Download 1 : A 60-year-old male patient on aspirin, nitrates, and a beta blocker

1 : A 60-year-old male patient on aspirin, nitrates, and a beta blocker, being followed for chronic
stable angina, presents to the ER with a history of two to three episodes of more severe and longlasting anginal chest pain each day over the past 3 days. His ECG and cardiac enzymes are
normal. The best course of action of the following is to
a. Admit the patient and begin intravenous digoxin
b. Admit the patient and begin intravenous heparin
c. Admit the patient and give prophylactic thrombolytic therapy
d. Admit the patient for observation with no change in medication
e. Discharge the patient from the ER with increases in nitrates and beta blockers
2 : A 60-year-old white female presents with epigastric pain, nausea and vomiting, heart rate of
50, and pronounced first-degree AV block on ER cardiac monitor. Blood pressure is 130/80. The
coronary artery most likely to be involved in this process is the
a. Right coronary
b. Left main
c. Left anterior descending
d. Circumflex
3 : You are seeing in your office a patient with the chief complaint of relatively sudden onset of
shortness of breath and weakness but no chest pain. ECG shows nonspecific ST-T changes. You
would be particularly attuned to the possibility of painless, or silent, myocardial infarction in the
a. Advanced coronary artery disease patient with unstable angina on multiple medications
b. Elderly diabetic
c. Premenopausal female
d. Inferior MI patient
e. MI patient with PVCs
4 : A 75-year-old female is admitted with acute myocardial infarction and congestive heart
failure, then has an episode of ventricular tachycardia. She is prescribed multiple medications
and soon develops confusion and slurred speech. The most likely cause of this confusion is
a. Captopril
b. Digoxin
c. Furosemide
d. Lidocaine
e. Nitroglycerin
5 : Two weeks after hospital discharge for documented myocardial infarction, a 65-year-old
returns to your office very concerned about low-grade fever and pleuritic chest pain. There is no
associated shortness of breath. Lungs are clear to auscultation and heart exam is free of
significant murmurs, gallops, or rubs. ECG is unchanged from the last one in the hospital. The
most effective therapy is likely
a. Antibiotics
b. Anticoagulation with warfarin (Coumadin)
c. An anti-inflammatory agent
d. An increase in antianginal medication
e. An antianxiety agent
6 : A 48-year-old man is admitted to the coronary care unit with an acute inferior myocardial
infarction. Two hours after admission, his blood pressure is 86/52 mmHg; his heart rate is 40
beats per minute with sinus rhythm. Which of the following would be the most appropriate initial
therapy?
a. Immediate insertion of a temporary transvenous pacemaker
b. Intravenous administration of atropine sulfate, 0.6 mg
c. Administration of normal saline, 300 mL over 15 min
d. Intravenous administration of dobutamine, 0.35 mg/min
e. Intravenous administration of isoproterenol, 5.0 g/min
7 : A 55-year-old patient presents to you with a history of having recently had a myocardial
infarction with a 5-day hospital stay while away on a business trip. He reports being told he had
mild congestive heart failure then, but is asymptomatic now with normal physical exam. You
recommend which of the following medications?
a. An ACE inhibitor
b. Digoxin
c. Diltiazem
d. Furosemide (Lasix)
e. Hydralazine plus nitrates
8 : A 48-year-old male with a history of hypercholesterolemia presents to the ER after 1 h of
substernal chest pain, nausea, and sweating. His ECG is shown. There is no history of
hypertension, stroke, or any other serious illness. Which of the following therapies is not
appropriate?
a. Aspirin
b. Beta blocker
c. Morphine
d. Digoxin
e. Nitroglycerin
f. Thrombolytic agent
9 : A 55-year-old obese woman develops pressurelike substernal chest pain 1 h in duration. Her
ECG is shown below.
The most likely diagnosis is
a. Costochondritis
b. Acute anterior myocardial infarction
c. Acute inferior myocardial infarction
d. Pericarditis
e. Esophageal reflux
f. Cholecystitis
10 : A patient has been in the cardiac care unit with an acute anterior myocardial infarction. He
develops the abnormal rhythm shown below.
You should
a. Give digoxin
b. Consult for pacemaker
c. Perform cardioversion
d. Give propranolol
e. Give lidocaine