Free CMC Certification MCQ Questions and Answers — Questions and Answers
Question 1: A woman, age 47, arrives at the hospital with a blood pressure reading of 220/130 mmHg. When she first arrives, she is bewildered, restless, and unable to respond to inquiries. Her family claims that earlier in the day, she had complained of a severe headache and nausea. Her spouse observes that she recently quit taking her blood pressure medication because she no longer felt the need for it. What type of medical intervention is best?
- With oral antihypertensive medicine, gradually lower the patient's diastolic blood pressure to 85 mmHg, and then change the dose to maintain blood pressure.
- Diastolic blood pressure should be quickly reduced to 100 mmHg with intravenous antihypertensive medication, and then gradually decreased to 85 mmHg with oral antihypertensive medication. (Correct answer)
- Intravenous (IV) antihypertensive therapy should be used to gradually lower the patient's systolic blood pressure to 120 mmHg before switching to oral antihypertensive therapy for maintenance.
- Use oral antihypertensive medicine to quickly reduce the patient's systolic blood pressure to 120 mmHg, and then adjust the dosage to maintain blood pressure.
Correct answer: Diastolic blood pressure should be quickly reduced to 100 mmHg with intravenous antihypertensive medication, and then gradually decreased to 85 mmHg with oral antihypertensive medication.
The patient is experiencing a hypertensive emergency (BP 220/130 mmHg) with evidence of acute end-organ damage (bewilderment, restlessness). In such cases, the initial goal is to rapidly but carefully reduce the diastolic blood pressure to approximately 100-110 mmHg (or a 25% reduction in mean arterial pressure) within the first hour using intravenous antihypertensive medications. This rapid reduction prevents further organ damage, followed by a more gradual decrease to normal levels (e.g., 85 mmHg) over the next 24-48 hours to avoid hypoperfusion.
Question 2: A 68-year-old woman comes in with dyspnea and acute substernal chest discomfort. Deep T-wave inversion with QT-interval lengthening is seen on an ECG. The results of a laboratory analysis show a very slight rise of cardiac enzymes and troponin. There was no history of heart illness in the patient. She had learned that her daughter and grandchild had perished in a vehicle accident just before her symptoms started. The apical half of the left ventricle (LV) was dyskinetic on echocardiography, along with apical ballooning. Only minor coronary atherosclerosis was seen after coronary angiography. Weeks later, the patient underwent a reevaluation, and it was discovered that she had regained her normal LV function. What most likely happened to this patient?
- Takotsubo cardiomyopathy (Correct answer)
- Hypertrophic cardiomyopathy
- Psychosomatic chest pain
- A myocardial infarction
Correct answer: Takotsubo cardiomyopathy
This patient's presentation is classic for Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy or 'broken heart syndrome.' Key features include acute chest pain and dyspnea following severe emotional stress, ECG changes mimicking an MI, only a slight rise in cardiac enzymes, characteristic apical ballooning of the left ventricle on echocardiography with otherwise normal coronary arteries, and eventual full recovery of left ventricular function. This condition is a transient form of heart failure triggered by intense emotional or physical stressors.
Question 3: A routine x-ray reveals an asymptomatic descending thoracic aortic aneurysm in the patient. The aneurysm is 4 cm in diameter. What initial management is advised?
- Surveillance only
- Aspirin, aggressive blood pressure control with a beta-blocker, an angiotensin-converting enzyme inhibitor, and surveillance
- Beta-blockers for aggressive blood pressure control and surveillance (Correct answer)
- Surgical correction
Correct answer: Beta-blockers for aggressive blood pressure control and surveillance
For an asymptomatic descending thoracic aortic aneurysm measuring 4 cm, which is below the typical threshold for surgical intervention (usually >5.5 cm), the recommended initial management involves aggressive medical therapy and regular surveillance. Beta-blockers are particularly important as they help reduce blood pressure and the shear stress on the aortic wall, which can slow aneurysm growth and decrease the risk of dissection or rupture. Regular imaging surveillance is essential to monitor for any changes in aneurysm size.
Question 4: A patient reports experiencing right calf soreness. In order to assess the patient for a potential deep venous thrombosis (DVT), the nurse makes the decision. Except for one, each of the following indications or symptoms is typical of a DVT.
- superficial venous dilation
- unilateral swelling of the calf
- warmth
- skin breakdown (Correct answer)
Correct answer: skin breakdown
Common signs and symptoms of a deep venous thrombosis (DVT) include unilateral swelling of the calf, warmth, pain or tenderness, and superficial venous dilation due to increased venous pressure. Skin breakdown, however, is not an acute symptom of DVT. While chronic venous insufficiency resulting from a long-standing DVT can eventually lead to skin changes and breakdown, it is not a typical immediate indicator of an acute DVT.
Question 5: Continuous positive airway pressure (CPAP) is contraindicated in patients who exhibit signs and symptoms of
- a pneumothorax (Correct answer)
- pneumonia
- chronic obstructive pulmonary disease
- cardiogenic pulmonary edema
Correct answer: a pneumothorax
Continuous positive airway pressure (CPAP) is contraindicated in patients with a pneumothorax because it delivers positive pressure to the airways. This positive pressure can worsen an existing pneumothorax by increasing the air leak into the pleural space, potentially leading to an expansion of the pneumothorax or even a tension pneumothorax, which is a life-threatening condition. CPAP is generally used for conditions like sleep apnea, COPD exacerbations, or cardiogenic pulmonary edema, where positive pressure can be beneficial.
Question 6: A 30-year-old lady who reports experiencing palpitations and chest pain is later found to have pericarditis. Pericardial effusion symptoms are visible on an echocardiography. The following vital signs are present: temperature, 98.5 °F; blood pressure, 117/68 mmHg; respiratory rate, 15 breaths/min; heart rate, 94 beats/min; and oxygen saturation, 100% on room air. There is no relevant medical history for the patient. Which course of action is best at this particular moment?
- Treat the underlying condition, but do not drain the effusion. (Correct answer)
- Schedule a surgical pericardiectomy to drain the effusion, and treat the underlying condition.
- Monitor the patient with telemetry until the effusion resolves.
- Schedule a pericardiocentesis to drain the pericardial fluid, and treat the underlying condition.
Correct answer: Treat the underlying condition, but do not drain the effusion.
The patient has pericarditis with a pericardial effusion but is hemodynamically stable, indicated by normal vital signs and no signs of cardiac tamponade. In such stable cases, the primary course of action is to treat the underlying cause of the pericarditis, as many effusions resolve with conservative medical management. Pericardiocentesis or surgical drainage is typically reserved for patients who develop cardiac tamponade or have large, symptomatic effusions that do not respond to medical therapy.
Question 7: What grade is most probable a slight cardiac murmur that may only be noticed when concentrating?
- Grade II
- Grade I (Correct answer)
- Grade IV
- Grade III
Correct answer: Grade I
Cardiac murmurs are graded on a scale of I to VI based on their intensity. A Grade I murmur is described as very faint, audible only with careful auscultation in a quiet environment and often requiring the listener to concentrate intently. It is the softest grade of murmur that can be heard, distinguishing it from louder grades that are more easily detected or palpable.
Free CMC Certification MCQ Questions and Answers
A woman, age 47, arrives at the hospital with a blood pressure reading of 220/130 mmHg.
When she first arrives, she is bewildered, restless, and unable to respond to inquiries.
Her family claims that earlier in the day, she had complained of a severe headache and nausea.
Her spouse observes that she recently quit taking her blood pressure medication because she no longer felt the need for it.
What type of medical intervention is best?