NMS Q&A Family Medicine

SECTION IIICardiovascular Diseasesin Primary Carechapter 6CardiologyExamination questions : Unless instructed otherwise, choosethe ONE lettered answer or completion that is BEST ineach case.1 A 45-year-old male smoker comes to his family doctor7 days after a 4-hour bout of squeezing anteriorchest pain that occurred while he was away with agroup on a hunting trip, on which they traveled bycanoe for 5 days away from their automobiles. Hethought that he had a bout of heartburn; he has feltwell since the attack and made the appointment “justin case.” His electrocardiogram (ECG) shows Q wavesin leads II, III, and AVF but no ST deviation norclearly abnormal T-wave patterns. There is no priorECG with which to compare. Which of the followingavailable laboratory tests would be the most sensitiveand specific indicator of a myocardial infarction (MI)having occurred 7 days before?(A) Aspartate amino transferase (AST, SGOT)(B) Myoglobin(C) Treponin(D) Creatine phosphate (CK-MB fraction)2 A 57-year-old male with symptomatic osteoarthritisof the knees and hips has had chest pains at oddtimes, not necessarily related to exercise, sometimesassociated with emotional stress. His resting pulserate is 52, sinus rhythm. An ECG is read as showingWenckebach phenomenon. You decide on a cardiacstress test. Which of the following would be the mostacceptable option?(A) Phased treadmill exercise stress test(B) Thallium sestamibi scintigraphy (scan forischemia before and after exercise)(C) Adenosine chemical stress test(D) Dobutamine, radionuclide angiography(E) Stress echo test3 A 14-year-old prospective competitive athlete isscheduled for a physical examination to “go out” forjunior varsity football. During the examination ofthe heart, a systolic murmur is heard over the leftupper sternal border. Which of the following maneuverswould help the most to delineate identify thepresence of infundibular hypertrophic subaorticstenosis (IHSS)?(A) Auscultation of the heart while the candidate isperforming the Valsalva maneuver phase 2 (thestraining down, inspired breath holding phase)(B) Auscultation of the heart while the patient issquatting during inspiration39