Internal-Medicine

Questions: 14–24 5
syncopal event 1 month ago. Her echocardiogram
reveals a cardiac tumor in the left atrium,
it is pendunculated and attached to the endocardium.
Which of the following is the most
likely cause of this lesion?
(C)
(D)
(E)
it is generally performed with
cardiopulmonary bypass
it may cause renal failure
it requires carotid artery puncture
(A)
(B)
(C)
(D)
(E)
myxoma
sarcoma
rhabdomyoma
fibroma
lipoma
19. A 72-year-old woman has new-onset atrial flutter
with a ventricular rate of 150/min. She is
hemodynamically stable with a blood pressure
of 155/90 mm Hg, but is experiencing palpitations.
Which of the following drugs is the best
intravenous choice for controlling the heart rate?
(A)
(B)
(C)
(D)
(E)
diltiazem
lidocaine
aminophylline
magnesium
atropine
20. Several of the older patients in your practice
intend to pursue exercise programs. They have
no cardiac symptoms, but some do have vascular
risk factors such as diabetes or hypertension.
In these patients, which of the following
is true about exercise electrocardiography?
(A) it is an invasive procedure
(B) it is contraindicated in patients over
65 years of age
(C) it detects latent disease
(D) it has a morbidity of approximately 5%
(E) it is used in pulmonary embolism
21. A 58-year-old man is undergoing cardiac
catheterization for evaluation of chest pain
symptoms. He is worried about the risks, and
as part of obtaining informed consent, you
advise him about the risks and benefits of the
procedure. Which of the following aspects of
angiography is true?
(A)
(B)
it is contraindicated in the presence of
cyanosis
it is considered noninvasive
22. A 23-year-old man develops sharp left-sided
chest pain, fever, and a friction rub heard at
the lower left sternal border, unaffected by respiration.
The pain is also aggevated by lying
down and relieved by sitting up. He is otherwise
well with no other symptoms and the
remaining physical examination is normal.
Which of the following is the most likely cause
for his symptoms?
(A)
(B)
(C)
(D)
(E)
rheumatic fever
tuberculosis (TB)
herpes simplex virus
MI
coxsackievirus
23. A 72-year-old woman with angina undergoes
cardiac catheterization. The pulmonary capillary
“wedge” pressure is an approximation of
the pressure in which of the following structures?
(A)
(B)
(C)
(D)
(E)
pulmonary artery (PA)
pulmonary vein
left atrium
right atrium
vena cava
24. A 58-year-old man with hypertension is
brought to the emergency room after suddenonset
chest pain that radiates to his back and
arms. He is in moderate distress with a blood
pressure of 160/90 mm Hg in the left arm and
120/70 mm Hg in the right arm. Cardiac examination
reveals a soft second heart sound and a
murmur of aortic insufficiency. His ECG shows
sinus tachycardia but no acute ischemic changes,
and the chest x-ray (CXR) is shown in Fig. 1–4.
Which of the following is the most appropriate
next step in confirming the diagnosis?
(A)
(B)
(C)
(D)
(E)
coronary angiography
transthoracic echocardiography
computerized tomography (CT) chest
exercise stress test
cardiac troponin level