NMS Q&A Family Medicine

42 NMS Q&A Family Medicine19 A 45-year-old man is seen in the emergency departmentwith chest pain radiating into the left arm. Hehas no atherosclerotic risk factors personally (excepthis sex) and has no family history of CAD in membersbefore the age of 70 years; he does not smoke and hasno chronic cough or other respiratory symptoms.Further history reveals that he complains of a sorethroat and fatigue that started 10 days ago. BP is130/85 and the systolic pressure drops by 12 mm Hgduring inspiration. Examination finds nontender cervicaladenopathy; there is no chest wall tenderness.The heart shows systolic and diastolic murmurlikesounds. The cardiac percussible silhouette is enlargedto beyond the left midclavicular line. An ECG showsST elevation across the entire precordium. Whiteblood cell count is 3,500 with 60% lymphocytes and isotherwise not remarkable. Which of the followingaccounts for the described clinical picture?(A) Acute MI(B) Acute pericarditis(C) Dressler syndrome(D) Acute bronchitis(E) Tietze syndromeFor Questions 20 through 24, match the lettered types oforthostatic hypotension with the numbered causes. A clinicaltype may apply to more than one cause.20 Pericarditis21 Alcoholic polyneuropathy22 Fe ver23 Hypertensive on beta-blocker24 Venous pooling after hot shower(A) Neurogenic hypotension(B) Nonneurogenic hypotension(C) Drug-related hypotension(D) Supine hypotension(E) Septic hypotensionFor Questions 25 through 29, match the lettered descriptionsof heart sounds to the numbered cardiac diagnoses.25 Aortic stenosis26 Mitral regurgitation27 Hypertrophic cardiomyopathy28 Mitral valve prolapse29 Aortic regurgitation(A) Holosystolic, low pitch; apex radiates to axilla(B) Diastolic decrescendo(C) Crescendo–decrescendo; radiates to carotids(D) Midsystolic or late systolic click(E) Crescendo–decrescendo; decreases with squatFor Questions 30 through 34, match the lettered effects withthe numbered maneuver that may influence murmurs.30 Inspiration, squatting31 Expiration, standing32 Valsalva phase 3 (release)33 Valsalva phase 4 (rebound)34 Handgrip(A) Decreases venous return(B) Raises systemic vascular resistance (SVR), heartrate, and cardiac output(C) Increases venous return(D) Decreases arterial BP(E) Raises arterial BP; slows heart rate