#Cardiovascular_System#Pre-Clinical/MBBS(MBChB)#Lecturio

72-year-old woman presents with left lower limb swelling. She first noticed her left leg was swollen about two weeks ago. She denies any pain and initially thought the swelling would subside on its own. Past medical history is significant for hypertension and hyperlipidemia. She is a smoker with a 35 pack-year history and an occasional drinker. She takes chlorthalidone, lisinopril, atorvastatin, and a multivitamin. On physical examination, her left leg appears larger than her right with 2+ pitting edema up to her knee. She also has a few distended superficial veins along the posterior aspect of her left leg. Lower extremities have 2+ pulses bilaterally. The ultrasound of her left lower thigh and leg shows an obstructing thrombosis of the distal portion of the femoral vein. Which of the following veins functions to prevent this woman's condition from happening?

A 76-year-old hypertensive man presents to his family physician with a painless ulcer on the sole of his left foot, located at the base of his first toe. He has a history of pain in his left leg, which awakens him at night, but is relieved if he dangles his foot off the side of the bed. His wife discovered the ulcer last week while doing his usual monthly toenail trimming. Review of the social history shows that he smoked 20 cigarettes a day for 40 years, but quit 5 years ago. During physical examination, palpation of the patient’s pulses reveals the following:

A 55-year-old man visits the clinic with his wife. He has had difficulty swallowing solid foods for the past 2 months. His wife adds that his voice is getting hoarse, but they thought it was part of his recovery from a recently diagnosed influenza infection. His medical history is significant for type 2 diabetes mellitus, for which he is on metformin. He suffered from many childhood diseases due to lack of medical care and poverty. His blood pressure is 125/87 mm Hg, pulse is 95/min, respiratory rate is 14/min, and temperature is 37.1°C (98.7°F). On examination, an opening snap is heard over the cardiac apex. An echocardiogram shows an enlarged cardiac chamber pressing into his esophagus. Changes in which of the following structures is most likely responsible for this patient’s symptoms?

A 17-year-old girl suddenly grabs her chest and collapses to the ground while playing volleyball at school. The teacher rushes to evaluate the situation and finds that the girl has no pulse and is not breathing. He starts chest compressions. An automated external defibrillator is brought to the scene within three minutes and a shock is delivered. The girl regains consciousness and a regular sinus rhythm is noted. She is then rushed to the emergency department. Blood pressure is 122/77 mm Hg and pulse is 65/min and regular. An electrocardiogram (ECG) shows a shortened PR interval, a wide QRS complex, a delta wave, and an inverted T wave. Which of the following is the most likely pathology in the conduction system of this girl’s heart?

A 43-year-old woman presents to the ED with a 1-week history of palpitations, dry cough, and shortness of breath. She immigrated to the United States from a developing country at the age of 20. She says that her heart is racing and that she had never felt these symptoms before. Her cough is dry and is associated with shortness of breath on minimal exertion. Her past medical history is otherwise unremarkable. She has no allergies and is not currently taking any medications. She is a nonsmoker. Her blood pressure is 100/65 mm Hg, pulse 76/min, respiratory rate 23/min, and temperature 36.8°C (98.2°F). Her physical examination is significant for bibasilar lung crackles and a nonradiating, low-pitched, mid-diastolic rumbling murmur best heard at the apical region. In addition, she exhibits jugular vein distention and bilateral pitting edema in her lower extremities. Which of the following statements best describes the infectious agent that led to this woman’s condition?

A 53-year-old businessman is rushed to the emergency department with sudden onset of severe crushing chest pain radiating to his left arm and jaw. He has a history of episodic chest pain on exertion for which he uses nitroglycerin sublingually, but his medication did not relieve the pain today. Blood pressure is 141/97 mm Hg, pulse is 110/min, respiratory rate is 18/min, and temperature is 37°C (98.6°F). Physical examination reveals an uncomfortable and diaphoretic man with mildly labored breathing. Cardiac auscultation reveals tachycardia with a regular rhythm. His electrocardiogram (ECG) shows ST-segment elevation in leads II, III, and aVF (click on image to enlarge). Laboratory testing shows elevated cardiac troponin. The patient undergoes percutaneous coronary intervention (PCI). Which coronary artery needs the stent?

A 27-year-old man is brought to the emergency department by ambulance thirty minutes after being involved in a motorcycle accident. Blood pressure is 80/50 mm Hg, pulse is 130/min, and respiratory rate is 40/min. Physical exam reveals a metallic foreign body protruding from his chest at the right parasternal border, fourth intercostal space. The man is immediately taken to the operating room, where a penetrating injury to the heart is identified. Which of the following coronary arteries supply the region of the heart that is most likely injured in this patient?

A 55-year-old man presents to the emergency department with shortness of breath and weakness. His past medical history includes coronary artery disease, hypertension, and congestive heart failure. He reports that the symptoms started 2 weeks ago and worsened gradually. His vital signs are: temperature 36.5°C (97.7°F); blood pressure 135/90 mm Hg; heart rate 95/min; respiratory rate 24/min; and oxygen saturation 94% on room air. Examination reveals jugular venous distention. Auscultation reveals crackles at lung bases bilaterally. Pitting edema of the lower extremities is noted symmetrically. The patient’s plasma brain natriuretic peptide (BNP) level is 500 pg/mL (reference range < 125 pg/mL). A chest X-ray shows an enlarged cardiac silhouette. He is diagnosed with acute-on-chronic left heart failure with pulmonary edema, and treatment with loop diuretics is initiated. The physician proposes a drug trial with a new BNP stabilizing agent. Which of the following changes are expected to occur if the patient is enrolled in this trial?

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