cavity with late diastolic collapse of the right atrium.

Which of the following physical fin

dings is

most important clue to this patients current condition?

A.

Pulsus alternans

B.

Dicrotic pulse

C.

Pulsus parvus

D.

Pulsus paradoxus

E.

Hyperkinetic pulse

136.

A 56-yea-old male presents complaining of progressively worsening dyspnea. He says

that he cannot walk more than few blocks without getting short of breath, and finds it

particularly difficulty to sleep while lying flat. He uses three pillows at night. The patient

does

not use tobacco, alcohol or drugs. He has been diagnosed with hypertension, but only t

akes his

medication when he experiences headaches. His blood pressure is 170/100 mm Hg and

his pulse

is 80 beats per minute. On physical examination, there are basilar lung crackles bilateri

ally,

jugular venous distention, and bilateral trace lower extremity edema. There is cardiome

galy on

chest x-ray, and evidence of left ventricular hypertrophy on EKG. Echocardiogram shows

significant pulmonary arterial hypertension. Which of the following is the most likely

explanation for this pati

ents pulmonary hypertension?

A.

Mechanical obstruction of the pulmonary arterial tree

B.

Hypoxia-induced pulmonary vasoconstriction

C.

Obliteration of the pulmonary vascular bed

D.

Inflammatory pulmonary vascular reaction

E.

Reactive vasoconstriction due to venous congestion

F.

Increased volume of flow and pressure in the pulmonary arteries

137.

A 23-year-old Caucasian student collapses and dies suddenly while taking an

examination. She had no significant past medical history. The myocardial histology pictur

ed

below suggests wh

ich of the following causes of this patients condition?

A.

Genetic

B.

Viral

C.

Nutritional

D.

Immune-mediated

E.

Toxic

138.

A 65-year-old Caucasian male dies while hospitalized. Light microscopic examination of

his lung reveals alveolar cells containing golden cytoplasmic granules that turn dark bl

ue with

Prussian blue staining. This patient most likely suffered from:

A.

Primary pulmonary hypertension

B.

Left ventricular dysfunction

C.

Acute airway obstruction

D.

Granulomatous lung inflammation

E.

Interstitial lung fibrosis

F.

Hypoproteinemia

139.

A 38-year-old male intravenous drug user hospitalized for high-grade fever, fatigue and

dyspnea dies in the intensive care unit (ICU). His lung autopsy findings are shown on th

e slide

below.

This patient most likely suffered from:

A.

Mycotic aortic aneurysm

B.

Tricuspid valve endocarditis

C.

Severe small airway obstruction

D.

Miliary tuberculosis

E.

Venous thromboembolism

140.

Autopsy of a 56-year-old Caucasian male who died in a motor vehicle accident shows

increased thickness of the left ventricular (LV) wall and decreased LV cavity size. The st

ructural

changes observed in this patient s heart are most likely associated with:

A.

Recent myocardial infarction

B.

Mitral insuffiency

C.

Atrial septal defect

D.

Hemochromatosis

E.

Longstanding hypertension

F.

Wolff-Parkinson-White syndrome

G.

Normal aging

141.

A 24-year-old African American female presents to your office with a three week history

of progressive fatigue. On physical examination, you note the following lesions to the pat

ients

nailbeds

Based on this finding, in what other part of the physical examination should you expec

t to find

abnormalities?

A.

Neck palpation

B.

Lung auscultation

C.

Cardiac auscultation

D.

Abdominal palpation

E.

Rectal exam

142.

A study was conducted to assess the association between simvastatin therapy and

serum fibrinogen level in patients who undergo percutaneous coronary interventions. The

data

from the study are given below:

Fibrinogen high

Fibrinogen normal

Simvastatin therapy

43

67

110

No simvastatin therapy

32

58

90

75

125

200

Which of the following is the best statistical method to assess the association between

simvastatin

therapy and elevated fibrinogen therapy?

A.

Two-sample t test

B.

Two-sample z test

C.

Chi-square test

D.

Analysis of variance (ANOVA)

E.

Meta-analysis

143.

Atherosclerotic lesions of coronary artery limit the potential for increase in blood flow

to the myocardium. Some preparations can cause coronary steal phenomenon due to

redistribution of blood flow. Which of the following effects of a drug is most likely to be

associated with the coronary steal phenomenon?

A.

Epicardial vessel dilation

B.

Coronary microvessel dilation

C.

Capacitance vessel dilation

D.

Capacitance vessel dilation

E.

Arterial dilation

F.

Mixed arterial and venous dilation

144.

A 23-year-old man has a mean arterial pressure of 95 mm Hg at rest. After swimming

for

30 minutes, his mean arterial pressure has risen only slightly to 115 mm Hg. A decreas

e in which

of the following during exercise most likely accounts for the observed finding?

A.

Systolic blood pressure

B.

Renal blood pressure

C.

Cardiac stroke volume

D.

Systemic vascular resistance

E.

Right atrial pressure

145.

A 52-year-old male is having low-grade fevers after recent replacement of his aortic

valve. Repeated blood cultures grow gram-positive cocci. Which of the following

characteristics

is most consistent with Staphylo

coccus epidermis as the cause of this patients symptoms?

A.

Catalase negative

B.

Coagulase negative

C.

Mannitol fermenting

D.

Novobiocin resistance

E.

Yellow pigment production

146.

A 73-year-old Caucasian male with advanced visceral cancer dies of extensive

myocardial infarction. Autopsy also reveals sterile non-destructive vegetations along the

mitral

leaflet edges. The pathogenesis of this patients vegetations is most similar to that of:

A.

Hypercalcemia of malignancy

B.

Distant metastases

C.

Lambert-Eaton syndrome

D.

Trousseau syndrome

E.

Raynaud phenomenon

147.

Some patients with tetralogy of Fallot (TOF) are cyanotic at birth. Others have relatively

mild symptoms and experience only episodic cyanosis and dyspnea. The severity of sym

ptoms in

patients with this disorder largely depends on the severity of:

A.

Right ventricular hypertrophy

B.

Ventricular septal defect

C.

Pulmonic stenosis

D.

Aortic insufficiency

E.

Atrial septal defect

148.

A 67-year-old Caucasian male is brought to the emergency department after a syncopal

episode. An ECG recording demonstrates bradycardia with regular rhythm and normal

QRS

complexes but no P waves. Which of the following is the most likely cardiac pacemaker

location

in this patient?

A.

SA node

B.

AV node

C.

AV bundle branch

D.

Purkinje system

E.

Left ventricular muscle

149.

Physical examination of newborn male reveals a continuous murmur with systolic

accentuation that is heard best at the left infraclavicular region. The peripheral pulses a

re

normal. The child is otherwise healthy and has no cyanosis or respiratory distress. This

child

would most likely benefit from?

A.

Furosemide