Heart
EKG and Leads
Embryology
Clinical Cases
Wild Card
100
A 69-year-old man comes to the physician for a routine examination. His blood pressure is 150/88 mm Hg, pulse is 102/min, and respirations are 18/min. Physical examination shows a systolic crescendo-decrescendo murmur. Which of the following changes would be most likely?
A 69-year-old man comes to the physician for a routine examination. His blood pressure is 150/88 mm Hg, pulse is 102/min, and respirations are 18/min. Physical examination shows a systolic crescendo-decrescendo murmur. Which of the following changes would be most likely?
ANSWER:E
100
A 22 year old medical student comes in to the doctor’s office because she drank two monsters and is worried she is having heart palpitations. To be safe the doctor decided to do an EKG and the results seen indicate she has…
Wekenback
Left Bundle Branch
Right Bundle Branch
Normal EKG
A 22 year old medical student comes in to the doctor’s office because she drank two monsters and is worried she is having heart palpitations. To be safe the doctor decided to do an EKG and the results seen indicate she has…
Wekenback
Left Bundle Branch
Right Bundle Branch
Normal EKG
100
A 46-year-old female gives birth to a premature baby girl. Upon physical examination, the baby is found to have a depressed nasal bridge, epicanthal folds, and a single palmar crease. She is also found to have an ASD that resulted from failure of closure of the foramen primum. What type of ASD does this child have?
Probe patent
Sinus venosus type
Ostium secundum type
Primum type
Common atrium
A 46-year-old female gives birth to a premature baby girl. Upon physical examination, the baby is found to have a depressed nasal bridge, epicanthal folds, and a single palmar crease. She is also found to have an ASD that resulted from failure of closure of the foramen primum. What type of ASD does this child have?
Probe patent
Sinus venosus type
Ostium secundum type
Primum type
Common atrium
100
The physician auscultates our 75-year-old septic patient and hears a 3/6 systolic ejection murmur. Between which points on the pressure-volume loop shown does this murmur occur?
1-2
2-3
3-4
4-1
The physician auscultates our 75-year-old septic patient and hears a 3/6 systolic ejection murmur. Between which points on the pressure-volume loop shown does this murmur occur?
1-2
2-3
3-4
4-1
100
A 20 year old man comes into the ED with hemolytic anemia after ingesting fava beans. What are the two main products of the pathway affected by this deficiency?
NADH and glucose
NADH and ribose
NADPH and glucose
NADPH and ribose
A 20 year old man comes into the ED with hemolytic anemia after ingesting fava beans. What are the two main products of the pathway affected by this deficiency?
NADH and glucose
NADH and ribose
NADPH and glucose
A 20 year old man comes into the ED with hemolytic anemia after ingesting fava beans. What are the two main products of the pathway affected by this deficiency?
NADH and glucose
NADH and ribose
NADPH and glucose
NADPH and ribose
200
A 50 year old man comes into the hospital complaining of shortness of breath and chest discomfort. He has 10 year history of hypertension. Physical exam shows pulmonary edema and the guyton crossplot as depicted. What is occurring to cause these issues?
Decreased contractility, increased EDV, increased venous pressure
Decreased contractility, increased EDV, decreased venous pressure
Decreased contractility, decreased EDV, increased venous pressure
Increased contractility, decreased EDV, decreased venous pressure
A 50 year old man comes into the hospital complaining of shortness of breath and chest discomfort. He has 10 year history of hypertension. Physical exam shows pulmonary edema and the guyton crossplot as depicted. What is occurring to cause these issues?
Decreased contractility, increased EDV, increased venous pressure
Decreased contractility, increased EDV, decreased venous pressure
Decreased contractility, decreased EDV, increased venous pressure
Increased contractility, decreased EDV, decreased venous pressure
200
ANSWER: -50 degrees
200
A 5-year-old boy is brought to the physician because of a 40-minute history of shortness of breath that began after physical activity. His has had similar prior episodes whenever he is anxious, in pain, or when he overexerts himself. His mother says that his symptoms generally improve if he hunches down with his face close to his knees. He is 107 cm (3 ft 5 in) tall and weighs 18 kg (40 lb). His BMI is 16.7 kg/m2. His pulse is 104/min, blood pressure is 116/86 mm Hg, respirations are 24/min and labored. Physical examination shows bluish discoloration of the skin. Which of the following congenital heart defects best explains the symptoms present in this child?
Persistent Truncus Arteriosus
Transposition of the Great Vessels
Tricuspid Atresia
Tetralogy of Fallot
VSD
A 5-year-old boy is brought to the physician because of a 40-minute history of shortness of breath that began after physical activity. His has had similar prior episodes whenever he is anxious, in pain, or when he overexerts himself. His mother says that his symptoms generally improve if he hunches down with his face close to his knees. He is 107 cm (3 ft 5 in) tall and weighs 18 kg (40 lb). His BMI is 16.7 kg/m2. His pulse is 104/min, blood pressure is 116/86 mm Hg, respirations are 24/min and labored. Physical examination shows bluish discoloration of the skin. Which of the following congenital heart defects best explains the symptoms present in this child?
Persistent Truncus Arteriosus
Transposition of the Great Vessels
Tricuspid Atresia
Tetralogy of Fallot
VSD
200
A 45 year-old woman is brought to the emergency department following an automobile crash. She is semi-conscious. She was not wearing a seatbelt and impacted the steering wheel in the collision. Her blood pressure is 76/52 mm HG, pulse is 170/min, respirations are 28/min and spO2 is 95% on supplemental oxygen. Physical examination shows diffuse bruising over the chest as well as distant heart sounds and jugular vein distension. Lung sounds are heard throughout both lung fields. A FAST exam (ultrasound of vital areas including the chest) is performed as part of her trauma evaluation. Which of the following ultrasound findings would most likely underlie this patient’s vital signs and physical examination?
A.Blood in the mediastinum
B.Stenosis of the aorta
C.Increased ejection fraction
D.Failure of the tricuspid valve to close
E.Blood in the pericardial space
A 45 year-old woman is brought to the emergency department following an automobile crash. She is semi-conscious. She was not wearing a seatbelt and impacted the steering wheel in the collision. Her blood pressure is 76/52 mm HG, pulse is 170/min, respirations are 28/min and spO2 is 95% on supplemental oxygen. Physical examination shows diffuse bruising over the chest as well as distant heart sounds and jugular vein distension. Lung sounds are heard throughout both lung fields. A FAST exam (ultrasound of vital areas including the chest) is performed as part of her trauma evaluation. Which of the following ultrasound findings would most likely underlie this patient’s vital signs and physical examination?
A.Blood in the mediastinum
B.Stenosis of the aorta
C.Increased ejection fraction
D.Failure of the tricuspid valve to close
E.Blood in the pericardial space
200
A 25-year-old man comes to the emergency department with mucosal bleeding and epistaxis. Laboratory tests show an increased bleeding time and an increased partial thromboplastin time. He has a history of nosebleeds and also states that his mother is anemic. Which of the following is the most likely diagnosis?
A Bernard-Soulier syndrome
B Glanzmann thrombocytopenia
C Hemophilia A
D Vitamin K deficiency
E Von Willebrand disease
A 25-year-old man comes to the emergency department with mucosal bleeding and epistaxis. Laboratory tests show an increased bleeding time and an increased partial thromboplastin time. He has a history of nosebleeds and also states that his mother is anemic. Which of the following is the most likely diagnosis?
A Bernard-Soulier syndrome
B Glanzmann thrombocytopenia
C Hemophilia A
D Vitamin K deficiency
E Von Willebrand disease
300
An unconscious 44-year-old woman is brought to the emergency department after a head-on car crash. Her pulse is 115/min, blood pressure is 75/50 mm Hg, and respirations are 25/min. Physical examination shows massive abdominal bruising and generalized pallor. Her heart stops soon after admission and the trauma team attempt resuscitation. In comparison to normal which of the following sets of parameters is most likely seen in this patient?
An unconscious 44-year-old woman is brought to the emergency department after a head-on car crash. Her pulse is 115/min, blood pressure is 75/50 mm Hg, and respirations are 25/min. Physical examination shows massive abdominal bruising and generalized pallor. Her heart stops soon after admission and the trauma team attempt resuscitation. In comparison to normal which of the following sets of parameters is most likely seen in this patient?
ANSWER: D
300
A 63-year-old man is brought to the emergency department because of sudden onset chest pain and shortness of breath. It started when he was out on his morning run. He has a 10-year history of hypercholesterolemia and diabetes type 2. Physical examination shows extreme diaphoresis. An ECG shows that the QRS complex for Lead II has a net deflection of zero, the aVL lead has a net positive QRS complex and aVL/Lead III are net negative. Which of the following mean electrical axes is most likely in this patient?
A. -120
B. +90
C. +60
D. -30
E. -150
A 63-year-old man is brought to the emergency department because of sudden onset chest pain and shortness of breath. It started when he was out on his morning run. He has a 10-year history of hypercholesterolemia and diabetes type 2. Physical examination shows extreme diaphoresis. An ECG shows that the QRS complex for Lead II has a net deflection of zero, the aVL lead has a net positive QRS complex and aVL/Lead III are net negative. Which of the following mean electrical axes is most likely in this patient?
A. -120
B. +90
C. +60
D. -30
E. -150
300
Which of the following correctly pairs the anatomical feature with its embryological origin?
Distal part of left 6th arch - ductus arteriosus
Proximal part of right 6th arch - arch of aorta
Proximal part of right fourth arch - common carotid artery
Distal part of left fourth arch - subclavian artery
Which of the following correctly pairs the anatomical feature with its embryological origin?
Distal part of left 6th arch - ductus arteriosus
Proximal part of right 6th arch - arch of aorta
Proximal part of right fourth arch - common carotid artery
Distal part of left fourth arch - subclavian artery
300
A 32 year old comes in with tendon xanthomas and xanthelasma near the eyelids.She has total cholesterol of 350 mg/dl as well as high LDL. What is the diagnosis and what letter would it be represented by on the image?
A , Type I
B, Type II - B
C, Type V
D, Type III
E, Type II - a
A 32 year old comes in with tendon xanthomas and xanthelasma near the eyelids.She has total cholesterol of 350 mg/dl as well as high LDL. What is the diagnosis and what letter would it be represented by on the image?
A , Type I
B, Type II - B
C, Type V
D, Type III
E, Type II - a
300
A 13-year-old girl comes to the emergency department due to abdominal pain, bloating and diarrhea after accidentally eating contaminated meat. Laboratory results indicate an increase in the cells shown in the image. Which of the following is present in the granules of these cells?
A Heparin
B Eosinophilic Chemotactic Factor
C Major Basic Protein
D Perforins
E Granzymes
A 13-year-old girl comes to the emergency department due to abdominal pain, bloating and diarrhea after accidentally eating contaminated meat. Laboratory results indicate an increase in the cells shown in the image. Which of the following is present in the granules of these cells?
A Heparin
B Eosinophilic Chemotactic Factor
C Major Basic Protein
D Perforins
E Granzymes
400
A 54-year-old man comes to the emergency department because of a 1-hour history of chest pain. He has 10/10 stabbing pain in his chest that radiates to his jaw and left arm. He has a 10-year history of hypercholesterolemia and has a 30-pack-year smoking history. His blood pressure is 150/100 mm Hg, pulse is 109/min, and respirations are 22/min. An ECG shows ST segment elevation in leads V3-5. He is stabilized and discharged with Captopril, an ACE inhibitor, atenolol, a β-blocker, simvastatin, and nitrates, as needed. One of the goals of the treatment is to decrease the work of the heart by decreasing preload. Which of the following changes in pump function will most likely result in response to this therapy?
Stroke volume increases
Aortic pressure increases
Ventricular contractility increases
Atrial contractility increases
Ejection fraction decreases
A 54-year-old man comes to the emergency department because of a 1-hour history of chest pain. He has 10/10 stabbing pain in his chest that radiates to his jaw and left arm. He has a 10-year history of hypercholesterolemia and has a 30-pack-year smoking history. His blood pressure is 150/100 mm Hg, pulse is 109/min, and respirations are 22/min. An ECG shows ST segment elevation in leads V3-5. He is stabilized and discharged with Captopril, an ACE inhibitor, atenolol, a β-blocker, simvastatin, and nitrates, as needed. One of the goals of the treatment is to decrease the work of the heart by decreasing preload. Which of the following changes in pump function will most likely result in response to this therapy?
Stroke volume increases
Aortic pressure increases
Ventricular contractility increases
Atrial contractility increases
Ejection fraction decreases
400
A 60-year-old woman had an EKG recorded at a local emergency department after an automobile accident. Her weight was 70 kg (154 lbs), and her aortic blood pressure was 140/80 mmHg. What is the heart rate using Lead I for the calculation?
70
88
100
112
148
A 60-year-old woman had an EKG recorded at a local emergency department after an automobile accident. Her weight was 70 kg (154 lbs), and her aortic blood pressure was 140/80 mmHg. What is the heart rate using Lead I for the calculation?
70
88
100
112
148
400
A 63-year-old man comes to the physician because of a 2-month history of progressive extreme shortness of breath associated with activity. Physical examination shows a loud crescendo-decrescendo murmur during systole and a delayed carotid pulse. What is the most likely diagnosis and the embryological origin of the affected blood vessel?
A.Aortic stenosis; truncus arteriosus
B.Mitral stenosis; bulbus cordis
C.Mitral regurgitation; sinus venosus
D.Aortic regurgitation; primordial atrium
E.Patent ductus arteriosus; primordial ventricle
A 63-year-old man comes to the physician because of a 2-month history of progressive extreme shortness of breath associated with activity. Physical examination shows a loud crescendo-decrescendo murmur during systole and a delayed carotid pulse. What is the most likely diagnosis and the embryological origin of the affected blood vessel?
A.Aortic stenosis; truncus arteriosus
B.Mitral stenosis; bulbus cordis
C.Mitral regurgitation; sinus venosus
D.Aortic regurgitation; primordial atrium
E.Patent ductus arteriosus; primordial ventricle
400
A 17 year old girl comes into the clinic with a high fever, vomiting, and severely low blood pressure and skin that is warm and dry. She explains that she had forgotten she left a tampon in for the last couple days and then started developing symptoms. The doctor suspects it is a result of endotoxins. Which of the following are likely to be evident?
Increased preload, decreased cardiac output, decreased SVR
Increased preload, increased cardiac output, increased SVR
Decreased preload, decreased cardiac output, decreased SVR
Decreased preload, increased cardiac output, decreased SVR
A 17 year old girl comes into the clinic with a high fever, vomiting, and severely low blood pressure and skin that is warm and dry. She explains that she had forgotten she left a tampon in for the last couple days and then started developing symptoms. The doctor suspects it is a result of endotoxins. Which of the following are likely to be evident?
Increased preload, decreased cardiac output, decreased SVR
Increased preload, increased cardiac output, increased SVR
Decreased preload, decreased cardiac output, decreased SVR
Decreased preload, increased cardiac output, decreased SVR
400
A 25 year old woman is running a marathon and she is wondering how her body is responding. Which of the following incorrectly illustrates the effects of exercise on the body?
Increased cardiac output, increased pulse pressure, increased stroke volume
The oxygen dissociation curve would shift to the right
There is an increased in PCO2 and a drop in pH
All of the above are correct
A 25 year old woman is running a marathon and she is wondering how her body is responding. Which of the following incorrectly illustrates the effects of exercise on the body?
Increased cardiac output, increased pulse pressure, increased stroke volume
The oxygen dissociation curve would shift to the right
There is an increased in PCO2 and a drop in pH
All of the above are correct