Situation: A 63 year old man complains of chest pain with exertion, dyspnea, and syncope.

On
examination, he is noted to have a mid-crescendo-decrescendo systolic murmur.

1. What maneuver will increase the intensity of the murmur?

a. Leg raising
b. Valsalva maneuver
c. Standing
d. Straining

Situation: a 65 year old female, diabetic, presents with the ER with severe, substernal, squeezing chest
pain, radiating to the arm and diaphoresis

1. Which of the following step is most appropriate step

a. Perform ECG
b. Check toponin I
c. Give aspirin
d. Do emergency PCI
2. The patient’s husband comes to take his wife home after an MI and asks how long they should
wait before they have sex. What do you tell her?
A. They should wait for a normal angiography
B. No waiting necessary
C. During the first1-2 weeks
D. After 4 weeks

Situation: a 24 year old man complains of shaking chills and fever. He is febrile with blood pressure of
110/60, HR of 109and a new holosystolic murmur at the apex. He has linear streaks of induration on
both arms.

1. Which of the following is a MAJOR criterion for this patient?

a. Intravenous drug use
b. Predisposing valvular lesion
c. 1 set of positive blood culture
d. Oscillating intracardiac mass (Rationale: Bacterial endocarditis; modified dukes cri)
2. If the patient has history of IV drug use, what is most likely the causative agent?
a. GAS
b. M. tuberculosis
c. Staphylococus aureus
d. S. epidermidis

Situation: A 65-year-old man presents to your clinic with fatigue and shortness of breath after
climbing 2 flights of stairs. His symptoms started 2 weeks ago and have progressed gradually. He has
history of hypertension and had myocardial infarction 1 year ago. On examination, there’s jugular
venous distention, bilateral bibasal crackles and bipedal pitting edema.

1. What is the NYHA classification of this patient?

a. I
b. II
c. III
d. V