A 56 year old male has a history of aortic stenosis

October 10, 2010

A 56 year old male has a history of aortic stenosis. Which of the following is associated with aortic stenosis? a) Atrial fibrillation b) Systolic ejection murmur c) Increased pulse pressure d) Diastolic murmur e) Right heart failure The correct answer is B With aortic stenosis there is a systolic ejection murmur that is heard loudest at [...]

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Familial Hypertrophic Cardiomyopathy

October 10, 2010

Familial hypertrophic cardiomyopathy is most likely to be secondary to a mutation in: a) Myosin regulatory proteins b) Myosin binding protein-C c) Myosin light chains d) Troponin I e) Troponin T The correct answer is B Molecular genetic research has demonstrated that familial hypertrophic cardiomyopathy is caused by a mutation in one of nine genes that [...]

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A 45-year-old man with a strong family history of ischaemic heart disease

October 10, 2010

A 45-year-old man with a strong family history of ischemic heart disease presents with atypical chest pains. Stress echocardiography is organised. What pharmacologic agent is likely to be used to produce cardiovascular stress during stress echocardiography in this patient? a) Dipyridamole b) Dobutamine c) Adenosine d) Arbutamine e) Atropine sulfate The correct answer is A Explanation [...]

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43-year-old, insulin-dependent diabetic patient

October 10, 2010

A 43-year-old, insulin-dependent diabetic patient is diagnosed with hypertension and begins therapy with an antihypertensive agent. Three days later, he measures his blood glucose at home and finds that it is 53 mg/dL. He recalibrates his glucose testing apparatus and repeats the test, only to find that the first reading was accurate. He is concerned that his hypoglycemia did [...]

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60 year old woman with weakness, headache, dizziness and tingling

March 28, 2010

A 60-year-old woman consults a physician because of weakness, headaches, dizziness, and tingling in her hands and feet. Physical examination demonstrates multiple areas of bruising on the back of her forearms and shins. On specific questioning, she reports having had five nosebleeds in the past two months, which she had attributed to “dry air”. Blood [...]

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37 year old woman with severe heart burn with or without meals

March 28, 2010

A 37-year-old woman presents with complaints of severe heartburn with or without meals. She has a history of hypertension, which has been treated with captopril. She also has a history of Raynaud disease, multiple facial telangiectasias, and very taut skin on the dorsum of both hands. She has failed to obtain relief for her heartburn [...]

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74 year old woman with total knee replacement, diabetes mellitus

March 28, 2010

A 74-year-old woman presents to her physician for a postoperative medical visit. Three days ago, she underwent a left total knee replacement for severe osteoarthritis. She has a past medical history significant for type 1 diabetes mellitus and glaucoma. Her hospital course was uneventful. She continues to take daily NPH insulin and has good control [...]

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Acutely ill 70 year old man with right temporal headache, fever and malaise

March 28, 2010

A 70-year-old man presents to the emergency department with a 3-day history of right temporal headache, fever, and profound malaise. He appears acutely ill. His temperature is 39.5°C (103.1°F), blood pressure is 130/80 mm Hg, pulse is 98/min, and respirations are 24/min. Tenderness over the right temporal region is appreciated on palpation. The right temporal [...]

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23 year old Type 1 Diabetic in the Emergency Department

March 28, 2010

A 23-year-old type 1 diabetic is brought to the emergency department after being found in a coma. The scent of acetone is present on the patient’s breath. Urinary catheterization with subsequent dipstick analysis demonstrates marked positivity for glucose and ketones. Stat blood chemistries would most likely show which of the following values for the anion [...]

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34 year old woman with fever and right lower lobe consolidation

March 28, 2010

A 34-year-old woman who is healthy without underlying medical problems presents to clinic with complaints of temperature up to 101°F and cough with greenish sputum production for 2 days without any dyspnea. Her heart rate is 88/min, and her respiratory rate is 18/min. There is no accessory muscle use or conversational dyspnea, nor are there [...]

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