NMS Q&A Family Medicine

40 NMS Q&A Family Medicine(C) Listening to the heart after the candidate jogs inplace for 1 minute(D) Auscultation of the heart standing duringexhalation(E) Listening for changes in the murmurimmediately upon the candidate arising fromthe supine position4 A 45-year-old woman with a complaint of atypicalchest pains comes to her new family physician for acheckup. Her blood pressure (BP) is 135/80; lipidsresults copied from the previous year are as follows:total cholesterol 150 mg/dL; high-density lipoproteincholesterol (HDLC) 60 mg/dL: low-density lipoproteincholesterol (LDLC) 90 mg/dL, and serum triglycerides120 mg/dL. She has no family history ofatherosclerotic vascular disease. Examination revealsa midsystolic click and a faintly perceptible systolicmurmur. The doctor wants to ascertain whether prophylacticantibiotics should be prescribed for thispatient before dental procedures. In an attempt todetermine whether the patient has a murmur ofmitral insufficiency, which of the following maneuverswould enhance that murmur for easier identification?(A) Inspiration, squatting(B) Expiration, standing(C) Valsalva phase 3 (the release phase)(D) Valsalva phase 4 (the rebound phase afterValsalva)(E) Handgrip5 A 67-year-old smoking woman with known chronicobstructive lung disease and right ventricular hypertrophyhas been treated with intermittent use of abeta-adrenergic agonist drug. She now has a bout ofincreased coughing and shortness of breath. Whichof the following blood tests might be the best indicatorruling out dyspnea caused by heart failure?(A) Serum aldosterone level(B) Serum cortisol level(C) Serum pro-BNP level(D) Serum digoxin level(E) Serum creatinine level6 A 63-year-old white man has had poorly controlledhypertension for at least 8 years. He has a family historyof hypertension and type II diabetes. He hadbeen on a calcium channel-blocking agent when hewas last seen by you 2.5 years ago. He failed to followup with you until he became dyspneic with exertionover the last week. BP is 160/105, apical heart rate is110, and the rhythm is irregular. The ECG showsvoltage criteria for left ventricular hypertrophy, andthe chest x-ray shows a “concentric hypertrophy”pattern in the cardiac silhouette (i.e., hypertrophywithout obvious dilatation). Which of the followingfindings would most certainly apply to this patient?(A) Distended neck veins(B) Ejection fraction 50%(C) Pulmonary venous hypertension(D) S 3 gallop(E) Hepatomegaly7 Regarding the patient in Question 6, what is the mostlikely type of dysrhythmia?(A) Multiple premature ventricular contractions(B) Primary atrial contractions(C) Sick sinus syndrome(D) Atrial fibrillation(E) Second-degree heart block8 Which of the following is the best therapeutic foundationfor managing the patient in Question 1?(A) BP control and heart-rate reduction(B) Aggressive diuresis(C) Angiotensin-converting enzyme inhibitors(ACEIs)(D) Oxygen therapy(E) Morphine sulfate injection9 A 75-year-old man is visiting you for a routinecheckup. He has seen few doctors in his lifetime andnone in your city since moving there 10 years ago.You hear a diastolic murmur over the apex that radiatesto the left axilla. Which of the following is thelikely diagnosis?(A) Aortic stenosis(B) Mitral stenosis(C) Dilated cardiomyopathy(D) Aortic insufficiency(E) Ventricular septal defect10 A 17-year-old boy, upon routine preparticipationsports examination, manifests BP of 150/90 in theright arm and 110/90 in the left. Which of the followingis the cause of this asymmetry of BP levels in theupper extremities?(A) Congenital arteriovenous shunt(B) Congenital abdominal aorta coarctation(C) Congenital coarctation of the aortic arch(D) Atherosclerotic blockage of the left subclavianartery(E) Congenital stenosis of the left subclavian artery11 In the patient in Question 10, which of the followingabnormalities, if any, is most likely to be found uponexamination?