Block 3 Practice Question Set 2

The percentage of the end-diastolic ventricular volume ejected with each stroke (ejection fraction) is

10% 20% 50% 65% 90%

Case: A 52-year-old man is found dead in his home. Autopsy reveals hemopericardium secondary to ventricular wall rupture. Question: How long before his death did the man probably have a myocardial infarction?

2 days 7 days 12 days 20 days 60 days

Based on the hypertensive patient subtype in the following description, choose which antihypertensive drug would be best suited for initial monotherapy. White male, aged 33, with high renin levels.

Furosemide Hydrochlorthiazide Diltiazam Captopril Minoxidil Guanethidine Diazoxide Reserpine Esmolol Methyldopa

Based on the hypertensive patient subtype in the following description, choose which antihypertensive drug would be best suited for initial monotherapy. Acute intraoperative hypertension with tachycardia, requiring short-acting agent.

Furosemide Hydrochlorthiazide Diltiazam Captopril Minoxidil Guanethidine Diazoxide Reserpine Esmolol Methyldopa

You see a 55-year-old, Caucasian woman in your family practice, who complains about chest pain. The nurse had already taken the vitals and states that the patient is tachycardic. Which heart rate do you expect?

40-60/min, regular beat 60-80/min, regular beat 100-120/min, regular beat 40-60/min, irregular beat 60-80/min, irregular beat

The output per minute per square meter of body surface is called

Cardiac output Stroke volume Afterload Cardiac index Preload

Case: A 35-year-old woman presents for her annual Pap smear. She tells you that she and her husband are now ready to start a family, but they are worried about the hypertension the patient has been suffering from for a year. When she tells you which medication she is on to control her blood pressure, you inform her that she needs to switch to another medication if she wants to get pregnant. Question: What antihypertensive drug is she likely on?

Alpha blockers Beta blockers ACE inhibitor Loop diuretic Ca channel blocker

A 45-year-old African American man presents with hypertension and type II diabetes. What is the best drug to prescribe this patient for initial monotherapy?

Furosemide Hydrochlorthiazide Diltiazam Captopril Minoxidil Guanethidine Diazoxide Reserpine Esmolol Methyldopa

A 14-year-old girl with established diagnosis of cystic fibrosis presented to your office with complaints of cough with copious amounts of purulent sputum, occasional hemoptysis, and mild wheezing. Chest X-ray showed irregular bronchial markings with small cystic spaces. On auscultation, bilateral persistent crackles mainly in lung bases are noted. You requested a sputum sample to be collected and the patient produced copious amounts of yellow green sputum. Gram stain of the sputum showed numerous gram-negative bacilli, whereas acid-fast stain was negative. What is the most likely diagnosis?

Active pulmonary tuberculosis Aspiration pneumonia Atypical pneumonia Bronchiectasis Bronchopneumonia

A 52-year-old woman was involved in a severe traffic accident. She is admitted to the ER with widespread soft tissue injuries and multiple fractures of her lower limbs. 3 days later she dies. Widespread petechiae are found in the cerebral white matter at autopsy. Which of the following is the most likely cause of these findings?

Air embolism Fat embolism Septicemia Subdural hematoma Unrecognized skull fracture

A 12-year-old girl with recently diagnosed bronchial asthma is prescribed 1-2 puffs of salbutamol metered dose inhaler (MDI). Which of the following is the primary mechanism of action (in asthma) of the drug prescribed to this patient?

Antimuscarinic action and decrease of vagal tone in the airways Stimulation of beta2 adrenergic receptors on the bronchial smooth muscle Adenosine antagonism and non-selective inhibition of phosphodiesterase Activation of glucocorticoid receptor to produce anti-inflammatory effect Stabilizing effect on the sensitized mast cell degranulation

A 36-year-old woman presents with chronic dyspnea that is worse while lying prone.The patient reports progressive worsening of the symptoms. On physical examination, a heart murmur is detected upon cardiac auscultation, heard best with the bell over the apex. The murmur is a non-radiating, low-pitched diastolic rumble. A loud S1 and opening snap can also be heard in addition to an apical thrill and decreased pulse pressure. An EKG is done and shows an arrhythmia. What is the patient's most likely underlying condition?

Aortic regurgitation Pulmonic stenosis Mitral stenosis Hypertrophic subaortic stenosis Mitral valve prolapse

Case: A 65-year-old male visits his family practitioner for a yearly examination. Measurement of his blood pressure reveals a systolic pressure of 190 mmHg and a diastolic pressure of 100 mmHg. His heart rate is 74/min, and pulse pressure is 90 mmHg. Question: A decrease in what is the most likely explanation for the high pulse pressure?

Arterial compliance Cardiac output Myocardial contractility Stroke volume Total peripheral resistance

A 56-year-old man presents with fatigue following evening walks. The patient has been treated with atorvastatin for hyperlipidemia for about 6 months. Other medications that the patient has been receiving include diltiazem, ciprofloxacin, alpha-tocopherol, aspirin, and actos. What pair of medications can cause this adverse reaction?

Atorvastatin and diltiazem Ciprofloxacin and alpha-tocopherol Atorvastatin and actos Ciprofloxacin and diltiazem Atorvastatin and ciprofloxacin

Case: A 64-year-old woman with a past medical history of hyperthyroidism presents with new-onset palpitations. The patient states that she has intermittent palpitations, and she is worried about heart disease. She is currently asymptomatic and reports no chest pain or shortness of breath. An EKG is obtained. Vital signs reveal a T 98.6° F, BP 134/88 mm Hg, P 119 beats/min R 12/min. The pulse is noted to be irregular. The EKG is shown below. Question: What arrhythmia does this patient most likely have?

Atrial flutter Atrial fibrillation Supraventricular tachycardia Ventricular tachycardia Torsades de pointes

Case: A 65-year-old woman is being treated for uncontrolled atrial fibrillation with a cardiac medication. The patient has had success with medication with few symptoms since beginning therapy 3 years ago; lately, however, the patient has experienced progressive shortness of breath and a persistent, nonproductive cough. A chest radiograph is ordered, and the radiology report is as follows: AP and Lateral Views of the Chest: The radiographic examination of the chest demonstrates bibasilar interstitial disease and reticulation with decreased lung volumes. The heart is mildly enlarged; no consolidation, effusion, or signs of cardiac failure are seen. The bones of the thorax are normal. No other cardiopulmonary abnormalities are observed. Question: Based on the clinical history, what medication was most likely administered in an effort to control the patient's atrial fibrillation?

Atropine Hydralazine Digoxin Amiodarone Phentolamine

A 44-year-old farmer consumed an unknown quantity of parathion in an attempt to commit suicide before he was discovered in his barn. What is a competitive muscarinic antagonistic drug that can be used with PAM to treat this patient?

Atropine Neostigmine D-tubocurarine Succinylcholine Carbachol

Case: While conducting a pharmacological experiment on canines, a researcher notes the following physiologic effects detailed in the chart below. (PVR in the table below stands for peripheral vascular resistance). Question: Based on the table above, what medication is Drug A most like?

Atropine Phentolamine Isoproterenol Hydralazine Metoprolol

Case: A 70-year-old man with type II diabetes mellitus, hyperlipidemia, homocysteinemia, and metabolic syndrome presents with a 5-month history of excessive daytime sleepiness, a lack of refreshing sleep, a depressed mood, and an inability to focus at work as well as while driving. Additionally, he has been told by his wife that he snores rather loudly while sleeping. He denies fever, chills, headache, cold intolerance, weight loss, hair changes, hoarseness, dysphagia, chest pain, edema, palpitations, or changes in his bowel habits. On physical exam, he is found to be hypertensive. He has elevated BMI with abdominal obesity, and has an enlarged neck circumference; no other abnormalities are noted. Question: What pathological mechanism best accounts for this patient s presentation?

Bacterial overgrowth of Group A ?-hemolytic Streptococcus, causing pharyngeal inflammation Lymphocytic infiltration of the thyroid, causing atrophy and fibrosis of the thyroid follicles Compression of the superior vena cava by an infiltrating mediastinal neoplasm Reduced inspiratory patency of the upper airway due to relaxation of the airway muscles Lower airway inflammation with mucosal thickening and mucus hypersecretion

Case: A 45-year-old Caucasian woman presents for her annual checkup. She has been seen regularly over the last 10 years. She has had Adult Onset Diabetes for the past 10 years. Her weight is 205 pounds at a height of 5 feet 1 inch. She is unsuccessful in losing weight. Her blood pressure is 170/95 mm Hg, temperature is 97.6 F, and heart rate is 82/min. High blood pressure and diabetes are the most common cause of end-stage renal disease in the United States. In a normal kidney when the blood pressure reaches >150 mmHg the body's ability to auto regulate glomerular capillary pressure will start to fail. In talking with the client, you explain that her blood pressure should be optimally below 127/75 mm Hg. Question: What medication would be appropriate for her?

Beta Blockers Nonsteroidal antiinflammatory Acetaminophen Calcium Channel Blockers (Angiotensin Converting Enzyme) Inhibitors

Case: An 82-year-old man presents with difficulty breathing and chest pain. He admits to poor follow-up with his primary care physician; he has not been seen by his doctor in several years. When last seen, his health issues included hypertension, hyperlipidemia, diabetes mellitus type II, and being grossly overweight. His prescriptions ran out, so he has not been on any treatment for these issues for several years. Chest X-ray done at the bedside reveals significant bilateral effusions that are initially felt to be secondary to congestive heart failure based on various other findings. A pulmonologist is consulted and performs bilateral thoracentesis to help alleviate the patient s symptoms. The right side is significantly more affected than the left, with over 1000 mL drained versus about 625 mL on the left. Question: During initial testing, what finding was most indicative of these thoracentesis results?

Bilateral decreased tactile fremitus Mediastinum shifted to the right Mediastinum shifted to the left Pleural friction rub heard throughout Bilateral inaudible breath sounds

A 45-year-old woman African American woman presents with dyspnea and extreme uncomfortability. She has a history of cardiovascular disease and asthma. She is given salbutamol via nebulizer. What is the best non-invasive method to determine if she is still cyanotic?

Blood gas analysis Pulse oximetry Checking her nail beds Checking her lips Checking her oral mucosa

Cystic fibrosis is a genetically transmitted disease. Which of the following statements is accurate in regards to its genetic transmission?

Both the parents of affected patients with cystic fibrosis are carriers of CFTR mutant alleles The phenotypic expression of the disease is seen even in a heterozygous state of the mutant gene Affected fathers transmit the mutant gene only to his daughter New mutation is common Affected patients show phenotypic expression of the disease at their forties

The substance secreted by the heart, which antagonizes the action of various vasoconstrictor agents and lowers blood pressure is called

Bradykinin Lysyl-bradykinin Atrial natriuretic peptide (ANP) VIP Endothelium-derived relaxing factor (EDRF)

Case: A healthy 42-year-old woman with a history of anxiety attacks sits in the hospital waiting room as her 3-year-old daughter undergoes open heart surgery for a septal malformation. The woman experiences a feeling of suffocation and is obviously hyperventilating. She informs her husband that she feels faint and has blurred vision. Question: What is the best treatment to relieve the symptoms caused by her hyperventilation?

Breathing a 10% oxygen/90% nitrogen mixture Breathing 100% nitrogen Breathing in and out of a paper bag Intravenous administration of bicarbonate Lying down

Case: A 67-year-old man presents for a routine follow-up visit. His past medical history includes chronic obstructive pulmonary disease (COPD) for the past 3 years and hypertension (HTN) for the past 5 years. Daily medications include a tiotropium inhaler and hydrochlorothiazide. He has smoked a pack of cigarettes a day for 50 years, and he has no desire to quit at this time. Physical exam remains unchanged from 3 months ago, and the patient has no complaints. His last pneumococcal and influenza vaccinations were 2 years ago. Question: What should be offered at this visit?

Bupropion Influenza vaccine Fluticasone and salmeterol Nicotine patch Pneumococcal vaccine

A patient presents with acute pulmonary edema secondary to congestive heart failure. She has been treated with digoxin, and is given furosemide to cause acute diuresis. Within several hours post-furosemide, the patient begins to show signs of acute digoxin toxicity. Which serum electrolyte must be monitored under such circumstances?

Ca²+ Na+ Mg²+ K+ HCO3¯

Case: A 56-year-old Caucasian man presents with a 2-month history of worsening cough. Over the past 2 days, he has been having difficulty breathing. He claims to have lost 4 kgs over the past 2 months. He has been a chain smoker for the past 35 years. A CT scan of the chest shows a right upper lobe primary tumor nodule and right hilar, subcarinal, and right supraclavicular adenopathy. Excisional biopsy of the supraclavicular lymph node reveals small cell carcinoma of the lung. Further investigations confirm limited stage disease. Question: The oncologist decides to start the PE regimen, which consists of etoposide and what other antineoplastic drug?

Cisplatin Cyclophasphamide Paclitaxel Carboplatin Topotecan

A 23-year-old primigravida is admitted to your ward because of vaginal bleeding and cramping at 26 weeks. The ultrasound shows fetal heartbeat, and you try to stop a miscarriage by ordering terbutaline. What do you tell the nurse to watch for?

Constipation and dry mouth Headache, tachycardia, and nausea Sedation, urinary retention, and dry mouth Anxiety, headache, and mydriasis Cold extremities, arrhythmia, and insomnia

What are the functions of the dorsal respiratory group?

Controls duration of inspiration and increases respiratory rate Controls expiration Controls inspiratory and rhythmical functions Limits volume of inspiration Stimulates vagal control of gas exchange

Case: A 12-year-old female presents to her pediatrician complaining of shortness of breath, cough, and wheezing. The patient is not in acute distress. The patient has a history of chronic atopic dermatitis and allergic rhinitis. Her family history is positive for urticaria and eczema. On examination, the patient has boggy nasal mucosa, allergic conjuctivitis, and expiratory wheezes diffusely in the lung bases bilaterally. Question: Which of the following medication combinations would best treat this patient s current symptoms?

Cromolyn sodium and salmeterol Montelukast and atropine Beclomethasone and albuterol Zileuton and azithromycin Theophylline and isoproterenol

Rifampin is a drug used for treatment of tuberculosis. It exerts its action by inhibiting the following process in Mycobacterium tuberculosis

DNA synthesis RNA synthesis Growth Protein synthesis Enzyme synthesis

The Department of Anesthesiology and Pain Management is doing an experiment on rats about the effects of atropine at different doses. There are 50 rats divided into 3 groups: the first group receives low doses (sub-therapeutic doses) of atropine; the second group receives therapeutic doses; and the third group receives high doses of Atropine. What effect would be expected to result from a sub-therapeutic dose of atropine?

Diarrhea Asystole Respiratory depression Bradycardia Hypersalivation

Case: A 5-month-old infant presents with irritability and restlessness for the last 6-8 hours. Physical examination reveals that he is hemodynamically stable, but has marked tachycardia; heart rate is 240 beats/min. ECG confirms the diagnosis of supraventricular tachycardia. Question: What is the drug of choice for the treatment of this infant?

Digoxin Adenosine Verapamil Amiodarone Mexiletine

Case: A 72-year-old man presents with double vision, weakness, fatigue, nausea, and abdominal discomfort. He describes seeing everything greenish. He suffers from congestive heart failure and is treated for that with digoxin, furosemide, and potassium. He has been taking acetylsalicylic acid since a TIA 2 years ago. He also takes amoxicillin for a urinary tract infection. Question: What medication can cause his symptoms?

Digoxin Furosemide Potassium Acetylsalicylic acid Amoxicillin

Case: A 4-year-old boy presents with clubbing of his fingers, cyanosis, and a heart murmur; he is easily fatigued. A chest X-ray reveals right ventricular hypertrophy. Cytogenetic analysis of a skin biopsy reveals a 46,XY karyotype. Question: What is the most likely diagnosis?

Down syndrome Patau syndrome Edwards syndrome Tetralogy of Fallot Atrial septal defect

What blood vessel, which is a vascular bypass shunt through the liver prior to birth, constricts after birth and becomes a fibrotic cord called the ligamentum venosum?

Ductus arteriosus Ductus venosus Umbilical artery Umbilical vein Inferior vena cava

A condition where a percentage of the cardiac output passes through the lung without exchanging gas with alveolar air is called

Emphysema Hypoventilation Diffusion barrier Ventilation-Perfusion mismatch Intrapulmonary shunts

A 42-year-old woman presents to your office with respiratory complaints. She has a 45-pack-year history of smoking. After a careful history and physical examination, you conclude that she has emphysema. What observation is most likely?

Enlargement of the air spaces Sputum production Abnormal dilation of bronchi Increased elastic recoil Hyper-responsiveness of the airways

Case: A 45-year-old man presents with a 30-minute history of chest pain; it began while he was on a long airline flight. He denies any trauma to the chest. On exam, his pulse is 110 BPM; respirations are 40/min. The chest radiograph reveals a wedge-shaped opacity. Question: What is the most likely cause of his chest pain?

Esophageal reflux Pneumonia Aortic dissection Pulmonary embolism Unstable angina

Case: After a serious argument with his wife about his diet and habits (he is overweight and a heavy smoker), your 55-year-old neighbor went to a pub and got drunk. On the way back to home, he felt sudden chest pain radiating to the left shoulder, shortness of breath, sweating, and anxiety. His ECG shows pathological Q wave and ST elevation. Laboratory results show that troponin levels are elevated. Question: What caused the rise in troponin levels in this patient?

Fatty changes in myocardial cells Increased synthesis of adhesion molecules Coexisting chronic viral infection Alcohol Injury to the myocardial cell membrane

Physiologic splitting is associated with which of the following?

First sound Second sound Third sound Fourth sound

Which of the following is heard about one-third of the way through diastole in many normal young individuals?

First sound Second sound Third sound Fourth sound

Case: Shortly after birth, the 2nd-born male twin of Caucasian parents shows progressive signs of respiratory distress (e.g., tachypnea, expiratory grunting, subcostal and intercostal retractions, cyanosis, and nasal flaring). The children were born at 34 weeks of gestation by means of Caesarean delivery. The mother has diabetes mellitus. The diagnosis of respiratory distress syndrome in the younger twin is established. Question: What is the cause of respiratory distress syndrome (RDS) in this child?

Gender Prematurity Mother s diabetes Cesarean delivery 2nd-born twin

A 36-year-old female presents with complaints of progressive fatigue, weakness, and exhaustion over the past 3 months. She also complains of noticeable weight loss over this period and pain over the right upper quadrant of her abdomen. On examination, she is found to be cachetic with prominent 'a' waves on the JVP. She has right upper quadrant tenderness on palpation. Cardiac examination reveals a hyperactive precordium on inspection and a systolic thrill and displaced apical impulse on palpation. Diagnostic studies reveal a sinus rhythm and left atrial enlargement on EKG. Echocardiogram reveals atrial enlargement, hyperdynamic left ventricle, and incomplete coaptation of anterior and posterior mitral leaflets. Auscultation reveals a very soft S1 and a fourth heart sound. Apart from these auscultatory findings what is the other finding that is expected in this patient?

High-pitched, blowing, and decrescendo diastolic murmur Low-pitched and rough ejection systolic murmur High-pitched late crescendo-decrescendo murmur Diastolic murmur in the tricuspid area Holosystolic murmur

Case: A 40-year-old obese Caucasian man says that his father recently passed away after having a heart attack. He is worried and wants to know whether he is at risk for cardiovascular disease. He is a hypertensive; however, he does not take any medications. His BP in the office today is 140/96 mmHg, and his BMI is 31. You explain to him that the risk factors for cardiovascular disease may be non-modifiable or modifiable. Question: What is the non-modifiable risk factor for CAD in this man?

His age His ethnicity Hypertension Obesity His gender

A 2-year-old boy was born prematurely. You do a cardiac exam and listen to the boy's heart for several minutes, using both the bell and diaphragm of your stethoscope. You recommend an echocardiogram, and it shows that the boy has a ventricular septal defect. Question: What type of murmur has the doctor probably heard?

Holosystolic murmur Diastolic murmur Venous hum Continuous murmur Systolic ejection murmur

Case: A 22-year-old man, who is a first year medical student, presents to your office with respiratory complaints. He is spending many hours working on the cadaver and has been breathing the fumes. After a careful history and physical examination, you conclude that he has asthma. Question: What observation is most likely?

Hyper-responsiveness of the airways Enlargement of the airspaces Loss of elastic recoil Watery rhinorrhea Sputum production

Case: A 44-year-old man presents after an episode what is described as ""passing out"". He has a past medical history of hypertension, diabetes mellitus type II, and osteoarthritis. Earlier in the day, the patient visited his primary care physician for routine blood work. During his blood draw, the patient had an acute onset of syncope. The patient never had such an episode before. Vital signs upon presentation are as follows: BP 124/82 mmHg, P 88 beats/min, R14/min. EKG is within normal limits. Cardiovascular examination reveals a normal S1 and S2, with no rubs, murmurs, or gallops. The patient is being treated with atenolol and hydrochlorothiazide for his hypertension. His blood sugar is 96 mg/dl. Question: What is the most likely cause of the patient's syncope?

Hypoglycemic episode Arrhythmia Neurogenic shock Vasovagal episode Orthostatic hypotension

Case: A 62-year-old man presents in acute respiratory distress. He has been smoking 2 packs of cigarettes a day for over 40 years, but 3 months ago reduced his consumption to 1 pack per day after experiencing shortness of breath, both after physical activity and at rest. He has lost 5 kilograms in the past month and is brought to the emergency room by paramedics after his daughter found him restless and distressed. Vital signs reported by the emergency medical technicians include: heart rate 115-120, respirations 28, and blood pressure 180/140. It is noted that the patient has prominent kyphosis and is still tachypneic. Arterial blood gases are drawn and reveal the following: Pao2 = 40 mm Hg, Paco2 = 55 mm Hg, and pH = 7.31. The patient is placed on oxygen at 2 L/min, delivered by nasal cannula. A chest radiograph reveals hyperinflation of the lungs, narrow mediastinum, and low, flat diaphragms. Chest auscultation reveals quiet breath sounds and the presence of expiratory wheezes. The patient is diagnosed with emphysema. He is given a course of nebulizer treatments with bronchodilators and then reassessed. Chest auscultation reveals decreased expiratory wheeze. Respiratory rate is 20 breaths per minute. Arterial blood gases indicate: Pao2 = 62 mmHg, Paco2 = 42 mmHg, and pH = 7.37. He is sent home after a few days with an incentive spirometer to practice breathing exercises and a smoking cessation program; he is maintained at home on oxygen at a 1 L/min flowrate. Question: What is responsible for the retention of carbon dioxide in this patient?

Hypoxemia Hypoventilation Tachypnea Relaxation of smooth muscle in noncartilaginous airways Hypercarbia

Peripheral chemoreceptors located in the carotid bodies are stimulated by:

Increased pH of cerebrospinal fluid Increased PCO2 of mixed venous blood Decreased PO2 of arterial blood Lung inflation

A 45-year-old male African American man with a 5-year history of hypertension goes to his primary care physician for a check up and review of blood work. The patient's blood work is notable for a fasting blood sugar of 133 mg/dl. The physician decides to prescribe an ACE inhibitor, lisinopril. The patient is already on hydrocholorothiazide (HCTZ) for his hypertension. The patient calls the physician a week later after being prescribed the medication and reports moderate tongue swelling. Which of the following is the most-likely mechanism of the tongue-swelling noted in this patient?

Increased production of aldosterone Decreased catabolism of bradykinin Decreased levels of angiotensinogen Increased renin production Inhibition of Na+/Cl- reabsorption in the kidney

Case: A 38-year-old woman is wheeled into the ER. On initial examination she is found to have excessive salivation, rigid paralysis of skeletal and respiratory muscles, pinpoint pupils and bradycardia. She was found in her garage lying next to an empty bottle of organophosphate insecticide. Question: What drugs should the attending physician administer?

Pancuronium and succinylcholine Scopolamine and succinylcholine Scopolamine and norepinephrine Pralidoxime and atropine Mecamylamine and pancuronium

Case: A 15-year-old boy presents with severe wheezing and tightness of the chest for the past few hours. The patient states that these episodes occur roughly 3 to 4 times per week. He also states that exercise and cold weather makes his condition worse. On examination, he appears to be in acute respiratory distress. His vitals are as follows: Pulse rate 94 beats/min, BP 120/80 mmHg, Respiratory rate 32/min, and afebrile. Oxygen saturation is 84%. He is aggressively treated with nebulizers and oxygen via nasal cannula, but he does not show improvement. The patient is transferred to the ICU and is treated with IV Magnesium. Question: What property of magnesium allows it to be effectively utilized in the treatment of asthma exacerbation in this patient?

Inhibition of 5-Lipoxygenase Inhibition of mast cell release Inhibition of leukotriene receptors Inhibition of phospholipase A2 Inhibition of Ca+2 effect on smooth muscle

Which of the following components discharge spontaneously during quiet breathing?

Inspiratory neurons Motor neurons to respiratory muscles Neurons in the apneustic center Pneumotaxic center Pulmonary stretch receptors

Case: A 22-year-old man with no significant past medical history presents with left-sided chest pain and shortness of breath. The patient states that he was lying on his couch watching TV when his symptoms began approximately 1 hour ago. At first, he tried to ignore the symptoms, but they worsened to the point that he could not ignore them any longer. He cannot recall any recent illness, and he has not had any surgeries or trauma. Examination reveals a tall, thin man in respiratory distress. He is tachypnic and tachycardic. His vital signs are as follows: blood pressure 110/72 mm Hg; pulse 122/min; respiratory rate 24 per minute; and temp 98.4 degrees Fahrenheit. A chest radiograph is significant for a gas collect at the apex of the left lung. Question: What concerning the patient's probable diagnosis is true?

It occurs most often in obese men. It is more common in men than in women. They usually represent an underlying disease process. They rarely resolve without surgical intervention. They often occur simultaneously with myocarditis.

Case: A 34-year-old male presents with a history of sharp chest pain and difficulty in breathing. He gives history of severe cough, blood tinged sputum, and dizziness. He also gives history of sickle cell disease and priapism. Physical examination shows a blood pressure 100/70 mm Hg. There is tachypnea, cyanosis of the extremities, and diaphoresis. Respiratory examination reveals pleural rub. Cardiac examination reveals a loud pulmonary component of the second heart sound and right ventricular lift. A gallop rhythm is heard. Extremity shows 2+edema. Diagnostic studies reveal slightly elevated WBC count. D-dimers are also elevated. Hemoglobin and hematocrit are reduced. Imaging studies are positive for infiltrates, atelectasis, and pleural effusions on chest x-ray. There is peripheral wedge-shaped density above the diaphragm. Ventilation/perfusion shows areas of decreased perfusion. CT scan shows a low density-filling defect within the pulmonary artery. Pulmonary angiography shows emboli. Echocardiography shows evidence of right ventricular strain. Question: What is the cause for this strain in this patient?

Large pulmonary embolus leading to a sudden increase in pulmonary artery pressure resulting in right ventricular strain and right heart failure Tricuspid valve regurgitation leading to back pressure and enlarged right ventricle Mitral valve regurgitation leading to back pressure in the pulmonary vasculature and right ventricle terminating in right heart failure and enlargement Pulmonary valve stenosis leading to the increased force of contraction of the right ventricle resulting in its enlargement Severe systemic hypertension leading to bilateral heart failure and right ventricle enlargement

Case: A 32-year-old black female has been undergoing treatment for cardiac arrhythmia for the last few months. She has now developed features of systemic lupus erythematosis. Question: What antiarrhythmic drug is likely to be responsible for this condition?

Lidocaine Procainamide Propranolol Disopyramide Amiodarone

In the newborn nursery, a neonate develops a bluish color when crying. What congenital defect may be the cause of this manifestation?

Patent ductus arteriosus Persistent truncus arteriosus Primum type atrial septal defect Secundum type atrial septal defect Ventricular septal defect

A physician should place the stethoscope where to listen for the sound of the mitral valve?

Medially in the 2nd left intercostal space Medially in the 2nd right intercostal space Midclavicular in the 4th left intercostal space Midclavicular in the 5th left intercostal space Anterior axillary border in the 4th intercostal space

Case: A 54-year-old man with emphysema presents with a blood pressure of 157/101 mmHg. Over the next several months, he is prescribed angiotensin-converting enzyme inhibitors, diuretics, and calcium channel blockers, but the patient has to discontinue each agent because of undesirable side effects. He is instead prescribed a beta antagonist. Question: What beta antagonist would be most appropriate for this particular patient?

Metoprolol Nadolol Propranolol Sotalol Timolol

Case: A 50-year-old male patient suffered a myocardial infarction and received drugs for the prophylaxis of cardiac arrhythmias. Now he complains of nausea, diarrhea, vertigo, tinnitus and visual disturbances. ECG shows prolonged PR and QT intervals and widening of QRS complex with T wave changes. Question: What drug is likely to be administered to the above patient?

Mexiletine Diltiazem Quinidine Disopyramide Amiodarone

Case: A 45-year-old man presents with a 2-hour history of left-sided chest pain. He denies any trauma to the chest; the pain began suddenly and is worsened by taking a deep breath. On examination, his RR is 40/min; he has decreased breath sounds on the left side. Question: What is the most likely cause of his chest pain?

Musculoskeletal pain Herpes zoster Spontaneous pneumothorax Angina Pericarditis

Case: A 58-year-old man presents for a routine physical exam. The only abnormal finding is a blood pressure of 150/96 mm Hg. 20 years ago, he quit smoking cigarettes after smoking at a rate of 1 pack/day for 10 years. Family history is significant for diabetes and hypertension in 2 elder siblings. Past medical history is insignificant, except for an appendectomy at the age of 28 and fractured right radius 15 years ago. Repeat BP recordings show a BP of 148/98 mm Hg and the of 150/98 mm Hg. Fasting blood glucose is 122 mg/dL. A renal profile, lipid profile, and fundoscopy are ordered. Question: Based on this patient's profile, what would be the best drug to start him on?

Nifedipine Prazosin Atenolol Hydrochlorthiazide Enalapril

Ventilation is essential for gas exchange. How does shallow breathing affect alveolar gas exchange?

Not at all The increase in time for the contact between air and erythrocytes benefits gas exchange Shallow breathing requires less muscle power, hence is superior to normal breathing Shallow breathing increases the ventilation of the anatomical dead space and decreases the alveolar ventilation Shallow breathing leads to respiratory alkalosis

A 40-year-old woman presents for pulmonary therapy. She has developed emphysema over the past year. She also has a history of asthma, and she is a chain smoker. You know that her physiologic dead space has increased. What is responsible for increasing the physiologic dead space in this patient?

Poorly perfused alveolus Pharynx Bifurcation of the trachea Tracheal deviation Blocked nasal passages

Digoxin is a purified glycoside from Digitalis lanata. Digitalis is of great use in the management of heart failure, as well as for the treatment of various types of cardiac arrhythmias. Interestingly, it is also capable of causing arrhythmias on its own if not used with care. What is the preferred anti-arrhythmic drug for the treatment of digitalis-induced arrhythmias?

Procainamide Lidocaine Propranolol Bretylium Verapamil

A 45-year-old man is hospitalized with chills, increased cough, increased sputum production, and shortness of breath. His BP is 115/70mmHg and HR is 84bpm. On physical examination you notice facial edema. The patient also complains of ear fullness. The patient undergoes MRI of the chest to evaluate the cause of dyspnea. You are reading the study of this patient. Refer to the image. What is the cause of the facial swelling in this patient?

RV failure, secondary to hepatomegaly Superior vena cava syndrome RV dysplasia Electrolyte depletion Decrease in cardiac contractility Secondary pulmonary hypertension

Case: A 55-year-old man with a 30-pack-year history of cigarette smoking presents with a 3-month history of cough productive of blood and sputum. The patient admits a weight loss of 25 pounds over the past year. The patient also notes diffuse 'bone pain', abdominal pain, polydipsia, polyuria, and anxiety over the past month; all are unusual symptoms for him. The patient denies recent travel. The patient was treated in the emergency room twice over the past 2 months for nephrolithiasis. On chest radiography, a 3 cm cavitary lesion with an air-fluid level is noted centrally in the left upper lung field; it is considered suspicious for a pulmonary abscess. The patient also exhibits clubbing on physical examination. The patient's PPD is negative, and there is no history of anti-tuberculosis medication use in this patient's history. The patient's laboratory values are as follows: Calcium: 13.2 (normal: 8.5 - 10.8 mg/dL). Phosphorus: 1.8 (normal: 2.5 - 4.5 mg/dL), Urine cyclic adenosine monophosphate (cAMP): 9.2 nmol/mL (normal: 1.6 - 6.2 nmol/mL). Question: What is the most likely diagnosis?

Reactivation of latent tuberculosis infection Small cell carcinoma Squamous cell carcinoma Bronchoalveolar cell carcinoma Large cell carcinoma

Case: A 54-year-old man has noticed unexplained weight loss. He has a bad cough and has started to bring up blood when he coughs. In addition, he feels discomfort with breathing. Finally, at the insistence of his wife, he sees his doctor. He reluctantly acknowledges that he has smoked 2 packs of cigarettes a day for many, many years. X-rays show a central chest lesion with cavitation. Cytologic studies and a biopsy are done. The pathologist comments to the treating physician that she saw intercellular bridges on biopsy. Question: What is the most likely diagnosis?

Small cell carcinoma Adenocarcinoma Metastatic Wilms tumor Large cell carcinoma Squamous cell carcinoma

A 2-year old infant was admitted for failure to thrive. The infant suffered from 4 episodes of respiratory tract infection since birth. During neonatal period, the child had intestinal obstruction due to inspissated meconium. The child is asthenic with little subcutaneous tissue and has a protuberant abdomen. Both the parents of the child are normal. Which of the following laboratory tests will be enable you to establish a diagnosis in this case?

Serum immunoglobulin level CT scan of the abdomen Bronchoscopic examination Sodium chloride content of sweat Endoscopic biopsy of intestinal mucosa

A 25-year-old Caucasian man suddenly passes out while playing basketball. Paramedics arrive, and EKG reveals the patient is in asystole. Unfortunately, the patient is unable to be resuscitated. This patient dies of the most common cause of death in a young athlete. What decreases the intensity of the murmur in this patient's condition?

a. Anxiety b. B-blockers c. Diuretics d. Nitroglycerin e. Valsalva maneuver

Case: A 61-year-old woman has noticed unexplained weight loss. She has a bad cough and has started to bring up blood when she coughs. In addition, she feels discomfort with breathing and presents for evaluation. Upon questioning for the medical history, she denies having ever smoked cigarettes. She has a history of tuberculosis. X-rays show a peripherally located lesion. A biopsy was positive with mucacarmin staining. Question: What is the most likely diagnosis?

Small cell carcinoma Adenocarcinoma Metastatic Wilms tumor Large cell carcinoma Squamous cell carcinoma

Case: A 65-year-old man presents with a 25-pound unexplained weight loss. He also has noticed a change in his usual cough. He sees his family doctor. Upon questioning for the medical history, the doctor discovers that he has a 60-pack/year history of smoking as well as dyspnea. On physical examination, he appears to have Cushing's syndrome. X-rays show a central lesion with no cavitation. A hilar mass is seen on chest X-ray. Question: What is the most likely diagnosis?

Small cell carcinoma Adenocarcinoma Metastatic Wilms tumor Large cell carcinoma Squamous cell carcinoma

Case: A 45-year-old man presents to your office with respiratory complaints. He has a 60-pack-year history of smoking. You take a careful history and do a complete physical examination. You also review chest X-rays. You conclude that he has chronic bronchitis. Question: What observation is most likely?

Sputum production Enlargement of the air spaces Loss of elastic recoil Watery rhinorrhea Hyper-responsiveness of the airways

Case: A 65-year-old white male has a 40-pack-year history of cigarette smoking. He is found to have a spot on his chest X-ray. A biopsy confirms that he has carcinoma of the lung, and he is admitted to the hospital. Over the course of the next few days, he develops lethargy and confusion and then proceeds to have a seizure. His urine output remains normal. Laboratory tests are performed on his blood and his urine. (Lab results retracted) Question: What type of tumor is most likely?

Squamous cell carcinoma Adenocarcinoma Small cell carcinoma Large cell carcinoma Bronchoalveolar cell carcinoma

Case: A 54-year-old female is brought to the emergency room in a lethargic state. Her hands and feet are cold, moist, and cyanotic. The pulse is 115 bpm and weak, BP taken by the paramedics was 84/54 mmHg. S-T segments and T-waves are normal on ECG. Implanted Swan-Ganz catheter shows pulmonary capillary wedge pressure of 9 mmHg. On review of systems you note preserved reflexes, and auscultation is not remarkable, except tachycardia. Question: What is the most likely diagnosis?

Stroke Myocardial infarction Hypovolumic shock Cardiac tamponade Acute congestive heart failure

Emphysema is characterized by permanent dilatation of air space. This dilatation occurs beyond which of the following structures along the airway of the lung?

Trachea Bronchi Terminal bronchiole Alveolar duct Alveoli

Spontaneous respiration ceases after

Transection of the brain stem above the pons Transection of the brain stem at the caudal end of medulla Bilateral vagotomy Bilateral vagotomy combined with transection of the brain stem at the superior border of the pons Transection of the spinal cord at the level of the first thoracic segment

Case: A male newborn is cyanotic. He is not eating well and seems to be out of breath. An echocardiogram is done; it shows that the right ventricle gives rise to the aorta and the coronary arteries and that the pulmonary artery comes off the left ventricle. There is also a ventricular septal defect present. Question: What is the most likely diagnosis?

Transposition of the great arteries Ebstein's anomaly Total anomalous pulmonary venous return Tetralogy of Fallot Truncus arteriosus

Case: A 26-year-old Caucasian woman presents with a 2-day history of dyspnea, productive cough, and high-grade fever with chills. She has been feeling extremely fatigued for the past few days. She is a chain smoker and IV drug abuser. Vitals are as follows: HR 110/min, Temp 101 degrees F, BP 110/70 mm Hg, and RR 26/min. On exam, the JVP is raised, and mild hepatomegaly is present. Cardiovascular exam reveals a pansystolic murmur at the lower left sternal border. You arrange for routine investigations, comprehensive panel, 3 sets of blood cultures, EKG, X-ray, and echocardiography. You strongly suspect infective endocarditis secondary to intravenous drug abuse. Question: Which valve is most likely to be affected?

Tricuspid valve Mitral valve Aortic valve Pulmonary valve Hasner s valve

Case: A 50-year-old man dies following an excruciating pain in the chest. At autopsy, he is found to have cardiac tamponade. The ascending aorta shows an intimal tear at 3 cms above the aortic valve with intramural hematoma. The microscopic examination of the aorta shows elastic tissue fragmentation and separation of the elastic and fibromuscular elements of the tunica media by small cleft like spaces filled with amorphous extracellular matrix. Question: The features are suggestive of what condition?

Tuberculous aneurysm Mycotic aneurysm Syphilitic aneurysm Atherosclerotic aneurysm Dissecting aneurysm

Case: A 70-year-old man presents with a mass in the abdomen which is present for the past 1 year but is slowly increasing in size. On examination, there is a pulsatile mass measuring 10 cms in size. He is advised surgical removal of the mass. Grossly, the mass is a fusiform swelling of the abdominal aorta. The inner wall is ulcerated and covered by thrombus. The microscopic examination of the wall shows dense hyaline fibrous tissue with a lining of laminated old and new thrombi and shows abundant lipid filled macrophages. Question: These features are suggestive of what diagnosis?

Tuberculous aneurysm Mycotic aneurysm Syphilitic aneurysm Atherosclerotic aneurysm Dissecting aneurysm

Case: At autopsy, a 60-year-old man is found to have a massively enlarged heart with aneurysmal dilatation of the aorta just above the aortic valve with dilatation of the aortic ring valve. The cut section of the aorta shows tree-bark appearance in this region. Microscopic examination of the dilated aorta shows inflammatory infiltrates in the adventitia with cuffing of the vasa vasorum by an infiltrate of lymphocytes and plasma cells. Question: The features are suggestive of what diagnosis?

Tuberculous aneurysm Mycotic aneurysm Syphilitic aneurysm Atherosclerotic aneurysm Dissecting aneurysm

Case: A 65-year-old white man has a 10-year history of angina which has, up until now, been treated effectively with nitroglycerin. Lately, he has been noticing that he is having chest pain more frequently. He no longer is able to complete his morning walk without the development of pain, whereas he previously had been able to complete the walk without a problem. He also notices that light gardening is starting to produce chest pain. He feels that the chest pain is more severe and lasts longer. As a consequence of these changes, he has to take increasing amounts of nitroglycerin to control the pain. Question: What is this phenomenon called?

Unstable angina Angina pectoris Variant angina Prinzmetal's angina Ludwig's angina

An 18-year-old woman presents to the Emergency Department with shortness of breath, cough, malaise, and dyspnea on exertion. Her symptoms began abruptly approximately 2 hours ago. She has no history of illness or disease and has been very healthy up until this point. Physical exam revealed a thin, ill-appearing young woman in obvious respiratory distress. Her oxygen saturation was 82%, and she had decreased breath sounds bilaterally. Vital signs are as follows: blood pressure 128/88 mm Hg; pulse 124/min; respiratory rate 26 per minute; temp 97.8 degrees Fahrenheit. Question: What concerning the patient s probable diagnosis is true?

Women are affected more often than men. Peak incidence is between 40 and 50 years. They are usually the result of trauma. Smoking can increase the chance of developing this condition. The trapped air is fixed and will not shift to the highest point when the patient is moved.

A 5-day-old baby boy presents with shortness of breath, tachypnea, cyanosis, and diaphoresis. Chest X-ray shows cardiomegaly with increased pulmonary vascularization. The echocardiogram shows a single arterial trunk arising from the ventricles. What best describes the great vessel abnormality in this patient?

a. Anterosuperior displacement of the aorticopulmonary septum b. Failure of the aortopulmonar septum to turn in a spiral c. Partial development of the aorticopulmonary septum d. Patent ductus arteriosus e. Premature closure of the foramen ovale

A 35-year-old pregnant diabetic woman shows up at the ER in stage 3 of labor. She has not received proper prenatal care. A baby girl is born without complications, but a few hours later the child presents with cyanosis and shortness of breath. The echocardiography shows a pulmonary artery originated in the posterior left ventricle and a VSD. What is the best description for the pulmonary abnormality in this patient?

a. Anterosuperior displacement of the aorticopulmonary septum b. Failure of the aortopulmonary septum to turn in a spiral c. Partial development of the aorticopulmonary septum d. Patent ductus arteriosus e. Premature closure of the foramen ovale

A 28-year-old Japanese man comes to primary care doctor presenting with 4 months of vertigo, myalgia, weight loss, and arthralgias. The findings at physical exam were: blood pressure 150/90 mm Hg, subclavian bruit, and no pulse in the upper extremities. Angiography showed narrowing of the aorta and some of its branches. What is the most probable diagnosis?

a. Buerger disease b. Giant cell arteritis c. Kawasaki disease d. Raynaud s disease e. Takayasu arteritis

A 3-year-old Japanese boy is brought to the pediatrician. His mother says the child has had a fever for the last 5 days (about 101°F). At physical exam, he shows conjunctival injection to dilation of conjunctival blood vessels, a macropapular rash on the thorax and extremities, erythema on the palms and soles, and "strawberry tongue". What is the most probable diagnosis?

a. Buerger's disease b. Giant cell arteritis c. Kawasaki disease d. Raynaud's disease e. Takayasu arteritis

As part of a regular check up, 2 athletes undergo lung function tests. Both have respiratory rates of 11/min and tidal volumes of 550 mL. However, arterial blood gas values show that the arterial PCO of 1 is 35 mm Hg, and the other is 42 mm Hg. A medical student observing the reports is intrigued and decides to look for a possible explanation. A difference in what value is likely to be responsible for the different in the athletes' arterial PCO2 values?

a. Cardiac output b. Dead space volume c. Inspiratory capacity d. Lung compliance e. Vital capacity

A 78-year-old female who is a known case of congestive cardiac failure presents to the clinic with complaints of a 2-day history of ulcers on her right foot. Examination reveals bilateral pitting pedal edema with 2 small 2X2 cm venous ulcers at the medial malleolus of her right foot along with increased jugular venous pressure (JVP), hepatomegaly, and S3 gallop on cardiac auscultation. The patient is advised to consider compression stocking for the venous ulcer. Application of compression stocking helps reduction of edema through which of the following hemodynamic mechanism?

a. Increasing capillary hydrostatic pressure b. Increasing capillary permeability c. Increasing tissue hydrostatic pressure d. Increasing tissue oncotic pressure e. Increasing venous pressure

Case: A 56-year-old woman presents with fatigue, cough, and breathlessness on exertion for the last 2 months that have progressively increased. She gets short of breath after walking two blocks or climbing several flights of stairs. In addition, she gives a history of hemoptysis on two recent occasions. In addition, she has noticed some recent ankle swelling. Her past medical history is significant for rheumatic fever 30 years ago. On examination, her blood pressure is 128/80 mm Hg, RR 22/min, pulse 70 bpm. Cardiac auscultation reveals a very loud S1, presence of an opening snap, mid-diastolic murmur heard at the apical region and a loud P2. A two-dimensional echocardiogram is presented below. Question: What is the most likely diagnosis based on this patient s history and examination?

a. Pulmonary regurgitation b. Mitral valve prolapse (MVP) c. Tricuspid regurgitation (TR) d. Mitral stenosis (MS) e. Aortic stenosis (AS)

Case: A 32 year-old asthmatic male presents with complaints of acute onset of severe breathlessness, cough, and wheezing for past 2 hours. PE revealed a male who is drowsy, sweating, his respirations are labored and he is using his accessory muscles of respiration. In addition, subconjunctival hemorrhage and bilateral mydriasis is noted. His vitals upon arrival are: pulse 122/min; RR 28/min, BP 140/80 mmHg. Later, arterial blood gas analysis reveals a PaC02 of 60 mm Hg and pH of 7.1. Question: What is the cause of the subconjunctival hemorrhage and bilateral mydriasis in this patient?

a. Respiratory alkalosis b. Hypocapnia c. Hypercapnia d. Increased ventilation-perfusion ratio e. Metabolic acidosis

A 65-year-old caucasian male, has a ten year history of angina, which has up until now, been treated effectively with nitroglycerine. Lately, he has been noticing that he is having chest pains more frequently, that are becoming more severe, and lasting longer. He is no longer able to complete his morning walk without the development of chest pain, whereas, he had previously been able to complete the walk without a problem. He also notices that light work, like gardening, is starting to produce chest pain. As a consequence of these changes, he has to take increasing amounts of nitroglycerine to control the pain. What is this condition called?

a. Unstable angina b, Stable angina c. Vincent angina d. Prinzmetal's angina e. Ludwig's angina

Appropriate outpatient prophylactic treatment following discharge for an acute myocardial infarction, which produced minimal alterations in cardiac output, might include aspirin to prevent platelet aggregation and which of the following?

digoxin to increase cardiac output atenolol to reduce cardiac work and ventricular ectopic foci lidocaine to prevent PVCs heparin to prevent venous thrombi amiodarone to control occasional PVCs

An undesirable side effect of propranolol with respect to treatment of stable angina is which of the following?

increased end diastolic volume increased time in diastole reflex tachycardia decreased end diastolic volume coronary arterial vasoconstriction

A 26-year-old woman who was a fanatical dieter, complained of dyspnea and fatigue after taking fenfluramine. She had no previous history of pulmonary disease, smoking, asthma, or lung trauma. The MOST likely diagnosis is which of the following?

pulmonary hypertension acute respiratory distress syndrome chronic obstructive pulmonary disease cystic fibrosis bronchogenic carcinoma

A patient with congestive heart failure has been treated with digoxin for 4 weeks and is experiencing symptoms of toxicity. Assuming a half life of 4 days for digoxin in this patient, what type of organ system failure could account for such toxicity?

renal hepatic cardiac pulmonary gastrointestinal

A 35-year-old asthmatic woman is diagnosed with atrial flutter. Which agent should be avoided in treating atrial flutter in this patient?

verapamil propranolol quinidine digoxin diltiazem