Multiple Choice Questions (MCQ)

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Category: Cardiology--->Pulmonary Hypertension And Pericardium
Page: 5

Question 21#Print Question

A 59-year-old man with a history of coronary artery disease (CAD) and remote coronary bypass surgery presents with progressive dyspnea and vague chest pain. He had a stress echocardiogram for these symptoms that demonstrated normal LV function with no stress-induced wall motion abnormalities. However, he returned to the emergency department a few days later with recurrent symptoms. This time the house officer examining the patient notes 3+ pedal edema. The patient is admitted and started on diuretics. His blood tests are as follows:

  • White blood cell count = 11,000
  • Hemoglobin = 14.2
  • Platelets = 172,000
  • Albumin = 4.6
  • Urea = 11
  • Creatinine = 0.9

Owing to the recurrent symptoms, his cardiologist decides to refer him for a right and left heart catheterization. The coronary grafts are all patent. The tracings from the study are shown in Figure below.

What is the most logical explanation for this patient’s symptoms?

A. Constrictive pericardial disease
B. Small-vessel CAD
C. Diastolic dysfunction related to his chronic CAD
D. Cardiac amyloid
E. Cardiac tamponade

Question 22#Print Question

A 73-year-old man with no cardiac history presents with chronic lower extremities edema. His primary care physician attributed his symptoms to old age. He was treated with hydrochlorothiazide. Initially, he reported a good response to the therapy, but, over the past few months, his edema recurred, and doubling the diuretic dose did not alleviate his symptoms. On his initial examination, you notice distended neck veins and a quiet precordium. He has mild hepatomegaly and 4+ pedal edema. A TTE is suboptimal because of the patient’s inability to lie flat and obstructive lung disease. His blood work is as follows: 

  • White blood cell count = 6,000
  • Hemoglobin = 12.7
  • Platelets = 225,000
  • Urea = 43
  • Creatinine = 2.4
  • Albumin = 3.6

A cardiac catheterization is performed. He has normal coronary arteries with mild impairment in LV systolic function. The tracings from the study are shown in Figure below.

What is your explanation of his symptoms?

A. You agree with his primary care physician. You tell the patient that he probably has peripheral venous insufficiency
B. This patient has significant diastolic dysfunction, and his prognosis is guarded
C. This patient’s symptoms are due to the LV systolic dysfunction and volume overload
D. This patient should be referred for surgical evaluation for possible pericardial stripping

Question 23#Print Question

A 56-year-old male smoker with a family history significant for CAD is presenting with dyspnea on exertion and nonexertional vague chest pain. His physical examination and his initial ECG are unremarkable. His CXR demonstrates an increased cardiac silhouette. There is also a small nodule seen in his right upper lobe. The radiologist is not certain about its significance. Given his risk factors and symptoms, he is referred for a perfusion stress test. The images from the stress test are shown in Figure below.

Which of the following does the patient clearly have? 

A. He has coronary ischemia and should be referred for coronary angiography
B. There is no evidence of pathology to justify his symptoms
C. His symptoms are related to impairment of RV filling and pericardial disease
D. He has mild ischemia and can be treated medically

Question 24#Print Question

A 58-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 below.

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

Question 25#Print Question

A 19-year-old male college student presents to his local physician for evaluation of a dry cough. His symptoms started 3 days ago but now appear to be resolving. He had planned a trip overseas but was concerned and is now seeking advice. His physical examination is unremarkable. A CXR is performed and is read as showing an enlarged right cardiac silhouette. A TTE is ordered, which is shown in Figure below.

The patient most likely has which of the following conditions?

A. He has a pericardial cyst that is benign; no further treatment should be offered
B. He has cardiac tamponade requiring a pericardial tap
C. He has a pleural effusion
D. There is no pathology. The CXR was misread
E. He has mesothelioma

Category: Cardiology--->Pulmonary Hypertension And Pericardium
Page: 5 of 8