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1. A 60 year old male patient on aspirin, nitrates and beta
blocker being followed for chronic stable angina, presents to
the ER with a history of tw to three episodes of more severe
and long lasting 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 Rx
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
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2. A 60 year old white female presents with
epigastric pain, nausea and vomiting, hear 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 artery
b. Left main
c. Left anterior descending
d. Circumflex
3. You are seeing in your office a patient with 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 tuned to
the possibility of painless, or silent, Myocardial infarction
in the:
 a. Advanced coronary artery disease patient with
unstable
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angina on multiple medications
 b. Elderly diabetic
 c. Premenopausal female
 d. Inferior MI patient
 e. MI patient with PVCs
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4. A 75 year old African American female is admitted
with acute MI and congestive heart failure, then has as
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. Lidocain
e. Nitroglycerin
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5. Two weeks after hospital discharge for documented
MI, a 65 yr old returns to your office very concerned
about low grade fever & pleuritic chest pain.There is no
associated SOB.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
c. An anti-inflammatory agent
d. An increase in anti-anginal medication
e. An anti-anxiety agent
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6. A 72yr old male presents to the ER with the chief
complaints of SOB that awakens him at night and also
night cough. Further questioning confirms recent
dyspnea on exertion. As you pursue the diagnosis of CCF
using the Framingham criteria, you note physical findings
below. Which of the findings is considerd among the less
specific minor criteria?
a. Neck vein distention
b. Rales
c. S3 Gallop
d. Positive hepatojugular reflux
e. Extremity edema
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7. A 55yr old patient presents to you with a history of
having recently had a MI with a 5 day hospital stay while
away on a business trip. He reports being told he had
mild CCF 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
e. Hydralazine plus nitrates
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8. A 75 yr old patient presents to the ER after a sudden syncopal
episode. He is again alert and in retrospect describes occasional
substernal chest pressure and SOB on exertion. His lungs have a
few bibasilar rales, & his BP is 110\80. On cardiac auscultation the
classic finding you expect to hear is:
a. A harsh systolic crescendo decrescendo murmur heard best at
the upper right sternal border
b. A diastolic decrescendo murmur heard at the mid left sternal
border
c. A holosystolic murmur heard best at the apex
d. A midsystolic click
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9. A 72yr old male comes to the office with
intermittent symptoms of dyspnea on exertion,
palpitations and cough occasionally productive of
blood. On cardiac auscultation, a low pitched
diastolic rumbling murmur is faintly heard
toward the apex. The origin of the patient’s
problem probably relates to:
a. Rheumatic fever as a youth
b. Long standing hypertension
c. Silent MI within the past year
d. Congenital origin
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10. A 40yr old male presents to the office with a
history of palpitations that last for a few seconds
and occur 2-3 times a week. There are no other
symptoms. ECG shows a rare single unifocal
PVC. The most likely cause of this finding is:
a. Underlying coronary artery disease
b. Valvular heart disease
c. Hypertension
d. Apathetic hyperthyroidism
e. Idiopathic or unknown
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11. Subsequent 24hr Holter monitoring in the
preceding patient confirms occasional single
PVCs plus occasional premature atrial
contractions (PACs). The BEST anti arrhythmic
management in this case is:
a. Anxiolytics
b. Beta blocker therapy
c. Digoxin
d. Quinidine
e. Observation, no medications
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12. An active 78 yr old female has been followed for
hypertension but presents with new onset of mild left
hemiparesis and the finding of atrial fibrillation on the
ECG, which persists throughout the hospital stay. She
had been in sinus rhythm 6 months earlier. Optimal
treatment by the time of hospital discharge includes anti
hypertensive plus
a. Close observation
b. Permanent pacemaker
c. Aspirin
d. Warfarin
e. Subcutaneous heparin
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13. In the ICU, a patient suddenly becomes
unresponsive, pulseless & hypotensive, with
cardiac monitor indicating ventricular
tachycardia. The crash cart is immediately
available. The first therapeutic step among the
following should be:
a. Amiodarone 3oomg IV push
b. Lidocaine 1.5 mg\kg IV push
c. Epinephrine 1mg IV push
d. Defibrillation at 200 joules
e. Defibrillation at 360 joules
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14. A 55yr old African American female presents to the ER with
lethargy & BP of 250\150. Her family members indicate that she was
complaining of sever headache & visual disturbance earlier in the
day. They report a past history of asthma but no known kidney
disease. On physical exam, papilledema & retinal hemorrhages are
present. The best approach is:
a. Intravenous labetalol therapy
b. Continous infusion of nitroprusside
c. Clonidine by mouth to lower BP slowly but surely
d. Nifedipine sublingually to lower BP rapidly & remove the
patient from danger
e. Further history about recent home anti hypertensives before
deciding current therapy
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15. A 50 yr old construction worker continues to have an
elevated BP of 160\95 even after third agent is added to
his antihypertensive regiment. Physical examination is
normal, electrolytes are normal and the patient is taking
no over-the-counter medications. The next helpful step
for this patient is to:
a. Check pill count
b. Evaluate for Cushing syndrome
c. Check chest x-ray for coarctation of aorta
d. Obtain renal angiogram
e. Obtain an adrenal CT scan
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16. A 35 year old male complains of substernal chest
pain aggravated by inspiration and relieved by sitting up.
He has a history of tuberculosis. Lung fields are clear to
auscultation and heart sounds are somewhat distant.
Chest x-ray shows an enlarged cardiac silhouette. The
next step in evaluation is:
a. Right lateral decubitus film
b. Cardiac catheterization
c. Echocardiogram
d. Serial ECGs
e. Thallium stress test
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17. The above mentioned patient then develops
jugular venous distention and hypotension. The
ECG shows electrical alternance. The most likely
additional physical finding is
a. Basilar rales halfway up both posterior lung
fields
b. S3 gallop
c. Pulsus paradoxus
d. Strong apical beat
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18. You are reviewing a number of patients with
congenital heart disease with specific attention
to whether they need an antiobiotic prophylaxis
for dental work. Which of the following cardiac
conditions creates the lowest risk for
development of infective endocarditis?
a. Coarctation of the aorta
b. VSD
c. ASD
d. PDA
e. Prosthetic heart valves
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19. An 80 year old with a past history of MI is
found to have LBBB on ECG. He is asymptomatic
with BP of 130/80, lungs clear to auscultation
and no leg edema. On cardiac auscultation the
most likely finding is :
a. Fixed (wide) split S2
b. Paradoxical (reversed) S2
c. S3
d. S4
e. Opening snap
f. Midsystolic click
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20. You are assisting for one month in a
cardiology vavular heart disease clinic detecting
a variety of murmurs and associated features.
Match they physical findings with the most likely
vavular or related heart disease.
a. Mitral stenosis
b. Tricuspid regurgitation
c. Mitral regurgitation
d. Aortic regurgitation
e. Aortic stenosis
f. Hypertrophic cardiomyopathy