1. A 47-year-old woman is seen in the emergency department for accelerated hypertension (blood

pressure 210/105 mm Hg). She notes frequent headaches for the past month but no chest pain,

shortness of breath, vision changes, or limb weakness. Her past medical history is negative

except for hypertension during her first pregnancy. Family history is also positive for both

parents and a brother who have hypertension.

On physical examination, the blood pressure is 210/105 mm Hg in both arms, the heart rate

is 88/min, and the patient is alert and oriented. The heart sounds reveal a S4, the lungs are clear

and there are no focal neurological deficits. What are most likely

on examination of the fundii41

2. A 32-year-old man presents to the office for routine evaluation. He has no symptoms but has

noticed some new "nodules" on his legs. The nodules are not tender or painful, and there is no

history of injury to the site. On physical examination there are lumps on his Achillis tendon, as

well as yellow lesions around his eyes, and pigmentation of his iris. (See Figure 1-10 a and b.)

Which of the following is the most likely diagnosis?

worse with lying down especially on her left side. One week prior to the onset of symptoms she

had "flu" like illness with fevers, chills, and myalgias. Her past medical history is negative and

she is not taking any medications.

On physical examination, the blood pressure is 130/80 mm Hg with no pulsus paradoxus,

and heart rate 100/min. The heart sounds are normal but there is a pericardial rub heard best at

the apex in the left lateral decubitus position, the lungs are clear and there is no peripheral

edema. Which of the following features determines the patient's clinical course and

prognosis?

4. A 65-year-old man comes to the office with symptoms of postural hypotension with dizziness.

These are new symptoms for him and he reports no chest pain, shortness of breath, or

palpitations. His past medical history is significant for type 2 diabetes, hypertension, and

dyslipidemia. Medications include hydrochlorothiazide, ramipril metformin, and insulin.

On physical examination, his blood pressure is 110/80 mm Hg supine and 85/70 mm Hg

standing (after 2 minutes), the pulse rate remains the same at 80/min. The jugular venous

pressure is 3 cm above the sternal angle and the heart sounds are normal.provide the best diagonosis

?

5. A 22-year-old woman is seen in the clinic for follow up on the results of a recently performed

echocardiogram. She was originally seen for an annual health assessment and on cardiac

examination an abnormality was detected which prompted the echocardiogram. She otherwise

is well and has no cardiac or respiratory symptoms. The echocardiogram reveals mitral valve

prolapse. Which of the following is the most common physical finding in this condition?

6. A 56-year-old man presents to the emergency department because of symptoms of persistent

palpitations. He admits to precordial discomfort, weakness, and anxiety. The symptoms started

suddenly earlier in the day, and there is no effect on the palpitations with exertion or rest. His

past medical history is negative for any cardiac conditions and he is not taking any prescription

medications.

On physical examination, his pulse rate is 150/min, the blood pressure is 124/70 mm Hg,

and the heart sounds are normal. Carotid sinus pressure gradually changes the rate to 100/min,

but when the carotid pressure is released, the pulse rate returns to 150/min.

7. A 25-year-old man presents to the emergency department complaining of left precordial chest

pain that radiates to the left shoulder but not down the left arm. The pain is accentuated by lying

supine as well as inspiration and relieved by sitting up. The pain is accompanied by fever and

chills.

On physical examination, his blood pressure is 105/75 mmHg, pulse is 110/min and regular,

and temperature 37.5C. The heart sounds are normal, there is a biphasic rub, and the lungs are

clear. The ECG shows ST-segment elevation in all leads except aVR and V1. On the third

hospital day, the patient's blood pressure falls, his jugular venous pressure is now elevated, the

heart sounds are faint, and his lungs have bibasilar crackles. Which of the following is the

most likely diagnosis?

8. An 80-year-old man presents to the emergency department with symptoms of increasing shortness

of breath over the previous week. The symptoms are worse on exertion and lately he is waking

up at night feeling short on breath. He reports no chest pain or any fever, cough, or sputum

production. His past medical history is significant for type 2 diabetes and hypertension.

On physical examination he appears short of breath, the blood pressure is 170/95 mm Hg,

pulse is 100/min and regular. The jugular venous pressure is 7 cmabove the sternal angle; there

is a loud second heart sound and a systolic ejection murmur at the right sternal border which

does not radiate. The lungs have bibasilar crakles up to the scapula. The CXR has bilateral

infiltrates and vascular redistribution. His echocardiogram reports aortic sclerosis, concentric

left ventricular hypertrophy (LVH), and normal ejection fraction.

9. A 68-year-woman presents to the emergency department complaining of chest pain for the past

30 minutes. The pain is retrosternal in location and it radiates to her neck. She has no history of

cardiac conditions or similar episodes of chest discomfort, and her past medical history

includes hypertension and dyslipidemia.

On physical examination, she is diaphoretic and in moderate distress. The blood pressure is

150/90 mm Hg, the heart sounds are normal, and the lungs clear on auscultation.

10. A 62-year-old man presents to the emergency department because of new symptoms of fevers,

chills, and malaise.