Soal Ok

1. What is the diagnosis of the following cardiac catheterization still-frame slide ?
a. VSD
b. Hypertrophic cardiomyopathy
c. Pulmonic stenosis
d. Coarctation of the aorta
e. Patent ductus arteriosus (PDA)
2. For which of the following conditions is IE prophylaxis not required prior to extensive dental procedures
(more than one option may be correct}?
a. 4 weeks following percutaneous closure of a secundum atrial septal defect (ASD)
b. Eisenmenger syndrome
c. Ebstein anomaly without prior intervention
d. Tetralogy of FaHot (TOF) with residual VSD at the site of prior surgical repair
e. Mechanical aortic valve replacement (AVR) for bicuspid aortic valve disease
3. A 26 year old woman who is 30 weeks pregnant is referred to yon because of a murmur that was noted during
her current pregnancy as welt as intermittently in the past. The patient is asymptomatic.
Physical examination shows slight elevation of the jugular venous pressure, with an A wave.
A parasternal lift is also noted. SL is normal, and S2 is somewhat prominent, fixed,and split A grade 2
inid-peaking ejection systolic murmur is noted at the left sternal border, true statememnt about this patient
condition include all of the following EXCEPT:
a. the sinus venosus type is almost always accompanied by anomalous pulmonary venous connections
b. in children this condition typically experience easy fatigability and exertional dyspnea
c. the most common presenting symptom are exercise intolerance and palpitation
d. atrial arrhythmia are uncommon in children with this condition
e. a patent foramn ovale can be found in approximately 25% of healthy adults
4. Which type of VSD is demonstrated in Figure 9.13?

a. Type 1/supracristaI
b. Type 2/perimembranous
c. Type 4/muscular
d. Type 3/inlet
5. Review the Image taken at the time of percutaneous closure of an intracardiac shunt in a 26-year-old patient
(Fig. 9 ,12]. Which cf the following, defects was closed in this patient?
a. Unroofed coronary sinus
b. Atrioventricular septal defect (AVSD)
c. Secundum ASD
d. Sinus venosus ASD
e. Primum ASD
6. What is the most common coexisting congenital anomaly in patients with coarctation of the aorta?
a. Ebstein anomaly
b. Bicuspid aortic valve
c. PDA
d. VSD
e. Cleft mitral valve
7. The peak age range for surgical intervention for patients with a bicuspid aortic valve is
a. 60 to 80 years.
b. 20 to 40 years
c. 10 to 20 years.
d. 40 to 60 years.
8. What is the most common cardiac defect seen in patients with Noonan syndrome?
a. Pulmonary stenosis
c. Mitral valve prolapse
d. AVSD
e. Coarctation of the aorta
9. A 46-year-old nan with known Ebstein anomafy seeks your advice with regard to optimal management.
He is asymptomatic and has an active lifestyle without any limitations. His physical examination is remarkable
for the absence of cyanosis. He has a loud hclosystolic murmur at the left lower sternal border that is
accentuated with respiration. He has no organomegaly or peripheral edema.
His TTE reveals moderately severe 3+ TR with an RV systolic pressure of 35 mmHg and normal
LV and RV systolic function. There is no evidence of interatrial communication.
Which of the following should you recommend?
a. Tricuspid valve repair
b. Regular follow-up with repeat TTE in 6 months
c. Furosemlde and digoxin
d. Dual-chamber pacemaker
e. Tricuspid valve replacement
10. A 21-year-old woman who has a family history of Marfan syndrome comes to you for prepregnancy counseling.
Echocardiogram and CT scan of the chest show 42-mm dilation of the aortic sinuses.
The patient is asymptomatic and does not have mitraf valve prolapse,
Which of the following is the most appropriate recommendation?
a. Initiate treatment with a (3-blocker, and proceed with pregnancy.
b. Recommend urgent aortic surgical intervention now.
c. Avoid pregnancy because of the autosomal dominant nature of Marfan syndrome.
d. Proceed with pregnancy, preferably sooner rather than later because of the size of the aorta,
e. Avoid pregnancy at ttiis time because of the size of the aorta, and initiate treatment with a (3 -blocker.
11. A 16-year-old girl is being evaluated for a heart murmur. She is asymptomatic. On physical examination,
her blood pressure Is 174/104 mm Hg on her right arm. Her pulses are 2+ on her upper extremities,
The femoral pulses are slightly lower in amplitude than the radial pulses.
Her cardiac examination reveals a short midsystolic murmur in the left tnfrascapuiar area, For this patient,
which of the following is most likely to be found on additional studies?
a. Stenotic pulmonic valve on echocardiogram
b. Cardiomegaly and pulmonary engorgement on chest x-ray
c. Rib notching and dilatation of the aorta on chest x-ray
d. Downward displacement of the tricuspid valve annulus toward the right ventricle apex on echocardiogram
12. The most common chromosomal abnormality associated with TOF is?
a. missense mutations in the PTPN11 gene on chromosome 12
b. 7q11.23 microdeletion
c. 22qll.2 microdeledon.
d. Trisomy 21.
e. M o n o s o m y X (45,X).
13. With which of the following adult congenital heart conditions can the following ECG tracing be seen ?
a. Congenitally corrected transposition
b. Primum ASD
c. Coarctation of the aorta
d. VSD
e. Ebstein anomaly
b. Primum ASD
d. VSD
e. Ebstein anomaly
15. Echocardiography in a 21-year-old asymptomatic man reveals a subaortic membrane with a peak gradient cf
20 mmHg. The aortic valve remains mobile,but there is associated mild to moderate aortic valve insufficiency,
LV size is normal ejection fraction is 60%. What should you advise this patient?
a. Transluminal balloon dilatation is the best treatment option in this case,
b. Surgical resection of the membrane and debridement cf the aortic valve to reduce aortic regurgitation is
Indicated.
c. There is no indication for intervention at this time.
d. AVR and membrane resection is indicated.
16. Which of the following syndromes is associated with pulmonary arteriovenous fistula?
a. Weber-Osier-Rendu syndrome
b. Bland-Garland-White syndrome
c. Crouzon syndrome
d. Kartagener syndrome
e. Williams syndrome
17. Which of the following is true for Loeys-Dietz syndrome (IDS)?

a. FBN1mutations have been implicated.
b. Inheritance is autosomal recessive.
c. Hypertelorism, bifid uvula,and arterial tortuosity are common features.
d. The risk of aortic dissection is lower than for patients with Marfan syndrome.
e. Patients are characteristically tall with long extremities
18. 43-year-old man was referred for evaluation of symptomatic
mitral regurgitation. He was diagnosed with mitral valve prolapse
that was not suitable for repair.
Given his family history of CAD and tobacco use,he underwent a
coronary angiogram, which revealed no
evidence of obstructive coronary disease.
He underwent an uneventful mitral valve replacement.
He was extubated and transferred from the intensive care
unit 48 hours after the operation.
On postoperation day 3, you note the patient to be pale and
lethargic and in mild respiratory distress. His BP is 100/60 mmHg.
His cardiac and lung examination is compromised by tbe
presence of rapid breathing and chest tubes.
His ECG reveals normal sinus rhythm (NSR) at 97 bpm
with no acute
ST-T changes. A TTE is performed. Selected views are shown in
Figure 13.8A. As the patient continues to deteriorate and
becomes hypotensive,a TEE is performed next, as shown in Figure
13.8B. What should you recommend?
a. A 500-cc bolus of IV normal saline solution should be started because the patient is dehydrated,
and no further intervention is needed
b. Immediate surgical intervention for malfunction of the prosthetic mitral valve
c. Immediate surgical exploration of the pericardium
d. Percutaneous aspiration of the fluid present in the pericardium
19. A 46 year old woman presents to the emergency department with eight hours of chest pain. The pain is constant,
-severe,and midsterna! in location. She notes that it is worse when she lies down. She denies exposure
to sick friends or relatives. Past history is notable for tobacco use,borderline hypertension,and elevated cholesterol.
Her father died of a myocardial infarction at age 67 years. Examination is notable fcr a heart rate of 104r and
a blood pressure of 125/80 in both arms. Her lungs are clear. On cardiac examination,
she has a prominent friction rub with two out of three components present.
The remainder of the examination is unremarkable.
Which of the following ECG abnormalities does not suggest pericarditis in the absence of an effusion?
a. Electrical alternans
b. Sinus tachycardia
c. PR segment elevation in lead aVR
d. Concave upward ST segment elevation
e. PR segment depression
20. A 63-year-old nan with cardiac risk factors of tobacco use, hypertension,and diabetes mellitus returns
for follow-up after latepresenting mid-left anterior descending arteiy (LAD} ST-elevation myocardial infarction (MI).
He had an occluded mid-LAD,which was successfully aspirated and stented with a single drug-eluting stent;
no significant disease elsewhere is noted.
The next day he reports progressive chest discomfort and mild fever and has developed a two-component
pericardial friction rub cn physical examination. His EGG is concerning for pericarditis (Dressier syndrome)
and an echo is performed showing no interval change from discharge other than the presence of a
small pericardial effusion. Which of the following regimens would be the most appropriate therapy in this patient?
a. Aspirin 325 daily for 2 weeks,then taper to 81 mg daily + ibuprofen 600 mg T1D fcr 3 months
b. Aspirin 650 HD for 2 weeks with taper to 81 mg daily + colchicine 0.5 mg BID for 3 months
21. A 23-year-oid white man is newly diagnosed with nonHodgkin lymphoma.
He undergoes a metastatic workup that includes art MRI of the chest and abdomen,
which is shown in Figure 13.11. The plan Is for chemotherapy,
but you are consulted for cardiac assessment before beginning chemotherapy.
Radionuclide ventriculography shows a normal LV EF of 65%. What should you recommend?
a. Proceeding with chemotherapy without further cardiac evaluation

b. Cardiothoracic surgical consultation before starting chemotherapy
c. Exercise stress testing
d. Ordering a TTE to delineate the abnormality
22. A 23-year-oid white man is newly diagnosed with nonHodgkin lymphoma.

He undergoes a metastatic workup that includes art MRI of the chest and abdomen,
which is shown in Figure 13.11. The plan Is for chemotherapy,
but you are consulted for cardiac assessment before beginning chemotherapy.
Radionuclide ventriculography shows a normal LV EF of 65%. What should you recommend?
a. Proceeding with chemotherapy without further cardiac evaluation

b. Cardiothoracic surgical consultation before starting chemotherapy
23. A 59-year-old man,with cardiac risk factors of tobacco use, hypertension,and hypercholesterolemia, presented
to the emergency department a few days ago with an acute onset of left-sided chest pain. His evaluation
revealed a diaphoretic man in moderate discomfort. An ECG was performed and showed a pattern consistent
with an inferior wall acute MI. The patient was treated with thrombolytics. Forty-five minutes after the initial
dose of the thrombolytics, he felt better and had complete resolution of his symptoms and normalization of
the ECG. On the third day after the event,he reports midsternal chest pain,vague in nature, with mild
diaphoresis and shortness of breath. An ECG is performed, as shown in Figure 13.5. Which of the following
should you tell the patient is the next step in managing his condition?
a. There is evidence of reocclusion of the infarct-related

artery, and rebolus with thrombolytics and heparin is
indicated.
b.He is showing signs of eariy postinfarction pericarditis,
and a nonsteroidal anti-inflammatory medication
should be stalled.
c. An LV aneurysm has developed,and a TTE is needed to
evaluate the extent of the aneurysm.
d.There is evidence of reocclusion of the infarct-related
artery, and a percutaneous intervention is needed

indicated.
b.He is showing signs of eariy postinfarction pericarditis,
and a nonsteroidal anti-inflammatory medication
should be stalled.
c. An LV aneurysm has developed,and a TTE is needed
toevaluate the extent of the aneurysm.
d.There is evidence of reocclusion of the infarct-related
artery, and a percutaneous intervention is needed
25. A 46-year-old male patient with a history of acute pericarditis now returns for outpatient follow-up with
increasing dyspnea and lower extremity edema. The patient was seen and started on high-dose aspirin and
colchicine (no nonsteroidal anti-inflammatory drugs [NSAIDs] due to allergy) and has not been able to taper
for the past 6 months due to persistent low-level symptoms. He has an elevated jugular venous pulse without
inspiratory decline, 2+ pedai edema,and congested liver without ascites, as well as a soft pericardial knock.
Laboratory values are notable for mild transaminitis as well as elevated ESR/hsCRP,ECG is unremarkable and
echo shows a small persistent pericardial effusion with tubular-shaped LV with normal function, along with
diastolic bounce and conical-shaped right ventricle (RV) as well as plethoric inferior vena cava and
respirephasic transmitral and trans-tricuspid variation all consistent wfth constrictive pericarditis. Which of the
following would be the next most appropriate step in management?
a. Surgical evaluation for pericardiec tomy/stripping
b. Repeat echo in 2 to 3 months aspirin and colchicine at current doses
c. Admit for IV diuresis and transition to PO diuretic regimen after' cardiac catheterization for constriction
evaluation
d. Initiate steroid therapy (0.25 to 0,5 mg/kg/day) along with colchicine, and initiate PO diuretic.
26. A 63-year-old nan is admitted with chronic obstructive pulmonary disease (CORD} and mild left ventricular (LV)
dysfunction (ejection fraction [EF] 45%} as well as symptomatic,recurrent atrial fibrillation (heart rate [HR]
120s to 150s) despite antiarrhythmic drug therapy and direct current cardioversion in the past. After rate
control with intravenous (IV) ?-blockers,the HR improves and the patient feels better. Given his recurrent
atrial fibrillation despite optimal medical therapy,the patient is referred for radiofrequency ablation cf atrial
fibrillation (pulmonary vein isolation] procedure. The procedure is performed on anticoagulation
(international normalized ratio >2.0} and is deemed a success, with no inducible atrial fibrillation at the end of
the case. A small atrial septal defect (ASD) was noted with intracardiac echocardiography at the end of the
case, with no other remarkable findings. That evening in the post-anesthesia care-unit (PACU), the patient is
noted to be hypotensive and tachycardic with increasing dyspnea. There is a concern for cardiac tamponade;
however,the arterial line does not show a significant respiratory variation of the blood pressure (BP]
waveform (pulsus paradoxus]. An echocardiogram is performed, demonstrating a large circumferential
effusion and the patient is referred for urgent pericardiocentesis. Which of the following explains why the
patient did not develop a pulsus on the arterial line, despite a large, hemodynamically significant pericardial
effusion?
a. LV dysfunction
b. COPD
c. Administration of excess IV fluid during the ablation
d. Presence of an ASD
27. A 60-year-old woman with a history of chronic renal Insufficiency presents to the emergency department with
anterior left-sided chest pain. She reports that the chest pain started after her last dialysis 7 days ago. She
appears lethargic and in mild respiratory distress. The physical examination demonstrates a BP of 160/90
mmHg and an HR of 100 bpm. On cardiac auscultation, a loud friction rub is heard, An ECG is obtained (Fig.
13.15). What is the most important next step in this case?
a. Prepare for pericardiocentesis.
b. Obtain an echocardiogram.
c. Admit the patient to the cardiac care unit to
rule cut MI
d. Perform emergency dialysis.
28. A 56-year-old white man presents for evaluation of chest pain. He has no prior medical problems, but he has
noted burning epigastric and chest discomfort for the past few months for which he was taking antacids with
some relief cf his symptoms. However, because the symptoms persisted,lie sought medical attention and was
referred for an esophagcgastroducdenoscopy,which was performed earlier today. He was found to have a
fundal hiatal hernia with a gastric ulcer that was cauterized,and he was started on omeprazole. On returning
home, he noted a new sharp anterior chest pain, somewhat positional related, that was not relieved with
antacids or omeprazole. This pain progressively worsened over the next few hours,and he came to the
emergency department. Examination in the emergency department revealed a temperature of 38.1°C, an HR
of 110 bpm, and a BP of 120/70 mmHg. Lung sounds were dear. Heart sounds appeared normal with the
patient sitting upright,but they were diminished with the patient lying in the supine position. An ECG did not
show any acute 5T-T wave abnormalities to suggest infarction. A CXR was performed,as shown in Figure 13.13.
You are called to further assess the patient, After reviewing the available data,which of the following is your
next step?
a. Immediate surgical consultation

b. Start a nonsteroidal anti-inflammatory medication and admit him for observation
c. Immediate pericardiocentesis
d. No further treatment is needed because his symptoms are caused by the hiatal hernia
29. A 50-year-old black man with hypertension and chronic renal insufficiency presents with dyspnea and fluid
overload with decreased urine output. He is treated in the hospital with diuretics, and his symptoms improve.
However, his renal function continues to deteriorate with an increasing blood urea nitrogen of 90 and a
creatinine of 5,4, In addition,the patient is noted to have several bruises on his arms from needlestick blood
draws and IV lines. On hospital day 4,the patient is noted to be hypotensive and tachycardie: BP, 80/40 mm
Hg;HR, 110 bpm. No jugular venous distention is noted, but heart sounds are diminished,and a loud pericardial
rub is heard, His TTE is shown in Figure 13,9, What is the next step in management?
a. Immediate dialysis
b. The continuation of diuretics with serial TTE
c. IV hydration
d. Urgent pericardiocentesis
30. A 46-year-oId woman with a history of treated carcinoma of the breast presents to the local emergency
department with a few days of severe chest pain. In the emergency department, she appears ill and pale and
in moderate discomfort. Her BP is 135/60 mmHg;her respiratory rate is 24 breaths per minute; her HR is 82
bpm; and her temperature is 100,8 CF, The resident on call reads her chest X-ray (CXR.) as unremarkable. Her
EGG is shown in Figure 13.1. What is the most reasonable next step?
a. Call the cardiac intervention team and rush the patient to the catheterization laboratory for emergency
coronary intervention.
b. Give aspirin and nitroglycerin and prepare to administer thrombolytics.
c. Discharge the patient and refer her for a gastroenterology follow-up as an outpatient.
d. Give a nonsteroidal anti-inflammatory medication.
31. You are called to the emergency department to see 2 74-yearold man. He has 2 history of heavy smoking and
hypertension. The patient cannot remember his medications, but he reports not taking them on a routine
basis. In the past few hours before presentation,, he experienced a sudden or set of severe left-sided chest
pain with radiaticr to the left scapula. Approximately half an hour later, he noted some difficulty breathing.In
the emergency department, , he is noted to be diaphoretic and in significant respiratory distress. His physical
examination reveals a BP of 160/90 mrnHg, elevated jugular venous pressures, and a quiet precordium. His
ECG is reported as sinus tachycardia with no acute ST-T charges. After iritial pain and BP management, 2
transesophageal echocardiography [TEE) is performed to rule out aortic dissection. The findings of the TTE are
shown in Figure 13.7. What is your recommendation?
a. The patient should ihave percutaneous pericardial
drainage to manage the cardiac tamponade and then a
surgical evaluation.
b. The patient reeds BP control and surgical evaluation
once he is medically stabilized.
c. The patient should ihave immeciate surgical
intervention.
d. . The diagnosis is unclear; a computed tomographic
(CT) scan or an aortic angiogram, is needed.
32. A 43-year-oid white male chef is brought into the emergency department after a motor vehicle accident in
which he fell asleep at the wheel and ran into a tree. He is reporting anterior chest discomfort and shortness
of breath. He relates no prior medical conditions and takes no medications. Vitals are stable with a BP of
120/60 mmHg and an HR of 90 bpm. His EGG is shown in Figure 13.IDA. ATTE is performed. Diastolic images
are shown in Figure 13.10B. Laboratory tests show modest elevation of creatinine phosphckinase at 240.
Which of the following is the most reasonable next step in managing this patient?
a. Start the patient on a nonsteroidal anti-inflammatory agent with
follow-up as an outpatient in lweek.
b. Admit the patient for observation on telemetry with a follow-up
TTE
c. The patient needs immediate percutaneous revascularization.
d. Send the patient for surgical treatment of pericardial rupture.
33. A 44-year-old nan comes to the emergency room for evaluation of severe chest pain that awoke him from
sleep. While the patient was seated, the pain gradually resolved after 5 minutes, but recurred several minutes
later. The patient reports that he has had nasal congestion, nausea, fatigue, and a low-grade fever for the past
few days. Physical examination shows a temperature of 38 °C (100.4 °F),heart rate of 104/min, and recurrence
of pain while tying in the left lateral decubitus position. A three-component pericardial friction rub is noted.
Laboratory findings include a total leukocyte count of 11,000/pL, an erythrocyte sedimentation rate of 55
mm/h, and a slightly elevated troponin level. Electrocardiogram shows diffuse ST-T-wave changes Which of
the following is the best course of treatment for this patient?
a. Reteplase, 10 \ i by intravenous bolus, repeated in 30 minutes
b. Colchicine, 0.5 mg twice a day orally for 2 weeks
c. Prednisone, 25 mg/d orally for 2 weeks, followed by a taper
d. Metcprolol, 25 mg twice a day orally
e. Indomethacin, 25 mg four times a day orally for 2 weeks
34. A 46-year-old woman with a history of fibromuscular dysplasia presents to the ER with an acute ST-e!evation
inferior MI. She is taken immediately to the cardiac catheterization laboratory for prima17 percutaneous
intervention of the right coronary artery (RCA). The first injection of the RCA shows a dissection extending
from the ostium to the posterior descending artery. A subsequent aortogram after stenting of the RCA is
performed (Fig. 6.11). What does the aortogram show?
a. Aortic root aneurysm
b. Anomalous RCA from the left cusp
c. Aortic root pseudoaneurysm
d. Aortic root localized dissection
35. A 60-year-old nan was hospitalized at the intensive care for 1 week. He arrived at emergency unit with chief
complaint of severe sharp epigastric and backpain 6 hours before admission. During his pain,he ever lost his
consciousness and lots of perspiration. The history of Illness was hypertension used amlodipin 5 mg twice
daily. On physical examination was found blood pressure 180/100 mmHg, heart rate 110 x/minutes and others
within the normal limit. An electrocardiogram showed left ventrical hypertrophy. A chest x-ray revealed
mediastinum enlargement. Blood study showed Hb 12 g/dL Ht 40 vol%, WBC 12.000/uL,Ddimer 19.000, CT
angio unenhancement of axial view showed crescent shape aortic appearance just after left subclavian artery
branch lengthened to diaphragms. However, an CT enhancement was seen contrast passed entry site fill
limited length portion of false lumen about 0,5 cm. Aortic arch was seen space among l ight inominate artery,
left carotid artery and left subclavian arteiy were very close. Which one of intervention management is
needed ?
a. De branching
b. De branching and TEVAR
c. Bental surgery
d. TEVAR
e. Chimney
36. A 80-year-old nan with HTN underwent a routine CXR and is found to have a thoracic aneurysm. He is
asymptomatic with weUcontrolled BP on a p-blocker. A CT angiogram of the chest is performed showing a
descending thoracic aortic aneurysm of 5.4 cm distal to the left subclavian artery with a chronic dissection.
The aneurysmal segment does not extend into the abdomen, The ascending aorta is 4.5 cm in the mid-portion
and 4.0 cm in the mid-arch. The patient has no other comorbid conditions. Which statement is correct
comparing TEVAR with open repair for thoracic aoitic aneurysms?
a. TEVAR is associated with a 30-day risk of endoleaks of 10%
b. TEVAR is associated with lower long-term mortality in randomized trials
c. TEVAR is associated with higher rates of hospital mortality
d. TEVAR is associated with higher risks of paraplegia
37. Which of the following cardiovascular risk factor assessment tools has not been demonstrated to be useful in
the risk assessment fora first atherosclerotic cardiovascular event?
a. Coronary artery calcium score
b. High-sensitivity C-reactive protein
c. Carotid intima-media thickness
d. ABI
e. Family history of premature coronary vascular disease
38. A 66-year-old nan Is seen by his internist for an annual evaluation. Past medical history is notable for HTN and
tobacco use. His BP is 186/80 mnHg on nonotherapy. Cardiac and abdominal examinations are unremarkable.
He has a friend who was detected to have an AAA on routine screening and asks his physician whether it is
indicated for him to be screened, A screening abdominal ultrasound is performed in this patient and shows an
infrarenal AAA of 5.5 cm. The patient is advised to undergo repair though wishes to consider the option of an
endovascular stent graft (EVAR)rather than an open repair. Which of the following statements is true
regarding recommendations for AAA repair?
a. Repair is Indicated for any AAA > 5.0 cm
b. Inflammatory or infectious aneurysms should be repaired at any size
c. Women should undergo repair only for AAA > 5.5 cm
d. Size cutoffs for AAA repair should be based on age, weight and height
left carotid artery and left subclavian arteiy were very close. On the following consists of conservative
treatment for clinical stabilization, except ?
a. Nicardipine HCL
b. Nftrat
c. Betablocker
d. Martin
e. Furosmide
40. A 40-year-old nan presents to the ED with shortness of breath and tachycardia. He eventually develops
hypotension with a systolic blood pressure of 80 mmHg. A stat CT scan of the chest reveals a saddle
pulmonary embolism involving the main pulmonary artery trunk, Which of the following is the next most
appropriate step?
a. Insert an inferior vena cava filter
b. Begin enoxaparin subcutaneous injections 1 mg/kg eveiy 12 hours
c. Begin aiteplase 100 mg IV over 2 hours
d. Begin an IV unfractionated heparin infusion at 18 U/kg/h
41. A 61 years old man with complaints night cramp, heaviness,pitting edemar hyperpigmentation and active skin
ulcer of left ankle since last year in the bilateral lower limbs. Varicose veins were seen in the medial of left
thigh and calf. Duplex ultrasound showed severe reflux in the bilateral lower limb but just only incompetent
calf perforator vein with diameter 5 mm in the left lower limb. Duplex ultrasound showed saphenous junction
with diameter 10 mm and great saphenous diameter 4,5 mm just above knee. Following are the role of
micronized purified flavcnoid fractionated on CVT treatment except ?
a. Increase tonus venule
b. Inhibit edema
c. Inhibit leucocyte trapping
d. Increase of limph drainage
e. Decrease venous reflux
42. A 46 year-old woman presented tc emergency with rest pain in the right leg since 7 hours before admission.
She often complained irregular heart beat and not treated by the doctor yet, On physical examination was
found irregularity of SI with diastolic rumble and others in the norma! limit The chief complaint of rest pain did
not change when the leg was hanging beside the bed.It was seen mottling appearance, pulseless of right
poplitea artery, cold palpable below the knee and sensory loss in the digital level. Loss audible ankle Doppler
of artery but stiill normal in the vein. ECG was found Atrial fibrillation. What is the earliest sign or symptom on
ALI7 ?
a. Mottling
b. Cyanotic
c. Coldness
d. Numbness
e. Paralysis
43. A 71 year old man presents with the sudden onset of tearing chest pain. On presentation,he has a heart rate
of 130 beats/min with a systolic blood pressure of 80 mm Hg, A bedside TEE demonstrates the presence of a
proximal aortic dissection. A pericardial effusion with partial diastolic collapse of the right ventricle is also
present. Significant respiratory variation is noted across mitral and tricuspid Doppler inflows. Appropriate
treatment is:
a. Immediate percutaneous pericardiocentesis to relieve the tamponade,followed by surgery to replace the
ascending aorta
b. Intra-aortic balloon pump to stabilize the hemodynamics, followed by surgery
c. Emergency angiography to define coronary anatomy,followed by surgery
d. to proceed immediately to the operating room
of 130 beats/min with a systolic blood pressure of &0 mm Hg. A bedside TEE demonstrates the presence of a
proximal aortic dissection. A pericardiaI effusion with partial diastolic collapse of the right ventricle is also
treatment is:
ascending aorta
45. A 46 year-old woman presented to emergency with rest pain in the right leg since 7 hours before admission.
She often complained irregular heart beat and not treated by the doctor yet. On physical examination was
found irregularity of SI with diastolic rumble and others in the normal limit. The chief complaint of rest pain
did not change when the leg was hanging beside the bed.It was seen mottling appearance, pulseless of right
of artery but still normal in the vein. ECG was found Atrial fibrillation. What should be needed before
undergoing revascularization to prevent reperfusion injury?
a. Heparin +- Pentoxyfilline + Bicarbonas Natricus + Alopurinole + Anticksidane
b. Alopurinole - Antioksidane Pentoxyfilline
c. Pentoxyfilline + Bicarbonas Natricus + Alopurinole + Anticksidane
d. Bicarbonas Natricus + Alopurinole + Antioksidane
46. A 56-year-oId woman presents to the ED with precordiai chest discomfort and shortness of breath. Her body
mass index is 34. Her medical history includes essential hypertension, diabetes meliitus type 2r and a 30 pack-
year smoking history. Laboratory results include a troponin of 2.4 mg/mL and a Btype natriuretic peptide of
840 pg/mL. An ECG reveals no STsegment elevation and nonspecific ST-T wave changes. The ED physician
requests cardiology consultation for an NSTEMI. When you arrive to see the patient you order an IV
contrastenhanced chest CT scan of the lungs. Findings are demonstrated in Figure 7.6. What is the diagnosis?
a. Type A aortic dissection
b. Saddle pulmonary embolism
c. Pneumonia Interstitial Eung fibrosis
d. Myocarditis
47. A 6Q-year-old morbidly obese woman is admitted for cholecystectomy and postoperatively is placed on deep
venous thrombosis (DVT) prophylaxis with mini-dose subcutaneous heparin. On hospital day 2, a peripherally
inserted central venous catheter is placed in the right arm. The patient is discharged to a rehabilitation facility
on hospital day 5 after removal of the venous catheter. Two days later she presents to the emergency room
with right upper extremity pain and swelling. She reports she has not felt well enough to participate with
physical therapy since being discharged from the hospital. Venous duplex of the right arm demonstrates acute
thrombosis of the right cephalic vein. Complete blood count (CBC) and chemistries are within normal range
with a platelet count of 180 K/pL. What Is the most appropriate management of this patient?
a. Prescribe enoxaparinlmg/kg every 12 hours and coumadin, Discharge with instructions for 4 to 5 days of
overlap and discontinue enoxaparin cnce the INR is within therapeutic range for 2 consecutive days.
Continue anticoagulant therapy for 6 months,
b. Prescribe enoxaparinlmg/kg every 12 hours and coumadin.Admit for 4 to 5 days of overlap and
discontinue enoxaparin cnce the international normalized ratio (INR) is within therapeutic range for 2
consecutive days. Continue anticoagulant therapy for 3 months.
c. Admit to the hospital and start on intravenous (IV) anticoagulation with heparin or a direct thrombin
inhibitor (DTI).
d. Prescribe enoxaparinlmg/kg every 12 hours and coumadin. Discharge with instructions for 4 to 5 days of
overlap and discontinue enoxaparin once the INR is within therapeutic range for 2 consecutive days.
Continue anticoagulant therapy for 12 months.
e. Warm compresses and nonsteroidal anti-inflammatory drugs for pain.
48. A 6Q-year-old nan was hospitalized at the intensive care for 1 week. He arrived at emergency unit with chief
left carotid artery and left subclavian arteiy were very close. Which of the following statement of new aortic
dissection on CT angio?
a. Intramural hematoma with classic aortic dissection
b. Penetration atherosclerotic ulcer
c. Intramural hematoma with discrete aortic dissection
d. Classic aortic dissection
e. Discrete aortic dissection
49. For the above patient you decide to start her on a new andhypertensive medication. Which of the following
class of medications are contraindicated?
a. Angiotensin-converting enzyme inhibitors
b. Thiazide diuretics jj-Adrenergic blockers
c. Angiotensin IIreceptor blockers
d. None of the above
50. Which of the following population groups Is it appropriate to do a screening ultrasound of the abdomen for an
AAA?
a. Men 65 to 75 years of age with a smoking history
b. Women >60 years of age with a first-degree relative with an AAA
c. Women 65 to 75 years of age with a smoking history
d. Men >60 years of age with a firstndegree relative with an AAA
e. All of the above groups are appropriate to screen for an AAA
left carotid artery and left subclavian arteiy were very close. Which of the following includes aortic dissection
type?
a. None of them
b. De-Backey typeI
c. De-Backey type III
d. De-Backey type II
e. Stanford type A
52. A 75-year-old nan is in the ECU (Intensive care unit) recovering from coronary artery bypass surgery and has
developed a hemorrhagic pericardial effusion. He is currently stable, but has noted swelling and pain in his left
leg. An ultrasound is ordered and reveals acute thrombus in the left peroneal vein. Which of the following is
the best management option?
a. Follow up with serial duplex ultrasound scans
b. Pneumatic compression stockings and enoxaparin 40 mg every 24 hours
c. Initiate a continuous unfracticnated heparin infusion
d. Proceed with placement of an inferior vena cava filter
e. No action is required because calf vein thrombus is not clinically important
53. A 59-year-old nan presents to the clinic with a complaint of bilateral lower extremity cramping muscular pain
with exertion relieved after a few minutes of rest, His medical history includes coronary artery disease status
post left anterior descending artery stent 2 years ago,diabetes mellitus type 2, and essential hypertension. An
ABI is performed in your office demonstrating a right ABI of 1.10 and left ABI of 1,04. What is the most
appropriate next step in the evaketion of this patient?
a. Order bilateral ABI measurements in the vascular laboratory at rest and following an exercise protocol
b. Have him return in 6 months and repeat the resting ABI measurements
c. Order magnetic resonance imaging cf the lumbosacral spine to confirm the likely diagnosis of
pseudoclaudication
d. Reassurance and suggest low-impact exercise, i.e,, swimming
e. Referral to a peripheral vascular interventionalist for lower extremity angiogram
54. A 46-year old business executive presents to A&.E with a 2-hour history of central crushing chest pain and
breathlessness. He is a non-smoker,previously very fit and well and attends a gym four times a week. There is
no family history of ischemic heart disease. His cholesterol measured at an insurance medical was 3,3 mmof/L.
His observations on admission are as follows;pulse IDS bpm;blood pressure 80/5D mmHg; 02 saturations 90%
on room air. He isapyrexial. An ECG is performed and shown sinus tachycardia of 105 bpm. Right-axis
deviation and non-spesific T-wave inversion in leads III,aVFr V2-V4. This patient returned to his countiy from a
business trip in Australia 2 weeks previously. On clinical examination, you can find all of the following,
EXCEPT?
a. There is a soft third heart sound over the the right sternal border
b. Cyanosed and cool peripherally
c. The troponinIwithin normal limits (<1 ug/ L)
d. The D-dimer is elevated to the 5 times the normal range
e. Jugular venous pressure is elevated
55. A 59-year-old nan with resistant hypertension returns for outpatient follow-up. His blood pressure is 163/79
mmHq and pulse 70 bpm, despite 25 mg hydrochlorothiazide daily, 200 mg metoprolol XL daily, 320 mg
valsartan dairy,10 mg amlodipine daily,and a 0.1 mg/24 hour clonidine patch, He is considering entering a
sympathetic denervation trial and has some questions about the procedure. Which of the following is the
most accurate brief description of the denervation procedure?
a. Access through a femoral artery,alcohol ablation of bilateral renal arteries
b. Access through a femoral artery, radiofrequency ablation of a unilateral renal artery
c. Access through a femoral artery, radiofrequency ablation of bilateral renal arteries
d. At this time renal denervation cannot be recommended for this patient population
e. Access through a femoral vein, radiofrequency ablation of bilateral renal arteries
f. Access through a femoral vein, cryoablation of a unilateral renal artery
56. A 39-year-old nan came to emergency department with chief complaint shortness of breath, non radiating
chest tightness and 2 sincopal episodes. " Hie symptom has been felt since 1 month before admission,but it
was going worse in the recent 1 week. From the anamnesis, one week before admission the patient felt pain
and swelling on upper right leg,after he drove a car for two and a half hours. The leg was then being massaged
and the symptoms were going worse and he started feeling shortness of breath. From the medical history,the
patient was obese (Body Mass Index 31kg/m2),and has history of smoking for 19 years. The patient was a
frequent distance traveler (average duration 4 to 6 hours for about 12 times/month), Patient has no history of
hypertension and diabetes, On admission,his blood pressure was 90/60 mmHg,pulse 120 times/minute and
regular,respiratory rate 26 breaths/minute, temperature 36oc, and oxygen saturation 89%. Other physical
examinations were unremarkable. Which of the following echocardiographic findings that can be found in
above patients?
a. RV acceleration time >60 ms in the presence of tricuspid insufficiency pressure gradient >60 mmHg
b. Visualization of true lumen and false lumen
c. Hypokinesis of the anterior and inferior waif
d. Right ventricular free wall hypokinesis in the presence of normal right ventricular apical.
e. Acute mitral regurgitation
57. A 57-year-old nan with resistant hypertension begins to take a new antihypertensive agent. Within the next
few weeks he is diagnosed with pericarditis. Which of the following agents is most likely responsible?
a. Amlodipine
b. Captopril
c. Minoxidil
d. Carvedibl
58. A 70-year-old woman with diabetes mellitus and hyperlipidemia and no history of hypertension is noted at her
yearly clinic visit to have new-onset hypertension with a blood pressure of 180/110 mmHg, She undergoes
screening for secondary causes of hypertension and is found to have a pheochromocytoma. What of the
following medications is contraindicated as monotherapy?
a. Metcprolol
b. Phentolamine
c. Hydrochlorothiazide
d. Lisinoprii
59. A 49-year-old obese man with hypertension,dyslipidemia, and diabetes melEttus presents to the outpatient
clinic for his yearly physical, He has refused medications tn the past, but now is willing to consider treatment,
His blood pressure is 145/95 mmHg with a heart rate of 80 bpm. His laboratory data are significant for a
creatinine of 13 mg/dL with the presence of microalbuminuria. Which of the following mediations would be
most appropriate?
a. Terazosin
b. Lisinopril
c. Chlorthalidone
d. Carvedilol
60. CASE 1. A 46-year old business executive presents to A&.E with a 2-hour history of central crushing chest pain
and breathlessness. He is a non-smokerr previously veay fit and well and attends a gym four times a week.
There is no family history of ischemic heart disease. His cholesterol measured at an insurance medical was 3,3
mmcl/L His observations on admission are as follows;pulse 105 bpm; blood pressure 80/50 mmHg; 02
saturations 90% on room air. He is apyrexiaI, An ECG is performed and shown sinus tachycardia of 105 bpin.
Right-axis deviation and non-spesific T-wave inversion in leads III,aVF,V2-V4. As a business executive, all of the
following aspects of the history and examination would help you to establish diagnosis,EXCEPT ?
a. Absence of exertional angina
b. The patient may have recently been on a long-haul flight
c. Family history of thromboembolic disease
d. Accentuated pulmonary second sound
e. Radiographic evidence of pulmonary edema
61. 69-year-old woman presents to your office for initial evaluation. She has had progressive dyspnea over the
past 2 years. She has long-standing hypertension and reports tobacco use (50 pack-years), She has been
treated with bcsentan for idiopathic PAH (iPAH). Currently, she is assessed as having World Health
Organization (WHO) functional class III limitations, Evaluation revels the following : Echocardiogram: ejection
fraction 66%, grade 3 diastolic abnormality,moderate left ventricular hypertrophy,no significant valvular
disease Right heart catheterization: right atrial pressure S mm Hgr right ventricular pressure 45/20 mm Hg,
pulmonary artely pressure 50/24 mm Hg, mean pulmonary artery pressure 33 mm Hg,pulmonary capillary
wedge pressure 25 mm Hg,and cardiac output 5.5 L/min Which of the following treatments would you
recommend at this time?
a. Diuretics, salt restriction, and blood pressure control
b. Cardiac resynchronization therapy
c. Phosphodiesterase-5 inhibitor
d. Increase boserttan dose
62. Which of the following patients with an LVEF of 25% would be most appropriate to refer for a right heart
catheterization?
a. A 20-year-old nan is referred for cardiac transplantation due to his low LVEF despite 6 months of beta-
blocker therapy. He reports mild fatigue while playing racquetball and his examination shows blood
pressure 120/80 mm Hg,pulse 72 bpm, JVP <8 with no hepatojugular reflux,and there is no S3, Extremities
are warm to touch,with no edema.
b. A 30-year-old woman is admitted to the hospital with shortness of breath and a blood pressure of 90/70
mm Hg. Following 2 days of intravenous diuretics,her examination is notable for JVP of 16 cm and 2+ leg
edema,with a systolic blood pressure of 78 mm Hg. Her creatinine has increased from 1.6 to 2.5,with
diuresis.
c. A 60-year-old man with an LVEF of 25% is admitted with shortness of breath and is found to have blood
pressure 130/80 mm Hg,pulse 90 bpmr and JVP of 14 cm with 2+ leg edema and warm extremities, with
creatinine 1.2.
d. A 40-year-old woman with asthma and heait failure is admitted to the hospital. Her examination is notable
for blood pressure 150/80 mm Hg; pulse 110 bpm and regular; lungs with diffuse expiratory wheezes; JVP
<8 cm with no hepatojugular reflux; cardiac auscultation with S12 and no S3;legs with no edema and are
warm to touch.
e. ,An 85-year-old man with a 30-year history of diabetes previously received laser photocoagulation therapy
of diabetic retinopathy, and has ongoing leg pain from neuropathy. He now presents with shortness of
breath, has a blood pressure of 200/100 mm Hg, anasarca, and a creatinine of 10,
63. A 77-year-old nan with hypertension has inadequate blood pressure control on chlorthalidone 25 mg dally. His
primary care doctor is choosing a second antihypertensive agent. Which of the following comorbidities would
be an evidence-based indication for choosing ramiprif over amlodipine as the second agent?
a. Sleep apnea
b. Heart failure with preserved ejection fraction (HFPEF)
c. Aoitic aneurysm
d. Peripheral arterial disease
64. An 84-year-old woman presents to cardiology clinic for follow-up of her hypertension and coronary artery
disease. Her only current symptom is dizziness on standing from a sitting position. The dizziness caused her to
lose balance and fall on two occasions. Her current resting blood pressure is 144/90 mmHg with pulse 60
beats per minute (bpm). Her medications include hydrochlorothiazide 25 mg daily,doxazosin 2 mg daily,
metoprolol XL 50 mg daily, simvastatin 40 mg daily, and aspirin 81 mg daily. What changes in medication
therapy would you recommend?
a. Discontinue hydrochlorothiazide and start lisinopril 20 mg daily.
b. Discontinue atenolol and increase hydrochlorothiazide to 50 mg daily.
c. Discontinue doxazosin and start lisinopril 5 mg daily,
d. Discontinue doxazosin and initiate clonidine 0.4 mg twice daily.
e. Discontinue doxazosin and increase metoprolol to 100 mg daily.
65. A 69-year-old nan with hypertension and history of a stroke presents for further management of his
hypertension. He Is currently prescribed a thiazide diuretic;however,his blood pressure remains elevated.
From the standpoint of decreasing his future risk of stroke,which of the following drug classes would be most
beneficial?
a. ACEI
b. Calcium channel blocker
c. ARB
d. p-Blocker
66. Which of the following tests would be appropriate to confirm a diagnosis of PAH in a patient with elevated
right ventricular systolic pressure demonstrated by echocardiography?
a. Transesophageal enchocardiography
b. Liver function tests
c. Right Heart catheterization
d. Antinuclear antibody
67. A 36-year-old woman at 24 weeks of pregnancy is found to have several blood pressure readings in the range
of 145 to 158 mmHg systolic, 80 to 92 mmHg diastolic. This is her first pregnancy and she has no prior history
of hypertension, She reports bilateral mild ankle swelling and nausea, but no right upper quadrant pain, visual
changes,headaches, or dyspnea, A 24-hour urine collection shows 360 g protein. The hemoglobin is 8.0 g/dL
and the platelet count is 43,000 cells/mm3 . Which of the following is the correct diagnosis?
a. Chronic hypertension
b. Preeclampsia
c. Eclampsia
d. Gestational hypertension
68. A 58-year-old woman with multidrug-resistant hypertension presents to her primary care doctor with multiple
complaints. Her antihypertensive regimen consists of valsartan,hydralazine, amlodipine, captcpril,and
hydrochlorothiazide. Which of the following pairings of medication and side effect are most likely to be
correct?
a. Valsartan and cough
b. Amiodipine and insomnia
c. Captoprif and constipation
d. Hydralazine and ankle edema
a. VSD
70. For which of the following conditions is IE prophylaxis not required prior to extensive dental procedures (more
than one option may be correct}?
71. A 26 year old woman who is 30 weeks pregnant is referred to yon because of a murmur that was noted during
her current pregnancy as welt as intermittently in the past. The patient is asymptomatic. Physical examination
shows slight elevation of the jugular venous pressure, with an A wave. A parasternal lift is also noted. SL is
normal, and S2 is somewhat prominent, fixed,and split A grade 2 inid-peaking ejection systolic murmur is
noted at the left sternal border, true statememnt about this patient condition include all of the following
EXCEPT:
c. Type 4/muscular
d. Type 3/inlet
c. Secundum ASD
e. Primum ASD
a. Ebstein anomaly
c. PDA
d. VSD
75. The peak age range for surgical intervention for patients with a bicuspid aortic valve is ?
a. 60 to 80 years.
b. 20 to 40 years.
c. 10 to 20 years.
d. 40 to 60 years
d. AVSD
77. A 46-year-old nan with known Ebstein anomafy seeks your advice with regard to optimal management. He is
asymptomatic and has an active lifestyle without any limitations. His physical examination is remarkable for
the absence of cyanosis. He has a loud hclosystolic murmur at the left lower sternal border that is accentuated
with respiration. He has no organomegaly or peripheral edema. His TTE reveals moderately severe 3+ TR with
an RV systolic pressure of 35 mmHg and normal LV and RV systolic function. There is no evidence of interatrial
communication. Which of the following should you recommend?
78. A 21-year-old woman who has a family history of Marfan syndrome comes to you for prepregnancy
counseling. Echocardiogram and CT scan of the chest show 42-mm dilation of the aortic sinuses. The patient is
asymptomatic and does not have mitraf valve prolapse, Which of the following is the most appropriate
recommendation?
a. Initiate treatment with a (3-blocker, and proceed with pregnancy
d. Proceed with pregnancy, preferably sooner rather than later because of the size of the aorta
e. Avoid pregnancy at ttiis time because of the size of the aorta, and initiate treatment with a (3 -blocker.
79. A 16-year-old girl is being evaluated for a heart murmur. She is asymptomatic. On physical examination, her
blood pressure Is 174/104 mm Hg on her right arm. Her pulses are 2+ on her upper extremities, The femoral
pulses are slightly lower in amplitude than the radial pulses. Her cardiac examination reveals a short
midsystolic murmur in the left tnfrascapuiar area, For this patient, which of the following is most likely to be
found on additional studies?
80. The most common chromosomal abnormality associated with TOF is

a. missense mutations in the PTPN11 gene on chromosome 12.
b. 7q11.23 microdeletion
c. 22qll.2 microdeledon
d. Trisomy 21
e. M o n o s o m y X (45,X)
b. Primum ASD
d. VSD
e. Ebstein anomaly
b. Primum ASD
d. VSD
e. Ebstein anomaly
a. Transluminal balloon dilatation is the best treatment option in this case
indicated
c. Crouzon syndrome

86. A 43-year-old man was referred for evaluation of symptomatic mitral regurgitation. He was diagnosed with
mitral valve prolapse that was not suitable for repair. Given his family history of CAD and tobacco use,he
underwent a coronary angiogram, which revealed no evidence of obstructive coronary disease. He underwent
an uneventful mitral valve replacement. He was extubated and transferred from the intensive care unit 48
hours after the operation. On postoperation day 3, you note the patient to be pale and lethargic and in mild
respiratory distress. His BP is 100/60 mmHg. His cardiac and lung examination is compromised by tbe presence
of rapid breathing and chest tubes. His ECG reveals normal sinus rhythm (NSR) at 97 bpm with no acute ST-T
changes. A TTE is performed. Selected views are shown in Figure 13.8A. As the patient continues to
deteriorate and becomes hypotensive,a TEE is performed next, as shown in Figure 13.8B. What should you
recommend?
a. A 500-cc bolus of IV normal saline solution should be
started because the patient is dehydrated, and no further
intervention is needed
b. Immediate surgical intervention for malfunction of the
prosthetic mitral valve
d. Percutaneous aspiration of the fluid present in the
pericardium
recommend?
a. A500-cc bolus of IV normal saline solution should be started
because the patient is dehydrated, and no further intervention is
needed
b. Immediate surgical intervention for malfunction of the
prosthetic mitral valve
pericardium
88. A 46 year old woman presents to the emergency department with eight hours of chest pain. The pain is
constant, -severe,and midsterna! in location. She notes that it is worse when she lies down. She denies
exposure to sick friends or relatives. Past history is notable for tobacco use,borderline hypertension,and
elevated cholesterol. Her father died of a myocardial infarction at age 67 years. Examination is notable fcr a
heart rate of 104r and a blood pressure of 125/80 in both arms. Her lungs are clear. On cardiac
examination,she has a prominent friction rub with two out of three components present. The remainder of
the examination is unremarkable. Which of the following ECG abnormalities does not suggest pericarditis in
the absence of an effusion?
b. Sinus tachycardia PR
c. segment elevation in lead aVR
89. A 63-year-old nan with cardiac risk factors of tobacco use, hypertension,and diabetes mellitus returns for
follow-up after latepresenting mid-left anterior descending arteiy (LAD} ST-elevation myocardial infarction
(MI). He had an occluded mid-LAD,which was successfully aspirated and stented with a single drug-eluting
stent;no significant disease elsewhere is noted. The next day he reports progressive chest discomfort and mild
fever and has developed a two-component pericardial friction rub cn physical examination. His EGG is
concerning for pericarditis (Dressier syndrome) and an echo is performed showing no interval change from
discharge other than the presence of a small pericardial effusion. Which of the following regimens would be
the most appropriate therapy in this patient?
90. A 23-year-oid white man is newly diagnosed with nonHodgkin lymphoma. He undergoes a metastatic workup
that includes art MRI of the chest and abdomen, which is shown in Figure 13.11. The plan Is for chemotherapy,
but you are consulted for cardiac assessment before beginning chemotherapy. Radionuclide ventriculography
shows a normal LV EF of 65%. What should you recommend?
a. Proceeding with chemotherapy without further cardiac
evaluation
b. Cardiothoracic surgical consultation before starting
chemotherapy
a. Proceeding with chemotherapy without further cardiac
evaluation
chemotherapy
a. There is evidence of reocclusion of the infarct-
related artery, and rebolus with thrombolytics and
heparin is indicated.
b. He is showing signs of eariy postinfarction
pericarditis, and a nonsteroidal anti-inflammatory
medication should be stalled.
c. An LV aneurysm has developed,and a TTE is
needed to evaluate the extent of the aneurysm.
d. There is evidence of reocclusion of the infarct-
related artery, and a percutaneous intervention is
needed.
the ECG. On the third day after the event,he reports
midsternal chest pain,vague in nature, with mild
diaphoresis and shortness of breath. An ECG is
performed, as shown in Figure 13.5. Which of the
following should you tell the patient is the next step
in managing his condition?
a. There is evidence of reocclusion of the infarct-
related artery, and rebolus with thrombolytics and
heparin is indicated.
b. He is showing signs of eariy postinfarction
pericarditis, and a nonsteroidal anti-inflammatory
medication should be stalled.
c. An LV aneurysm has developed,and a TTE is needed to evaluate the extent of the aneurysm.
d. There is evidence of reocclusion of the infarct-related artery, and a percutaneous intervention is needed.
evaluation
d. Initiate steroid therapy (0.25 to 0,5 mg/kg/day) along with colchicine, and initiate PO diuretic
95. A 63-year-old nan is admitted with chronic obstructive pulmonary disease (CORD} and mild left ventricular (LV)
dysfunction (ejection fraction [EF] 45%} as well as symptomatic,recurrent atrial fibrillation (heart rate [HR]
effusion?
a. LV dysfunction
b. COPD
96. A 60-year-old woman with a history of chronic renal Insufficiency presents to the emergency department with
anterior left-sided chest pain. She reports that the chest pain started after her last dialysis 7 days ago. She
appears lethargic and in mild respiratory distress. The physical examination demonstrates a BP of 160/90
c. Admit the patient to the cardiac care unit to
rule cut MI.
d. Perform emergency dialysis.
next step?
a. mmediate surgical consultation
b. Start a nonsteroidal anti-inflammatory medication and
admit him for observation
d. No further treatment is needed because his symptoms
are caused by the hiatal hernia
c. IV hydration
department with a few days of severe chest pain. In the emergency department, she appears ill and pale and
in moderate discomfort. Her BP is 135/60 mmHg;her respiratory rate is 24 breaths per minute; her HR is 82
bpm; and her temperature is 100,8 CF, The resident on call reads her chest X-ray (CXR.) as unremarkable. Her
EGG is shown in Figure 13.1. What is the most reasonable next step?
a. Call the cardiac intervention team and rush the patient to the catheterization laboratory for emergency
coronary intervention.
b. Give aspirin and nitroglycerin and prepare to administer thrombolytics.
c. Discharge the patient and refer her for a gastroenterology follow-up as an outpatient.
d. Give a nonsteroidal anti-inflammatory medication
100. You are called to the emergency department to see 2 74-yearold man. He has 2 history of heavy
smoking and hypertension. The patient cannot remember his medications, but he reports not taking them on
a routine basis. In the past few hours before presentation,, he experienced a sudden or set of severe left-sided
chest pain with radiaticr to the left scapula. Approximately half an hour later, he noted some difficulty
breathing.In the emergency department, , he is noted to be diaphoretic and in significant respiratory distress.
His physical examination reveals a BP of 160/90 mrnHg, elevated jugular venous pressures, and a quiet
precordium. His ECG is reported as sinus tachycardia with no acute ST-T charges. After iritial pain and BP
management, 2 transesophageal echocardiography [TEE) is performed to rule out aortic dissection. The
findings of the TTE are shown in Figure 13.7. What is your recommendation?
intervention.
d. The diagnosis is unclear; a computed tomographic
(CT) scan or an aortic angiogram, is needed
a. Start the patient on a nonsteroidal anti-inflammatory agent with follow-up as an outpatient in lweek.
b. Admit the patient for observation on telemetry with a follow-up TTE,
c. The patient needs immediate percutaneous revascularization.

left carotid artery and left subclavian arteiy were very close. Which one of intervention management is
needed ?
a. De branching
b. De branching and TEVAR
c. Bental surgery
d. TEVAR Q Chimney
105. A 80-year-old nan with HTN underwent a routine CXR and is found to have a thoracic aneurysm. He is
asymptomatic with weUcontrolled BP on a p-blocker. A CT angiogram of the chest is performed showing a
descending thoracic aortic aneurysm of 5.4 cm distal to the left subclavian artery with a chronic dissection.
The aneurysmal segment does not extend into the abdomen, The ascending aorta is 4.5 cm in the mid-portion
and 4.0 cm in the mid-arch. The patient has no other comorbid conditions. Which statement is correct
comparing TEVAR with open repair for thoracic aoitic aneurysms?
a. TEVAR is associated with a 30-day risk of endoleaks of 10%
b. TEVAR is associated with lower long-term mortality in randomized trials
c. TEVAR is associated with higher rates of hospital mortality
d. TEVAR is associated with higher risks of paraplegia
106. Which of the following cardiovascular risk factor assessment tools has not been demonstrated to be useful
in the risk assessment fora first atherosclerotic cardiovascular event?
a. Coronary artery calcium score
b. High-sensitivity C-reactive protein
c. Carotid intima-media thickness
d. ABI
e. Family history of premature coronary vascular disease
107. A 66-year-old nan Is seen by his internist for an annual evaluation. Past medical history is notable for HTN
and tobacco use. His BP is 186/80 mnHg on nonotherapy. Cardiac and abdominal examinations are
unremarkable. He has a friend who was detected to have an AAA on routine screening and asks his physician
whether it is indicated for him to be screened, A screening abdominal ultrasound is performed in this patient
and shows an infrarenal AAA of 5.5 cm. The patient is advised to undergo repair though wishes to consider the
option of an endovascular stent graft (EVAR)rather than an open repair. Which of the following statements is
true regarding recommendations for AAA repair?
a. Repair is Indicated for any AAA > 5.0 cm
b. Inflammatory or infectious aneurysms should be repaired at any size
c. Women should undergo repair only for AAA > 5.5 cm
d. Size cutoffs for AAA repair should be based on age, weight and height
a. Nicardipine HCL
b. NFtrat
c. Betablocker
d. Martin
e. Furosmide
appropriate step?
110. A 61 years old man with complaints night cramp, heaviness,pitting edemar hyperpigmentation and active
skin ulcer of left ankle since last year in the bilateral lower limbs. Varicose veins were seen in the medial of left
b. Inhibit edema
ALI7?
a. Mottling
b. Cyanotic
c. Coldness
d. Numbness
e. Paralysis
treatment is:
ascending aorta
treatment is:
ascending aorta
c. Emergency angiography to define coronary anatomy,followed by surgeiy
b. Alopurinole – Antioksidane
c. Pentoxyfilline
d. Pentoxyfilline + Bicarbonas Natricus + Alopurinole + Anticksidane
e. Bicarbonas Natricus + Alopurinole + Antioksidane
c. Pneumonia
d. Interstitial Eung fibrosis
e. Myocarditis
116. A 6Q-year-old morbidly obese woman is admitted for cholecystectomy and postoperatively is placed on
deep venous thrombosis (DVT) prophylaxis with mini-dose subcutaneous heparin. On hospital day 2, a
peripherally inserted central venous catheter is placed in the right arm. The patient is discharged to a
rehabilitation facility on hospital day 5 after removal of the venous catheter. Two days later she presents to
the emergency room with right upper extremity pain and swelling. She reports she has not felt well enough to
participate with physical therapy since being discharged from the hospital. Venous duplex of the right arm
demonstrates acute thrombosis of the right cephalic vein. Complete blood count (CBC) and chemistries are
within normal range with a platelet count of 180 K/pL. What Is the most appropriate management of this
patient?
b. Prescribe enoxaparinlmg/kg every 12 hours and coumadin.Admit for 4 to 5 days of overlap and discontinue
enoxaparin cnce the international normalized ratio (INR) is within therapeutic range for 2 consecutive
days. Continue anticoagulant therapy for 3 months.
inhibitor (DTI)
Continue anticoagulant therapy for 12 months.
b. Thiazide diuretics
c. -Adrenergic blockers
d. Angiotensin IIreceptor blockers
e. None of the above
119. Which of the following population groups Is it appropriate to do a screening ultrasound of the abdomen for
an AAA?
type?
a. None of them
b. De-Backey typeI J
e. Stanford type A
122. A 59-year-old nan presents to the clinic with a complaint of bilateral lower extremity cramping muscular
pain with exertion relieved after a few minutes of rest, His medical history includes coronary artery disease
status post left anterior descending artery stent 2 years ago,diabetes mellitus type 2, and essential
hypertension. An ABI is performed in your office demonstrating a right ABI of 1.10 and left ABI of 1,04. What is
the most appropriate next step in the evaketion of this patient?
pseudoclaudication
EXCEPT?
c. The troponinIwithin normal limits (<1 ug/L)
above patients?
a. Amlodipine
b. Captopril
c. Minoxidil
d. Carvedibl
127. A 70-year-old woman with diabetes mellitus and hyperlipidemia and no history of hypertension is noted at
her yearly clinic visit to have new-onset hypertension with a blood pressure of 180/110 mmHg, She undergoes
a. Metcprolol
b. Phentolamine
d. Lisinoprii
most appropriate?
a. Terazosin
b. Lisinopril
c. Chlorthalidone
d. Carvedilol
129. CASE 1. A 46-year old business executive presents to A&.E with a 2-hour history of central crushing chest
pain and breathlessness. He is a non-smokerr previously veay fit and well and attends a gym four times a
week. There is no family history of ischemic heart disease. His cholesterol measured at an insurance medical
was 3,3 mmcl/L His observations on admission are as follows;pulse 105 bpm; blood pressure 80/50 mmHg; 02
catheterization?
pressure 120/80 mm Hg,pulse 72 bpm, JVP <8 with no hepatojugular reflux,and there is no S3, Extremities
are warm to touch,with no edema.
diuresis.
creatinine 1.2.
warm to touch.
e. An 85-year-old man with a 30-year history of diabetes previously received laser photocoagulation therapy
132. A 77-year-old nan with hypertension has inadequate blood pressure control on chlorthalidone 25 mg dally.
His primary care doctor is choosing a second antihypertensive agent. Which of the following comorbidities
would be an evidence-based indication for choosing ramiprif over amlodipine as the second agent?
a. Sleep apnea
c. Aoitic aneurysm
d. Discontinue doxazosin and initiate clonidine 0.4 mg twice daily.
e. Discontinue doxazosin and increase metoprolol to 100 mg daily.
beneficial?
a. ACEI
c. ARB
d. p-Blocker
136. A 36-year-old woman at 24 weeks of pregnancy is found to have several blood pressure readings in the
range of 145 to 158 mmHg systolic, 80 to 92 mmHg diastolic. This is her first pregnancy and she has no prior
history of hypertension, She reports bilateral mild ankle swelling and nausea, but no right upper quadrant
pain, visual changes,headaches, or dyspnea, A 24-hour urine collection shows 360 g protein. The hemoglobin
is 8.0 g/dL and the platelet count is 43,000 cells/mm3 . Which of the following is the correct diagnosis?
b. Preeclampsia
c. Eclampsia
137. A 58-year-old woman with multidrug-resistant hypertension presents to her primary care doctor with
multiple complaints. Her antihypertensive regimen consists of valsartan,hydralazine, amlodipine, captcpril,and
correct?
a. VSD
139. For which of the following conditions is IE prophylaxis not required prior to extensive dental procedures
(more than one option may be correct}?
140. A 26 year old woman who is 30 weeks pregnant is referred to yon because of a murmur that was noted
during her current pregnancy as welt as intermittently in the past. The patient is asymptomatic. Physical
examination shows slight elevation of the jugular venous pressure, with an A wave. A parasternal lift is also
noted. SL is normal, and S2 is somewhat prominent, fixed,and split A grade 2 inid-peaking ejection systolic
murmur is noted at the left sternal border, true statememnt about this patient condition include all of the
following EXCEPT:

c. Type 4/muscular
d. Type 3/inlet
c. Secundum ASD
e. Primum ASD
a. Ebstein anomaly
c. PDA
d. VSD
144. The peak age range for surgical intervention for patients with a bicuspid aortic valve is?
a. 60 to 80 years.
b. 20 to 40 years.
c. 10 to 20 years.
d. 40 to 60 years.
d. AVSD
146. A 46-year-old nan with known Ebstein anomafy seeks your advice with regard to optimal management. He is
asymptomatic and has an active lifestyle without any limitations. His physical examination is remarkable for
the absence of cyanosis. He has a loud hclosystolic murmur at the left lower sternal border that is accentuated
with respiration. He has no organomegaly or peripheral edema. His TTE reveals moderately severe 3+ TR with
an RV systolic pressure of 35 mmHg and normal LV and RV systolic function. There is no evidence of interatrial
communication. Which of the following should you recommend?
147. A 21-year-old woman who has a family history of Marfan syndrome comes to you for prepregnancy
counseling. Echocardiogram and CT scan of the chest show 42-mm dilation of the aortic sinuses. The patient is
asymptomatic and does not have mitraf valve prolapse, Which of the following is the most appropriate
recommendation?
a. Initiate treatment with a (3-blocker, and proceed with pregnancy.
d. Proceed with pregnancy, preferably sooner rather than later because of the size of the aorta,
e. Avoid pregnancy at ttiis time because of the size of the aorta, and initiate treatment with a |3 –blocker
148. A 16-year-old girl is being evaluated for a heart murmur. She is asymptomatic. On physical examination, her
blood pressure Is 174/104 mm Hg on her right arm. Her pulses are 2+ on her upper extremities, The femoral
pulses are slightly lower in amplitude than the radial pulses. Her cardiac examination reveals a short
midsystolic murmur in the left tnfrascapuiar area, For this patient, which of the following is most likely to be
found on additional studies?
149. The most common chromosomal abnormality associated with TOF is?
a. 7q11.23 microdeletion.
b. 22qll.2 microdeledon.
c. Trisomy 21.
d. M o n o s o m y X (45,X)
b. Primum ASD
d. VSD
e. Ebstein anomaly

b. Primum ASD
d. VSD
e. Ebstein anomaly
a. Transluminal balloon dilatation is the best treatment option in this case,
indicated
c. Crouzon syndrome

recommend?
started because the patient is dehydrated, and no further
intervention is needed\
b. Immediate surgical intervention for malfunction of
the prosthetic mitral valve
pericardium
recommend?
started because the patient is dehydrated, and no
further intervention is needed\
b. Immediate surgical intervention for malfunction of
the prosthetic mitral valve
d. Percutaneous aspiration of the fluid present in
thepericardium
157. A 46 year old woman presents to the emergency department with eight hours of chest pain. The pain is
constant, -severe,and midsterna! in location. She notes that it is worse when she lies down. She denies
exposure to sick friends or relatives. Past history is notable for tobacco use,borderline hypertension,and
elevated cholesterol. Her father died of a myocardial infarction at age 67 years. Examination is notable fcr a
heart rate of 104r and a blood pressure of 125/80 in both arms. Her lungs are clear. On cardiac
examination,she has a prominent friction rub with two out of three components present. The remainder of
the examination is unremarkable. Which of the following ECG abnormalities does not suggest pericarditis in
the absence of an effusion?
b. Sinus tachycardia
c. PR segment elevation in lead aVR
158. A 63-year-old nan with cardiac risk factors of tobacco use, hypertension,and diabetes mellitus returns for
follow-up after latepresenting mid-left anterior descending arteiy (LAD} ST-elevation myocardial infarction
(MI). He had an occluded mid-LAD,which was successfully aspirated and stented with a single drug-eluting
stent;no significant disease elsewhere is noted. The next day he reports progressive chest discomfort and mild
fever and has developed a two-component pericardial friction rub cn physical examination. His EGG is
concerning for pericarditis (Dressier syndrome) and an echo is performed showing no interval change from
discharge other than the presence of a small pericardial effusion. Which of the following regimens would be
the most appropriate therapy in this patient?
a. Proceeding with chemotherapy without further

cardiac evaluation
chemotherapy
a. Proceeding with chemotherapy without further
cardiac evaluation
chemotherapy
161. A 59-year-old man,with cardiac risk factors of tobacco use, hypertension,and hypercholesterolemia,
presented to the emergency department a few days ago with an acute onset of left-sided chest pain. His
evaluation revealed a diaphoretic man in moderate discomfort. An ECG was performed and showed a pattern
consistent with an inferior wall acute MI. The patient was treated with thrombolytics. Forty-five minutes after
the initial dose of the thrombolytics, he felt better and had complete resolution of his symptoms and
normalization of the ECG. On the third day after the event,he reports midsternal chest pain,vague in nature,
with mild diaphoresis and shortness of breath. An ECG is performed, as shown in Figure 13.5. Which of the
following should you tell the patient is the next step in managing his condition?
indicated.
b. He is showing signs of eariy postinfarction pericarditis,
and a nonsteroidal anti-inflammatory medication should be
stalled
162. A 59-year-old man,with cardiac risk factors of tobacco use, hypertension,and hypercholesterolemia,
presented to the emergency department a few days ago with an acute onset of left-sided chest pain. His
evaluation revealed a diaphoretic man in moderate discomfort. An ECG was performed and showed a pattern
consistent with an inferior wall acute MI. The patient was treated with thrombolytics. Forty-five minutes after
the initial dose of the thrombolytics, he felt better and had complete resolution of his symptoms and
normalization of the ECG. On the third day after the event,he reports midsternal chest pain,vague in nature,
with mild diaphoresis and shortness of breath. An ECG is performed, as shown in Figure 13.5. Which of the
following should you tell the patient is the next step in managing his condition?
indicated.
b. He is showing signs of eariy postinfarction pericarditis,
and a nonsteroidal anti-inflammatory medication should be
starlet
evaluation
d. Initiate steroid therapy (0.25 to 0,5 mg/kg/day) along with colchicine, and initiate PO diuretic
164. A 63-year-old nan is admitted with chronic obstructive pulmonary disease (CORD} and mild left ventricular
(LV) dysfunction (ejection fraction [EF] 45%} as well as symptomatic,recurrent atrial fibrillation (heart rate [HR]
effusion?
a. LV dysfunction
b. COPD
165. A 60-year-old woman with a history of chronic renal Insufficiency presents to the emergency department
with anterior left-sided chest pain. She reports that the chest pain started after her last dialysis 7 days ago.
She appears lethargic and in mild respiratory distress. The physical examination demonstrates a BP of 160/90
c. Admit the patient to the cardiac care unit to rule cut MI.
d. Perform emergency dialysis
next step?
a. Immediate surgical consultation
b. Start a nonsteroidal anti-inflammatory medication and
admit him for observation
d. No further treatment is needed because his symptoms
are caused by the hiatal hernia
c. IV hydration
department with a few days of severe chest pain. In the emergency department, she appears ill and pale and in
moderate discomfort. Her BP is 135/60 mmHg;her respiratory rate is 24 breaths per minute; her HR is 82 bpm;
and her temperature is 100,8 CF, The resident on call reads her chest X-ray (CXR.) as unremarkable. Her EGG is
shown in Figure 13.1. What is the most reasonable next step?
a. Call the cardiac intervention team and rush the patient
to the catheterization laboratory for emergency coronary
intervention.
b. Give aspirin and nitroglycerin and prepare to
administer thrombolytics.
c. Discharge the patient and refer her for a
gastroenterology follow-up as an outpatient.
d. Give a nonsteroidal anti-inflammatory medication
169. You are called to the emergency department to see 2 74-yearold man. He has 2 history of heavy smoking and
hypertension. The patient cannot remember his medications, but he reports not taking them on a routine
basis. In the past few hours before presentation,, he experienced a sudden or set of severe left-sided chest
pain with radiaticr to the left scapula. Approximately half an hour later, he noted some difficulty breathing.In
the emergency department, , he is noted to be diaphoretic and in significant respiratory distress. His physical
examination reveals a BP of 160/90 mrnHg, elevated jugular venous pressures, and a quiet precordium. His
ECG is reported as sinus tachycardia with no acute ST-T charges. After iritial pain and BP management, 2
transesophageal echocardiography [TEE) is performed to rule out aortic dissection. The findings of the TTE are
shown in Figure 13.7. What is your recommendation?
intervention.
d. The diagnosis is unclear; a computed tomographic (CT)
scan or an aortic angiogram, is needed.
a. Start the patient on a nonsteroidal anti-inflammatory agent with follow-up as an outpatient in
lweek
b. Admit the patient for observation on telemetry with a follow-up TTE,
c. The patient needs immediate percutaneous revascularization
a. Nicardipine HCL
b. Nftrat
c. Betablocker
d. Morfin
appropriate step?
175. A 61 years old man with complaints night cramp, heaviness,pitting edemar hyperpigmentation and active
skin ulcer of left ankle since last year in the bilateral lower limbs. Varicose veins were seen in the medial of left
b. Inhibit edema
ALI7?
a. Mottling
b. Cyanotic
c. Coldness
d. Numbness
e. Paralysis
treatment is:
ascending aorta
treatment is:
ascending aorta
c. Emergency angiography to define coronary anatomy,followed by surgeiy
b. Alopurinole – Antioksidane
c. Pentoxyfilline
d. Pentoxyfilline + Bicarbonas Natricus + Alopurinole + Anticksidane
e. Bicarbonas Natricus + Alopurinole + Antioksidane
c. Pneumonia
d. Interstitial Eung fibrosis
e. Myocarditis
181. A 6Q-year-old morbidly obese woman is admitted for cholecystectomy and postoperatively is placed on
deep venous thrombosis (DVT) prophylaxis with mini-dose subcutaneous heparin. On hospital day 2, a
peripherally inserted central venous catheter is placed in the right arm. The patient is discharged to a
rehabilitation facility on hospital day 5 after removal of the venous catheter. Two days later she presents to
the emergency room with right upper extremity pain and swelling. She reports she has not felt well enough to
participate with physical therapy since being discharged from the hospital. Venous duplex of the right arm
demonstrates acute thrombosis of the right cephalic vein. Complete blood count (CBC) and chemistries are
within normal range with a platelet count of 180 K/pL. What Is the most appropriate management of this
patient?
b. Prescribe enoxaparinlmg/kg every 12 hours and coumadin.Admit for 4 to 5 days of overlap and discontinue
enoxaparin cnce the international normalized ratio (INR) is within therapeutic range for 2 consecutive
days. Continue anticoagulant therapy for 3 months
inhibitor (DTI).
Continue anticoagulant therapy for 12 months
b. Thiazide diuretics
c. |3-Adrenergic blockers
d. Angiotensin IIreceptor blockers
e. None of the above
184. Which of the following population groups Is it appropriate to do a screening ultrasound of the abdomen for
an AAA?
type?
a. None of them
b. De-Backey type I
187. A 59-year-old nan presents to the clinic with a complaint of bilateral lower extremity cramping muscular
pain with exertion relieved after a few minutes of rest, His medical history includes coronary artery disease
status post left anterior descending artery stent 2 years ago,diabetes mellitus type 2, and essential
hypertension. An ABI is performed in your office demonstrating a right ABI of 1.10 and left ABI of 1,04. What is
the most appropriate next step in the evaketion of this patient?
pseudoclaudication
EXCEPT?
c. The troponinIwithin normal limits (<1 ug/L)
above patients?
a. Amlodipine
b. Captopril
c. Minoxidil
d. Carvedibl
192. A 70-year-old woman with diabetes mellitus and hyperlipidemia and no history of hypertension is noted at
her yearly clinic visit to have new-onset hypertension with a blood pressure of 180/110 mmHg, She undergoes
a. Metcprolol
b. Phentolamine
d. Lisinoprii
most appropriate?
a. Terazosin
b. Lisinopril
c. Chlorthalidone
d. Carvedilol
194. CASE 1. A 46-year old business executive presents to A&.E with a 2-hour history of central crushing chest
pain and breathlessness. He is a non-smokerr previously veay fit and well and attends a gym four times a
week. There is no family history of ischemic heart disease. His cholesterol measured at an insurance medical
was 3,3 mmcl/L His observations on admission are as follows;pulse 105 bpm; blood pressure 80/50 mmHg; 02
catheterization?
pressure 120/80 mm Hg,pulse 72 bpm, JVP <8 cm with no hepatojugular reflux,and there is no S3,
Extremities are warm to touch,with no edema.
diuresis.
creatinine 1.2.
warm to touch.
e. An 85-year-old man with a 30-year history of diabetes previously received laser photocoagulation therapy
197. A 77-year-old nan with hypertension has inadequate blood pressure control on chlorthalidone 25 mg dally.
His primary care doctor is choosing a second antihypertensive agent. Which of the following comorbidities
would be an evidence-based indication for choosing ramiprif over amlodipine as the second agent?
a. Sleep apnea
c. Aoitic aneurysm
d. Discontinue doxazosin and initiate clonidine 0.4 mg twice daily
beneficial?
a. ACEI
c. ARB
d. p-Blocker
201. A 36-year-old woman at 24 weeks of pregnancy is found to have several blood pressure readings in the
range of 145 to 158 mmHg systolic, 80 to 92 mmHg diastolic. This is her first pregnancy and she has no prior
history of hypertension, She reports bilateral mild ankle swelling and nausea, but no right upper quadrant
pain, visual changes,headaches, or dyspnea, A 24-hour urine collection shows 360 g protein. The hemoglobin
is 8.0 g/dL and the platelet count is 43,000 cells/mm3 . Which of the following is the correct diagnosis?
b. Preeclampsia
c. Eclampsia
202. A 58-year-old woman with multidrug-resistant hypertension presents to her primary care doctor with
multiple complaints. Her antihypertensive regimen consists of valsartan,hydralazine, amlodipine, captcpril,and
correct?

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1. What is the diagnosis of the following cardiac catheterization still-frame slide ?

4. Which type of VSD is demonstrated in Figure 9.13?

17. Which of the following is true for Loeys-Dietz syndrome (IDS)?

a. Proceeding with chemotherapy without further cardiac evaluation

22. A 23-year-oid white man is newly diagnosed with nonHodgkin lymphoma.

a. Proceeding with chemotherapy without further cardiac evaluation

a. There is evidence of reocclusion of the infarct-related

a. There is evidence of reocclusion of the infarct-related

a. Immediate surgical consultation

80. The most common chromosomal abnormality associated with TOF is

85. Which of the following is true for Loeys-Dietz syndrome (IDS)?

a. Aortic root aneurysm

141. Which type of VSD is demonstrated in Figure 9.13?

a. Congenitally corrected transposition

154. Which of the following is true for Loeys-Dietz syndrome (IDS)?

a. Proceeding with chemotherapy without further

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