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A 29-year-old man is brought to the emergency department in a comatose state a few hours after complaining of sudden onset of excruciating headache. Neurologic examination reveals dilated pupils poorly responsive to light. A CT scan of the head without contrast demonstrates hyperdensity within the suprasellar cistern, while MRI is unremarkable. Lumbar puncture shows hemorrhagic [...]

A patient has persistent >2mm ST elevation in V2-6 two hours following a myocardial infarction, with hypertension of 205/115 mmHg. He has already been given morphine and aspirin. What is the next management of choice? a) IV Nitroglycerine b) Double-bolus r-PA c) IV GTN d) IV streptokinase e) Subcutaneous heparin The correct answer is A A working [...]

What would typically cause the pressure–volume curve of the left ventricle to be shifted to the left? a) Aortic regurgitation b) Mitral stenosis c) Aortic stenosis d) Mitral regurgitation e) Tricuspid stenosis The correct answer is C In severe aortic stenosis , the left ventricle functions at the steep portion of the pressure-volume curve. In [...]

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 [...]

Familial Hypertrophic Cardiomyopathy

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 [...]

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 [...]

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 [...]

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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