Internal-Medicine

4 1: Cardiology
14. A patient with new-onset syncope has a blood
pressure of 110/95 mm Hg and a harsh systolic
ejection murmur at the base, radiating to
both carotids. Auscultation of the second heart
sound at the base might reveal which of the
following findings?
(A) it is accentuated
(B) it is diminished
(C) it is normal in character
(D) it is widely split due to delayed
ventricular ejection
(E) it shows fixed splitting
15. A 69-year-old woman complains of easy fatigue
and one episode of presyncope. On examination
of the jugular venous pressure (JVP), there
are irregular large a waves. The ECG has fixed
PP and RR intervals but varying PR intervals.
Which of the following conditions is this most
likely caused by? (See Fig. 1–3.)
(A) surgical removal of an atrium
(B) independent beating of atria and
ventricles
(C) a reentry phenomenon
(D) a drug effect
(E) a heart rate under 60 beats/min
16. A 57-year-old man has an anterior MI. It is complicated
by the development of heart failure.
Nitroglycerin would be a useful first medication
under which circumstances?
(A)
(B)
(C)
(D)
(E)
severe pulmonary congestion, blood
pressure 80 mm Hg systolic
clear lungs, blood pressure 120 mm Hg
systolic
clear lungs, blood pressure 80 mm Hg
systolic
clear lungs, blood pressure 160 mm Hg
systolic
moderate pulmonary congestion, blood
pressure 130 mm Hg systolic
17. A 28-year-old man develops viridans group
streptococci septicemia. Which of the following
cardiac lesions has the highest risk of developing
endocarditis?
(A)
(B)
(C)
(D)
(E)
ventricular septal defect
atrial septal defect, secundum type
mitral valve prolapse with regurgitation
pure mitral stenosis
asymmetric septal hypertrophy
18. A 47-year-old woman has new-onset transient
right arm weakness and word finding difficulty
symptoms lasting 3 hours. She is also
experiencing exertional dyspnea, and had a
Figure 1–3.
(Reproduced, with permission, from Fuster V, et al., Hurst’s the Heart, 11th ed. New York: McGraw-Hill, 2004:904.)