Module 5 Rosh Review Prep
1. A 3-year-old boy presents to a provider for his yearly health examination. On exam, a grade 2
systolic murmur, best heard in the left lower sternal border, is heard. The murmur is vibratory and
is loudest when the patient is supine, rather than when he is sitting. Which of the following is the
most likely diagnosis?
a. Atrial septal defect
b. Mitral regurgitation
c. Pericarditis
d. Still’s murmur
2. A 70-year-old woman presents to clinic with fatigue and palpitations for the last few weeks. Her
medical history includes hypertension, diabetes mellitus, and hypothyroidism. You obtain an ECG
which is shown above. What is her diagnosis?
a. Atrial fibrillation
b. Atrial flutter
c. Multifocal atrial tachycardia
d. Sinus tachycardia
3. A 48-year-old man presents to the primary care office for a blood pressure follow-up. He was
diagnosed with essential hypertension 3 months ago and was prescribed lisinopril 10 mg daily. He
reports that, since his last visit, he has decreased his sodium consumption, increased his fruit and
vegetable intake, and started walking for 1 hour per day. He measures his blood pressure at home
twice weekly, and his readings at home have ranged from 138/80 mm Hg to 148/90 mm Hg. His
blood pressure today is 140/88 mm Hg, and his examination is unremarkable. Which of the
following is the most appropriate next step in managing this patient’s blood pressure?
a. Add clonidine 0.1 mg twice a day
b. Add losartan 25 mg daily
c. Increase lisinopril to 20 mg daily
d. Switch to metoprolol succinate 50 mg twice a day
, 4. A 69-year-old man with a history of smoking, stroke, and myocardial infarction presents with a
painful 2 cm deep ulcer on his right lateral malleolus that has been present for four weeks. It started
to appear after he injured his foot on something in the garage. He has not been picking at his skin.
The ulcer has even, punched-out borders, and there is minimal bleeding. He has hair loss on his
right toes, and the skin appears pale and atrophic. The right dorsalis pedis pulse is 1+ and deep
tendon reflexes are 2+. Which of the following is the most likely diagnosis?
a. Arterial ischemic ulcer
b. Factitious ulcer
c. Neuropathic ulcer
d. Venous stasis ulcer
5. Which of the following is an indication for permanent pacemaker placement?
a. Asymptomatic Mobitz type I second-degree AV block
b. Asymptomatic Mobitz type II second degree heart block
c. Asymptomatic sinus bradycardia with heart rate of 40/min
d. Asymptomatic three second sinus pauses
6. A 49-year-old patient with a history significant for type 2 diabetes mellitus presents with blood
pressure of 153/94 mm Hg. The patient was seen in the office last month for a screening exam.
Their blood pressure at last month’s office visit was 149/90 mm Hg. The patient was asked to keep
a log of home blood pressure readings, and they are consistently around 150/85 mmHg. Which of
the following is the most appropriate next step in management?
a. Initiate metoprolol succinate (Toprol XL)
b. Prescribe isosorbide mononitrate
c. Recommend lifestyle modifications
d. Start lisinopril (Zestril)
7. A 48-year-old woman with a history of stage 3 chronic kidney disease and dyslipidemia presents
for a follow-up. Her medications include pravastatin, coenzyme Q10 (CoQ10), vitamin D, and low-
dose aspirin. Her initial BP is 128/76 mm Hg, and a repeat blood pressure after 5 minutes of quiet
rest is 126/78 mm Hg. Results from a 24-hour ambulatory BP monitor show an average daytime BP
of 135/88 mm Hg. Based on the 2017 American Heart Association/American College of Cardiology
(AHA/ACC) guidelines, which of the following is the correct blood pressure diagnosis for this
patient?
a. Masked hypertension
b. Resistant hypertension
c. Sustained hypertension
d. White coat hypertension
1. A 3-year-old boy presents to a provider for his yearly health examination. On exam, a grade 2
systolic murmur, best heard in the left lower sternal border, is heard. The murmur is vibratory and
is loudest when the patient is supine, rather than when he is sitting. Which of the following is the
most likely diagnosis?
a. Atrial septal defect
b. Mitral regurgitation
c. Pericarditis
d. Still’s murmur
2. A 70-year-old woman presents to clinic with fatigue and palpitations for the last few weeks. Her
medical history includes hypertension, diabetes mellitus, and hypothyroidism. You obtain an ECG
which is shown above. What is her diagnosis?
a. Atrial fibrillation
b. Atrial flutter
c. Multifocal atrial tachycardia
d. Sinus tachycardia
3. A 48-year-old man presents to the primary care office for a blood pressure follow-up. He was
diagnosed with essential hypertension 3 months ago and was prescribed lisinopril 10 mg daily. He
reports that, since his last visit, he has decreased his sodium consumption, increased his fruit and
vegetable intake, and started walking for 1 hour per day. He measures his blood pressure at home
twice weekly, and his readings at home have ranged from 138/80 mm Hg to 148/90 mm Hg. His
blood pressure today is 140/88 mm Hg, and his examination is unremarkable. Which of the
following is the most appropriate next step in managing this patient’s blood pressure?
a. Add clonidine 0.1 mg twice a day
b. Add losartan 25 mg daily
c. Increase lisinopril to 20 mg daily
d. Switch to metoprolol succinate 50 mg twice a day
, 4. A 69-year-old man with a history of smoking, stroke, and myocardial infarction presents with a
painful 2 cm deep ulcer on his right lateral malleolus that has been present for four weeks. It started
to appear after he injured his foot on something in the garage. He has not been picking at his skin.
The ulcer has even, punched-out borders, and there is minimal bleeding. He has hair loss on his
right toes, and the skin appears pale and atrophic. The right dorsalis pedis pulse is 1+ and deep
tendon reflexes are 2+. Which of the following is the most likely diagnosis?
a. Arterial ischemic ulcer
b. Factitious ulcer
c. Neuropathic ulcer
d. Venous stasis ulcer
5. Which of the following is an indication for permanent pacemaker placement?
a. Asymptomatic Mobitz type I second-degree AV block
b. Asymptomatic Mobitz type II second degree heart block
c. Asymptomatic sinus bradycardia with heart rate of 40/min
d. Asymptomatic three second sinus pauses
6. A 49-year-old patient with a history significant for type 2 diabetes mellitus presents with blood
pressure of 153/94 mm Hg. The patient was seen in the office last month for a screening exam.
Their blood pressure at last month’s office visit was 149/90 mm Hg. The patient was asked to keep
a log of home blood pressure readings, and they are consistently around 150/85 mmHg. Which of
the following is the most appropriate next step in management?
a. Initiate metoprolol succinate (Toprol XL)
b. Prescribe isosorbide mononitrate
c. Recommend lifestyle modifications
d. Start lisinopril (Zestril)
7. A 48-year-old woman with a history of stage 3 chronic kidney disease and dyslipidemia presents
for a follow-up. Her medications include pravastatin, coenzyme Q10 (CoQ10), vitamin D, and low-
dose aspirin. Her initial BP is 128/76 mm Hg, and a repeat blood pressure after 5 minutes of quiet
rest is 126/78 mm Hg. Results from a 24-hour ambulatory BP monitor show an average daytime BP
of 135/88 mm Hg. Based on the 2017 American Heart Association/American College of Cardiology
(AHA/ACC) guidelines, which of the following is the correct blood pressure diagnosis for this
patient?
a. Masked hypertension
b. Resistant hypertension
c. Sustained hypertension
d. White coat hypertension
