephedrine © © Amasaone eto 20 ‘2 T.yearold man brought tothe Emergincy Room bacause he lst his cancun whe woking in the garden. He sae nat hahadceveralepsades of neo sycope on satan raceny, Me past mega historyisinsqnficart Hes nets any medeabons Hood pressure 11/85 mg and eat oe ‘min Pare a mauimalimpucs is nceaseain tansy Cara auscutatan reveals doctan pe syste ‘murmur ttre nace ans hearin raion tne saronesteres OG demanerstes evennause Fypenrosy, and secondary ST sepment and Twas changes nats the most prooabls caves of hs ters cand? i ‘© A Rheumateendocarsts 1s (© 8 Bacteralendocaris 7 © C Hypetersion (© Cangenta anomaly » © & Aperelatedsclercalaitie changes 5 Poot oa | ab.yearol feral presents to your office for a routing chec-up. She has no conplaes ander past ‘meacalhstay/seignficart. Shem ntaking ay meciesbans and denies ug abuse. Her ood pressue '5 1258 meiigand hear ate Bllman Cards bison revi ary anole murmr othe ok Semaloraer What she hes bes sep nthe management of he pater? ‘© A Enshacarbogran © B.Chesberay © ©. Coranay anaiozaphy © D Echacarsoaragty © E Nofirther wasup 5 Poot Block 2 28 yeacold woman whois 25 mechs pregnant presents athe emergency department ih sue ant Severe ehrneeeoftreath and nab toe fat. She avery emrated om Eastam Eurepe, Hat mescal Fistor ssificartforrecurert soe teats requrngtonsletomy a5 ach. Peserty Re lod presareie DED mmiigang nr tear rates 20min. an ES yb Sip suggests aa fanlaten. When afte alongs te most ky agnosis? (© A.Hypsruophiccarcomopaty © B Constictvepeicaris © CMa stenosis © D.Myocardalifarcion © E Antic nsutclency eto 2 year man brought nthe emergency oom ater he passed aut for ane mute ding an eary rmoring . He was notcorfused ater Be episod: and not have bowel r laste ncertnence. He has Seen hang everoral chest pon and shares of tea ar epee meth. He has newer hod ny ‘sg chat pln. He has ose beat excep or paren, win he skesPyracisaisnde He has 820 pack year smalang history and accasonaly nis sass cf ine. Hs taod pressures 14200 rm hg. ule © 80min, aid reepratons as ISinin. Caro puis delved 2 is weak ard an S46 resent gras a eytle seston murmur ii thei 20a eteoostal space, radatng tothe areds. Newragial samnabon eves ne focal fndngs, and ete afe no sgn of head Wauma, AO EKG r ‘howe le verttclarhyperropy. Thee oe of eardac enzymes ie negab. hich af te flaning ee ‘ost apron nest step n management ° © A CT esan ore neat ® © 8 Ghctoenceshlaram (EES) © C Erase stess tes 2 © 0 Echocssogrem = (© E CTagioyam ofthe ches 5 Poot | T.yeacol feral atc the CU wth severe chestpsin, The inal at of eardac eraymes ie poste and her ENG roves an ans wal myocar marian. She recanes veamant wth apn, lopdoge metoprl, nogycerne ip, and maphine. Tea aur er, he elemety monte spay he atoning mye, tt Wich othe aloning is he best next step managing is patent? © A Usoraine © 8 Deftain © ¢.Dgo0n © 0 -Ariedarone © E immedi echacerstogr © F-Epnephnine © 6 Magnesium suate Poot 88. yearold Caucasian fra prasant othe emigany toomnth recent neat af sided ‘esiness. Shafas been exeeiencng nce ose fatabliy lv grade fevers and occasion palpation (perth past two mons. ‘She has ost seven pounds cng fe same pena, Her temperate te STC 286 Fh pulses admin guar blast possura is 12/7emmbig ang espana ate mm Harlungs se [ear Caraae aussuanon revesia moral fret ana sseana/nean seunds ane a mi-aerte rae tthe Spex. Eenocstdopraohy chums amas nthe rom. When fh felwng ee most ey agnosie? ‘© A Congenital hear detect, © infective cndacardis (© C rrcaniac turar © 0. Myremataus vale degeneration © & Rheumatic fever and tial thrombus Poot ‘a yeacold male presets tothe ER wih chest pain His medical his i sinicatfor state ange for ‘che takes aspen and sosortde divas, wal 3s hypertension ar tranchal asta. O=casonaly heuses an abel ial He's adits tthe hasta, and we hous te, he begs fel ightheaded ansiweal His blad rescues TOMB] mig £9 EXC ie ota ana issnown blow 8 sa Which fhe flowing isthe best net steph managing his patient? x © & Conds eoetreton “ © B. Pacemaker insertion = © C Aderasine > © 0 Dann = © Nera rs eros c | Sb. yearold male presants win progessily worsening dyspnea and aie edema. Ha dari hast pan, syncope ar palpatins. He doesnot emako a ink aeahol. He aeies bates mals, Pyperercion, ot Fypeipcermia. His temperatures 3 1C (387), puses Ton bloodpressure is Toe Tommi, and ‘ppratan ate Isimin Examnaton shows eleva guar venous ensreblateta aria eet 3nd {enderhepatamegay Chest auscuain shows tbat aks. His heart stands afe stat an teres no ‘turn Chest ray cone mi caomepay and gh siad peal fusion ECG shoe lw eloge [GR comgiewes and nonspeene ST-T wave changes. EchacarSopioly shows norma et vnticust “ue min syrmetical tckenng of he et vera wale and sight recuced syste tuctan. Wich fhe floning woul reprovent a potertil reversible cause of is pales haartdieeare? © A Armaidoss © B Sarcoidosis © C Hemachromatoss © D Schroder Poot 2.4 yeacold ite males found to have premature aia compleses (PACS) an rautne EKG. He dens Chest pan shores of uresih or igtthesvecrees. Haas smated 2 packs of gare daly for tne past aD years. He asohas 920 year hist of al-chalsm hough rece he has ied his use to (2 Eeralaay "Te pate amy nay Ye siesta a racer narton ra mater a age 26 and 8 sake nis fer tage 12. He has no persona isin a Pyperensin er dabetes. Physica examination, incu val gn sane tn normal ims. What ete bes es tp the management of ie ere i © A Reassurance 5 © 8 aur Har mantoang ° © C Echocssogram © 0 sunt tetatiocer merapy © E Advse rita stop alchalandtabacco a Poot Block ‘year man s brought tn the emergency department cto syncope. He has ha similar episodes 2 ‘ewtmas durng he past few weeks These episades usualy occur afer he cxens hevsef He does rat feo confused or red afer ese episodes. He denies ary chest par or paptations. Hise rpars hat len ne colanses, he seme tose consciousness for fw secon, Cu Men ls bac ing der Nt ‘ony She danes ay joing mavemerts. He past medcal history sipiceredvericuoss fr whch {akes ber supstments. He snot on ay ether medcaton. His tamperatureis 37.1 (9887), boad presurets T1068 mm Ha, pusets Bn, and respratons ae Wrmn On examination. e has a fourth Feat sound ang haan Si syste murmur best herd over te ghstralrger The mana {accented an expan. The ng els are leat auscutaten. Aer prtarming an echecraograph ta orf the dagnsis, wich f he felonng management epbons s most operant? © A Bote vahetom (© B Aatic vale replacement {© © Close ousatetoloveup wit serial echocrdograms (© D Barciee tetlooking for anhyhmise © E Observe ute patent develops breathlessness eto 2 12yearolihite male ants opatcipatein spre shoal Hess teen rong nrmaly sie tire mmunzatons ae pt dao and he sat sting tom any tomnmedcal conor. Which of the folowing mepsures shuld be hen sereen hmiforindethnghemt esas hat coud cause seen (© A\No screenings required © 8 Hetary ane physical exam © C Rleadeco © D.Bchacardogrsohy © Bverise sresstestna Poot 2 5S.yeacoi male presents othe emergency tom wih iat ied weakness hathas petite forthe past vet ours. He abo compl of severe central chest pan rats "ping ual and rates to Fistosk He has hag hypertension tore past seven years ang has net ben arg any aspen ‘escaton. He hasteun smoling one pack al agaretes pet day ar the pst 28 yews ie faher ea o Coronary artery asease a age 4 years Hs temperanrels <7 °C (G0) pulses Tema. tload pressure fe Tea! 20 mmHg inte ttt xm rd 11070 mmg inthe sham. nd etpraone ae Tomi Hee Siogrore and comused. Hs newologcalexarinaon signin fr deceased power and tone nthe ght upper and glover edremtes. The est hs physical examina unvemartatle ECO shows leant devision nda chest ray nama). Baeedon teas findhnge hate the most aly Saaroce? (© A Subarachnoid hemorhage (© BHemarhapic see (© ©. Patadavical pulmanary ema {© 0 Myocardial infaeson with hremboeméctsm © E Aare dssectn Poot Peer | S-yearo ran is brought ta the ERtves hous ar the ance of sever, 1010, tetng subsea chest an radiating this back, He sl comare of pan and czciness atte ta of anal. Physical ‘amnaton demonstrates» path ma has ans and daphoree bond pressures SOND fms nie tis am ana 1d righ he et arm Theteis an Te mea aerence nsytote lesa pressure betveeninspraton and exprston Hs up ves se dstnded whl sting Bedade Schocardogram demonstates 3 moderate amount of prcatal ui. Wich a the floning isthe most, Ihe doanoss? (© A Aewe myocar eectan © 8 Acute pacartts © © ate dissecbon © 0 Purmonay emaatsm © € Tension meumatrorar Ceile) ‘A s2yeacold Caucasian femdleis beng evaluated ser she ha an episade of syncpe. She complains af having progressive evorional jepnca aver the st wo monte wah an ocasioaldrycough. Cadac fascufaton ngs overthe ape are gen ten hich fhe felwng bes cpa he physial ndras inne pater oats "A Ascending aoc aneurysm B Consticvepericariis 1 © G.mratregutanon _Tcuspidvahe stonsis a zz ‘The combinabon otis psbents exetonal dyspnea, ty cough and losis mm on sustain are ost suggestive af rival regurtaion (MR). Aough he cial manestatane of Me vary signin wah the degre erregurgtatan,everonal jspnea and aigue ae the mostcamren sympms, whch cut Seconda fo #carbnaban of Gecreased cada ouput and ricteasadlet tia jesture Ths pater oy cough may relate to pumenay angestan and edema, which's an inca’ f rare severe Gseae hat hos Fesuted nek eredar shncon ‘The mumr OFM fs cassicalyahasysale murmurheard est (ver the apex enh radiation te ts ‘Maa regurgation can occur 35a resut of primary mival vate csease (eg rheumatic heart sess, Inocive enancardte, or tau) or may be seeelaed wth over carsac condor (e.g. ham htt {ase98e or mpatomhic cxdoryop30y) (Choice A) An ascending artic aneizyam canbe assacitd wth aoe ragutatan, which woul auto a ‘Foetaie murmur {Chotee 8 atnoua patents nin consichepereardts oten present wt serra spnes, onc Constnawe pecans © C Mira regugtaton .Treuspidvahe stenosis Explanation: ‘The cambinabon otis patents exetonal dyspnea, cou, an loystalie mums on sustain are most suggesve af mira regurtain (WR). Amoug he cca manfesttans af M vary significant wh the degre efregurgatin,exeronal spnea nd faigue are the mostcamren sympms, wich 924 secant fo a combnatn of Geceased cada ouput and nteasedet atid pressure Ths pateres oy ough may rele to fumenay cangestan and edama,wfich's an ines’ f rare seveie Gsease ha Nas ‘eedted mle vented dehncon. The murmur oF fe cacecaly a layatale murmur heard Ut (ver the apex nih radiation to fe ala nal reguraton can acura result primary il vate sease eg stmumaic eat disease inecve endocardt, or aura) or may be seerlated wath oer carda: condor (29. /chami att isease oF patorhc corsoryepaty) (Chotew A) tn ascending sarc aneurysm canbe assacied with aot reguatatan, which woud esutin ‘ieee murmur {Choice B) atrough patents mth conse percarts often presen sth exerboral rspnea, physical [nage sucht ovaad agua venous pressure, pulstlehepstormgay, and sgn of hu omit = ten resereas wal (Choice 0) Ticuspid stenosis vould cause a dastols murmur, ot syst. Rheumabichenrt disease isthe ‘ost common cau a euspld nena ueational asjeceve: Ito reparation assay resus ina hlosyste murmurheord best atthe apex wth adaton tothe ‘Conan cinca features o MR nude evertora dyspnea, fatgue, ata Rotana ps of hea fale 888 of pov nsisred his aveston corey astute (17/2008 Copyright® LEMLENORLD LLC. Bark ver 200802 ‘A T4yeacolsman presents to your ote or 9 oun check-up. He has no present corelants. His mei history a agnfeartfar ght ines dsloertir He takes naprnsne acasinaly to elev ee pan He oes hat sme or consume aahol. is BP is 16575 mm Hg and is 70min The physical amnton ‘Showed omit systae eeboreype murmur ae base of heart tothe rah Ar EG reveled \erbeulrypervopy and secondary ST segrrt and T ave changes Nagel veniedar hinenraey nai any fon stnarmaines wns semonststes on schocardararhy. The sector wosten as 0086 What's the mest potable cause othypertanson mts patent” © A Rigy of fe areal wal 5 Elevate plasma renin actity Carte nsuicieney 1. inerease9 carder ouDut E ncreaseantovasculr volume Isolated systaic hypertension (SH) san imparant cause of hypartenson in eld pats. The pahophysiosic mechanism lang oISHis beloved be decreased lacy ot arterial al which lebisto'onncrenced ay nod pressure, eahoxtconcrtnt mores [and fren decree] m Gate Hood pressure Namaly during systole, the ea eects he loud unde a cetan pressure tats dumped by last properos oft sata and majr areas. Than tis lash recol cs anal wall corerbtes the Goss fw ofthe aod ard dastlc pressure When clos properties ofthe areal wal ash and ‘teres tecome more igi ‘duping of pressure changes dura cardi ye algo decreases. AS [Fresut ot nerearedaran racy ports mish nave 3 vsanes ple presour he derenceEetaeen Sysacand las pressure). dened pubs prssure was recon recogtzed as importa arbovaeaa isk aot Metre, I shold be Weston aptroptey,m ste ote act tht Gstol> pressure ie not seve, paractornazie consieredt be he rag of acs forts canon. ‘Anincreased plasma renin activity (Chole B) causes syste and ast hypertanson as aon neal awtery Senos Ren act sl tsnarmal dung ISH, atic nsuticincy (Chole €) aden cevated pulse pressure and can causeicdate sstalic hypernsion bute wae ule out ty echacetdogany. 1 Inrensed cardiac ut E ncteacedrtavaeclr volume Explanation: Isolated systolic hypertension (SH) san impatant cause f hypertension in elder patents. The panopnyaiage mechansm leaang‘oISHis telovedta ba deceased estery ee aera val which lebdsto an incrensed ay hod pressireehoutconcrrntnoreae [and even decrease] dastle ‘bad gressure Nomaly ding esol, the eat eects We ood unde a can pressure ats drnpeo by elas properties ofthe sata and majy ates Then this elshc recol cfs atal wal coretes the lassie ta ofthe aod and dastolz pressure. When clas: properties of th arterial wal inch and Series tecore more nas supra of pressure changes dura ecard yee ako decreases. AS [Trasutof creased anand rgd), patent hgh nave a vadene pls pressure (he derencebatween Systac and las pressure) dened pubs pressure as recent recognized as animporare Cardovascariskfactr Therefore, IS shold be eae aporopiteym pte ofthe fact tht dite Dressurets no seve. Hydosroramazive conser to be Me up of noe Tor Ps conan ln netesced plasms renn acti (Chole B) causes ates and sete hypertension os sen inrenl attery stenosis Renin actvy swt normal dung SH, Aortic sucky (Chokes) kaso esate pulse pressure and can cause eae systalc hypenenson ourtns nes ule out ty ecmacersogsohy An ncteased cardiac apt (Cheiee 0) canbe» cause of ystsic hypertension in hyperdymamic sates sh as nhygertyroigam, Theelsro sit ofhyperamame crcustn mths cao! Increased iravascuar vue (Chole E causes stl and istic hypertension nvareus renal dearer, waa decrease in he abiy ofthe Kicrey to excrete sees andor water Ecucationsl objective: [esses syste paterson an iparan couse of ypetanion neler patents pia stesesty ocraased clas properties of he atl wal Awa teased etl ypatnsin. in spe ef the fact that dasa blood prescur sot elevate. The dug of chace ald be hyhoshathaee opsonisananereomn Lastupdated (912/208 ©, Berk ver 200802 F | 32. year ot Caucasian fem comes tone physi because oa aneweek history of ave progressive marsenng of sharness af breath, and snelingaffeet She denies ary chest pain‘She has a fer metic problems except recent clé bm washs ago, Sheienattaing any mec aon. Het femperore 928 © (99) loos presi is THOS mtg pulses Son pndrespratons are $i tral bac race, eet guar vinous pressure and 2+ Data ping edema othe anes srenated Complt iad courts ureranable Transhracic ecacaiogam of er hea Wi ‘ost they show? 75 Concerti hypetiophy ofthe eat 5 Eccenti ypertopy ofthe heat ial tenasie D Hypoknesia tn or wa E Vegeatonson antic vave F Asymmetric septal hyperraty © 6 Diatea vertices wah dts hypsknesa H.Prmary pumonay hyserensin ‘Tha incl presantton ofthis paterissupgesive of congestive hear flrs (CHE). stay af recert Upper espretary tact rfecbon fled by suden onset of cards flure nan thers haf paterts Sipgestve of alte cardonoraty.most key secondary io sou wal myocar. Dist cardamyopaty isthe endresut f myocardial damage produced by a varity oftoic, metataeor infectious agers al or slope myocar is most corany Seen faloning Carsacke 5 rectn \ralmyacarats i sean n 0x 35.8 Yo patents rected ah Corsacne Buus. Oe wes Implcatd ore alenoveua eytamegelavr, echovrus, hepa © influenza ws, paras 10, ond Epetein Sarr srue. The diagnose fe mode by echocardiogram which Spcay shove dite vente nih fie hypokinesia reslong nie eect acto (ysaledysfuncbn) al myocardhs can cause sted ardamyopathy by ect wal damage, as nel 5 Sequel ofhumeral or celuarinrune responses erste walinecton Diate cardamyopaty isthe end resut f myocardial damage produce bya vary afta, meatal or infectious agers. Val ar iopaic myocarditis most cormany Seen faloning Cavsacke 5 ecain “Ural myocor s seen abou 35% of parts rected wih Covsachie wus. Cher visas Impicates are azenovrus,cyomegaours, echovrs, pena ,imuerza wus, parawus E18, ant EpstemBar crus The daghost & made by echocardogram, which ypcaly shoves diated verti nth «tse Iypoknsia reeling ine eect actin aysale dfuncban) Viral myocar can cause dated Cardomopathy by rectal damage, as nel a= Seauel ofhumerl or celular mre responses © persist walntechon (holes A) Concers: hypettooty ofthe hears seen foloning ctrani peseure ovelad, a nvahlr ore stenosis or untested hypertension onever, these ae chon eaters ard woud rathave acute (holes 8) Ecceneshyeerrapy oftne nets seentaening crane voume averisad, ae seen invekular Tegzatabon pavever hs fsa tron conston ant noua hve se onset Pea aire {hotew ) Mira stenosis ic characterized by middastole: mum and opening snap EKG shows it tal Fypertopy. Crvaic mea sterass would cause ng verrclarhypenropy anus, Nghe venncuar heave secondaty to pulmonary hypetensin {hoiee 0) iylinesi atte arior wal woul ue Seen incase a fear wll myocar ftcton, but inesi pretension crn paper eno sugpestv a myocar {hoice ) Aor vate vegetation can cause aoc regugtaton, which, facut, noul not hve ated Neat ad, f cron, woul nay acetic hypetopny ofthe heart Aso, gates wth rece enocrss Sppear ick andthey wllnae eto rgh-gase fevers, cil, orn shat {holes F) Asymmetric septal hypertophy is seen in hypertrophic cardomyepaty Hyperrophic ‘arbomyapaty i 9 dseaee oe young and Is ef reser tn ate coool eer han Slisdn Gardae death wih is commaly seen, eéueatonal Objective: Disted cardamyopay maybe seen foloving val mocardts(eostrarum) patcuay olowng (Consache 8 nfecton Diagnose mace by schocadegrm, winch ypicaly shoes died vente snd Cause ypohnesiareculong in ystoteaysuncn (os jestan Mactan), 47-year ols woman les conscusness fr 2 minutes whe shooping na supemaet Inthe emespeney ‘am, she recaurts eng nausea and wan spreading oe her bay medal before passing oe ‘She has reverhad a simfar episode before. Shethas not sean a coca for eoerl yrs an oes not ake Sry medimors nor docs she use ttacra, aaholor dupe. Herfomy sory sunvemartatc. Vite ot thefoloving mosey causes encase? ' Catdac amttenia 8 sekue © C Newacardogeic syncope 1D Heatvatve desase thstatchypatension F Transietischeme ach Newrocaragenc syncope, lsalnown 25 vasovagal syncope, is @ common cause offantng. occurs due to excessie val toe ad ischaraceiedby nausea, lapharesi, toyeasia, and plored flora the synconal olsode. reaver accusin response t sess, pan and o=ran Dy acon 3 Unnston) esperar commanin yung nomen, Vasavagslayneape canbe grazed nye tse (hotes 9 Conducton disoters (ea. AV toe) tacryanmytmis (9. verte or supaventcuar {estyearda), and Garde ot autamatcy (eg ck anus syndrome) canal cause tang, Caneraly there fe preceding sso yous eceifr alate sme, Fates ual hav ndehng {holes ) Seiures and syncopa encodes are sometimes ficult distinguish. This pater des nt have cra Signs of seaure (eg angvo ibn), ahs of seizures, of 3 pos-ca state, making Syncope more ike (holes 0) Syncope dueta sure stanasis mast afenaccurs wih acy. Dyspes chest pa an ftv (en exerton are symtoms of are stenosis thar geeraly cur eanleinthe dsease course, Explanation: Newocaragenc syncope alsalnown 35 vasovagl syncope is 2 common cause oftanting. occurs die to xcesshe veal tne and is charactonaed by nausea, dapharesi, tachycardia, and pear mmedatay pirate syrcopal pisede.Requenly accursin response to tess pan and cetam bay acon (2g Uiatany i paricury commana yung nomen, Vasaragaleyneape canbe gazed ne ale {thoice a) Conducton iserders (e.g. AV toc. tachyanhytmia (29. vericubr or supraventricular {oetyeai8a), snd lsrders of automatic (eg. Sk snus eyndrame) cana cause ang. Genera tere E {rene precede eo rpms, cet opus same Peas aly he wer {holes 8 Seizures and eyrcopd eneotes are someimes cut ta dsthgush. Tis pate does nt have cea Sins of seaute (eg Tanguebitng),shisioy/of sures, o poset stae makina sytcope moray {hotes 0) syncope due ta sorts stunosis most en occurs wth acy. Dyspnes chest mand ftgue nexerton are symptoms of are stenosis that gertaly occur ean the dseare cause {holes ) Onnosttichypatension i dafined as a hp in syst boo pressure eater han 20 rim Hy fe he patert ses ea siandng poston. is ostcomvman the alder bets, those wth “Alanami newopay (29 Parson's disease) those rh hypevaema, ast peop lag recs ‘asoslamrs or renege bockng ageres. Praongedrecumeence increases mevisk Patents commonly ‘rperence presynccpalihtheadesness (holes F) Transient chine atscie (Ts) ean produce syncope, but ae ara eau because ne TH Thus atectnenostenar arctan an eran stem mas forsyneoreto secur, The pee nas na nak ‘etre fo soe Ecucatonsl objective: Newrocarsogenc, or vasovgal grcope accurs duets excess vagaltone. Episodes ae pracesed by nausea, daphorei, tachycardia and paler. Pan, sess, ar stuatans Ike medal needes and urnaton Canal pecitatevasovaal scape rae Los upastes: ©, Berk ver 200802 25 yea oi wuman eipeienas suden onset papatons an generaizesineainess. Dung is {pss her load preseure 1D meng ander heat asic Tebmin an fegr. Shs has no Slnicar past medica Nstary ard does net take ary medcatons, She reports hag jf staat poadee he past wen se has sa-teatea by rmerang her Tacein cad water General she S22, ait aterimmarsion elev her syretams win several mutes. This cl water herapy Werks by Sfectng union of the folening? 2 Vasclerne B Sinctral nage sutras 6 C.Ativenscusr nade cardi Putri feerconucton E Venticular myocardium corsacity F enous etm othe hea Patcuysialsupraverbcubar tachycardia [PSVT) isthe mast cammen pataysma tachycarain people vahot srucura heat dseare.Adacksbegn abrgth and ar chracanized by heat rates bebween {W220 ents per manus The mast common mechan undying PSVT is reanty io te AV nade. Mechanical and mascal herpasfor PVT dasteste AV nade conducty, Vagalmanauers, Such = "Yasak corns snus massage ansimmérnan insider erence vapltans ane deceacstandton through the AV nase This los theeartrate and can ofen beak he yim. Adenoshne 9 ry sho ‘acing AV-nads Locker tats oten ubed 3 wel Explanation: (holes A) Coit water immersin increases te vasculartone nin fate but hs ie nattne mesnansm ay (meh PSVT raccbes, {Chotes 8 vapal maneuvers oo oearease SA node autem but SA node automate sate Underngpracernin SVT In most cases, rurvant pattwoys tough the AV nade ae respansbe ‘Thus, AV nde susresson, nat SAnade suppression wiles PSVT. {hotee 0 Aeration In Pure fer conducton nous nt start aect PST because te eetant F YC Hsvermeusr nose sau Purine fer conduction Venticula myocardium corsacthty F enum tthe het Paroweral supraventricular tactycarda (PST) isthe mast common garonsma tchycarainpeonle ‘enhutstucuta heat dseare.Adacks begh aig and are chracerzed by hea tates bebaeen 120220 este per minus. ‘Tha mat corn mechani undsrhingPSVT is re any fro te AV node. Mechanica and masca thergpesfor PVT decrease AV nade conduct. Vagalmenewers, such = \Vasave, carat srus massage, ardimmesionn alder areas vaaltane and decrease conduction trraugnine AV nase Ths lees tne nsarate and can aten ashe mmm Acenosne ey) snor acing AV-nadal locker tat sen used 9s wel Explanation: (hotew A) Cald water immersion increases the vascular tone nth ace bt his is ratthe mecha women svt rsces m by {Choice 8) Vagal maneuvers do decrease SA nese automatism bit SA node atoms snot he Ungerng prdlem n FST In most cases, reantrantpatwoys tough the AV noe ae response ‘Thus, AV nade supression nat SAnoge suppression wil uestPSVT {hoice ) aeration in Pure fer conducton wuld nt sigifearty affect PSV because the reentant pataysin PSVT do not vatve be Puke ye (Chale 2) ery gc coma sceses ih nesevag ie, Chg moa Educational jective royal suprevertcuar tachycardia (PSV) mast cammanlyresuts ram accessory conduction tay through ie AV node, Vagal maneuvers and mediator at decrease conduction ough he AV rode fen esa the SVT ‘Comsat USM 0 DLC Berk ver 200802 | BT-yer-ot mans evaluate fot Mpertesion, He comelans of occasional morning headaches. Hs past ‘medcalhstay ia signficartfa ype 2 dstetes melts caonay afary disease, anda Sroka wih Fesidallefe-sid weakness. He underent coronary ror byparssugery seven year ago and carat {ndarerectomy fie yers ago. His cent medcatan Ist ncides hap hysoctarsthacie.arodane, ‘matoprca asprin meio and ghturds Fi land pessire 30/120 meg onthe naan sn Tur id mmbp ont et rm, Hishearrats © ssn Priel examinston reveal aperumeles sysclcdiatole But_Thelate thangis best exlaned ty which ofthe flowing? 73 Abvainal ao aneurysm B Arte deeecton Carte cosettion © D.Renalanerystenoss Aaron itl ‘This paterthas aheroscleat vascular disease, hypertension and an absominal rut cancring renal tary sanasis. onal artery sterosis isa eaing cause of secondary and refacioy hypertension nd ‘rane hdnes dense Cute ae causes by trl blond ow thin a veel and aeneectlurinalreguantse, Haden! buts are qute common n young pease acing upto 30% of ponents wtiot hypertension. They are found up 86% of paves wa real aay stnoss, comatesta 25% of parts wh typsension. THe Chaacteref ebruts aka ugoestve cena arr cients. Sysaie-dastl ruts we seen spyrotly 408 of paerts ith eal atery senate butlers han 1% of patents whoutrenlatary sions (holes A) Aadorinal aris meuryers ae aan mast commenyin alder man wth aheroeletene ane Smainghsioy. Theyclasscaly preserevithapulsaile absomnal mass. A ysl tut maybe Hear, ta syuuie daca tut oul bere {holes By Aric dct presents withering pain of acute onset Aro nt tle Explanation: ‘Ths paertnas aereseleate vascular asease,hysetanson eran absamial nut concen ten nary stenosis. Renal artery sterass isa eacing cause of secondary and racy hyperension an Conic dey disease. ruts ae caused by tubule bled tow iti a veel and fen reflect urinal aguas, Abdi buts ate qute common n young people, fecung upto 20% of panete witout hypertension. They ae Faund inup to 85% of paberts wt real artery stasis, comparedts 25% of paberts wh fypetansion. The Chaactere Metruts ba ugoestne cena aay sienoisSysoie-dastol buts ae seen spyronmate 408 f parts ith eal arery stenoses butless han 19 of patents wino.erena ate (Choice A) Audorinal aati anuryms ae aan mast cammenyin ade man wih aeroslercis and Smaknghtioy. Thay classicaly pecerewthapulsatl abdominal mas. A ysl bu maybe heard, uta syscie-daso tut oul bare (Ghotee 8 Arte dissec presents wih eanng pain of acute anset (holes 6) Aarts coarctation are congenta sticwres along ne aoa. They can cause hypertension and titerences ntood pressures between the upper erdlaver exemtes Pater ate mast ten doghased iminfancy or chdhoed (hotew ) aro.erteriFtulas are rate causes of massive gastoetestalhemarthage. They maybe primary r Secondary (Le. ute sugany). Ths patent aoesncthave any is af surgery r Ol bledng Norover ar prosrter fsa would Cause hypoensennothyperenson Educational abectve: ‘Tha presence of systole dastalc abdominal butin a patent wih ypstension and aberoscerosis iron suggesteorenal fry tenons JORLD LLC. Oorkver 200902 F 08 of pan a | BT-year oi aes trout ote emeipency department afer a synconal eis, He lst = Consciousness whieshoppingin he mal H= denies ary nausea, Saphares, chest pan, a shatess ot ° breah. He hashad wo spades of igttheadedness oh ast man buthas nt sean a doctor. His past medcalfstary fs synicart fr longstrdnghygetensn whichis bea Weated wera, His Etbod pressures 1890 rag he supe. and 1SUES rena he tandng. is heat Yates SUM ECG sans a srus yh win hgh vatage pralged PR: wtenal rlonged ORS ienval normal OT intra andoxcasicna premature vertsculr corrosion (PVC). Echocaraograpy reveals verticur Iygertosy ad an elecuon acon) of 8%. Which fe lowing Me most ety cause ots meres syncope? © A Srasyantyrmia B Decreased myacardalcortactty | 1 Torsaies deportes D.Autnom= éystncion E Venti premanire bests F Secues eotnton _ ‘Scope is characterized bythe sudan, rariet los of corscousnets wih a without warring Symtoms Wm symtms use Ighincadedness, sul tng hres ana aus. Pater Usual do notRave any conusen or reurdagea deft olaang recovery tam te syncapa esate Nama patents can maintain th ceretral blood supe ih a at ae ranging am 2a 180 bam. When theeatrates ver tan Dom, cerebral persion s pared, evenf heres acorpersabry increase Instoka alums. Apart wth adiease ef the sinus nade (sick crus synurame) or conuchon System can ave irtriter ranjcarda ard ypealy manfest wih reurere syncopalepsoces The presence of oniucon dsturbance on elecrocardogrepy (e.g, prolonged PR or ORS interval en associted hy ‘raga. (Gholee 8) Patents wth casiomypathy and alon glean racton can present wth sarise induced ‘3yncopalepeodes. An gecton racton of 86% goes agaht he dagnows of ecreased myocardial ona F ‘Syncope is chractenzed by he susen warsiet los of consciausness wih ar without wang ‘SmnptomsWaming symptoms ncuseIghfebdedness snl Sunng daghoresie and rausen Pater {sua do notnave any comusen a neurbogiea deat alvang recovery fom the eyncopa esate Narra stents can matin te cerebral blond supny wh arte ranging am 20% 180 bpm. When thehearrate over han 20m, crea parson mpared. evan her fea comeeneaary crs Insayevalume. pert wth disease ote sms nde (sok snus snarome) or conducaon Sytem can ave interrater rasjcarda ar bypealymanfest th fecueresyncopalepsoces The presence of = anducon disturbance an elecuocardoaraty (ea. proangedPR or ORS itera) i ofan assacited ath rayne q {Choice 5) Patents wth casiomypathy and aon secon Facton ca present wth earciseinduced syncopal epsades. An gcton Fachon a S5% goes aganst he dagnous of ecreasad myocar, Contract (Choice ¢) 2 prlonsed OT itzrvalis associated wih polvmarpicverticular tachycardia called arses {epontes” anihne ORE comploves undue seers pane." mast emponare sau at oeades ce pores i hypomagnesemia, {Choice 0) Posural spaersion ue to atanam dstuncton can cause pessncepe ans Scape however vs pater nat have any postal fypatenaen fe, ables pressure readings drat Sonicare decrease ram arecubertto an usa posion, + (holes) vertouar bets, tynemsenes, ae nat assanereg wn simenpe (holes £) Ths mast mearan terest agnosie ctsyneae a generaized seizures. Distnguanng features of seizure lads he posencs of stains cms ten movement angus bing ana poeta corrusen ueational objective: Dprcanaed ORS intra is tpcay bundle branch blak) eugoeete 2 tradyanthmia,hteos 3 pobrged OT rlenal sunsets 3tachvanhtims Los upastes: ©, Berk ver 200802 F A s.r males 2 days status pos. pany perutaneous coronary erventon (PC wth stent Placement: Head revausysuerdiom ar anterolateral myacarsa iarceon. Hs card enzymes have bosn ening sarm ence asmisean. He hae recovtes el and ready fr dachage. He ecuenty | asymptomabc Hes teperaies 37 5 (995) teed pressure is 13070 rev Hy, pubes Sen, ans ‘apravane ae tan Wels dharged wth ntiuctne fa take follwing meds ap Sirvasta, snap, etapa ar subinquaragycerne. In daon the madatans ted stove, hich of healing maciestone shoul the ptr eo bang ae eh ' lsosride monontate Lon molecular weight napa 4 Warr ve 0.Copiog# E Aria etme: 7 Al gatens na have hada myocardial inaction shoudracive sacondary prevention. The flowing rmedcatons haybaen shawn fav array bref whan ghon as secondary revanton. 4. spin (1-325 mali) 2 Beta Dockers 8 ace nner 4 Lpidlowerng statin rugs In adion,clapidagrel should te prescribed a al patients with unstable aninalran ST devaton (Anise), a wel as pares no are post PCI (percuraneaus coranaryifeneon). Clopidogrel belongs tothe class of rugs caled Thenapydnes, whch also elu elopne. These tugs have an ‘nt pale eect and act by atagoiang ADP Clopidogrel is prefered over Scone because RNasiess tovety assoc tht ‘tues have shown the follwing regarding re ect of caida 1. Forgatens whe need tote on apn but cannot left, clnisonel's an aoropatatemathe bessuss reas enectve ‘tutes nave show the folng regarding the efecto ctasoae. 1. Forpateris whe needa be on ascrn but canst tert, cloioarel isan aporopaealemative because tsar ehecbe — 2 Forpabers ra we post UANSTEM.clopdogel + asprin as ben shown be more eet, n {ems mata, han apn ane, Data sggest hat capogr shouldbe cored oat ‘2mortsfalningLANSTEM. Asp sad be sorte dente. 2 Gapsagel = spn smo efecbe man spin alms terns et 0 a tlawng perczaenie xtra arene (PC), set hapepreet saaesertombost. Paes a erse Shon sng ses nod loge ron Sesiaeopaelizabon annie oa Inptieres wth STEM (ST lean Ml) the rl of loge! depends on the farm of epertsian therapy (atimay FC), rmbt, orn epetfusin). Cl doyalsrecammendodfar atest one marhin Bates who have ungergene pom PClwty sen (3s stated above). Eis ss clea hater clei ‘Shauldbe used i tamale tetany ora eperusan therapy, although some expe chaase le dasa {holes A zosorbte monanirats i appropriate ithe patent contnues to xperence angina however, tS benefs are symplomateandithasro eect on moray (hotew ) Low maleular weighthepain (LIANH) i usualy oven post Mfr the ist 8 hows or ub ngogrphy performed butts nernecsseay ater the patent has been dachared fom thhaspta (Choice c)vararn is incaed Fhe paterthas esenceofvenlncur reméus hich is usally seen Insc th apical watts and oystnete wal mobonabnormaltes {Ghotee 2) isipne a caicum chamslbockr 1 picaly not nicted acute coronary synatome 2 nlm charna tortor have ton associate ah inerease marty mts pate papuan These re ‘ypealy used ae an-angna meray, slang thong acting rates m patents win ase curnaty rey (ibease wna are not canaate fr ether PC or coarary ater bypass ga (ypcaly reed as medica ‘manager Ecuestons! objective: ‘iepidgrel shel be nciuse as secondary prevertn faloning UANSTEM for atleast I2 marth. ‘haul aba be prascrbed ar thty days (ore metal sets to one yea (4ug eng stents foloeirg PC 35 Ithasteen shown help revert subecate see Brombost ‘uetpeces anenerosine guseton carey Last update: vaizo: \Copyraht@QUSWLEWORLDLLC Bark ver 20080 F |AAT-yearo ral presents ta youreffce wth ata meorth het olehargy and screseeditia Hs redcalrecadsrved tar rohas ban Usted or Jan pan an selng ove ta ist saris ae was Gfogrosed ity dates metus one year ago. Pye examination reveals hepatomegaly and tesicuar Strapny. When of te foaing caraoe skncrmales a most ha tao be preset ns patent? 2 al septal defect, B parte erase Hypersonic caomonaty yo 0 Caries concuenon lak Endocardial frceestasi “This pater presents wit signs and symptoms ofa mut-argan system disease process, nln Iypoganedsm (esucuaratophy decteased soul wins). atvepaty pancreatic endocine dyshncon {sisete) ana nepstimegal.Hemochramatesie es conshon met san eau the Soave tng moon tocardac abneralties. Cacia inolemert may nelde diated or etic cardiomyopathy leasing to heat aur or vanous conductenatrarmaltes. HemosMern oeposton ne ptr can 20a Fypoganasticlehypoganais and deposton inthe ots can cause ahopaty Explanation: (roice A) Aral septal defects are usualy slated, sporadic congental anomales. On rary do hey eau a ptt ef aninherted dsarderinvoking abe afganSstems (eq Hob Orem syratome, whch sa (causes uper ime ders) (hotee 8 aoe stenosis generayesuts om laze sen cae changes toe ve cn may te Setsirsted by tha resence of cangantaly Buspar ve {hoice 6) Hipertophs cardiomyopathy ress rom mattis in genes that encode care sarcomere Poti. rut on tobe associated uth Repalomegat tosh aphy pancreaeendoce F Endocardial ftroeactasle ‘This pater presente wit signs and symptoms ofa mu-rgan system disease graces, inlung Iygoginedsm (estou auch, oscreasad sexual ave), atvopaby pancreatic endocne dytuncton (Gets) and nepalomegalHemochvomatasie ea condbon at can cause he above ndings, adecn tocar anomalies. Cadac inoNemort may icude diated or estcive caamyopatyleaing 2 heat four orvanaus confucten atnormaites. Hemostcrn deposton nthe ptr ca leno Iypoganadicotchypoganatsm and depostan nt jrts can cause atvapaty {totes A) Ail septal detects are usualy slate, sporadic congenital anomalies. On ary do hey ono ato an nneted sarder ving ce atgan syste (2g. HOE-Oram syome, whch 0 (Causes uper ime deforates) (Choice 8) Arte stenosis penerayesuts om cae semi clei changes tothe vale hich maybe Sets by tha presence ofa cngantaly beuspd ari vate (choles ) Hypertrophic carsmyapaty resus rom maton ingens that encade care sarcomere + oti. ts rat inonn tbe associates wih Nepatmegay,testcuaratopty,pancreae endocrine Insuficene a atrophy (Ghoice E) Eniocail rclastoss's arate, won, aus relat thickening of hele vericular ndacarsum usualy occurs rth ti ya's of fe aa ganetly ot ax aed ih hepatomegaly testulr atopy, pancrean: endocnne sufiency or atrophy Eéueatona objective: ereatay hemactramitoss can cause cirtsis,parcreatc foross(iatetes) an increased skin lero du to melanin ae hemosden deposton(renze date), s well 2s armas oF andar canton, 2 oto Lastupdsted (16/2010 JORLD.LLC. Ober ver 200902 F | 36-year oi Caucason mates beng evaluate for poor eerie tlance and muscle weamess. He nas ro pastmedcel tar. Hs bleed pressure ranges om 175185 reg syste and OS 15 mtg (Gaetaic an repeat msaeuemere. He heart ree 78-0dmn Hi etum chemist i anfcat or eood fucose of 35 male. serum ceabine oO mpl, seri lao 146 real, and serum of 24 mEgL. CT Sear athe abdomen teveds as emmassintveleh siren gand. Which othe falovng addtional hod wld you expectin is patent? Plasmareninactty Serum aldosterone Serum bicarbonate va os i doce im vo we oD. tw oh se Explanation: — ‘This paert has prmary hyperatosternism (Con's sytem). Th presentation of a young nan-cbese and or-block patent) hypeiension should raise suspicion for secendryhypetersen.Furhermiae Ihspateree sya, eaues and adrenalmate suggest conn syndtrme, Cows snsrane presents uth persian mld ypemarema,typsalema, ard metbotcahalets This combat of Sbnormaltas the result case aostrore which promats distal bua resbsorton of adm ‘alums extanson. and seorton af potas andrdogenions. The mase Seen ante pats CT san 'Stkaly an atanal adenoma secreting excess alaserana To Gently dgnose Conns syndrome. enn Snd ltctron nel shouldbe checked. Alsotrorereloes terequsted by renin. Tresor, ile Sastre levels ae elevated n Com'ssynctome, ren ves ae decreased ave to feeseack lthttan. Syrgtoms of must wesiness and eres trance athe ecu hype Eéueatonal ajeetve mary hypeaosteranism aka Cor's Syrome) causes hypertension mil hypematera, hypokalemia, fangmasztc alaoss’ The daynaes er Con's syrome can be crtved by thangs ca ay fen ie nian vated osteran ev ena nopastmedcalhstary. Hs blond preseur ranges rom 175-186 mei syst and (06-115 mma F ot ‘osteo epeat mezeuremers. He hea rae 7-36 His etum anemsty is Sgnteant a eoad = fucose of 85mg. serum creatine oO Tmglal, serum Na 148 real, and serum Kat 2.4™mEgL. CT au Sean ofthe abdomen roveds a emmass nie et atrena gana. Which othe folowng addtional nds os old you enpectin is paert? — Plasmarenn actuty Serum aldosterone Sen bcartanate AA Hin Hh aw Be. Hoh Hh Hah vec tw Hah Hon 0. Low Han Low Ee Hon ow igh “This paterthas praryhyperatosternism (Con's syndrome). The presentation ofa young non-obese and ar black tart ih hypetansin hau rage susan ar Secenday peterson. Fute‘mate thspaneres syretams, kb vues and adrenal mass suggest Canns syrarome. Com’ snarame presents wth ypertenson mld rypemarera,fypotalema. and metabaleabalsts Ths corbrabon of Sbnormaltes'sthe regu of excess asstrone wich ponte dal bul restsooton of sad ‘yume expansan and setetan of potssum and hydrogenions,Themass seen an the pats CT scan Isthaly an asanal adsnoma cecretng grcorsatosorns. To deal gross Cons syoms, enn ‘nd itctorone levels sub chezked. Aldosterone renee equate by ren’ Tremor, ie ‘Atasterae lls ae lead Cor ssyciome, ein eves ate decreased aueto fedback InhetonSymstoms at muaele nealnere anc exes lance arte recut hype Eéucatona objective may Iypealesteranism (aka Cores Syndrome] causes hypertension, ml hypernavera paler, anmezeale aliens The dagross of Cam's syarome can be carved by Snags o ala Fenn ve Sand a elevated aldosterone eve nsiered is queso caret Lastupdatea (2009 Copy USI 2000 02 ‘A sreacolsnameles male peserts 24 hour are onset at subsemalehest pan ands dagnoses feta areerar wal myocardial mfaeion. There's nahin of pews chest pa, dyspnea paplars, [Syncans or lag syslng, He hana ypsrenson or dabetee mallue He dose aclnondg 240 pack yet SmoknghisioyUpen dschargeechocardoaraphy shows rrmalievetrculr size fe vetcl {tar wallhypoknests and an jacon fachan of S%,Toryoas the pant fund deed the ‘ret. Auopay reveals alate la verti wa otuar shape and annea wals lor wih a scar an he Snr al Which fhe falovng woul have most el preverted his pent’ potogs nanos? "3 Aspen © B.Enalsot Amos 1 tsasortae atate E Dion Fcourasin fatan mz Faloning 3 myocar rarcton,yenticuar remodeling occurs and atualy causes ston f the Senmele vin homing ofthe vertnculr ai Thscantesutin Ch. venmlarremadsing aesurs nthe ‘ees to mors flewing 3 myacadalifaco,Horfre Kas at sean onthe patents discharge fehosardagram ACE Hnare nave Geen shown ait verve emoasing bn 2C wnbor Shaul be lated in 24 hours of mocada farcton ms patents hata cortrandeaton {holes A) Asp bpicalycven'o paterts ater myacardaintarcton tinplate aggregation and Drevertrecurence of coronary afer boslage. However, aspnn has re efecto vertu erasing {holes 6) Calcium channa backers such a amlodpine re rt routinely prescribed fr paterts fling ‘myocardial iracton. They could be added fa patonnas hypertension rt completely coated th ACE Inhbors ana blskers {hotew )soscbie neat s along acing tite used to prevent angina chestpan_ maybe needed Dy seme patents wt chron symptoms cf stable angina, bul doesnot revert vertu remadeing = © adie ie D lve Ste a = Oonin = = cas — wat Le Faloning 2 myocardial rvarcto,vanicular remodeling occurs ard radualy causes dition of the tt ‘erie wan nig othe vn wals ‘Ths can esutn CH. Versa modaing eoows the leeks ta mors flowing 2 macs facto, Pefore tas at seen onthe pats dschate Schocardugram ACE rnttare nave been shauna im veriicvaremodsing” on AC rhbtor enous be Inte tn 25 hours of myocar frcton nal patents hata corrardcaton (Cholee A) Asp cay aven a patents ater macananactn to nip aggregation sn Dreverereturance of toronar ay nsiage, Hanae sepinnfes no eect an verte emossing {hoice 6) Calcium channe! blockers such as anlopine ae rt routinely prescbe for pater lira Imyoeataleatan They call aadedf 3 part as hypeteslon ra comply ca aleg ih BCE Inherars ana bicker, {Choice Dp 'soscbie intra along-acing rte used to prevent angi chestpan_ km be needed Dy sume patents chronic smpioms or stable anna, tui does rot revert verti ead (Gholee £)Digoun is shawn to prove symptomatic elt parts wth systoic hear flue. However it Goes not provide armory benef, ad itdos not Pelpto revert he remodeling process (hotee septate agents such a= asprin af tavore ovr wera n post pants, tut nether wl Fedars venue remaseing. Eéucatona sbjective Vertrcuir renasaing ne weeks to mats olonng myocar arctan ean ato aston one verbcle, Tha praces 's lessened by ACE nnars, 24% of people answered hs quectoncoect astute (1206 Copyngt@ UML =WORLD LLC. Bark ver 2008.02 so.year ols woman presents a your ofce complanng toner extern edema Mat tare seve ‘eels ogo, ard slonly progressed heteafer Herpast medcalhitoyis sic fr hyperiensin Nested ‘nh mstogrialfr 2 ears, Ariodne vee added rcartbecaues of hadequateconbl of SF with ‘etptll ale, She does ct smoke consume lea She has no monn dug ales Her boo’ Pressureis Tats Hg and er Pear rae simu. The pica xaminatn eval isealsyrmetic 5+ pring edema ota loner eerertes, itr any sn changes ovancasties Her nec ven pulsation |snormal Otter physical ngs ar thn normal ies Her iaberatary ses reveal te flaaing ‘Senan aburin 459, TTerisenmeintin amg Senm sodium a0 meg. ‘Serun potasiom s0megL Senn gene Oem sna win nara iis. hati the mest hay cause ofthe ede this tnt? 2 Hea faire 5 Liver disase Renal sae 1.Venausinsueteney 1.6 E Side tect other meseatons Its empatartto remember that pergheral ema is 2 common sie ft ofthe westment wth

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