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Clinical Case: Chest Pain

Total questions: 100

Worksheet time: 50mins

Name
Class
Date
1.

Possible causes of chest pain in an elderly patient climbing stairs include:

a)

Angina due to coronary artery disease

b)

Asthma exacerbation

c)

Gastroesophageal reflux disease

d)

Musculoskeletal strain

2.

What is the age of Sr. Pedro Carvalho?

a)

61 years old

b)

45 years old

c)

72 years old

d)

54 years old

3.

What is the sex of Sr. Pedro Carvalho?

a)

Male

b)

Female

c)

Non-binary

d)

Prefer not to say

4.

What is the marital status of Sr. Pedro Carvalho?

a)

Married

b)

Single

c)

Divorced

d)

Widowed

5.

What is the profession of Sr. Pedro Carvalho?

a)

Retired (former high school teacher)

b)

Doctor

c)

Engineer

d)

Chef

6.

What is the religion of Sr. Pedro Carvalho?

a)

Catholic

b)

Buddhist

c)

Hindu

d)

Muslim

7.

What is the place of birth (naturalidade) of Sr. Pedro Carvalho?

a)

São Paulo - SP

b)

Rio de Janeiro - RJ

c)

Belo Horizonte - MG

d)

Curitiba - PR

8.

What is the place of origin (procedência) of Sr. Pedro Carvalho?

a)

São Paulo - SP

b)

Rio de Janeiro - RJ

c)

Belo Horizonte - MG

d)

Curitiba - PR

9.

What is the main complaint of Sr. Pedro Carvalho?

a)

I have chest pain when I climb a hill

b)

I have a headache after eating

c)

I feel dizzy when standing up

d)

I have a sore throat in the morning

10.

Based on the clinical case described: The patient reports retrosternal chest pain radiating to the jaw, of moderate intensity (5/10), triggered by exertion (such as climbing hills or two flights of stairs). The symptoms last 5-7 minutes and improve at rest. The onset was 6 months ago. The patient denies sweating, nausea, and other associated symptoms. The patient also denies pain at rest, shortness of breath, palpitations, and syncope. What is the most likely diagnosis?

a)

Stable angina

b)

Unstable angina

c)

Myocardial infarction

d)

Gastroesophageal reflux disease

11.

According to the case, does the patient report any worsening of symptoms recently?

a)

True

b)

False

12.

Fill in the blank: The patient's chest pain is triggered by ________ (such as climbing hills or two flights of stairs) and improves with rest.

a)

exertion

b)

sleep

c)

hydration

d)

medication

13.

Is the patient's weight stable, and do they deny fever or asthenia?

a)

True

b)

False

14.

Neurological: Does the patient have headache, dizziness, visual changes, or motor deficits?

a)

True

b)

False

15.

Neurological: Does the patient deny changes in consciousness?

a)

True

b)

False

16.

Respiratory: Does the patient deny dyspnea and cough?

a)

True

b)

False

17.

Does the patient have postprandial fullness, no nausea/vomiting, and no constipation?

a)

True

b)

False

18.

Does the patient deny changes in frequency, volume, and appearance of urine?

a)

True

b)

False

19.

Does the patient deny dysuria?

a)

True

b)

False

20.

Cardiovascular: Does the patient deny palpitations, syncope, and edema?

a)

True

b)

False

21.

Musculoskeletal: Does the patient have no joint pain, muscle pain, or low back pain?

a)

True

b)

False

22.

What comorbidity has been present for 13 years?

a)

Hypertension (Hipertensão arterial sistêmica)

b)

Diabetes Mellitus

c)

Asthma

d)

Chronic Kidney Disease

23.

What is the patient's BMI?

a)

38

b)

22

c)

27

d)

31

24.

How long has the patient had type 2 diabetes?

a)

11 years

b)

5 years

c)

2 years

d)

20 years

25.

Which medication is taken at a dose of 50mg/day?

a)

Losartan (Losartana)

b)

Amlodipine (Amlodipina)

c)

Metformin

d)

Simvastatin

26.

Which medication is taken as 500mg XR, 2 tablets every 12 hours?

a)

Glifage XR

b)

Metformin IR

c)

Januvia

d)

Glyburide

27.

Which medication is taken at a dose of 10mg/day for diabetes?

a)

Dapagliflozin (Dapagliflozina)

b)

Metformin

c)

Glipizide

d)

Insulin

28.

Which medication is taken at a dose of 10mg/day for cholesterol?

a)

Rosuvastatin (Rosuvastatina)

b)

Paracetamol

c)

Amoxicillin

d)

Metformin

29.

Which medication is taken at a dose of 100mg/day for lipid control?

a)

Ciprofibrate (Ciprofibrato)

b)

Atorvastatin

c)

Gemfibrozil

d)

Simvastatin

30.

Does the patient consume alcohol?

a)

True

b)

False

31.

How many years has the patient been an active smoker?

a)

16 years

b)

5 years

c)

10 years

d)

20 years

32.

Is the patient sedentary?

a)

True

b)

False

33.

Does the patient live alone with basic sanitation?

a)

True

b)

False

34.

Is the patient's vaccination up to date?

a)

True

b)

False

35.

Has the patient had previous surgery?

a)

True

b)

False

36.

According to the passage, how often does the person usually eat fruits or vegetables? Fill in the blank: The person usually eats fruits or vegetables at least ____ a day.

a)

once

b)

twice

c)

three times

d)

never

37.

According to the passage, what type of oil does the person use in some preparations? Fill in the blank: The person uses ____ in some preparations.

a)

olive oil

b)

coconut oil

c)

vegetable oil

d)

sesame oil

38.

According to the passage, how many times per week does the person frequently consume red meat? Fill in the blank: The person frequently consumes red meat ____ times per week.

a)

3-4

b)

1-2

c)

5-6

d)

7-8

39.

According to the passage, does the person regularly consume yellow cheese and processed meats?

a)

True

b)

False

40.

According to the passage, does the person consume sweets and sugary drinks a few times per week?

a)

True

b)

False

41.

According to the passage, does the person habitually use industrialized seasonings?

a)

True

b)

False

42.

According to the passage, does the person add salt to the table?

a)

True

b)

False

43.

According to the passage, does the person occasionally eat fast food?

a)

True

b)

False

44.

Who in the family had hypertension and died of myocardial infarction at the age of 58?

a)

Mother

b)

Father

c)

Brother

d)

Sister

45.

Which family member has type 2 diabetes without other comorbidities?

a)

Father

b)

Mother

c)

Sister

d)

Brother

46.

Who in the family has type 2 diabetes?

a)

Paternal grandfather

b)

Maternal grandmother

c)

Father

d)

Mother

47.

According to the slide 'Illness: Perception and Patient Concerns', what is the patient worried about? Fill in the blank: The patient is worried about chest pain and is avoiding _________.

a)

leaving the house

b)

eating spicy food

c)

talking to friends

d)

watching television

48.

According to the slide 'Illness: Perception and Patient Concerns', what does the patient want to understand? Fill in the blank: The patient wants to understand if the problem is ________.

a)

serious

b)

temporary

c)

common

d)

avoidable

49.

What is the heart rate (FC) in bpm according to the General Physical Examination?

a)

75

b)

60

c)

90

d)

110

50.

What is the blood pressure (PA) in mmHg according to the General Physical Examination?

a)

150/95

b)

120/80

c)

135/85

d)

110/70

51.

What is the respiratory rate (FR) in irpm according to the General Physical Examination?

a)

13

b)

10

c)

18

d)

22

52.

What is the oxygen saturation (SpO₂) percentage according to the General Physical Examination?

a)

97%

b)

92%

c)

88%

d)

100%

53.

What is the height (Altura) in cm according to the General Physical Examination?

a)

164 cm

b)

150 cm

c)

172 cm

d)

180 cm

54.

What is the weight (Peso) in kg according to the General Physical Examination?

a)

102 kg

b)

85 kg

c)

120 kg

d)

95 kg

55.

What is the BMI (IMC) according to the General Physical Examination?

a)

38

b)

22

c)

27

d)

31

56.

According to the General State description, is the patient described as dehydrated?

a)

True

b)

False

57.

According to the General State description, is the patient described as jaundiced (anicteric)?

a)

True

b)

False

58.

According to the General State description, is the patient described as cyanotic?

a)

True

b)

False

59.

According to the General State description, is the patient alert and oriented?

a)

True

b)

False

60.

What lymph nodes were not palpable on examination of the head and neck?

a)

Cervical, axillary, and inguinal lymph nodes were not palpable.

b)

Submandibular, supraclavicular, and popliteal lymph nodes were not palpable.

c)

Preauricular, mediastinal, and mesenteric lymph nodes were not palpable.

d)

Occipital, hilar, and femoral lymph nodes were not palpable.

61.

Was jugular stasis present on examination of the head and neck?

a)

True

b)

False

62.

What abnormal skin finding was noted on the head and neck?

a)

Eruptive xanthomas

b)

Alopecia areata

c)

Vitiligo

d)

Seborrheic keratosis

63.

Where was the ictus visible and palpable on cardiovascular examination?

a)

5th left intercostal space, left midclavicular line

b)

4th right intercostal space, right midclavicular line

c)

6th left intercostal space, left anterior axillary line

d)

5th right intercostal space, right midclavicular line

64.

What was the rhythm and character of the heart sounds on cardiovascular examination?

a)

Regular rhythm, normal phonetic heart sounds, no audible murmur in the second heart sound.

b)

Irregular rhythm, muffled heart sounds, loud murmur in the first heart sound.

c)

Regular rhythm, split heart sounds, audible murmur in the third heart sound.

d)

Irregular rhythm, normal heart sounds, continuous murmur throughout all heart sounds.

65.

What was the finding on respiratory examination?

a)

Preserved expansibility. Vesicular murmur present, no adventitious sounds.

b)

Reduced expansibility. Bronchial breath sounds with crackles.

c)

Normal expansibility. Wheezing and rhonchi present.

d)

Decreased expansibility. Diminished breath sounds with crepitations.

66.

Describe the abdominal findings on physical examination.

a)

Globose, hydroaerial sounds present, liver span 9 cm, palpable 1 cm below right costal margin, painless, no other changes.

b)

Scaphoid, absent bowel sounds, liver span 15 cm, tender on palpation, ascites present.

c)

Flat, hyperactive bowel sounds, liver not palpable, severe pain on palpation, guarding present.

d)

Distended, normal bowel sounds, liver span 7 cm, palpable spleen, rebound tenderness.

67.

What was the finding regarding edema and perfusion in the limbs?

a)

No edema and well perfused.

b)

Significant edema and poor perfusion.

c)

Mild edema and cyanosis.

d)

No edema but poorly perfused.

68.

What was the capillary refill time (TEC) in the limbs?

a)

Less than 2 seconds

b)

2-4 seconds

c)

More than 4 seconds

d)

No refill observed

69.

What skin findings were noted on elbows and knees?

a)

Tuberous xanthelasma on elbow and knee

b)

Psoriatic plaques on elbow and knee

c)

Eczematous lesions on elbow and knee

d)

Lichen planus papules on elbow and knee

70.

What general skin condition was noted?

a)

Diffuse dryness

b)

Localized redness

c)

Oily patches

d)

Blistering

71.

What is the name of the skin condition shown in the image, characterized by yellowish nodules on the elbow and knee?

a)

Xanthelasma tuberoso

b)

Psoriasis vulgaris

c)

Lichen planus

d)

Erythema nodosum

72.

Which of the following is a finding in the physical exam described in the image?

a)

Erythema nodosum

b)

Xanthelasma tuberoso

c)

Psoriasis

d)

Lichen planus

73.

What is another skin finding mentioned in the physical exam besides xanthelasma tuberoso?

a)

Diffuse dryness

b)

Petechiae

c)

Bullae

d)

Erythema nodosum

74.

What is the creatinine clearance value (using the ckdepi formula) for Diabetes Renal Disease?

a)

55ml/min/1.73

b)

80ml/min/1.73

c)

30ml/min/1.73

d)

100ml/min/1.73

75.

What is the albuminuria/creatinuria ratio (using an isolated urine sample) for Diabetes Renal Disease?

a)

45mg/g

b)

10mg/g

c)

100mg/g

d)

200mg/g

76.

What is the result of retinal mapping in diabetic retinopathy?

a)

Mild involvement (Acometimento Leve)

b)

Severe hemorrhage (Hemorragia Grave)

c)

Total retinal detachment (Descolamento Total da Retina)

d)

Macular edema (Edema Macular)

77.

What is the pattern of paresthesia in peripheral neuropathy associated with diabetes mellitus?

a)

Glove and boot pattern (Padrão luva e bota)

b)

Stocking and cap pattern (Padrão meia e boné)

c)

Patchy and random pattern (Padrão irregular e aleatório)

d)

Belt and glove pattern (Padrão cinto e luva)

78.

Is autonomic neuropathy present in this case of diabetes mellitus?

a)

True

b)

False

79.

Refer to the ECG tracing provided. What is the heart rhythm shown in this ECG?

a)

Sinus rhythm

b)

Atrial fibrillation

c)

Ventricular tachycardia

d)

Heart block

80.

Refer to the ECG tracing provided. What is the heart rate (beats per minute) approximately?

a)

40 bpm

b)

60 bpm

c)

75 bpm

d)

120 bpm

81.

Name the lead labeled 'V2'.

a)

V2

b)

V1

c)

V3

d)

V4

82.

Is there any evidence of ST elevation in any of the leads?

a)

True

b)

False

83.

Refer to the ECG tracing provided. Identify the abnormality observed in the ECG.

a)

Atrial fibrillation

b)

Normal sinus rhythm

c)

Ventricular tachycardia

d)

First-degree heart block

84.

What is the normal range for the Aorta (Diameter of Root) in males according to the ECOTT table?

a)

20-37 mm

b)

30-40 mm

c)

42-57 mm

d)

25-40 mm

85.

What is the normal range for the Left Atrium in females according to the ECOTT table?

a)

20-37 mm

b)

27-38 mm

c)

25-40 mm

d)

39-53 mm

86.

According to the ECOTT table, what is the normal range for the Diastolic Thickness of the Septum in males?

a)

A) 6-10 mm

b)

B) 6-9 mm

c)

C) 10-15 mm

d)

D) 15-23 mm

87.

According to the ECOTT table, what is the normal Ejection Fraction (Teicholz) in females?

a)

> 51%

b)

> 53%

c)

> 30%

d)

67-155 ml

88.

The echocardiogram report states that the cardiac chambers are of normal dimensions.

a)

True

b)

False

89.

The report mentions that the left ventricular contractility is preserved, with no segmental deficits.

a)

True

b)

False

90.

The report indicates indirect signs of pulmonary hypertension.

a)

True

b)

False

91.

Fill in the blank: The mitral valve shows _______ reflux on Doppler according to the report.

a)

minimal

b)

severe

c)

moderate

d)

absent

92.

Fill in the blank: The pericardium is described as _______ in the report.

a)

normal

b)

enlarged

c)

inflamed

d)

thickened

93.

According to the ECOTT table, what is the normal range for the Left Ventricular Mass in males?

a)

A) 88-224 gr

b)

B) 67-162 gr

c)

C) 49-115 gr

d)

D) 43-95 gr

94.

According to the 2024 ESC Guidelines, is chest radiography commonly used in the evaluation of patients with chest pain?

a)

Yes

b)

No

95.

In the context of chronic coronary syndrome, does chest radiography provide specific information for a precise diagnosis or risk stratification?

a)

Yes

b)

No

96.

Chest radiography can help in the evaluation of patients suspected of having ________ or pulmonary diseases.

a)

heart failure

b)

diabetes

c)

liver failure

d)

kidney stones

97.

What is the normal range for Hemoglobin according to the laboratory tests?

a)

12–16 g/dL

b)

8–10 g/dL

c)

16–20 g/dL

d)

10–12 g/dL

98.

What is the reported value for Leukocytes in the laboratory tests?

a)

5,700/mm³

b)

10,000/mm³

c)

3,200/mm³

d)

8,500/mm³

99.

What is the reported value for Platelets in the laboratory tests?

a)

270,000/mm³

b)

150,000/mm³

c)

400,000/mm³

d)

100,000/mm³

100.

What is the reported value for Urea in the laboratory tests?

a)

34

b)

18

c)

45

d)

60

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