Questions 103-108: Cardiovascular pathology

QUESTION 103

A 57-year-old male with a past history of treated hypertension for 15 years, diabetes mellitus type II, and a 20 pack-year smoking history presented to an acute care clinic complaining that over the past 6 months when climbing from the 1st floor to the 3rd floor at work by the stairwell, that he had developed a pressure-like sensation in his chest. Each episode lasted for about 5 minutes, and resolved shortly after he stopped climbing the stairs. Of the following, what is the most likely diagnosis?

A. Aortic dissection
B. Metastatic lung carcinoma
C. Stable angina
D. Unstable angina
E. Acute myocardial infarct

QUESTION 104

A 52-year-old male with a past history of treated hypertension for 20 years, diabetes mellitus type II, and a 30 pack-year smoking history presented to an acute care clinic complaining that over the past 4 months when climbing from the 1st floor to the 4th floor at work by the stairwell, that he had developed a pressure-like sensation in his chest. Each episode lasted for about 5 minutes, and resolved shortly after he stopped climbing the stairs. Given that his heart is the source of his symptoms, of the following list of possible lesions of a coronary artery, what was the most likely source of the symptoms?

A. An atheroma producing 25% stenosis
B. An atheroma producing 50% stenosis
C. An atheroma producing 75% stenosis
D. A non-occlusive thromboembolus
E. A partial coronary artery dissection

QUESTION 105

A 49-year-old male with a 40 pack-year smoking history presented to an acute care clinic complaining that over the past 6 months each time he has mowed the lawn that he developed a pressure-like sensation in his chest that occasionally was associated with some nausea. Each episode lasted for about 5 to 10 minutes, and resolved shortly after he stopped pushing the mower. His wife finally convinced him to see a doctor although he believes it was just bad heartburn. Given that his heart was the source of his symptoms, of the following, which was the initiating step in his disease process?

A. Necrosis of smooth muscle cells
B. Rupture of elastic lamina
C. Generation of reactive oxygen species
D. Endothelial dysfunction
E. Constriction of vaso vasorum

QUESTION 106

A 52-year-old male with a 30 pack-year smoking history and poorly-controlled hypertension presented to an acute care clinic complaining that over the past 3 months each time he has walked his dog at night that after 5 blocks, he developed a pressure-like sensation in his chest that occasionally was associated with some nausea. Each episode lasted for about 5 to 10 minutes, and resolved shortly after he stopped walking. Given that his heart was the source of his symptoms, of the following, which laboratory test is more likely to be elevated?

A. Troponin I
B. CK-MM
C. Erythrocyte sedimentation rate
D. ASO titer
E. Alanine aminotransferase

QUESTION 107

A 54-year-old male with a past history of hypertension, diabetes mellitus type II and elevated cholesterol, presented to an acute care clinic complaining that over the past 6 months when taking the stairs to his 4th floor office, that he had developed a pressure-like sensation in his chest. Each episode lasted for about 5 minutes, and resolved shortly after he stopped climbing the stairs. Sometimes, the pain was associated with nausea, occasionally with some shortness of breath, and once, the pain radiated into his left arm. Of the following, which test would confirm the diagnosis?

A. CT scan of the chest
B. Echocardiogram
C. MRI of the back
D. Coronary artery angiogram
E. Lumbar puncture with culture

QUESTION 108

A 58-year-old male presented to an acute care clinic complaining that he had developed a pressure-like sensation in his chest while playing basketball at the gym today with friends. The episode lasted for about 10 minutes, and was associated with some nausea and shortness of breath. The primary care physician determines that the patient’s heart is the source of the condition. Of the following, which condition would most likely be a risk factor for the patient’s disease process?

A. Chronic alcoholism
B. Metastatic tumor
C. High concentrations of HDL
D. Diabetes mellitus
E. Recurrent sinus infections

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