A 64-year-old man suffers an anterior myocardial infarction. A few hours later, his pulse rate is noted to be 46/minute and his blood pressure 94/59 mm Hg. He is short of breath and has slight central chest pain. The monitor showed sinus bradycardia. What would be your choice of management?

A 68-year-old woman complains of sudden onset of severe pain in her right thigh, calf and leg of 6 hours duration. She has lost sensations from the mid-thigh distally, cannot move her foot or knee, her skin feels very cold and pale. There are no pulses felt over the femoral and popliteal arteries. She gives a history of a myocardial infarction 6 weeks ago. What is the appropriate diagnosis?

A 66-year-old woman is admitted to the hospital because of a 3-month history of shortness of breath that has progressively worsened during the past month. Initially the symptom occurred with moderate exertion; now she has shortness of breath at rest. She also has a 1-week history of swelling of her legs and feet. She has hypertension treated with 5 mg bisoprololy. Her temperature is 37 °C, pulse is 120/min, respirations are 28/min, and blood pressure is 165/95 mm Hg in both extremities. Pulse oximetry on room air shows an oxygen saturation of 92%. Physical examination shows no cyanosis. Jugular venous distention is present 4 cm above the sternal angle. Auscultation of the lungs discloses bilateral crackles in the lower and mid lung fields. Cardiac examination discloses an S3 and S4. There is bilateral pitting edema of the lower extremities to the knee. An ECG shows sinus tachycardia and bi-atrial and biventricular hypertrophy. Which of the following is the most appropriate pharmacotherapy?

A 3-month-old infant is found to have a continuous murmur all over the precordium during her routine well baby checkup. The infant is 6 kg in weight and appears well. All peripheral pulses are present and easily palpable. Oxygen saturation is 96%. What is the most likely finding on echocardiography?

A 40-year-old male presents with palpitations. ECG showed atrial fibrillation. Blood pressure is 80/50, heart rate is 130, O2 saturation is 93%. Which is the best initial step

A 12-year-old girl diagnosed as rheumatic fever has a 3-week history of intermitted fevers, and malaise. Which of the following clinical findings occurs in infective endocarditis?

A 4 year old child presented with short breath and edema of both feet. Liver span was 16 cm and hepatic tenderness was noticed. Heart sounds were weak without any murmurs. X ray of the chest showed significant cardiomegaly. There was history of upper respiratory catarrh 8 weeks ago. What is the most likely diagnosis?

Uncomplicated bowel resection is performed for perforation of a diverticulum with evidence of fecal peritonitis. Intraoperatively there was cardiovascular instability and an episode of supraventricular tachycardia requiring treatment. Which of the following should be offered to the patient postoperatively?

A 20-year-old basketball player collapses and dies while playing a game. Which of the following is the most likely cause?

A 22 years old man is having inflammatory bowel disease. Which one of the following does not occur as a systemic manifestation of inflammatory bowel disease?

A 60-year-old man complains of chest pain of 2 hours duration. He is diabetic. The patient is sweaty, pulse is 110 b/min and Bp is 90/60. There is bilateral basal crepitation over the back of his chest. ECG showed raised ST segment in V1 till V6. Troponin is positive. Which of the following is the most likely diagnosis?

A 30 year-old woman complaining of shortness of breath and productive cough of 4 months duration. She came to the outpatient clinic because she noticed bilateral leg swelling. Physical examination revealed: pulse is 110 b/min. Bp 105/60. General examination revealed Raised JVP with bilateral pitting lower limb edema. Loud 1st heart sound with mid-diastolic murmur over her cardiac apex and ejection systolic murmur over the 2nd left intercostal space. Chest X-ray revealed cardiomegaly. What is the most likely diagnosis?

A patient in labor with a systolic BP of 125 mm Hg has just been given a saddle block. While lying on her back pushing on the delivery table, the level of the block stabilized at thorathic 10, fetal heart tones show a bradycardia to 105 bpm and her blood pressure drops to 90 mm Hg systolic. Which of the following is the most likely cause of these symptoms?

A 72-year-old man was admitted with acute pain in the right leg of several hours' duration. He gave a history of stable exertional angina and had smoked 24 cigarettes a day for many years. On direct questioning, he admitted to pain in both legs on walking for some months, which was worse on the right. On examination, the right leg was colder than the left and the foot and toes showed dusky purple discoloration with slow capillary return. The pulses in the right leg were impalpable below the femoral. Movement and sensation were normal. Which of the following is the investigation requested for this patient?

A 60-year-old banker with no past medical history presents to the emergency department 4 hours after the onset of severe substernal crushing chest pain with radiation to the left arm and neck. Electrocardiography reveals significant ST-segment elevation in leads I, L, V5, and V6. What is the most probable diagnosis in this case?

A 25-year-old man complaining of bilateral lower limb swelling of 6 months duration and abdominal distension of 1 month duration. Clinical examination revealed: Pulse 100 b/min., regular of low volume, Bl pressure 100/70, jaundice with raised JVP and bilateral pitting lower limb edema. Cardiac examination showed loud 1st heart sound with mid-diastolic murmur over the apex and ejection systolic murmur over the 2nd left space. Chest examination revealed bilateral basal crepitation. Abdominal examination showed hepatomegaly with sharp border and positive shifting dullness. What is the cause of this edema?

A 16-year-old adolescent male comes to the clinic needs medical clearance to share in his high school football team. He has no complaints, and his history is unremarkable, except for a family history which includes an uncle dying suddenly while jogging at age 25. His physical examination is unremarkable except for a harsh systolic murmur loudest over his left lower sternal border. ECG shows left ventricular hypertrophy. Which of the following is the most appropriate next step in management?

A 50-year-old hypertensive man who had a heart attack 6 months ago, presents with severe chest pain, vomiting and sweating for the last four hours. ECG shows ST elevation in leads V1 – V4. Cardiac Troponin: 24 pg/mL (N. 14.5 pg/mL) & Troponin I is 12 ng/ml. (N. Below 0.04 ng/ml). What is the most appropriate line of therapy?

A 16-year-old boy accidentally presents during a school examination with a prominent left precordium and fixed splitting of the second heart sound. An ejection systolic murmur in the second left intercostal space. What is the most likely underlying structural cardiac disorder?

A 6-year-old boy is found to have a systolic murmur at the left upper sternal border with a widely split fixed S2. Chest X-ray shows increased pulmonary vascular markings. Which of the following is the most likely diagnosis? [7/2025R]

A 19-year-old woman has had increasing malaise for the past 5 months. On examination she has a systolic murmur best heard at the end of the left border of the sternum with congested jugular veins, enlarged liver and bilateral edema of both lower limbs. Laboratory investigation: Serum bilirubin: 1.0 mg/dl (N. 0.2–1.2 mg/dL) Serum albumin: 3.6 gm/dl (N. 3.5 to 5.4 g/dL) Serum creatinine is 1.5 mg/dl (N. 0.84 to 1.21). What is the most likely cause of edema in this patient? [2/2021R_1/2023M_11/2023T_2/2024T_11/2024S]

Which sign of following is most alarming for acute aortic dissection in a 51 years old male presenting with acute chest pain? [12/2020T_12/2021T_11/2023T_2/2024T_8/2024S]

A 35-year-old woman came to ER complaining of palpitation, cold extremities and dizziness. By examination, blood pressure was $$60/40$$ and HR was $$200$$ b/min. ECG showed wide QRS complex tachycardia. Which of the following is the most appropriate first approach? [12/2020T_11/2023T_2/2024T_8/2024S]

A 75-year-old man has been resuscitated for more than 45 minutes following a cardiac arrest and after excluding all reversible causes. There is no sign of return of spontaneous circulation and a decision has been made to stop resuscitation. His relatives are waiting and are unaware of the decision. Which of the following is the most appropriate step to be taken? [11/2023T_2/2024T_8/2024S]

A 25-year-old woman presents in the emergency department with acute palpitations. She is fully conscious, pulse $$150$$ bpm, BP $$125/75$$ mmHg, respiratory rate $$20$$ /min, oxygen saturation $$99\%$$ on air, chest auscultation is clear with no evidence of cardiac failure. ECG shows narrow complex regular tachycardia. What is the most appropriate initial management step? [11/2023R_2/2024R_11/2024T_11/2024S_2/2025R_7/2025R]

A 45-year-old man presents to the emergency department complaining of the sudden onset of left substernal chest pain rated $$8$$ on a scale of $$1$$ to $$10$$ . He has a history of hypercholesterolemia for which he takes a lipid-lowering drug. On physical examination, he appears anxious and is diaphoretic. His blood pressure is $$100/90$$ mmHg. ECG reveals ST elevation in leads II, III, and aVF. He is diagnosed with an acute myocardial infarction. On cardiac catheterization, which of the following vessels will most likely be occluded? [8/2024R_2/2025T_2/2025S_7/2025T]

A 65-year-old man comes to the clinic with dyspnea and fatigue. He was previously diagnosed with ischemic heart disease and atrial fibrillation and was on amiodarone. On examination, he has clubbing and cyanosis. Which of the following is a side effect of amiodarone in this patient? [2/2024R_11/2024S]

A 21-year-old primigravid woman at term presents to the physician because of lightheadedness for the past 2 days. The lightheadedness comes on only when she is lying on her back and resolves completely when she sits up or stands. Which of the following is the most likely cause of this patient’s lightheadedness? [2/2024R]

A 75-year-old woman came to the clinic with a two-month history of recurrent transient loss of vision in her right eye. Her ECG was normal and carotid duplex showed a 30% stenosis of the right internal carotid artery. Which one of the following is indicated for this patient management?

Which of the following is the commonest acyanotic heart disease?

A 52-year-old woman comes to the office because of a 2-day history of pain in her right calf when walking that occurs in the evening. Twelve hours later, she had onset of rapid swelling of her right leg and she now has difficulty in walking. She says her symptoms began after she returned from a long vacation flying for 10 hours. She has a 10-year history of type 2 diabetes mellitus treated with metformin. Her temperature is 37.9°C, pulse is 75/min, respirations are 16/min, and blood pressure is 120/70 mm Hg. Physical examination shows edema and tenderness to palpation of the right calf. No erythema is noted. Pedal pulses are normal. Which of the following is the most likely diagnosis?

The most effective method of deep venous thrombosis (DVT) prophylaxis for a fifty-year-old woman presenting for anterior resection for cancer of the colon would be

A 65-year-old man who underwent an anterior resection for rectal cancer complains of pain in his left calf on the first postoperative day. On examination he has low-grade pyrexia (37.5°C), and the calf looks swollen with shiny skin and is tender. The patient experiences pain on dorsi flexing his foot. What is the appropriate diagnosis?

A 70-year-old hypertensive man, heavy smoker with a 3-month history of backache presents with acute excruciating epigastric pain radiating to the back. On examination: blood pressure is $$80/50$$ mmHg, pulse is 130 bpm (right femoral pulse is absent, while left femoral pulse is weak), marked abdominal tenderness and rigidity. What is the cause of his abdominal pain?

A 75-year-old man is found by his internist to have sudden dizziness, visual disturbances, numbness in one limb side. His blood pressure is $$170/100$$ with a carotid bruit. Which of the following is the best initial diagnostic investigation?

All of following decrease the sensitivity and specificity of FAST exam (Focused Assessment with Sonography for Trauma) except:

A 55-year-old diabetic man complains of shortness of breath and chest pain at rest of 2 hours duration. On examination: patient is sweaty, pulse 100 b/min regular of low volume, blood pressure $$140/90$$ . Respiratory rate is 16 breath/min. Cardiac and chest examinations are unremarkable. Investigations: Troponin is elevated. Which one of the following is the gold standard investigation to diagnose this patient?

A 65-year-old woman presents to the clinic complaining of progressive shortness of breath on exertion. She reports no chest pain, cough, or wheeze, and otherwise feels well. There is no history of overt blood loss, change in bowel habits, or weight loss. Her past medical history is significant only for cholecystitis, and a remote wrist fracture after a fall. On examination, blood pressure of $$120/50$$ mmHg, a soft S2, and a diastolic and systolic murmur heard best at the left sternal border. There is also a rapidly rising, forceful carotid pulse that collapses quickly. Which of the following is the most likely diagnosis?

Which one of the following clinical features is least consistent with a type B aortic dissection?

A man aged 62 had developed pain in his right foot at rest and particularly at night. This had persisted for 2 weeks and was resulting in considerable loss of sleep. There was a history of pain in the left calf on walking for about 100 m during the previous 6 months. Examination revealed that pulses were absent in both feet and the right foot was cold and pale compared with the left. There was a right carotid bruit. Which of the following is the most likely diagnosis?

A 55-year-old man who has a prosthetic aortic valve and is receiving warfarin 6 mg/day comes to the clinic for follow up. Which of the following is the essential test to monitor his warfarin dose?

if present on physical examination, would be the most specific indicator of Pulmonary arterial hypertension in this patient [10/2020T_1/2021T-10/2021T_11/2022R_2/2023S_6/2023R_11/2023S_2/2024S_8/2024T]

A 40 year old man, 18 hours after a gastrectomy, suddenly becomes hypotensive with a blood pressure of 80/60, tachycardia of 110/min, CVP +2 cm, H2O and a temperature of 39C. The likely diagnosis is: [12/2020T_12/2021T_11/2023R_2/2024S_11/2024T_2/2025R_7/2025R]

A 56-year-old woman came to the clinic because of chest pain (usually worse with breathing) anxiety, palpitations (heart racing) and coughing up blood. She was diagnosed as acute pulmonary embolism. Which of the following is the most frequent ECG finding in this case? [2/2024R_11/2024T]

A 48-year-old man is admitted to the coronary care unit with an acute inferior myocardial infarction. Two hours after admission, his blood pressure is 86/52 mmhg, his heart rate is 40 beats per minute with sinus rhythm. He gives a history of recurrent attacks of chest pain in the left side of the chest over the last 2 years that always comes after severe effort. The pain is relieved by rest or some sublingual drugs prescribed by his doctor. Which of the following would be the most appropriate initial therapy? [2/2024R_11/2024T]

A 45-year-old man comes to the clinic with sudden onset of dyspnea, pleuritic chest pain, and tachycardia. Which of the following diagnostic tests is the most appropriate initial step in the evaluation of suspected pulmonary embolism? [2/2024R]

A 65-year-old patient with dilated cardiomyopathy is wakened up two hours after sleep on dyspnea, wheezes and coughing pink frothy sputum, which of the following is the most likely cause? [11/2023R]

A 45-year-old woman came to the clinic complaining of progressively worsening symptoms, including fatigue, weight gain, and depression. She has a history of untreated hypothyroidism. On examination, a significant swelling of the face, hands, and feet, along with coarse, dry skin were noticed. Laboratory tests confirm hypothyroidism with elevated TSH levels and low free T4. If left untreated, which of the following is the most likely complication? [2/2024R]

A 54-year-old man presents with orthopnea, paroxysmal nocturnal dyspnea, and bilateral lower extremity edema. On physical examination, crackles are heard bilaterally in the lung bases. Which of the following is the most likely type of heart failure? [2/2024R]

A 78-year-old man with a history of heart failure lives with his daughter. He recently started taking a new medication for high blood pressure. Over the past week, he has become increasingly withdrawn and stems to be forgetting things more often than usual. He has also had a few falls recently. Which of the following is the most likely explanation for the patient's recent decline? [8/2024R]

A 55-year-old male smoker with diabetes and hypertension presents with complains of chest pain on exertion. Exercise stress testing shows reversible ischemia in the anteroseptal portion of the heart after exercising 4 minutes. Cardiac catheterization reveals on 80% stenosis of the left main coronary artery. Which of the following is the most appropriate intervention? [8/2024R]

A 55-year-old man comes to the clinic with LDL level of 150 mg/dL. He is diabetic and obese. Which of the following medications should be given at this time? [2/2024R]#

A 55-year-old man with type 2 diabetes and no known cardiovascular disease presented to the outpatient clinic for a routine check-up. His LDL-C is 130 mg/dL. He does not smoke and has well-controlled blood pressure. Which of the following is the most appropriate management regarding his LDL-C result? [7/2025R]

A 75-year-old man with a history of heart failure presents with worsening shortness of breath and swollen ankles. He is taking diuretics, but reports do not restrict his fluid intake. Which of the following is the most appropriate next step in managing his heart failure? [8/2024R_2/2025T_2/2025S_7/2025T]

On the second postoperative day after an abdominoperineal resection for cancer of the rectum a 72-year-old man complains of severe retrosternal pain. The pain is crushing in nature and radiates to the left arm. He also becomes short of breath and tachycardiac. Except for his fresh surgical wounds and postoperative discomfort, physical examination is unremarkable. He does not have distended neck veins. Which of the following is the most appropriate next step in diagnosis? [2/2024R_11/2024T]

A 40-year old retired professional football player reports a sudden onset of palpitations and shortness of breath five days following knee replacement surgery. His pulse regular at 100 beats per minute with an oxygen saturation of 90% on room air. An electrocardiogram (EDG) shows sinus tachycardia, and a chest X-ray reveals no abnormalities. Which of the following is the most appropriate next step in management? [2/2025R_7/2025S]

A 68-year-old man on warfarin for atrial fibrillation is scheduled for elective knee replacement. Which of the following is the recommended warfarin management? [7/2025R]

A 40-year-old retired professional football player complains of sudden onset of palpitations and shortness of breath 5 days after having knee replacement surgery. His pulse is 100 beats/minute and regular. Oxygen saturation is 90% at room air. An ECG reveals sinus tachycardia. A chest X-ray film is unremarkable. Which of the following is the most appropriate next step in management? [2/2024R]

A 43-year-old woman, gravida 2, para 1, at 34 weeks' gestation comes to the physician because of shortness of breath, which began yesterday while she was lying down. Today, she notices pain when she takes a deep breath. Her temperature is 37.0 C, blood pressure is 110/70 mm Hg, pulse is 90/min, and respirations are 25/min. Oxygen saturation is 94% on room air. Examination is unremarkable. ECG shows sinus tachycardia at 104/min. A chest xray film is negative. Which of the following is the most appropriate initial step in management? [2/2024R]

A 62-year-old, right-handed man has transient episodes of paralysis of the right arm and inability to express himself. There is no associated headache. The episodes have sudden onset, last about 5 to 10 minutes, and leave no neurologic sequelae. The patient is overweight and sedentary. He smokes one pack of cigarettes per day and has high cholesterol, but he is not hypertensive. The only abnormality in the physical examination is a bruit over the left carotid bifurcation. Which of the following is the most appropriate initial step in diagnosis? [10/2020T_2/2024S]

widespread Q waves. You suspect Hypertrophic Obstructive Cardiomyopathy (HOCM), which of the following is associated with increased risk of sudden death? [11/2021R_11/2023R_2/2024R_8/2024S-8/2024R_11/2024T_11/2024S_2/2025T_2/2025R_7/2025T_7/2025R]

After examining a young girl presenting symptoms of breathlessness and palpitations over the past year, the cardiology registrar diagnoses her with mitral stenosis upon auscultating the precordium. What specific sign serves as the cornerstone for this diagnosis? [11/2023R]

A 45-year-old man complains of episodes of palpitations and headache. He has no known history of hypertension or other medical problems. He is not a cigarette smoker. On examination BP: 160/100 mm Hg; heart rate: 100 beat/min otherwise, the exam is normal. Laboratory investigation revealed: Fasting Blood Sugar: 109 mg/dl (N. 100 to 125 mg/dL) • S. creatinine is 1.3 mg/dL (N. 0.84 to 1.21). What is the most probable diagnosis? [2/2021R_1/2023M_11/2023T_2/2024T]

A 44-year-old woman presents with palpitations. ECG showed atrial fibrillation. Blood pressure is 120/80, heart rate is 130, O2 saturation is 93%. Which is the best initial step? [11/2020T_1/2023M_6/2023S]

A65-year-old female is admitted with a right hemiparesis. Examination reveals she is in atrial fibrillation. CT confirms an ischemic stroke and aspirin 300mg is commenced. If the patient is well and develops no new problems at what point should warfarin be started? [12/2021T_1/2023M_5/2023M_6/2023S_11/2023T_2/2024T]

60y female (158 cm height, 51 kg body weight) diagnosed with stage 1 hypertension. Her BP averages 135/85 mmHg. She has no other comorbid conditions and is otherwise in excellent health. What initial therapy would be most appropriate for this patient? [2/2021R_1/2023M_5/2023M]

A 60-year-old woman has been diagnosed with stage 1 hypertension, with her blood pressure consistently averaging 135/85 mmHg. She does not have any other medical conditions and is generally in excellent health. Which of the following is the initial step in management of this patient? [8/2024R_2/2025S_7/2025T]

Regarding the use of ultrasound for central venous catheter (CVC) placement, which of the following is FALSE? [12/2021T_11/2022R]

A 46-year-old male sustains a gunshot wound to the abdomen, vital signs are 74/32 mmHg, his heart rate is 136 bpm present only at the carotid, and respiratory rate 24 breaths/min and shallow. Which of the following is the target out of hospital of fluid resuscitation? [1/2021T_11/2021R_11/2022R_8/2024S]

In a patient with peripheral arterial disease, which one of the following features suggests the worst prognosis? [12/2020T_1/2023M_2/2023T-2/2023R_6/2023S_6/2023R_2/2024T_8/2024S]

A 56-year-old woman with a long history of untreated hypertension is brought to the emergency department because of a severe headache and confusion. The patient is oriented to person, but not to time or place. Her blood pressure is 230/140 mm Hg, pulse is 86/min, and respirations are 18/min. Funduscopic examination reveals optic disk edema, and a dipstick test shows protein in the urine. Which of the following is the most appropriate pharmacotherapy? [11/2024S]

A 63-year-old man comes to the outpatient clinic complaining of severe bilateral calf pain while walking, which resolves with rest. He also reports numbness and tingling in his feet. He has poorly controlled type 2 diabetes. Ankle-brachial index (N. 1.0 and 1.4) testing reveals a value of 0.5. Which of the following is the most likely complication he is experiencing? [11/2024R]

A 45-year-old woman arrives at the emergency department with a severe headache and blurred vision that have persisted for the past few hours. She has a history of uncontrolled hypertension. Upon examination, her blood pressure is 220/120 mmHg, heart rate is 90 bpm, and she appears anxious. A fundoscopic examination reveals papilledema and retinal hemorrhages. She denies any chest pain, shortness of breath, or abdominal pain. Laboratory tests indicate normal kidney functions, and a CT scan of the head shows no signs of intracranial hemorrhage. Which of the following is the most appropriate initial management for this patient? [11/2024R]

A 49-year-old man has his serum lipids tested during a routine checkup. Which of the following lipid patterns indicates the lowest risk for coronary artery disease?

A 57-year-old man presents with a 2-day history of shortness of breath and wheezing. He also reports lower leg swelling that began after a 200-mile car trip 3 days ago. He has a 20-year history of poorly controlled hypertension, currently managed with hydrochlorothiazide. His vital signs are: temperature 37°C (98.6°F), pulse 100/min and regular, respirations 24/min, and blood pressure 170/100 mm Hg. Physical examination reveals jugular venous distension, bilateral crackles and wheezes in the lower lung fields, a prominent S3 gallop at the apex, and 4+ ankle edema. Chest X-ray shows cardiomegaly and cephalization of the pulmonary vessels. Which of the following is the most likely diagnosis?

A 57-year-old man visits the physician complaining of a 3-month history of worsening calf pain that occurs when he walks more than half a mile. The pain subsides after 5 minutes of rest, allowing him to walk another half mile before it returns. He has a 40-year smoking history of one pack per day and has well-controlled hypertension for 10 years managed with hydrochlorothiazide and atenolol. His popliteal, dorsalis pedis, and posterior tibialis pulses are slightly diminished, while femoral pulses are normal. The ankle-brachial index measures 0.8 (normal is greater than 1). Besides advising smoking cessation, which of the following is the most appropriate next step in management?

A 61-year-old man presents with a 3-month history of calf pain that occurs after walking more than half a mile and resolves within 5 minutes of rest. He has a 40-year, one-pack per day smoking history and is being treated for hypertension with hydrochlorothiazide and atenolol. On examination, his popliteal and pedal pulses are reduced, and his ankle brachial index is 0.8. Which of the following is the most appropriate next step in management?

A 72-year-old man is brought to the emergency department with the acute onset of severe shortness of breath. He reports experiencing orthopnea, paroxysmal nocturnal dyspnea, and a 5 kg weight gain over the past week. He has a history of ischemic heart disease, atrial fibrillation, and chronic heart failure. On examination, he appears visibly distressed, with a blood pressure of 90/60 mmHg, heart rate of 120 bpm, respiratory rate of 28 breaths per minute, and an oxygen saturation of 85% on room air. He has cold extremities, jugular venous distension, and diffuse crackles throughout both lung fields. A chest X-ray reveals cardiomegaly and pulmonary edema. An echocardiogram shows a left ventricular ejection fraction (LVEF) of 30%, and laboratory results indicate an elevated troponin level. Which of the following is the most appropriate next step in managing this patient?

A 68-year-old man comes to the emergency department complaining of abdominal cramps after eating for two weeks. He has experienced occasional loose stools but reports no blood in them. He has a history of hypertension and congestive heart failure, with medical records from 6 months ago indicating a left ventricular ejection fraction of 20%. Upon arrival, he appears thin and uncomfortable, with a temperature of 37°C, pulse of 96/min, respirations of 18/min, and blood pressure of 138/72 mm Hg. Cardiopulmonary examination reveals an S3 heart sound and bilateral basilar crackles. His abdomen is soft with minimal generalized tenderness, and the rest of the examination is unremarkable. Which of the following is the most appropriate next step in diagnosis? [11/2024R]

A 68-year-old man presents to the emergency department with a 2-week history of postprandial abdominal cramping and occasional loose, non-bloody stools. His medical history includes hypertension and congestive heart failure, with a left ventricular ejection fraction of 20% noted six months ago. He appears thin and uncomfortable. Vital signs are: temperature 37°C, heart rate 94/min, respiratory rate 18/min, and blood pressure 140/70 mmHg. Physical examination reveals an S3 gallop, bilateral basilar crackles, and mild abdominal tenderness. Which of the following is the most appropriate next step in the diagnostic evaluation? [7/2025R]

A 68-year-old man is brought to the emergency department with severe substernal chest pain for two hours and worsening shortness of breath for 30 minutes. His medical history includes type 2 diabetes mellitus, treated with an oral hypoglycemic agent, and hypertension, managed with a diuretic. His temperature is 37.5°C (99.5°F), pulse is 104/min, respirations are 28/min, and blood pressure is 100/78 mmHg. He has elevated jugular venous pressure, bilateral crackles throughout all lung fields, and both S3 and S4 gallops on auscultation. Pulse oximetry on room air shows an oxygen saturation of 88%. Chest X-ray reveals bilateral perihilar infiltrates and a slightly enlarged cardiac silhouette. ECG shows ST-segment elevation and T-wave inversion in leads V2 through V5. Which of the following is the most likely diagnosis? [2/2025R_7/2025S]

A 72-year-old man develops severe retrosternal crushing pain radiating to his left arm, shortness of breath, and tachycardia on the second postoperative day following abdominoperineal resection for rectal cancer. Physical examination is unremarkable except for surgical wounds, with no distended neck veins. Which of the following is the most appropriate next diagnostic step? [2/2025R_7/2025S]

A 60-year-old man presents with worsening shortness of breath, orthopnea, and bilateral leg swelling. His brain natriuretic peptide (BNP) level is elevated, and an echocardiogram reveals a left ventricular ejection fraction (EF) of 35%. Which of the following medications improves mortality in this patient? [7/2025R]