SHELF / USMLE Step 2 Practice Questions > Internal Medicine > Cardiology
Q1) A 54 y/o male is discharged from the hospital 3 days after undergoing stenting of the left anterior descending coronary artery for acute coronary syndrome. Serum cholesterol was high on admission. Telemetry showed frequent PVCs w. occasional couplets. At discharge, he is asymptomatic, and left ventricular function, bp & plasma glucose levels are normal. The patient went home on clopidogrel, aspirin, metoprolol & symvastatin. Which of the following meds would likely prevent future cardiac events?
a) folic acid
b) vit. E
d) isosorbide mono
Q2) A 43 y/o male presents to the ER with severe chest pain that awoke him from sleep. While the pt. is seated the pain gradually resolves after 5 minutes by the recurs several minutes later. He admits to nasal congestion, nausea, fatigue & a low-grade fever for the past few days. T 100.4, HR = 104bpm, & pain is reproduced by lying the pt in teh left lateral decubitus position. A three component pericardial friction rub is noted. Lab findings include a WBC ct. of 11,0000 , and ESR of 55 & a slightly elevated troponin. EKG shows diffuse ST-elevation and peaked T-waves. Which f the following is the est course of tx for this pt?
Q3) A 25 y/o primagravida pregnant woman is referred for evaluation of a heart murmur noted during the 2nd trimester of this pregnancy. The pt. has no h/o CV dz, and the murmur was not heard on previous cardiac exams. She is asymptomatic. Exam shows a mildly displaced apical impulse & lower extremity edema. S1 & S2 are nl. & an S3 is noted at the apex. A 2/6 early-mid peaking systolic murmur is audible at the left sternal border. Based on the pt's hx & PE which of the following is the most likely cause of the murmur?
a) bicuspid aortic valve w. mild to mod. stenosis
b) congenitally abnl. pulm. valve w. mod stenosis
c) physiologic murmur of pregnancy
d) mitral valve regurg. related to mitral valve prolapse
e) bicuspid aortic valve w. mod. regurgitation.
A1) c - ramipril
A2) d - indomethacin (25mg qid, p.o. for 2 wks)
A3) c - physiologic murmur of pregnancy
Most recommended question book for the medicine Shelf exam:
MKSAP for Students 3: Medical Knowledge Self-Assessment Program