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A 30 year old man with a viral myocarditis who develops hypotension, neck vein distention, a drop in blood pressure on inspiration, and muffled heart sounds most likely has:
- A. Hypertrophic cardiomyopathy
- B. Constrictive pericarditis
- C. Hypovolemic shock
- D. A pericardial effusion
Correct Answer: D
Rationale: Pericardial effusion post-viral myocarditis can cause tamponade, with signs like hypotension, neck vein distention, pulsus paradoxus, and muffled heart sounds.
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57 y/o male is admitted with acute cholecystitis due to cholelithiasis and undergoes an uneventful laparoscopic cholecystectomy. He is discharged the next day but returns to the ER 2 days later due to abdominal pain, distension, and fever. Abdominal CT is only positive for moderate ascites. Paracentesis reveals 50 PMNs and bilious fluid. What is the most likely diagnosis?
- A. Cirrhosis of the liver
- B. Secondary bacterial peritonitis
- C. Bile leak
- D. Retained common bile duct stone
Correct Answer: C
Rationale: Bile leak is a known complication of cholecystectomy, leading to bilious ascites and peritonitis symptoms like pain and fever.
The Frank-Starling mechanism:
- A. explains the increased heart rate during exercise.
- B. determines the method of computing cardiac output.
- C. shows the relationship between the stretch of heart muscle and strength of contraction.
- D. determines peripheral resistance by determining blood viscosity and vasoconstriction.
Correct Answer: C
Rationale: The Frank-Starling mechanism correlates the stretch of cardiac muscle fibers with the strength of contraction.
The skeletal muscle pump refers to skeletal muscles compressing against the walls of_____ to increase ______.
- A. arteries; blood flow to the lower extremities
- B. arteries; blood flow to the head
- C. veins; blood flow to the lower extremities
- D. veins; return of blood to the heart
Correct Answer: D
Rationale: The skeletal muscle pump assists in venous return by compressing veins and pushing blood toward the heart.
A 56-year-old man presented to his primary care physician complaining of difficulty urinating. Digital rectal exam reveals an enlarged prostate. The patient is started in a trial of Terazosin, after which his symptoms improve dramatically. Which of the following describes terazosin's drug class?
- A. Alpha1-adrenergic antagonist
- B. Alpha2-adrenergic antagonist
- C. Beta2-adrenergic agonist
- D. Beta2-adrenergic antagonist
Correct Answer: A
Rationale: Terazosin, an alpha1-adrenergic antagonist, relaxes prostate smooth muscle.
Which of the following is not known to predispose to the risk of developing transitional cell carcinoma of the bladder?
- A. Smoking
- B. Paint and leather industrial workers
- C. Textile workers
- D. Past infection with Schistosoma hematobium
Correct Answer: D
Rationale: Schistosoma hematobium is associated with squamous cell carcinoma rather than transitional cell carcinoma of the bladder.