1/31/24

KBMD
CARDIOLOGY
Medsynapse by Dr. Nikita

A 48-year-old male patient is admitted with chronic

angina. Coronary angiography reveals nearly total
blockage of the circumflex artery near its origin from the
left coronary artery. When this artery is exposed to
perform a bypass procedure, what accompanying vein
must be protected from injury?

A. Middle cardiac
B. Great cardiac
C. Small cardiac
D. Anterior cardiac
E. Posterior cardiac

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A 72 yr old man has dyspnea & chest pain. On exam,

there is a 3/6 systolic ejection murmur. Between
which points on the pressure volume loop below
does this murmur occur?

a) 1-2
b) 2-3
c) 3-4
d) 4-1

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A 78-year-old woman presents for routine evaluation. She has not

been to a doctor for many years. She has severe osteoarthritis. Her
functional capacity is limited mostly to walking short distances in her
home. She denies chest pain, dyspnea or syncope. On physical
examination, a 3/6 systolic crescendo-decrescendo murmur is
detected. Which of the following suggest severe valvular disease in
this patient?

a) Loud S1
b) Quiet S2
c) Brisk carotid upstrokes
d) Early peaking of murmur
e) Fixed split S2

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A 51-year-old man comes to the emergency department because of

a 3-day history of shortness of breath, fever, and chills. He has no
history of serious illness. His temperature is 39.5°C (103.1°F).
Physical examination shows a grade 4/6, holosystolic, blowing
murmur over the apex that radiates to the axilla. Crackles are heard
in both lower lung fields. Examination of the extremities shows
several nontender, nonblanching, erythematous macules on the
palms and soles. Histopathologic examination of these macules is
most likely to show which of the following?
a) Capillary wall rupture with fibrin thrombus formation
b) Microabscesses with neutrophil infiltration of capillaries
c) Epithelioid cells with surrounding multinucleated giant cells
d) Cleft-like vacuoles within the arterioles

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The waveform indicated by the arrow most likely

corresponds to which of the following
a) lsovolumetric ventricular contraction
b) Carotid pulse upstroke
c) Tricuspid valve opening
d) Tricuspid valve closure
e) Atrial contraction

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A woman in the ICU develops the ECG shown below. Which of the
following is the best next step in management?

a) Beta blocker therapy

b) Electrical cardioversion
c) Amiodarone
d) Urgent echocardiogram
e) Emergent coronary angiography

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A 32-year-old woman comes to the physician because of worsening fatigue and shortness of
breath. Her symptoms began 8 months ago and have progressively worsened since then. She
had recurrent episodes of joint pain and fever during childhood. She does not smoke or drink
alcohol. She emigrated from the Congo with her parents when she was 12 years old. Her
temperature is 37.4°C (99.3°F), pulse is 90/min and regular, respirations are 18/min, and
blood pressure is 140/90 mm Hg. There is an opening snap followed by a diastolic murmur at
the fifth left intercostal space in the midclavicular line. If left untreated, this patient is at
greatest risk for which of the following complications?

• A Retinal vein occlusion

• B Esophageal compression
• C Left ventricular hypertrophy
• D Ventricular tachycardia

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A 45-year-old woman presents with palpitations. She is in good general health with
no history of cardiac disease. She reports no dyspnea or chest pain. On physical
exam, blood pressure is normal. Pulse is tachycardic and irregularly, irregular. Which
of the ECG tracings below is most likely to be found in this patient?

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36-year-old man presents to the clinic with complaints of a

genital sore. The patient is a sexually active heterosexual
involved with three partners and practices unprotected
intercourse. Fours days ago he noted a painless sore on his
penis. He is afebrile, with a heart rate of 80/min and blood
pressure of 120/77 mm Hg. Physical examination reveals a
solitary ulcerated lesion located on the lateral aspect of his
penis. The lesion is nontender and associated with bilateral
inguinal lymphadenopathy. Physical examination is otherwise
normal. If left untreated, this man is at increased risk for
which of the following?
(A) Ascending aortic aneurysm
(B) Coronary artery aneurysm
(C) Endocarditis
(D) Mitral valve stenosis
(E) Rupture of ventricular free wall

A 56-year-old woman was recently started on medication for high

blood pressure. At her next offi ce visit her hypertension is under
good control, but she now complains of “feeling strange” since she
started the medication. On further questioning, she reports feeling
chest tightness several times over the past 2 weeks, and has also
noticed pain in her elbows and knees. Her blood pressure is
124/78 mm Hg (146/82 mm Hg on last visit), heart rate is 102/min,
and respiratory rate is 14/min. Her examination is notable for
several erythematous plaques on the malar distribution of the
face, arms, and upper torso. What medication was she most likely
started on during her last visit
(A) Captopril
(B) Furosemide
(C) Hydralazine
(D) Metoprolol
(E) Verapamil

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A 70-year-old woman comes to the emergency

department with crushing substernal chest pain for the
last hour. The pain radiates to her left arm and is
associated with anxiety, diaphoresis, and nausea. She
describes the pain as “sore” and “dull” and clenches her
fist in front of her chest. She has a history of
hypertension. Which of the following is most likely to be
found in this patient?

a) Decrease of >10 mm Hg in blood pressure on inhalation.

b) Increase in jugular venous pressure on inhalation.
c) Triphasic scratchy sound on auscultation.
d) Continuous “machinery” murmur.
e) S4 gallop.

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