1. A 58-year-old man is undergoing cardiac catheterization for evaluation of chest pain symptoms.

He is worried about the risks, and as part of obtaining informed consent, you advise him about

the risks and benefits of the procedure. Which of the followingWhat best describes coronary

angiography?21

2. A 23-year-old man develops sharp left-sided chest pain and presents to the office for evaluation.

The pain does not change with respiration but is aggravated by lying down and relieved by

sitting up. He reports having flu like illness 1 week prior to presentation with fevers, chills, and

myalgias. He is otherwise well with no other symptoms or significant past medical history.

On physical examination, the blood pressure is 130/75 mm Hg, heart rate is 92/min, and

cardiac auscultation reveals a friction rub heard at the lower left sternal border, unaffected by

respiration. The lungs are clear and the remaining physical examination is normal. Provide

the most likely cause for his symptoms?

3 . A 72-year-old woman with angina and heart failure undergoes right and left cardiac

catheterization. The pulmonary capillary "wedge" pressure is an approximation of the

pressure in which structures?

4. A 58-year-old man with hypertension is brought to the emergency room after sudden-onset chest

pain that radiates to his back and arms. The pain does not change with deep inspiration, and he

reports no fever, cough, or sputum. His only medication is losartan.

On physical examination he is in moderate distress with a blood pressure of 160/90 mm Hg

in the left arm and 120/70 mm Hg in the right arm. Cardiac examination reveals a soft second

heart sound and a murmur of aortic insufficiency. His ECG shows sinus tachycardia but no

acute ischemic changes what

is the most appropriate next step in confirming the diagnosis?

5. A 25-year-old woman is evaluated in the office for symptoms of gradual but progressive

exertional dyspnea. She has been well with no prior health history. Presently she reports no

cough, sputum, wheezing, or pleuritic chest discomfort symptoms.

On examination, the blood pressure is 110/70 mm Hg, heart rate is 88/min, and auscultation

of the heart reveals a normal S1 but fixed splitting of her second heart sound and a 3/6 systolic

ejection murmur heard best over the left sternal border. An echocardiogram confirms the

presence of an atrial septal defect. What is the best physiologic explanation

for hercondition?

6. A 19-year-old man comes to his doctor's office complaining of chest discomfort on exertion.

There is no history of chest trauma, respiratory symptoms, constitutional symptoms, or cocaine

use. The discomfort is described as chest heaviness radiating to his arms and neck which

exertion, and relieved with rest. He has no prior medical illnesses, and there is no family

history of premature CAD.

His physical examination is entirely normal as is the ECG and CXR. Name

the most likely diagnosis?

7. A 65-year-old woman presents to the office complaining of progressive shortness of breath on

exertion. She reports no chest pain, cough, or wheeze, and otherwise feels well. There is no

history of overt blood loss, change in bowel habits, or weight loss. Her past medical history is

significant only for cholecystitis, and a remote wrist fracture after a fall.

On examination the only pertinent physical findings are a blood pressure of 120/50 mm Hg,

a soft S2, and a diastolic and systolic murmur heard best at the left sternal border. There is also

a rapidly rising, forceful carotid pulse that collapses quickly. Provide the

most likely diagnosis?

8. A 63-year-old woman on digoxin for chronic atrial fibrillation experiences fatigue, nausea, and

anorexia. Her symptoms started gradually about 1 week ago. She notes no chest pain,

palpitations, fever, or shortness of breath. Her past medical history is significant for heart

failure, type 2 diabetes, and chronic kidney disease.

On physical examination her pulse is regular at 50 beats/min, blood pressure is 130/80 mm

Hg, and the heart sounds, chest, and abdominal examinations are normal. On the ECG, no P

waves are visible and the QRS complexes are narrow and regular. (See Figure 1-5.) Her

complete blood count (CBC) and electrolytes are normal except for an increase in her urea and

creatinine twice over baseline. What is the most appropriate management

step?

9. A 47-year-old man presents to the emergency department complaining of progressive swelling in

his feet and abdomen, and shortness of breath on exertion. Physical examination confirms the

presence of edema, ascites, and hepatosplenomegaly. Inspection of the jugular venous pulse

reveals a markedly elevated venous pressure with a deep y descent. The cardiac silhouette on

the chest x-ray is normal. Provide a possible explanation for

this syndrome?

10 . A 65-year-old man presents to the emergency department after developing symptoms of

palpitations and dizziness. The symptoms started suddenly and were not associated with any

chest pain or shortness of breath.