A 75-year-old woman with a history of diabetes mellitus, hypertension, hyperlipidemia, and peripheral artery disease presents with a chief complaint of cough while eating. On further history, she describes trouble initiating her swallow as well as recent dysarthria.
Which of the following is the most likely cause of her symptoms?
A. Achalasia
B. Esophageal web
C. Stroke
D. Zenker diverticulum
Answer:
A 75-year-old woman with a 50-pack-year history of cigarette smoking presents to her primary care physician (PCP) with 10 years of progressive dyspnea on exertion. She notes episodic wheezing and experiences a “chest cold” about two times per year. Her examination reveals distant breath sounds to auscultation and hyper-resonant chest to percussion, with otherwise unremarkable examination. A CXR demonstrates hyperinflation with flattening of the bilateral hemidiaphragms. Pulmonary function tests (PFTs) reveal a forced expiratory volume (FEV1) of 50% predicted, forced vital capacity (FVC) of 70% predicted, and FEV1/FVC of 0.50. There is no response to bronchodilator.
What pattern best describes her PFT results?
A. Cannot determine without more information
B. Normal
C. Obstructive
D. Restrictive
Answer:
A 75-year-old man with a history of hypertension and peptic ulcer disease presents with dyspnea on exertion to the emergency department (ED). He notes black-colored stools for the past 2 weeks. His initial examination is notable for conjunctival pallor, clear lung fields without rales, wheezing, or rhonchi, as well as tachycardia with a regular rhythm, normal s1 and s2, and without murmurs, rubs, or gallops. Initial laboratory workup reveals a hemoglobin of 5.5 g/dL, reduced from a baseline of 12 g/dL on routine outpatient laboratory testing from 3 months prior. His basic metabolic panel, arterial blood gas (ABG), and lactateare all within normal limits. A chest radiograph (CXR) is normal.
What is the mechanism of this man’s dyspnea on exertion?
A. Decreased cardiac output
B. Decreased oxygen delivery
C. Decreased systemic vascular resistance
D. High-output heart failure
E. Pulmonary edema
Answer:
A 59-year-old man with a history of hypertension and hyperlipidemia presents with 1 hour of substernal chest pressure rated an 8 on a scale of 1 to 10 with radiation down the left arm and associated with diaphoresis. Initial vital signs are notable for a blood pressure (BP) of 92/64 mmHg and a heart rate (HR) of 92 beats/min. His electrocardiogram (ECG) is shown below
What is the most likely diagnosis?
A. Anterior ST-elevation myocardial infarction
B. Inferior ST-elevation myocardial infarction
C. Pericarditis
D. ST changes not meeting specific ischemia criteria; additional ECGs should be obtained.
ANSWER:
