A 56-year-old man is evaluated in hospital. Cardiac  auscultation is performed.

Which of the following is the most likely explanation for this patient’s findings?

A) Aortic dissection
B) Calcified bicuspid aortic valve
C) Immune hypersensitivity
D) Intravenous drug use
E) Myxomatous degeneration

A 36-year-old man is evaluated in hospital. Cardiopulmonary auscultation is performed.

Which of the following is most likely to be seen in this patient?

A) Cocaine use
B) History of 20-30 episodes of left-sided “fleeting” chest pain
C) Murmur that increases with inspiration
D) Myocardial ischemia
E) Myxomatous degeneration

A 71-year-old man is brought in by ambulance after an episode of crushing chest pain. He has a history of hypertension and diabetes. Which of the following vessels is most likely occluded in this patient?

A) Left anterior descending artery
B) Left circumflex artery
C) Left main coronary artery
D) Obtuse marginal artery
E) Posterior descending artery

A 63-year-old man is evaluated in hospital for a 2-month history of several episodes of unexplained syncope. His blood pressure is 150/90. His mother died at age 68 from cerebrovascular disease. ECG shows Q waves in II, III, and aVF. Which of the following is the most likely explanation for this patient’s findings?

A) Arrhythmia
B) Carotid stenosis
C) Cerebrovascular disease
D) Circumflex artery disease
E) Ventricular thromboemboli

A 33-year-old woman G1P0 at 38 weeks’ gestation presents to the physician for a routine antenatal appointment. She has had a 1-month history of progressive shortness of breath with exertion. There is mild ankle edema. Cardiopulmonary examination shows diffuse crackles. Which of the following is the most appropriate next step in diagnosis?

A) Autoantibody screening
B) ECG
C) No specific diagnostic test necessary at this time
D) Transesophageal echocardiography
E) Transthoracic echocardiography

Which of the following is most likely to be seen in this patient?

A) Decreased alveolar-arteriolar oxygen gradient
B) Decreased intravascular oncotic pressure
C) Loud pulmonic component of S2
D) Normal pulmonary capillary wedge pressure
E) Reduced splenic size

A 4-year-old girl is brought to the physician by her mother for a follow-up appointment. The following schematic reflects the oxygen tension at various cardiopulmonary locations.

Which of the following is most likely to be seen in this patient?

A) Early diastolic murmur
B) Fixed splitting of second heart sound
C) Jugular venous distention
D) Holosystolic murmur
E) Soft second heart sound

A 54-year-old man comes to the physician for a follow-up appointment. Which of the following is most likely to be seen in this patient?

A) Angina
B) Blood pressure of 150/50
C) Cannon A waves
D) Myxomatous degeneration
E) Pulsus parvus et tardus

A 43-year-old woman undergoes an appendectomy. She has a history of hypercalcemia, redness of her shins, and an ongoing dry cough, for which she is managed with multiple medications. Intraoperatively, her blood pressure falls to 80/40. One liter of 0.9% NaCl is administered. Which of the following is the most appropriate next step in management for this patient?

A) Additional bolus of 0.9% NaCl
B) Dopamine
C) Epinephrine
D) Hydrocortisone
E) Norepinephrine

A 13-year-old girl is brought to the physician for a follow-up appointment. She has a 1/6 systolic murmur auscultated at the upper chest, right-axis deviation on ECG, and a second heart sound that doesn’t oscillate. She is not cyanotic.  Chest x-ray shows increased pulmonary vascularity. Which of the following is the most likely explanation for this patient’s findings?

A) Aortic stenosis
B) Myxoma
C) Patent foramen ovale
D) Pulmonic stenosis
E) Venous hum