Internal-Medicine

Questions: 59–73 17
(H) normal or high cardiac output
(I) low systemic vascular resistance
(J) normal or high systemic vascular
resistance
(K) normal or high PA diastolic pressure
For the following patients, select the hemodynamic
parameters that are most likely to apply.
65. A 52-year-old man with alcoholic cirrhosis
develops a variceal bleed with hypotension.
His blood pressure is 85/60 mm Hg, pulse
120/min, and heart sounds are normal. The
JVP is not visible, the lungs are clear, and his
extremities are pale, cool, and clammy. Central
hemodynamic monitoring would reveal
(SELECT FOUR)
66. A 73-year-old man has an inferior infarct with
ST elevation documented on right-sided precordial
leads. He is hypotensive (blood pressure
90/70 mm Hg) and tachycardic. The JVP
is 10 cm, the heart sounds are normal, lungs are
clear, and his extremitites are cool. Central
hemodynamic monitoring would reveal
(SELECT SIX)
67. A 20-year-old man is being treated for acute
lymphoblastic leukemia. While neutropenic,
he becomes severely hypotensive with a temperature
of 38.5°C. His blood pressure is 80/60
mm Hg, pulse 120/min, and heart sounds are
normal. The JVP is below the sternal angle,
lungs are clear, and his extremities are warm
and flushed. Central hemodynamic monitoring
would reveal (SELECT SIX)
68. A 78-year-old woman has an acute anterior
wall MI with hypotension and pulmonary congestion.
Her blood pressure is 90/70 mm Hg,
pulse 110/min, JVP at 8 cm, and the heart
sounds are normal. The lungs have bibasilar
crackles, and her extremities are cool and
diaphoretic. Hemodynamic monitoring would
reveal (SELECT FIVE)
Questions 69 and 70
(A)
(B)
high-pitched holosystolic murmur
early and midsystolic murmur
(C)
(D)
(E)
(F)
rapid decompensation with pulmonary
edema
diminished S1
may be tolerated without loss of cardiac
reserve for years
diminished forward stroke volume
Select the typical auscultation findings for the following
patients.
69. An asymptomatic 19-year-old student with a
murmur is found to have mitral regurgitation
on echocardiogram. The physical findings
might include (SELECT THREE)
70. A 60-year-old man with an acute myocardial
infarct develops a new murmur. Echocardiogram
reveals acute MR. The findings might include
(SELECT THREE)
Questions 71 through 75
(A)
(B)
(C)
(D)
(E)
prolonged PR interval
broad-notched P wave in lead II
short QT interval
short PR interval
LVH
For each of the following patients, select the characteristic
ECG finding.
71. A 25-year-old woman develops exertional dyspnea
and fatigue. Her past history is significant
for rheumatic fever as a child. Auscultation of
the heart reveals a loud first heart sound and a
low-pitched middiastolic sound. (SELECT ONE)
72. A 70-year-old man with a prior anterior MI
comes for his routine evaluation. He feels well
and has no symptoms. He is taking metoprolol
100 mg bid, aspirin 81 mg od, enalapril 10 mg
bid, and simvastatin 40 mg od for secondary
prevention. (SELECT ONE)
73. A 20-year-old woman develops palpitations
and dizziness. Her blood pressure is 100/70
mm Hg, pulse 140/min, and heart sounds are
normal. She has had symptoms of palpitations
for many years. (SELECT ONE)