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PRETEST ACUTE COMPLAINTS, UROGENITAL
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pretest board style questions for acute GI complaints
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ACUTE COMPLAINTS QUESTIONSCARDIOLOGY
1. You are evaluating a 40-year-old male patient in the office who is complaining of
chest pain. His father had a myocardial infarction at age 42 and the patient is quite
concerned. Which characteristic if included in the history decreases the likelihood
that his chest pain is cardiac in origin?
A. The pain is worse with inspiration
B. The pain radiates to his right arm
C. The pain radiates to his left arm
D. Th pain is associated with nausea
E. The pain is associated with sweating
2. You are evaluating a 61-year-old man in the office who is complaining of chest pain. Given
his history and risk factors, you are concerned about myocardial ischaemia and order and
ECG. Which of the following ECG features, if present, would most markedly increase the
likelihood of an acute myocardial infarction?
A. Any ST segment elevation greater than or equal to 1 mm.
B. Any ST segment depression
C. Any Q wave
D. Any conduction defect
E. A new conduction defect
3. A 43-year-old woman with a history of well-controlled hypertension and diabetes presents
to your office complaining of intermittent chest pain for the last 3 months. The most recent
episode was 1 week ago, after climbing 4 flights of stairs at work. The pain was relieved with
rest. An ECG in your office is shown below. She is currently asymptomatic. Which of the
following is the most appropriate next step?
, A. Reassure the patient and have her return if symptoms continue.
B. Reassure the patient but increase her medication to ensure tight control of her blood
pressure and glucose levels.
C. Admit the patient to the hospital for serial enzymes.
D. Obtain a treadmill stress ECG.
E. Obtain a treadmill stress echocardiogram.
4. You are evaluating a 75-year-old woman with diabetes and hyperlipidemia who is
complaining of chest pain. She reports having occasional chest pain with exertion for years,
but yesterday she reported chest pain while walking up steps then she passed out. On
examination, she is afebrile with mildly elevated blood pressure. Cardiac auscultation
demonstrates a harsh, rasping crescendo-decrescendo systolic murmur heard best at the
second intercostal space at the right upper sternal border. Her carotid pulse is small and
rises slowly. Which of the following is the most likely diagnosis?
A. Pulmonary embolism
B. Aortic dissection
C. Left ventricular hypertrophy
D. Aortic stenosis
E. Mitral valve prolapse
5. You are caring for a 38-year-old male patient who reports episodic chest pain. He reports
that the pain feels like “tightness” is located right behind his sternum, lasts less than 3
minutes and is relieved by rest. He takes no medications, has no family history of coronary
disease and has never smoked. His ECG in the office is normal. Which of the following tests
should be done to determine whether or not his chest pain is due to ischemia.
A. Exercise ECG
B. Resting echocardiogram
C. Stress echocardiography
D. Radionuclide angiography
E. Electron-beam computed tomography(CT)
6. You are evaluating a 33-year-old woman complaining of palpitations. Which of the
following characteristics, if present increase the likelihood that the symptoms are cardiac in
aetiology?
A. The fact that the patient is female
B. The fact that the patient has a sister with similar symptoms
C. Her description of the symptoms as an “irregular heartbeat”
D. The fact that her father has a history of heart disease
E. The fact that the episodes last less than 1 minute
7. The patient in the question above reports random and episodic feelings of palpations. You
complete a detailed history and physical examination and do not find an obvious cause or
precipitating factor. Her 12-lead ECG, thyroid-stimulating hormone (TSH),
haemoglobin/haematocrit and electrolytes are all normal. Which of the following is the best
next step?
A. Ambulatory ECG for 2 weeks
B. Ambulatory ECG for 4 weeks
, C. Electrophysiology consultation
D. Echocardiogram
E. Observation and reassurance
8. You are seeing a hypertensive 56-year old woman who is complaining a “fluttering in her
chest”. She is otherwise well and denies shortness of breath, light-headness, pedal edema
or other symptoms when her “fluttering” occurs. On examination, her pulse rate is rapid and
irregular. She has no other complaints and the rest of her physical examination is normal.
Which of the following is her most likely diagnosis?
A. Atrial fibrillation
B. Paroxysmal supraventricular tachycardia(PSVT)
C. Stable ventricular tachycardia
D. Stimulant abuse
E. Hyperthyroidism
9. You are seeing a 32-year-old otherwise healthy woman who is complaining of palpitations.
She describes the sensation as a “flip flop” in her chest. They only last an instant and are not
associated with light-headedness or other symptoms. She denies other symptoms. Which of
the following is the most likely aetiology of her complaint?
A. Atrial fibrillation
B. PSVT
C. Ventricular premature beats
D. Stimulant abuse
E. Hyperthyroidism
10. You are seeing a 19-year-old African American student who reports that he can “ feel his
heartbeat”. It happens with exercise and is associated with some light-headedness and
shortness of breath. On examination, his heart has a regular rate and rhythm, but you hear a
holosystolic murmur along his left sternal border. It increases with Valsalva manoeuvre.
Which of the following is the most likely cause of his symptoms?
A. Mitral valve prolapse
B. Hypertrophic obstructive cardiomyopathy
C. Dilated cardiomyopathy
D. Atrial fibrillation
E. Congestive heart failure(CHF)
11. You are evaluating a 23-year-old swimmer who is complaining of episodes of
symptomatic rapid heart beating. Twice during swim practice, he has developed a sensation
that his heart is racing. When he measures his heart rate, he finds it to be between 160 and
220 beats/min. The first episode lasted approximately 4 minutes and the second lasted more
than 10 minutes. He denies light-headedness or other symptoms during the events. Limited
laboratory evaluation is normal and ECG shows a normal QRS duration. Which of the
following is the next step in the evaluation?
A. Reassure and continue observation
B. Ambulatory ECG monitoring
C. Consultation with an electrophysiologist
D. Stress testing
E. Echocardiography
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