I want to die
A 67-year-old woman with poorly controlled diabetes presents with crushing chest pain, diaphoresis, and nausea. ECG shows ST elevation in leads V2–V4. Most likely diagnosis?
A. STEMI
B. Pulmonary embolism
C. Pericarditis
D. Aortic dissection
A. STEMI
A patient reports a burning sensation in the chest that worsens after large meals and when lying down, and improves with antacids.
What is the most likely cause?
A) Angina pectoris
B) Pericarditis
C) GERD
D) Esophageal spasm
C) GERD
A patient reports shortness of breath that improves when sitting upright but worsens when standing.
This positional dyspnea is known as:
A) Trepopnea
B) Platypnea
C) Orthopnea
D) Paroxysmal nocturnal dyspnea
B) Platypnea
A 54-year-old man has bounding pulses and a blowing, high-pitched, early diastolic decrescendo murmur best heard along the left sternal border when leaning forward. Which is most likely?
A. Aortic stenosis
B. Pulmonic stenosis
C. Mitral regurgitation
D. Aortic regurgitation
D. Aortic regurgitation
A 65-year-old man on prolonged bedrest develops acute unilateral calf swelling, then sudden pleuritic chest pain and dyspnea. Lung exam may be unremarkable or show localized crackles; oxygen saturation is low. Most likely diagnosis?
A. Deep venous thrombosis
B. Community-acquired pneumonia
C. Spontaneous pneumothorax
D. Acute heart failure
A. Deep venous thrombosis
A patient has loud S1 at the apex, mid-diastolic rumble, and an opening snap. Which condition is most likely?
A) Mitral regurgitation
B) Pulmonic stenosis
C) Aortic stenosis
D) Mitral stenosis
D) Mitral stenosis
A respiratory therapist is assessing a patient and notes breath sounds that have inspiratory and expiratory components of almost equal duration. These sounds are heard predominantly in the area between the patient's scapulae and are of intermediate intensity and pitch. Based on your notes, which type of normal breath sound is the therapist most likely hearing?
A) Vesicular
B) Bronchial
C) Tracheal
D) Bronchovesicular
D) Bronchovesicular
A 55-year-old patient with a long history of chronic bronchitis presents with increased sputum production. During lung auscultation, the healthcare provider hears relatively low-pitched sounds that have a coarse, snoring quality. The provider notes that these sounds are somewhat louder on expiration and seem to clear partially after the patient coughs.
Based on these specific characteristics from your notes, what adventitious breath sound is being heard?
A) Wheezes
B) Fine crackles
C) Rhonchi
D) Stridor
C) Rhonchi
A patient with heart failure presents with pitting edema in the lower extremities.
The mechanism involves:
A) Decreased capillary hydrostatic pressure
B) Increased plasma oncotic pressure
C) Increased capillary hydrostatic pressure
D) Decreased interstitial oncotic pressure
C) Increased capillary hydrostatic pressure
A patient is observed in the clinic actively using their sternocleidomastoid muscles during inspiration, and their lips are slightly pursed with each exhalation.
According to your notes, what do these observations most strongly indicate about the patient's respiratory status?
A) Normal breathing, which is quiet and easy.
B) The patient is in respiratory distress.
C) The patient is exhibiting bradypnea due to CNS depression.
D) The patient has Cheyne-Stokes breathing from brain injury.
B) The patient is in respiratory distress.
A patient with palpitations has an irregularly irregular rhythm and no distinct P waves on ECG. Which diagnosis fits best?
A. Atrial fibrillation
B. Sinus arrhythmia
C. Atrial flutter
D. Ventricular premature contractions
A. Atrial fibrillation
Which disease does NOT have a cough with bloody sputum:
A) Bronchietasis
B) HF
C) Lung Cancer
D) TB
B) HF
A patient with chest pain has localized tenderness over the costosternal junction that reproduces the pain on palpation. Which diagnosis is most likely?
A. Angina pectoris
B. Costochondritis
C. Pericarditis
D. Pleuritic pain
B. Costochondritis
A patient presents with shortness of breath that is episodic, associated with wheezing, and occurs at night. Which is the most likely diagnosis?
A. Asthma
B. COPD
C. Pneumonia
D. Anxiety with hyperventilation
A. Asthma
A patient reports chronic cough. On percussion, you find hyperresonance and decreased breath sounds bilaterally. Which is most likely?
A. Pulmonary tuberculosis
B. Pneumonia
C. COPD
D. Lung abscess
C. COPD
A 29-year-old woman on oral contraceptives presents with sudden pleuritic chest pain and dyspnea. She is tachycardic and hypoxic; exam may be normal. Which diagnosis is most likely?
A. Asthma exacerbation
B. Pulmonary embolism
C. Pericarditis
D. Pneumonia
B. Pulmonary embolism
A patient presents with a dry cough lasting several weeks, associated with weight loss and night sweats. Which is the most likely diagnosis?
A. Pulmonary tuberculosis
B. Acute bronchitis
C. Postnasal drip
D. GERD
A. Pulmonary tuberculosis
Palpitations described as a regular, rapid pounding that radiates to the neck suggest:
A) Sinus bradycardia
B) Supraventricular tachycardia
C) Ventricular tachycardia
D) Atrial fibrillation
B) Supraventricular tachycardia
23. A patient presents with a productive cough lasting several weeks, sputum is blood-tinged, and the patient also reports weight loss. Which is the most likely diagnosis?
A. Lung cancer
B. Chronic bronchitis
C. Pulmonary tuberculosis
D. GERD
A. Lung cancer
A 40-year-old patient presents to the clinic with a complaint of pleuritic chest pain and shortness of breath that began three hours ago. Physical examination reveals decreased breath sounds over the left upper lobe. Percussion is resonant, and tactile fremitus is absent over the left upper lobe. Which of the following is the most likely diagnosis based on these findings from your notes?
A) Pleural effusion
B) Pneumonia
C) Heart failure
D) Pneumothorax
D) Pneumothorax
A patient has paradoxical (reversed) split S2, heard on expiration and disappearing with inspiration. Most likely cause?
A) Right bundle branch block
B) Pulmonic stenosis
C) Left bundle branch block
D) Atrial septal defect
C) Left bundle branch block
A 60-year-old with sudden high fever, productive cough with rusty sputum, pleuritic chest pain, and focal bronchial breath sounds has a lobar consolidation on CXR. Which organism/diagnosis is classically associated?
A. COPD exacerbation from Haemophilus influenzae
B. Mycoplasma pneumoniae causing atypical interstitial pattern
C. Streptococcus pneumoniae causing lobar pneumonia
D. Pulmonary embolism
C. Streptococcus pneumoniae causing lobar pneumonia
A 66-year-old man with left-sided heart failure develops pleuritic chest pain; auscultation shows a high-pitched, scraping sound that disappears when he holds breath. Which is the most likely diagnosis?
A. Mediastinal crunch (Hamman sign)
B. Pericardial friction rub from pericarditis
C. Bronchial breath sounds from consolidation
D. Pleural friction rub from pleuritis (likely secondary to pneumonia or PE)
D. Pleural friction rub from pleuritis (likely secondary to pneumonia or PE)
A 28-year-old woman with fever and a history of IV drug use has a loud holosystolic murmur at the lower left sternal border that increases with inspiration. She has fever and a new-onset systolic murmur. Most likely diagnosis?
A. Tricuspid regurgitation
B. Mitral valve prolapse
C. Aortic stenosis
D. Patent ductus arteriosus
A. Tricuspid regurgitation
A 54-year-old man reports progressive exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. Exam shows displaced PMI, bibasilar crackles, JVD, and bilateral lower extremity pitting edema. Most likely diagnosis?
A. Systolic HF
B. Primary pulmonary hypertension
C. COPD exacerbation
D. Acute massive pulmonary embolism
A. Systolic HF