1. A 64-year-old man with a history of hypertension and Type 2 Diabetes Mellitus presents with sudden-onset substernal chest pain radiating to his left jaw. ECG shows ST-segment elevation in leads II, III, and aVF. Which of the following physical exam findings would most likely be present if this patient develops a new holosystolic murmur at the apex 3 days later?
Correct Answer: B
This patient has an inferior MI (RCA distribution). A new holosystolic murmur at the apex 3-5 days later indicates acute mitral regurgitation due to papillary muscle rupture. The sound radiates to the axilla.
Educational Objective: Post-MI papillary muscle rupture results in acute mitral regurgitation radiating to the axilla.
2. A 4-year-old boy is brought to the clinic for "clumsiness." On exam, he uses his hands to walk up his legs to stand from a sitting position (Gowers' sign) and has firm, prominent calves. The most likely underlying molecular defect involves:
Correct Answer: B
This is Duchenne Muscular Dystrophy (DMD), caused by frameshift mutations in the dystrophin gene leading to a complete absence of the protein.
Educational Objective: DMD is an X-linked recessive disorder caused by frameshift mutations leading to non-functional dystrophin.
3. A 28-year-old woman is brought to the ED after ingesting a pesticide. She has pinpoint pupils, profuse salivation, wheezing, and a heart rate of 45 bpm. Which medication should be administered immediately to address her bradycardia and secretions?
Correct Answer: B
Organophosphate poisoning causes a cholinergic crisis. Atropine is the muscarinic antagonist used to reverse life-threatening respiratory secretions and bradycardia.
Educational Objective: Atropine is the first-line treatment for muscarinic symptoms in cholinergic toxicity.
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