Internal-Medicine

Questions: 47–52 13
Figure 1–12.
(Reproduced, with permission, from Fuster V, et al., Hurst’s the Heart, 11th ed.
New York: McGraw-Hill, 2004:1356.)
51. A 58-year-old man with no prior cardiac history
presents with retrosternal chest pain starting
at rest and lasting 30 minutes. The pain
radiates to the left arm and is associated with
diaphoresis and dyspnea. His blood pressure is
150/90 mm Hg, pulse 100/min, the heart
sounds are normal, and the lungs are clear to
auscultation. Which of the following is the next
most appropriate investigation?
(A)
(B)
(C)
(D)
(E)
CT scan—chest
CXR
cardiac troponin
ECG
myocardial perfusion imaging
52. The laboratory results shown in Table 1–1 are
obtained from the investigation of a 37-year-old
African-American woman who has a blood
pressure at rest of 140/100 mm Hg. Which of
the following is the most likely diagnosis?
(A) Cushing’s syndrome
(B) primary aldosteronism
(C) essential hypertension
(D) pyelonephritis
(E) bilateral renal artery stenosis
TABLE 1–1. LABORATORY INVESTIGATIONS
Urinalysis
pH 5.2
Albumin
Negative to trace
Serum Na
140 mEq/L
K
3.5 mEq/L
Cl
100 mEq/L
CO 2
25 mEq/L
Creatinine
1.0 mg/100 mL
Fasting sugar
90 mg/100 mL
Calcium
9.0 mg/100 mL
Uric acid
5.0 mg/100 mL