everything is provided please attempt

1 . A 62-year-old man with coronary artery disease (CAD) presents to the emergency room with

symptoms of feeling faint. The symptoms started earlier in the day and are more prominent when

he is standing up. He reports no chest pain or dyspnea and is otherwise well. Medical history

includes type 2 diabetes, dyslipidemia, and hypertension. His medications are atenolol,

metformin, atorvastatin, and ramipril.

On physical examination, blood pressure is 125/70 mm Hg, heart rate is 56/min and irregular.

Heart sounds S1 and S2 are normal, the lungs are clear, and he is alert and oriented. The

electrocardiogram (ECG) shows Wenckebach typ atrioventricular (AV) block. Which of the

following are you most likely to see on the ECG?

2. A 72-year-old woman is seen in the office for routine follow-up. She had a pacemaker inserted 4

years ago for symptomatic bradycardia because of AV nodal disease. She is clinically feeling

well and has not experienced any angina, dyspnea on exertion, or syncope. Her past medical

history also includes chronic stable angina and hypertension. Medications are atenolol, fosinopril,

and hydrochlorothiazide.

Physical examination is normal except for a pacemaker in the left upper chest. Her ECG shows

normal sinus rhythm at a rate of 68/min but no pacemaker spikes. Her pacemaker only functions

when the ventricular rate falls below a preset interval. Which of the following best describes

her pacemakerfunction?

3. A 42-year-old man is brought to the emergency department 7 days after an open cholecystectomy

complaining of sudden onset shortness of breath (SOB) and chest pain. The pain does not radiate,

is sharp in quality, and gets worse with inspiration. He reports no fever, cough, or sputum

production and was well up until today.

On physical examination, blood pressure is 145/86 mm Hg, pulse is 120/min, respirations

24/min, and oxygen saturation of 97%. The heart sounds are normal, the lungs clear on

auscultation, and there is no chest-wall tenderness on palpation. The surgical site is clean and not

inflamed, and the abdomen soft and not tender. The left calf diameter is larger than the right.

Pulmonary embolism is clinically suspected. Which of the following is the most common ECG

finding of pulmonary embolism?

4 . A 63-year-old woman is brought to the emergency department after developing symptoms of

exertional chest discomfort and one episode of transient loss of consciousness. She noticed nonradiating retrosternal chest discomfort starting 3 weeks ago, and today while out walking with her

daughter started feeling lightheaded and transiently lost consciousness. There was no seizure

activity or incontinence noted and she made a full recovery within minutes.

The physical examination shows a blood pressure of 150/80 mm Hg, heart rate is 88/min and

regular. On cardiac auscultation S1 is normal, S2 is soft, and there is a 3/6 systolic ejection

murmur with radiation to the carotids. The carotid upstroke is diminished, lungs are clear, and

there are no focal neurological deficits. Provide the most likely diagnosis?

5. A 42-year-old man is seen in the clinic with a 1-week history of fever and chills. He reports no

localizing symptoms for the fever and there is no recent travel history. His past medical history is

significant for congenital valvular heart disease which has been asymptomatic, and he is not on

any medications.

On examination he appears unwell; blood pressure is 120/70 mm Hg, heart rate is 100/min,

and there is a 3/6 pansystolic murmur at the apex that radiates to the axilla and a soft S1 sound.

His lungs are clear, abdomen is soft but there are petechiae on his conjunctival sac, linear

hemorrhages under a few fingernails, and painful, tender, and erythematous nodules on some of the

distal fingertips. Provide the responsible mechanism for these physical

findings?

6 . A 73-year-old man is seen in the office for routine follow-up appointment. Medical history

6 . A 73-year-old man is seen in the office for routine follow-up appointment. Medical history

includes paroxysmal atrial fibrillation, hypertension, dyslipidemia, and type 2 diabetes. His

medications are amiodarone, enalapril, diltiazem, atorvastatin, and warfarin.

On physical examination, blood pressure is 135/80 mm Hg, heart rate is 72/min regular, the

heart sounds are normal, there is a S4, and the lungs are clear. Which of the following drugs

mediates its effect by interfering with movement of calciumthrough the slow channel?

7 . A 67-year-old man presents to his local emergency department with anterior chest discomfort

radiating down his left arm and associated sweating and shortness of breath. His ECG reveals an

anterior myocardial infarction (MI) and he receives thrombolytic therapy since primary

angioplasty is not available at this center. Three days later, he develops chest pain that is made

worse by lying down and better with sitting up. The pain is sharp in quality and non-radiating. It is

also different fromthe pain associated with his MI, and sublingual nitroglycerine has no effect.

On physical examination, blood pressure is 145/80 mm Hg, heart rate is 100/min and regular.

Heart sounds are normal except for a biphasic rub heard best at the apex. The lungs are clear to

auscultation, and the remaining exam is normal. His ECG shows evolving changes from the

anterior infarction but new PR-segment depression and 1-mmST-segment elevation in all the limb

leads. Which of the following is the most likely diagnosis?

8. Which of the following best describes the effect of calciumions on the myocardium?

9. A 22-year-old primagravida woman develops hypertension at 32 weeks. She reports no vision

change, headache, shortness of breath, or abdominal symptoms. Her pregnancy is uneventful until

now. She has no significant past medical history and is not on any medications except vitamins.

On examination the blood pressure is 160/100 mm Hg, heart rate is 100/min, and the rest of the

examination is normal except for 1+ pedal edema. Her complete blood count, liver enzymes, and

electrolytes are normal. The urinalysis is positive for proteinuria. Which of the following is true

forthis type of hypertension?

10. A 61-year-old man is evaluated in the emergency department for chest pain with radiation to his

neck. He is having an anterior ST-elevation MI and is admitted to the coronary care unit after

undergoing primary angioplasty which resolved his symptoms. The following day, he develops

bradycardia but no symptoms of chest pain or shortness of breath. His medications are

clopidogrel, aspirin, metoprolol, and ramipril.

On physical examination, his blood pressure is 126/84 mm Hg, pulse is 50/min, and on

cardiac auscultation the heart sounds are normal, with no extra sounds or rubs. His ECG has

changed from one obtained post angioplasty. Which of the following ECG findings is the best

indication forthis patient to receive a pacemaker?